Sport-related Concussion Research Articles

Personality and social determinants of health predict adolescent comfort and honesty reporting sports-related concussion symptoms.

Proper diagnosis is essential in mitigating risk associated with sports-related concussion (SRC); however, 50% of SRCs remain undiagnosed due to unreported symptoms. The current study aimed to identify the most clinically-relevant, attainable personality and social determinants of health variables that are associated with honesty and comfortability reporting symptoms in 317 adolescents (Mage = 17.8, SD = 0.97, female = 55.0%, white racial identity = 81.4%). Three variables emerged as significantly associated with symptom disclosure outcomes. Openness to experience was positively associated with comfort and honesty in symptom disclosure, while impulsivity and pressure to continue playing were negatively associated with these outcomes. Importantly, increased pressure to continue playing was the most salient factor associated with symptom disclosure. These results underscore the importance of considering these specific variables when tailoring SRC intervention and prevention efforts at the individual, environmental, and systemic levels.

Social Demographic and Clinical Predictors of Time to Clinic Presentation After a Sport-Related Concussion.

To investigate the associations between clinical risk factors, social demographic and time to concussion clinic presentation after sports-related concussion in young athletes. Retrospective cohort study. Multidisciplinary regional concussion center. Athletes ages 12 to 18 years who sustained a SRC from November 2017 to April 2022. Independent variables included social demographic factors (ie, race, ethnicity, public vs private school, public vs private insurance), patient medical history, family medical history, acute concussion characteristics, and initial presentation elsewhere. Descriptive statistics were employed to assess for group differences. Mann-Whitney U tests, Spearman rank order correlations, and linear regressions were performed to explore associations between each independent variable and the main outcome, days to concussion clinic presentation. A total of 945 athletes we included (age 15.8 ± 1.61, 33.7% female). Hispanic/Latino background, (P = 0.009), public insurance status (U = 47 377.0, P = 0.002), amnesia (U = 57 738.0, P = 0.002) at time of injury, family psychiatric (U = 35 091.0, P < 0.001) or migraine (U = 59 594.5, P < 0.001) histories, and personal psychiatric (U = 30 798.0, P = 0.004) or migraine (U = 34 133.5, P = 0.011) histories were associated with longer time to concussion clinic presentation. A multivariable linear regression found that initial presentation elsewhere (β = 0.37, P < 0.001), family migraine history (β = 0.18, P < 0.001), public insurance status (β = 0.09, P = 0.024), and history of learning disability (β = 0.09, P = 0.032) were the only predictors of longer time to concussion clinic presentation. Variables that predicted longer time to concussion clinic presentation included initial presentation elsewhere, public insurance status, positive family migraine history, and history of learning disability. Further research is needed to elucidate these findings and determine how they impact concussion seeking behavior.

Improvement in Persistent Post-Concussive Symptoms After Treatment with Neuromodulation: A Case Study

AbstractUp to 30% of youth with concussion experience persistent post-concussive symptoms (PPCS) impacting cognitive, social, mental, and physical health. Limited evidence-based therapies exist to treat PPCS. We present a case of an adolescent female with multiple sports-related concussions with persistent symptoms, including headache, nausea, dizziness, brain fog, and anxiety. After 4 weeks of treatment with an auricular percutaneous electrical nerve field stimulation (PENFS) device, she had near-complete resolution of her symptoms, allowing a return to her previous level of academic achievement, as well as physical activity. Emerging evidence suggests that various forms of neuromodulation, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), can benefit patients with post-concussive symptoms. This adolescent female’s improvement with PENFS contributes to this expanding field.

Injury Characteristics and Risk Factors of Sport-Related Concussion Among High School Athletes in School-Sponsored Sports.

