Specialist Referral and Outcomes in Adolescent Athletes With Prior Concussion History

ObjectiveTo examine specialist referral patterns and clinical outcomes in adolescents with differing levels of prior concussion history.BackgroundLimited evidence exists on healthcare utilization and outcomes in concussed adolescent athletes with and without a history of prior concussion.Design/MethodsData were prospectively collected from participants aged 12–18 diagnosed with a sport-related concussion and documented prior concussion history between August 2015-March 2020. Participants were separated into 3 groups: 0, 1, and 2 + prior concussions. Demographics, medical history, specialist referrals, and clinical outcome variables obtained at 3-months post-concussion were analyzed.ResultsOne thousand one hundred ninety-seven participants were included: 114 (10.4%) had 2+, 213 (19.4%) had 1, and 770 (70.2%) had 0 prior concussions. There was no difference in sex or time to presentation. A small difference was found across age (15.3 ± 1.6 vs 14.9 ± 1.6 vs 14.5 ± 1.6 years, p < 0.001). Significant differences were also observed between groups in self-reported history of psychological disorders (14.9 vs 15 vs 8.4%, p = 0.01) and headaches/migraines (25.4 vs 20.2 vs 15.5%, p = 0.02). Significant differences between the groups were found in specialist referrals, with more referrals made in the 2 + group to physical therapy (39.6 vs 28.2 vs 23.4%, p = 0.001), neuropsychology (17.1 vs 5.3 vs 7.5%, p = 0.001), and neurology (8.9 vs 2.9 vs 2.2%, p = 0.001). Fewer participants in the 2 + group recovered in = 30 days (53.6 vs 65.6 vs 68.5%, p = 0.04) and reported lower rates of return to activity at 3-months post-concussion (67.9 vs 85.9 vs 87.6%, p < 0.001). No differences were seen in symptom severity, PHQ-8, or GAD-7 scores. All reported as 2 + vs 1 vs 0.ConclusionsConcussed adolescent athletes with a history of 2 or more prior concussions had a higher rate of specialist referrals, were less likely to have returned to prior level of play/activity 3 months following injury, and were less likely to have resolution of symptoms in 30 days or less.

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High School Athletes With ADHD and Learning Difficulties Have a Greater Lifetime Concussion History

Journal of Attention Disorders ◽

10.1177/1087054716657410 ◽

2016 ◽

Vol 24 (8) ◽

pp. 1095-1101 ◽

Cited By ~ 23

Author(s):

Grant L. Iverson ◽

Magdalena Wojtowicz ◽

Brian L. Brooks ◽

Bruce A. Maxwell ◽

Joseph E. Atkins ◽

...

Keyword(s):

Sex Differences ◽

Learning Difficulties ◽

Prevalence Rates ◽

High School Athletes ◽

Adolescent Athletes ◽

Developmental Problems ◽

Lifetime History ◽

History Of ◽

Concussion History ◽

Developmental Conditions

Objective: Examine lifetime history of concussions in adolescents who have developmental problems in comparison with those with no developmental problems. Method: Thirty-two thousand four hundred eighty-seven adolescent athletes completed baseline/pre-season evaluations. Based on self-reported histories, athletes were divided into four groups: ADHD only, ADHD and learning difficulties (LD), LD only, and controls. Results: Athletes with ADHD, LD, or ADHD plus LD reported a greater prevalence of prior concussions than athletes without these developmental conditions ( ps < .05). When adjusting for sex differences in concussion prevalence rates (boys are greater than girls), there was an increase in prevalence of prior injuries in those with ADHD, and ADHD plus learning difficulties compared with those with LD only. This pattern was found for both girls and boys. There was no additive effect of having both conditions. Conclusion: Developmental conditions in adolescent athletes, such as ADHD and learning difficulties, are associated with a greater prevalence rate of prior concussion.

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Influences of Mental Illness, Current Psychological State, and Concussion History on Baseline Concussion Assessment Performance

The American Journal of Sports Medicine ◽

10.1177/0363546518765145 ◽

2018 ◽

Vol 46 (7) ◽

pp. 1742-1751 ◽

Cited By ~ 13

Author(s):

Michelle L. Weber ◽

John-Henry L. Dean ◽

Nicole L. Hoffman ◽

Steven P. Broglio ◽

Michael McCrea ◽

...

