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.

scholarly journals The Influence of Hormonal Contraceptives on Cognitive Recovery in Concussed Collegiate Athletes: Data from the NCAA-DoD CARE Consortium

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S14.3-S15
Author(s):  
Jacob Kay ◽  
Andrew Lapointe ◽  
Thomas McAllister ◽  
Michael McCrea ◽  
Steven Broglio ◽  
...  
Keyword(s):  
Verbal Memory ◽  
Female Athletes ◽  
Clinical Symptoms ◽  
Collegiate Athletes ◽  
Neurological Status ◽  
Return To Play ◽  
Hormonal Contraceptives ◽  
Cognitive Efficiency ◽  
Concussion Recovery ◽  
The Impact

ObjectiveTo longitudinally examine the relation between hormonal contraceptives and concussion recovery. We hypothesized that female athletes using hormonal contraceptives would exhibit faster recovery times and smaller post-injury alterations in neurological status, cognition, and clinical symptoms than female athletes not using hormonal contraceptives.BackgroundResearch indicates sex may moderate concussion outcomes, with some females experiencing protracted recovery relative to males. It is hypothesized that fluctuations of sex hormones lead to poorer outcomes in these females. Thus, female athletes taking hormonal contraceptives may exhibit better recovery than their un-medicated counterparts, as their hormone levels are artificially stabilized.Design/MethodsData from the NCAA-DOD Grand Alliance: Concussion Assessment, Research, and Education (CARE) Consortium were used to evaluate female athletes who were (n = 50) and were not (n = 50) taking hormonal contraceptives. Baseline assessments were completed prior to athletes’ sport season. Athletes were re-assessed 24–48 hours post-concussion, and again at the unrestricted return-to-play. Length of recovery was defined as days between injury and the unrestricted return-to-play. Neurological status was measured using the Standardized Assessment of Concussion (SAC). Cognitive function and clinical symptoms were measured using the ImPACT test. Participants were matched on age, sex, body mass index, sport, and concussion history.ResultsNo group differences in length of recovery were observed (p > 0.05). Across all timepoints, analyses revealed main effects of group for concentration (SAC; p = 0.04), verbal memory (ImPACT; p = 0.03), and cognitive efficiency (ImPACT; p = 0.01). No differences in change scores (relative to baseline) were observed between groups.ConclusionsThe current results suggest that hormonal contraceptives do not influence concussion recovery. However, irrespective of injury status, our findings indicate that females on hormonal contraceptives may exhibit better concentration, working memory, and cognitive efficiency.

scholarly journals No Differences in HADS Scores Between Acutely Concussed and Healthy Collegiate Student-Athletes

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S12.1-S12
Author(s):  
Corey Lanois ◽  
Francis Wang ◽  
Brant Berkstresser ◽  
Jessie Oldham ◽  
William Meehan ◽  
...  
Keyword(s):  
Student Athletes ◽  
Depression Scale ◽  
Collegiate Athletes ◽  
Anxiety And Depression ◽  
Post Injury ◽  
Depression Subscale ◽  
Significant Difference ◽  
Prolonged Recovery ◽  
Healthy Control ◽  
Concussion Recovery

ObjectiveTo investigate differences in Hospital Anxiety and Depression Scale (HADS) scores between acutely concussed collegiate student-athletes and healthy, matched group of collegiate athletes.BackgroundMood disturbances have been documented acutely following concussion. The presence of anxiety and/or depression may complicate and prolong concussion recovery among some athletes. Therefore, it is important to examine acute post-injury anxiety and depression to facilitate proper management decisions.Design/MethodsTwenty-six student-athletes (54% female, 19.92 ± 5.56 years of age) with a diagnosed concussion completed the HADS questionnaire within a week of injury. Twenty-six healthy student-athletes (54% female, 18.82 ± 0.54 years of age) completed the HADS during pre-season baseline testing, individually matched by sex and sport. Independent samples t-tests were used to explore differences in HADS scores between groups.ResultsThere was no significant difference (p = 0.50) between total HADS scores of the concussion group (6.77 ± 6.17) and healthy cohort (5.81 ± 3.85). There were also no significant differences between concussion and uninjured groups on the HADS Anxiety subscale (4.38 ± 4.24 vs. 4.50 ± 2.83; p = 0.91) or HADS Depression subscale (2.38 ± 2.82 vs. 1.31 ± 1.67; p = 0.10).ConclusionsHADS scores obtained among collegiate student athletes acutely following concussion did not significantly differ relative to matched healthy control participants. It is possible that one week post-injury was not enough time to observe measurable effects of anxiety or depression, as those are commonly seen in cases of prolonged recovery.

