Postconcussion Symptom Scores Research Articles

Influence of Preexisting Conditions and Concussion History on Postconcussion Symptom Severity and Recovery Time in Collegiate Athletes.

Mental health conditions and concussion history reported by a collegiate athlete may contribute to prolonged recovery and symptom severity after concussion. This work examined the potential associations among concussion history, preexisting conditions, and sex relative to initial symptom severity and recovery duration following sport-related concussion (SRC) in a cohort of Division 1 National Collegiate Athletic Association athletes. This prospective cohort study analyzed symptom severity, recovery, and return-to-play (RTP) times reported post-SRC using data collected as part of the Pac-12 Concussion Assessment, Research and Education Affiliated Program and Health Analytics Program. Health history questionnaires that included self-reported history of preexisting conditions were completed at baseline. When consented athletes were diagnosed with a concussion, daily postconcussion symptom scores were evaluated until an athlete was clinically determined to be asymptomatic. Generalized linear and Cox proportional hazards models were used to determine associations between preexisting conditions and recovery and RTP times. Ninety-two concussions met inclusion criteria. Notable differences in initial symptom severity existed between females and males who had mood disorders (effect size [d] = 0.51) and attention-deficit hyperactivity disorder (ADHD; d = 0.93). The number of previous concussions was a strong predictor of athletes reporting preexisting mood disorders, depression, anxiety, and ADHD (p = 0.008-0.04). Females with ≥2 previous concussions required more days to RTP than males (d = 0.31-0.72). Weekly recovery and RTP probabilities substantially differed between athletes who did or did not have learning disorders (LDs; hazard ratio [HR]Recovery = 0.32, HRRTP = 0.22, d = 1.96-2.30) and ADHD (HRRecovery = 3.38, HRRTP = 2.74, d = 1.71-4.14). Although no association existed between concussion history and acute symptom severity, collegiate athletes with a history of concussion had higher probabilities of reporting depression, mood disorders, anxiety, and ADHD. Having ADHD or LDs likely strongly affects time to recovery and RTP for collegiate athletes.

Concussion risk and symptomology severity in adolescents are associated with pre-season drowsiness and emotional complaints.

Concussions are an ever present risk for many sports. Underlying emotional disturbances and drowsiness are associated with worse post-concussion symptom scores. Yet, not study has examined associations of both emotional disturbances and drowsiness on concussion severity and symptomology. Examine the associations between baseline sleepiness, emotional complaints, and concussion risk and symptom severity in adolescent athletes. A cohort of 626 adolescent athletes underwent baseline/pre-season concussion screening. Those who experienced a physician diagnosed concussion underwent follow up concussion symptomology assessment. Over 90% of players were seen within two weeks of the concussion incident. Linear regression examined for associations between concussion symptom scores and baseline drowsiness and baseline emotional symptoms. Logistic regression examined for association between each symptom and baseline drowsiness and baseline emotional symptoms. Of the 626 athletes that underwent baseline testing, 292 experienced a concussion. Of those 292 athletes, 174 (59.6%) reported baseline drowsiness and 183 (62.7%) baseline emotional symptoms. Baseline drowsiness and emotional complaints were associated with a 2.6 (95% confidence interval = 1.9 to 3.6) and 2.8 (95% confidence interval = 2.0 to 3.9) times greater odds of sustaining a concussion respectively. Increased symptomology after concussion was associated with both baseline drowsiness (unstandardised b = 4.6, p < 0.01) and baseline emotional complaints (unstandardised b = 6.0, p < 0.01). Preseason drowsiness and emotional complaints in adolescent athletes are associated with higher risk of adverse clinical outcomes following concussion. Therefore, clinicians and coaches should be aware, and properly screen, for sleep and emotional problems as part of pre-season/baseline health screening.

Change in health-related quality of life and functional disability over time post-concussion in youth.

