Self-reported Concussion History Research Articles

Measurement implications on the association between self-reported concussion history and depression: An NFL-LONG study

ObjectiveThis study examined how associations of self-reported concussion history and depression vary based on different variable characterizations. Methods Former NFL players (n = 1,697) completed a General Health Survey, indicating the number of concussions they sustained during their football career and whether a physician had diagnosed them with depression, and the PROMIS 4-item Depression scale. Self-reported concussion history was characterized as: a 3-category variable (0, 1–2, 3+) with (1) indicator variables and (2) as an ordinal variable; a 5-category variable (0, 1–2, 3–5, 6–9, 10+) with (3) indicator variables and (4) as an ordinal variable; and (5) the original interval scale (0, 1, 2,…, 10, 10+). Depression was characterized as: (1) physician diagnosis (yes/no); and the PROMIS 4-item Depression scale treated as: (2) the original T-score variable and (3) using a cut-off of a T-score >60 versus ≤60. Regression models with various combinations of the characterizations, while adjusting for age, race/ethnicity, education, pain interference, and stress level, estimated prevalence ratios and mean differences for binary and continuous outcomes, respectively. Concussion history-related effect estimates were compared across all models. Results Self-reported concussion history emerged as a significant predictor of each depression measure. With a higher number of concussions reported, be it via the categories or the interval scale, stronger associations between self-reported concussion history and depression were observed. Conclusions The various approaches to characterize self-reported concussion history and depression provided evidence of significant associations between the two variables, with the degree of association varying based on characterization of each construct.

The stability of self-reported professional football concussion history among former players: A longitudinal NFL-LONG study

ABSTRACT Objectives To examine the stability of former National Football League (NFL) players’ recall of professional football concussion. Methods Two-hundred-and-nine former NFL players (ceasing football participation before/in 2001) completed surveys in 2001, 2010, and 2019 and reported the number of concussions sustained during their professional careers (0, 1 … 10, >10). Participants were categorized into four ‘recall stability’ groups, based upon concussion recall [e.g., ‘Same’ (same number recalled), ‘Increased’ (more recalled than in prior time point)]. In 2019, participants completed measures of functioning (e.g., PROMIS Cognitive Function, Anxiety, Depression). Fleiss Kappa and generalized linear mixed models (GLMM)-based ordinal measures Kappa assessed stability across time points. ‘Recall stability group’ functioning scores were compared. Results Overall, 45.9% recalled more concussions over time; 14.8% reported the same number. Fleiss Kappa and GLMM-based ordinal measures Kappa suggested fair (0.22, 95% CI: 0.26, 0.38) and moderate stability (0.41, 95% CI: 0.35, 0.46), respectively. Higher cognitive functioning (P = 0.002), lower anxiety (P = 0.003), and lower depression (P = 0.007) were observed in the ‘Same’ vs ‘Increased’ groups. Conclusions Despite subtle time-based variations in reporting, professional football concussion history recall was relatively stable. Better cognitive and psychological functioning was associated with greater stability in concussion recall.

Investigating the association between subjective and objective performance-based cognitive function among former collegiate football players

Objective Studies have observed variable associations of prior contact sport participation with subjective and objective measures of cognitive function. This study directly investigated the association between subjective self-report and objective performance-based cognition among former collegiate football players, as well as its relationship to self-reported concussion history. Methods Former collegiate football players (N = 57; mean age = 37.9 years [SD = 1.49]) retired from sport 15-years prior were enrolled. Linear regression models examined associations between subjective cognition (Quality of Life in Neurological Disorders Cognitive Functioning-Short Form), and performance on a neuropsychological battery. Domain specific (executive function) metrics of subjective (Behavior Rating Inventory of Executive Function-Adult) and objective cognition were also exclusively examined. Associations between self-reported concussion history with subjective and objective measures were tested. Potential influential factors (sleep quality and distress) were included as covariates. Results Subjective cognition was not significantly associated with any objective measures of cognitive functioning (p’s > .05). Greater self-reported concussion history was inversely associated with subjective cognition (B = −2.49, p = .004), but not objective performance-based cognition (p’s > .05). Distress was significantly related to all metrics of subjective cognition (p’s < .001) as well as performance on delayed recall and verbal fluency (p’s < .05). Sleep quality was only significantly related to timed visuospatial sequencing (p = .033). Conclusions Reliance on self-reported measures of cognitive functioning alone is insufficient when assessing cognition in former contact sport athletes. Assessment of other factors known to influence subjective cognitive complaints should also be examined in determining the presence of cognitive deficits.

