Related Concussion Research Articles

Differing clinical characteristics among individuals with concussions sustained at work, in motor vehicle collisions, and sport

ABSTRACT Purpose To compare clinical characteristics in patients with concussions sustained by prevalent, but understudied, mechanisms (work-related concussion [WRC] and motor vehicle collision [MVC]-related concussion) to sport-related concussion (SRC). Methods Retrospective review of 281 electronic medical records from an outpatient concussion clinic. Time since injury (days), duration of care (days), amount of care (number of visits), and perceived health (Short-Form 12) were collected. Results The time between injury and clinic presentation was significantly greater in WRC and MVC-related concussion compared to SRC. These groups were also older, had a longer duration of care, required more referrals for outside clinical services, and reported worse perceived mental and physical health versus SRC. Conclusion These results suggest that clinical courses may be significantly different for individuals with SRC, WRC and MVC-related concussion, and that different management approaches and expectations may be necessary for these groups. Further research is indicated.

Understanding underwriter uncertainty in rugby league related concussion

ABSTRACT Purpose/Rationale The purpose of this exploratory paper is to critically explore the liability underwriting landscape for insuring concussion risks in rugby league in the UK. Design/Methodology/Approach The authors approached this study using a qualitative methodology via exploratory expert interviews with four experienced liability underwriters and interpreted the data using thematic analysis. Findings The issues of causation and volatility are of immediate concern for underwriters causing systemic uncertainty. The inherent risk relating to the game of rugby league, physiology of participants and degenerative diseases such as CTE are identified as significant risk factors when evaluating concussion liability risks in rugby league. Practical Implications The findings of this study have implications for rugby league stakeholders including the RFL leadership, scientists, doctors, lawyers, insurance brokers and risk managers, to produce scientific data for the underwriting community to greater understand the concussion exposure. Research Contribution Sports concussion research concerning the liability insurance market is drastically underexplored. This study is at the beginning of researching this specific field. These novel findings provide insights to help explain the current state of underwriting concussion liability in rugby league. Originality/Value The authors understand that this study is the first to be conducted with underwriters regarding the issue of concussion in rugby league. It is important to change the direction of travel between underwriters and rugby league.

Early vestibular rehabilitation initiation is associated with faster recovery after sport related concussion

ObjectivesVestibular rehabilitation is a recommended treatment after sport related concussion (SRC), but the optimal timing is not fully understood. This research examined the association between the timing of vestibular rehabilitation initiation and recovery time in adolescent patients with SRC. DesignRetrospective cross-sectional. Methods112 patients with SRC were referred to vestibular rehabilitation at a specialty concussion clinic. Vestibular rehabilitation initiation was defined as days from date of injury to date of first vestibular rehabilitation assessment. Patients were dichotomized by vestibular rehabilitation initiation: EARLY (8–10 days) and LATE (>10 days). Recovery time was defined as days between injury and medical clearance from the clinic. Results60 (average age 15.22 ± 1.61 years; 51.7 % male) patients were in the EARLY group and 52 (average age 15.37 ± 1.31 years, 28.9 % male) patients were in the LATE group. There were more female patients in the LATE group (p = 0.01) and the LATE group had their first clinic visit later than the EARLY group (p < 0.02). The EARLY group had shorter recovery time (median 26, IQR [21, 32.5] days) compared to the LATE group (median 31, IQR [23.5, 52.5] days; p = 0.02). After controlling for confounding variables, the LATE group had recovery times that were 1.39 times as long as the EARLY group (p < 0.01). ConclusionsFor patients with vestibular issues after SRC, early vestibular rehabilitation initiation is associated with faster recovery time after SRC. The current study provides clarity on the optimal timing of vestibular rehabilitation after SRC.