Concussions can have detrimental on children's cognitive, emotional, behavioral, and/or social functioning. We sought to examine changes in health-related quality of life (HRQOL) and functional disability from pre-injury to 1-week post-concussion, and to symptom resolution among youth ages 11-17 with a concussion. In this prospective, longitudinal cohort study, 83 concussed youth, ages 11-17, self-reported post-concussion symptoms daily as well as HRQOL and functional disability at baseline (pre-injury, retrospective), 1-week post-concussion, and symptom resolution. We modeled changes in overall and sub-scale HRQOL and functional disability scores over time from pre-injury to 1-week post-concussion and from 1-week post-concussion to symptom resolution using a piecewise linear mixed model, adjusting for potential covariables. Estimated fixed effects with a corresponding adjusted coefficient (beta), along with their 95% confidence intervals are presented. Overall HRQOL worsened from pre-injury to 1-week post-injury (β = -5.40, 95%CI -9.22, -1.58) but did not change from 1-week post-injury to symptom resolution. Physical HRQOL worsened from pre-injury to 1-week post-injury (β = -9.90, 95%CI -14.65, -5.14) but improved from 1-week post-injury to symptom resolution (β = 1.64, 95%CI 0.50, 2.78), while psychosocial HRQOL showed no change over time. Functional disability worsened from pre-injury to 1-week post-injury (β = 8.36, 95%CI 5.93, 10.79) but with no change from 1-week post-injury to symptom resolution. Youth with symptom duration > 14days reported worse HRQOL and functional disability than those who recovered in ≤ 14days and greater daily post-concussion symptom scores were associated with worse HRQOL and functional disability. Concussions have a negative impact on overall and physical HRQOL and functional disability in youth acutely post-injury. Ratings of HRQOL could be used to inform clinical treatment decisions to assist with the recovery process.

New Strategies Show Promise for Concussion

New Strategies Show Promise for Concussion

Test-Retest Reliability and Efficacy of Individual Symptoms in Concussion Management.

(1) To determine test-retest reliability of individual Sport Concussion Assessment Tool-Third Edition (SCAT-3) symptom scores and symptom severity scores, (2) to examine the specificity/sensitivity of individual SCAT-3 symptom severity scores acutely (24-48 hours) postconcussion, and (3) to develop a model of symptoms best able to differentiate concussed from nonconcussed student athletes and cadets. Prospective, longitudinal, and cross-sectional. Twenty-six civilian schools and 3 US service academies. Collegiate student athletes (n = 5519) and cadets (n = 5359) from the National Collegiate Athletic Association-Department of Defense Grand Alliance: Concussion Assessment, Research and Education Consortium, including 290 student athletes and 205 cadets, assessed 24 to 48 hours postconcussion. Concussed and nonconcussed student athlete and cadet groups. Sport Concussion Assessment Tool-Third Edition individual symptom severity scores, total symptom scores, and symptom severity scores. Results indicated poor test-retest reliability across all symptom scores (intraclass correlation coefficient = 0.029-0.331), but several individual symptoms had excellent predictive capability in discriminating concussed from nonconcussed participants (eg, headache, pressure in the head, and don't feel right had area under the curve >0.8, sensitivity >70%, and specificity >85%) regardless of baseline testing. These symptoms were consistent with Chi-square Automatic Interaction Detector classification trees with the highest mean probability. Findings support the excellent diagnostic accuracy of honest symptom reporting, notwithstanding the known limitations in symptom underreporting, and suggest that there may be added value in examining individual symptoms rather than total symptom scores and symptom severity scores alone. Finally, findings suggest that baseline testing is not necessary for interpreting postconcussion symptom scores.

Post-concussion symptoms and clinical reaction time performance of athletes with a history of concussion.

The symptom presentation after sport-related concussion is highly subjective, while the clinical test of reaction time (RT) has been presented as an objective tool to the effects of sport-related concussion. A multimodal assessment approach supports concussion management; therefore, it is appropriate to explore the relationship between modals. The aim of the present study is to investigate the relationship of clinical RT and post-concussion symptom (PCS) score, number of experienced concussions, and time since concussion. Based on retrospective concussion history, 53 athletes were selected for this study. Athletes were questioned using a standardized questionnaire to obtain concussion history data, such as number of cumulative concussions and date of most recent concussion. Symptom scores were gathered through Sport Concussion Assessment Tool. A clinical RT test was used to obtain RT data. A significant positive correlation was found between RT and the PCS score. A linear regression revealed that the PCS score but neither the cumulative number of experienced concussions, nor the time post-concussion significantly predicts increased RT. Reaction time positively correlates with the symptoms neck pain, dizziness, balance problems, light sensitivity, feeling slowed down, feeling like in a fog, do not feel right, drowsiness, and irritability. This study presents that the PCS score particularly predicts increased RT after sport-related concussions. Furthermore, a specific set of symptoms significantly impacts the RT of athletes. The results suggest that not a single symptom drives the relationship between PCS score and RT, highlighting the heterogeneity of this injury.

Risk factors for prolonged recovery from concussion in young patients

ObjectivesFor young patients sustaining concussion, assessing recovery is vital in determining safe return to play. Identifying risk factors may aid clinicians in recognising patients at risk for prolonged recovery. The...

