Previous Concussion History Research Articles

Alterations in dual-task walking persist two months after mild traumatic brain injury in young adults

Objectives To compare dual-task performance involving different cognitive-locomotor combinations between healthy controls and participants with sub-acute mild traumatic brain injury (mTBI) and to correlate dual-task performances to history of prior head injuries. Methods Eighteen participants having recently sustained mTBI and 15 controls performed nine dual-tasks combining locomotor (level-walking, narrow obstacle, deep obstacle) and cognitive (Stroop task, Verbal fluency, Counting backwards) tasks. Previous history of concussion was also investigated. Results Slower gait speeds were observed in the mTBI group compared to controls during both single and dual-tasks. Longer response times to cognitive tasks in the mTBI group further suggested the presence of residual impairments two months following injury. No combination of dual-task was more sensitive. Correlations were observed between history of mTBI and several measures of dual-task performance, underlying the need to further consider the effects of multiple injuries in relation to dual-task walking. Conclusion Dual-tasks using simultaneously locomotor and cognitive functions represent an ecological way for clinicians to detect residual, but subtle, alterations post-mTBI. History of previous mTBI needs to be considered as a personal characteristic which may influence dual-task walking performance.

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.

High sensitivity C-reactive protein: Potential biomarker of inflammation in acute mTBI

ObjectiveThis study investigated the utility of high-sensitivity C-Reactive Protein (hsCRP) as a blood biomarker for mild traumatic brain injury (mTBI).BackgroundValidation of a blood biomarker panel will greatly improve mTBI diagnosis and prognosis. hsCRP has been validated as a sensitive biomarker for inflammation. Previous studies have established relationships between CRP levels and TBI, but the utilization of hsCRP levels in assessing mTBI requires further exploration.MethodsRetrospective chart review collected hsCRP values in acute mTBI patients seen within 30 days of injury. Patients with any comorbid diagnosis known to cause elevation of inflammatory proteins were excluded. Continuous hsCRP levels were transformed into quartiles: <0.200 mg/L for Quartile 1 (Q1); 0.200–0.415 mg/L for Quartile 2 (Q2); 0.415–1.100 mg/L for Quartile 3 (Q3); and ≥1.100 mg/L for Quartile 4 (Q4). Multivariable binary logistic regression modeling identified potential factors for elevated hsCRP at first visit. Cox regression analysis identified potential factors for delayed time to recovery.ResultsThree hundred twelve injuries in 311 patients were reviewed (mean age 21 ± 12 years, 53% female). Mean hsCRP was elevated patients who presented within 2 days of injury and was found to significantly decrease between first visit and 4 weeks post-injury (p = 0.016). Initial hsCRP level was positively correlated with age (r = 0.163, p = 0.004) and negatively associated with previous concussion history (p = 0.031). When analyzed as quartiles, patients in Q4 were more likely to have endorsed headache (p = 0.036) or fatigue (p = 0.030). Age significantly increased between quartiles (p = 0.013). Multivariable binary logistic regression showed that increased age (OR: 3.48) and patients presenting with headache (OR: 3.48) or fatigue (OR: 2.16) were significantly associated with increased risk of having an hsCRP level in Q4. Females (HR: 0.32) and increased age (HR: 0.95) were associated delayed time to recovery.ConclusionshsCRP may be a viable addition to acute and longitudinal biomarker panels for diagnosis and prognosis of mTBI.

Determinants of intention to disclose concussion symptoms in a population of U.S. military cadets