Keyword(s):

Symptom Severity ◽

State Anxiety ◽

Student Athletes ◽

Psychological State ◽

Depression And Anxiety ◽

History Of ◽

Concussion History ◽

Assessment Performance ◽

Current Psychological ◽

Anxiety Depression

Background: A student-athlete’s mental state, including history of trait anxiety and depression, or current psychological state may affect baseline concussion assessment performance. Purpose: (1) To determine if mental illness (anxiety, depression, anxiety with depression) influences baseline scores, (2) to determine if psychological state correlates with baseline performance, and (3) to determine if history of concussion affects Brief Symptom Inventory–18 (BSI-18) subscores of state anxiety, depression, and somatization. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A sample of 8652 collegiate student-athletes (54.5% males, 45.5% females) participated in the Concussion Assessment, Research and Education (CARE) Consortium. Baseline assessments included a demographic form, a symptom evaluation, Standardized Assessment of Concussion, Balance Error Scoring System, a psychological state assessment (BSI-18), and Immediate Post-concussion Assessment and Cognitive Test. Baseline scores were compared between individuals with a history of anxiety (n = 59), depression (n = 283), and anxiety with depression (n = 68) and individuals without a history of those conditions (n = 8242). Spearman’s rho correlations were conducted to assess the relationship between baseline and psychological state subscores (anxiety, depression, somatization) (α = .05). Psychological state subscores were compared between individuals with a self-reported history of concussions (0, 1, 2, 3, 4+) using Kruskal-Wallis tests (α = .05). Results: Student-athletes with anxiety, depression, and anxiety with depression demonstrated higher scores in number of symptoms reported (anxiety, 4.3 ± 4.2; depression, 5.2 ± 4.8; anxiety with depression, 5.4 ± 3.9; no anxiety/depression, 2.5 ± 3.4), symptom severity (anxiety, 8.1 ± 9.8; depression, 10.4 ± 12.4; anxiety with depression, 12.4 ± 10.7; no anxiety/depression, 4.1 ± 6.9), and psychological distress in state anxiety (anxiety, 3.7 ± 4.7; depression, 2.5 ± 3.6; anxiety with depression, 3.8 ± 4.2; no anxiety/depression, 0.8 ± 1.8), depression (anxiety, 2.4 ± 4.0; depression, 3.2 ± 4.5; anxiety with depression, 3.8 ± 4.8; no anxiety/depression, 0.8 ± 1.8), and somatization (anxiety, 2.3 ± 2.9; depression, 1.8 ± 2.8; anxiety with depression, 2.2 ± 2.4; no anxiety/depression, 0.9 ± 1.7). A moderate positive relationship existed between all BSI-18 subscores and total symptom number (n = 8377; anxiety: rs = 0.43, P < .001; depression: rs = 0.42, P < .001; somatization: rs = 0.45, P < .001), as well as total symptom severity (anxiety: rs = 0.43, P < .001; depression: rs = 0.41, P < .001; somatization: rs = 0.45, P < .001). Anxiety, depression, and somatization subscores were greater among student-athletes that self-reported more concussions. Conclusion: Clinicians should be cognizant that student-athletes with a history of trait anxiety, depression, and anxiety with depression may report higher symptom score and severity at baseline. Individuals with extensive concussion history may experience greater state anxiety, depression, and somatization.

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INITIAL CLINICAL PRESENTATION OF PEDIATRIC PATIENTS WITH PSYCHOLOGICAL DISORDERS FOLLOWING CONCUSSION

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00080 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0008

Author(s):

Hannah M. Worrall ◽

Shane M. Miller ◽

C. Munro Cullum ◽

Jane S. Chung

Keyword(s):

