Sport-related Concussion Research Articles

An Assessment of Existing Sport-Related Concussion Guidelines in Ireland: The Need for a United Approach.

In 2014, an Irish parliament white paper called for greater addressing of sport-related concussions (SRCs) in Ireland, requesting the adoption of the Concussion in Sport Group's (CISGs) guidelines and greater consistency in SRC return to play (RTP) management. Ten years later, it is unclear how these requests have been addressed. Recently, the United Kingdom's government centralised guidelines to one SRC document for all grassroots sports. This study aimed to investigate all publicly available SRC guidance in Irish sports and national governing bodies (NGBs) to determine if centralised guidelines are warranted. Sport Ireland and the Irish Federation of Sports were searched for all recognised NGBs and sports in Ireland. Websites were searched for any information pertaining to SRCs and data were extracted and collated in Microsoft Excel. In total, 15 of 83 sports and/or NGBs included SRC guidance, nine of which provided RTP protocols. Various iterations of the CISGs guidance and tools were implemented. Several sports with a documented SRC risk had no guidelines present. The findings indicate disjointed and outdated guidance across Irish sport. Additionally, there are sports with a documented concussion risk that have no SRC guidance available. This study provides support for centralised guidelines to be adopted in Irish grassroots sports.

Latent Profiles of Acute Symptoms, Cognitive Performance, and Balance in Sport-Related Concussions

Background: A sport-related concussion (SRC) is a common injury that affects multiple clinical domains such as cognition, balance, and nonspecific neurobehavioral symptoms. Although multidimensional clinical assessments of concussion are widely accepted, there remain limited empirical data on the nature and clinical utility of distinct clinical profiles identified by multimodal assessments. Purpose: Our objectives were to (1) identify distinct clinical profiles discernible from acute postinjury scores on the Sport Concussion Assessment Tool (SCAT), composed of a symptom checklist, a cognitive assessment (Standardized Assessment of Concussion), and a balance assessment (Balance Error Scoring System), and (2) evaluate the clinical utility of the identified profiles by examining their association with injury characteristics, neuropsychological outcomes, and clinical management–related outcomes. Study Design: Cohort study (Prognosis); Level of evidence, 2. Methods: Up to 7 latent profiles were modeled for 1885 collegiate athletes and/or military cadets who completed the SCAT at 0 to 12 hours after an injury. Chi-square tests and general linear models were used to compare identified profiles on outcomes at 12 to 72 hours after the injury. Kaplan-Meier analysis was used to investigate associations between clinical profiles and time to return to being asymptomatic and to return to play. Results: There were 5 latent profiles retained: low impairment (65.8%), high cognitive impairment (5.4%), high balance impairment (5.8%), high symptom severity (16.4%), and global impairment (6.5%). The latent profile predicted outcomes at 12 to 72 hours in expectable ways (eg, the high balance impairment profile demonstrated worse balance at 12 to 72 hours after the injury). Time to return to being asymptomatic and to return to play were different across profiles, with the high symptom severity and global impairment profiles experiencing the longest recovery and the high balance impairment profile experiencing an intermediate-length recovery (vs low impairment profile). Conclusion: An SRC is a heterogeneous injury that presents in varying ways clinically in the acute injury period and results in different recovery patterns. These data support the clinical prognostic value of diverse profiles of impairment across symptom, cognitive, and balance domains. By identifying distinct profiles of an SRC and connecting them to differing outcomes, the findings support more evidence-based use of accepted multimodal clinical assessment strategies for SRCs.

Ethical concerns in integrating sport-related concussion (SRC) genetic testing into return-to-play (RTP) protocols

ABSTRACT The occurrence of sport-related concussions (SRCs) has emerged as a significant health concern in professional sports, with millions of concussions occurring worldwide each year. Current return-to-play (RTP) protocols after SRCs involve a multi-disciplinary approach with growing interest in genetic testing technology. Numerous studies have indicated that the gene Apolipoprotein E4 (APOE4) holds promise as a predictive factor for developing diseases after concussions and other traumatic brain injuries. Nevertheless, there is an ongoing and contentious debate surrounding the impact of SRC genetic testing on the RTP decision, encompassing concerns about the potential adverse effects on individual athletes, coaches, and even the whole sport community at large not in a small degree due to incidental findings. Hence, the purpose of this article is to explore the clinical and ethical components of SRCs genetic testing and its potential integration into RTP protocols by utilizing the ACCE framework to assess the validity, utility, and ethical aspects of SRCs.