ObjectivesNon-disclosure of concussion complicates concussion management, but almost nothing is known about non-disclosure in military settings. This study describes concussion disclosure-related knowledge, attitudes, perceived social norms, perceived control, and intention. Additionally, the study identifies determinants of high intention to disclose concussion symptoms. DesignCross sectional survey. MethodsFirst-year service academy cadets completed a cross-sectional survey to assess perceptions of concussion disclosure. Independent variables included: gender, race, ethnicity, high school athlete status, NCAA athlete status, previous concussion history, previous concussion education, socioeconomic proxy, concussion-related knowledge, attitudes about concussion, perceived social norms (perceived peer/organizational support and actions), and perceived control over disclosure. Log-binomial regression was used to identify determinants of high intention to disclose concussion symptoms. ResultsA total of 972 first-year military service academy cadets completed the survey [85% response; age=18.4±0.9y]. In the simple models, previous concussion history was associated with lower intention to disclose concussion symptoms. High perceived control over disclosure, higher concussion knowledge, more favorable attitudes and social norms about concussion were associated with high intention to disclose. In the multivariable model, a 10% shift towards more favorable perceived social norms (PR=1.28; p<0.001) and attitudes (PR=1.07; p=0.05) about concussion were associated with high intention to disclose concussion symptoms. High perceived control over disclosure was associated with high intention to disclose concussion symptoms (PR=1.39; p=0.08). ConclusionsConcussion-related perceived social norms, attitudes, and perceived control are associated with intention to disclose. Organizationally appropriate intervention strategies can be developed from these data.

Isometric Cervical Muscular Strength in Pediatric Athletes With Multiple Concussions.

To compare maximal cervical muscle strength among athletes with a history of 2 or more concussions relative to athletes with no history of a previous concussion. Athletes in the 2 groups were frequency-matched. Linear mixed models were used to test for differences in peak isometric flexion, extension, left lateral flexion, and right lateral flexion cervical muscle torque between groups. Pediatric sports medicine clinic. Athletes with a history of multiple concussions (n = 16) and athletes with no previous concussion history (n = 17). INTERVENTIONS (OR ASSESSMENT OF RISK FACTORS OR INDEPENDENT VARIABLES):: Concussion history (group), age, sex, neck girth, and height. Peak isometric torque measured with a stationary isokinetic dynamometer during a 3-second isometric hold. There was no significant difference in peak flexion [mean difference: 21.2%, 95% confidence interval (CI): -6.6% to 57.4%, P = 0.1413], extension (mean difference: 17%, 95% CI, -6.8% to 47.1%, P = 0.1667), left lateral (mean difference: 4.4%, 95% CI, -16.9% to 31.1%, P = 0.7011), or right lateral (mean difference: 9.3%, 95% CI, -14.5% to 39.8%, P = 0.4627) isometric torque in the concussion group relative to the control group. Across all muscle actions, neck torque was significantly (P < 0.05) higher in male compared with female athletes. Increasing neck girth was also associated with a significant (P < 0.05) increase in neck torque. There was no evidence of a consistent cervical muscle strength deficit among athletes with a history of 2 or more concussions relative to athletes with no previous history of a concussion. Age, neck girth, and sex were significantly associated with cervical muscle strength. Isometric cervical muscle strength testing may not be a reliable test for differentiating athletes with a history of multiple concussions relative to athletes with no history of concussions in the pediatric and adolescent population. Our study presents a reliable methodology for testing cervical muscle strength among young athletes.

A History of Concussion Does Not Lead to an Increase in Ocular Near Point of Convergence.

Ocular near point of convergence (NPC) has been shown to be sensitive to the effects of concussion and subconcussive impacts. To determine if NPC is also sensitive to a previous history of concussion, male contact-sport athletes either with (n=26) or without (n=16) a history of at least one previous concussion had their NPC assessed. The results showed that participants with a history of concussion displayed NPC values (9.4±1.6 cm) indistinguishable from those with no history of concussion (8.4±2.1 cm, t-test, p=0.09). This was the case regardless of whether 1, 2, or 3 or more concussions had occurred and despite the fact participants with concussion (mean time since last concussion: 1136 days) suffered from an increased number and severity of symptoms as assessed with the SCAT 3 (3.6±2.2 vs. 2.13±1.89 symptoms, 6.1±4.1 vs. 3.19±2.99 severity, t-test, p<0.05). Taken together, these results imply that NPC may not be a suitable tool to assess the potential long-term effects of one or more concussions over a longer time frame.: Future research using larger sample sizes is warranted to evaluate the potential dose-response relationship between number of prior concussions and NPC.

