Sport-related Concussion Research Articles

Assessment of Sports Concussion in Female Athletes: A Role for Neuroinformatics?

Over the past decade, the intricacies of sports-related concussions among female athletes have become readily apparent. Traditional clinical methods for diagnosing concussions suffer limitations when applied to female athletes, often failing to capture subtle changes in brain structure and function. Advanced neuroinformatics techniques and machine learning models have become invaluable assets in this endeavor. While these technologies have been extensively employed in understanding concussion in male athletes, there remains a significant gap in our comprehension of their effectiveness for female athletes. With its remarkable data analysis capacity, machine learning offers a promising avenue to bridge this deficit. By harnessing the power of machine learning, researchers can link observed phenotypic neuroimaging data to sex-specific biological mechanisms, unraveling the mysteries of concussions in female athletes. Furthermore, embedding methods within machine learning enable examining brain architecture and its alterations beyond the conventional anatomical reference frame. In turn, allows researchers to gain deeper insights into the dynamics of concussions, treatment responses, and recovery processes. This paper endeavors to address the crucial issue of sex differences in multimodal neuroimaging experimental design and machine learning approaches within female athlete populations, ultimately ensuring that they receive the tailored care they require when facing the challenges of concussions. Through better data integration, feature identification, knowledge representation, validation, etc., neuroinformaticists, are ideally suited to bring clarity, context, and explainabilty to the study of sports-related head injuries in males and in females, and helping to define recovery.

Assessing Helmet Fit for Varsity Ice Hockey Athletes: A Field Intervention Study

Background: Protective equipment is at the forefront of the discussion on reducing sports-related concussions, with the role of helmets being equivocal. Data suggest that modern helmets are not entirely protective against concussions, and ill-fitting helmets may contribute to concussions with longer-lasting symptoms. Helmet fit can be assessed via a checklist, but its application outside of youth sport is lacking. Objectives: The purpose of this study was to assess helmet fit and the effect of feedback for a men’s (n=22) and a women’s (n=20) university varsity ice hockey team across a season. Methods: This field intervention study used a 12-item helmet fit checklist which was divided into five categories, defining “proper fit” as meeting all criteria of the stability and size categories. Players’ concussion histories and helmet fit knowledge were assessed using a survey. Results: The number of properly fitting helmets for males increased from 23% to 77% over the season, while remaining consistent at 50% for females. For males, 73% had an increase in overall checklist scores and 27% saw no change; 45% of females had an increase, 5% saw no change, and 50% decreased. Reported female (85%) concussion rate was double that of males (41%), but perceived knowledge of helmet fit (male=36%, female=30%) and actual knowledge (male=77%, female=85%) were similar. Conclusions: Feedback only had a positive effect on helmet fit for males across the season, potentially due to helmet style differences for females. Improvements to checklist criteria and scoring would increase the effectiveness of assessing fit for multiple helmet styles.

Associations of Sex and Sport Contact-Level with Recovery Timelines Among Collegiate Athletes with Sport-Related Concussion