Knowledge, Attitude, Beliefs, and Practice Related to Concussion Injury Among Sports Physical Therapists in Riyadh, Saudi Arabia. A Cross-sectional Analysis.

Sport-related concussions (SRC) are estimated to affect more than 55 million individuals annually. Physical therapists ought to have fundamental knowledge regarding the evaluation and treatment of SRC. Thus, this study aims to evaluate the knowledge, attitude, and practice of the physical therapists regarding SRC management in Riyadh, Saudi Arabia. The cross-sectional study enrolled 83 sports physical therapist who had atleast undergraduate degree and above in physical therapy from Riyadh region. The participants who worked outside the Riyadh region were excluded. A validated adopted questionnaire was used to evaluate the outcome measures. The study showed that sport physical therapists have a good understanding and knowledge about concussions having 3.91 ± 0.98 scores on the five-point Likert scale. In addition, participants were able to recognize concussion signs and symptoms correctly; however, they felt that they lacked confidence to make a decision regarding return to play. Our study revealed important knowledge gaps regarding the utilization of concussion severity scales, management of youth concussion, and/or the use of neurological imaging modalities for diagnosing concussion cases.

Biomarkers of Neurobiologic Recovery in Adults With Sport-Related Concussion

ImportanceSport-related concussion (SRC), a form of mild traumatic brain injury, is a prevalent occurrence in collision sports. There are no well-established approaches for tracking neurobiologic recovery after SRC.ObjectiveTo examine the levels of serum glial fibrillary acidic protein (GFAP) and neurofilament light (NfL) in Australian football athletes who experience SRC.Design, Setting, and ParticipantsA cohort study recruiting from April 10, 2021, to September 17, 2022, was conducted through the Victorian Amateur Football Association, Melbourne, Australia. Participants included adult Australian football players with or without SRC. Data analysis was performed from May 26, 2023, to March 27, 2024.ExposureSport-related concussion, defined as at least 1 observable sign and/or 2 or more symptoms.Main Outcomes and MeasuresPrimary outcomes were serum GFAP and NfL levels at 24 hours, and 1, 2, 4, 6, 8, 12, and 26 weeks. Secondary outcomes were symptoms, cognitive performance, and return to training times.ResultsEighty-one individuals with SRC (median age, 22.8 [IQR, 21.3-26.0] years; 89% male) and 56 control individuals (median age, 24.6 [IQR, 22.4-27.3] years; 96% male) completed a total of 945 of 1057 eligible testing sessions. Compared with control participants, those with SRC exhibited higher GFAP levels at 24 hours (mean difference [MD] in natural log, pg/mL, 0.66 [95% CI, 0.50-0.82]) and 4 weeks (MD, 0.17 [95% CI, 0.02-0.32]), and NfL from 1 to 12 weeks (1-week MD, 0.31 [95% CI, 0.12-0.51]; 2-week MD, 0.38 [95% CI, 0.19-0.58]; 4-week MD, 0.31 [95% CI, 0.12-0.51]; 6-week MD, 0.27 [95% CI, 0.07-0.47]; 8-week MD, 0.36 [95% CI, 0.15-0.56]; and 12-week MD, 0.25 [95% CI, 0.04-0.46]). Growth mixture modeling identified 2 GFAP subgroups: extreme prolonged (16%) and moderate transient (84%). For NfL, 3 subgroups were identified: extreme prolonged (7%), moderate prolonged (15%), and minimal or no change (78%). Individuals with SRC who reported loss of consciousness (LOC) (33% of SRC cases) had higher GFAP at 24 hours (MD, 1.01 [95% CI, 0.77-1.24]), 1 week (MD, 0.27 [95% CI, 0.06-0.49]), 2 weeks (MD, 0.21 [95% CI, 0.004-0.42]) and 4 weeks (MD, 0.34 [95% CI, 0.13-0.55]), and higher NfL from 1 week to 12 weeks (1-week MD, 0.73 [95% CI, 0.42-1.03]; 2-week MD, 0.91 [95% CI, 0.61-1.21]; 4-week MD, 0.90 [95% CI, 0.59-1.20]; 6-week MD, 0.81 [95% CI, 0.50-1.13]; 8-week MD, 0.73 [95% CI, 0.42-1.04]; and 12-week MD, 0.54 [95% CI, 0.22-0.85]) compared with SRC participants without LOC. Return to training times were longer in the GFAP extreme compared with moderate subgroup (incident rate ratio [IRR], 1.99 [95% CI, 1.69-2.34]; NfL extreme (IRR, 3.24 [95% CI, 2.63-3.97]) and moderate (IRR, 1.43 [95% CI, 1.18-1.72]) subgroups compared with the minimal subgroup, and for individuals with LOC compared with those without LOC (IRR, 1.65 [95% CI, 1.41-1.93]).Conclusions and RelevanceIn this cohort study, a subset of SRC cases, particularly those with LOC, showed heightened and prolonged increases in GFAP and NfL levels, that persisted for at least 4 weeks. These findings suggest that serial biomarker measurement could identify such cases, guiding return to play decisions based on neurobiologic recovery. While further investigation is warranted, the association between prolonged biomarker elevations and LOC may support the use of more conservative return to play timelines for athletes with this clinical feature.

