Preseason Symptom Reporting and Cognition in Middle School Athletes with Past Concussions

2022 ◽  
Author(s):  
Grant L. Iverson ◽  
Paul D. Berkner ◽  
Ross Zafonte ◽  
Bruce Maxwell ◽  
Douglas P. Terry
Keyword(s):  
Visual Memory ◽  
Cognitive Testing ◽  
Symptom Reporting ◽  
Symptom Scale ◽  
Health History ◽  
School Sports ◽  
History Of ◽  
Concussion History ◽  
Composite Scores ◽  
The Impact

AbstractThis study examined the association between past concussions and current preseason symptom reporting and cognitive performance in 9,257 youth ages 11–13. Participants completed neurocognitive testing prior to participating in a school sports between 2009 and 2019. We stratified the sample by gender and number of prior concussions and assessed group differences on the Post-Concussion Symptom Scale total score and the ImPACT cognitive composite scores. Those with≥2 prior concussions reported more symptoms than those with 0 concussions (d=0.43–0.46). Multiple regressions examining the contribution of concussion history and developmental/health history to symptom reporting showed the most significant predictors of symptoms scores were (in descending order): treatment for a psychiatric condition, treatment for headaches, history of learning disability (in boys only), history of attention-deficit/hyperactivity disorder, and age. Concussion history was the weakest statistically significant predictor in boys and not significant in girls. Cognitively, boys with 1 prior concussion had worse speed those with 0 concussions (d=0.11), and girls with≥2 prior concussions had worse verbal/visual memory than girls with 0 concussions (ds=0.38–0.39). In summary, youth with≥2 prior concussions reported more symptoms than those with no concussions. Boys with multiple concussions performed similarly on cognitive testing, while girls had worse memory scores.

A-14 Mechanisms and Neuropsychological Correlates of Sleep Disruption in Concussed College Athletes

2021 ◽  
Vol 36 (6) ◽  
pp. 1036-1036
Author(s):  
Kaitlin E Riegler ◽  
Erin T Guty ◽  
Garrett A Thomas ◽  
Megan Bradson ◽  
Peter A Arnett
Keyword(s):  
Memory Performance ◽  
Neuropsychological Testing ◽  
Cognitive Testing ◽  
Symptom Reporting ◽  
Sleep Disruption ◽  
Neuropsychological Battery ◽  
Symptom Scale ◽  
Concussion Management ◽  
Falling Asleep ◽  
Concussion History

Abstract Objective First, to explore demographic/injury characteristics associated with increased sleep disruption post-concussion. Second, to examine the association between sleep disruption post-concussion and symptom reporting and cognitive variability. Method 124 athletes (M = 103, F = 21) completed neuropsychological testing within 14 days of concussion. Athletes were categorized as sleep-disrupted (n = 52) or not sleep-disrupted (n = 72). Athletes in the sleep-disrupted group endorsed one or more of the following from the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) Post-Concussion Symptom Scale (PCSS): trouble falling asleep, sleeping more than usual, and sleeping less than usual. Loss of consciousness (LOC) and concussion history were explored. Two neurocognitive variability measures were derived from the neuropsychological battery: intraindividual standard deviation (ISD) and maximum discrepancy score (MDS). Variability in memory and attention/processing speed (APS) composites were explored. Total PCSS symptom score, without sleep items, was calculated. Results A significantly greater proportion of sleep-disrupted athletes experienced LOC (30%) compared to not sleep-disrupted athletes (13%), χ2(1,N = 118) = 4.99, p < 0.03, φ = 0.21. Sleep-disrupted athletes reported more symptoms, t(122) = −5.42, p < 0.001, d = 0.98, and demonstrated more memory variability (memory ISD, t(122) = −2.22, p = 0.03, d = 0.40, and memory MDS, t(122) = −2.29, p = 0.02, d = 0.41) than not sleep-disrupted athletes. Groups did not differ in APS variability or concussion history. Conclusions Given the higher rate of LOC in sleep-disrupted athletes, it is possible that LOC is a mechanism leading to post-concussion sleep difficulties. Furthermore, sleep disruption following concussion results in more variable memory performance and higher symptom reporting. Symptom reporting and/or return to baseline cognitive functioning are often decision-making tools in concussion management. The difficulties experienced by sleep-disrupted athletes may complicate recovery.

scholarly journals A-110 Are Invalid Baselines More Frequent in those with Concussion History?