The Role of Active Rehabilitation in Concussion Management: A Systematic Review and Meta-analysis.

This study aimed to conduct a systematic review and meta-analysis of active rehabilitation on concussion management. We also examined moderator variables that may contribute to differences across studies: symptom scale, physical activity type, time of injury to recruitment, and mechanism of injury. The standardized effect size of physical activity on concussion management was computed for 23 studies (29 effect sizes). Effect sizes were coded as positive when studies reported an improvement in symptom scores, which was represented by a decrease in postconcussive symptom scores. The overall effect size of physical activity on concussion recovery was large and positive (g = 1.03). Subthreshold aerobic activity provided the largest effect size (g = 1.71), whereas multimodal interventions had a moderate effect size (g = 0.70). All other moderator variables produced positive effect sizes ranging from g = 0.59 to g = 1.46. This systematic review and meta-analysis demonstrates that current evidence supports the notion that physical activity is beneficial in decreasing postconcussive symptoms in both the acute and chronic phases after concussion. The results indicate that unimodal subthreshold aerobic activity may be the best course of action compared with multimodal interventions. Despite this growing body of evidence, additional research is needed to determine the optimal intensity, duration, and time to initiation of aerobic exercise after concussion.

The Influence of Timing of Reporting and Clinic Presentation on Concussion Recovery Outcomes: A Systematic Review and Meta-Analysis

Identifying risk factors for prolonged recovery following concussion can assist clinicians with appropriate management strategies. It is thought that athletes who continue to participate following a hit to the head or body may take longer to recover following a concussion diagnosis. To systematically review the body of literature regarding the effect of delayed reporting and delayed presentation to medical providers on concussion recovery times. Systematic review with meta-analysis. PubMed, Ovid Medline, SPORTDiscus, Cochrane Central Register of Controlled Trials and hand searches of reference lists. All the searches were performed in April 2020. Studies included an investigation of immediate versus delayed reporting or early versus late presentation following a concussion, were published in the past ten years, and were level 4 evidence or higher. 12 studies were included. Patients who continued play or delayed reporting their concussion had significantly longer recovery times (standardized mean difference = 0.36 days (95%CI 0.066, 0.662) than those who immediately reported or were removed from play (p = 0.017). Expressed in raw scores, those who immediately reported recovered in 5.4 days (95% CI − 10.14, − 0.75) fewer than delayed reporters. Comparable results were found for post-concussion symptom scores (p = 0.034) with immediate reporters demonstrating lower symptom severity scores. Our qualitative synthesis found patients who presented earlier to a concussion specialist tended to recover faster than those who presented later. Patients who delayed reporting or continued play had longer recovery times compared to their immediately-reporting peers. Providers should ask concussion patients approximately how long they waited to report their injury, and also focus educational efforts on encouraging immediate reporting of concussion.

History of Functional Somatic Syndromes and Persistent Symptoms After Mild Traumatic Brain Injury.

Somatization is thought to underlie functional somatic syndromes (FSSs) and may also contribute to prolonged symptoms after mild traumatic brain injury (mTBI). The investigators evaluated the prevalence of FSSs in patients seeking specialty care after mTBI and whether a history of FSSs was associated with symptom persistence. A total of 142 patients with mTBI completed questionnaires regarding demographic information, injury characteristics, and medical history, including history of diagnosed FSSs at clinic intake (mean=41 days postinjury [SD=22.41]). Postconcussion symptoms were assessed at clinic intake and again 1 and 3 months later. A linear mixed-effects model was used to determine whether history of FSSs was related to persistent mTBI symptoms over time. A history of at least one FSS was reported by 20.4% of patients. In the linear mixed model, postconcussion symptom scores were not significantly different over time among patients with a history of one or more FSSs or two or more FSSs from those with no FSSs. A history of one or more FSSs or two or more FSSs (versus no FSS) was not associated with increased odds of severe postconcussion symptoms at clinic intake (one or more FSSs: odds ratio=0.88, 95% CI=0.38-2.03; two or more FSSs: odds ratio=1.78, 95% CI=0.45-7.03), at the 1-month follow-up visit (one or more FSSs: odds ratio=0.57, 95% CI=0.22-1.45; two or more FSSs: odds ratio=0.57, 95% CI=0.14-2.37), or at the 3-month follow-up visit (one or more FSSs: odds ratio=0.97, 95% CI=0.36-2.63; two or more FSSs: odds ratio=1.27, 95% CI=0.29-5.65). In this sample, the prevalence rates of FSSs were higher than rates previously reported for the general population. However, FSS history did not predict higher postconcussion symptom burden at clinic intake or persistence over the following 3 months. Further research is needed to clarify the potential role of somatization in poor mTBI outcome.

