Post-injury Assessments Research Articles

64 Comparison of Post-Concussion Symptom Network Structure at Baseline and Post-Concussion

Objective:Recent conceptualizations of concussion symptoms have begun to shift from a latent perspective (which suggests a common cause; i.e., head injury), to a network perspective (where symptoms influence and interact with each other throughout injury and recovery). Recent research has examined the network structure of the Post-Concussion Symptom Scale (PCSS) cross-sectionally at pre-and post-concussion, with the most important symptoms including dizziness, sadness, and feeling more emotional. However, within-subject comparisons between network structures at pre-and post-concussion have yet to be made. These analyses can provide invaluable information on whether concussion alters symptom interactions. This study examined within-athlete changes in PCSS network connectivity and centrality (the importance of different symptoms within the networks) from baseline to post-concussion.Participants and Methods:Participants were selected from a larger longitudinal database of high school athletes who completed the PCSS in English as part of their standard athletic training protocol (N=1,561). The PCSS is a 22-item self-report measure of common concussion symptoms (i.e., headache, vomiting, dizziness, etc.) in which individuals rate symptom severity on a 7-point Likert scale. Participants were excluded if they endorsed history of brain surgery, neurodevelopmental disorder, or treatment history for epilepsy, migraines, psychiatric disorders, or alcohol/substance use. Network analysis was conducted on PCSS ratings from a baseline and acute post-concussion (within 72-hours post-injury) assessment. In each network, the nodes represented individual symptoms, and the edges connecting them their partial correlations. Estimations of the regularized partial correlation networks were completed using the Gaussian graphical model, and the GLASSO algorithm was used for regularization. Each symptom’s expected influence (the sum of its partial correlations with other symptoms) was calculated to identify the most central symptoms in each network. Recommended techniques from Epskamp et al. (2018) were completed for assessing the accuracy of the estimated symptom importance and relationships. Network Comparison Tests were conducted to observe changes in network connectivity, structure, and node influence.Results:Both baseline and acute post-concussion networks contained negative and positive relationships. The expected influence of symptoms was stable in both networks, with difficulty concentrating having the greatest expected influence in both. The strongest edges in the networks were between symptoms within similar domains of functioning (e.g., sleeping less was associated with trouble falling asleep). Network connectivity was not significantly different between networks (S=0.43), suggesting the overall degree to which symptoms are related was not different at acute post-concussion. Network structure significantly differed at acute post-concussion (M=0.305), suggesting specific relationships in the acute post-concussion network were different than they were at baseline. In the acute post concussion network, vomiting was less central and sensitivity to noise and mentally foggy more central.Conclusions:PCSS network structure at acute post-concussion is altered, suggesting concussion may disrupt symptom networks and certain symptoms’ associations with the experience of others after sustaining a concussive injury. Future research should compare PCSS networks later in recovery to examine if similar structural changes remain or return to baseline structure, with the potential that observing PCSS network structure changes post-concussion could inform symptom resolution trajectories.

Association between trauma triage and time-to-vaso-occlusive events in patients with sickle cell disease after traumatic injury: a retrospective study

IntroductionSickle cell disease (SCD) is associated with vaso-occlusive events (VOEs) that can lead to disease complications, including early mortality. Given that similar inflammatory responses characterize VOE and traumatic injury, injured...

Female Collegiate Athletes' Concussion Characteristics and Recovery Patterns: A Report from the NCAA-DoD CARE Consortium.