2020 ◽  
Vol 35 (6) ◽  
pp. 903-903
Author(s):  
Maietta J ◽  
Hopkins N ◽  
Maietta L ◽  
Flood S ◽  
Johnson L ◽  
...  
Keyword(s):  
High School ◽  
Test Performance ◽  
Impact Testing ◽  
Cognitive Testing ◽  
Return To Play ◽  
Future Research ◽  
High School Athletes ◽  
History Of ◽  
Concussion History ◽  
The Impact

Abstract Objective The Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) is a commonly utilized measure for sports concussion. Across the literature we have reviewed there is an abundance of information that focuses on invalid baselines and the effects of concussions. Yet, no previous studies have investigated the effect of a history of concussion on frequency of invalid baselines. The current study examined these effects within high school athletes. Methods Participants included 47,874 high school athletes (mean age = 15.0, SD = 1.2; mean education = 9.0; SD = 1.5; 42.6% female). These athletes were selected from a larger database of athletes who completed baseline ImPACT testing from 2008–2016. Self-reported history of concussion (none vs. 1+) was obtained from the demographic section of the ImPACT. Invalid performance was based on standard ImPACT criteria (“Baseline++”). Results Chi-square tests of homogeneity were performed to assess differences in invalid baselines between those with and without a history of concussion. Results revealed significantly more invalid baselines for those with a history of concussion (p < .01). Conclusions Results indicate that high school athletes with a self-reported history of concussion may be more likely to have invalid baseline test performance. Based on these preliminary results, clinicians who are managing return-to-play decisions may want to take into account concussion history when interpreting baseline data. Future research should, of course, investigate whether this result is consistent in other samples and, if so, whether alternative validity criteria may be needed. Future investigations of athletes with confirmed clinical diagnosis of concussion is an important next step in investigating differences in rates of invalid baselines.

B-64 Symptom Reporting and Cognitive Functioning in Middle School Athletes with Past Concussions

2019 ◽  
Vol 34 (6) ◽  
pp. 1011-1012
Author(s):  
D Terry ◽  
B Maxwell ◽  
R Zafonte ◽  
P Berkner ◽  
G Iverson
Keyword(s):  
Learning Disability ◽  
Mental Health Problems ◽  
Cognitive Testing ◽  
Symptom Reporting ◽  
Prior History ◽  
Motor Speed ◽  
Significant Independent Predictor ◽  
Significant Difference ◽  
History Of ◽  
Concussion History

Abstract Objective We examined the association between past concussions and current preseason symptom reporting and cognitive performance in boys participating in school sports. Method A sample of 2,582 boys ages 11-13 completed neurocognitive testing prior to participating in a school sport, using ImPACT®, between 2009-2015. A minority reported prior concussions: 0 (n = 2,244, 86.9%), 1 (n = 261, 10.1%), and ≥2 (n = 77, 3.0%). Results There was a significant difference in total symptom scores across groups (Kruskall-Wallis = 10.75, p = .005). Those with ≥2 prior concussions reported more symptoms than those with 0 concussions (p = .004, Cohen’s d = 0.41). A multivariate regression examining the contribution of concussion history and developmental/health history to symptom reporting was significant [F(7, 2,267) = 16.80, p < .001]. The following were independent predictors of symptoms scores (in descending order of strength): treatment for a psychiatric condition, treatment for headaches, history of learning disability, age, and history of ADHD. Prior concussion history was not a significant independent predictor in this multivariate model. There was a very small omnibus difference in visual motor speed (ANOVA, F = 4.10, p = .02); athletes with 1 prior concussion performed worse than those with no prior concussions (Tukey p = .01; d = 0.19). There were no significant differences on the other cognitive variables. Conclusions Boys with two or more prior concussions reported more symptoms than those with no prior concussions, but performed similarly on cognitive testing. The strongest predictors of current symptom reporting were a prior history of treatment for mental health problems or headaches, and a personal history of learning disability.

scholarly journals Do Sideline Concussion Assessments Predict Subsequent Neurocognitive Impairment After Sport-Related Concussion?

