scholarly journals A prospective study of physician-observed concussion during a varsity university ice hockey season: incidence and neuropsychological changes. Part 2 of 4

2012 ◽  
Vol 33 (6) ◽  
pp. E2 ◽  
Author(s):  
Paul S. Echlin ◽  
Elaine N. Skopelja ◽  
Rachel Worsley ◽  
Shiroy B. Dadachanji ◽  
D. Rob Lloyd-Smith ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Neuropsychological Test ◽  
Neuropsychological Testing ◽  
Relative Number ◽  
Primary Objective ◽  
Ice Hockey ◽  
Cognitive Test ◽  
Men And Women ◽  
Hockey Players ◽  
The Impact

Object The primary objective of this study was to measure the incidence of concussion according to a relative number of athlete exposures among 25 male and 20 female varsity ice hockey players. The secondary objective was to present neuropsychological test results between preseason and postseason play and at 72 hours, 2 weeks, and 2 months after concussion. Methods Every player underwent baseline assessments using the Sport Concussion Assessment Tool-2 (SCAT2), Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), and MRI. Each regular season and postseason game was observed by 2 independent observers (a physician and a nonphysician observer). Players with a diagnosed concussion were removed from the game, examined in the team physician's office using the SCAT2 and ImPACT, and sent to undergo MRI. Results Eleven concussions occurred during the 55 physician-observed games (20%). The incidence of concussion, expressed as number of concussions per 1000 athlete exposures, was 10.70 for men and women combined in regular season play, 11.76 for men and women combined across both the regular season and playoff season, 7.50 for men and 14.93 for women in regular season play, and 8.47 for men across both the regular season and playoff season. One male player experienced repeat concussions. No concussions were reported during practice sessions, and 1 concussion was observed and diagnosed in an exhibition game. Neuropsychological testing suggested no statistically significant preseason/postseason differences between athletes who sustained a physician-diagnosed concussion and athletes who did not sustain a physician-diagnosed concussion on either the ImPACT or SCAT2. The athletes who sustained a physician-diagnosed concussion demonstrated few reliable changes postinjury. Conclusions Although the incidence of game-related concussions per 1000 athlete exposures in this study was half the highest rate reported in the authors' previous research, it was 3 times higher than the incidence reported by other authors within the literature concerning men's collegiate ice hockey and 5 times higher than the highest rate previously reported for woman's collegiate ice hockey. Interestingly, the present results suggest a substantively higher incidence of concussion among women (14.93) than men (7.50). The reproducible and significantly higher incidence of concussion among both men and woman ice hockey players, when compared with nonphysician-observed games, suggests a significant underestimation of sports concussion in the scientific literature.

Return to play after an initial or recurrent concussion in a prospective study of physician-observed junior ice hockey concussions: implications for return to play after a concussion

2010 ◽  
Vol 29 (5) ◽  
pp. E5 ◽  
Author(s):  
Paul Sean Echlin ◽  
Charles H. Tator ◽  
Michael D. Cusimano ◽  
Robert C. Cantu ◽  
Jack E. Taunton ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Consensus Statement ◽  
Assessment Tool ◽  
Ice Hockey ◽  
Return To Play ◽  
Cognitive Test ◽  
Time Interval ◽  
Test Results ◽  
Hockey Players ◽  
The Mean

