Management Of Sport-related Concussion Research Articles

Sports-related concussion management as a control problem: using STAMP to examine concussion management in community rugby

The effective management of sports-related concussion is an on-going problem in amateur sport due to a number of systemic issues. These factors have often been studied in isolation with minimal consideration for the interactions between them, or the overall system in which they occur. The aim of this research was to model the actors, controls, and feedback mechanisms influencing the management of concussion in community rugby union using the Systems-Theoretic Accident Model and Processes (STAMP) method. Findings show that there are currently many inadequate controls, that are directly and indirectly impacting effective concussion management. The practical implications of these findings are discussed (e.g. improved guideline education, mandatory medical presence, rule amendments). Additionally, the model provides a sound framework similar team sports can use to inform research into injury management and prevention (e.g. rugby league, hockey, AFL).Practitioner Summary: Research shows that concussion management in regional sport is inconsistent due to contextual limitations. Systems-Theoretic Accident Model and Processes was applied to identify the systemic factors currently influencing concussion management practices in community sport. Findings show inadequate controls precipitate concussion management gaps. Practical implications of the findings are discussed.

Preventing Catastrophic Injury and Death in Collegiate Athletes: Interassociation Recommendations Endorsed by 13 Medical and Sports Medicine Organisations.

The Second Safety in College Football Summit resulted in interassociation consensus recommendations for three paramount safety issues in collegiate athletics: (1) independent medical care for collegiate athletes; (2) diagnosis and management of sport-related concussion; and (3) year-round football practice contact for collegiate athletes. This document, the fourth arising from the 2016 event, addresses the prevention of catastrophic injury, including traumatic and non-traumatic death, in collegiate athletes. The final recommendations in this document are the result of presentations and discussions on key items that occurred at the summit. After those presentations and discussions, endorsing organisation representatives agreed on 18 foundational statements that became the basis for this consensus paper that has been subsequently reviewed by relevant stakeholders and endorsing organisations. This is the final endorsed document for preventing catastrophic injury and death in collegiate athletes. This document is divided into the following components. (1) Background-this section provides an overview of catastrophic injury and death in collegiate athletes. (2) Interassociation recommendations: preventing catastrophic injury and death in collegiate athletes-this section provides the final recommendations of the medical organisations for preventing catastrophic injuries in collegiate athletes. (3) Interassociation recommendations: checklist-this section provides a checklist for each member school. The checklist statements stem from foundational statements voted on by representatives of medical organisations during the summit, and they serve as the primary vehicle for each member school to implement the prevention recommendations. (4) References-this section provides the relevant references for this document. (5) Appendices-this section lists the foundational statements, agenda, summit attendees and medical organisations that endorsed this document.

Concussion in Youth Sport: Developmental Aspects

Sport-related concussion (SRC) is a growing health concern, particularly in younger, at-risk athletic populations. These injuries commonly present with a wide range of clinical signs (i.e., poor coordination, behavioral, mood changes) and symptoms (i.e., headache, dizziness, difficulty concentrating), along with neurocognitive and vestibular/ocular impairments. This review of SRCs in youth athletes focuses on individuals 5–18 years of age and includes an overview of concussion (i.e., definition, signs/symptoms, epidemiology), as well as concussion education and awareness. This is followed by a review of SRC assessment and management strategies, along with common recovery, return-to-play, and treatment approaches. Finally, suggestions are made for future research and recommendations pertaining to SRC in youth athletes.

Peripheral Vestibular and Balance Function in Athletes With and Without Concussion.