2017 ◽  
Vol 52 (7) ◽  
pp. 676-681 ◽  
Author(s):  
Alicia Sufrinko ◽  
Jamie McAllister-Deitrick ◽  
Melissa Womble ◽  
Anthony Kontos
Keyword(s):  
High School ◽  
Verbal Memory ◽  
Visual Memory ◽  
Standard Of Care ◽  
Cognitive Testing ◽  
Assessment Tools ◽  
Motor Speed ◽  
Neurocognitive Testing ◽  
Symptom Scale ◽  
The Impact

Context:  Comprehensive, multidomain assessment is the standard of care after sport-related concussion. However, the relationship between performance on sideline concussion-assessment tools and in-office computerized neurocognitive testing has received little attention, and the prognostic utility of sideline measures is unknown. Objective:  To evaluate concurrent impairment on commonly used concussion measures 24 to 48 hours postinjury while also determining the predictive utility of sideline measures on computerized neurocognitive testing in the acute to subacute recovery periods postinjury. Design:  Case-control study. Setting:  High school and collegiate athletics. Patients or Other Participants:  A total of 125 high school and college-aged athletes (85 males, 40 females) 14 to 23 (16.8 ± 2.21) years old. Main Outcome Measure(s):  Participants were administered sideline concussion-assessment measures (ie, Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT], Standardized Assessment of Concussion [SAC], and Balance Error Scoring System [BESS]) 24 to 48 hours postinjury and completed ImPACT and the Post-Concussion Symptom Scale 5 to 7 and 10 to 14 days postinjury. Outcome measures were the ImPACT composite (verbal memory, visual memory, reaction time, visual-motor speed), SAC, and BESS scores and total symptom score on the Post-Concussion Symptom Scale. Results:  Participants demonstrated heterogeneous patterns of impairment on measures 24 to 48 hours postinjury, with the most common pattern being impairment on ImPACT and the SAC. Performance on the SAC and BESS at 24 to 48 hours after injury did not distinguish between those with and those without impairment on ImPACT at 5 to 7 days postinjury (χ2 = 5.076, P = .079) or 10 to 14 days postinjury (χ2 = 2.04, P = .361). Conclusions:  More than 90% of athletes were impaired on at least 1 sideline or neurocognitive measure 24 to 48 hours after sport-related concussion. Although sideline measures are useful for concussion diagnosis, they are not suitable for prognostication of impairment or the presence of symptoms 1 to 2 weeks postinjury.

Multivariate Base Rates of Low Scores and Reliable Decline on ImPACT in Healthy Collegiate Athletes Using CARE Consortium Norms

2019 ◽  
Vol 25 (09) ◽  
pp. 961-971 ◽  
Author(s):  
Zac M. Houck ◽  
Breton M. Asken ◽  
Russell M. Bauer ◽  
Anthony P. Kontos ◽  
Michael A. McCrea ◽  
...  
Keyword(s):  
Collegiate Athletes ◽  
Cognitive Testing ◽  
Chi Square ◽  
Reliable Change ◽  
Black African ◽  
Hyperactivity Disorder ◽  
Base Rates ◽  
African American Athletes ◽  
Concussion History ◽  
Composite Scores