BackgroundGrowing interest has motivated recent studies to examine differences in recovery after sport-related concussion (SRC) by sex. However, heterogeneity in study design, participants, and recovery outcomes has led to mixed findings. Further work is needed to evaluate potential differences by sex and to investigate the role of related characteristics, such as sport contact-level, in recovery timelines. This study aimed to investigate whether concussion recovery trajectories differ by sex, considering a priori clinical and demographic covariates, and accounting for the sequence of recovery outcomes. Our secondary question was whether sport contact-level modifies the relationship between sex and time to outcomes. Using data from the Ivy League–Big Ten Epidemiology of Concussion Study, we included SRCs reported across five academic years; 2015–2020 (February 2020). We used Cox proportional hazards regressions to estimate associations between sex and time from injury to three outcomes: (1) symptom resolution, (2) return to academics, (3) return to full play, accounting for measured confounders.ResultsAmong 1160 SRCs (male, n = 667; female, n = 493) with complete data, median age overall was 20 years (25th-75th percentiles:19–21), and most occurred among athletes playing high-contact sports (78.0%). Males were slightly more likely to complete symptom resolution over time compared to females (HR = 1.18, 95%CI = 1.05–1.33), but results were attenuated in fully adjusted models (HR 1.13, 95%CI = 0.99–1.29). Similarly, the HR of full academic return for males compared to females was 1.22 (95%CI = 1.07–1.38), but was attenuated in fully adjusted models (HR = 1.11, 95%CI = 0.97–1.28). The HR of full return to play for males compared to females was 1.14 (95%CI = 1.02–1.28), and was attenuated after adjustment (HR = 1.06, 95%CI = 0.93–1.20) as well. The interaction between sex and playing a high/low-contact sport was not statistically significant across models, though differences were apparent.ConclusionsAmong a cohort of collegiate athletes with SRC, recovery timelines appeared similar between male and female athletes, adjusting for measured confounders. Differences by sex, considering sport contact-level, were evident and may be important clinically and in future studies. This study used robust methods, accounting for nesting in the sequence of RTP outcomes. Results inform concussion management protocols and planned qualitative work to further elucidate how collegiate athletes experience concussion recovery.Key PointsHeterogeneity in study design, participants, and recovery outcomes has led to mixed findings in determining differences in recovery trajectories after concussion by sex.We found that having longer time to symptom resolution, and also the sequence of having academic return before symptoms resolve and longer time to academic return were confounders in the relationship between sex and RTP timelines. Time to sequential recovery outcomes appeared similar between male and female athletes, adjusting for observable confounders. Further differences by sex were evident when considering contact-level, and may be important to consider clinically and in future research.Results indicate that differences in concussion recovery trajectories by sex may be largely attributed to and driven by differences in sports with a men’s or women’s team only, such as football, and this should be explored further.

Non-reporting of sport-related concussion symptoms: a cross-sectional study of community rugby league players in the UK

Recognising and removing players with suspected sport-related concussions is crucial for community sports.ObjectivesQuantify rates and factors associated with non-reporting of concussion symptoms in community rugby league.MethodsOverall, 484 community rugby league...

Aotearoa New Zealand physiotherapists’ perspectives of potential expanded roles for sports-related concussion management: A qualitative study

Aotearoa New Zealand physiotherapists’ perspectives of potential expanded roles for sports-related concussion management: A qualitative study

Do high-risk head trauma sports athletes have impaired vestibular function?

PurposeThe primary aim of this study was to examine the vestibular function of athletes involved in high-risk head trauma sports by means of complete vHIT testing of all six semicircular canals (SCCs). The secondary objective was to investigate whether the vestibular function is significantly reduced among athletes within certain high-risk sports. MethodsA prospective cross-sectional study of 137 adult athletes in football, handball, boxing, horseback riding, and ice hockey with a minimum of one reported sports-related head injury within the past five years. All subjects underwent screening with a complete examination of all six SCCs with vHIT and fulfillment of the dizziness handicap inventory (DHI). ResultsTwo subjects (1.5 %) fulfilled the criteria of having a pathological vHIT. Some degree of impairment of the vestibular function was seen when data was divided into individual sports and time since the last head injury. Likewise, no subjective dizziness was seen in the group of athletes when evaluated by total DHI scores. This score did not differ significantly between groups when subgrouped into number of head injuries or time since the last head injury. When divided into type of sport, total DHI scores differed significantly between groups. These total DHI-scores did, however, all fall within the range of the “no dizziness handicap” classification. ConclusionThe results suggest that the vestibular function of athletes in high-risk head trauma sports is unaffected by the practice of a high-risk head trauma sport. Therefore, vHIT has no clinical utility in the assessment of a sports-related concussion (SRC) in athletes with no subjective feeling of dizziness.

Biclustering Multivariate Longitudinal Data with Application to Recovery Trajectories of White Matter After Sport-Related Concussion.

