scholarly journals STEP UP! LESS PHYSICAL ACTIVITY AFTER CONCUSSION IS ASSOCIATED WITH PROLONGED CLINICAL RECOVERY AMONG ADOLESCENTS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0003
Author(s):  
Corrine N. Seehusen ◽  
Julie C. Wilson ◽  
Gregory A. Walker ◽  
Sarah E. Reinking ◽  
David R. Howell
Keyword(s):  
Physical Activity ◽  
Classification Accuracy ◽  
Activity Level ◽  
Return To Play ◽  
Initial Visit ◽  
Adolescent Athletes ◽  
Post Injury ◽  
Concussion Management ◽  
Clinical Recovery ◽  
Concussion Recovery

Background: While many adolescent athletes recover from concussion within one month, some will not recover within this timeframe. Concussion management guidelines have evolved to de-emphasize rest and promote early re-introduction of sub-symptomatic physical activity. However, the optimal levels of physical activity during concussion recovery have yet to be determined. Hypothesis/Purpose: To investigate the association between quantity, frequency and intensity of physical activity after concussion with clinical recovery, defined as return-to-play (RTP) clearance from their physician. Methods: We conducted an observational, prospective cohort study of 26 youth athletes who sustained a concussion and were evaluated at two time points: initial visit (<14 days post-injury) and RTP clearance visit. Participants reported concussion symptoms using the Post-Concussion Symptom Inventory (PCSI). Participants wore an activity tracking device for the first two weeks after initial visit. This allowed us to quantify average steps/day, exercise frequency (average workouts/week), exercise duration (average time/workout), and exercise intensity (average/maximum HR during workouts). We grouped participants by clinical recovery timing (RTP <28 days vs. ≥28 days post-injury) and compared physical activity measures using independent samples t-tests. We then identified the sensitivity, specificity, and classification accuracy of cutpoints for each exercise variable using a Receiver Operating Characteristic (ROC) and Area under the Curve (AUC) analysis. Results: Half (n=13) of the participants required ≥28 days to receive RTP clearance. The two groups were similar in age, proportion of females, and past concussion history (Table 1). Those who required ≥28 days for RTP clearance reported significantly greater symptom severity at the initial examination than the RTP <28 days group, despite similar initial visit timing (Table 1). During the two weeks after the initial visit, the RTP ≥28 days group took fewer steps/day, exercised fewer days/week, and exercised fewer total minutes/week (Table 2). Among the activity/exercise variables examined, the highest classification accuracy between groups consisted of ≥9,100 average steps/day, ≥4 sessions/week, and spending ≥135 total minutes/week exercising (Table 3). Conclusion: Higher daily step counts and more frequent/longer exercise sessions were associated with clearance for RTP within 28 days from concussion in adolescent athletes. These preliminary results further support the benefit of physical activity during concussion recovery. However, our study cannot assess the causal effect of these findings, given that those who felt better earlier may have been willing to participate in more physical activity. Further research is needed to develop duration-, frequency- and intensity-specific physical activity level guidelines to aid clinicians in concussion management. [Table: see text][Table: see text][Table: see text]

scholarly journals More Physical Activity after Concussion Is Associated with Faster Return to Play among Adolescents

2021 ◽  
Vol 18 (14) ◽  
pp. 7373
Author(s):  
Corrine N. Seehusen ◽  
Julie C. Wilson ◽  
Gregory A. Walker ◽  
Sarah E. Reinking ◽  
David R. Howell
Keyword(s):  
Physical Activity ◽  
Return To Play ◽  
Post Injury ◽  
Exercise Frequency ◽  
Early Introduction ◽  
Youth Athletes ◽  
Concussion Management ◽  
Concussion History ◽  
Concussion Recovery ◽  
Optimal Quantity