According to the most recent consensus statement on management of sport-related concussion (SRC), athletes with suspected SRC should receive a comprehensive neurological examination. However, which measures to include in such an examination are not defined. Our objectives were to (1) evaluate test-retest reliability and normative data on vestibular and balance tests in athletes without SRC; (2) compare athletes with and without SRC on the subtests; and (3) identify subtests for concussion testing protocols. Healthy athletes (n = 87, mean age 20.6 years; standard deviation = 1.8 years; 39 female and 48 male) and athletes with SRC (n = 28, mean age 20.7 years; standard deviation = 1.9 years; 11 female and 17 male) were tested using rotary chair, cervical vestibular-evoked myogenic potential (c-VEMP), and the Sensory Organization Test (SOT). A subset (n = 43) were tested twice. We analyzed reliability of the tests, and compared results between athletes with and without SRC. Reliability ranged from poor to strong. There was no significant difference between athletes with and without SRC for tests of peripheral vestibular function (ie, rotary chair and c-VEMP). Athletes with SRC had significantly worse scores (P < 0.05) on vestibular-ocular reflex (VOR) cancellation gain, subjective visual vertical and horizontal variance, and all conditions of the SOT. SRC did not affect medium frequency VOR or saccular function. SRC did affect the ability to use vestibular inputs for perception of vertical and postural control, as well as ability to cancel the VOR.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A274).

Capturing concussion related changes in dynamic balance using the Quantified Y Balance Test - a case series of six elite rugby union players.

Concussion is one of the most common injuries reported across a myriad of sports. Recent evidence suggests that individuals may possess sensorimotor deficits beyond clinical recovery, predisposing them to further injury. This preliminary prospective case series aimed to determine if an inertial sensor instrumented Y balance test can capture changes in dynamic balance, regardless of apparent `clinical recovery', in six concussed elite rugby union players. The findings from this case series demonstrate that the inertial sensor-based measures can detect clinically meaningful changes in dynamic balance performance, not captured by the traditional clinical scoring methods, 48-hours post-injury and at the point of `clinical recovery' (return to play). Further research should investigate the role such instrumented dynamic balance assessments may play in the management of sports-related concussion.

Administering Computerized Neurocognitive Testing Does Not Increase Symptoms Following Sport-Related Concussion

Computerized neurocognitive testing (CNT) is an important component for the management of sport-related concussion (SRC). The cognitive demands required to complete CNT may exacerbate SRC symptoms. PURPOSE: To prospectively examine changes in post-concussion symptom reporting after completing CNT. METHODS: One hundred forty-five athletes (15.72 ± 1.78 years) with a medically diagnosed SRC completed the Post-Concussion Symptom Scale (PCSS) before and after completing a CNT (e.g., The Immediate Post-Concussion Assessment and Cognitive Testing: ImPACT). Changes in total PCSS symptoms and symptom clusters (somatic, affective, and cognitive-migraine-fatigue) were examined with a series of paired samples t-tests. Participants were also assigned to groups based on the time elapsed from injury until their first clinical visit: 0-7, 8-14, and 15-21 days. A series of 3 (time since injury group) X 2 time (pre, post) analysis of variance were performed on symptom totals and clusters. Statistical significance was set at a Bonferroni-corrected p < .01. RESULTS: There were no significant differences in total (t (145) = -.69, p = .49), somatic, (t (145) = -1.02, p = .31), or cognitive-migraine-fatigue symptoms (t (145) = -1.75, p = .08) before and after CNT. There was a significant difference for affective symptoms (t (145) = 2.51, p = .01). Affective symptoms were significantly higher before CNT (M = 2.19, SD = 3.15) compared to after CNT (M = 1.80, SD = 2.89). There were no between-subjects or within-subjects main effects for total, somatic, affective, or cognitive-migraine-fatigue symptom clusters (p > .05). There were also no significant group x time interactions for total symptoms (Wilks λ =.99, F [1, 142] = 0.20, p = .40, η2 = .01), somatic, (Wilks λ =1.00, F [2, 142] = .30, p =.74, η2 = .004), affective (Wilks λ =.99, F [2, 142] = 0.89, p =.43, η2 = .01), or cognitive-migraine-fatigue symptom clusters (Wilks λ =.99, F [2, 141] = 0.41, p =.67, η2 = .01). CONCLUSIONS: The administration of CNT during recovery from SRC does not increase concussion symptoms. Sports medicine professionals should administer CNT to concussed athletes even when symptomatic, to more accurately identify neurocognitive impairment, which will help determine targeted treatment options.