Object The authors investigated return-to-play duration for initial and recurrent concussion in the same season in 2 teams of junior (16–21-year-old) ice hockey players during a regular season. Methods The authors conducted a prospective cohort study during 1 junior regular season (2009–2010) of 67 male fourth-tier ice hockey players (mean age 18.2 ± 1.2 years [SD], range 16–21 years) from 2 teams. Prior to the start of the season, every player underwent baseline assessments that were determined using the Sideline Concussion Assessment Tool 2 (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). The study protocol also required players who entered the study during the season to complete a baseline SCAT2 and ImPACT. If the protocol was not followed, the postinjury test results of a player without true baseline test results were compared with previously established age- and sex-matched group normative levels. Each game was directly observed by a physician and at least 1 neutral nonphysician observer. Players suspected of suffering a concussion were evaluated by the physician during the game. If a concussion was diagnosed, the player underwent clinical evaluation at the physician's office within 24 hours. The return-to-play decision was based on clinical evaluation guided by the Zurich return-to-play protocol (contained in the consensus statement of international expert opinion at the 3rd International Conference on Concussion in Sport held in Zurich, November 2008). This clinical evaluation and return-to-play protocol was augmented by the 2 tests (SCAT2 and ImPACT) also recommended by the Zurich consensus statement, for which baseline values had been obtained. Results Seventeen players sustained a physician-observed or self-reported, physician-diagnosed concussion during a physician-observed ice hockey game. The mean clinical return-to-play duration (in 15 cases) was 12.8 ± 7.02 days (median 10 days, range 7–29 days); the mean number of physician office visits by players who suffered a concussion (15 cases) was 2.1 ± 1.29 (median 1.5 visits). Five of the 17 players who sustained a concussion also suffered a recurrent or second concussion. One of the 5 individuals who suffered a repeat concussion sustained his initial concussion in a regular season game that was not observed by a physician, and as a result this single case was not included in the total of 21 concussions. This initial concussion of the player was identified during baseline testing 2 days after the injury and was subsequently medically diagnosed and treated. The mean interval between the first and second concussions in these 5 players was 78.6 ± 39.8 days (median 82 days), and the mean time between the return-to-play date of the first and second concussions was 61.8 ± 39.7 days (median 60 days). Conclusions The mean rates of return to play for single and recurrent concussions were higher than rates cited in recent studies involving sport concussions. The time interval between the first and second concussions was also greater than previously cited. This difference may be the result of the methodology of direct independent physician observation, diagnosis, and adherence to the Zurich return-to-play protocol.

A prospective study of physician-observed concussions during junior ice hockey: implications for incidence rates

2010 ◽  
Vol 29 (5) ◽  
pp. E4 ◽  
Author(s):  
Paul Sean Echlin ◽  
Charles H. Tator ◽  
Michael D. Cusimano ◽  
Robert C. Cantu ◽  
Jack E. Taunton ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Single Case ◽  
Impact Testing ◽  
Ice Hockey ◽  
Return To Play ◽  
Cognitive Test ◽  
Test Results ◽  
Hockey Players ◽  
Follow Up Studies

Object The objective of this study was to measure the incidence of concussion (scaled relative to number of athlete exposures) and recurrent concussion within 2 teams of fourth-tier junior ice hockey players (16–21 years old) during 1 regular season. Methods A prospective cohort study called the Hockey Concussion Education Project was conducted during 1 junior ice hockey regular season (2009–2010) involving 67 male fourth-tier ice hockey players (mean age 18.2 ± 1.2 years, range 16–21 years) from 2 teams. Prior to the start of the season, every player underwent baseline assessments using the Sideline Concussion Assessment Tool 2 (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). The study protocol also required players who entered the study during the season to complete baseline SCAT2 and ImPACT testing. If the protocol was not followed, the postinjury test results of a player without true baseline test results would be compared against previously established age and gender group normative levels. Each regular season game was observed by a qualified physician and at least 1 other neutral nonphysician observer. Players who suffered a suspected concussion were evaluated at the game. If a concussion diagnosis was made, the player was subsequently examined in the physician's office for a full clinical evaluation and the SCAT2 and ImPACT were repeated. Based on these evaluations, players were counseled on the decision of when to return to play. Athlete exposure was defined as 1 game played by 1 athlete. Results Twenty-one concussions occurred during the 52 physician-observed games (incidence 21.5 concussions per 1000 athlete exposures). Five players experienced repeat concussions. No concussions were reported during practice sessions. A concussion was diagnosed by the physician in 19 (36.5%) of the 52 observed games. One of the 5 individuals who suffered a repeat concussion sustained his initial concussion in a regular season game that was not observed by a physician, and as a result this single case was not included in the total of 21 total concussions. This initial concussion of the player was identified during baseline testing 2 days after the injury and was subsequently medically diagnosed and treated. Conclusions The incidence of game-related concussions (per 100 athlete exposures) in these fourth-tier junior ice hockey players was 7 times higher than the highest rate previously reported in the literature. This difference may be the result of the use of standardized direct physician observation, diagnosis, and subsequent treatment. The results of this study demonstrate the need for follow-up studies involving larger and more diverse sample groups to reflect generalizability of the findings. These follow-up studies should involve other contact sports (for example football and rugby) and also include the full spectrum of gender, age, and skill levels.