Cortical Volume and Thickness in Youth Several Years After Concussion.

The long-term effects of pediatric concussion on brain morphometry remain poorly delineated. This study used magnetic resonance imaging (MRI) to investigate cortical volume and thickness in youth several years after concussion. Participants aged 8-19 years old with a history of concussion (n = 37) or orthopedic injury (n = 20) underwent MRI, rated their postconcussion symptoms, and completed cognitive testing on average 2.6 years (SD = 1.6) after injury. FreeSurfer was used to obtain cortical volume and thickness measurements as well as determine any significant correlations between brain morphometry, postconcussion symptoms (parent and self-report), and cognitive functioning. No significant group differences were found for either cortical volume or thickness. Youth with a history of concussion had higher postconcussion symptom scores (both parent and self-report Postconcussion Symptom Inventory) than the orthopedic injury group, but symptom ratings did not significantly correlate with cortical volume or thickness. Across both groups, faster reaction time on a computerized neurocognitive test battery (CNS Vital Signs) was associated with a thinner cortex in the left pars triangularis of the inferior frontal gyrus and the left caudal anterior cingulate. Better verbal memory was associated with a thinner cortex in the left rostral middle frontal gyrus. Findings do not support differences in cortical volume or thickness approximately 2.5 years postconcussion in youth, suggesting either long-term cortical recovery or no cortical differences as a result of injury. Further research using a longitudinal study design and larger samples is needed.

Associations Between Neurochemistry and Gait Performance Following Concussion in Collegiate Athletes.

To evaluate the strength of associations between single-task and dual-task gait measures and posterior cingulate gyrus (PCG) neurochemicals in acutely concussed collegiate athletes. Participants were recruited from an NCAA Division 1 University. Nineteen collegiate athletes acutely (<4 days) following sports-related concussion. We acquired magnetic resonance spectroscopy (MRS) in the PCG and gait performance measurements in the participants, acutely following concussion. Linear mixed-effects models were constructed to measure the effect of gait performance, in the single- and dual-task settings, and sex on the 6 neurochemicals quantified with MRS in mmol. Correlation coefficients were also calculated to determine the direction and strength of the relationship between MRS neurochemicals and gait performance, postconcussion symptom score, and number of previous concussions. Average gait speed, average cadence, N-acetyl aspartate, choline, myo-inositol, glutathione, glutamate plus glutamine, and creatine. Single-task gait speed (P = .0056) and cadence (P = .0065) had significant effects on myo-inositol concentrations in the PCG, independent of sex, in concussed collegiate athletes. Single-task cadence (P = .047) also had a significant effect on glutathione in the PCG. No significant effects were observed between dual-task gait performance and PCG neurochemistry. These findings indicate that increased concentrations of neuroinflammatory markers in the PCG are associated with slower single-task gait performance within 4 days of sports-related concussion.

Changes in exertion-related symptoms in adults and youth who have sustained a sport-related concussion

ObjectivesTo identify the symptoms responsible for cessation of exercise testing and evaluate changes in post-concussion symptom scores on the Post-Concussion Symptom Scale (PCSS) from the Sport-Concussion Assessment Tool (SCAT5) immediately, 1–4h, and 6–12h following completion of the Buffalo Concussion Treadmill Test (BCTT) in youth and adults who have sustained a sport-related concussion. DesignProspective case-series. MethodsIndividuals who were diagnosed with a sport-related concussion and self-reported difficulties with exertion were referred to perform an exertional treadmill test. Individuals were recruited from a university sports medicine clinic. Change in PCSS symptom severity scores were operationally defined as a change ≥4 points. ResultsForty-five individuals aged 13–57 years consented to participate. A total of 14/24 (58.3%) female and 13/21 (61.9%) male participants reported an increase in symptom severity scores immediately following the BCTT. At 1–4h, 5/10 (50.0%) males and 5/14 (35.7%) females who completed the PCSS had elevated symptom severity scores compared to pre-exertion. Only 24.2% (3/17 males and 5/16 females) of participants completing the PCSS at 6–12h reported increased symptom severity scores. ConclusionExertional testing is an important component of a multifaceted assessment following concussion; however, previous research evaluating symptom responses to exertion is limited. This study provides evidence to suggest individuals who experience an exacerbation of concussion-associated symptoms after exertion are likely to return to pre-exertion levels within the same day. Future research monitoring symptoms following exertion and throughout recovery should be performed in tandem with physiological measures to better understand the source of symptoms.