Symptom Severity ◽

Pediatric Patients ◽

Clinical Presentation ◽

Anxiety And Depression ◽

Anxiety Group ◽

Severity Scores ◽

Significant Difference ◽

History Of ◽

Concussion History ◽

History Of Depression

Background: There is limited evidence regarding the impact of pre-existing psychological disorders on the initial clinical presentation in pediatric patients following concussion. Hypothesis/Purpose: To examine differences in clinical symptom measures between pediatric patients with a history of depression and/or anxiety and no history of psychological disorder (PD) following a concussion. Methods: Data were prospectively collected from participants enrolled in the North Texas Concussion Network Registry (ConTex) between August 2015 and March 2020. Participants aged 5-18 years diagnosed with a concussion were included. Demographic variables and a range of clinical measures from initial presentation were reviewed, including SCAT-5 Symptom Log, Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7) scale, and Brief Resiliency Scale (BRS). Participants were separated into four groups based on self-reported prior diagnosis: depression, anxiety, depression+anxiety, and no PD. Results: A total of 1770 participants were included: 50 with depression, 82 with anxiety, 84 with both, and 1554 with no history of PD. There was no significant difference in age, sex, prior concussion history, or time to presentation between the depression and no PD group, or between the anxiety and no PD group. A significant difference was found between the depression+anxiety group and no PD group in the following variables: age (15.11±1.8 vs 13.68±2.61 years, p<0.001), prior concussion history (40.5% vs 23.9%, p=0.001), and time to presentation (31.47±25.82 vs 19.85±26.33 days, p=0.01). Additionally, there were more females in the depression+anxiety group than the no PD group (71.4% vs 47.8%, p<0.001). The depression, anxiety, and depression+anxiety groups had significantly higher rates of learning disorders than the no PD group (40%, 47.6%, 46.4% vs 16.4%, all p<0.001). A significant difference in SCAT-5 symptom severity scores between the depression, anxiety, and depression+anxiety groups compared to the no PD group was found. The PD groups all reported higher GAD-7 and PHQ-8 scores and lower BRS scores compared to the no PD group. The depression+anxiety group had the highest symptom severity, GAD-7, and PHQ-8 scores along with the lowest BRS score. Table 1.1 summarizes these significant findings. Conclusion: Differences were seen in participants with a history of depression and/or anxiety at initial clinical presentation, including history of learning disability, SCAT-5 symptom severity scores, and common screening tests for depression, anxiety, and resiliency compared to those without a history of PD. Understanding these differences at initial presentation may urge providers to engage multidisciplinary teams early in facilitating patient recovery. Tables/Figures: [Table: see text]

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A history of botanical collections in the Luangwa Valley, Zambia

Archives of Natural History ◽

10.3366/anh.1998.25.2.283 ◽

1998 ◽

Vol 25 (2) ◽

pp. 283-291

Author(s):

P.S.M. PHIRI ◽

D.M. MOORE

Keyword(s):

Eighteenth Century ◽

Environmental Impact ◽

Impact Assessment ◽

Vascular Plants ◽

Central Africa ◽

Peak Activity ◽

Historical Account ◽

History Of ◽

The 1960S ◽

Made In

Central Africa remained botanically unknown to the outside world up to the end of the eighteenth century. This paper provides a historical account of plant explorations in the Luangwa Valley. The first plant specimens were collected in 1897 and the last serious botanical explorations were made in 1993. During this period there have been 58 plant collectors in the Luangwa Valley with peak activity recorded in the 1960s. In 1989 1,348 species of vascular plants were described in the Luangwa Valley. More botanical collecting is needed with a view to finding new plant taxa, and also to provide a satisfactory basis for applied disciplines such as ecology, phytogeography, conservation and environmental impact assessment.

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Chasing Angels: The Sweet Wine Angelica

Gastronomica The Journal of Food and Culture ◽

10.1525/gfc.2008.8.3.74 ◽

2008 ◽

Vol 8 (3) ◽

pp. 74-78

Author(s):

hank shaw

Keyword(s):

The State ◽

The Real ◽

Mission Period ◽

History Of ◽

Uncertain Future ◽

Sweet Wine ◽

Made In

Portugal has port, Spain has sherry, Sicily has Marsala –– and California has angelica. Angelica is California's original wine: The intensely sweet, fortified dessert cordial has been made in the state for more than two centuries –– primarily made from Mission grapes, first brought to California by the Spanish friars. Angelica was once drunk in vast quantities, but now fewer than a dozen vintners make angelica today. These holdouts from an earlier age are each following a personal quest for the real. For unlike port and sherry, which have strict rules about their production, angelica never gelled into something so distinct that connoisseurs can say, ““This is angelica. This is not.”” This piece looks at the history of the drink, its foggy origins in the Mission period and on through angelica's heyday and down to its degeneration into a staple of the back-alley wino set. Several current vintners are profiled, and they suggest an uncertain future for this cordial.

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Not as It Is Written

The Public Historian ◽

10.1525/tph.2020.42.2.78 ◽

2020 ◽

Vol 42 (2) ◽

pp. 78-100

Author(s):

Benjamin Houston

Keyword(s):

African American ◽

Civil Rights ◽

Oral History ◽

Civil Rights Movement ◽

International Exhibition ◽

Black Experience ◽

American Perspective ◽

History Of ◽

Black Life ◽

Made In

This article discusses an international exhibition that detailed the recent history of African Americans in Pittsburgh. Methodologically, the exhibition paired oral history excerpts with selected historic photographs to evoke a sense of Black life during the twentieth century. Thematically, showcasing the Black experience in Pittsburgh provided a chance to provoke among a wider public more nuanced understandings of the civil rights movement, an era particularly prone to problematic and superficial misreadings, but also to interject an African American perspective into the scholarship on deindustrializing cities, a literature which treats racism mostly in white-centric terms. This essay focuses on the choices made in reconciling these thematic and methodological dimensions when designing this exhibition.