A qualitative analysis of existing concussion return to play protocols and psychological recovery management in Gaelic games

Background Sports related concussions are a common injury in field-based contact sports including Gaelic games. Even though accurate data on concussion in Gaelic games is currently limited, it is well documented that concussion is a common injury in Gaelic sports. The purpose of this current research was to discern the psychological impact of concussion on Gaelic games athletes as in many instances, recovery from concussion focuses mainly on physical recovery. Methods A grounded theory methodology was used to explore the experiences of a cohort of adult male and female amateur and elite amateur Gaelic games athletes (n = 22) and their experiences involving psychological recovery post-concussion and eventual return to play. The data for this study were gathered through a series of individual semi-structured interviews. Results Two major themes were identified, (1) lack of psychological recovery management for concussion in Gaelic games athletes and, (2) non-standardised concussion protocols and concussion education within Gaelic games. These themes were further divided into categories and subcategories. Conclusion Recovery from concussion in Gaelic games is broadly a non-standardised process, whereby recovery processes are haphazard and lack enforcement. There are no directives or guidance for recognising the need for psychological recovery, or assistance to recover from concussion in the acute or chronic phases or for those with long term post-concussion syndrome.

Posttraumatic stress symptoms in recovery from concussion

ABSTRACT Background Previous literature suggests that lingering concussion symptoms may be influenced by psychological factors. The relationship of posttraumatic stress symptoms (PTSS) during recovery with pre-existing/injury related factors and concussion symptomology is not fully understood. Identification of factors contributing to symptoms of posttraumatic stress may provide guidance to improve treatment following concussion. Method This study included 287 participants (Male 40.42%, n = 116; Female 59.58%, n = 171) aged 13–75 years diagnosed with a recent concussion at one of the North Texas Concussion Registry (ConTex) specialty concussion clinic sites. Preinjury emotional history, injury related factors, and emotional state at time of initial evaluation were analyzed as predictors of post-traumatic stress symptoms (PCL-5) during recovery. Results Sixty-one percent of participants endorsed at least one PTSS. Correlations were found between initial Sport Concussion Assessment Tool 5Ⓡ (SCAT5) total emotional symptom severity and screening measures for anxiety (GAD-7; r = .453, p < .001) and depression (PHQ-8; r = .550, p < .001) symptom scores. Of the measures from the initial visit included in the multiple regression model predicting severity of PTSS at follow-up (R2 = 0.554, β < .001), three measures predicted PTSS severity: initial SCAT5 total emotional symptom severity (β = 0.565, p < .001), PHQ-8 score (β =.166, p = .009), and GAD-7 score (β = 0.119, p = .044). Conclusions Symptoms of anxiety and depression along with specific SCAT5 emotional symptoms present at the time of initial evaluation may serve to predict overall level of PTSS and increased risk for PTSS during recovery. PTSS may be another dimension of response to injury and concussion recovery, with a large percentage of individuals endorsing at least one PTSS. Clinicians can utilize brief assessments such as the SCAT5 at the time of initial clinical evaluation to identify those at risk for PTSS following concussion.

Advanced assessment approaches in sports related concussion

Advanced assessment approaches in sports related concussion

Retraction: Paediatric sport related concussion pilot study

Retraction: Paediatric sport related concussion pilot study

Framing racial disparities within sports related concussion (SRC): an ecological framework for understanding biases and disparities in concussion care for black athletes

Privilege and marginalization associated with racial background have been posited as contributors to why Black athletes face disparities within their care, treatment, and recovery from sport-related concussion (SRC). However, empirical findings have limited exploration on how disparate outcomes have emerged, and the interaction with systems of biases, power and disenfranchisement. To understand concussion care disparities, a qualitative content analysis was conducted in three phases: [I] identifying salient literature on racial differences for Black athletes with SRC (N = 29), [II] qualitative analysis of literature to determine salient topics, themes and patterns within the literature, and [III] constructing a novel ecological-systems framework that encapsulates the ‘why’ and ‘how’ related to psychosocial and sociocultural experiences of power, access, and biases for Black athletes. The content analysis yielded two patterns, where concussion care decisions are influenced by (1) biased, unconscious beliefs that posit Black athletes as uniquely invincible to injury and pain, and (2) inadequate access to concussion knowledge and resources, which both moderate SRC injury risk, diagnosis, recovery and outcomes. Ultimately, our novel framework provides a clear thread on how historical, macro-level policy and perceptions can impact micro-level clinical care and decision-making for Black athletes with SRC.