Prevention and Management of Sport-Related Concussions in Uganda: A Case Study

Head injuries in sports often go unnoticed and untreated with a risk of increasing the severity of neurological difficulties for affected athletes. While there is much research on athletes in developed countries, the data on athletes from developing countries is lacking. Using a descriptive case study approach, this report focuses on concussions from four main sports (football, athletics, basketball and rugby). Emphasis was placed on those athletes who had been identified with a sport-related concussion (SRC). The phases of emergency, intermediate, rehabilitative, and return to sports participation were considered in this study. Three SRC cases from both male and female athletes were observed and interviewed for post-injury management from the emergency phase to return to sports participation. There was evidence of lack of specific pre-season screening of athletes for concussion history and standard care for concussed athletes in all the three cases observed using the best medical practice framework. Our study shows barriers such as knowledge among the sports resource providers; a law and policies to mandate care, and the absence of specific facilities for managing athletes with concussions. Implementation of sports health care policies is necessary to mandate care for athletes. Strategies for prevention and management of concussions are necessary, especially through increasing the awareness and knowledge using the Concussion Awareness Training Tool (CATT). Further studies with larger samples are encouraged to ascertain the magnitude of existing barriers.

Preseason to Postseason Changes on the BTrackS Force Plate in a Sample of College Athletes.

Balance testing is a vital component in the evaluation and management of sport-related concussion. Few studies have examined the use of objective, low-cost, force-plate balance systems and changes in balance after a competitive season. To examine the extent of preseason versus postseason static balance changes using the Balance Tracking System (BTrackS) force plate in college athletes. Pretest, posttest design. Athletic training facility. A total of 47 healthy, Division-I student-athletes (33 males and 14 females; age 18.4 [0.5]y, height 71.8 [10.8]cm, weight 85.6 [21.7]kg) participated in this study. Total center of pressure path length was measured preseason and postseason using the BTrackS force plate. A Wilcoxon signed-rank test was conducted to examine preseason and postseason changes. SEM and minimal detectable change were also calculated. There was a significant difference in center of pressure path length differed between preseason (24.6 [6.8]cm) and postseason (22.7 [5.4]cm) intervals (P = .03), with an SEM of 3.8cm and minimal detectable change of 10.5cm. Significant improvements occurred for center of pressure path length after a competitive season, when assessed using the BTrackS in a sample of college athletes. Further research is warranted to determine the effectiveness of the BTrackS as a reliable, low-cost alternative to force-plate balance systems. In addition, clinicians may need to update baseline balance assessments more frequently to account for improvements.

Rest Evaluation for Active Concussion Treatment (ReAct) Protocol: a prospective cohort study of levels of physical and cognitive rest after youth sports-related concussion

IntroductionAlthough current guidelines for the early clinical management of sports-related concussion (SRC) call for a gradual return-to-activity, the optimal level of rest needed to promote recovery remains unknown. This paper...

Treatment of Acute Sports-Related Concussion.

Here, we summarize the current scientific literature on the management of sports-related concussion (SRC) in the acute period (< 6weeks post-injury) with a focus on rest, return to learn, return to play, and emerging treatments. While relative rest is recommended for the first 24-48h following acute SRC, the most recent guidelines highlight the lack of evidence for complete rest and in fact show that prolonged cognitive and physical rest can be detrimental. Gradual return to learn and play is recommended. Return to sport should only occur once the patient is symptom free. While there are no FDA-approved medications for acute treatment of concussion, there is preclinical data for the benefit of omega 3 fatty acids. Evidence is limited around the benefits of treating sleep disorders, vestibular-ocular dysfunction, and neck pain in the acute period. After 24-48h of rest, SRC patients may gradually resume cognitive and physical activity. More research is needed to determine if any supplements, medications, and/or physical therapy are indicated in the management in acute SRC.