Concussion has been described in the United States (US) collegiate student-athlete population, but female-specific findings are often underrepresented and underreported. Our study aimed to describe female collegiate student-athletes' initial injury characteristics and return to activity outcomes following concussion. Female collegiate student-athletes (n = 1393) from 30-US institutions experienced a concussion and completed standardized, multimodal concussion assessments from pre-injury through unrestricted return to play (uRTP) in this prospective, longitudinal cohort study. Initial injury presentation characteristics, assessment, and return to activity outcomes [<48-h (acute), return to learn, initiate return to play (iRTP), uRTP] were collected. We used descriptive statistics to report injury characteristics, return to activity outcomes, and post-injury assessment performance change categorization (worsened, unchanged, improved) based on change score confidence rank criteria across sport contact classifications [contact (n = 661), limited (n = 446), non-contact (n = 286)]. The median (25th to 75th percentile) days to return to learn was 6.0 (3.0-10.0), iRTP was 8.1 (4.8-13.8), and uRTP was 14.8 (9.9-24.0), but varied by contact classification. Across contact levels, the majority experienced worse SCAT total symptom severity (72.8-82.6%), ImPACT reaction time (91.2-92.6%), and BSI-18 total score (45.2-51.8%) acutely relative to baseline, but unchanged BESS total errors (58.0-60.9%), SAC total score (71.5-76.1%), and remaining ImPACT domains (50.6-66.5%). Our findings provide robust estimates of the typical female collegiate student-athlete presentation and recovery trajectory following concussion, with overall similar findings to the limited female collegiate student-athlete literature. Overall varying confidence rank classification was observed acutely. Our findings provide clinically-relevant insights for athletes, clinicians, researchers, and policymakers to inform efforts specific to females experiencing concussion.

Long-term Multidomain Patterns of Change After Traumatic Brain Injury: A TRACK-TBI LONG Study.

Traumatic brain injury (TBI) may be a chronic condition carrying risk of future sequelae; few prospective studies examine long-term postinjury outcomes. We examined the prevalence of functional, cognitive, and psychiatric change outcomes from 1 to 7 years postinjury. Transforming Research and Clinical Knowledge in TBI LONG (TRACK-TBI LONG) participants were prospectively enrolled within 24 hours of injury and followed up to 1 year postinjury; a subset participated in long-term follow-up from 2 to 7 years postinjury. Reliable change thresholds for the Brief Test of Adult Cognition by Telephone General Composite (cognition) and Brief Symptom Inventory (BSI)-18 (psychiatric) were derived from orthopedic trauma controls (OTCs). Multiple assessments were completed (postinjury baseline assessment and 2 or 3 visits 2-7 years postinjury) within a sample subset. Change was assessed for functional outcome (Glasgow Outcome Scale-Extended [GOSE]) and self-report/informant report of decline. Prevalence ratios for outcomes classified as stable, improved, and declined were reported individually and collectively. The Fisher exact test and log-binomial regression models examined factors associated with decline and improvement. Of the sample (N = 1,264; mild TBI [mTBI], Glasgow Coma Scale [GCS] 13-15, n = 917; moderate-to-severe TBI [msTBI], GCS 3-12, n = 193; or OTC n = 154), "stable" was the most prevalent outcome. Functional outcome showed the highest rates of decline, regardless of TBI severity (mild = 29%; moderate/severe = 23%). When measures were collectively considered, rates of decline included mTBI (21%), msTBI (26%), and OTC (15%). Age and preinjury employment status were associated with functional decline (per 10 years; relative risk [RR] 1.16, 95% CI 1.07-1.25, p < 0.001; higher in retired/disabled/not working vs full-time/part-time; RR 1.81, 95% CI 1.33-2.45, respectively) in the mTBI group. Improvement in functional recovery 2-7 years postinjury was associated with higher BSI scores (per 5 points; RR 1.11, 95% CI 1.04-1.18, p = 0.002) and GOSE score of 5-7 (GOSE = 8 as reference; RR 2.64, 95% CI 1.75-3.97, p < 0.001). Higher BSI scores and identifying as Black (RR 2.28, 95% CI 1.59-3.25, p < 0.001) were associated with a greater likelihood of improved psychiatric symptoms in mTBI (RR 1.21, 95% CI 1.14-1.29, p < 0.001). A greater likelihood of cognitive improvement was observed among those with higher educational attainment in msTBI (per 4 years; RR 2.61, 95% CI 1.43-4.79, p = 0.002). Function across domains at 1-year postinjury, a common recovery benchmark, undergoes change across the subsequent 6 years. Results support consideration of TBI as a chronic evolving condition and suggest continued monitoring, rehabilitation, and support is required to optimize long-term independence and quality of life.

A-64 The Impact of a Sports-Related Concussion on Emotional Beliefs of Collegiate Athletes.