Categorizing Sports-Related Concussion Disparities by Key Domains of Social Determinants of Health.

To explore recently published data on disparities in concussion and best categorize these data into domains of social determinants of health (SDOH). Disparities in concussion cover a range of SDOH domains. Questions on disparities in concussion remain. Interventions to reduce these disparities and inequities are needed. Social determinants of health may play a significant role in disparities and inequities in sports related concussion. There is interplay and overlap in SDOH domains that affect concussion outcomes. It is possible that an increase in SDOH may affect concussion disparities by moderated mediation; however, further data is needed to validate this potential effect. Moreover, attention to SDOH domains in sports related concussion may provide insight on intervention targets to ameliorate disparities in sports related concussion.

The Effect of Ball Heading and Subclinical Concussion On the Neuromuscular Control Of The Lower Limb: A Systematic Review.

Soccer is unique among sports because it is the only sport that involves purposeful use of the head to control, pass, or shoot the ball. Over the previous five years, a relationship between lower extremity (LE) injury and sports related concussion (SRC) has been established in various sporting populations. Athletes at the high school, collegiate, and professional levels have demonstrated a greater risk for sustaining a LE injury post SRC. The purpose of this systematic review was to examine the relationship of the SRC with the incidence of LE injuries. Ten databases were searched with the following keywords: Lower limb, ball heading, neuromuscular control, concussion, MEDLINE, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R), EMBASE, and Scopus. The search was limited to English-language and peer-reviewed publications, until 15/12/2022. The PEDro scale was used for the assessment of the risk of bias among the included studies. All included papers were qualitatively analyzed. A total of 834 studies were identified and 10 articles (four concussion-MSK biomechanics, six concussion-MSK injury) were included in the qualitative analyses. Included papers ranged from low to high quality. Due to the heterogeneous nature of the included study designs, quantitative meta-analysis was unable to be performed. All four of the included concussion-MSK biomechanics studies demonstrated, to some degree, that worse cognitive performance was associated with lower extremity MSK biomechanical patterns suggestive of greater risk for MSK injury. Among the six injury related studies, two investigations failed to determine group differences in cognitive performance between subsequently injured and non-injured athletes. More research is needed to better understand the relationship of SRC and lower extremity injuries and the extent to which they are related to concussions and/or repetitive neurotrauma after ball heading sustained in soccer. 2.

Return to Sports Following Sports-Related Concussion in Collision Sports: An Expert Consensus Statement Using the Modified Delphi Technique

The purpose of this study was to perform a Delphi consensus for return to sports (RTS) following sports related concussion (SRC). Open-ended questions in rounds 1 and 2 were answered. The results of the first two rounds were used to develop a Likert style questionnaire for round 3. If agreement at round 3 was <80% for an item, if panel members were outside consensus or there were >30% neither agree/disagree responses, the results were carried forward into round 4. The level of agreement and consensus was defined as 90%. Individualized graduated RTS protocols should be used. A normal clinical, ocular and balance examination with no more headaches and asymptomatic exertional test allows RTS. Earlier RTS can be considered if athletes are symptom free. SCAT5 and VOMS are recognized as useful tools to assist in decision making. Ultimately RTS is a clinical decision. Baseline assessments should be performed at both collegiate and professional level and a combination of neurocognitive and clinical tests should be used. A specific number of recurrent concussions for season - or career ending decisions could not be determined but will affect decision making for RTS. Consensus was achieved for 10 of the 25 RTS criteria: early RTS can be considered earlier than 48-72 hours if athletes are completely symptom-free with no headaches, a normal clinical, ocular and balance examination. A graduated RTS should be utilized but should be individualized. Only two of the nine assessment tools were considered to be useful: SCAT5 and VOMS. RTS is mainly a clinical decision. Only 31% of the baseline assessment items achieved consensus: baseline assessments should be performed at collegiate and professional levels using a combination of neurocognitive and clinical tests. The panel disagreed on the number of recurrent concussions that should be season- or career ending.