American Medical Society for Sports Medicine Position Statement on Concussion in Sport

Sport-related concussion (SRC) is a common injury in recreational and organized sport. Over the past 30 years, there has been significant progress in our scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment, and management of SRC. In addition to a growing need for knowledgeable health care professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC. The American Medical Society for Sports Medicine formed a writing group to review the existing literature on SRC, update its previous position statement, and address current evidence and knowledge gaps regarding SRC. The absence of definitive outcomes-based data is challenging and requires relying on the best available evidence integrated with clinical experience and patient values. This statement reviews the definition, pathophysiology, and epidemiology of SRC, the diagnosis and management of both acute and persistent concussion symptoms, the short- and long-term risks of SRC and repetitive head impact exposure, SRC prevention strategies, and potential future directions for SRC research. The American Medical Society for Sports Medicine is committed to best clinical practices, evidence-based research, and educational initiatives that positively impact the health and safety of athletes.

Concussion Education Programs for High School Football Coaches: An Overview

The increasing epidemic of concussion injuries in sports continues to attract significant attention throughout society. Leaders within the field of sports medicine have attempted to address athlete safety through educational programs. Although concussion education for athletic coaches is required by all states, individual learners should be considered when implementing these programs. Varying educational initiatives, lack of appropriate healthcare providers at athletic events, the difficulty recognizing the “invisible injury” by a diverse group of individuals, and the lack of enforcement of enacted laws are just a few obstacles that inhibit the concussion educational process required by legislation in all states. Appropriately delivered educational programs have the potential to improve management of sport-related concussion (SRC) at high school levels, providing a significant benefit to individuals across all societal levels. A comprehensive overview of commonly used concussion education programs provides a foundation of themes included in each program, while elucidating differences in program lengths, delivery methods, and targeted audiences. However, these concussion educational programs have been largely ineffective regarding injury reporting and participant safety. Researchers must study the effectiveness of the current programs through a lens of the five principles of knowledge transfer to make recognizable progress within this public health priority. A few recommendations to enhance the effectiveness of concussion educational programming include utilizing a dispersed delivery method to decrease the cognitive load and fatigue of participants, integrating reflective actions into modes of delivery for coaches, and employing reminder messages as cues to action. Schools would benefit from formally evaluating their current educational structure to ensure alignment with some of the recommendations.

Use of supervised exercise during recovery following sports-related concussion

ObjectiveTo assess the safety of supervised exercise (SE) in acute sport related concussion (SRC), and explore its influence on recovery.BackgroundPrevious guidelines for the management of SRC have suggested complete physical and cognitive rest until asymptomatic, while he 2017 Berlin consensus statement now suggests return to light activity after 24–48 hours. The influence of early exercise on recovery following SRC remains unclear, and there is little evidence regarding its safety or efficacy.Design/methodsRetrospective chart review of 124 patients with SRC who presented to a university sports neurology clinic within 30 days of injury between September 2016 and January 2017. Symptomatic patients who initiated SE within 16 days of injury were compared to those who did not undergo SE or initiated SE later than post-injury day 16 using Cox regression. The regression model controlled for multiple covariates including age, sex, history of previous concussions, injury severity, relevant co-morbidities, and other treatments received.ResultsNo serious adverse events were observed in the early SE group. Furthermore, early SE was associated with earlier return to sport (hazard ratio = 2.35, p = 0.030), and the early SE group had fewer days from SRC until clearance for return to sport (mean 26.5 ± 11.2 days vs 35.1 ± 26.5 days, p = 0.020). There also was a non-significant trend toward fewer asymptomatic days in the early SE compared to non-early SE groups (mean 16.7 ± 7.1 days vs 22.4 ± 22.5 days, p = 0.054).ConclusionEarly SE performed in the acute symptomatic stage of SRC was safe and was associated with earlier return to sport.