Effect of high intensity, intermittent exercise on EyeGuide Focus smooth pursuit assessments in amateur female rugby union athletes

Ocular assessment tools provide insights into neurological functioning when diagnosing sport-related concussions (SRCs). Emerging technologies such as EyeGuide Focus have attempted to improve on pre-existing clinical tools however the reliability of the tool is currently uncertain and it is unclear if physical exertion may affect the validity of the device as seen with similar ocular assessments. The aim of this study was to determine if EyeGuide Focus accuracy is affected by high-intensity, intermittent exercise. Seven amateur female rugby union athletes were recruited (Mean age [± SD] = 23 ± 5 years; stature = 172 ± 4 cm, mass = 87 ± 20 kg). Athletes completed baseline testing on the unit which included two to four familiarisation trials and three official tests on the unit measured in arbitrary units (AUs). Testing was completed in a dark room free from distraction, and participants wore noise-cancelling headphones (BOSE QC45) during assessment. The athlete then performed a brief warmup before beginning the exercise protocol by Whyte et al. (2022, Phys Therapy Sport, 58, 126-133) which involves repeated circuits of acceleration, deceleration, backpedalling, change of direction, jumping, and side shuffling. This protocol has previously displayed significant effects on Vestibular Ocular Motor Screening testing. Athletes repeated circuits until they reported 17-18/20 on the Borg Scale with 30s between each circuit. Athletes then completed three more trials at five- and 10-mins post-exercise cessation. Data were exported to Microsoft Excel and Statistical Packages for the Social Sciences for analysis. Athletes completed an average of 03:15 ± 23 s total work in circuits. Significant differences existed between athlete’s heart rate at rest and post-warmup, post individual circuits, and five mins post-test (P < 0.05) but not 10 mins post-test (P > 0.05). Mean EyeGuide Focus scores were 23443.29 ± 8082.18, 35684.04 ± 13279.40, and 22927.64 ± 6377.61 AUs at baseline, 5 mins post-test, and 10 mins post-test respectively. Scores were significantly different between baseline and 5 mins post-test (P < 0.001), and between 5- and 10-mins post-test (P < 0.001), but not baseline and 10 mins post-test (P > 0.848). Three mins of high-intensity, intermittent exercise was sufficient to induce significant changes in amateur female athletes’ EyeGuide Focus scores, returning to baseline after 10 mins of rest. The findings indicate that physical activity can impact on EyeGuide Focus scores and thus sufficient rest is required when assessing athletes for SRCs. Future research should investigate if sport-related contact or collisions also impact scoring on this device.