Over a million sport-related concussions (SRC) affect children annually in the United States, posing a significant public health concern. Limited data exist on the premorbid risk factors and injury characteristics of SRCs in high school athletes. This study aims to understand acute SRC injury characteristics and describe premorbid risk factors in high school athletes. Athletes (aged 14-19 years) from 19 central Illinois high schools participating in school-sponsored sports from 2009 to 2023 were included. Sports Concussion Assessment Tool evaluations were performed as part of preseason and postinjury evaluations. Injury characteristics, such as mechanism, setting, and symptoms, were described using all SRCs in the study period. Odds ratios (OR) were computed to determine risk factors using athletes with a baseline Sports Concussion Assessment Tool before SRC and nonconcussed athletes. In total, 4360 athletes were included (3953 without SRC; 407 with ≥1 SRC of whom 168 had a previous baseline). Overall, 24.2% of SRCs occurred in female athletes, and most SRCs occurred in competitions while playing American football (52.3%), soccer (20.4%), and basketball (7.6%). Blow/hit to the head was the most common mechanism. Headache was the most severe symptom (2.55 ± 1.51 [SD]), and symptoms of emotionality and nervousness/anxiety were significantly more severe in female athletes (P < .05). Students with previous concussions (OR 2.64 95% CI [1.81, 3.78]), previous hospitalization for head injury (OR 3.19 95% CI [1.9, 5.14]), headache/migraine disorders (OR 2.23 95% CI [1.29, 3.66]), and learning disabilities (OR 2.69 95% CI [1.47, 4.61]) had greater odds of SRC (P < .05). Lower odds of SRC were seen in athletes identifying as Black or African American (vs White) (OR 0.54 95% CI [0.32, 0.86]) and those attending larger (vs smaller) schools (OR 0.64 95% CI [0.46, 0.88]). Understanding SRC risk factors and characteristics in high school athletes is critical for developing prevention and management programs, guiding neurosurgeons in mitigating SRC risk, and informing return-to-play decisions.

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.

Attention-Deficit/Hyperactivity Disorder (ADHD) as a Predictor of Prolonged Functional Recovery from Sports-Related Concussion in High School Athletes.

Attention-Deficit/Hyperactivity Disorder (ADHD) has been speculated to prolong concussion recovery; however, the evidence regarding concussion recovery for individuals with ADHD is limited. To examine the concussion recovery time based on ADHD status, sex, and age. Cross-Sectional Study. High school. 935 (female n=382, 40.1%) concussions including 78 (female n=13, 20.0%) self-identified ADHD data were analyzed. A Poisson regression was utilized to estimate the Return- to-Learn (RTL) and Return-to-Sport (RTS) recovery outcomes with three predicting variables: ADHD status, sex, and age. The mean RTL days of the ADHD and non-ADHD groups were 12.86 ± 10.89 (Median 11.0; IQR=8; 7.0-15.25) and 1.43 ± 8.39 (Median 9.0; IQR=9.0; 6.0-14.0), respectively. The mean RTS days of the ADHD and non-ADHD groups were 20.82 ± 15.25 days (Median 17.0; IQR=9; 12.0-21.0) and 18.03 ± 11.42 days (Median 15.0; IQR=10.0; 11.0-21.0), respectively. For RTL, the ADHD status (RR=1.16, 95%CI:1.08, 1.24, p<.001) and female sex (RR=1.13, 95%CI: 1.08, 1.17, p<.001) were significant variables for longer recovery, while the age was not (RR=0.995, 95%CI: 0.98, 1.01, p=.056). For RTS, the ADHD status (RR=1.17, 95%CI:1.12,1.23, p<.001), female sex (RR=1.07, 95%CI:1.04, 1.11, p<.001), and younger age (RR=0.98, 95%CI:0.96, 0.99, p<.001) were all significant variables for longer recovery. Healthcare providers must be aware of the elevated risk of prolonged concussion recovery among high school athletes with ADHD.

Sports-Related Concussion Among Physically Active Adolescents in the Southeastern United States: Effects on Mental Health During the Pandemic.