Biclustering is the task of simultaneously clustering the samples and features of a data set. In doing so, subsets of samples that exhibit similar behaviors across subsets of features can be identified. Motivated by a longitudinal diffusion tensor imaging study of sport-related concussion (SRC), we present the problem of biclustering multivariate longitudinal data in which subjects and features are grouped simultaneously based on longitudinal patterns rather than magnitude. We propose a penalized regression based method for solving this problem by exploiting the heterogeneity in the longitudinal patterns within subjects and features. We evaluate the performance of the proposed methods via a simulation study and apply them to the motivating dataset, revealing distinctive patterns of white-matter abnormalities within subgroups of SRC cases.

Social Determinants of Health and Health Equity in the Treatment and Rehabilitation of Sport-Related Concussion: A Content Analysis of Intervention Research and Call-To-Action.

This review was designed to (1) determine the extent to which the clinical science on sport-related concussion treatment and rehabilitation has considered social determinants of health (SDoH) or health equity and (2) offer recommendations to enhance the incorporation of SDoH and health equity in concussion treatment research and clinical care. The Concussion in Sport Group consensus statement (2023) was informed by two systematic reviews examining prescribed rest or exercise following concussion and targeted interventions to facilitate concussion recovery. We examined 31 studies, including 2,698 participants, from those two reviews. Race (k = 6; 19.4%) and ethnicity (k = 4; 12.9%) of the study samples were usually not reported. Four studies examined ethnicity (i.e., Hispanic), exclusively as a demographic category. Five studies (16.1%) examined race as a demographic category. Three studies (9.7%) examined socioeconomic status (SES; measured as household income) as a demographic category/sample descriptor and one study (3.2%) examined SES in-depth, by testing whether the treatment and control groups differed by SES. Five studies examined an SDoH domain in a descriptive manner and four studies in an inferential/intentional manner. No study mentioned SDoH, health equity, or disparities by name. Many studies (61.3%) excluded participants based on demographic, sociocultural, or health factors, primarily due to language proficiency. The new consensus statement includes recommendations for concussion treatment and rehabilitation that rely on an evidence base that has not included SDoH or studies addressing health equity. Researchers are encouraged to design treatment and rehabilitation studies that focus specifically on underrepresented groups to determine if they have specific and unique treatment and rehabilitation needs, whether certain practical modifications to treatment protocols might be necessary, and whether completion rates and treatment adherence and response are similar.

The Significance of Off-Season Tailor-Made Baseline Measurements in the Assessment of Post-Concussion in University Athletes.

This study aimed to investigate the significance of baseline measurements for amateur team athletes playing contact and collision team sports with a specific focus on the Sports Concussion Assessment Tool (SCAT) to improve concussion management. Symptoms of sports-related concussions (SRCs) can be diverse and long-lasting and include cognitive impairment, sleep disturbances, and vestibular dysfunction. Therefore, comprehensive baseline data are essential to preventing recurrent concussions and secondary injuries. This study was conducted during the 2023 off-season and evaluated the baseline condition of 65 male university rugby players using the SCAT5, which includes self-reported symptoms, and the modified Balance Error Scoring System (mBESS). The athletes were assessed for the presence or absence of SRC, and the mean values were compared using the Mann-Whitney U test. Among the participants, 35.38% (23/65) reported symptoms, with an average of 1.5 ± 2.8 symptoms per player and an average symptom score of 2.66 ± 5.93. In the mBESS, no errors were observed in the tandem stance test; however, 72.31% (47/65) made errors in the single-leg stance test on the non-dominant foot, with an average of 1.7 ± 1.5 errors. Many athletes self-reported symptoms and balance errors, even during asymptomatic periods before experiencing concussion, indicating unresolved issues. In the injury history survey, the baseline evaluations and injury histories of the participants classified into the SRC and non-SRC groups were compared. In the mBESS single-leg stance test (non-dominant foot), 84.21% (32/38) of the SRC group participants made errors, with an average score of 2.13 ± 1.52, whereas 55.55% (15/27) of the non-SRC group participants made errors, with an average score of 1.15 ± 1.35, showing a significant difference (p = 0.007). Additionally, significant differences were observed in the average number of ankle sprains (p = 0.027) and fractures (p = 0.048) between patients with and without a history of SRC. These findings indicate that athletes may have underlying issues even during normal periods before concussion. Moreover, the results highlighted the impact of previous concussions on motor control and injury risk. This underscores the importance of preseason baseline measurements using the SCAT to identify at-risk athletes and implement preventive measures. These findings align with the recommendations of the 6th International Conference on Concussion in Sport and suggest further refinement of concussion assessment tools.