Uses and abuses of the concept of race in genomics of sport performance and sport-related traumatic brain injury: epistemological and ethical considerations

ABSTRACT In this article, we tackle the epistemological and ethical issues related to the use of race concepts in the genomics of sport performance and sport-related concussion (SRC). In the first part of the article, we show how the concept of race is ubiquitous in scientific literature, besides the fact that ‘race’ as other analogous population descriptors like ‘ancestry’ and ‘continent’ carry ancestral genetic heterogeneity and therefore they cannot be used to infer any kind of genetic or physiological property. Then, we investigate the question of whether genomics research focusing on racial categories and race-specific genes of sport performance and of risk of health outcomes due to repetitive head impacts (RHI) is justified from an epistemological point of view, arguing that it is not; we show that the evidence supporting the existence of genetic variants determining an elite athlete status or a predisposition to health outcomes after SRC is scarce, and the use of racial categories (e.g. African or Black, Caucasian or White, Asian, etc.) as proxies for genetic variants associated with an elite athlete status/a predisposition to health outcomes after SRC is ill-conceived. In the second part of the article, we analyze the main ethical issues concerning the reification of race concepts in sport genomics, also considering the more general issue of the ethical and social impact of the use of a genetic framework in the explanation of individual differences in sport performance and SRC.

Striking Differences in Kendo Headgear.

Kendo, a martial art developed by the samurai, is rooted deep in Japanese culture with traditional armor that has seen little change over the past centuries.Despite its century-old design, kendo helmets are manufactured without third-party testing to verify their quality and effectiveness against head trauma. To evaluate the effectiveness of different helmet stitching patterns and padding materials in mitigating impact forces that could lead to sports-related concussions (SRC) in kendo, and to assess variations in safety performance across different genders and kendo ranks (Dan and Kyu). We collected data from 10 kendo practitioners (six males and four females), analyzing over 4,000 strikes using shinai on a sensor-equipped mannequin. Various helmet stitching patterns (ranging from 2 mm to 9 mm) and padding types (polyurethane-based and different thicknesses of cotton-based pads) were tested under controlled conditions simulating realistic impacts encountered in kendo practice. The results indicated that helmets with wider stitching patterns (e.g. 8 mm and 9 mm) generally offered better energy absorption, exhibiting statistically significant lower mean g-forces with a 95% confidence interval compared to tighter patterns (2 mm, 4 mm, 6 mm, and 8 mm x 2 mm) (p < 0.001). Additionally, the polyurethane-based padding outperformed cotton-based padding by a statistically significant reduction of impact force (p < 0.001). Significant differences in striking force were also observed between genders and ranks, with male and higher-rank (Dan) practitioners delivering stronger impacts (both p < 0.001). This study highlights the critical influence of helmet stitching patterns and padding materials on the protective capabilities against concussions in kendo. Even though helmets with narrower stitching patterns cost more, helmets with wider stitching patterns and polyurethane padding material provide enhanced safety benefits. We do not know how the difference in striking force between genders and ranks affects the outcome of a kendo match.

An examination of social relations and concussion management via the blue card.