Abstract Purpose The purpose of this review is to summarize the current literature on the effects of sports-related concussion on an athlete’s emotional beliefs. Emotional beliefs are an individual’s beliefs on whether emotions are controllable, as well as useful or unwanted. Understanding how a concussion affects an athlete’s emotional beliefs can assist in determining appropriate interventions for treatment. Data Selection: The informal literature search was conducted through EBSCOhost and PsychINFO databases from August 2022 through February 2023 for articles containing CONCUSSIONS plus one of the following: EMOTIONAL BELIEFS, COLLEGIATE ATHLETES, EMOTIONS. Inclusion criteria included data collected from a collegiate sample, article presented original research, articles published in 2000 or later, and articles contained relevant information regarding emotional beliefs in collegiate athletes. Due to the dearth in the literature regarding emotional beliefs, only five studies were reviewed. Results Currently within the literature, there is debate about the construct of emotional beliefs. The literature is mixed on how to define emotional beliefs as well as how to distinguish emotional beliefs from cognition. Within the literature there is agreement that emotional beliefs are additionally influenced by a myriad of factors. Although emotional changes are observed in concussed athletes, there has been little research on how concussions impact athlete's beliefs about their emotions. Baseline concussion testing often does not include any mood measures, thus limiting post-injury assessment to strictly cognitive domains. Conclusions Sustaining a concussion can lead to increased stress and exacerbate pre-existing psychological disturbances. Changes in emotional beliefs can affect an athlete’s mental well-being, which in turn can affect their athletic and academic performance. In sum, there is a need for further research on the effects of concussions on cognitive and emotional beliefs in the field of sports neuropsychology.

Symptomatic and Functional Recovery Following Concussion in Adolescents With and Without a History of Psychiatric Disorder (P7-1.003)

<h3>Objective:</h3> Our study aimed to examine whether symptomatic and functional recovery post-concussion varies between adolescents with and without a history of psychiatric disorder. <h3>Background:</h3> Pre-existing comorbidities can exacerbate impairments following concussion. Psychiatric disorders are associated with emotional symptoms and altered cognition, and similar outcomes are frequently observed post-concussion. Thus, it is possible that a history of psychiatric disorder may be associated with poorer concussion outcomes. <h3>Design/Methods:</h3> We conducted a retrospective analysis of data from a pediatric concussion clinic. Adolescents who had sustained a concussion completed initial (~2 weeks) and follow-up (~5 weeks) post-injury assessments. Assessments included questionnaires regarding concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire—RPQ), depressive symptoms (Beck Depression Inventory-Youth—BDI), parent-reported executive function (Behavior Rating Inventory of Executive Function—BRIEF), and a modified CogState testing battery. Groups were categorized as adolescents with a parent-reported history of psychiatric disorder (PD+; n = 13) and those reporting no history (PD−; n = 26). <h3>Results:</h3> The PD+ group reported greater severity of RPQ—somatic, RPQ—emotional, and BDI symptoms across time points and had poorer BRIEF—behavioral regulation scores at follow-up (<i>p</i>’s &lt; .05). Compared to PD−, the PD+ group also had greater improvements in accuracy on a two-back working memory task from initial to follow-up evaluations, with higher accuracy at follow-up specifically (<i>p</i>’s &lt; .05). <h3>Conclusions:</h3> Adolescents with a history of psychiatric disorder exhibit more severe concussive and depressive symptoms and poorer behavioral regulation post-concussion than adolescents with no such history. They also display greater increase in working memory accuracy over time; however, this may be attributable to poorer initial performance and a larger subsequent improvement by follow-up. These findings demonstrate a discrepancy between adolescent behavior and parent observations, highlighting the importance of acknowledging psychiatric comorbidities in concussion recovery and incorporating the perspective of both parent and child. <b>Disclosure:</b> Miss Mangold has nothing to disclose. Mr. Kay has nothing to disclose. Dr. Wagner has nothing to disclose. Dr. Holloway has nothing to disclose. Dr. Moore has nothing to disclose.