The stability of ImPACT baseline test performance over a 3-year period in high school athletes

PurposeAnnual baseline assessment using computerized neurocognitive tests have been recommended by governing healthcare bodies for the management of sport-related concussion but is supported by limited evidence. The current study examined the stability of ImPACT performance across three-successive years in adolescent athletes.MethodThis prospective cohort included 229 (117 male, 112 female) high school student-athletes from 2 private high schools. ImPACT was administered in a controlled group setting (1–17 participants) at years 1 (T1; n = 229), 2 (T2; n = 101) and 3 (T3; n = 47). Repeated measures analyses of variance (ANOVA 4 × 3) were used to examine performance on ImPACT's Verbal Memory (VEM), Visual Memory (VIS), Visual Motor Speed (VMS), and Reaction Time (RT) composite scores. Paired t-tests were used for post-hoc analyses. Two-way mixed intraclass correlation coefficients (ICC [3,1]) with 95% confidence intervals (CI) were calculated between time points. Group mean and within-subject differences between each time point for ImPACT scores were analyzed using manufacturer provided reliable change indices (RCI). All analyses were performed with alpha = 0.05.ResultsA significant main effect was observed for VMS (F [2,92] = 27.90, p = 0.001) across time. Participants significantly improved on VMS between T2 and T1 (t [100] = 4.15, p = 0.001), T3 and T2 (t [46] = 7.19, p = 0.001), and T3 and T1 (t [46] = 3.85, p &lt; 0 .001). Weak (VEM: ICC = 0.37, CI = 0.19, 0.55) to strong (VMS: ICC = 0.83, CI = 0.74, 0.90) ICCs were observed for ImPACT scores. No group mean differences exceeded the 80% CI for ImPACT's RCI, although within-subject differences for at least 1 score exceeded the 80% CI between T2 and T1 (24%–39%), T3 and T2 (26%–45%), and T3 and T1 (32%–51%).ConclusionsOverall, statistically significant improvement was observed for VMS, however, the magnitude of the change may not be clinically meaningful. Similar to previous research, reliability of ImPACT scores ranged from weak to strong. Our results support annual baseline assessment of young athletes for progression of neurocognitive functioning.

The Influence of Athletic Trainers on the Incidence and Management of Concussions in High School Athletes.

In many US high schools, the athletic trainer (AT) has the responsibility to identify and manage athletes with concussions. Although the availability of ATs varies a great deal among schools, how the level of AT availability in high schools affects the reported incidence and management of sport-related concussions (SRCs) is unknown. To determine how the presence of an AT affects the reporting and management of SRCs. Prospective cohort study. A total of 2459 (female = 37.5%, age = 16.1 ± 1.2 years) athletes from 31 Wisconsin high schools were categorized as having low availability (LoAT), mid availability (MidAT), or high availability (HiAT) of ATs. Athletic trainers recorded the incidence, days lost from sport, and postconcussion management through return to sport. The incidence of SRC reporting among categories was examined using a multivariate Cox proportional hazards model. Fisher exact tests were used to determine if postconcussion management differed based on AT availability. The incidence of reported SRCs was lower for the LoAT schools (2.4%) compared with the MidAT (5.6%, hazard ratio = 2.59, P = .043) and HiAT (7.0%, hazard ratio = 3.33, P = .002) schools. The median time before the first AT interaction was longer for LoAT schools (24.0 hours) than for MidAT (0.5 hours, post hoc P = .012) and HiAT (0.2 hours, post hoc P = .023) schools. The number of post-SRC interactions was different in all groups (LoAT = 2 interactions, MidAT = 3, and HiAT = 4; all post hoc P values < .05). Days lost were greater for MidAT and HiAT (both 14 days lost) schools compared with LoAT schools (11.5 days lost, post hoc P = .231 and P = .029, respectively). Athletes at LoAT schools were less likely to undergo a return-to-play protocol (9/18 SRCs, 50.0%) than athletes at MidAT (44/47 SRCs, 93.6%; post hoc P = .001) or HiAT (64/64 SRCs, 100%; post hoc P < .001) schools. The level of AT availability positively influenced the reported incidence of SRCs as well as postconcussion management activities in this sample of high schools.