Adolescent athletes with learning disability display atypical maturational trajectories on concussion baseline testing: Implications based on a Finnish sample

ABSTRACTPrevious research has reported lower cognitive test scores on baseline testing in athletes reporting multiple previous concussions or a history of learning disability (LD). Age also has an important influence on cognitive performance. While these factors have been considered individually in previous studies, the present study is the first to explore the interaction of age, self-reported LD, and history of concussion on baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®) in a nationwide study of adolescent athletes. ImPACT® was administered to 1823 Finnish male ice hockey players (aged 12–21 years old) prior to the 2015–2016 or 2016–2017 playing seasons. Linear regressions and simple slopes analyses were used for clarifying the impact of LD and previous concussion history on maturational trajectories. In comparison to typically developing athletes, athletes with LD had lower neurocognitive scores in all composites and differing maturational trajectory in verbal memory and visual motor speed. The number of previous concussions did not impair neurocognitive performance at baseline assessment. Application of standard age-based norms to adolescent athletes with a history of LD has the potential to negatively skew clinical decision-making. Separate reference values for LD athletes are warranted due to their unique developmental cognitive trajectories. The reference values for the Finnish participants in this study are presented.

Baseline Visual Measures in High School Football Players With and Without Previous Concussion

Visual impairments are common following sport-related concussion and may negatively affect athlete performance and safety if unresolved. PURPOSE: To examine differences in baseline visual assessment measures in high school football players with and without previous concussion. A secondary purpose was to examine the correlations between these asessments. METHODS: High school varsity football players (n=64, n=24 with concussion history) from a single high school (mean age=15.6±1.3 years) were enrolled in the study. Participants completed the following assessments prior to the start of the competitive football season: 1) three near-point of convergence (NPC) trials, 2) vision and sensory performance testing via the Senaptec Sensory Station, and 3) a demographic questionnaire. The independent variable was previous concussion history (with vs. without). Primary outcomes were average NPC across three trials (measured in centimeters) and the Senaptec Sensory Station scores for: visual clarity, contrast sensitivity, depth perception, near-far quickness, perception span, multiple object tracking, and hand-reaction time. Independent samples t-tests were used to examine differences in visual assessments between those with and without previous concussion. Pearson correlations examined relationships between all Senaptec Sensory Station and mean NPC measures. Alpha level was set to P < 0.05 a priori. RESULTS: Over half (62.5%) of those who reported a concussion history indicated that their most recent concussion was within the last year. There was no significant effect of concussion history on any of the visual assessment measures. There was a significant, but clinically insignificant correlation between mean NPC and binocular visual clarity (r=0.26; P=0.03). No other significant correlations among the visual assessment measures were identified (P < 0.05). CONCLUSION: High school football athletes, regardless of concussion history, exhibit similar baseline clinical and performance visual measures. Our data suggest that NPC and binocular visual clarity, while statistically correlated are clinically independent of one another and both worthy of evaluation in assessing concussion.

Sub-concussive trauma, acute concussion, and history of multiple concussions: Effects on quiet stance postural control stability.

Although balance control has been studied extensively following acute concussion, little is known regarding repetitive sub-concussive head impacts or chronic exposure to multiple concussive events. Quiet stance postural control was characterized in contact sport athletes at pre-season (n = 135) and post-season (n = 48) to evaluate the effects of subconcussive trauma to the head. To determine the impact of acute concussion on postural control, athletes diagnosed with a concussion during the season (n = 12) were tested at 72-h, 2-weeks, and 1-month post-injury. Because only 4 of the concussed athletes completed baseline testing, control athletes (n = 12) matched for sport, age, body mass index (BMI), and previous concussion history served as a comparison group. Finally, the effects of previous concussion history on quiet stance postural control were determined by comparing pre-season data in contact sport athletes with either zero (Hx0, n = 50) or three or more (Hx3+, n = 25) previous concussions. A force plate was used to compare changes in centre-of-pressure root-mean-square displacement (RMSdisp) and mean-velocity (COPvel) in the anterior/posterior (AP) and medial/lateral (ML) directions. One-minute trials were performed with feet hip-width apart, hands-on-hips, and A) eyes-open and B) eyes-closed. Biomechanical head-impact exposure (impacts over 10 g) was indexed over the season using mastoid-fixed impact sensors. In acutely injured athletes, repeated-measures ANOVA revealed a significant effect of time for RMSdisp AP with increased displacement at 2 weeks compared to 72 h (p = 0.008, 95% CI: -0.180, -0.310 cm). No other COP variables were affected by acute concussion. Moreover, there was no effect of concussion history or repeated sub-concussive impacts on any quiet stance metric. Additionally, head-impact exposure metrics were not correlated with COP metrics. Taken together, the data suggests alterations in COP sway during quiet stance persist in the acute 2-week period after injury. These findings were not present with either a history of multiple concussions or exposure to sub-concussive head impacts indicating acute concussion does not have appear to have long term effects for these measures.