187 Use of Quantitative Pupillometry in Mild Traumatic Brain Injury to Diagnose and Predict Symptom Severity

INTRODUCTION: Concussion screening using the Military Acute Concussion Evaluation (MACE 2) and imaging modalities can be subjective, time intensive, and monopolize scarce resources in a forward deployed environment. The Pupillary light reflex (PLR) has shown recent promise in identifying mild traumatic brain injuries. METHODS: Freshman entering a military service academy had baseline PLR measurements (starting pupillary diameter, ending pupillary diameter, average constriction velocity, average dilation velocity, constriction latency, constriction percentage, T75 and pupillary wave form) completed using a Neuroptic PLR-3000. If a subject experienced a concussion they returned for PLR measurements and Sport Concussion Assessment Tool (SCAT) scores within 48 hours of injury. RESULTS: Five hundred and fourteen cadets (383 males and 131 females) completed baseline PLR measurements. Sixteen cadets subsequently sustained an mTBI and performed full post-injury assessments. The one-way MANCOVA performed on PLR metrics controlling for symptom severity revealed a marginally significant difference in combined PLR metrics between baseline and post-injury time points [Wilks’ λ = .578, F(8,22) = 2.01, p = .094, partial η = .422]. A significant difference in outcomes between baseline and post-injury were observed for starting pupillary diameter [F(1,29) = 3.10, p = .089, partial η2 = .097], average constriction velocity [F(1,29) = 5.79, p = .023, partial η2 = .167], and maximum constriction velocity [F(1,29) = 4.54, p =.042, partial η2 = .135]. Correlation coefficients demonstrated that post-injury changes in pupillary metrics were strongly associated with post-injury changes in symptom severity, particularly for starting pupillary diameter, constriction percentage, average constriction velocity, maximum constriction velocity, and T75. CONCLUSIONS: In this evaluation of service academy cadets there are measurable differences in pupillary dynamics after sustaining an mTBI which correlates with symptom severity.

Virtual Reality Application for Vestibular/Ocular Motor Screening: Current Clinical Protocol Versus a Novel Prototype.

Virtual reality (VR) has been explored to improve baseline and postinjury assessments in sport-related concussion (SRC). Some experience symptoms related to VR, unrelated to concussion. This may deter use of vestibular/ocular motor screening (VOMS) using VR. Baseline VR VOMS symptomatology differentiates baseline from overall symptomatology. There will be no difference between current clinical manual VOMS (MAN), a clinical prototype (PRO), and VR for symptom provocation change score (SPCS) and near point of convergence (NPC) average score in a healthy population and sex differences among the 3 modes of administration. Cohort study. Level 3. A total of 688 National Collegiate Athletic Association Division I student-athletes completed VOMS using 3 methods (MAN, N = 111; female athletes, N = 47; male athletes, N = 64; average age, 21 years; PRO, N = 365; female athletes, N = 154; male athletes, N = 211; average age, 21 years; VR, N = 212; female athletes, N = 78; male athletes, N = 134; average age = 20 years) over a 3-year period (2019-2021) during annual baseline testing. Exclusion criteria were as follows: self-reported motion sickness in the past 6 months, existing or previous neurological insult, attention deficit hyperactivity disorder, learning disabilities, or noncorrected vision impairment. Administration of MAN followed the current clinical protocols, PRO used a novel prototype, and VR used an HTC Vive Pro Eye head mounted display. Symptom provocation was compared using Mann-Whitney U tests across each VOMS subtest with total SPCS and NPC average by each method. MAN had significantly (P < 0.01) more baseline SPCS (MAN = 0.466 ± 1.165, PRO = 0.163 ± 0.644, VR = 0.161 ± 0.933) and significantly (P < 0.01) and more SPCS (MAN = 0.396 ± 1.081, PRO = 0.128 ± 0.427, VR = 0.48 ± 0.845) when compared with PRO and VR. NPC average measurements for VR (average, 2.99 ± 0.684 cm) were significantly greater than MAN (average, 2.91 ± 3.35 cm; P < 0.01; Cohen's d = 0.03) and PRO (average, 2.21 ± 1.81 cm; P < 0.01; Cohen's d = 0.57). For sex differences, female athletes reported greater SPCS with PRO (female athletes, 0.29 ± 0.87; male athletes, 0.06 ± 0.29; P < 0.01) but not in VR or MAN. Using a VR system to administer the VOMS may not elicit additional symptoms, resulting in fewer false positives and is somewhat stable between sexes. VOMS may allow for standardization among administrators and reduce possible false positives.

Multicentre evaluation of anxiety and mood among collegiate student athletes with concussion

ObjectivesMental health problems are a premorbid and postinjury concern among college student athletes. Clinical phenotypes of anxiety and mood disruption are prevalent following mild traumatic brain injury, including concussion, a...

Unintentional Effects from Housing Enhancement Resulting in Functional Improvement in Spinal Cord-Injured Mice.