Initially developed by New Zealand Rugby in 2014, the Blue Card initiative in rugby enables match officials to remove athletes from play if they are suspected to have sustained a concussion. Considerable attention has been paid by sport and health advocates to the possibilities and limitations of this initiative in safeguarding athlete health. However, little if any attention has been paid to the well-being of those responsible for administering the Blue Card (i.e., match officials). The aim of this paper was to examine match officials' experiences with and perspectives on implementing the Blue Card initiative in Ontario, Canada, with focused attention on the tensions around their ability to manage games and participants (e.g., athletes, coaches) while attempting to safeguard athlete well-being. Using Relational Coordination Theory (RCT) as a guiding framework and qualitative research method, we highlight the rich accounts of 19 match officials' perspectives and experiences regarding sport-related concussion (SRC) management and the Blue Card protocol. Four themes were derived from the data, reflecting latent assumptions embedded within the concussion management process, which include: assumptions of trust, respect, and cooperation; assumptions of shared responsibility; assumptions of shared understanding; and assumptions of harassment-free sport. Our findings emphasize the need to attend to social relations in concussion management and provide insight into match officials' fraught experiences on the frontlines of concussion management. We identify factors affecting match official well-being and provide considerations for concussion management initiatives designed to improve athlete safety, such as the Blue Card.

CSP2023: 398 - Exploring multimodal Sports Related Concussion (SRC) assessment, performed by a single clinician compared to the reference standard (SCAT5)

CSP2023: 398 - Exploring multimodal Sports Related Concussion (SRC) assessment, performed by a single clinician compared to the reference standard (SCAT5)

Understanding Abnormal Examination Findings During Concussion Recovery: A Retrospective Chart Review.

Physical examination findings in athletes with sport-related concussion (SRC) are not well described in the literature. The objective of this study was to describe physical examination findings during the first month following concussion in athletes, with a focus on the effect of sex, age, and time since injury. This was a retrospective electronic medical record (EMR) review of physical examination findings in 500 patients aged 6-24 who were initially seen within 15 days of SRC at a multidisciplinary outpatient academic concussion clinic between 2017 and 2019. A standardized concussion examination built in the EMR recorded mental status, cranial nerve, vestibulo-ocular motor screen, and balance findings for all patients. The primary outcome was the frequency of abnormal examination findings during the first 30 days postinjury, which was further analyzed by sex, age, and time since injury using mixed logistic regression models. The most common abnormal examination findings overall were eyes-closed single-leg stance, vestibular-ocular reflex, visual motion sensitivity, the neck examination, and eyes-closed tandem stance. Abnormal findings were more frequent in female athletes for vestibular ocular reflex and visual motion sensitivity. The frequency of abnormal findings increased with age for vestibulo-ocular reflex, visual motion sensitivity, the neck examination, convergence testing, and eyes-open single-leg stance, whereas abnormalities decreased in frequency with age for eyes-open tandem stance and tandem gait. The frequency of abnormal findings generally decreased with time over the first 4 weeks following injury. A comprehensive physical examination is pivotal for evaluation of athletes with concussion. These findings highlight high-yield components of the concussion examination and support use of these examination components as injury markers. Future work should investigate associations between physical examination findings and postconcussion symptoms and recovery outcomes. This retrospective cohort study provides Class IV evidence that neurologic examination with specifically designed clinical tests are helpful for diagnosis of traumatic brain injury in young athletes at age 6-24.

The Prevalence and Influence of New or Worsened Neck Pain After a Sport-Related Concussion in Collegiate Athletes: A Study From the CARE Consortium

Background: Neck pain in a concussion population is an emerging area of study that has been shown to have a negative influence on recovery. This effect has not yet been studied in collegiate athletes. Hypothesis: New or worsened neck pain is common after a concussion (>30%), negatively influences recovery, and is associated with patient sex and level of contact in sport. Study Design: Cohort study; Level of evidence, 2. Methods: Varsity-level athletes from 29 National Collegiate Athletic Association member institutions as well as nonvarsity sport athletes at military service academies were eligible for enrollment. Participants completed a preseason baseline assessment and follow-up assessments at 6 and 24 to 48 hours after a concussion, when they were symptom-free, and when they returned to unrestricted play. Data collection occurred between January 2014 and September 2018. Results: A total of 2163 injuries were studied. New or worsened neck pain was reported with 47.0% of injuries. New or worsened neck pain was associated with patient sex (higher in female athletes), an altered mental status after the injury, the mechanism of injury, and what the athlete collided with. The presence of new/worsened neck pain was associated with delayed recovery. Those with new or worsened neck pain had 11.1 days of symptoms versus 8.8 days in those without (P < .001). They were also less likely to have a resolution of self-reported symptoms in ≤7 days (P < .001). However, the mean duration of the return-to-play protocol was not significantly different for those with new or worsened neck pain (7.5 ± 7.7 days) than those without (7.4 ± 8.3 days) (P = .592). Conclusion: This novel study shows that neck pain was common in collegiate athletes sustaining a concussion, was influenced by many factors, and negatively affected recovery.