Hyperactive movement behaviour of athletes with post-concussion symptoms

ObjectiveObservations of hyperactive (/restless, agitated) behaviour as a consequence of mild traumatic brain injuries (mTBI) in sports are inconclusive as reduced or slowed movement behaviour is also commonly described post-concussion. This might be grounded in the fact that the movement behaviour of athletes has not been systematically investigated during standardized settings and with objective methods of nonverbal movement analysis. Thus, we investigate whether symptoms after mTBI in sports are characterized by a hyper- or hypoactive movement behaviour experimentally. MethodsThree matched groups of 40 athletes were investigated: 14 symptomatic and 14 asymptomatic athletes with a mTBI; and 12 non-concussed athletes. Four certified raters analysed with a standard analysis system for nonverbal behaviour each athlete’s hand movement activity, hand movement contacts, and resting positions that were displayed during a videotaped standardized anamnesis protocol. ResultsSymptomatic athletes spend significantly more time with act apart hand movements and less time with closed rest positions when compared to non-concussed athletes. Post-concussion symptom (PCS) scores positively correlate with act apart hand movements. A linear regression analysis revealed that act apart hand movements significantly predict the PCS score. ConclusionsAthletes with increased symptoms after mTBI move their hands in a hyperactive and restless manner. Increased act apart hand movements, i.e., when both hands move simultaneously without touching each other, indicate a motoric destabilization in symptomatic athletes’ behaviour that might be related to impaired inhibitory motor control systems. Future diagnoses should concern the systematic analysis of the nonverbal movement behaviour as a potential behavioural marker of symptoms after mTBI.

Hyperactive behavior of athletes with post-concussion symptoms

ObjectiveObservations of hyperactive (/restless, agitated) behavior as a consequence of sport related concussions (SRC) are inconclusive as hypoactivity has also commonly been described. This might be grounded in the fact that the movement behavior of athletes has not been systematically investigated during standardized settings and with objective methods of movement analysis.BackgroundThus, we investigated the contradiction whether symptoms after SRC are characterized by a hyper- or hypoactive movement behavior experimentally.Design/MethodsThree matched groups were investigated: 14 symptomatic and 14 asymptomatic athletes with a concussion; and 12 non-concussed athletes. Four certified raters analyzed with the NEUROGES the Activation and Contact incl. Rest/Pose categories as reliable measures of hypo/hyperactivity of (hand) / body movement activity that were displayed during a videotaped standardized anamnesis protocol.ResultsSymptomatic athletes spend significantly more time with act apart hand movements and less time with closed rest positions when compared to non-concussed athletes. Post-concussion symptom (PCS) scores positively correlate with act apart hand movements. A linear regression analysis revealed that act apart hand movements significantly predict the PCS score.ConclusionsIn line with previous descriptions of hyperactivity after SRC, athletes with increased symptoms after mTBI in sports behave hyperactive and restless when analyzed systematically. Because agitated/restless behavior was previously described in the concussed athletes who were later diagnosed with chronic traumatic encephalopathy (CTE), we suggest that future diagnoses should concern the detailed analysis of the movement activity as a potential behavioral marker of sport related concussions.

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.

Baseline concussion symptom score differences comparing collision, contact, and noncontact sports and comparison of between sexes

ObjectiveTo determine if baseline concussion symptoms scores in athletes prior to the start of their season vary by sport or sex.BackgroundConcussion is a clinical diagnosis that includes an appropriate clinical scenario, reporting of symptoms through a post concussion symptom score list, and an objective neurologic exam. Symptom reporting is considered when determining if an athlete has recovered from their concussion. Recent studies have shown that athletes at baseline can report symptoms at a rate high enough to meet criteria for post concussion syndrome without any history of concussion. The number of symptoms reported was found to be higher in female athletes than male athletes, but to date there has not been a clear consideration of how these symptoms compare across different sports played.MethodsRetrospective chart review of baseline pre-participation sport exams from 2016. More than 2000 charts were reviewed for age, sex, sport played, number of past concussions. Baseline concussion symptom checklist scores were reviewed for number of symptoms reported and severity of symptoms reported. Comparisons were made between groups comparing age, sex, sport played, and number of previous concussions prior to the start of this season.ResultsFemale athletes in all sports compared reported more baseline symptoms and more severe symptoms compared to their male counterparts. Athletes of the same sex, male or female who participated in collision or contact sports reported less baseline symptoms than athletes who participated in noncontact sports.ConclusionContact and collision sport athletes report at baseline less concussion checklist symptoms than noncontact sport athletes in all age groups compared. This leads to many questions about why certain athlete populations report less symptoms. Symptom reporting could be due to underlying physical traits in different sports, or player psychology differences between sports.