Expert consensus on the terminology, diagnostics and management of persisting symptoms after concussion with a focus on mental health, postural stability, electroencephalogram and balance testing: A cross-sectional Delphi-like survey.

Persisting symptoms after concussion (PSaC) are a pathological manifestation of head injuries that present with symptoms after the acute phase of head trauma has subsided. Insufficient research about PSaC has led to gaps in knowledge and incorrect terminology being applied. Furthermore, gaps exist in standardised assessment protocols and understanding of mental health symptoms associated with sports. The study aimed to; 1) Determine expert consensus on appropriate terminology for symptoms lasting >4 weeks, 2) Investigate associations with mental health and postural stability symptoms, 3) Evaluate experts' views on quantitative balance and electroencephalogram (EEG) testing. A Delphi-like survey was designed in REDCap and sent to identified experts in the field of sports-related concussions (SRC). Expert consensus was defined as ≥75% agreement. Expert consensus identified the following mood and motor control symptoms being associated with PSaC: increases in emotional state (80%), irritability (87%), nervousness (87%), sadness (80%), balance impairment (80%), dizziness (87%) and feeling slow (80%). Numbness and tingling were not considered longer-term effects (80%). Additionally, 93% of respondents acknowledged mental health symptoms as potential longer-term effects, with 80% agreeing on inadequate current management. Respondents indicated PSaC are only somewhat adequately managed (73%) or not managed well enough (27%). The use of EEG and quantitative balance testing remains open for debate. The survey response rate was 21%. Improving mental health management for athletes with PSaC and standardising terminology is crucial. Future research is required to establish effective diagnosis and treatment methods. Addressing these issues may result in better care and safer return to play for athletes.

Adolescents With a High Burden of New-Onset Mood Symptoms After Sport-Related Concussion Benefit From Prescribed Aerobic Exercise, a Secondary Analysis of 2 Randomized Controlled Trials.

Approximately 20% of students with sport-related concussion (SRC) report new symptoms of anxiety and depression which may be associated with delayed recovery and increased risk for developing a mood disorder. Early prescribed aerobic exercise facilitates recovery in athletes with concussion-related exercise intolerance. We studied the effect of aerobic exercise treatment on new mood symptoms early after SRC. Exploratory secondary analysis of 2 randomized controlled trials (RCT). Sports medicine clinics associated with UB (Buffalo, NY), CHOP (Philadelphia, PA), and Boston Children's Hospital (Boston, MA). Male and female adolescents (aged 13-18 years) diagnosed with SRC (2-10 days since injury). Participants were randomized to individualized targeted heart rate aerobic exercise (n = 102) or to a placebo intervention designed to mimic relative rest (n = 96). Incidence of Persisting Post-Concussive Symptoms (PPCS, symptoms ≥28 days). First RCT recruited from 2016 to 2018 and the second from 2018 to 2020. Of 198 adolescents, 156 (79%) reported a low burden (mean 1.2 ± 1.65/24) while 42 (21%) reported a high burden (mean 9.74 ± 3.70/24) of emotional symptoms before randomization. Intervention hazard ratio for developing PPCS for low burden was 0.767 (95% CI, 0.546-1.079; P = 0.128; β = 0.085) and for high burden was 0.290 (95% CI, 0.123-0.683; P = 0.005; β = 0.732). High burden of mood symptoms early after injury increases risk for PPCS, but the sports medicine model of providing early targeted aerobic exercise treatment reduces it. Nonsports medicine clinicians who treat patients with a high burden of new mood symptoms after concussion should consider prescribing aerobic exercise treatment to reduce the risk of PPCS and a mood disorder.