A controlled early-exercise rehabilitation program commencing within 48 hours of a Sports-Related Concussion improves recovery in UK student-athletes: A prospective cohort study

ObjectivesExplore if implementing an individualised Sub-Symptom Heart Rate Threshold (SSHeRT) rehabilitation program within 48 hours versus physical rest for 14 days affects recovery following SRC in university-aged student-athletes. DesignProspective, observational cohort study. MethodsTwo UK university-aged student-athlete rugby union cohorts were compared (Physical Rest Group (PRG), n = 140, July 2019–March 2020 and Controlled Early-Exercise Group (CEG), n = 167, July 2021–April 2023). Both groups completed the test battery (Post-Concussion Symptom Scale (PCSS), Immediate Post-Concussion and Cognitive Test (ImPACT), Vestibular-Ocular Motor Screening Tool (VOMS)) during pre-season to provide a baseline and within 48 hours, at 4, 8, 14-days post-SRC and at Return to Play (RTP). The PRG (n = 42) physically rested for 14 days as per the nationwide community guidelines. The CEG (n = 52) followed the SSHeRT rehabilitation program. Individual change to baseline was used in all analyses. ResultsThe CEG performed better on ImPACT's verbal memory at 4 (PRG; −5.5 (−10.8–0.0), CEG; 1.0 (−2.0–10.5), p = 0.05) and 14 days (PRG; −2.0 (−10.0–3.0), CEG; 4.0 (−1.0–11.0), p = 0.05) and on the VOMS at 4 (PRG; 3.0 (0.0–12.0), CEG; 0.0 (0.0–5.0), p = 0.03, OR; 2.910) and 14-days post-SRC (PRG; 0.0 (0.0–1.0), CEG; 0.0 (0.0–0.0), OR; 5.914). Near point convergence was better at all time points for the CEG. The CEG was 26.7 % more likely to have RTP within 30 days, and 6.7 and 5.1 times more likely to have resumed non-contact and contact academic activities by 4 days. ConclusionsSSHeRT is safe, can be used within 48 hours of a SRC and may hasten university-aged student-athletes recovery following an SRC.

Examining the role of depression on the relationship between performance-based and self-reported cognitive functioning after sport-related concussion.

Little is known about the relationship between neuropsychological test performance, cognitive symptom reporting, and depressive symptoms after sport-related concussion. Accordingly, this cross-sectional study examined these relationships in collegiate athletes. It was hypothesized that depressive symptoms would moderate and mediate the relationship between performance-based and self-reported cognitive functioning after concussion. After sustaining a sport-related concussion, 110 collegiate athletes completed a neuropsychological battery, the Post-Concussion Symptoms Scale, and the Beck Depression Inventory-Fast Screen. Neuropsychological test performance, depressive symptoms, and their interactions were entered into distinct hierarchical linear regression analyses with self-reported cognition as the dependent variable to assess moderation. Mediation was analyzed using the PROCESS macro with 5000 bootstrap samples and a 95% confidence interval. There was a significant interaction between the mean memory composite and depressive symptoms when predicting cognitive symptom reporting, p = 0.047. Simple effects tests revealed that for athletes who had a lower memory composite score, an increase in depressive symptoms led to an increase in self-reported cognitive dysfunction, p < 0.001, ηp2 = 0.11. Depressive symptoms partially mediated the relationship between the memory composite and cognitive symptom reporting, indirect effect = -0.26, 95%CI[-0.58,0.001], but this relationship was not found for any other neurocognitive domain. For tests of memory, depressive symptoms moderated and partially mediated the relationship between performance-based and self-reported cognitive functioning after sport-related concussion. Athletes reporting high depressive symptoms and cognitive dysfunction may need more comprehensive evaluations to inform return-to-play decisions, and depression could be a treatment target for athletes who report high levels of cognitive dysfunction after concussion.