Poster 131: Comparison of Post-Concussive Total Symptom Scores on ImPACT Testing by Demographic Data

Poster 131: Comparison of Post-Concussive Total Symptom Scores on ImPACT Testing by Demographic Data

When is it time to start rehab? exploring the optimal timing to initiate active rehabilitation for concussion management in children and adolescents

ObjectiveEstimate the influence of time to initiation of active rehabilitation on post-concussion symptom (PCS) severity in youth who are slow to recover from concussion.DesignRetrospective analysis of a prospective cohortSettingConcussion clinic of a tertiary care Paediatric Trauma Centre in Canada.Participants569 youth (14.3±2.3 years) with persistent PCS. Clinic patients’ information is entered prospectively in a clinical database and participants were selected for this study if they 1) participated in the active rehabilitation program, and 2) had available PCS assessments at the intake and follow-up visits.InterventionActive rehabilitation consisting of: aerobic exercise, coordination exercises and, education/motivation. The intervention was initiated with a Physical Therapist in the Concussion clinic continued as a daily home program. The independent variable was time to initiation of the active rehabilitation program measured in weeks (2, 3, 4, 5, 6+).Outcome measureSymptom severity measured by the PCS scale of the SCAT3 at follow-up visit, 2 weeks after initiation of intervention.Main results: Patients initiating active rehabilitation 2 weeks post-injury were significantly less symptomatic at follow-up (Mdn PCS score=5) compared to those starting five (Mdn=17) and six weeks or more (Mdn=17.5) (p=0.0002). Those starting at 3 (Mdn=9) and 4 (Mdn=10) weeks also had significantly less severe symptoms compared to those starting 6 weeks or later (p&lt;0.05).ConclusionsThe findings suggest that children benefit more from active rehabilitation if it is initiated between two and four weeks post-injury, and have poorer outcomes if it is delayed beyond 6 weeks post-injury.Competing interestsNone.

Impact of Diagnosed Sleep Disorder on Baseline Concussion Assessments in Collegiate Athletes

Research suggests at least 27% of college students are at risk for at least one sleep disorder. Adolescents with sleep-related symptoms and reduced sleep duration perform worse on baseline neurocognitive testing, although this effect size is small and samples have not included older or collegiate-level athletes. Previous research has not taken into consideration the effects of previously diagnosed sleep disorders on performance of preinjury baseline assessment. PURPOSE: The purpose of the current study was to compare athletes with and without a history of diagnosed sleep disorders on commonly used baseline concussion assessments. METHODS: All participants completed baseline testing including: the Balance Error Scoring System (BESS), Brief Symptom Inventory (BSI), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Post-Concussion Symptom Score (PCSS), Standardized Assessment of Concussion (SAC) and Vestibular/Ocular Motor Screening (VOMS). A total of 632 NCAA student-athletes participated in the study including 316 with previously diagnosed sleep disorders and 316 with no history of sleep disorder, matched for age, sex, sport, concussion history and race. Both groups were 19.87 years old (SD = 1.36), consisted of 176 males (55.7%), with 119 athletes (37.7%) previously having sustained a concussion, and represented a multitude of sports. RESULTS: A series of one-way ANOVAs with Bonferroni corrections revealed significant differences between groups on BESS (F(1, 535) = 4.02, p = .045), BSI somatization (F(1,623) = 11.41, p < .01), BSI depression (F(1, 623) = 13.59, p < .01), BSI anxiety (F(1, 623) = 20.97, p < .01), BSI global severity index (F(1, 623), p < .01) and PCSS (F(1, 396) = 22.86, p < .01). Specifically, the diagnosed sleep disorder group scored worse on the BESS and reported higher BSI and PCSS symptoms. No differences were noted between groups on VOMS, ImPACT neurocognitive measures, and SAC. CONCLUSION: Collegiate student-athletes with sleep disorders may have elevated affective and concussion symptoms at baseline that could affect interpretation of post-injury impairment and symptoms. Clinicians should assess diagnosed sleep disorders during pre-participation sport physicals and consider them when interpreting post-injury assessments.