Agreement between parent reported and child self-reported sport-related concussion history: A brief report

This cross sectional investigation measured the agreement between parent report of their 8–14 year old child’s sport-related concussion (SRC) history and their child’s self-report of their own SRC history. Parent–child dyads (n = 405) within a youth contact sports (e.g., football, ice hockey, lacrosse, soccer) setting participated in the study. Parents (6.2%) and 8.6% of children self-reported a history of at least one diagnosed SRC. We observed substantial agreement between the number of parent-reported and child self-reported SRCs (κ = 0.613, p ≤ .001). Partial agreement regarding the number of SRCs reported by both groups was also substantial (weighted κ = 0.693, p ≤ .001). Removing dyads where neither the parent nor the child reported a diagnosed SRC, sensitivity analyses revealed only fair agreement in parent–child SRC recall. These results indicate that parents and youth athletes overall accounts of their diagnosed SRC history correspond. However determining specifics (e.g., total concussion counts) may benefit from concurrent parent reports, or documented events in medical histories.

Concussion Nondisclosure in Youth Sports.

Researchers conducting studies about sport-related concussion (SRC) reporting behaviors and reasons for nondisclosure primarily focus on older athletic populations. Youth athletes participating in contact sports are also at risk for SRC; however, little is known about their SRC disclosure patterns and reasons for nondisclosure. To examine the self-reported SRC history and reasons for SRC nondisclosure of youth athletes aged 8-14 years. Cross-sectional study. Youth athletes in organized football, ice hockey, lacrosse, or soccer. A total of 411 youth athletes (boys = 70.0% [n = 287/410]; median age = 11 [interquartile range = 10-13] years). A 15-minute survey including self-reported demographics, diagnosed and nondisclosed SRC history, and reasons for nondisclosure of suspected SRCs. Ten percent of respondents (n = 41/411) recounted ≥1 diagnosed SRC, 12.7% (n = 52/411) did not report a suspected SRC, 13.1% (n = 53/404) indicated they continued to practice, and 12.3% (n = 50/406) reported they continued to play in a game after a suspected SRC. Significant associations between sport and nondisclosure existed (P values < .001) but not with self-reported concussion history (P = .14). In sex-comparable analyses, boys' lacrosse players had a higher frequency of nondisclosure than girls (P = .05). The most common reasons for nondisclosure were not wanting to lose playing time (66.7%, n = 32/48), miss a game (56.3%, n = 27/48), and let the team down (43.8%, n = 21/48) and uncertainty over injury severity and the presence of SRC (43.8%, n = 21/48). Ten percent of youth athletes self-reported at least 1 diagnosed SRC. However, they also described continuing to practice or play in a game after a suspected SRC. Reasons for nondisclosure at this age were similar to those reported in high school and collegiate athletes. Recent researchers suggested negative consequences of continued play with SRC, especially in the acute stages. Anyone conducting future educational initiatives should emphasize these risks and focus on reasons why athletes of both sexes withhold reporting.

Epidemiological Characteristics of Sport-Related Concussion in Athletes of Brazilian Jiu-Jitsu and Muay Thai

To evaluate the self-reported history of concussion in athletes of both Brazilian Jiu-Jitsu (BJJ) and Muay Thai. Combat sports are widely practiced around the world. They include modalities that involves punches or kicks directed at the opponent's head (Striking sports) or that consists of grabbing an opponent and taking him to the ground (Grappling sports). Due to the objectives and close contact in combat sports, the risk of concussion is significant. This was a cross-sectional study involving a Brazilian sample of BJJ athletes (n-18) and Muay Thai athletes (n-22). The sample was consisted of both professional and amateur athletes (Women constituted 20% of sample). Through individual interviews with a researcher the following data were collected: self-report of concussion and the moment of the injury (whether in practice or in the fight). The Post-Concussion Symptoms Scale (PCSS) was also applied. In the present study, a concussion was considered as a direct impact on the head followed by symptoms. This study was approved by a local Ethics Committee. Among BJJ athletes, 61% reported a history of concussion, while among Muay Thai athletes the percentage was more higher (86%). The main mechanisms of head impact were the throw/takedown and elbow-hits to the head in BJJ and punches and knee-hits to the head in Muay Thai. There was no difference in the symptom score between BJJ and Muay Thai concussed athletes (average of 11 vs 10.7, respectively). The most common symptoms were dizziness, headache and nausea in BJJ athletes, and headache, nausea, drowsiness and brain fogginess in Muay Thai ones. The results presented herein suggest that concussions in Muay Thai and BJJ occur through different mechanisms. The clinical profile of post-concussion symptoms appears to be different between BJJ and Muay Thai athletes.