scholarly journals Youth Developmental Experiences Among Female Hockey Players: The Role of Relative Age

2019 ◽  
Vol 14 (4) ◽  
pp. 83-100 ◽  
Author(s):  
Laura Chittle ◽  
Jess C. Dixon ◽  
Sean Horton
Keyword(s):  
Cognitive Skills ◽  
Online Survey ◽  
Sport Participation ◽  
Ice Hockey ◽  
Developmental Experiences ◽  
Relative Age ◽  
Hockey Players ◽  
Wilks Lambda ◽  
Experience Survey ◽  
The Impact

Relative age differences can lead to varying sport participation opportunities; however, scant research has focused on the impact of relative age on experiences within sport. This study explored if youth developmental experiences differed by relative age among competitive female ice hockey players. Players within Ontario (n = 264) completed an online survey that contained the Youth Experience Survey for Sport (YES-S) along with additional demographic questions. The YES-S measures 5 dimensions of positive (i.e., personal and social skills, cognitive skills, goal setting, and initiative) and negative developmental experiences in sport. The results of the multivariate analysis of variance (MANOVA) suggested that the developmental experiences reported by athletes did not differ across birth quartiles (Wilks’ Lambda = 0.940, F (15, 707.105) = 1.061, p = .390). Although there was a relative age effect (RAE) trend within this sample of competitive female ice hockey players, the differences across birth quartiles were not statistically significant. It appears that relative age does not result in youth having different positive and negative sporting experiences. Exploring the characteristics of sport environments (e.g., coaches, practices) and personality traits of competitive athletes to better understand how relatively younger athletes continue their participation in sport despite being at a perceived disadvantage warrants further investigation.

scholarly journals Is there a correlation between cognition and the ability to remember how to use assistive devices?

2019 ◽  
Vol 47 (1) ◽  
pp. 58-72
Author(s):  
Gerard Mc Carroll ◽  
Mary Cooke
Keyword(s):  
Null Hypothesis ◽  
Assessment Tool ◽  
Mmse Score ◽  
Primary Objective ◽  
Assistive Devices ◽  
Assessment Instrument ◽  
Cross Sectional ◽  
Content Type ◽  
Objective Evidence ◽  
The Impact

Purpose This study aims to establish a correlation between a patient’s mini mental state examination (MMSE) score and their ability to remember how to use common assistive dressing devices. Design/methodology/approach The study was a prospective, cross-sectional and correlational study. A final sample of 63 patients formed the study. Patients’ cognition was measured using the MMSE, and a new assessment tool was developed to assess patients’ ability to use three assistive devices and piloted on 15 patients to address normality, reliability, validity and clinical usefulness. Pearson’s rank correlation coefficient was used to establish direct correlations between the MMSE score and the assessment tool score. Eta squared was used to calculate the effect size to achieve an indication of the difference between the groups. Ethical approval had been granted by the regional ethics committee. The null hypothesis states that patients with an MMSE score of 22 or less show no difference in their ability to safely and appropriately use assistive devices provided and demonstrated by an occupational therapist than patients with an MMSE score of 23 or higher. Findings The null hypothesis was rejected and patients with an MMSE score of 22 or less showed a significant difficulty in their ability to use the three devices. Correlation coefficients showed significant positive correlations between MMSE scores and assistive devices scoring tool results for all three devices: Helping hand (r = 6.677, n = 60, p = 0.01), shoe horn (r = 0.649, n = 54, p = 0.01) and sock aid (r = 0.877, n = 54, p = 0.01). Originality/value The study is in an Irish context and demonstrated primary, objective evidence of the impact of impaired cognition on functional ability. Patients with cognitive deficits pose a larger safety challenge but still should be afforded an opportunity to use and benefit from assistive devices. The assessment tool is a new and unique instrument and although requires further development, may conceivably act not just as an assessment instrument but also an effective treatment tool.