What are the Protocols and Resources for Sport-Related Concussion Among Top National Collegiate Athletic Association Football Programs? A Cross-Sectional Survey of A5 Schools.

This study summarizes findings from a cross-sectional survey conducted among National Collegiate Athletic Association (NCAA) Division 1 football programs, focusing on sport-related concussion (SRC) protocols for the 2018 season. Cross-sectional survey study. 65 football programs within the Autonomy Five (A5) NCAA conferences. Athletic trainers and team physicians who attended a football safety meeting at the NCAA offices June 17 to 18, 2019, representing their respective institutions. Electronic surveys were distributed on June 14, 2019, before the football safety meeting. Results for 16 unique questions involving SRC protocols and resources were summarized and evaluated. The survey garnered responses from 46 of 65 programs (response rate = 71%). For baseline testing, 98% measured baseline postural stability and balance, 87% used baseline neurocognitive testing, while only 61% assessed baseline vestibular and/or ocular function. Regarding concussion prevention, 51% did not recommend additional measures, while 4% and 24% recommended cervical compression collars and omega-3 supplementation, respectively. In postconcussion treatment, 26% initiated aerobic exercise 1 day postconcussion if symptoms were stable, 24% waited at least 48 hours, 4% waited for the athlete to return to baseline, 11% waited until the athlete became asymptomatic, and 35% determined procedures on a case-by-case basis. Most institutions assessed postural stability/balance and neurocognitive functioning at baseline and introduced light aerobic exercise within 48 h postconcussion. There was variation in baseline assessment methods and concussion prevention recommendations. These survey findings deepen our understanding of diverse SRC protocols in NCAA football programs.

Association of Sport Helmet Status on Concussion Presentation and Recovery in Male Collegiate Student-Athletes.

Sporting helmets contain force attenuating materials which reduce traumatic head injury risk and may influence sport-related concussion (SRC) sequelae. The purpose of this study was to examine the association of sport helmet status with SRC-clinical presentation and recovery trajectories in men's collegiate athletes. Sport helmet status was based on the nature of sports being either helmeted/non-helmeted. 1070 SRCs in helmeted (HELM) sports (Men's-Football, Ice Hockey, and Lacrosse), and 399 SRCs in non-helmeted (NOHELM) sports (Men's-Basketball, Cheerleading, Cross Country/Track & Field, Diving, Gymnastics, Soccer, Swimming, Tennis, and Volleyball) were analyzed. Multivariable negative binomial regression models analyzed associations between sport helmet status and post-injury cognition, balance, and symptom severity, adjusting for covariate effects (SRC history, loss of consciousness, anterograde/retrograde amnesia, event type). Kaplan-Meier curves evaluated median days to: initiation of return to play (iRTP) protocol, and unrestricted RTP (URTP) by sport helmet status. Log-rank tests were used to evaluate differential iRTP/URTP between groups. Two independent multivariable Weibull accelerated failure time models were used to examine differential iRTP and URTP between groups, after adjusting for aforementioned covariates and symptom severity score. Overall, the median days to iRTP and URTP was 6.3 and 12.0, respectively, and was comparable across NOHELM- and HELM-SRCs. Post-injury symptom severity was lower (Score Ratio 0.90, 95%CI 0.82, 0.98), and cognitive test performance was higher (Score Ratio 1.03, 95%CI 1.02, 1.05) in NOHELM-compared to HELM-SRCs. Estimated time spent recovering to iRTP/URTP was comparable between sport helmet status groups. Findings suggest that the grouping of sports into helmeted and non-helmeted show slight differences in clinical presentation but not recovery.