Examining Acute Symptoms After Sport-Related Concussion in Collegiate Athletes With Preinjury Migraines.

To examine whether a personal history of migraines is associated with worse acute symptom burden after sport-related concussion (SRC). Retrospective cohort study. National Collegiate Athletic Association Division III collegiate programs. Collegiate athletes from a prospective concussion surveillance system between 09, 2014, and 01, 2023. Preinjury migraines (yes/no) were self-reported by athletes. Post-Concussion Symptom Scale (PCSS) were collected within 3 days postinjury. Mann-Whitney U tests compared total PCSS scores and individual symptom scores between athletes with and without preinjury migraines. Chi-squared tests were used to compare proportions of athletes endorsing individual symptoms (ie, item score ≥1) between 2 groups. Multivariable regression analyzed potential predictors of PCSS scores. Of 1190 athletes with SRC, 93 (7.8%) reported a preinjury history of migraines. No significant difference in total PCSS scores was found between athletes with and without preinjury migraines (22.0 ± 16.4 vs 20.5 ± 15.8, U = 48 719.0, P = 0.471). Athletes with preinjury migraines reported greater severity of "sensitivity to light" (1.59 ± 1.59 vs 1.23 ± 1.41, P = 0.040) and "feeling more emotional" (0.91 ± 1.27 vs 0.70 ± 1.30; P = 0.008) and were more likely to endorse "feeling more emotional" (45.2% vs 29.5%, P = 0.002). No differences were found across all other symptoms, including headaches (migraine = 87.1% vs no migraine = 86.3%, P = 0.835). In a multivariable model, a history of migraine was not a significant predictor of acute PCSS scores, but those with a history of psychological disorders (β = 0.12, P <0 .001) and greater number of days to symptom evaluation (β = 0.08, P = 0.005) had higher PCSS scores. Collegiate athletes with a pre-existing history of migraines did not have higher acute symptom burden after SRC.

Symptom Exacerbation and Adverse Events during a Randomized Trial of Early-stage Concussion Rehabilitation.

Few studies utilize randomized clinical trials (RCT) to quantify clinical intervention safety of rehabilitation after sport-related concussion across sport levels. Describe symptom exacerbation and adverse events (AEs) associated with two concussion rehabilitation interventions. Cluster Randomized Controlled Trial (XXX). Sports medicine clinic and field settings. The RCT enrolled 251 concussed athletes (median age=20 years; female n=48) across 28 sites from New Zealand professional rugby (n=31), Canadian professional football (n=52), United States (U.S.)/Canadian colleges (n=128) and U.S. high schools (n=40). Two medically supervised interventions: 1) Enhanced Graded Exertion (EGE): international return to sport strategy and sport specific activities only (EGE-only n=119) and 2) Multidimensional Rehabilitation (MDR) followed by EGE: early symptom-directed exercises once symptoms were stable, followed by EGE after symptoms resolved (MDR+EGE n=132). Primary outcomes were intrasession total symptom severity score exacerbation and significant intersession (increase 10+ severity points) sustained total symptom severity exacerbation, each measured with a Postconcussion Symptom Scale (132 total severity points on scale). Reported AEs were also described. Activity-based rehabilitation sessions (n=1437) were the primary analysis unit. Frequencies, proportions, medians, and Interquartile Ranges (IQRs) were calculated for outcomes by treatment group. The 251 post-injury participants completed 1437 (MDR+EGE=819, EGE-only=618) activity-based intervention sessions. A total of 110 and 105 participants contributed data (those missing had no documented session data) to at least 1 activity-based session in the MDR+EGE and EGE-only arms respectively. Intrasession symptom exacerbations were equivilantly low in MDR+EGE and EGE-only arms (MDR+EGE: 16.7%, 95% CI:14.1%,19.1%; EGE-only: 15.7%, 95% CI: 12.8%,18.6%). In total, 9/819 MDR+EGE sessions (0.9%) and 1/618 EGE-only sessions (0.2%) resulted in a pre- to post-session symptom exacerbation beyond a 10+ severity point increase; 8/9 resolved to <10 points by the next session. Two study-related AEs (1 in each arm) were reported. Participants in MDR+EGE and EGE-only activities reported equivalently low rates of symptom exacerbation.