Concussion Education Content and Delivery: Qualitative Study of Primary Stakeholders of Education Programs

To describe primary stakeholders' perceptions of the availability, usefulness and acceptability of educational content and delivery for identification and management of sport-related concussion. Despite widespread use of education prevention, evidence supporting concussion educational practices is mixed.

The Self-Efficacy of Certified Athletic Trainers in Assessing and Managing Sport-Related Concussions.

Diagnostic and return-to-play assessments of athletes with sport-related concussions (SRCs) have changed dramatically over the past decade. Currently, SRC assessment and management has taken a multifaceted approach, with new SRC measures being developed yearly. However, to date, no researchers have examined certified athletic trainers' (ATs') self-efficacy in assessing and managing a patient with an SRC. To examine the self-efficacy of ATs in assessing and managing athletes with SRCs, with a secondary purpose of examining job setting (high school and college). Cross-sectional study. Web-based questionnaire. A total of 94 ATs (high school setting = 54.3%, n = 51; collegiate setting = 45.7%, n = 43) completed an online survey, for a response rate of 9.2%. The survey contained 3 primary subsections: demographics, self-efficacy in assessing SRCs, and self-efficacy in managing SRCs. Possible self-efficacy ratings for SRC assessment and management in the survey ranged from 0 to 100. Multivariate analyses of variance were performed to identify differences in the self-efficacy of high school and collegiate ATs in assessing and managing athletes with SRCs. The self-efficacy of all 94 participants in their assessment of SRCs was 60.34 ± 14.5 and in their management of SRCs was 55.30 ± 14.1. Collegiate ATs reported higher self-efficacy in the assessment of SRCs using balance ( P < .001) and the King-Devick test ( P = .04), and their responses approached significance for vestibular-ocular motor screening ( P = .05). Additionally, their self-efficacy in the management of SRCs was greater using balance ( P < .001) and vestibular-ocular therapy ( P = .01) compared with high school ATs. Athletic trainers had moderate self-efficacy regarding their assessment and management of SRCs. Collegiate ATs had higher self-efficacy in newer SRC assessment and management tools than high school ATs.

Return to Learn After Sport-Related Concussion: A Survey of Secondary School and Collegiate Athletic Trainers.

Recent recommendations have emphasized return-to-learn (RTL) protocols to aid athletes in recovery from sport-related concussion (SRC) but have been based primarily on anecdotal evidence. To investigate the RTL practices of certified athletic trainers (ATs) after an SRC. Cross-sectional study. Online survey. A total of 1083 individuals (27%) from a random sample of 4000 ATs in the National Athletic Trainers' Association membership database completed an electronic survey. Participants consisted of 729 self-identified secondary school ATs (SSATs; 67.3%; experience = 14.0 ± 9.7 years) and 354 self-identified collegiate ATs (CATs; 32.7%; experience = 13.4 ± 9.7 years). We used χ2 analyses to assess respondent differences related to current knowledge, current practices, and available resources. Independent t tests were used to compare SSATs and CATs on years of certification and annual number of SRCs evaluated. Of our total respondents, 41.2% (n = 446) correctly indicated the absence of evidence-based RTL guidelines. Whereas most (73.9%, n = 800) respondents had an established RTL policy, only 38.1% (n = 413) used such guidelines in their clinical practice. Most (97.1%, n = 708) SSATs and 82.2% (n = 291) of CATs had access to (a) mental health professional(s); however, minorities of SSATs (21.4%, n = 156) and CATs (37.0%, n = 131) never accessed these resources to care for concussed student-athletes. Our results suggested that, despite the absence of empirical evidence, most surveyed ATs incorporated some form of RTL protocol in their SRC management policy. The varying AT knowledge, clinical practices, and resources highlighted by our results should be considered when creating or refining an RTL protocol.