Neuroergonomic Evaluation, Using Mobile fNIRS and Real-World Cognitive Task, Reveal Differences in Adolescents With Mild Traumatic Brain Injury (mTBI) Within an Expected Time Window of Recovery

Neuroergonomic Evaluation, Using Mobile fNIRS and Real-World Cognitive Task, Reveal Differences in Adolescents With Mild Traumatic Brain Injury (mTBI) Within an Expected Time Window of Recovery

Normative Values of the Sport Concussion Assessment Tool 3 (SCAT3) in High School Athletes.

Establish sex, age, and concussion history-specific normative baseline sport concussion assessment tool 3 (SCAT3) values in adolescent athletes. Prospective cohort. Seven Wisconsin high schools. Seven hundred fifty-eight high school athletes participating in 19 sports. Sex, age, and concussion history. Sport Concussion Assessment Tool 3 (SCAT3): total number of symptoms; symptom severity; total Standardized Assessment of Concussion (SAC); and each SAC component (orientation, immediate memory, concentration, delayed recall); Balance Error Scoring System (BESS) total errors (BESS, floor and foam pad). Males reported a higher total number of symptoms [median (interquartile range): 0 (0-2) vs 0 (0-1), P = 0.001] and severity of symptoms [0 (0-3) vs 0 (0-2), P = 0.001] and a lower mean (SD) total SAC [26.0 (2.3) vs 26.4 (2.0), P = 0.026], and orientation [5 (4-5) vs 5 (5-5), P = 0.021]. There was no difference in baseline scores between sex for immediate memory, concentration, delayed recall or BESS total errors. No differences were found for any test domain based on age. Previously, concussed athletes reported a higher total number of symptoms [1 (0-4) vs 0 (0-2), P = 0.001] and symptom severity [2 (0-5) vs 0 (0-2), P = 0.001]. BESS total scores did not differ by concussion history. This study represents the first published normative baseline SCAT3 values in high school athletes. Results varied by sex and history of previous concussion but not by age. The normative baseline values generated from this study will help clinicians better evaluate and interpret SCAT3 results of concussed adolescent athletes.

Increased symptom reporting in middle school athletes based on history of previous concussions

ObjectiveGiven findings of increased symptomatology in high school, college, and professional athletes with history of multiple concussions, we sought to identify incidence of symptom reporting at baseline, in middle-school youth athletes on the basis of concussion history.DesignPre-test only.ParticipantsA multi-centre sample of 2,600 middle-school athletes, ages 10–14, who completed baseline evaluations, were assigned to groups on the basis of concussion history: None (N=1210), One (N=1191), Two or more (N=199).InterventionThe Post-Concussion Symptom Scale (PCSS) was administered during athletes’ pre-season baseline evaluations. Cross-sectional analyses (ANOVAs) were used to examine symptoms reported at the time of baseline testing by concussion history groupMain resultsOtherwise healthy middle school athletes with a concussion history were statistically (p&lt;0.001) more likely to report symptoms of headache, light sensitivity, irritability, drowsiness, difficulty falling asleep, and sleeping less than usual, than middle school athletes with no history of concussion. Analysis of symptom clusters revealed increased endorsement of symptoms in physical and sleep clusters on the basis of concussion history (p&lt;0.001), but not in cognitive or emotional clusters.ConclusionsDevelopmentally, younger athletes may be less insightful in identifying their cognitive or emotional symptoms. Younger athletes who sustain multiple concussions may experience residual symptoms, which may be precursors to future concussion-related difficulties. These results raise poignant implications for: 1) symptom reporting in younger athletes, thus affecting research and clinical assessment, and 2) the possible impact of early concussion residuals on future functioning of college and professional athletes.Competing interestsDr. Schatz serves on the ImPACT Scientific Advisory Board.