scholarly journals Hockey Concussion Education Project, Part 3. White matter microstructure in ice hockey players with a history of concussion: a diffusion tensor imaging study

2014 ◽  
Vol 120 (4) ◽  
pp. 882-890 ◽  
Author(s):  
Takeshi Sasaki ◽  
Ofer Pasternak ◽  
Michael Mayinger ◽  
Marc Muehlmann ◽  
Peter Savadjiev ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
White Matter ◽  
Diffusion Tensor ◽  
Ice Hockey ◽  
Cognitive Test ◽  
Corona Radiata ◽  
White Matter Microstructure ◽  
Hockey Players ◽  
History Of ◽  
The Right

Object The aim of this study was to examine the brain's white matter microstructure by using MR diffusion tensor imaging (DTI) in ice hockey players with a history of clinically symptomatic concussion compared with players without a history of concussion. Methods Sixteen players with a history of concussion (concussed group; mean age 21.7 ± 1.5 years; 6 female) and 18 players without a history of concussion (nonconcussed group; mean age 21.3 ± 1.8 years, 10 female) underwent 3-T DTI at the end of the 2011–2012 Canadian Interuniversity Sports ice hockey season. Tract-based spatial statistics (TBSS) was used to test for group differences in fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and the measure “trace,” or mean diffusivity. Cognitive evaluation was performed using the Immediate Postconcussion Assessment and Cognitive Test (ImPACT) and the Sport Concussion Assessment Tool–2 (SCAT2). Results TBSS revealed a significant increase in FA and AD, and a significant decrease in RD and trace in several brain regions in the concussed group, compared with the nonconcussed group (p < 0.05). The regions with increased FA and decreased RD and trace included the right posterior limb of the internal capsule, the right corona radiata, and the right temporal lobe. Increased AD was observed in a small area in the left corona radiata. The DTI measures correlated with neither the ImPACT nor the SCAT2 scores. Conclusions The results of the current study indicate that a history of concussion may result in alterations of the brain's white matter microstructure in ice hockey players. Increased FA based on decreased RD may reflect neuroinflammatory or neuroplastic processes of the brain responding to brain trauma. Future studies are needed that include a longitudinal analysis of the brain's structure and function following a concussion to elucidate further the complex time course of DTI changes and their clinical meaning.

Epidemiology of Upper Extremity Injuries in NCAA Men’s and Women’s Ice Hockey

2018 ◽  
Vol 46 (10) ◽  
pp. 2521-2529 ◽  
Author(s):  
Patricia R. Melvin ◽  
Spenser Souza ◽  
R. Nelson Mead ◽  
Christopher Smith ◽  
Mary K. Mulcahey
Keyword(s):  
Upper Extremity ◽  
Acromioclavicular Joint ◽  
Injury Rate ◽  
Injury Surveillance ◽  
Ice Hockey ◽  
Surveillance Program ◽  
Time Loss ◽  
Injury Rates ◽  
Men And Women ◽  
Hockey Players