Paper 61: NCAA Football Players are at Higher Risk of Upper Extremity Injury After Concussion

Objectives: Sport related concussion has been repeatedly demonstrated to increase the risk of subsequent lower extremity injury in athletes. The current literature suggests that, for multiple years after a concussion, athletes are at increased risk of lower extremity injury. However, we are unaware of any studies that have demonstrated an increase in risk for upper extremity injuries after sport related concussion. The purpose of this study was to investigate a change in the risk of upper extremity injuries for NCAA football players after return to play from a sport related concussion. Methods: The Sports Injury Research Archive (SIRA) of a single NCAA athletic conference was queried for de-identified injury data on concussions and upper extremity injuries. All football players diagnosed with a concussion and recorded in the database were identified between 2017-2021. Athletes were excluded if their concussion was not sport related, if they had multiple concussions, or if they did not return to previous activity level in their respective sport. Each concussed athlete was then retrospectively followed for the year prior to their concussion as well as for one year after their concussion, beginning at 3 months after the date of their concussion. If the athlete was known to have not returned to play within 3 months they were excluded from the study. All upper extremity injuries were identified in the year prior to concussion and for the previously described year after the concussion. The mean number of concussions per athlete were identified in the pre-concussion and post-concussion groups. The odds ratio, 95% confidence interval, and statistical significance between groups were calculated using Microsoft Excel. Results: After exclusions, 230 de-identified football players from a single conference were identified with concussions from the 2017 through 2021 NCAA football seasons. In these athletes there were a total of 60 upper extremity injuries in the year preceding concussion and a total of 111 in the year they were followed after concussion. The mean number of upper extremity injuries per athlete in the year prior to concussion was 0.26, and in the post-concussion athletes was 0.48. The odds of upper extremity injury in the post-concussion year were 1.85 times higher than in the pre-concussion year (OR = 1.85, 95% CI 1.29 – 2.66, p &lt; 0.001). Conclusions: The data collected in this study demonstrates that collegiate football players are at higher risk of upper extremity injury after concussion. Multiple studies have shown an increased risk of lower extremity injury in athletes after sport related concussion. This study is the first to demonstrate an increased risk of injury specifically in the upper extremities after concussion. The explanation for why these athletes’ injury risk changes after concussion is still not fully understood. Prior research has shown that athletes have alterations in their balance, gait, and landing biomechanics after concussion, which could possibly be causative in upper extremity injuries. Various studies have investigated changes in the coupling between perception and reaction amongst athletes after head injury and have theorized these changes as potential causes of the increase in injury risk. Another consideration is simply that athletes may change the way they approach their sport after sustaining a concussion. Further research on the topic should aim at characterizing the types of injuries that portend the largest increase in risk, exploring different sports, and investigating the magnitude of the risk at longer post-concussion time points. Delineating a clear explanation for why athletes have increased risk of injury after concussion is worthy of future research.

A-61 Exploring The Role Of Acculturation In The Development Of Post-Concussive Symptoms In Minority College Athletes

Abstract Purpose This review explored the role acculturative stress may have in the development of post-concussive symptoms of minority college athletes. Data Selection The data was collected via scientific journals accessed library databases, google scholar, and PubMed. Criteria for the selection included: published since the year 2011, focus on college students, studies that were parsimonious and examined post-concussive symptoms, acculturation, and sports related concussions. Guidelines for abstracting data included comparing study abstract to text to confirm accuracy, and being aware of bias by selecting relevant research and interpreting results based on context and available evidence. Nine (N=9) studies were reviewed. Results The results showed that college athletes are at higher risk for developing PCS if they had experienced multiple concussions, pre-morbid mood disorders, and/or if they were experiencing co-morbid psychosocial stressors. Concerning acculturation among college students, the literature suggests that acculturative stress puts this population at an increased risk for the development of mood disorders like depression. Conclusions There may be a relationship between acculturation and the development of post-concussive symptoms in college students but more studies should be conducted that test the direct relationship.