AbstractObjectives: To describe multivariate base rates (MBRs) of low scores and reliable change (decline) scores on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in college athletes at baseline, as well as to assess MBR differences among demographic and medical history subpopulations. Methods: Data were reported on 15,909 participants (46.5% female) from the NCAA/DoD CARE Consortium. MBRs of ImPACT composite scores were derived using published CARE normative data and reliability metrics. MBRs of sex-corrected low scores were reported at &lt;25th percentile (Low Average), &lt;10th percentile (Borderline), and ≤2nd percentile (Impaired). MBRs of reliable decline scores were reported at the 75%, 90%, 95%, and 99% confidence intervals. We analyzed subgroups by sex, race, attention-deficit/hyperactivity disorder and/or learning disability (ADHD/LD), anxiety/depression, and concussion history using chi-square analyses. Results: Base rates of low scores and reliable decline scores on individual composites approximated the normative distribution. Athletes obtained ≥1 low score with frequencies of 63.4% (Low Average), 32.0% (Borderline), and 9.1% (Impaired). Athletes obtained ≥1 reliable decline score with frequencies of 66.8%, 32.2%, 18%, and 3.8%, respectively. Comparatively few athletes had low scores or reliable decline on ≥2 composite scores. Black/African American athletes and athletes with ADHD/LD had higher rates of low scores, while greater concussion history was associated with lower MBRs (p &lt; .01). MBRs of reliable decline were not associated with demographic or medical factors. Conclusions: Clinical interpretation of low scores and reliable decline on ImPACT depends on the strictness of the low score cutoff, the reliable change criterion, and the number of scores exceeding these cutoffs. Race and ADHD influence the frequency of low scores at all cutoffs cross-sectionally.

Earliest historic reference of ’tinnitus’ is controversial

2004 ◽  
Vol 118 (7) ◽  
pp. 487-488 ◽  
Author(s):  
S. Dietrich
Keyword(s):  
Ancient Egypt ◽  
Point Of View ◽  
Historical Period ◽  
Common Phenomenon ◽  
Original Source ◽  
The Past ◽  
Health History ◽  
History Of ◽  
The Impact ◽  
Modern Status

Tinnitus, that is defined as ’ringing in the ear’, is and has probably always been a very common phenomenon in the health history of mankind. A variety of pathomechanisms for its onset has been proposed in the past and this trend sees no stopping. Precise pathomechanisms still remain unclear. From the historical point of view, tinnitus is a very interesting topic but there is a lack of scientific enquiries. As its earliest historic reference, the Papyrus Ebers is often cited. By reviewing the original source, however, it is very unlikely that this contains the earliest historic reference of tinnitus. It is rather likely indeed that tinnitus was a known symptom in the ancient Egypt but it has never been exclusively been written down. This article reviews data provided by this fascinating historical period on the questionable reference and highlights the impact of history on the modern status of tinnitus.

scholarly journals A community-engaged protocol for evaluating environmental toxicants in a U.S. border community: the public health impacts of perchlorate and pesticide exposure (Preprint)

2019 ◽  
Author(s):  
Robert Trotter II ◽  
Julie Baldwin ◽  
Charles Loren Buck ◽  
Mark Remiker ◽  
Amanda Aguirre ◽  
...  
Keyword(s):  
Animal Model ◽  
Toxic Metal ◽  
Clinical Population ◽  
Metal Exposure ◽  
Mechanisms Of Toxicity ◽  
Health History ◽  
Access To Health ◽  
History Of ◽  
Local Water ◽  
The Impact