Subjective Concerns Regarding the Effects of Sport-Related Concussion on Long-Term Brain Health among Former NFL Players: An NFL-LONG Study.

Potential links between a history of sport-related concussions and later-life neurobiological and psychological brain health have been studied in former collision-sport athletes. However, empirical studies of how former athletes perceive the future of their brain health as a result of these injuries are missing. We aimed to (1) identify the extent to which former National Football League players currently have concerns about their long-term psychological and cognitive functioning as a result of concussions sustained while playing football; (2) examine whether current concerns are different than concerns they had while playing football; (3) examine the relationship between current brain health concerns and self-reported concussion history (SR-CHx); and (4) explore other important factors associated with these concerns. In this cross-sectional study, former National Football League players with a SR-CHx of one or more concussions (n = 1514; aged mean [standard deviation] = 52.3 [15.7] years) completed a general health questionnaire. Participants reported their lifetime concussion history, as well as both their current concerns and concerns while playing football (i.e., retrospective concerns) regarding the long-term effects of concussions on their memory, thinking skills, and risk of developing chronic traumatic encephalopathy. Current and retrospective concerns were self-reported on a five-point Likert scale. Four concussion history categories were created based on SR-CHx: 1-2 (n = 309); 3-5 (n = 413); 6-9 (n = 356); and 10 + (n = 436) lifetime concussions. Proportions of participants reporting each level of current and retrospective concerns were examined to identify whether concerns presently exist in these former players, and whether their current concerns are different than retrospective concerns. Next, we explored associations between current concerns and SR-CHx. More than one-third of participants reported being currently "extremely concerned" about memory problems (36.9%), thinking skills (37.8%), and developing chronic traumatic encephalopathy (39.5%). In contrast, when asked about concerns while playing, most reported being "not at all concerned" regarding memory = 61.2%, thinking skills = 56.1%, and developing chronic traumatic encephalopathy = 71.2%. Of those who retrospectively endorsed being "not at all" or "slightly" concerned regarding memory (n = 1159/1514), thinking skills (n = 1080/1514), and developing chronic traumatic encephalopathy (n = 1219/1514), approximately half reported being currently "moderately" or "extremely" concerned about those same issues (n = 586/1159; n = 534/1080; n = 619/1219, respectively). Current concerns regarding memory (χ216 = 316.61; p < 0.001; V = 0.264), thinking skills (χ216 = 333.17; p < 0.001; V = 0.271), and developing chronic traumatic encephalopathy (χ216 = 280.85; p < 0.001; V = 0.249) were significantly related to SR-CHx, with more concussions being associated with greater current concerns. Former National Football League players reported significant concerns regarding the potential effects of their prior concussions on long-term brain health, and these concerns are more prevalent now than when they were playing football. Cognitive and mental health concerns are readily identifiable targets for clinical intervention. Clinicians working with former players may wish to explore the extent to which individual players experience these concerns, the nature and depth of these concerns, and the impact of these concerns on the player's functioning and well-being.

Concussion among female athletes in Iceland: Stress, depression, anxiety, and quality of life

The objective of the study was to examine the relationship between self-reported concussion history and stress, depression, anxiety, and quality of life among Icelandic female athletes. Participants were 508 Icelandic female athletes, aged 18–45 (M = 26.99, SD = 7.14), that had, or were currently training and competing in the two top leagues in basketball, soccer, and handball, in the top league in ice-hockey and national tournaments in mixed martial arts, taekwondo, karate, and boxing. Participants completed an online questionnaire regarding their age, sport, and concussion history before answering standard mental health scales concerning stress (PSS), depression (PHQ-9), anxiety (GAD-7), and quality of life (QOLS). Female athletes reporting a history of concussions scored higher on PSS, PHQ-9, and GAD-7 than those reporting no history of concussion. Scores on the QOLS were not significantly different between the groups. Female athletes that had sustained a concussion were 3.48 to 4.85 times more likely (depending on the number of concussions) to score above the clinical cut-off on PHQ-9 than those that had not sustained a concussion. Athletes that reported 2–3 or ≥ 4 concussions were 3.52 and 3.40 times more likely to score above the clinical cut-off on GAD-7, respectively. Results indicate that Icelandic female athletes with a history of concussion report more symptoms of distress than those with no history of concussion, and the higher number of concussions sustained, the worse they feel.