It is well established that both positive and negative housing conditions of laboratory animals can affect behavioral, biochemical, and physiological responses. Housing enhancements have been shown to have beneficial effects on locomotor outcomes in rodents with spinal cord injury (SCI). Subsequent to an unplanned housing enhancement of the addition of a balcony to home cages by animal care personnel at a research facility, a retrospective analysis of multiple SCI studies was performed to determine whether outcomes differed before (four studies, N = 28) and after (four studies, N = 23) the addition of the balcony. Locomotor and morphological differences were compared after a mild-moderate T9 spinal cord contusion injury in wild-type mice. Post-injury assessments of locomotor function for 6 weeks included Basso Mouse Scale (BMS) and treadmill kinematic assessments (week 6). Balcony-housed mice showed greater improvements not only in basic locomotor functions (weight-supported stepping, balance) compared to those in standard housing, but also surpassed mice in standard housing without the balcony in higher-order locomotor recovery outcomes, including BMS late-stage recovery measures (paw, tail, and trunk indices). Additionally, balcony-housed mice had overall higher BMS scores, consistently attained more BMS subscores, and had better treadmill track width and stride length compared to those with no balcony. The housing enhancement of a balcony led to unforeseen consequences and unexpected higher recovery outcomes compared to mice in standard housing. This retrospective study highlights the importance of housing conditions in the key outcomes of locomotor recovery after incomplete contusive SCIs in mice.

Evaluation and Utility of the King-Devick With Integrated Eye Tracking as a Diagnostic Tool for Sport-Related Concussion.

Eye-tracking technology for detecting eye movements has been gaining increasing attention as a possible assessment and monitoring tool for sport-related concussion (SRC). To determine the diagnostic accuracy of a rapid number-naming task with eye tracking, the King-Devick Eye Tracking (K-D ET) assessment, in identifying SRC. Cohort study. One female and 1 male team of United States collegiate rugby-15 players competing during the 2018 season were recruited. Variables assessed were total saccades, saccade velocity, total fixations, fixation duration, fixation polyarea, and test duration. A generalized estimating equation was used to examine group (concussion vs nonconcussion), time (baseline vs postinjury/postseason), and sex-based differences for each outcome measure. In addition, the different components of diagnostic accuracy of the K-D ET were calculated. Baseline K-D ET assessment for 49 participants (25 male, 24 female) were assessed at the beginning of the season, with 28 participants who did not sustain a head injury during the season completing the postseason assessments and 6 participants completing a postinjury (suspected concussion) assessment. Significant differences were observed between concussed and nonconcussed groups for total saccades (P = .024), fixation duration (P = .007), and fixation polyarea (P = .030), with differences from baseline to follow-up observed for saccade velocity (P = .018) in both groups. Sex-based differences were noted for total fixations (P = .041), fixation polyarea (P = .036), and completion time (P = .035). No significant Group × Time interactions were noted. The K-D ET test duration indicated high specificity (0.86) but not high sensitivity (0.40). No other variables reported high sensitivity or specificity. Other than completion time of the K-D ET test, no K-D ET oculomotor parameter was highly sensitive or specific in the diagnosis of concussion in this study.

Minimal Detectable Change for the ImPACT Test Administered Remotely.

Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) is one of the most widely used computerized neurocognitive assessment batteries in athletics and serves as both a baseline and postinjury assessment. It has become increasingly popular to administer the ImPACT baseline test in an unsupervised remote environment; however, whether the lack of supervision affects the test-retest reliability is unknown. To establish the minimal detectable change (MDC) of composite scores from the ImPACT test when administered to National Collegiate Athletic Association Division I student-athletes in an unsupervised remote environment before 2 consecutive athletic seasons. Cross-sectional study. Participants were provided with a unique link and detailed written instructions on how to complete the ImPACT test at home. Division I student-athletes. Remote baseline ImPACT results from the 2020-2021 and 2021-2022 athletic seasons were analyzed. The MDC was calculated at the 95%, 90%, and 80% CIs for each of the ImPACT composite scores as well as the average and SD. The MDC at the 95% CI was 18.6 for the verbal memory composite score, 24.44 for visual memory, 8.76 for visual motor, 0.14 for reaction time, and 6.13 for impulse control. One-way repeated-measures multivariate analysis of variance, repeated-measures analysis of variance, and Wilcoxon signed ranks tests suggested no difference in the composite scores and impulse control between time points. The ImPACT composite scores and impulse control did not change between the 2 remote testing time points when administered approximately 1 year apart. Our study suggests that the MDC serves as a clinician's guide for evaluating changes in ImPACT baseline scores and in making clinical judgments on sport-related concussion when the test is administered at home.