Impact of fish oil supplementation on plasma levels of highly unsaturated fatty acid-containing lipid classes and molecular species in American football athletes

BackgroundPrevious studies have linked sports-related concussions and repeated subconcussive head impacts in contact sport athletes to elevated brain injury biomarkers. Docosahexaenoic acid (DHA), the primary omega-3 (n-3) highly unsaturated fatty acid (HUFA) in the brain, has shown neuroprotective effects in animal models after brain injury, but clinical research has shown mixed results.MethodsWe conducted a randomized, double-blind, placebo-controlled study on 29 Division 1 collegiate American football players, exploring the impact of DHA (2.5 g) and eicosapentaenoic acid (EPA) (1.0 g) supplied as ethyl esters, on levels of plasma lipids shown to cross the blood-brain barrier. Dietary intake data was collected using food frequency questionnaires (FFQ). Complex lipids and unesterified fatty acids were isolated from plasma, separated via reversed-phase liquid chromatography and analyzed by targeted lipidomics analysis.ResultsFFQ results indicated that participants had low dietary n-3 HUFA intake and high omega-6 (n-6):n-3 polyunsaturated fatty acids (PUFA) and HUFA ratios at baseline. After DHA + EPA supplementation, plasma lysophosphatidylcholine (LPC) containing DHA and EPA significantly increased at all timepoints (weeks 17, 21, and 26; p < 0.0001), surpassing placebo at Weeks 17 (p < 0.05) and 21 (p < 0.05). Phosphatidylcholine (PC) molecular species containing DHA or EPA, PC38:6 PC36:6, PC38:7, PC40:6, and PC40:8, increased significantly in the DHA + EPA treatment group at Weeks 17 (and 21. Plasma concentrations of non-esterified DHA and EPA rose post-supplementation in Weeks 17 and 21.ConclusionsThis study demonstrates that n-3 HUFA supplementation, in the form of ethyl esters, increased the DHA and EPA containing plasma lipid pools the have the capacity to enrich brain lipids and the potential to mitigate the effects of sports-related concussions and repeated subconcussive head impacts.Trial RegistrationAll deidentified data are available at ClinicalTrials.gov #NCT0479207.

A - 32 Framing Racial Disparities within Sports Related Concussion from an Ecological Systems Perspective: a Content Analysis of Literature on Black Athletes’ Risk and Protective Factors

Abstract Purpose There is an apparent phenomenon where Black adult and pediatric athletes face disparities within their care, treatment, and recovery from mild traumatic brain injury (mTBI), or concussion while playing their sport: previous literature has demonstrated that Black athletes who have experienced sports-related concussions (SRC) are less likely to demonstrate concussion knowledge and symptom identification, as well as intention to report injury and overall poorer psychosocial outcomes following injury. Overall, the axis of privilege and marginalization associated with Race, can impact presentation for care, receiving diagnoses, symptom reporting and tracking, and the process of recovery or return to baseline functioning. However, empirical findings from publications do not elucidate why nor how these various factors compound. The purpose of this literature review was to (I) identify salient literature on racial differences for Black athletes with SRC, and (II) create a framework that encapsulates the “why”and “how” sociocultural experiences of power, access, and biases can impact Black athletes. The authors used Ecological Systems Theory (EST; Bronfenbrenner, 1979) to create a novel organization-systems model of identified findings and theory that demonstrate and support racial disparities within SRC and larger mTBI literature. Method A comprehensive literature search was employed to identify recent empirical studies and theoretical perspectives on racial disparities in mTBI for Black populations and athletes (N = 30). Publications for literature review were identified through the following Boolean search parameter on Google Scholar: [((race OR racial) OR (Black* OR African* OR BIPOC*)) AND (*brain injury OR “mild traumatic brain injury” OR mTBI OR concussion) AND (sport* OR athlet*)], where publications of interest were compiled and annotated by authors. Inclusion criterion for publication was established by the team as: (a) focusing on an element of concussion or mild traumatic brain injury, such as patient risk for injury, diagnosis, recovery or post-injury outcomes, (b) participants‚Äô racial background (race) must have been either an independent variable included within an analysis for quantitative designs, or be a salient topic or variable of interest within qualitative designs, and (c) published between 2018 and 2023. Publications from all journals and topic areas were included if the paper met above criterion. Results Approximately, two major patterns emerged that may underlie current empirical data on diagnoses, injury recovery and post injury outcomes. The two patterns illustrate how both clinicians and athletes (1) biased, unconscious beliefs that posit Black athletic bodies as invincible to injury &amp; pain, and athletes (2) indirect and direct access to concussion knowledge and resources, can moderate the likelihood of SRC injury risk, diagnosis, recovery and post-injury outcomes for Black athletes across various athletic age and ability levels. Conclusions Ultimately, the organizational EST model for each pattern provides a clear thread on how historical, and macro-level policy and perceptions, can impact micro-level clinical care and decision-making for Black athletes and their experiences with SRC. Future directions suggest an application of EST models or further qualitative investigation with clinicians and Black athletes to understand more microsystem-level perceptions, beliefs, and thought processes that spur and impact clinical care.