Concussion management has evolved to de-emphasize rest in favor of early introduction of post-injury physical activity. However, the optimal quantity, frequency and intensity of physical activity are unclear. Our objective was to examine the association between objective physical activity metrics and clinical recovery after concussion. We prospectively enrolled a cohort of 32 youth athletes with concussion, evaluated within 14 days of injury and after return-to-play (RTP) clearance. For two weeks after enrollment, we quantified steps/day and exercise frequency, duration, and intensity via wrist-worn actigraphy. We grouped participants by RTP clearance timing (<28 days vs. ≥28 days). Seventeen (53%) participants required ≥28 days post-concussion for RTP clearance. Groups were similar in age (14.9 ± 1.9 vs. 15.4 ± 1.5 years; p = 0.38), proportion of females (47% vs. 40%; p = 0.69), and concussion history (59% vs. 47%; p = 0.49). During the study period, the RTP ≥ 28 days group took fewer steps/day (8158 ± 651 vs. 11,147 ± 4013; p = 0.02), exercised fewer days/week (2.9 ± 2.4 vs. 5.0 ± 1.9 days/week; p = 0.01), and exercised fewer total minutes/week (117 ± 122 vs. 261 ± 219 min/week; p = 0.03). Furthermore, we observed ≥10,251 average steps/day, ≥4 exercise sessions/week, and exercising ≥134 total minutes/week were optimal cutpoints to distinguish between groups. These findings support the benefit of physical activity during concussion recovery.

scholarly journals Preliminary Evidence-Based Recommendations for Return to Learn: a novel pilot study tracking concussion recovery in college students

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S33.3-S34
Author(s):  
Zachary Bevilacqua ◽  
Mary Kerby ◽  
David Fletcher ◽  
Zhongxue Chen ◽  
Becca Merritt ◽  
...  
Keyword(s):  
Physical Activity ◽  
Longitudinal Design ◽  
Text Messages ◽  
Return To Play ◽  
Evidence Based ◽  
Full Time ◽  
Symptom Resolution ◽  
Phone Calls ◽  
Return To Learn ◽  
Concussion Recovery

ObjectiveInvestigate the potential factors influencing resolution of chief concussion symptoms in a longitudinal design. Second, assess subjects’ perception of their concussion recovery and what types of activities and accommodations appeared beneficial.BackgroundAthletes re-entering the academic setting after a concussion is commonly referred as return-to-learn (RTL), which has appeared secondary to the abundantly researched return-to-play protocols implemented ubiquitously. Importantly, every concussed collegiate, adolescent, and pediatric athlete is first and foremost a student-athlete, with “student” holding the emphasis. To date, very few studies have examined the RTL aspect of concussion recovery, and the effects premature classroom attendance may cause.Design/MethodsNine concussed, college aged (18-26 years), full-time students were monitored longitudinally throughout their recovery from diagnosis to full symptom-free academic participation. Symptom severity for five prevalent symptoms were recorded 4 times per day, along with a daily phone call to report participant’s diet, duration of screen-time usage and music listened to, physical activity participation, and types of classes attended.ResultsResponse rates to text messages and phone calls yielded a mean 92% and 93% respectively across the nine subjects. Additionally, five variables were significantly associated with symptom resolution (music, sleep, physical activity, water, and time) (p = 0.0004 to p = 0.036). Lastly, subjects reported math and computer-oriented courses as the most difficult (33% and 44% respectively). Additional time on assignments/exams and reducing screen brightness were the most beneficial accommodations (66% and 56% respectively).ConclusionsOur findings introduce a novel and robust approach to monitoring concussed students throughout their recovery. Furthermore, this methodology is the first to produce holistic evidence-based results concerning re-integrating students to the classroom. Lastly, it appears that dietary and social behaviors can indeed influence symptom resolution.

scholarly journals OCULOMOTOR FUNCTION IN ADOLESCENT ATHLETES FOLLOWING CONCUSSION

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0015
Author(s):  
Tracy Zaslow ◽  
Nicole M. Mueske ◽  
Gene J. Yu ◽  
Adriana Conrad-Forrest ◽  
Bianca Edison ◽  
...  
Keyword(s):  
Smooth Pursuit ◽  
Objective Measure ◽  
Return To Play ◽  
Initial Visit ◽  
Adolescent Athletes ◽  
Similar Time ◽  
Treatment Protocols ◽  
Time Points ◽  
Oculomotor Function ◽  
Speed Accuracy