Sports-related concussions (SRC) pose risks to young people's physical and mental health. During the COVID-19 pandemic, we studied linkages between youths' SRC experiences and internalizing problems (depression, self-harm, and suicidality) among a representative sample in Southeastern state (n = 4,668 total, n = 547 reported SRC experience). Logistic regressions indicated significant associations between youths' SRC experiences and depression (AOR = 1.32, p < .05), suicidality (e.g., attempted suicide AOR = 2.68, p < .001), and self-harm (AOR = 1.97, p < .001) while controlling for being bullied or teased, gender, age, race, and COVID-19's mental health impact. Contrary to prior findings: (1) SRC associations with self-harm and suicide attempts were consistent across genders; and (2) African American students with SRC were significantly more likely to experience depression, self-harm, suicide planning, and attempts than peers without SRC. Results indicated mental health resilience post-concussion for Latinx youth. Implications advocate population-specific health promotion measures that address vulnerabilities and protective factors while emphasizing SRC education for parents, coaches, and young athletes for timely psychological evaluation and support.

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.

Transient Increases in Alpha Power Relative to Healthy Reference Ranges in Awake Piglets After Repeated Rapid Head Rotations

Background/Objectives: Sports-related concussions are a main cause of cognitive dysfunction and somatic complaints, particularly in youth. While the majority of concussion symptoms resolve within one week, cognitive effects may persist. In this study, we sought to study changes to cognition within this acute time frame. Methods: In this current study, we use an established swine model of traumatic brain injury (TBI) to study the effects of single and repeated head rotations on resting-state electroencephalography (rs-EEG) in awake piglets in the acute (within 7 days) time period after injury. We studied both healthy and experimental groups to (1) establish healthy reference ranges (RRs; N = 23) for one-minute rs-EEG in awake piglets, (2) compare the effects of single (N = 12) and repeated head rotations (N = 13) on rs-EEG, and (3) examine the acute time course (pre-injury and days 1, 4, and 7 post-injury) in animals administered single and repeated head rotations. EEG data were Fourier transformed, and total (1–30 Hz) and relative power in the alpha (8–12 Hz), beta (16.5–25 Hz), delta (1–4 Hz), and theta (4–7.5 Hz) bands were analyzed. Results: Total power and relative alpha, beta, delta, and theta power were consistent measures across days in healthy animals. We found a significant and transient increase in relative alpha power after repeated injury on day 1 in all regions and a rise above the healthy RR in the frontal and left temporal regions. Conclusions: Future studies will expand the study duration to investigate and inform clinical prognoses from acute measurements of rs-EEG.

Impact of moderate aerobic exercise on small-world topology and characteristics of brain networks after sport-related concussion: an exploratory study

Sport-related concussion (SRC) is a complex brain injury. By applying graph-theoretical analysis to networks derived from neuroimaging techniques, studies have shown that despite an overall retention of small-world topology, changes in small-world properties occur after brain injury. Less is known about how exercise during athletes’ return to sport (RTS) influences these brain network properties. Therefore, in the present study dense electroencephalography (EEG) datasets were collected pre- and post-moderate aerobic exercise. Small-world properties of whole brain (WB) and the default mode network (DMN) were extracted from the EEG datasets of 21 concussed athletes and 21 healthy matched controls. More specifically, path length (LP), clustering coefficient (CP), and small-world index (SWI) in binary and weighted graphs were calculated in the alpha frequency band (7–13 Hz). Pre-exercise, SRC athletes had higher DMN-CP values compared to controls, while post-exercise SRC athletes had higher WB-LP compared to controls. Weighted WB analysis revealed a significant association between SRC and the absence of small-world topology (SWI ≤ 1) post-exercise. This explorative study provides preliminary evidence that moderate aerobic exercise during athletes’ RTS induces an altered network response. Furthermore, this altered response may be related to the clinical characteristics of the SRC athlete.

Determinants of symptom presentation and resolution following concussions in high school sports

ABSTRACT Sport-related concussions (SRCs) are prevalent in high school (HS) sports, though the determinants of, and relationships between concussion symptoms in this population remain relatively unknown. We analysed SRC data captured within the HS RIO injury surveillance system during 2014/15-2018/19. We used Generalized Estimating Equations to simultaneously assess covariate predictors of symptom presentations and identify pairwise symptom associations and employed multivariable ordinal logistic regressions to determine symptom resolution time (SRT) predictors. Among the 8,969 concussions assessed, headaches (94.3%) and dizziness (73.3%) were the most prevalently reported symptoms. In 5,953 boys’ concussion assessed, class year, event type and injury mechanism emerged as determinants of various concussion symptoms, while in 3,016 girls’ concussions assessed, class year, event type, injury mechanism, and sport type emerged as significant symptom determinants. In both groups, difficulty concentrating, sensitivity to light, sensitivity to noise, and disorientation were symptoms with the strongest associations with other symptoms. Odds of longer SRT were higher with greater endorsement (i.e. counts) of the subset of symptoms with strongest cross-domain associations (ORadj. = 1.35; 95% CI = [1.30, 1.40]). Our findings provide valuable information for informing sideline and follow-up clinical concussion assessment algorithms in high school athletes.