Evaluating Post-Injury Functional Status among Patients Presenting for Emergency Care in Kigali, Rwanda

Despite high injury-related morbidity, approaches for evaluating post-injury functional status after emergency care are poorly characterized in resource-limited settings. This study evaluated the feasibility of standardized disability assessments among patients presenting with significant trauma to the Centre Hospitalier Universitaire de Kigali ED in Rwanda from January–June 2020. The functional status at 28-days post-injury was assessed using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2), the Katz Activities of Daily Living (ADL) Scale, and self-reported functional state. The primary outcome was a descriptive profile of the disability status at 28-days post-injury. The WHODAS 2.0, Katz ADL Scale and patients’ self-perceived functional status was compared using Kendall’s rank correlation coefficient. Twenty-four patients were included. The most common injury mechanism was road traffic accident (70.8%); 58.3% of patients had traumatic brain injury. The self-perception questionnaire and the Katz ADL scale were strongly correlated with the WHODAS 2.0 scale; however, self-perception was not well correlated with the ADL scale. Post-injury morbidity was high and morbidity assessment was feasible, with a strong correlation between patients’ self-perceived functional status and the WHODAS-2 scale. Structured post-injury assessments may serve to inform the development of rehabilitation services in Rwanda, although larger studies are needed to inform such initiatives.

High altitude modulates concussion incidence, severity, and recovery in young athletes

ABSTRACT Background High altitude may affect concussion, but prior studies are limited . We tested whether high altitude affects sport-related concussion (SRC) incidence, severity, and recovery. Methods Twenty-five thousand eight hundred fifteen baseline and post-injury Immediate Post-Concussion Assessment and Cognitive Testing results were compiled from Florida and Colorado, low (27 m or 62 m) and high (1,640 m or 1,991 m) altitude locations, respectively. Incidence, severity, and recovery of injury were compared between altitudes. Results High altitude was associated with increased suspected concussion incidence (adjusted OR, 2.04 [95% CI, 1.86 to 2.24];P < .0001). However, high altitude was associated with lower concussion severity measured by Severity Index (SI) (adjusted OR, 0.42 [95% CI, 0.37 to 0.49];P < .0001). High altitude was associated with decreased recovery from post-concussive symptoms in the migraine (β, −2.72 [95% CI, −3.31 to −2.13]; P < .0001), cognitive (β, −1.88 [95% CI, −2.40 to −1.36]; P < .0001), and sleep symptom clusters (β, −0.30 [95% CI, −0.52 to −0.08]; P = .007). Athletes with initial SI≥8 showed prolonged neurocognitive dysfunction at high altitude (HR, 1.38 [95% CI, 1.06 to 1.81]; P = .02). Conclusions High altitude was associated with increased suspected concussions and prolonged recovery but less severe initial injury.

Improved post-injury cognitive test results: examining invalid baseline ImPACT testing

ABSTRACT Objective Evidence suggests that Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) validity thresholds may not be adequately sensitive to baseline performances that are not representative of an athlete’s full, uninjured cognitive abilities. The true prevalence of this occurrence is unknown. This study used improvement on post-injury testing (i.e., better performance after the athlete has been removed from play due to suspected concussion than at baseline) to assess the frequency of unrepresentative baseline ImPACT assessments. Method Post-injury ImPACT assessments by NCAA athletes with preceding baseline performance that was considered valid using traditional indices were included. Published reliable change indices (RCI) identified acute post-injury composite scores that improved from baseline. Results Of 155 post-injury assessments, 68 (43.9%) exhibited reliable improvement from baseline on at least 1 composite score, even after excluding persons with invalid protocols. Conclusions Prevalence of ImPACT unrepresentative baseline ImPACT performances may be higher than previously estimated, and many individuals may not be detected by current validity indices. Further research is needed to refine assessment and promote player safety.

The Natural History of Sport-Related Concussion in Collegiate Athletes: Findings from the NCAA-DoD CARE Consortium.