A - 13 Social Determinants of Health and Health Equity in Return to Learn Following Sport-Related Concussion

Abstract Purpose We conducted a narrative review and content analysis to (i) determine the extent to which research on return to learn (RTL) following sport-related concussion (SRC) has considered social determinants of health (SDoH) or health equity and (ii) provide recommendations to enhance the incorporation of SDoH and health equity into considerations of how best to support concussed students as they RTL following injury. Data Selection We coded 32 studies from a systematic review focused on clinical recovery following SRC, including RTL (Putukian et al., 2023). The review informed the latest Concussion in Sport Group consensus statement (Patricios et al., 2023). We examined studies to determine whether the SDoH domains and subcategories, derived from the US Department of Health and Human Services Healthy People 2020 and 2030 websites, were addressed. Pairs of raters coded articles independently and resolved disagreements through discussion. Conclusions SDoH remain largely unrepresented in studies on return to school following concussion. Future research is needed to better characterize how SDoH and health equity factors influence return to school following concussion to ensure that concussed and recovering students are supported.

A - 40 The Impact of Early Access on Sports-Related Concussions in Youth Hockey Players

Abstract Purpose Sports-related concussions are the most common setting for adolescents to sustain a concussion. Delayed access to care is a risk factor for recovery and youth athletes have limited access to early intervention often due to lack of athletic trainer coverage. The purpose of this study was to evaluate the effect of early access on sports-related concussions in youth hockey players. Method Participants (n = 67) included youth athletes from hockey organizations who partnered with a local specialty concussion clinic. Athletes presented to clinic for care (median = 2 days) after sustaining a concussion. We examined whether the number of days since injury to initial exam (DSI) significantly predicted recovery time while controlling for common injury modifiers, such as symptom severity, anxiety sensitivity, and age. Recovery was measured in number of days since injury to the date of medical clearance. Results Multivariate general linear analyses indicated that DSI (M = 4.96, SD = 8.90), significantly predicted the number of recovery days (M = 12.85, SD = 9.47), with each day earlier to initial exam predicting almost one day faster recovery (B = 0.92; p &amp;lt; 0.001; ηp2 = 0.813). Variables of age (M = 13.78, SD = 2.59), anxiety sensitivity (M = 8.91, SD = 9.69), and concussion severity (M = 19.22, SD = 8.90), were not predictive recovery. Conclusions Early access resulted in faster medical clearance. This sample of youth hockey players do not have access to an athletic trainer to provide early intervention. Our results suggest that the ability to have early intervention through a specialty concussion clinic partnership resulted in faster recovery, highlighting the importance of continuing to explore and cultivate these relationships with youth sports.