Sport-Related Injury and Performance Enhancing Substance Use by Young Athletes.

Legal performance enhancing substance (PES) use is increasing in young athletes and may lead to banned PES use. This study examines legal PES use and consideration of banned PES use in young athletes with a season-ending injury (SEI) compared to young athletes with non-SEI/no previous injury. Young athletes sustaining SEI or concussions have increased odds of reporting legal PES use and consideration of banned PES use compared with non-SEI or no injury. Cross-sectional study. Level 4. Cross-sectional study from 2013 to 2020 of athletes aged 6 to 25 years. No association was found between reporting legal PES use or consideration of banned PES use and young athletes with SEI or concussion compared with no injury/non-SEI. 14% of athletes reported legal PES use and 3% reported consideration of banned PES use. In adjusted analysis, athletes who were male (odds ratio [OR], 1.38; 95% CI, 1.16-1.73; P = 0.03), have history of depression (OR, 3.01; 95% CI, 1.26-7.18; P = 0.01), weight train (OR, 1.66; 95% CI, 1.04-2.65; P = 0.03), and believe that athletic ability is influenced by weight (OR, 1.75; 95% CI, 1.08-2.83; P = 0.02) had increased odds of reporting legal PES use. Older (OR, 1.18; 95% CI, 1.03-1.36; P = 0.02) and male (OR, 1.57; 95% CI, 1.02-1.81; P < 0.04) athletes had increased odds of consideration of banned PES use. This study found no increased odds of reported PES use in young athletes with sports-related injury or concussion regardless of injury type or severity. Factors associated with PES use were male sex, age, history of depression, weight training, and belief that weight affects athletic performance. Risk factors associated with PES use in young athletes are essentially unknown. This study can inform pertinent clinical care, education, and policy implementation.

Microstructural Alterations of Gray and White Matter in Active Young Boxers with Sports-Related Concussions.

The existing research on the microstructural alterations associated with sport-related concussions (SRCs) has primarily focused on deep white matter (DWM) fibers, while the impact of SRCs on the superficial white matter (SWM) and gray matter (GM) remains unknown. This study aimed to characterize the altered metrics obtained from neurite orientation dispersion and density imaging (NODDI) in boxers with SRCs, and thereby determine whether distinct regional patterns of microstructural alterations can offer valuable insights for accurate diagnosis and prognosis. Concussed boxers (n = 56) and healthy controls (HCs) with typically developing (n = 72) underwent comprehensive neuropsychological assessment and magnetic resonance imaging (MRI) examinations. The tract-based spatial statistics approach was used to investigate alterations in the DWM and SWM, while the gray matter-based spatial statistics approach was used to examine changes in the GM. The median time from the last SRC to MRI in the SRC group was 33.5 days (interquartile range, 45.25). In comparison with HCs, the SRC group exhibited lower fractional anisotropy (FA), neurite density index (NDI), and isotropic volume fraction (ISOVF), as well as higher mean diffusivity, axial diffusivity (AD), and radial diffusivity in both the DWM and SWM. Moreover, the SRC group exhibited lower FA, NDI, orientation dispersion index, and ISOVF in the GM, as well as higher AD. The altered microstructure of both gray and white matter was found to be associated with deficits in working memory and vocabulary memory among boxers. In addition to characterizing the DWM impairment, NODDI further elucidated the effects of SRCs on the microstructure of GM and SWM, offering a reliable imaging biomarker for SRC diagnosis and shedding light on the pathophysiological changes underlying SRCs.