Establishment of a multidisciplinary concussion program: impact of standardization on patient care and resource utilization

2014 ◽  
Vol 13 (1) ◽  
pp. 82-89 ◽  
Author(s):  
Sara Anne Wilkins ◽  
Chevis N. Shannon ◽  
Steven T. Brown ◽  
E. Haley Vance ◽  
Drew Ferguson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Resource Utilization ◽  
Media Coverage ◽  
Public Awareness ◽  
Return To Play ◽  
Management Protocol ◽  
Before And After ◽  
Multiple Variables ◽  
The Impact

Object Recent legislation and media coverage have heightened awareness of concussion in youth sports. Previous work by the authors' group defined significant variation of care in management of children with concussion. To address this variation, a multidisciplinary concussion program was established based on a uniform management protocol, with emphasis on community outreach via traditional media sources and the Internet. This retrospective study evaluates the impact of standardization of concussion care and resource utilization before and after standardization in a large regional pediatric hospital center. Methods This retrospective study included all patients younger than 18 years of age evaluated for sports-related concussion between January 1, 2007, and December 31, 2011. Emergency department, sports medicine, and neurosurgery records were reviewed. Data collected included demographics, injury details, clinical course, Sports Concussion Assessment Tool-2 (SCAT2) scores, imaging, discharge instructions, and referral for specialty care. The cohort was analyzed comparing patients evaluated before and after standardization of care. Results Five hundred eighty-nine patients were identified, including 270 before standardization (2007–2011) and 319 after standardization (2011–2012). Statistically significant differences (p < 0.0001) were observed between the 2 groups for multiple variables: there were more girls, more first-time concussions, fewer initial presentations to the emergency department, more consistent administration of the SCAT2, and more consistent supervision of return to play and return to think after adoption of the protocol. Conclusions A combination of increased public awareness and legislation has led to a 5-fold increase in the number of youth athletes presenting for concussion evaluation at the authors' center. Establishment of a multidisciplinary clinic with a standardized protocol resulted in significantly decreased institutional resource utilization and more consistent concussion care for this growing patient population.

Post-Concussion Psychological Distress at Return to Play Does Not Predict Subsequent Musculoskeletal Injury

Neurology ◽  
2020 ◽  
Vol 95 (20 Supplement 1) ◽  
pp. S7.2-S7
Author(s):  
Alexander Enrique ◽  
Katie Hunzinger ◽  
Autumn Gourley ◽  
Kelsey Bryk ◽  
Thomas A. Buckley
Keyword(s):  
Psychological Distress ◽  
Psychological Health ◽  
Injury Risk ◽  
Collegiate Athletes ◽  
Musculoskeletal Injury ◽  
Brief Symptom Inventory ◽  
Return To Play ◽  
Limited Attention ◽  
Global Severity Index ◽  
Post Injury