Sport-related concussion is recognized as a significant injury with variable recovery rates. This study defined the acute natural history of sport concussion in male and female collegiate athletes participating in a broad array of sports. We conducted a prospective, longitudinal investigation among collegiate student athletes (n = 34,709) from 30 academic institutions. Primary outcomes included the time (days) from injury until initiation of a return to participation (RTP) protocol and time from injury until medical clearance for unrestricted RTP. Concussed athletes (n = 1751, 19.2years, 63.2% male) participating in 22 different sports began the RTP protocol in a median 6.4 (IQR 3.7-11.8) days. Time to initiate the RTP protocol was lengthened by less frequent post-injury assessments, greater initial post-injury symptom severity, limited contact sports participation, practice/training injuries, and three or more prior concussions. The median total RTP duration was 12.8 (IQR 8.7-20.1) days. Total RTP duration was shorter with ADHD medication usage, males, and greater assessment frequency; while greater initial post-injury symptom severity, practice-/training-related injuries, and three or more prior concussions had longer recoveries. Although median recovery times are consistent with previous guidelines, it was not until 1month post-injury that a preponderance of collegiate athletes were cleared to begin the RTP protocol (92%) or cleared for unrestricted sport participation (85%). Intrinsic and extrinsic factors had a small effect, altering recovery trajectories by up to 2days, suggesting a largely unified approach to post-injury monitoring and management across all athletes. These data represent a shift from previous classification parameters of normal clinical recovery.

Virtual Reality Application For The Vestibular Ocular Motor Screen: A Comparison With A Novel Prototype.

Clinical assessment of sport related concussion (SRC) involves a multifaceted test battery reliant upon accurate baseline measures. Advances in technology have prompted the use of virtual reality (VR) platforms to improve enjoyment of baseline and post-injury assessments. Possible influence of VR sickness for some users may deter the use symptom provocation tests like the Vestibular/Ocular Motor Screening (VOMS) exam in VR. It is important to understand baseline performance of the VOMS in VR as it might influence overall symptom provocation. PURPOSE: The purpose of this study was to examine differences in the VOMS using a clinical prototype (PRO) versus using a virtual reality (VR) stimulus with respect to symptom provocation change score (SPCS) and near point convergence (NPC) average score in a healthy population. METHODS: Data was collected from 15 healthy subjects (Female = 9, male = 6, avg. age = 20.86 years) who completed the VOMS assessment using the PRO and VR method in the same sitting. Symptoms assessed consisted of headache, nausea, dizziness, and fogginess. Subjects were asked to state the severity of each symptom based upon a scale of 0-10. After a 5-minute break, the same subjects completed the VOMS with an HTC Vive Pro Eye HMD (90 Hz; 2880x1600 pixels). The headset was powered by an Acer Predator gaming laptop with a 7th Generation Intel Core i7 Quad-Core processor with 16GB of memory and NVIDIA GeForce GTX 1070 graphics card. The VOMS stimuli was created with the Unity Software package (Unity3D engine version 2019.1.6) in which the VOMS protocol was simulated in a VR environment. Mann-Whitney U tests assessed the differences in total SPCS and NPC average score from baseline between both methods. RESULTS: For SPCS, the results indicate that the PRO method (avg = 1.4 ± 1.77 symptoms) and the VR method (avg = 0.9 ± 1.18 symptoms) of administering the VOMS were not significantly different (p = 0.33, Cohen’s d = 0.33). With respect to NPC average, there was no significant difference (p = 0.19, Cohen’s d = 0.22) between the PRO method (avg = 2.33 ± 1.74 cm) and the VR method (avg = 3.08 ± 4.42 cm). CONCLUSION: These data suggests that using a VR system to administer the VOMS may not elicit additional symptoms and it may be a viable tool for the collection of baseline symptom provocation data in a healthy population.

Objectively Assessing Sports Concussion Utilizing Visual Evoked Potentials.