Initial Symptom Severity and Recovery of Sport-Related Concussion in Team Versus Individual Sport Athletes.

Recovery after sport-related concussion is variable, and potential differences between team vs individual sport athletes are not fully understood. In a cohort of athletes with concussions, we sought to compare these groups across (1) symptom severity score, (2) individual symptom cluster scores, and (3) recovery metrics. A retrospective, cohort study of 13 to 23-year-old athletes treated at a regional sport concussion center between November 2017 and April 2022 was conducted. Athletes were categorized into team vs individual sport athletes, with additional classification of individual sports based on strong vs minimal team elements (ie, the degree of interdependence displayed by athletes). The primary outcomes were symptom severity score, measured by either the Sport Concussion Assessment Tool-5th Edition or the Immediate Post-Concussion Assessment and Cognitive Testing, and physical, cognitive, emotional, and sleep symptom cluster scores. Secondary outcomes were recovery metrics, including time to return-to-learn, symptom resolution, and return-to-play. Of the 1051 athletes, 954 (90.8%) were in team sports and 97 (9.2%) in individual sports. In multivariable linear regression, individual sport athletes had higher emotional symptom severity compared with team sport athletes (β = 0.09 [0.01, 0.17], P = .034) when adjusting for sex, attention-deficit/hyperactivity disorder, psychological disorders, time to clinic, on-field evaluation, and Immediate Post-Concussion Assessment and Cognitive Testing vs Sport Concussion Assessment Tool-5th Edition scale. There were no significant differences in return-to-learn (P = .104), symptom resolution (P = .941), or return-to-play (P = .279) on univariate regressions. In the current single-center, pilot study of athletes with a sport-related concussion, individual sport athletes exhibited more emotional symptoms than team sport athletes. These preliminary data lend early support that individual sport athletes may be more at risk of emotional symptoms than team sport athletes after a sport-related concussion. Clinicians may use these findings to identify athletes who may be particularly vulnerable to emotional symptoms.

Mechanisms and Trends in Women's Lacrosse Head and Musculoskeletal Injuries: A 15-Year Review of National Injury Data.

Head injury rates in lacrosse may be higher among women compared with men. Understanding these trends can guide appropriate injury prevention for female athletes. Injuries most commonly involve the head, with no significant decline over the study period; contact with other players would be the most common injury mechanism. Descriptive epidemiological. Level 3. The National Electronic Injury Surveillance System (NEISS) was queried (January 1, 2008 to December 31, 2022) for women's lacrosse injuries presenting to United States (US) emergency departments (EDs). Patient demographics, injury diagnosis, body part injured, disposition, and clinical narrative were extracted. The provided narrative identified the mechanism of injury. Linear regression analysis assessed trends over time. An estimated 57,635 women's lacrosse injuries occurred during the study period extrapolated from 1899 evaluated NEISS cases. The mean age was 15.81 ± 5.35 years, with 68.3% of injuries sustained by high school (14- to 18-year-old) players. Over one-third of all injuries were to the head (national estimate [NE], 19,358; 33.6%), followed by the ankle (NE, 10,475; 18.2%), then the knee (NE, 6969; 12.1%). Strain/sprains were most common (NE, 19,402; 33.7%) followed by closed head injury (CHI)/sports-related concussion (SRC) (NE, 11,794; 20.5%) and contusion/abrasion (NE, 10,605; 18.4%). ED presentations of CHIs/SRCs and fractures remained elevated with no significant decline over the study period (P > 0.05), despite a significant decrease in strains/sprains and contusions/abrasions (P < 0.01 and P = 0.01, respectively). The most common injury mechanism was collision/contact with another player (NE, 10,664; 18.5%). An estimated one-third of women's lacrosse players in the study sample had a head injury. CHIs and SRCs accounted for 20.5% of all injuries. Given the high proportion of contact-related head injuries, headgear mandates and improved player safety protocols may be warranted.

Concussion Incidence by Type of Sport: Differences by Sex, Age Groups, Type of Session, and Level of Play An Overview of Systematic Reviews With Meta-analysis.