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RISHTAN SCHOOL OF CERAMICS

Journal of look to the past ◽

10.26739/2181-9599-2019-16-12 ◽

2019 ◽

Vol 16 (2) ◽

pp. 73-77

Author(s):

Akmal Marozikov ◽

Keyword(s):

Central Asia ◽

Building Materials ◽

Works Of Art ◽

The World ◽

Ferghana Valley ◽

History Of ◽

Made In ◽

National Style

Ceramics is an area that has a long history of making clay bowls, bowls, plates,pitchers, bowls, bowls, bowls, pots, pans, toys, building materials and much more.Pottery developed in Central Asia in the XII-XIII centuries. Rishtan school, one of the oldest cities in the Ferghana Valley, is one of the largest centers of glazed ceramics inCentral Asia. Rishtan ceramics and miniatures are widely recognized among the peoples of the world and are considered one of the oldest cities in the Ferghana Valley. The article discusses the popularity of Rishtan masters, their products made in the national style,and works of art unique to any region

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Ten Percent of SIDS Cases are Murder — or are They?

Academic Forensic Pathology ◽

10.23907/2017.018 ◽

2017 ◽

Vol 7 (2) ◽

pp. 163-170 ◽

Cited By ~ 2

Author(s):

Christopher M. Milroy ◽

Charis Kepron

Keyword(s):

Sudden Infant Death ◽

Current Data ◽

History of otorhinolaryngology in Germany before 1921

HNO ◽

10.1007/s00106-021-01046-9 ◽

2021 ◽

Vol 69 (5) ◽

pp. 338-365

Author(s):

Albert Mudry ◽

Robert Mlynski ◽

Burkhard Kramp

Keyword(s):

Head And Neck ◽

19Th Century ◽

Neck Surgery ◽

German Society ◽

100Th Anniversary ◽

Head And Neck Surgery ◽

History Of ◽

Academic Organization ◽

The 19Th Century ◽

Made In

AbstractIn 2021, the German Society of Otorhinolaryngology, Head and Neck Surgery is celebrating the 100th anniversary of its foundation. The aim of this article is to present the main inventions and progress made in Germany before 1921, the date the society was founded. Three chronological periods are discernible: the history of otorhinolaryngology (ORL) in Germany until the beginning of the 19th century, focusing mainly on the development of scattered knowledge; the birth of the sub-specialties otology, laryngology (pharyngo-laryngology and endoscopy), and rhinology in the 19th century, combining advances in knowledge and implementation of academic structures; and the creation of the ORL specialty at the turn of the 20th century, mainly concentrating on academic organization and expansion. This period was crucial and allowed for the foundation of the German Society of Otorhinolaryngology, Head and Neck Surgery on solid ground. Germany played an important role in the development and progress of ORL internationally in the 19th century with such great contributors as Anton von Tröltsch, Hermann Schwartze, Otto Körner, Rudolf Voltolini, and Gustav Killian to mention a few.

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Case report: Manual therapies promote resolution of persistent post-concussion symptoms in a 24-year-old athlete

SAGE Open Medical Case Reports ◽

10.1177/2050313x20952224 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2095222

Author(s):

Susan Vaughan Kratz

Keyword(s):

Case Report ◽

Symptom Severity ◽

Impact Test ◽

Manual Therapies ◽

Symptom Checklist ◽

Post Concussion Syndrome ◽

Persistent Symptoms ◽

Short Period ◽

History Of ◽

Headache Impact

This case report illustrates the treatment outcomes of a collegiate athlete presenting with an 18-month history of post-concussion syndrome who received a series of mixed manual therapies in isolation of other therapy. Persistent symptoms were self-reported as debilitating, contributing to self-removal from participation in school, work, and leisure activities. Patient and parent interviews captured the history of multiple concussions and other sports-related injuries. Neurological screening and activities of daily living were baseline measured. Post-Concussion Symptom Checklist and Headache Impact Test-6™ were utilized to track symptom severity. Treatments applied included craniosacral therapy, manual lymphatic drainage, and glymphatic techniques. Eleven treatment sessions were administered over 3 months. Results indicated restoration of oxygen saturation, normalized pupil reactivity, and satisfactory sleep. Post-concussion syndrome symptom severity was reduced by 87% as reflected by accumulative Post-Concussion Symptom Checklist scores. Relief from chronic headaches was achieved, reflected by Headache Impact Test-6 scores. Restoration of mood and quality of life were reported. A 6-month follow-up revealed symptoms remained abated with full re-engagement of daily activities. The author hypothesized that post-concussion syndrome symptoms were related to compression of craniosacral system structures and lymphatic fluid stagnation that contributed to head pressure pain, severe sleep deprivation, and multiple neurological and psychological symptoms. Positive outcomes over a relatively short period of time without adverse effects suggest these therapies may offer viable options for the treatment of post-concussion syndrome.

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