Gait Assessment in College Athletes: Do Concussion History, Symptoms, Gender, and Type of Sport Matter?

Though previous research has focused on examining the effects of concussion history using a dual-task paradigm, the influence of factors like symptoms (unrelated to concussion), gender, and type of sport on gait in college athletes is unknown. To examine the effect of concussion history, symptoms, gender, and type of sport (noncontact/limited contact/contact) individually on gait among college athletes. Exploratory cross-sectional study. Laboratory. In total, 98 varsity athletes (age, 18.3 [1.0]y; height, 1.79 [0.11]m; mass, 77.5 [19.2]kg; 27 with concussion history, 58 reported at least one symptom, 44 females; 8 played noncontact sports and 71 played contact sports) walked under single- and dual-task (walking while counting backward by 7) conditions. Not applicable. Dual-task cost (DTC; % difference between single task and dual task) of gait speed, cadence, step length and width, percentage of swing and double-support phases, symptom score, and total symptom severity score. Independent samples t tests and 1-way analysis of variance were conducted (α value = .05). Self-reported concussion history resulted in no significant differences (P > .05). Those who reported symptoms at testing time showed significantly greater DTC of step length (mean difference [MD], 2.7%; 95% confidence interval [CI], 0.3% to 5.1%; P = .012), % of swing phase (MD, 1.0%; 95% CI, -0.2 to 2.1%; P = .042), and % of double-support phase (MD, 3.9%; 95% CI, 0.2% to 7.8%; P = .019). Females demonstrated significantly higher DTC of gait speed (MD, 5.3%; 95% CI, 1.3% to 9.3%; P = .005), cadence (MD, 4.0%; 95% CI, 1.4% to 6.5%; P = .002), % of swing phase (MD, 1.2%; 95% CI, 0.1% to 2.3%; P = .019), and % of double-support phase (MD, 4.1%; 95% CI, 0.4% to 7.9%; P = .018). Noncontact sports athletes had significantly greater step width DTC than contact sports athletes (MD, 14.2%; 95% CI, 0.9% to 27.6%; P = .032). Reporting symptoms at testing time may influence gait under dual-task conditions. Additionally, female athletes showed more gait changes during a dual task. Sports medicine professionals should be aware that these variables, while unrelated to injury, may affect an athlete's gait upon analysis.

Cortical Volumes Did Not Associate With Mental Health Symptoms In Special Operations Forces Service Members

Military service may lead to mental health consequences including depression, anxiety, and posttraumatic stress. Studies have identified associations among negative mental health symptoms and brain structure, including in the ventromedial prefrontal cortex (vmPFC). PURPOSE: To associate vmPFC volume with mental health symptoms. METHODS: Participants were 212 Special Operations Forces (SOF) combat Service Members (SMs) (age = 32.2 ± 3.7 years). Most SOF SMs were beginning their SOF career (n = 132, 62.3%), and a large minority had served for multiple years (n = 80, 37.7%). The SOF SMs self-reported concussion history [yes = 93 (50.3%); no = 92 (49.7%); 27 did not disclose]. They also reported mental health symptoms [depression (BSI-18 depression subscale), anxiety (GAD-7), posttraumatic stress (PCL-5), subjective well-being (MHC)] at a clinical research center via an online platform. Neuroimaging was collected at a biomedical research imaging center. The vmPFC volume was measured using 3.0-Tesla MRI scanners (Siemens MAGNETOM Prisma and Siemens Biograph mMR). Whole-brain T1-weighted 3D anatomical images (voxel size = 1.0 mm3, TR = 2300 ms, TE = 2.98 ms), acquired with magnetization-prepared rapid gradient echo were processed with FreeSurfer 7.1.0 cortical reconstruction and segmentation. All mental health outcome variables were skewed and discrete. Therefore, Poisson regression models were fit while controlling for total intracranial volume and concussion history. Statistical significance threshold was set at α = 0.05. RESULTS: Only 185 SMs had all data elements and were included in our analyses. The vmPFC volume did not significantly predict variance in depressive (χ2(1) = 0.39, p = 0.53), anxiety (χ2(1) = 1.50, p = 0.22), posttraumatic stress (χ2(1) = 0.95, p = 0.33), or well-being (χ2(1) = 0.62, p = 0.43) symptoms. CONCLUSION: Previous findings linking vmPFC volume to mental health symptoms were not replicated in our SOF SMs. Mental health symptom variance was not explained by anatomic volume in a brain region key in emotion and social processing. It is possible that potential adverse effects of prolonged military service may result in a different relationship between these factors and outcomes. Funded by US Special Operations Command