Background: Visual impairments affect up to 90% of patients post-concussion. These impairments may include deficits in fixation accuracy, smooth pursuit, saccadic latencies, vergence, accommodation, and vestibule-ocular reflexes. Quantitative assessment of oculomotor function may provide a sensitive and objective measure of concussion diagnosis and recovery since coordinated eye movements require the use of diverse and widely dispersed areas of the brain. This study quantified oculomotor function over time in adolescents following concussion. Hypothesis/Purpose: We hypothesized that adolescent concussion patients would demonstrate deficits of oculomotor function that would resolve by the time of return to play (RTP) and remain stable after RTP. Methods: 13 adolescent athletes diagnosed with mild to moderate concussion (7 male; mean age 15.1, SD 2.1, range 10-17 years) were prospectively evaluated at their initial visit (mean 18, range 4-43 days post-concussion), at the time of clearance to RTP (mean 46, range 12-173 days post-concussion), and one month later (mean 26, range 20-41 days after RTP). 11 controls without past concussion or injury (3 male; mean age 12.3, SD 3.1, range 8-17 years) were also tested at similar time points. Eye tracking was recorded as participants followed a target moving on a screen in predefined patterns related to sinusoid and trapezoid smooth pursuit, vergence, saccade, and anti-saccade. Metrics characterizing the speed, accuracy, and variability of tracking were compared between groups and visits using t-tests and linear mixed-effects regression. Results: At their initial visit, patients tended to have greater overshoot and greater variability in tracking compared with controls (Table 1.1). Overshoot and variability of tracking during sinusoid smooth pursuit (both overall variability and variability of overshoot) decreased from initial visit to RTP (Table 1.2). Undershoot during sinusoid smooth pursuit tended to decrease from RTP to 1-month follow-up. The rate of convergence in the distance vergence task increased while the rate of divergence decreased between these time points. Conclusion: The main oculomotor deficits observed in concussed adolescents related to overshoot and variability of tracking during sinusoid smooth pursuit. These deficits resolved by the time of RTP and generally remained stable or continued improving after RTP. These results suggest that oculomotor function recovers sufficiently under current conservative treatment protocols. [Table: see text][Table: see text]

Symmetry does not Indicate Recovery: Single-Leg Hop Before and After a Lower Extremity Injury

2020 ◽  
Author(s):  
Janet E Simon ◽  
Jae Yom ◽  
Dustin R Grooms
Keyword(s):  
Lower Extremity ◽  
Sports Participation ◽  
Return To Play ◽  
Lower Extremity Injury ◽  
Extremity Injury ◽  
Adolescent Athletes ◽  
Post Injury ◽  
Injured Limb ◽  
Before And After ◽  
And Performance

AbstractCurrent recommendations for return-to-play decision-making involve comparison of the injured limb to the uninjured limb. However, the use of the uninjured limb as a comparison for hop testing lacks empirical evidence. Thus, the purpose of this study was to determine the effects of lower extremity injury on limb symmetry and performance on the single-leg hop for distance. Two-hundred thirty-six adolescent athletes completed the single-leg hop for distance before the beginning of the season (pre-injury). Forty-four adolescent athletes sustained a lower extremity injury (22 ankle and 12 knee) and missed at least three days of sports participation. All individuals had completed the single-leg hop for distance before the beginning of the season (pre-injury) and at discharge (post-injury). Injured limb single-leg hop for distance significantly decreased at return-to-play from pre-injury with a mean decrease of 48.9 centimeters; the uninjured limb also significantly decreased, with a mean decrease of 33.8 centimeters. Limb symmetry did not significantly change pre- to post-injury with a mean difference of 1.5%. Following a lower extremity injury, single-leg hop for distance performance degrades not only for the injured limb but also the uninjured limb. However, limb symmetry did not change following a lower extremity injury.

scholarly journals The Influence of Psycho-Stimulant Medication on Concussion Recovery in Athletes with ADHD: Findings from the NCAA-DOD Concussion Consortium

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S22.2-S23
Author(s):  
Brett Gunn ◽  
Michael McCrea ◽  
Steven Broglio ◽  
R. Davis Moore
Keyword(s):  
Repeated Measures ◽  
Stimulant Medication ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Adhd Group ◽  
Post Injury ◽  
Stimulant Medications ◽  
Multiple Variables ◽  
Concussion Recovery ◽  
The Impact