Cognitive Deficits Following Concussion: A Systematic Review

Context In the U.S., approximately 1.6 to 3.8 million concussions occur yearly as a result of sports. Athletes are especially at risk of sustaining cognitive deficits as a result of a concussion. These can manifest as impairments of attention, verbal and visual memory, visual perception, and executive function. Objective The purpose of this study was to examine cognitive deficits following sport-related concussions in the acute, intermediate, and long-term time period after initial head trauma. Data Sources A systematic review of the literature was performed according to PRISMA guidelines using the PubMed, Psychinfo, and Web of Science databases. Study Selection Search terms included sports-related concussion, traumatic brain injury (TBI), and cognitive impairments. Studies were excluded if they measured non-cognitive deficits or had subjective results. Participant characteristics such as average age, gender, and athletic status were also included from all articles. Study Design Systematic Review. Level of Evidence Level 4. Data Extraction Studies were included if they met the following criteria: explicit time points following injury, focus on cognitive deficits, and injuries were not self-diagnosed. Results Twenty-six studies, with a total of 4,534 patients, were included. Ten of twenty-six (38.4%) studies were separated into control groups versus concussed groups, while nine of twenty-six (34.6%) compared baseline scores to post-injury scores. In the included studies, cognitive deficits were seen across all of the domains in all three time periods following an initial concussion. Conclusion A sports related concussion could result in cognitive deficits in the domains of visual memory, verbal memory, processing speed, executive function, and reaction time. Additionally, athletes typically experience cognitive deficits for only days to weeks following a sports related concussion, but symptoms can continue for months or years following the injury, depending on severity. These conclusions should be taken into consideration when determining inidivudalized return-to-play protocol for each athlete.

Epidemiological analysis of pediatric baseball and softball concussions in United States emergency departments

PurposeTo evaluate the epidemiology of concussions in pediatric baseball and softball players. We hypothesized that head-to-ball injuries would be the most common cause of concussions. MethodsThe National Electronic Injury Surveillance System (NEISS) database was used to gather data. Concussions occurring during baseball and softball participation in pediatric patients (4–17 years old) from 2012 to 2021 was gathered. Concussion mechanisms were grouped into 5 categories: head-to-player, head-to-ball, head-to-surface (ground, walls, railings), head-to-bat, and unknown. Linear regression models were used to assess changes in yearly concussion rates over the study period. Results from these models were reported using parameter estimates and the estimated Pearson correlation coefficient. ResultsA weighted total of 54,978 baseball and softball related concussion injuries were analyzed. The average weighted age of our cohort at the time of injury was 13.1 years, with 54.1% (n = 29,761) of concussions occurring in males. The national estimated incidence of concussion injuries decreased non-significantly over the study period (slope estimate = −311 concussions/year, r = −0.625, p-value = 0.054). The majority of weighted national estimate concussions were due to head-to-ball injuries (n = 34,650; 63.0%), followed by head-to-player (n = 8501; 15.5%), head-to-surface (n = 5347; 9.7%), and head-to-bat (n = 5089; 9.3%). On sub-analysis, individuals were grouped into 3 age brackets: 4–8, 9–13, and 14–17 years. The most common mechanism of concussions in children of all ages was head-to-ball. The incidence of head-to-player and head-to-surface injuries increased throughout each age group, while head-to-bat decreased. ConclusionThe incidence of concussions in pediatric baseball and softball athletes has been decreasing non-significantly over our 10-year study period. The most common mechanism of concussions in our study was head-to-ball injuries.

Concussions in young adult athletes: No effect on cerebral white matter.