Background: Ice hockey is a physically demanding sport where athletes are susceptible to a variety of injuries. Several studies reported the overall injury rates in ice hockey; however, there is a paucity of information on upper extremity (UE) injuries among collegiate ice hockey players. Purpose: To describe the epidemiology of UE injuries among collegiate male and female ice hockey players with NCAA (National Collegiate Athletic Association) injury surveillance data from 2004-2005 to 2013-2014. Study Design: Descriptive epidemiology study. Methods: Data were obtained from the NCAA Injury Surveillance Program for all UE injuries sustained during the academic years 2004-2005 to 2013-2014. Injury rates, rate ratios (RRs), and injury proportion ratios were reported with 95% CIs. Results: During the 10 years studied, the overall rate of UE injuries for men was higher than that for women (236 vs 125 injuries per 100,000 athlete-exposures [AEs]; RR, 1.89; 95% CI, 1.67-2.15). UE injuries sustained during either pre- or postseason were approximately 3 times higher for men than for women (preseason: 149 vs 53 per 100,000 AEs; RR, 2.83; 95% CI, 1.69-4.74; postseason: 143 vs 49 per 100,000 AEs; RR, 2.91; 95% CI, 1.33-6.38). The overall injury rate was highest during the regular season (men: 257 per 100,000 AEs; 95% CI, 242-272; women: 143 per 100,000 AEs; 95% CI, 126-160). Additionally, the injury rate for men and women was higher during competition than practice (men: 733 vs 83 per 100,000 AEs; 95% CI, 687-780 and 75-92; women: 303 vs 64 per 100,000 AEs; 95% CI, 259-348 and 52-76). The most common injury observed was acromioclavicular joint sprain (men, 29.1%; women, 13.8%). For both groups, acromioclavicular joint injuries accounted for most non–time loss, moderate time loss (2-13 days), and severe time loss (≥14 days) injuries. Conclusion: Men and women sustained a significant number of UE injuries playing collegiate ice hockey during the period studied, with acromioclavicular joint sprain being the most common UE injury and the one that most frequently led to significant time loss. These data may provide insight for future injury prevention and guide improvements in training.

Sport Concussion Assessment Tool: Interpreting day-of-injury scores in professional ice hockey players

2018 ◽  
Vol 21 (8) ◽  
pp. 794-799 ◽  
Author(s):  
Timo Hänninen ◽  
Jari Parkkari ◽  
Markku Tuominen ◽  
Juha Öhman ◽  
David R. Howell ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Ice Hockey ◽  
Hockey Players ◽  
Sport Concussion

scholarly journals Half of purposeful sandbaggers undetected by ImPACT's embedded invalidity indicators

Neurology ◽  
2018 ◽  
Vol 91 (23 Supplement 1) ◽  
pp. S4.3-S5
Author(s):  
Courtney Raab ◽  
Amy Peak
Keyword(s):  
Impact Assessment ◽  
Neuropsychological Tests ◽  
Primary Outcome ◽  
Primary Objective ◽  
Cognitive Test ◽  
Control Group ◽  
Secondary Objective ◽  
Composite Scores ◽  
The Impact ◽  
Test Impact

ObjectiveThe primary objective of this study is to determine the ability of embedded invalidity indicators (EIIs) within the Immediate Post-concussion Assessment and Cognitive Test (ImPACT) to accurately identify individuals purposefully underperforming (sandbagging) on the baseline assessment. The secondary objective is to determine if any of the 5 specific EIIs are more or less likely to identify purposeful sandbaggers.BackgroundSandbagging baseline neuropsychological tests is a growing problem with significant potential consequences including premature post-concussion clearance.Design/methodsVolunteers were recruited to complete a baseline ImPACT assessment. Participants were randomized to either a control group or a coached sandbagging group. Primary outcome measures were the number of participants identified as invalid via any EII, as well as mean raw composite scores and percentiles for each sub-section within the ImPACT assessment.ResultsSeventy-seven participants (37 control and 40 sandbaggers) completed the study. Only half (50%, n = 20) of the purposeful sandbaggers were identified via any EII. Appropriately, no participants in the control group were identified as invalid. The Working Memory EII correctly identified 40% of the purposeful sandbaggers, and the Three Letters EII identified 35% of purposeful sandbaggers. All other EIIs identified 15% of purposeful sandbaggers. Twenty-six purposeful sandbaggers achieved at least 1 composite sub-score, 1st percentile; 27% of those were not identified via any EII. One participant scored ≤ 1st percentile in every composite category and was not identified via any EII.ConclusionSandbagging baseline ImPACT assessments without detection likely occurs more often than previous literature suggests. Half of purposeful sandbaggers were not identified via current EIIs, and 3 of 5 EIIs identified 15% of purposeful sandbaggers. Re-evaluation or recalibration of ImPACT's current EIIs may be appropriate.Disclosures: Dr. Raab has nothing to disclose. Dr. Peak has nothing to disclose.

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