Attention problems as a risk factor for concussion in youth ice-hockey players

ObjectiveTo examine attention problems in youth ice-hockey players as a risk factor for concussion.DesignSecondary analysis of two prospective cohort studies.SettingIce-rinks and Sport Medicine Centres in two Canadian cities over three ice-hockey seasons (2011/12, 2012/13, 2014/15).Assessment of risk factorsSelf-report of formal diagnosis of attention or learning disorders were collected on previously validated preseason baseline questionnaires by all participating players. Parents and players completed the Behaviour Assessment System for Children (BASC-2), which includes inattention and hyperactivity scales.Participants2,364 Canadian ice-hockey players (11–17 years old, 87% male).Outcome measuresA previously validated prospective injury surveillance system was used. All suspected concussions were referred to the study physician for confirmation of diagnosis. Concussion risk ratios (RR) were estimated, including stratification by known risk factors.ResultsOne-hundred ninety-two of 2,215 players (9%) self-reported attention and/or learning disorders at baseline. Overall, 256 players (11%) sustained one or more concussions during a season. Players identified as “at-risk” for attention-deficit hyperactivity disorder (ADHD), based on BASC-2 T-scores (inattention and/or hyperactivity scale) greater than 60, had a greater risk of concussion during the season based on child report [RR=1.51 (95% CI 1.13–2.04)] and parent report [2.97 (95% CI 1.65–5.34)]. In players with no history of previous concussion, the RR based on child report was 1.88 (95% CI 1.22–2.90) and based on parent report was 5.03 (95% CI 2.45–10.29).ConclusionsIce-hockey players identified as “at-risk” for ADHD on the basis of baseline BASC-2 scores are at a greater risk of concussion.Competing interestsNone.

Role of sport-related concussion on academic achievement among youth athletes

ObjectiveDetermine change in report card grades in youth after sustaining an acute sport-related concussion.DesignProspective case-series.SettingPaediatric, multi-disciplinary concussion.Participants48 youth athletes (mean age 14.3; SD: 0.9; male: 57.6%) who sustained a sport-related concussion during the school year. Overall, 3 youth were lost to follow-up and 12 youth submitted only one report card.Interventions (or assessment of risk factors)Subsequently developing Post-Concussion Syndrome (PCS: symptomatic after 30 days), initial concussion severity (Post Concussion Symptom Scale), self-reported concussion history, sex, age, and academic accommodations during recovery.Outcome measuresThe report card immediately before the concussion and the report card immediately after medical clearance were collected. Pre-concussion and post-concussion overall and core grade-point average was calculated from report cards. Core grade-point average (GPA) included math, sciences, social studies, English, and foreign languages.Main resultsOverall GPA was 82.9% (SD 8.5%) pre-concussion and 82.7% (SD 8.0%) after concussion recovery (difference: −0.2%, 95% CI: −1.6%, 1.1%). Core GPA was 80.0% (SD 10.1%) pre-concussion and 79.4% (SD 10.4%) after concussion recovery (difference: −0.6%, 95% CI: −2.8%, 1.6%). There were no significant differences in overall or core GPA when stratified by sex, age, initial concussion severity, previous concussion history, receiving adequate school accommodations during recovery, or subsequently developing PCS.ConclusionsThere were no statistically or clinically significant changes in overall or core GPA during concussion recovery. Further research is needed to determine if there are more subtle changes in academic performance during the recovery process.Competing interestsNone.