ObjectiveTo assess the association between the Brief Symptom Inventory 18 (BSI-18) response at post-concussion return to play (RTP) and subsequent lower extremity musculoskeletal injury (LE-MSI).BackgroundConcussion evaluation includes a multifaceted neurologic assessment at baseline and post-injury. Despite emotional sequelae after concussion, psychological assessments have received limited attention thus athletes may RTP despite persistent psychological distress post-concussion. Recent evidence has suggested an ∼2x elevated rate of post-concussion LE-MSI in collegiate athletes; however there is limited understanding of potential mechanisms. As psychological distress has been associated with MSI, the purpose of this study was to assess BSI-18 as a potential predictor of subsequent MSI.Design/MethodsThis analysis utilized a cross-sectional design of 67 NCAA intercollegiate students-athletes with a diagnosed concussion (59.7% female, age: 19.7 ± 1.4 years). Participants completed the BSI-18, an 18-item questionnaire based on a 5-point Likert scale (0–4) used to measure psychological distress at the RTP clinical time-point. Outcome measures were the Global Severity Index (GSI) which is the total score of symptoms (0–72) with higher scores representing greater psychological distress and subsequent MSI (yes or no) collected retrospectively through an electronic medical record in the year following diagnosed concussion. Binary logistic regression was used to assess the predictive capabilities of BSI-18 GSI and subsequent LE-MSI.ResultsThe BSI-18 GSI did not significantly predict subsequent LE-MSI (p = 0.095, Exp(B) = 2.436, Nagelkerke R2 = 0.181).ConclusionsThe BSI-18 GSI at RTP did not predict post-concussion subsequent LE-MSI. While the underlying mechanism for post-concussion MSI remains to be fully elucidated, results suggest that psychological health, as measured by the BSI-18 GSI, at RTP is not associated with subsequent LE-MSI. If MSI risk can be predicted then targeted, established, and clinically feasible injury prevention programs can be implemented to reduce injury risk.

scholarly journals Recovery Profiles Following Concussion Among Male Athletes with a Family History of Neurodegenerative Disease: Data from the NCAA-DOD CARE Consortium

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S13.2-S14
Author(s):  
Adam Harrison ◽  
Steven Broglio ◽  
R. Davis Moore ◽  
Andrew Lapointe ◽  
Michael McCrea
Keyword(s):  
Family History ◽  
Neurodegenerative Disease ◽  
Repeated Measures ◽  
Visual Memory ◽  
Memory Performance ◽  
Return To Play ◽  
Post Injury ◽  
Male Athletes ◽  
Time Interaction ◽  
History Of

ObjectiveLongitudinally assess recovery following concussion in male athletes with fhNDD.BackgroundResearch suggests that a family history of neurodegenerative disease (fhNDD) may predispose an athlete to abnormal recovery following brain injury. However, no one has longitudinally assessed recovery following concussion in male athletes with fhNDD.Design/MethodsData from the NCAA-DOD Grand Alliance: Concussion Assessment, Research, and Education (CARE) Consortium were used to compared male athletes with (n = 51) and without (n = 102) a family history of neurodegenerative disease (Parkinson’s, Alzheimer’s, Non-Alzheimer’s Dementia, and Mild Cognitive Impairment). All athletes completed baseline ImPACT assessments prior to the beginning of their sporting season. Athletes that sustained a concussion were then re-evaluated 24-48 hours post-injury, prior to un-restricted return to play (RTP), and again 6 months post-injury. Athletes without fhNDD were double matched based on age, body mass index, sport category, and concussion history.ResultsRepeated measures ANCOVA models were used to evaluate performance at each post-injury timepoint, while controlling for baseline performance. A group × time interaction was observed for visual memory performance. Post-hoc univariate analyses revealed that male athletes with fhNDD demonstrated significantly poorer visual memory performance 24–48 hours post-injury compared to controls (p ≤ 0.005). Additionally, we found a main effect of group for impulse control, indicating that male athletes with fhNDD demonstrated an increase number of impulse errors at all three post-injury evaluations (p ≤ 0.004). We did not to observe any other group differences (p’s > 0.05).ConclusionsOur results suggest that male athletes with a family history of neurodegenerative disease may exhibit greater post-injury cognitive deficits compared to controls. Additionally, some deficits may persist for at least 6 months post-injury. Further research is warranted to investigate the interaction between family history of neurodegenerative disease and concussion.

scholarly journals Reconsidering Return-to-Play Times: A Broader Perspective on Concussion Recovery

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711876085 ◽  
Author(s):  
Christopher D’Lauro ◽  
Brian R. Johnson ◽  
Gerald McGinty ◽  
C. Dain Allred ◽  
Darren E. Campbell ◽  
...  
Keyword(s):  
Recovery Time ◽  
Time Window ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Sample Population ◽  
Intercollegiate Athletes ◽  
Level Of Evidence ◽  
Athletic Status ◽  
Recovery Times ◽  
Concussion Recovery