A Higher Playing Standard, Bowling, and Intermittent Helmet Use Are Related to a Greater Odds of Injury or Concussion in Cricket.

To determine if playing position, a higher playing standard, and nonhelmet use are related to an increased odds of joint-specific injury and concussion in cricket. Cross-sectional cohort. Twenty-eight thousand one hundred fifty-two current or former recreational and high-performance cricketers registered on a national database were invited to participate in the Cricket Health and Wellbeing Study. Eligibility requirements were aged ≥18 years and played ≥1 cricket season. Main playing position (bowler/batter/all-rounder), playing standard (high-performance/recreational), and helmet use (always/most of the time/occasionally/never). Cross-sectional questionnaire data included cricket-related injury (hip/groin, knee, ankle, shoulder, hand, back) resulting in ≥4 weeks of reduced exercise and self-reported concussion history. Crude and adjusted (adjusted for seasons played) odds ratios and 95% confidence interval (CIs) were estimated using logistic regression. Of 2294 participants (59% current cricketers; 97% male; age 52 ± 15 years; played 29 ± 15 seasons; 62% recreational cricketers), 47% reported cricket-related injury and 10% reported concussion. Bowlers had greater odds of hip/groin [odds ratio (95% CI), 1.9 (1.0-3.3)], knee [2.0 (1.4-2.8)], shoulder [2.9 (1.8-4.5)], and back [2.8 (1.7-4.4)] injury compared with batters. High-performance cricketers had greater odds of injury and concussion than recreational cricketers. Wearing a helmet most of the time [2.0 (1.4-3.0)] or occasionally [1.8 (1.3-2.6)] was related to higher odds of self-reported concussion compared with never wearing a helmet. Concussion rates were similar in cricketers who always and never wore a helmet. A higher playing standard and bowling (compared with batting) were associated with greater odds of injury. Wearing a helmet occasionally or most of the time was associated with higher odds of self-reported concussion compared with never wearing a helmet.

Individual Baseline Balance Assessments in a Large Sample of Incoming NCAA Division I Athletes Using a Force Plate System

BACKGROUNDIndividualized baseline testing is resource and time intensive. The use of normative data to approximate changes after a suspected concussion is thus an appealing alternative. Yet, few peer-reviewed, large-sample studies are available from which to develop accurate normative averages of balance using force-plate technology.PURPOSEThis study sought to validate a normative dataset from the force-plate manufacturer and examine the magnitude and nature of sample variability.STUDY DESIGNCross-sectional.METHODSBaseline balance and self-reported sex, sport, and concussion history were assessed in 533 prospective collegiate athletes (45% female) during pre-participation physical examinations. Balance was measured using four stances from the modified Clinical Test of Sensory Interaction and Balance and quantified as Sway Index Scores with the Biodex Biosway Portable Balance System. Group averages are contrasted to data from the force-plate manufacturer. Individual variability around these averages was visualized and analyzed by sex and sport.RESULTSMale student athletes showed significantly more sway in the eyes open, soft stance condition than female athletes. These differences were maintained when concussion history was included as a covariate. Athletes, particularly male athletes, in the high versus low contact sport group showed significantly more sway in the eyes open, soft surface and the eyes closed, hard and soft surface stances.CONCLUSIONThere was substantial individual variability that was partially explained by sex differences and sport differences. The development of normative averages for sway may benefit from consideration of sex and sport. Further studies should characterize other factors that influence baseline balance in collegiate athletes.LEVEL OF EVIDENCE2b

Distinct latent profiles based on neurobehavioural, physical and psychosocial functioning of former National Football League (NFL) players: an NFL-LONG Study

ObjectiveTo identify subgroups of former National Football League (NFL) players using latent profile analysis (LPA) and examine their associations with total years of participation (TYP) and self-reported lifetime sport-related concussion...