History of multiple sport-related concussions alters variability of heart rate response to activity

ObjectiveTo examine the effect of multiple previous concussions on heart rate variability (HRV) in contact-sport athletes.DesignRetrospective Cohort.SettingLaboratory.Participants136 male elite contact-sport (hockey and football) athletes were recruited for this study. Forty-one had no previous concussion history (Hx-), while nineteen had a history of three or more concussions (Hx+). All testing was preformed prior to the start of the competitive seasonInterventionsHRV was assessed during 5-minutes of quiet stance, and while actively squatting at 0.10 Hz via a 3-lead electrocardiogram, using Kubios software. Independent variables included condition (rest vs active) and group (Hx+ vs Hx-)Outcome measuresTime-Domain: square root of mean squared differences of successive R-R intervals (RMSSD), percentage of successive R-R intervals that differ by more than 50 milliseconds (pNN50). Frequency-Domain: total power.Main resultsMixed ANOVA revealed repeated squat-stand manoeuvres challenged the autonomic system, increasing total power by 2477 milliseconds2(95% CI: 1153–3801, p&lt;0.001). A significant interaction effect was observed for RMSSD (p=0.031) and pNN50 (p=0.012), characterised by a greater increase in HRV in the Hx+ group than in Hx- from rest to squatting (95%CIs for group differences, RMSSD: 13.2–26.3 ms, p=0.006; pNN50: 3.6–15.1%, p=0.002)ConclusionsA history of multiple sport-related concussions impairs the ability of the autonomic system to respond to an everyday stressor applied to the cardiovascular system (squatting and standing). This is an important finding, as it reveals that cumulative concussions may impart long-term impairments in the ability to accurately regulate the autonomic system.Competing interestsNone.

Retrospective analysis of the first year of an elite sports multidisciplinary complex concussion service in the uk

ObjectiveTo define the characteristics, investigation, diagnosis and management of elite athletes attending a complex concussion service.DesignRetrospective analysis of case notes.SettingSecondary care single centre.ParticipantsAll patients (n=38, aged 16-35, 79% male) seen between April 2015 and April 2016.OutcomesPatient characteristics (sport, position played in rugby, previous concussion history), referral reason, investigations, diagnosis, interventions.Main resultsMost referrals came from Rugby (74% Rugby, 16% soccer, 8% other). Back row (57%) and centre (25%) were the commonest rugby positions seen. The average number of previous concussions of this cohort was 2.5 (95% CI±0.85). Referral reasons included chronic symptoms following concussion (53%), delayed GRTP (21% of which 28% were due to reduced performance on computerised neuropsychological testing), multiple concussions (18%) and severe injury (8%). 95% of patients had brain MRI imaging (with SWI sequences) and 4 patients (10%) had abnormalities (cortical cavernoma, brainstem cavernoma, diffuse axonal injury, obstructive hydrocephalus). 30% of patients required additional vestibular and/or neuropsychological assessment in addition to screening. Post-traumatic migraine was the commonest single diagnosis (36%) followed by isolated vestibular dysfunction (16%). 30% had multiple diagnoses (usually migraine, vestibular dysfunction and mood disorder). 8% did not have concussion. Intervention with medical management for migraine was initiated in 40%, vestibular rehabilitation in 20% and psychological intervention in 15%.ConclusionsA proportion of elite athletes with sports related concussion in the UK have complex needs. These require expert MDT assessment and management. The limited provision of such services needs to be addressed.Competing interestsNone.

Concussion knowledge, attitudes, and perceived level of involvement by american youth sport coaches in concussion management

ObjectiveTo describe concussion knowledge and attitudes of youth sport coaches and relationships among knowledge, attitudes, and perceptions of coach involvement in concussion management.DesignCross-sectional survey.SettingYouth sport coaches in North Carolina and Arizona.Subjects81 youth sport coaches (males: n=69; females: n=11; age=42, IQR=33,45).InterventionA validated survey identifying demographics, concussion knowledge, attitudes, and beliefs.Outcome measuresThe primary outcome was perceived level of coach involvement in concussion management. Descriptive and univariable statistics were used to examine knowledge and attitude differences by demographic factors and perceived involvement. Multivariable logistic regression examined associations between knowledge and attitude and perceived level of coach involvement (lower agreement vs. higher agreement).ResultsKnowledge was low-moderate (Median=13/23, IQR=11,14.5), with 75% indicating a loss of consciousness always occurs with concussion. Attitudes were positive (Median=42/42, IQR=40,42). Forty-seven (58%) strongly agreed or agreed that coaches should be involved in clinical decision-making. There were no differences in knowledge or attitudes across gender, age, previous concussion education, or previous concussion history. Knowledge and attitude were not correlated (r=0.114; p=0.343). There were no knowledge (Median=13, IQR=12,15 vs. Median = 12, IQR=11,14) or attitude (Median=42, IQR=41,42 vs. Median = 42, IQR=39,42) differences between lower and higher perceived involvement, respectively. No associations were observed in the multivariable model with perceived coach involvement (p&gt;0.05).ConclusionsCoaches had limited knowledge, but expressed positive attitudes towards concussion. Educational efforts should target both knowledge and attitudes, as these constructs are not related, but are both key to improving the culture concerning concussion.Competing interestsThe project was funded in part by a grant from the National Operating Committee on Standards for Athletic Equipment.