ObjectiveWe sought to longitudinally evaluate concussion recovery in collegiate athletes with ADHD who were and were not taking psycho-stimulant medication.BackgroundPsycho-stimulant medication is commonly prescribed to individuals with ADHD. Some have posited that psycho-stimulant medications may mitigate impairments following sport-related concussion. However, no studies longitudinally evaluated the influence of psycho-stimulant medications on concussion recovery in collegiate athletes.Design/MethodsData from the NCAA-DOD Grand Alliance: Concussion Assessment, Research, and Education (CARE) Consortium were used to evaluate athletes with ADHD who were not taking psycho-stimulant medications (Rx-ADHD; n = 20), athletes with ADHD who were taking psycho-stimulant medications (Rx+ADHD; n = 20), and controls (n = 80). Athletes with ADHD were double-matched to controls on biological sex, age, and body mass index. All athletes were assessed prior to their sporting season, 24-48 hours post-injury, and again upon unrestricted return-to-play (RTP). Cognition and clinical symptoms were evaluated using the ImPACT test.ResultsAthletes in the Rx-ADHD (10.4 ± 1.5 days) and Rx + ADHD (11.9 ± 1.7) groups exhibited prolonged symptom durations compared to controls (4.2 ± .8; p’s ≤ 0.05). Repeated-measures analyses of covariance (baseline scores = covariate) group × time interactions for multiple variables (p’s ≤ 0.05). Univariate analyses revealed that both groups with ADHD demonstrated poorer verbal memory, and greater total symptoms at 24–48 hours post-injury than controls (p’s ≤ 0.01). Additionally, athletes in the Rx-ADHD group demonstrated poorer cognitive efficiency at 24–48 hours post-injury, and at RTP than controls (p’s ≤ 0.05). Lastly, athletes in the Rx+ADHD group demonstrated slower visual motor speed at 24–48 hours post-injury, and at RTP than controls (p’s ≤ 0.05).ConclusionsT Our findings suggest that following concussion athletes with ADHD may experience longer recovery than controls, regardless of medicated status. Interestingly, athletes with ADHD who were taking medication did not appear to have different recovery time relative to un-medicated athletes with ADHD.

Nonsteroidal anti-inflammatory drug use and concussions in adolescent athletes: incidence, severity, and recovery

2021 ◽  
Vol 28 (4) ◽  
pp. 476-482
Author(s):  
Zachary Spiera ◽  
Theodore Hannah ◽  
Adam Li ◽  
Nickolas Dreher ◽  
Naoum Fares Marayati ◽  
...  
Keyword(s):  
Head Trauma ◽  
Injury Severity ◽  
Multivariable Analysis ◽  
Return To Play ◽  
Young Athletes ◽  
Adolescent Athletes ◽  
Inflammatory Drug ◽  
Cohort Differences ◽  
Anti Inflammatory ◽  
Concussion Recovery

OBJECTIVE Given concerns about the potential long-term effects of concussion in young athletes, concussion prevention has become a major focus for amateur sports leagues. Athletes have been known to frequently use anti-inflammatory medications to manage injuries, expedite return to play, and treat concussion symptoms. However, the effects of baseline nonsteroidal anti-inflammatory drug (NSAID) use on the susceptibility to head injury and concussion remain unclear. This study aims to assess the effects of preinjury NSAID use on concussion incidence, severity, and recovery in young athletes. METHODS Data from 25,815 ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) tests were obtained through a research agreement with ImPACT Applications Inc. Subjects ranged in age from 12 to 22 years old. Those who reported NSAID use at baseline were assigned to one (anti-inflammatory [AI]) cohort, whereas all others were assigned to the control (CT) cohort. Differences in head trauma and concussion incidence, severity, and recovery were assessed using chi-square tests, unpaired t-tests, and Kaplan-Meier plots. RESULTS The CT cohort comprised a higher percentage (p < 0.0001) of males (66.30%) than the AI cohort (44.16%) and had a significantly greater portion of athletes who played football (p = 0.004). However, no statistically significant differences were found between the two cohorts in terms of the incidence of head trauma (CT = 0.489, AI = 0.500, p = 0.9219), concussion incidence (CT = 0.175, AI = 0.169, p = 0.7201), injury severity, or median concussion recovery time (CT = 8, AI = 8, p = 0.6416). In a multivariable analysis controlling for baseline differences between the cohorts, no association was found between NSAID use and concussion incidence or severity. CONCLUSIONS In this analysis, the authors found no evidence that preinjury use of NSAIDs affects concussion risk in adolescent athletes. They also found no indication that preinjury NSAID use affects the severity of initial injury presentation or concussion recovery.