A portable system capable of measuring steady-state visual-evoked potentials (SSVEP) was developed to provide an objective, quantifiable method of electroencephalogram (EEG) testing following a traumatic event. In this study, the portable system was used on 65 healthy rugby players throughout a season to determine whether SSVEP are a reliable electrophysiological biomarker for concussion. Preceding the competition season, all players underwent a baseline SSVEP assessment. During the season, players were re-tested within 72 h of a match for either test-retest reliability or post-injury assessment. In the case of a medically diagnosed concussion, players were reassessed again once deemed recovered by a physician. The SSVEP system consisted of a smartphone housed in a VR-frame delivering a 15 Hz flicker stimulus, while a wireless EEG headset recorded occipital activity. Players were instructed to stare at the screen's fixation point while remaining seated and quiet. Electrodes were arranged according to the 10-20 EEG-positioning nomenclature, with O1-O2 being the recording channels while P1-P2 the references and bias, respectively. All EEG data was processed using a Butterworth bandpass filter, Fourier transformation, and normalization to convert data for frequency analysis. Players SSVEP responses were quantified into a signal-to-noise ratio (SNR), with 15 Hz being the desired signal, and summarized into respective study groups for comparison. Concussed players were seen to have a significantly lower SNR compared to their baseline; however, post-recovery, their SNR was not significantly different from the baseline. Test-retest indicated high device reliability for the portable system. An improved portable SSVEP system was also validated against an established EEG amplifier to ensure the investigative design is capable of obtaining research quality EEG measurements. This is the first study to identify differences in SSVEP responses in amateur athletes following a concussion and indicates the potential for SSVEP as an aid in concussion assessment and management.

Preliminary Safety and Efficacy of Head and Neck Cooling Therapy After Concussion in Adolescent Athletes: A Randomized Pilot Trial.

Objective:To determine the safety and efficacy of head and neck cooling when applied up to 8 days after concussion among adolescent athletes.Design:A randomized nonblinded pilot trial.Setting:Sports Medicine Clinic in a tertiary hospital.Patients:Adolescent athletes aged 12 to 17 years diagnosed with a concussion within 1 week of injury.Interventions and Main Outcome Measures:The control group (n = 27) received standard treatment (short term brain rest), whereas the treatment group (n = 28) received standard treatment and head and neck cooling. Head and neck cooling treatment was applied to patients at the postinjury assessment visit and at 72 hours post-injury. The SCAT5 (Sport Concussion Assessment Tool) total symptom severity score was collected at postinjury assessment visit, pre- and post-treatment at 72 hours, and at 10 days, and 4 weeks post-treatment.Results:Athletes who received head and neck cooling had a faster symptom recovery (P = 0.003) and experienced significant reduction in symptom severity scores after treatment (P < 0.001). Sport type and gender did not influence the treatment outcome (P = 0.447 and 0.940, respectively).Conclusions:This pilot study demonstrates feasibility of head and neck cooling for the management of acute concussion in adolescent athletes.

Predictors of Driving Status in Service Members and Veterans at 1 Year Posttraumatic Brain Injury: A VA TBI Model Systems Study.

To identify predictors of driving status in service members and veterans 1 year following a traumatic brain injury (TBI). The 5 Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs). A total of 471 service members and veterans (128 with mild/complicated mild TBI and 343 with moderate/severe TBI) who received TBI-focused inpatient rehabilitation at one of the VA PRCs and who participated in a 1-year postinjury follow-up assessment. Secondary analysis from the Department of Veterans Affairs Polytrauma Rehabilitation Centers Traumatic Brain Injury Model Systems (VA PRC TBIMS) national database. Primary outcome was a single item that assessed driving status at 1 year postinjury. Predictor variables included demographics; sensory impairment, substance use, and employment status at time of injury; PTSD symptoms reported at study enrollment; and functional impairment rated at rehabilitation discharge. In unadjusted bivariate analyses, among those with a mild/complicated mild TBI, older age and greater functional impairment were associated with lower likelihood of driving. Among those with a moderate/severe TBI, discharge to a nonprivate residence, greater functional impairment, and higher PTSD symptoms were linked to lower likelihood of driving. Adjusted multivariate analyses indicated that functional impairment was uniquely associated with driving status in both TBI severity groups. After controlling for other predictors, self-reported PTSD symptoms, particularly dysphoria symptoms, were associated with lower likelihood of driving in both severity groups. Given the significance of clinician-rated functional impairment and self-reported PTSD symptoms to the prediction of driving status 1 year post-TBI among service members and veterans, rehabilitation efforts to improve functioning and reduce negative affect may have a positive impact on driving and community integration.