Increased Symptom Reporting in Young Athletes Based on History of Previous Concussions

ABSTRACTResearch documents increased symptoms in adolescents with a history of two or more concussions. This study examined baseline evaluations of 2,526 younger athletes, ages 10 to 14. Between-groups analyses examined Post Concussion Symptom Scale symptoms by concussion history group (None, One, Two+) and clusters of Physical, Cognitive, Emotional, and Sleep symptoms. Healthy younger athletes with a concussion history reported greater physical, emotional, and sleep-related symptoms than those with no history of concussion, with a greater endorsement in physical/sleep symptom clusters. Findings suggest younger athletes with a history of multiple concussions may experience residual symptoms.

Heart Rate Variability of Athletes Across Concussion Recovery Milestones

To assess heart rate variability (HRV) in athletes with concussion across three phases of recovery. A prospective matched control group design included the collection of HRV and symptoms measured by the Rivermead Post-Concussion Questionnaire. These measures were taken at 3 phases of recovery [(1) symptomatic; (2). asymptomatic; and (3) one-week after return-to-play (RTP)]. The same protocol was completed by noninjured athletes. Interuniversity sports teams at a single institution. 11 athletes, across 7 sports, diagnosed with concussion, and 11 matched-athlete controls volunteered for the study. Physician diagnosed concussion and a sitting to standing protocol for HRV monitoring. The frequency, time, and nonlinear domains of HRV were assessed along with the absolute difference between sitting and standing for each. A 2 x 3 (group x phase) repeated-measures analysis of variance revealed significant interactions for sitting High Frequency (HF) norm, sitting Low Frequency (LF) norm, the difference between sitting and standing HF norm, and difference between sitting and standing LF norm. Acutely, athletes with concussion displayed increased LF norm and decreased HF norm while sitting and a decreased change in their HF and LF norm measures between sitting and standing. A significant group effect for sample entropy when standing was detected, with the concussed group displaying decreased values compared with the matched controls. Athletes with concussion displayed autonomic dysfunction in some measures of HRV that persisted beyond RTP and were related to a previous history of concussion.

Is Migraine Headache Associated With Concussion in Athletes? A Case-Control Study.

The purpose of this study was to investigate the association between migraine headache and concussion in athletes. Case-control observational study. A university-associated combined sports neurology and orthopedic sports medicine clinic. A total of 221 male (n = 140) and female (n = 81) athletes aged 12 to 24 years, including 115 concussion cases (52%) and 106 orthopedic controls (48%), were included in this study. Participants completed a one-page questionnaire that recorded their age, sex, reason for visit (concussion vs any other injury), concussion history, and self/immediate family member migraine headache history. The odds of having a previous history of migraine headache were compared in the concussion group versus orthopedic controls. Controlling for between-group differences in age and sex, there was a significant positive association between concussion group status and history of migraine headache [adjusted odds ratio (OR), 1.90; 95% confidence interval (CI), 1.03-3.50. P = 0.039]. However, when including a previous concussion history in the statistical model, this relationship failed to reach significance [adjusted OR, 1.68; 95% CI, 0.89-3.16. P = 0.107]. These results suggest that there is an association between migraine headache and concussion in athletes, but the cause-effect nature of this relationship cannot be determined. Migraine headache should be considered a modifying factor when caring for concussed athletes.