A - 46 Putting Together “Puzzle Pieces” of the Game: Executive Functions in Athletes with Sports-Related Concussion History

Abstract Purpose While previous quantitative research has explored the malleability of executive functions in sports, there’s a gap in understanding athletes’ descriptions and utilization of executive functions during gameplay. Understanding these processes from athletes’ perspectives is crucial for developing relevant assessments, particularly following sports-related concussion (SRC), as well as using accessible athlete-driven language to describing executive function in sports neuropsychology. Thus, our study aimed to explore how athletes deploy executive functions during games and identify the most crucial executive function components for success. Method 19 Canadian collegiate athletes (ages 18–25; 37% female) with a history of SRC across various sports (soccer, volleyball, rugby, and basketball) were recruited. Participants completed semi-structured interviews via Zoom with a focus on identifying their executive function processes in their respective sports. Thematic analysis, following Braun and Clarke’s (2006) approach, was used to analyze the interview transcripts. Results We generated three themes: 1) Planning, organizing, and deciding action before actively involved in the play; 2) Problem solving when the contingencies for the pre-planned play changes; 3) Processing and evaluating performance immediately after a play. Conclusions These results provide nuance to our understanding of executive functions in sport by gaining insight into how athletes think while playing, information that neither tasks nor questionnaires offer. Through qualitative interviews, we discovered athletes engage in various executive processes throughout the game, including strategic planning and problem-solving. Overall, this study highlights specific executive processes employed throughout a game, which may become areas of focus for assessment, interventions, and follow-up for athletes following SRC.

A - 54 Changes in the Blink Reflex after a Sport-Related Concussion: Test–Retest Reliability of a Blink Reflexometer

Abstract Purpose The blink reflex may be affected by concussion, but psychometric analyses examining devices that measure the blink reflex are limited. This study assessed the test–retest reliability of the Blinkcns EyeStatTM device at two pre-season baseline time points in a cohort of healthy high school athletes. Method During pre-season, high school athletes completed the EyeStatTM scanning twice, 15-minutes apart. Pearson/Spearman correlations and Intraclass Correlation Coefficients (ICC, i.e., the measure of test re-test reliability) were calculated across 10 different parameters (e.g., latency, total blink time, oscillations, time to open/close). Additionally, t-tests examined if these parameters differed based on biological sex, sleep status (i.e., &amp;lt;8 vs. ≥8 hours the night before), and prior concussion history (i.e., 0 vs. ≥1 prior concussions). Results Of the 48 athletes (age, M = 16.0¬ ± 1.2 years), 35.4% were female. Correlations ranged from 0.45–0.82 (all p-values&amp;lt;0.001) between the two assessments, and ICCs were 0.46–0.87 (all p-values&amp;lt;0.02). Additionally, none of the Eyestat parameters were significantly associated with biological sex, sleep status, or prior concussion history (all p-values&amp;gt;0.05). Conclusions This study suggests substantial test–retest reliability of the EyeStatTM device across 10 parameters in a cohort of healthy high school athletes. The findings support the potential utility of the EyeStatTM device as a reliable baseline measure for assessing the blink reflex among young athletes.

A - 26 A Survey of Sports Concussion Specialists’Clinical Criteria to Determine Concussion Recovery

Abstract Purpose To identify criteria used by sports concussion specialists in determining recovery from sport-related concussion. We hypothesized differences in use of decision-making criteria among neuropsychologists, physicians, and certified athletic trainers (ATCs). Method 143 sports concussion specialists (neuropsychologists = 45, physicians = 41, and certified athletic trainers (ATCs) = 57) completed a survey rating the importance of specific criteria for determining concussion recovery in youth and adult athletes. Differences between specialist groups were examined with Kruskal-Wallis tests. Results There were significant differences in criteria ratings across specialist groups regarding youth and adults for “use of neurocognitive test scores,”“balance testing,”“physical examination,”“no symptom provocation with neurocognitive testing,”“athlete report of anxiety about return to sport,“and “family member’s report of recovery,“all p’s &amp;lt; 0.001. For youth and adults, physicians ranked “use of neurocognitive test scores”and “no symptom provocation with neurocognitive testing”as less important than other providers, while “physician examination”was ranked as more important. Neuropsychologists ranked “balance testing”and “athlete report of anxiety about return to sport”as less important than other providers; and ATCs ranked “family member’s report of recovery”as less important than other providers. Conclusions Our results advance understanding of multidisciplinary standards of care in determining recovery from sports concussion and suggest the importance of collaboration in establishing clinical criteria common to all sports concussion health care providers.