Physical Activity Levels to Estimate the Energy Requirement of Adolescent Athletes

2011 ◽  
Vol 23 (2) ◽  
pp. 261-269 ◽  
Author(s):  
Anja Carlsohn ◽  
Friederike Scharhag-Rosenberger ◽  
Michael Cassel ◽  
Josefine Weber ◽  
Annette de Guzman Guzman ◽  
...  
Keyword(s):  
Physical Activity ◽  
Energy Expenditure ◽  
Energy Requirement ◽  
Resting Energy Expenditure ◽  
Activity Level ◽  
Activity Levels ◽  
Doubly Labeled Water ◽  
Adolescent Athletes ◽  
Activity Data ◽  
Competitive Athletes

Adequate energy intake in adolescent athletes is considered important. Total energy expenditure (TEE) can be calculated from resting energy expenditure (REE) and physical activity level (PAL). However, validated PAL recommendations are available for adult athletes only. Purpose was to comprise physical activity data in adolescent athletes and to establish PAL recommendations for this population. In 64 competitive athletes (15.3 ± 1.5yr, 20.5 ± 2.0kg/m2) and 14 controls (15.1 ± 1.1yr, 21 ± 2.1kg/m2) TEE was calculated using 7-day activity protocols validated against doubly-labeled water. REE was estimated by Schofield-HW equation, and PAL was calculated as TEE:REE. Observed PAL in adolescent athletes (1.90 ± 0.35) did not differ compared with controls (1.84 ± 0.32, p = .582) and was lower than recommended for adult athletes by the WHO. In conclusion, applicability of PAL values recommended for adult athletes to estimate energy requirements in adolescent athletes must be questioned. Instead, a PAL range of 1.75–2.05 is suggested.

scholarly journals White Matter Abnormalities on Diffusion Tensor Imaging Following Recovery from Sport-Related Concussion and Risk of Subsequent Re-injury

2019 ◽  
Vol 34 (5) ◽  
pp. 736-736
Author(s):  
B L Brett ◽  
Y Wu ◽  
S M Mustafi ◽  
J Harezlak ◽  
C C Giza ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Diffusion Tensor ◽  
A Priori ◽  
Mean Diffusivity ◽  
Region Of Interest ◽  
Return To Play ◽  
Physiological Effects ◽  
Post Injury ◽  
Clinical Recovery ◽  
The Relationship

Abstract Purpose A recent systematic review determined that the physiological effects of concussion may persist beyond clinical recovery. Preclinical models suggest that these physiological effects are accompanied by a window of cerebral vulnerability that is associated with risk for subsequent, more severe injury. This study examined the association between persistent diffusion tensor imaging signal following clinical recovery of sport-related concussion and risk of re-injury. Methods Average mean diffusivity (MD) was obtained in a region-of-interest (ROI) in which concussed athletes showed significantly elevated MD acutely after injury (<48 hours), at an asymptomatic timepoint, 7-days post-return to play, and 6 months post-injury relative to controls. The relationship between MD in the identified ROI and risk of sustaining a subsequent concussion over a 1-year period was examined with a binary logistic regression (re-injured, yes/no). Results Eleven of 83 concussed athletes suffered a second concussion within a 1-year period. The relationship between MD at 7-days post return to play and risk of sustaining a secondary injury within 1-year showed a non-significant trend (X2(1)=4.17, p=.057, B=0.03, SE=0.017; Nagelkerke R2=0.16). Mean differences in MD between the repeat injury and non-reinjured group at 7-days post return to play produced a large effect, d=.75. MD in the a priori ROI at the other recovery time points did not predict elevated risk of re-injury. Conclusion These preliminary findings suggest that a large effect size was present in the relationship between persistent diffusion signal abnormalities and risk for subsequent re-injury. This provides support for a window of cerebral vulnerability following concussion, though further examination is needed.