BACKGROUND The Northern Arizona University (NAU) Center for Health Equity Research (CHER) is conducting community-engaged health research “environmental toxicant scans” in the Yuma County (Yuma, Somerton, San Luis) regions in collaboration with community health stakeholders including the Yuma Regional Medical Center (YRMC), the Regional Center for Border Health, Inc. (RCBH), Campesinos sin Fronteras (CSF), the Yuma County Public Health District, and government agencies and NGO’s working on border health issues. OBJECTIVE We set out to construct a joint community/university effort to examine human exposures to the water-soluble contaminant perchlorate and to agricultural pesticides. This project includes development of a new animal model for investigation of mechanisms of toxicity following a “one health” approach. The ultimate goal of this community-engaged effort is to develop interventions to reduce exposures and health impacts of contaminants in Yuma populations. METHODS All participants completed the informed consent process, which included information on the purposes of the study, a request for access to health history and medical records data, and an interview. The interview included questions related to: 1) demographics, 2) social determinants of health, 3) health screening (e.g., family history of diseases), 4) occupation and environmental exposure to perchlorate and pesticides, and 5) access to health services. Each participant provided a hair sample for quantification of metals used in pesticides, a urine sample for perchlorate quantification, and a blood sample for endocrine assays. Data are modeled with measured levels of contaminants and hormones, and health status of the clinical population; data from the clinical population are compared to results from the general population. In parallel, an animal model for the impact of perchlorate and toxic metal exposure is being established through the collection of rodents that live near residences, farms, and local water sources. RESULTS We recruited, consented, enrolled, and surveyed 323 adults currently residing in Yuma County over a period of one year. One hundred and forty-seven residents are patients from either YRMC or RCBH with a primary diagnosis of thyroid disease, including hyperthyroidism, hypothyroidism, thyroid cancer, or goiter. The remaining 176 participants are from the general population but with no history of thyroid disorder. All participants completed the informed consent process, which included information on the purposes of the study, a request for access to health history and medical records data, and an interview. In parallel, an animal model for the impact of perchlorate and toxic metal exposure is being established through the collection of rodents that live near residences, farms, and local water sources. We are measuring perchlorate and toxic metals in tissues and examining the same health outcomes as with people (endocrine disruption), plus organ-specific histopathology, gene expression, and lipid accumulation. CONCLUSIONS Findings will elucidate mechanisms of toxicity and the population health effects of contaminants, as well as provide a new animal model to develop precision medicine capabilities for the population. CLINICALTRIAL not a clinical trial

scholarly journals Preseason Baseline Neurocognitive Performances and Symptom Reporting on ImPACT®: A Comparison of Adolescent Student-Athletes Tested in Spanish and English

2020 ◽  
Author(s):  
Justin E. Karr ◽  
Mauricio A. Garcia-Barrera ◽  
Jacqueline M. Marsh ◽  
Bruce Maxwell ◽  
Paul D. Berkner ◽  
...  
Keyword(s):  
Symptom Severity ◽  
Student Athletes ◽  
Symptom Reporting ◽  
Group Differences ◽  
Language Group ◽  
Motor Speed ◽  
Language Groups ◽  
Baseline Testing ◽  
Composite Scores ◽  
The Impact

Abstract Context: Student-athletes are commonly administered the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®) battery at preseason baseline and post concussion. The ImPACT® is available in many different languages, but few studies have examined differences in cognitive performances and symptom ratings based on language of administration. Objective: This study examined differences on ImPACT® neurocognitive composites and symptom reporting at preseason baseline testing between student-athletes completing ImPACT® in Spanish versus English. Design: Cross-sectional study. Setting: Preseason baseline testing for a high school concussion management program in STATE-XXX. Patients of Other Participants: Adolescent student-athletes completing testing in Spanish (n=169) and English (n=169) were matched on age, gender, and health/academic history. Language groups were compared on each outcome for the full sample and for gender-stratified subsamples. Main Outcome Measure(s): Neurocognitive composite scores and individual and total symptom severity ratings from the ImPACT® battery. Results: Athletes tested in Spanish had lower neurocognitive performances on two of five composite scores (i.e., Visual Motor Speed, p&lt;.001, d=.51; Reaction Time: p=.004, d=.33) and reported greater symptom severity (p&lt;.001, r=.21). When analyses were stratified by gender, similar Visual Motor Speed differences were observed between language groups among boys (p=.001, d=.49) and girls (p=.001, d=0.49), whereas Reaction Time showed a larger group difference for boys (p=.012, d=.42) than girls (p=.128, d=.21). Language group differences in symptom reporting were similar for boys (p=.003, r=.22) and girls (p=.008, r=.21), with more frequent endorsement of physical and affective symptoms by athletes tested in Spanish. Conclusions: Language group differences in total symptom severity were small (r=.21), and language group differences in neurocognitive performances were small-to-medium (d=.05–.51). Compared to previous studies comparing athletes tested in Spanish and English on ImPACT®, smaller effects were observed in the current study, which may be attributable to close matching on variables related to neurocognitive performances and symptom reporting. Key points:

scholarly journals The Impact of a Community Pharmacy Diabetes Self-Management Education Program on Diabetes Distress