OBJECTIVES: To (1) summarize pooled prevalence and incidence rates of concussion by type of sport and (2) synthesize the differences in prevalence or incidence rates of concussion by type of sports in terms of sex, age, type of session, and level of competition. DESIGN: An overview of systematic reviews with meta-analysis. LITERATURE SEARCH: CINAHL, Embase, Epistemonikos, PubMed, Scopus, SPORTDiscus, and the Cochrane Library databases were searched. STUDY SELECTION CRITERIA: Systematic reviews with meta-analyses reporting pooled incidence or prevalence of sport-related concussion. DATA SYNTHESIS: AMSTAR 2 was used to assess the methodological quality of reviews. Overlap between reviews was calculated. RESULTS: Ten systematic reviews with meta-analysis were included, all evaluating incidence rates of concussion. There were no meta-analyses of concussion prevalence. Concussions seem to have a higher incidence in rugby, snowboarding, ice hockey, and American football. In reviews that explored sex-based differences across subgroups, there was a higher incidence rate of concussion in baseball-softball, basketball, and soccer in females compared to males. There were no age subgroups analyzed. The incidence of concussions was higher during games compared to practice in American football, ice hockey, rugby, and soccer. Amateur rugby had higher concussion rates compared to professional rugby. CONCLUSIONS: Rugby, snowboarding, ice hockey, and American football had the highest incidence rate of concussion when no other differences (eg, type of session) were considered. However, important methodological flaws were detected, such as the lack of use of the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system and subgroups for specific factors (eg, age groups). J Orthop Sports Phys Ther 2024;54(11):1-9. Epub 15 October 2024. doi:10.2519/jospt.2024.12677.

Quality of Life in Adolescent Athletes With Sport-Related Concussion Prescribed Heart Rate-Targeted Aerobic Exercise Within 10 Days of Injury.

Individualized aerobic exercise treatment prescribed within 10 days of injury facilitates recovery in adolescents after sport-related concussion (SRC) and reduces incidence of persisting post-concussive symptoms (PPCSs) beyond 4 weeks. The effect of aerobic exercise treatment on quality of life symptoms is, however, unknown. This planned secondary aim of a published randomized controlled trial found that while adolescents prescribed aerobic exercise recovered faster, there was no difference on the Pediatric Quality of Life (PedsQL) questionnaire scores during the 4-week intervention period. Nevertheless, adolescents who experienced PPCS reported significantly worse initial visit (within 10 days of injury) symptoms on the PedsQL than those who recovered within 4 weeks. Higher scores on the PedsQL correlated with greater initial visit concussion symptom burden and more abnormalities on a concussion-relevant visio-vestibular examination. Thus, the PedsQL captures the clinical severity of concussion and is prognostic of risk for delayed recovery when administered early after SRC in adolescents.

Experiences of a controlled early exercise intervention following a sport-related concussion: A qualitative study of rugby union student-athletes

BackgroundEarly aerobic exercise is associated with improved outcomes following recovery from sport-related concussion (SRC) and is now recommended in guidance for clinicians managing athletes return-to-play. ObjectivesTo explore student-athlete experiences of a novel early aerobic exercise intervention. DesignQualitative study using semi-structured interviews. SettingLoughborough University, UK. ParticipantsTen rugby union university aged student-athletes (6 men) that had been medically diagnosed with an SRC sustained playing rugby. ResultsThree themes divided into eight supporting subthemes were generated. Main findings were: 1) Experience: despite some apprehension over the novel approach, most had a positive experience, 2) Adherence: Participants suggested reasonably good overall adherence to the prescribed exercises but intrinsic and extrinsic factors for non-adherence were identified, 3) Outcomes: the intervention was perceived to help rehabilitation, improve confidence, support retention of athletic identity and, for some, influenced more cautious attitudes toward brain health. ConclusionsThe novel early exercise intervention was reasonably well received and adhered to. Unintended benefits included supporting retainment of athletic identity and encouraging precautious health behaviours. As early exercise protocols are refined, these findings will help inform the design and delivery of future interventions, particularly in relation to intensity and diversity of exercises and supporting education.