A Perspective on the 6th International Conference on Sports Concussion.

The International Conference on Sports Concussion, held every four years since 2001, has been instrumental in forming the international consensus on sports-related concussions. However, due to the unprecedented global pandemic of COVID-19, not only the Tokyo Olympics 2020, but also the initially scheduled sixth conference was postponed multiple times. Finally, the 6th International Conference on Sports Concussion took place in Amsterdam at the end of October 2022. In July 2023, the Amsterdam Declaration, reflecting the outcomes of this sixth conference, was released. This paper provides an overview of the conference, in which significant updates were revealed and introduced, including revisions to the definition of sports-related concussions, as well as the latest version of the Sports Concussion Assessment Tool (SCAT), known as SCAT6, the Office Assessment Tool (SCOAT), and the updated staged return-to-play protocol.

A treadmill running research protocol to assess dynamic visual acuity and balance for athletes with and without recent concussion history

Athletes interpret dynamic visual scenes quickly and accurately during physical exertion. It is important to understand how increased exertion may impact vision and cognition following sport-related concussion (SRC).Purpose To examine the effect of a treadmill running research protocol on the assessment of dynamic visual acuity (DVA) and balance for athletes with and without recent history of SRC.Methods Varsity athletes following recent SRC (CONC=12) were compared to athletes without SRC (ATHLETE=19). The DVA task presented a Tumbling ‘E’ target in four possible orientations during random walk (RW) or horizontal (H) motion at a speed of 30°/s. Participants performed DVA trials standing on a force plate (1000Hz) at four time points: 1) pre-exercise (PRE-EX), 2) immediately (POST1), 3) 10-minutes (POST10), and 4) 20-minutes post- exercise (POST20). Performance was calculated as a change in DVA score from PRE-EX and median response time (RT, ms). Balance control was analyzed using the root mean square of centre of pressure displacement (dCOP).Results Both groups maintained DVA scores for both motion types and exhibited immediate exercise-induced benefits on RT. Both groups had similar change in balance control strategy following treadmill exercise.Conclusion Both groups elicited similar exercise-induced benefits on DVA following exercise. A repeated measures assessment following vigorous exercise may provide meaningful insights about visual and neurocognitive functions for athletes returning to sport following concussion.

Retraction: Paediatric sport related concussion pilot study

Retraction: Paediatric sport related concussion pilot study

Navigating uncertainty: exploring parents' knowledge of concussion management and neuropsychological baseline testing.

Parents play an important role in preventing and managing sport-related concussions among youth sport participants. Research indicates that parents understand the severity and consequences associated with the injury but gaps exist in their knowledge of its management. Neuropsychological baseline testing (NBT) is a modality that has gained interest in youth sport to purportedly better manage concussion injuries. Little is known about parents' perspectives on the use of NBT in the management process. The present qualitative study used Protection Motivation Theory as a guiding framework and employed focus groups (N = 2) with parents (N = 11) to gain insight into parents' perceptions and experiences with concussion management, specifically focusing on NBT. Inductive Content Analysis developed a core theme of navigating uncertainty. Participants expressed uncertainty about the nature of concussion and its management process, where concussion was not always easy to identify, youth were not always reliable reporters, and there was no prescribed or proscribed path for recovery. Personal experience and concussion management policy provided participants with a degree of certainty in managing concussions. Participants gave NBT mixed reviews in potentially promoting greater certainty but also held reservations about its usefulness in concussion management. We discuss findings relative to existing knowledge and theory in youth sport concussion and identify implications for practice.