scholarly journals P115: Limiting functional decline in seniors evaluated for minor injuries in the ED

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S117
Author(s):  
M. Sirois ◽  
R. Daoust ◽  
M. Émond ◽  
J. Blais ◽  
M. Aubertin-Leheudre ◽  
...  
Keyword(s):  
Physical Activity ◽  
Functional Status ◽  
Physical Activity Level ◽  
Motor Vehicle ◽  
Functional Decline ◽  
Activity Level ◽  
Post Injury ◽  
Emergency Team ◽  
Muscle Strengthening ◽  
Minor Injuries

Introduction: In its prospective cohorts of independent seniors with minor injuries, the CETIe (Canadian Emergency Team Initiative) has shown that minor injuries trigger a spiral of mobility and functional decline in 18% of those seniors up to 6 months post-injury. Because of their effects on multiple physiological systems, multicomponent mobility interventions with physical exercises are among the best methods to limit frailty and improve mobility &amp; function in seniors. Methods: Pilot clinical trial among 4 groups of seniors, discharged home post-ED consultation for minor injuries. Interventions: 2x 1 hour /week/12 weeks with muscle strengthening, functional and balance exercises under kinesiology supervision either at home (Jintronix tele-rehabilitation platform) or at community-based programs (YWCA, PIED) vs usual ED-discharge (CONTROL). Measures: Functional Status in ADLs (Older American Ressources Scale); Global physical &amp; social functioning (SF-12 questionnaire), physical activity level (RAPA questionnaire) at initial ED visit and at 3 months. Results: 135 seniors were included (Controls: n=50; PIED: n=28; Jintronix: n=27; YWCA: n=18). Mean age was 72.6±6.2 years, 45% were prefrail, 86% and 8% had a fall or motor vehicle-related injuries (e.g. fractures: 30%; contusions: 37%). Intervention could start as early as 7 days post-injury. Seniors in interventions (Home, YWCA or PIED) maintained or improved their functional status (84% vs 60%, p≤0.05), their physical (73% vs 59%, p=0.05) and social (45% vs 23%, p≤0.05) functioning. While 21% of CONTROLs improved their physical activity level three months post-injury, 46% of seniors in intervention did (p≤0.05). Conclusion: Exercises-based interventions can help improve seniors’ function and mobility after a minor injury.

Sports Concussions (TBI), Imbalance, and Dizziness

2015 ◽  
Vol 25 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Steven M. Doettl
Keyword(s):  
Assessment Tools ◽  
Vestibular Evoked Myogenic Potentials ◽  
Post Injury ◽  
Management Tools ◽  
Concussion Management ◽  
Post Concussion Syndrome ◽  
Behavioral Marker ◽  
Valid Assessment ◽  
Injury Assessment

It has been widely accepted that the assessment of balance after concussion plays a large role in determining deficit. Qualitative balance assessments have been an established piece of the post-injury assessment as a clinical behavioral marker of concussion for many years. Recently more specific guidelines outlining the role of balance evaluation in concussion identification and management have been developed as part of concussion management tools. As part of the ongoing development of concussions protocols, quantitative assessment of balance function following concussion has also been identified to have an important role. Frequently imbalance and dizziness reported following concussion is assumed to be associated with post-concussion syndrome (PCS). While imbalance and dizziness are common complaints in PCS, they can also be a sign of additional underlying pathology. In cases of specific dizziness symptoms or limited balance recovery beyond the initial post-concussive period, a quantitative vestibular assessment may also be needed. Electronystagmography and videonystagmography (ENG/VNG), rotary chair testing (RCT), and vestibular evoked myogenic potentials (VEMPs) have all been identified as valid assessment tools for vestibular dysfunction following traumatic brain injury (TBI). The assessment of balance and dizziness following sports-related concussions is an integral piece of the puzzle for removal from play, assessment of severity, and management.

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