Missing School Days Following Sport-Related Concussion in High School Athletes

Sport-related concussions (SRC) can significantly impact students' attendance and academic performance, highlighting the importance of gradual return-to-learn protocols for recovery. Understanding the association between missed school days and recovery, especially across genders, is vital for effective concussion management in high school athletes. To describe missed school days in high school athletes with SRC and to determine associations between missed school days and authorized clearance to return to competition; secondarily, to determine whether school days missed differed by gender. Cohort study among student athletes participating in athletics sponsored by the Michigan High School Athletic Association (MHSAA) during academic years 2015 to 2023. SRC was a participant eligibility criterion and was defined as a head injury during participation in a MHSAA-sanctioned event. Data were analyzed from August 2015 to June 2023. Primary exposure was missed school days; additional exposures included gender, year of season, concussion history, event type, sport level, contact level, and athletic trainer involvement. The primary outcome was time to full unrestricted clearance following SRC. The analysis included a total of 20 934 individuals with SRC (13 869 boys [66.25%]). Gender (χ23 = 167.40; P < .001), season (χ221 = 57.41; P < .001), event type (χ23 = 99.29; P < .001), sport level (χ29 = 68.15; P < .001), contact level (χ26 = 56.73; P < .001), and initial evaluation (χ23 = 147.13; P < .001) were independently associated with missed school days. Athletes took a median (IQR) of 11 (7-16) days to return to full unrestricted clearance. Relative to no missed school days, there was a significant mean increase of 57% (incidence rate ratio, 1.57; 95% CI, 1.52-1.62) in time to full unrestricted clearance for 3 or more missed school days. The estimated mean days to return to sport were 12.15 (95% CI, 12.00-12.30) for 0 missed school days, 12.68 (95% CI, 12.39-12.96) for 1 missed school day, 15.47 (95% CI, 15.06-15.87) for 2 missed school days, and 19.08 (95% CI, 18.55-19.62) for 3 or more missed school days. This cohort study found that high school athletes typically missed 2 or fewer school days after SRC, suggesting that concussion management teams adhered to current recommendations of 24 to 48 hours of initial rest. The dose association, with more missed school days associated with slower return to play, suggests athletes' missing more school days (eg, ≥3) may be associated with severity of concussion and warrant additional support to return to school and/or sport.

The Adolescent Patient Perspective on Activity Limitations After Sport-Related Concussion.

Assessment of sport-related concussion (SRC) has begun to include patient-reported outcome measures. However, understanding of which health limitations are most meaningful to adolescents after SRC is limited. To explore patient-perceived activity limitations after SRC and throughout recovery to return to play and mapped according to the International Classification of Functioning, Disability, and Health (ICF) model. Longitudinal study. Secondary school athletic training facilities. Fifty patients (41 males, 5 females, 4 sex not reported, age = 14.9 ± 3.5 years, grade = 10.2 ± 0.93 level) with a medically diagnosed SRC. The Patient Specific-Functional Scale (PSFS) was used to assess changes in the patient's condition and the effect the injury posed on their ability to perform activities. The PSFS is a self-reported assessment of health used to identify activity limitations and rate the difficulty of performing those tasks. The PSFS was administered to patients on days 3 (D3) and 10 (D10) after SRC and at return to play. Activities affected by injury were coded into common categories and themes by a 3-person research team for subsequent analysis. The coded themes were also mapped to the ICF domains, chapters, and categories. The dependent variables were the PSFS themes, number of activities endorsed, PSFS scores, ICF domains, chapters, and categories. Descriptive analyses and frequencies were reported for the dependent variables. A total of 157 different activities were identified at D3 and coded into 28 categories that fit into 6 themes: activities of daily living, cognitive and school (COG), sports and physical activity (SPA), screen time, sleep, and social. On D3, all patients (50/50) identified at least 1 activity limitation. Most related to SPA (37.6%) and COG (31.2%). Sixty percent of patients endorsed activity limitations at D10, primarily in COG (38.6%) and SPA (36.6%). All (100%) response categories were mapped to the ICF, with most (75%) fitting the activities and participation domain. Our primary findings suggest that SRC influences many facets of the lives of adolescent athletes. Specifically, adolescent athletes identified activity restrictions primarily related to physical activity and sports participation.