2018 ◽  
Vol 35 (1) ◽  
pp. 3-10 ◽  
Author(s):  
Morgan L. Machen ◽  
Hamilton C. Borden ◽  
Kenneth C. Hohmeier
Keyword(s):  
Community Pharmacy ◽  
Management Education ◽  
Information Age ◽  
Retrospective Chart Review ◽  
Self Management ◽  
Diabetes Distress ◽  
Health History ◽  
Scale Scores ◽  
History Of ◽  
The Impact

Background: Negative psychosocial implications stemming from the presence of diabetes, known as diabetes distress, place people with diabetes at twice the likelihood of having clinical depression than those who do not have the disease. While many community pharmacies have incorporated diabetes self-management education (DSME) programs into their practices, there are no known studies that evaluate the impact that this model may have on diabetes distress. Objective: The purpose of this study is to evaluate the impact that a community pharmacy DSME program has on diabetes distress. Methods: Retrospective chart review for pre- and post-DSME Problem Areas in Diabetes scale scores, pertinent health history (type and duration of diabetes, A1C, and medications), and demographic information (age, gender) of patients who completed Blount Discount Pharmacy’s DSME program. Data were analyzed using descriptive and inferential statistics. Results: Of the 17 charts that were reviewed, there was an overall decrease in Problem Areas in Diabetes scale scores from baseline ( P = .029). Greater reduction was observed in patients with a long-standing history of diabetes compared with those who were diagnosed with diabetes within the previous 12 months of DSME. Conclusions: The findings suggest that a community pharmacy DSME program may reduce diabetes distress and warrant future study.

scholarly journals DIVERGENT INTERPRETATION OF POST-CONCUSSIVE SYMPTOMS BETWEEN PARENT AND CHILD

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0009
Author(s):  
Jennifer Kieschnick ◽  
Ben Seagraves ◽  
Holly Nieman ◽  
Todd Caze
Keyword(s):  
Parent Education ◽  
Self Report ◽  
Symptom Reporting ◽  
Symptom Scale ◽  
Injured Child ◽  
Age Appropriate ◽  
Report Symptom ◽  
The Impact ◽  
Insight Into ◽  
Symptom Rating

Background: Self-report symptom scales are often given to both parents and the injured child to rate a child’s symptoms following concussion. Previous research has shown that individual symptom reporting may not reflect agreement between parent and child. While total calculated scores may reflect agreement, looking at the total number of items reported may provide more insight into consistency between parent and child symptom rating following concussion. Purpose/Hypothesis: To evaluate the degree of divergence in post-concussive symptom reporting between parent and child. It was hypothesized the parent would endorse their child as having more symptoms following their concussion than self-reported by the child. Methods: The concussed child and their parent completed the Post-Concussion Symptom Inventory (PCSI), a self-reported concussion symptom scale to document symptoms related to the injury. The concussed child completed the age-appropriate version (8-12 years-old or 13-18 years-old) of the PCSI while the parent reported their perception of symptoms experienced by the child. The parent version of PCSI has 26 items, the adolescent version has 25 items, and the child version has 23 items. The total number of symptoms endorsed were calculated by recoding each symptom as a 0 or 1 variable to account for the item differences on the scales. A difference in total items reported, between parent and child as well as parent and adolescent PCSI, were calculated. Results: A total of 36 patients, 15 males and 21 females aged 8-18 (13.8±12.1 years), filled out the PCSI with 10 patients filling out the 8-12 years-old version and 26 filling out the 13-18 years-old version. The 10 parents of children ages 8-12, endorsed 2.9±2.7 more concussion symptoms. Of the 26 parents to adolescents ages 13-18, 1.08±6.28 more concussion symptoms were reported. Conclusion: Current results suggest the parents endorse their child experiencing more symptoms following their concussion than what is self-reported by the child. A future study to investigate the impact of parents’ elevated PCSI score(s) (i.e. total score or endorsed items) when compared to patient’s duration of recovery is recommended. This research would provide more comprehensive guidelines for recovery by means of patient and parent education.

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