The media's recent focus on possible negative health outcomes following sports- related concussion has increased awareness as well as anxiety among parents and athletes. However, the literature on concussion outcomes is equivocal and limited by a variety of diagnostic approaches. The current study used a rigorous, open- access concussion identification method-the Ohio State University Traumatic Brain Injury Identification method (OSU TBI-ID) to identify concussion and periods of repeated, subclinical head trauma in 108 young adult athletes who also underwent a comprehensive protocol of cognitive tests, mood/anxiety questionnaires, and high-angular-resolution diffusion-weighted brain imaging to evaluate potential changes in white matter microstructure. Analyses showed that athletes with a history of repetitive, subclinical impacts to the head performed slightly worse on a measure of inhibitory impulse control and had more anxiety symptoms compared to those who never sustained any type of head injury but were otherwise the same as athletes with no history of concussion. Importantly, there were no group differences in cerebral white matter as measured by tract- based spatial statistics (TBSS), nor were there any associations between OSU TBI-ID measures and whole-brain principal scalars and free-water corrected scalars. Our results provide support for the hypothesis that it is not concussion per se, but repetitive head impacts that beget worse outcomes.

Epidemiological analysis of concussions in youth ice hockey players: A national emergency department database study

PurposeTo evaluate the epidemiology of concussions in youth ice hockey players. MethodsThe National Electronic Injury Surveillance System (NEISS) database was used to gather data. Concussions occurring during ice hockey participation in youth patients (4–21 years old) from 2012 to 2021 was gathered. Concussion mechanisms were grouped into 7 categories: head-to-player, head-to-puck, head-to-ice, head-to-board/glass, head-to-stick, head-to-goal post, and unknown. Hospitalization rates were also tabulated. Linear regression models were used to assess changes in yearly concussion and hospitalization rates over the study period. Results from these models were reported using parameter estimates [with 95% confidence intervals (CI)] and the estimated Pearson correlation coefficient. Additionally, logistic regression was used to model the risk of hospitalization across the different cause categories. ResultsA total of 819 ice hockey related concussions were analyzed between 2012 and 2021. The average age of our cohort was 13.4 years, with 89.3% (n = 731) of concussions occurring in males. The incidence of head-to-ice, head-to-board/glass, head-to-player, and head-to-puck concussion mechanisms decreased significantly over the study period (slope estimate = −2.1 concussions/year [CI: (−3.9, −0.2)], r = −0.675, p = 0.032), (slope estimate = −2.7 concussions/year [CI: (−4.3, −1.2)], r = −0.816, p = 0.004), (slope estimate = −2.2 concussions/year [CI: (−3.4, −1.0)], r = −0.832, p = 0.003), and (slope estimate = −0.4 concussions/year [CI: (−0.62, −0.09)], r = −0.768, p = 0.016), respectively. Majority of patients were discharged from the emergency department (ED) to their home, as only 20 people (2.4%) were hospitalized over our study period. The majority of concussions were due to head-to-ice (n = 285, 34.8%), followed by head-to-board/glass (n = 217, 26.5%) and head-to-player (n = 207, 25.3%). The most common cause for hospitalizations due to concussions was head-to-board/glass (n = 7, 35%), followed by head-to-player (n = 6, 30%) and head-to-ice (n = 5, 25%). ConclusionThe most common mechanism of youth ice hockey concussions was head-to-ice in our 10-year study period, while head-to-board/glass was the most common cause of hospitalizations. IRBThis project did not require review by the institutional review board.

Sports-Related Concussions and Adverse Health Behaviors Among Middle and High School Students

Background: Concussions affect millions of youths in the United States each year, and there is concern about long-term health effects from this injury. Purpose: To examine the association between sports- or physical activity–related concussion and health risk behaviors among middle and high school students in 9 states. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Data from the 2019 middle school and high school Youth Risk Behavior Survey were used for this analysis. Nine states were identified that included the same question on concussion and similar questions on health risk behaviors in their 2019 Youth Risk Behavior Survey. Students were asked to self-report whether they had ≥1 sports- or physical activity–related concussions during the 12 months preceding the survey. Self-reported concussion was the primary outcome of interest. Other variables included sex, race/ethnicity, played on a sports team, were physically active 5 or more days/week, ever tried cigarette smoking, ever used an electronic vapor product, academic grades, drank alcohol, were in a physical fight, seriously considered attempting suicide, made a suicide plan, and attempted suicide. Results: Among the 9 states, 18.2% of middle school students and 14.3% of high school students self-reported ≥1 sports- or physical activity–related concussions. Among both middle school and high school students, the prevalence of ≥1 sports- or physical activity–related concussions was higher among students who played on a sports team, were physically active 5 or more days per week, had ever tried cigarette smoking, had ever used an electronic vapor product, had seriously considered attempting suicide, had made a suicide plan, and had attempted suicide compared with those who had not engaged in those behaviors. The prevalence of sports- or physical activity–related concussion was consistently higher among middle school students than high school students across sex, race/ethnicity, and adverse health behaviors. Conclusion: Middle school students with a history of concussion warrant attention as an at-risk population for concussions and adverse health behaviors. Health care providers may consider screening students for adverse health behaviors during preparticipation examinations and concussion evaluations.