Health-promoting behaviours and concussion history are associated with cognitive function, mood-related symptoms and emotional–behavioural dyscontrol in former NFL players: an NFL-LONG Study

ObjectivesTo examine the relationships among self-reported sport-related concussion (SRC) history and current health-promoting behaviours (exercise frequency, diet quality and sleep duration) with self-reported measures of brain health (cognitive function, symptoms...

Is the incidence of depressive disorders increased following cerebral concussion?

EVIDENCE-BASED ANSWER: Yes, in some populations. Youth and adolescents with self-reported history of concussion had increased risk of depressive disorders (strength of recommendation [SOR]: B, based on a prospective cohort study and a retrospective cohort study). Evidence was inconsistent for college athletes. Athletes with ≥ 3 concussions exhibited more depressive disorders, but no association was observed for those with 1 or 2 concussions compared to nonconcussion injuries (SOR: B, based on a cross-sectional study, a small prospective cohort study, and a case-­control study).

Athlete concussion history recall is underestimated: a validation study of self-reported concussion history among current professional rugby union players

ABSTRACT Objective: To assess the concurrent validity and test re-test reliability of the Michigan Traumatic Brain Injury Identification Method (MTBIIM). The psychometric properties of this concussion index were investigated by comparing the agreement between player self-reported diagnosed concussions and medical record diagnosed concussions among professional rugby union players. Study Design: Cross-sectional study i) validation and ii) test re-test reliability. Methods: The MTBIIM was administered via a structured interview to obtain the number and nature of player self-reported concussion histories from players, while contracted to the host club. Self-reported concussion history information was compared to medically recorded data captured between 2008 and 2017. A mixed-effects logistic regression model explored predictors of player self-report accuracy. Results: Data from 62 players (25.39[4.36] years) included 99 unique rugby related concussions. Medically documented concussions (n = 92) per player (1.48 [1.96]) were 30% more than the mean number of self-reported diagnosed (n = 63) concussions per player (1.02 [1.21] events). Overall, self-reported diagnosed concussions and medical record diagnosed concussion histories had a ‘fair’ level of agreement (k=0.274; SE [0.076]), p=.001). Self-reported lifetime concussion history was signicantly negatively correlated with recall of concussions. Conclusions: Initial concurrent validity of the MTBIIM was found to be fair with the average athlete under-reporting the number of clinically diagnosed concussions.

Self-reported history of concussions is associated with risk factors for suicide completion among middle school students: A cross-sectional study

PurposeThis study aims to examine the relationship between self-reported history of concussion and risk factors for completed suicide among middle school students. MethodsWe analyzed state-level data from the 2017 YRBS. The study sample was n = 19,254 middle school students in 7 States: Delaware, Florida, Hawaii, Kentucky, Nevada, Rhode Island, and Virginia. We conducted multi-level, multivariate logistic regression models to assess the relationship between self-reported concussions and suicidal ideations, planned suicide attempt, and past suicide attempt. ResultsApproximately 17.8% of the sample self-reported a history of concussion. Self-reported history of concussion was significantly associated with greater odds for history of suicidal ideation (Adj OR: 1.31), planned suicide attempt (Adj OR: 1.36), and past suicide attempt (Adj OR: 1.67). ConclusionsThis is the first study to examine the relationship between self-reported concussion and risk factor for completed suicide among middle school students. Research findings mirror similar study done among high school students and young adults. Findings suggest the need to expand prevention programs, intervention strategies and education campaigns to include middle school students.

Evaluating Multiple Domains of Health in High School Athletes With Sport-Related Concussion.