Musculoskeletal Injury Risk After Sport-Related Concussion: A Systematic Review and Meta-analysis

Background: Clinical management of sport-related concussion typically involves a symptom checklist, clinical examination of mental status, and neurocognitive testing. However, recent studies have identified unresolved, impaired sensorimotor function after athletes return to sport. A review and meta-analysis of all current literature regarding risk of subsequent musculoskeletal (MSK) injury after concussion has yet to be published in the medical literature. Purpose/Hypothesis: To determine the odds that athletes will sustain MSK injury after concussion. It was hypothesized a priori that concussion would increase the risk for MSK injury. Study Design: Systematic review and meta-analysis. Methods: PubMed and Google Scholar were searched from January 2000 to November 2017. Reference lists of the included studies were manually searched. Two reviewers independently searched the literature for studies published in English that reported MSK injury after athletes returned to play following a concussion. Two independent reviewers completed data extraction using PRISMA guidelines and assessed study quality using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies from the National Institutes of Health. Random effects meta-analyses were used to calculate odds ratio (OR) and incidence rate ratio (IRR) of MSK injury after concussion. The primary study outcome of interest was the number of athletes who sustained MSK injury after concussion. Results: Eight studies met inclusion criteria for meta-analysis. Meta-analysis results indicated that athletes who had a concussion had 2 times greater odds of sustaining a MSK injury than athletes without concussion (OR, 2.11; 95% CI, 1.46-3.06). In addition, athletes with concussion demonstrated a higher incidence of MSK injury after return to sport compared with nonconcussed athletes (IRR, 1.67; 95% CI, 1.42-1.96). Further analysis showed that both male and female athletes with concussion were at an increased risk of MSK injury compared with their respective same-sex, nonconcussed controls (OR > 1.56, P < .01). Conclusion: Based on the evidence of higher risk of MSK injuries after concussion, standard clinical assessments for athletes with concussion should include not only physical symptoms and cognitive function before return to sport but also neuromuscular risk factors associated with increased risk for MSK injuries.

Identifying dyslexia risk for sport-related concussion management: Sensitivity and specificity of self-report and rapid naming

Background: Dyslexia is the most common type of learning disability and studies have shown that student-athletes with learning disabilities sustain more concussions than their non-affected peers. However, current methods of dyslexia identification in college students are potentially invalid because they rely on students to self-report formal dyslexia diagnoses.Methods: To test the accuracy of self-report against two alternative methods of dyslexia screening, 94 college students completed three dyslexia symptom inventories, two rapid naming (RAN) tasks, and a standard word reading measure.Results: Reliability was acceptable for screening purposes on the inventories (α =.70, −.72), and excellent for RAN (α = .91, −.94). Specificity was acceptable (82.5%), but sensitivity was low (14.3%) when students self-reported suspected diagnoses of reading impairment. Sensitivity and specificity were higher for the digit RAN task (71 and 98%, respectively) compared to the letter RAN task (57 and 90%). Sensitivity (92.7%) and specificity (92.5%) were optimal when a cut-score of ≥27 seconds was used. A binary logistic regression showed digit RAN alone significantly predicted whether students were classified as typical or inefficient readers, p< .001, whereas the most reliable dyslexia inventory alone did not, p=.284. Including inventories along with RAN provided no additional predictive value.Conclusion: Self-report inventories missed many cases of inefficient word reading. The digit RAN task classified 93.6% of the cases correctly compared to 72.3% for self-report inventory. Thus, we recommend that neuropsychologists working with college concussion management programs add to their baseline screening protocols the digit RAN task, which can be completed in less than one minute.