Diagnostic tools for return-to-play decisions in sports-related concussion

Research has improved the understanding of sports related concussion (SRC), and several classification systems and guidelines are available in the literature. The exact timing and clearing of athletes for return-to-play (RTP) is still based primarily on subjective reports of concussion symptoms, however symptoms link poorly to objective recovery. Current literature suggest that symptoms alone cannot accurately identify either all concussed athletes or their recovery. The difficult task of interpreting which symptoms are directly related to concussion, and which are related to other conditions, speaks for an increased focus on the RTP process itself. This study examines the literature on neurocognitive assessments and their importance as indicators of accurate timing of when athletes can return to either ball training with duels or the playing field. Entries in three electronic databases (PubMed, Web of Science, and SURF) were searched from January 2000 to June 2022. Search terms were concussion, mild traumatic brain injury (mTBI), sport, athlete, expert, elite, professional, diagnostic, testing, return to play, management, neurocognitive, and cognitive. Inclusion criteria comprised performance-based participation in a team sport and being in the age range of possible peak performance (18–40 years). In addition, only studies with pre-post designs were considered. The PEDro scale was used to assess methodological quality. The methodological quality of the fifteen included studies ranged from 5 (one study) to 6 (fourteen studies) from a maximum of 10. Despite being symptom-free, athletes in all fifteen studies showed lower performance compared to controls on tests of visual and verbal memory (approx. 3–5% deficit) and on processing speed (approx. 6% deficit) after mTBI. All studies report specific neurocognitive deficits after mTBI, although the athletes were declared clinically symptom-free. Therefore, the systematic consideration of neurocognitive parameters in RTP decision making is recommended, especially in light of subsequent muscular injuries of the lower musculoskeletal system, recurrence of mTBI, and residual neurodegenerative disorders.

Inversion position testing in concussed athletes

Context No prior study has examined inversion position testing in individuals who have experienced sports related concussions. Objective To investigate whether the inversion position testing (IPT) would un-mask symptoms in asymptomatic concussed collegiate athletes during the return to play progression assessment. Design Case-Control Study. Setting Athletic Training Room. Participants One hundred and thirty-nine collegiate student athletes were randomly recruited from 12 different sports belonging to National Collegiate Athletic Association Division I Conference. Main outcome measure(s) A baseline concussion symptom questionnaire was administered. Of the 139, 122 participants without any of the suspicious symptoms related to concussions were examined using the Concussion Symptom Inventory (CSI) in connection with IPT. Also, the 18 concussed athletes underwent the IPT when any symptom subsided. Results Eighteen of the 122 (16.2%) non-concussed athletes showed some post-IPT symptoms, while 5 of 12 (41.7%) concussed athletes showed some post-IPT symptoms in the baseline test. For the latter, neither the interaction ( P = 0.08) nor difference in the total CSI score was observed either from pre- to post-IPT ( P = 0.14) or between the baseline and post-concussion ( P = 0.96). Conclusion This study demonstrated that symptoms could be exacerbated by the IPT in concussed athletes even when their original symptoms had subsided prior to the testing. The IPT exacerbated post-concussive symptoms may depend on a number of days required for post-concussive symptoms to subside. The innovative instrument of IPT may prove effective in clarifying the degree to which post-concussive symptoms have subsided. Key words Concussion, College athletes, Inversion position, Symptoms.