Background: Return-to-play protocols describe stepwise, graduated recoveries for safe return from concussion; however, studies that comprehensively track return-to-play time are expensive to administer and heavily sampled from elite male contact-sport athletes. Purpose: To retrospectively assess probable recovery time for collegiate patients to return to play after concussion, especially for understudied populations, such as women and nonelite athletes. Study Design: Cohort study; Level of evidence, 3. Methods: Medical staff at a military academy logged a total of 512 concussion medical records over 38 months. Of these, 414 records included complete return-to-play protocols with return-to-play time, sex, athletic status, cause, and other data. Results: Overall mean return to play was 29.4 days. Sex and athletic status both affected return-to-play time. Men showed significantly shorter return to play than women, taking 24.7 days (SEM, 1.5 days) versus 35.5 days (SEM, 2.7 days) ( P < .001). Intercollegiate athletes also reported quicker return-to-play times than nonintercollegiate athletes: 25.4 days (SEM, 2.6 days) versus 34.7 days (SEM, 1.6 days) ( P = .002). These variables did not significantly interact. Conclusion: Mean recovery time across all groups (29.4 days) showed considerably longer return to play than the most commonly cited concussion recovery time window (7-10 days) for collegiate athletes. Understudied groups, such as women and nonelite athletes, demonstrated notably longer recovery times. The diversity of this sample population was associated with longer return-to-play times; it is unclear how other population-specific factors may have contributed. These inclusive return-to-play windows may indicate longer recovery times outside the population of elite athletes.

scholarly journals King-Devick Sensitivity and Specificity to Concussion in Collegiate Athletes

2021 ◽  
Author(s):  
Rachel K. Le ◽  
Justus D. Ortega ◽  
Sara P. D. Chrisman ◽  
Anthony P. Kontos ◽  
Thomas A. Buckley ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Area Under The Curve ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Cutoff Score ◽  
Confounding Factors ◽  
Post Injury ◽  
Cross Sectional ◽  
Cutoff Scores

Context: The King-Devick (K-D) is used to identify oculomotor impairment following concussion. However, the diagnostic accuracy of the K-D over time has not been evaluated. Objective: (a) Examine the sensitivity and specificity of the K-D test at 0–6 hours of injury, 24–48 hours, asymptomatic, return-to-play, and 6-months following concussion and (b) compare outcomes for differentiating athletes with a concussion from non-concussed across confounding factors (sex, age, contact level, school year, learning disorder, ADHD, concussion history, migraine history, administration mode). Design: Retrospective, cross-sectional design. Setting: Multisite institutions within the Concussion Assessment, Research, and Education (CARE) Consortium. Patients or Other Participants: 1239 total collegiate athletes without a concussion (age=20.31±1.18, male=52.2%) were compared to 320 athletes with a concussion (age=19.80±1.41, male=51.3%). Main Outcome Measure(s): We calculated K-D time difference (sec) by subtracting baseline from the most recent time. Receiver operator characteristics (ROC) and area under the curve (AUC) analyses were used to determine the diagnostic accuracy across timepoints. We identified cutoff scores and corresponding specificity at 80% and 70% sensitivity levels. We repeated ROC with AUC outcomes by confounding factors. Results: King-Devick predicted positive results at 0-6 hours (AUC=0.724, p&lt;0.001), 24-48 hours (AUC=0.701, p&lt;0.001), return-to-play (AUC=0.640, P&lt;0.001), and 6-months (AUC=0.615, P&lt;0.001), but not at asymptomatic (AUC=0.513, P=0.497). The 0–6 and 24–48-hour timepoints yielded an 80% sensitivity cutoff score of −2.6 and −3.2 seconds (faster) respectively, but 46% and 41% specificity. The K-D test had significantly better AUC when administered on an iPad (AUC=0.800, 95%CI:0.747,0.854) compared to the spiral card system (AUC=0.646, 95%CI:0.600,0.692; p&lt;0.001). Conclusions: The K-D test has the greatest diagnostic accuracy at 0–6 and 24–48 hours of concussion, but declines across subsequent post-injury timepoints. AUCs did not significantly differentiate between groups for confounding factors. Our negative cutoff scores indicate that practice effects contribute to improved performance, requiring athletes to outperform their baseline.