Concussions are shown to hinder multiple health dimensions, including health-related quality of life (HRQOL), suggesting a need for a whole-person approach to assessment and treatment. Patient-reported outcome measures are one method to gather the patient's perspective regarding their HRQOL. To evaluate perceived HRQOL using the Patient-Reported Outcomes Measurement Information System Pediatric-25 subscale in patients throughout concussion recovery. Prospective cohort, descriptive survey. There were 9 high school athletic training facilities. A total of 70 patients with diagnosed concussions (51 males, 7 females, 12 unreported; age = 15.7 [0.9]y, height = 174.6 [8.4]cm, mass = 72.8 [14.8]kg, grade = 10.0 [0.9] level). Patient-Reported Outcomes Measurement Information System Pediatric-25 was administered at 3 days, 10 days postconcussion, and return to play (RTP). Patient-Reported Outcomes Measurement Information System Pediatric-25 subscale T scores and self-reported concussion history (yes/no). A total of 70 patients completed the study. For the Pediatric-25 subscales, the severity of problems associated with Physical Function Mobility, Anxiety, Depression, Fatigue, and Pain Interference were highest 3 days postconcussion, decreasing at 10 days and RTP (all p < .05). No differences were found between days 3 and 10 for Peer Relationship scores, but improvements were identified at RTP (p < .05). Pediatric-25 subscale scores at the 3 measurements were not statistically associated with concussion history (all p > .05). Ceiling and floor effects were present in all subscales throughout each timepoint, except for Physical Function Mobility (14.7%), and pain interference (11.8%) at day 3 postinjury. Patients who had suffered a concussion improved from day 3 through RTP on multiple health domains as demonstrated through the Pediatric-25 subscales. These findings highlight the need for health care professionals to serially monitor HRQOL and social factors that may affect the patient postconcussion as part of a multifactorial assessment. Ceiling effects in high functioning adolescent athletes were present; thus, efforts should be made to identify appropriate scales for use in managing recovery in athletic populations.

Self-reported concussion history among Icelandic female athletes with and without a definition of concussion

Objective This study examined whether Icelandic female athletes in contact sports, based their self-reported concussion history on adequate medical definitions, by assessing self-reported concussion history with and without a definition of concussion. Another aim was to examine whether currently active athletes were more knowledgeable of concussions than retired athletes. Methods Participants (age = 26.9, SD = 7.1) were 508 former (34.5%) and current (65.5%) elite female athletes in soccer (41%), handball (30.6%), basketball (19.1%), ice hockey (4.5%) and combat sports (4.7%). An online questionnaire (QuestionPro) was distributed to females in contact sports (snowball sampling). Participants later came for an in-person interview where the authenticity of previous responses was confirmed. In the questionnaire, participants answered background questions and questions about concussion history. First, they reported the total number of sustained concussions without a prompt. They reported the number of sustained concussions again after reading a definition of concussion. Participants could not correct their previous answers. Pearson’s Chi-square was used for group comparisons. Results The prevalence of reported concussions increased from 40.2% to 64.8% following a definition. There was no significant difference in how many participants changed their answer when asked about sustaining SRCs before and after reading the definition based on whether the participants were still competitive or retired X 2(1) = 0.69, p = 0.41. Conclusions Our data suggest that understanding of concussions is inadequate among female athletes. Self-report will continue to be an essential source of clinical information and prompting with a definition can increase the reliability of self-reported concussions.

Neurovascular Coupling in Special Operations Forces Combat Soldiers.

The purpose of this study was to investigate how concussion history affects neurovascular coupling in Special Operations Forces (SOF) combat Soldiers. We studied 100 SOF combat Soldiers [age = 33.5 ± 4.3 years; height = 180.4 ± 6.0 cm; 55 (55.0%) with self-reported concussion history]. We employed transcranial Doppler (TCD) ultrasound to assess neurovascular coupling (NVC) via changes in posterior cerebral artery (PCA) velocity in response to a reading and a visual search task. Baseline TCD data were collected for 2 min. NVC was quantified by the percent change in overall PCA response curves. We employed linear mixed effect models using a linear spline with one knot to assess group differences in percent change observed in the PCA velocity response curves between SOF combat Soldiers with and without a concussion history. Baseline PCA velocity did not significantly differ (t98 = 1.28, p = 0.20) between those with and without concussion history. Relative PCA velocity response curves did not differ between those with and without a concussion history during the reading task (F1,98 = 0.80, p = 0.37) or the visual search task (F1,98 = 0.52, p = 0.47). When assessing only SOF combat Soldiers with a concussion history, differential response to task was significantly greater in those with 3 or more concussions (F1,4341 = 27.24, p < 0.0001) relative to those with 1-2 concussions. Despite no main effect of concussion history on neurovascular coupling response in SOF combat Soldiers, we observed a dose-response based on lifetime concussion incidence. While long-term neurophysiological effects associated with head impact and blast-related injury are currently unknown, assessing NVC response may provide further insight into cerebrovascular function and overall physiological health.