The Effects of Concussion on Quantity and Quality of Sleep in Football Athletes

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S22.1-S22
Author(s):  
Taren Bone ◽  
Suzanne M. Konz ◽  
William Garrett ◽  
Charles Andrew Gilliland
Keyword(s):  
Sleep Disturbances ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Quality Of Sleep ◽  
Time In Bed ◽  
Study Results ◽  
Sleep Parameters ◽  
Concussion Recovery ◽  
Initial Measurement

ObjectiveThe objective was to observe the quantity and quality of sleep of collegiate athletes following a concussion.BackgroundPatients diagnosed with a concussion report a disruption or change in their sleep with 46% of patients still having sleep disturbances 3 months after the event. Research is lacking on the sleep disruption or sleep changes in athletes who have experienced a concussion.Design/MethodsThis IRB-approved convenient cohort study involved athletes from 2 local universities. 27 (20 non-concussed and 7 concussed) male collegiate football players (19.93 ± 1.14 years old, 1.82 ± 0.08 m, and 96.42 ± 21.26 kg) wore a Readiband device for 7–10 days or throughout concussion recovery. Concussed participants completed a symptom score sheet each day. Participants returned the Readiband device and completed the Pittsburgh Sleep Quality Index Questionnaire (PSQIQ) after 7–10 days or on return to play. The sleep parameters, and PSQIQ scores were analyzed using non-parametric & independent t-tests with the alpha level set at 0.05.ResultsThe t-tests indicated a difference between the total minutes in bed at the initial measurement (F = 11.839, df = 1, p = 0.037) between the concussed (353.29 ± 110.48 minutes) and non-concussed (471.5 ± 125.09 minutes) groups. There was also a difference between the total minutes asleep at the initial measurement (F = 12.662, df = 1, p = 0.032) between the concussed (286.43 ± 86.73) and non-concussed groups (383.7 ± 104.86). The last measurement that indicated a difference was the calculated minutes in bed at the initial measurement (F = 11.916, df = 1, p = 0.023) between the concussed (326.4 3 ± 97.01) and non-concussed groups (441.60 ± 110.55).ConclusionsThe study results indicate that concussion affects the quantity of sleep, with concussed athletes spending less time in bed and fewer minutes asleep. Changes in sleep occur post-concussion, which may delay concussion recovery.

Differences in sport-related concussion for female and male athletes in comparable collegiate sports: a study from the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium

2020 ◽  
pp. bjsports-2020-103316
Author(s):  
Christina L Master ◽  
Barry P Katz ◽  
Kristy B Arbogast ◽  
Michael A McCrea ◽  
Thomas W McAllister ◽  
...  
Keyword(s):  
Sex Differences ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Extrinsic Factors ◽  
Contact Sports ◽  
Recovery Times ◽  
Division Ii ◽  
Concussion Recovery ◽  
Research And Education ◽  
Assessment Research

ObjectivesTo examine sex differences in sport-related concussion (SRC) across comparable sports.MethodsProspective cohort of collegiate athletes enrolled between 2014 and 2017 in the Concussion Assessment, Research and Education Consortium study.ResultsAmong 1071 concussions (females=615; 57.4%), there was no difference in recovery (median days to full return to play) (females=13.5 (IQR 9.0, 23.1) vs males=11.8 (IQR 8.1, 19.0), p=0.96). In subgroup analyses, female recovery was longer in contact (females=12.7 days (IQR 8.8, 21.4) vs males=11.0 days (IQR 7.9, 16.2), p=0.0021), while male recovery was longer in limited contact sports (males=16.9 days (IQR 9.7, 101.7) vs females=13.8 days (IQR 9.1, 22.0), p<0.0001). There was no overall difference in recovery among Division I schools (females=13.7 (IQR 9.0, 23.1) vs males=12.2 (IQR 8.2 19.7), p=0.5), but females had longer recovery at the Division II/III levels (females=13.0 (IQR 9.2, 22.7) vs males=10.6 (IQR 8.1, 13.9), p=0.0048).ConclusionOverall, no difference in recovery between sexes across comparable women’s and men’s sports in this collegiate cohort was found. However, females in contact and males in limited contact sports experienced longer recovery times, while females had longer recovery times at the Division II/III level. These disparate outcomes indicate that, while intrinsic biological sex differences in concussion recovery may exist, important, modifiable extrinsic factors may play a role in concussion outcomes.

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.

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