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 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 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 Adolescents With ADHD Do Not Take Longer to Recover From Concussion

2021 ◽  
Vol 8 ◽  
Author(s):  
Nathan E. Cook ◽  
Grant L. Iverson ◽  
Bruce Maxwell ◽  
Ross Zafonte ◽  
Paul D. Berkner
Keyword(s):  
Recovery Time ◽  
Return To Play ◽  
Return To School ◽  
Prior History ◽  
Return To Sports ◽  
Full Time ◽  
Recovery Times ◽  
Concussion History ◽  
Concussion Recovery ◽  
Medication Status

The objective of this study was to determine whether adolescents with attention-deficit/hyperactivity disorder (ADHD) have prolonged return to school and sports following concussion compared to those without ADHD and whether medication status or concussion history is associated with recovery time. We hypothesized that having ADHD would not be associated with longer recovery time. This prospective observational cohort study, conducted between 2014 and 2019, examined concussion recovery among school sponsored athletics throughout Maine, USA. The sample included 623 adolescents, aged 14–19 years (mean = 16.3, standard deviation = 1.3 years), 43.8% girls, and 90 (14.4%) reported having ADHD. Concussions were identified by certified athletic trainers. We computed days to return to school (full time without accommodations) and days to return to sports (completed return to play protocol) following concussion. Adolescents with ADHD [median days = 7, interquartile range (IQR) = 3–13, range = 0–45] did not take longer than those without ADHD (median days = 7, IQR = 3–13, range = 0–231) to return to school (U = 22,642.0, p = 0.81, r = 0.01; log rank: χ12 = 0.059, p = 0.81). Adolescents with ADHD (median days = 14, IQR = 10–20, range = 2–80) did not take longer than those without ADHD (median days = 15, IQR = 10–21, range = 1–210) to return to sports (U = 20,295.0, p = 0.38, r = 0.04; log rank: χ12 = 0.511, p = 0.48). Medication status and concussion history were not associated with longer recovery times. Adolescents with ADHD did not take longer to functionally recover following concussion. Recovery times did not differ based on whether adolescents with ADHD reported taking medication to treat their ADHD or whether they reported a prior history of concussion.

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.

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.

Consideration of the Federal Guidelines for Academic Services for Student-Athletes with Sports-Related Concussion

2012 ◽  
Vol 13 (3) ◽  
pp. 70-78 ◽  
Author(s):  
Bess Sirmon-Taylor ◽  
Anthony P. Salvatore
Keyword(s):  
Student Athletes ◽  
Section 504 ◽  
Return To Play ◽  
Behavioral Deficits ◽  
Prevention Education ◽  
Concussion Management ◽  
School Settings ◽  
Definition Of ◽  
Federal Guidelines ◽  
Academic Services

Abstract Purpose: Federal regulations should be implemented to provide appropriate services for student-athletes who have sustained a concussion, which can result in impaired function in the academic setting. Eligibility guidelines for special education services do not specifically address the significant, but sometimes transient, impairments that can manifest after concussion, which occur in up to 10% of student-athletes. Method: We provide a definition of the word concussion and discuss the eligibility guidelines for traumatic brain injury and other health-impaired under IDEA, as is the use of Section 504. Results: The cognitive-linguistic and behavioral deficits that can occur after concussion can have a significant impact on academic function. We draw comparisons between the clinical presentation of concussion and the eligibility indicators in IDEA and Section 504. Conclusion: Speech-language pathologists are well-positioned to serve on concussion management teams in school settings, providing services including collection of baseline data, intervention and reassessment after a concussion has occurred, prevention education, and legislative advocacy. Until the cultural perception of concussion changes, with increased recognition of the potential consequences, student-athletes are at risk and appropriate implementation of the existing guidelines can assist in preservation of brain function, return to the classroom, and safe return to play.

scholarly journals Concussion Knowledge among Medical Students and Neurology/Neurosurgery Residents

2012 ◽  
Vol 39 (3) ◽  
pp. 361-368 ◽  
Author(s):  
Miranda Boggild ◽  
Charles H. Tator
Keyword(s):  
Medical Students ◽  
Chronic Traumatic Encephalopathy ◽  
Sample Population ◽  
Diagnosis And Management ◽  
University Of Toronto ◽  
Concussion Management ◽  
Life Threatening ◽  
Concussion History ◽  
The University ◽  
Impact Syndrome

Background and Objectives:Concussion is a prevalent brain injury in the community. While primary prevention strategies need to be enhanced, it is also important to diagnose and treat concussions expertly and expeditiously to prevent serious complications that may be life-threatening or long lasting. Therefore, physicians should be knowledgeable about the diagnosis and management of concussions. The present study assesses Ontario medical students’ and residents’ knowledge of concussion management.Methods:A survey to assess the knowledge and awareness of the diagnosis and treatment of concussions was developed and administered to graduating medical students (n= 222) and neurology and neurosurgery residents (n = 80) at the University of Toronto.Results:Residents answered correctly significantly more of the questions regarding the diagnosis and management of concussions than the medical students (mean = 5.8 vs 4.1, t= 4.48, p<0.01). Gender, participation in sports, and personal concussion history were not predictive of the number of questions answered correctly. Several knowledge gaps were identified in the sample population as a whole. Approximately half of the medical students and residents did not recognize chronic traumatic encephalopathy (n = 36) or the second impact syndrome (n = 44) as possible consequences of repetitive concussions. Twenty-four percent of the medical students (n = 18) did not think that “every concussed individual should see a physician” as part of management.Conclusions:A significant number of medical students and residents have incomplete knowledge about concussion diagnosis and management. This should be addressed by targeting this population during undergraduate medical education.

Developmental Training Model for the Sport Specialized Youth Athlete: A Dynamic Strategy for Individualizing Load-Response During Maturation

2021 ◽  
pp. 194173812110560
Author(s):  
Neeru Jayanthi ◽  
Stacey Schley ◽  
Sean P. Cumming ◽  
Gregory D. Myer ◽  
Heather Saffel ◽  
...  
Keyword(s):  
Skill Acquisition ◽  
Injury Risk ◽  
Specific Capacity ◽  
Training Model ◽  
Return To Play ◽  
Level Of Evidence ◽  
Training Models ◽  
Youth Athletes ◽  
Medical Evaluation ◽  
Youth Athlete

Context: Most available data on athletic development training models focus on adult or professional athletes, where increasing workload capacity and performance is a primary goal. Development pathways in youth athletes generally emphasize multisport participation rather than sport specialization to optimize motor skill acquisition and to minimize injury risk. Other models emphasize the need for accumulation of sport- and skill-specific hours to develop elite-level status. Despite recommendations against sport specialization, many youth athletes still specialize and need guidance on training and competition. Medical and sport professionals also recommend progressive, gradual increases in workloads to enhance resilience to the demands of high-level competition. There is no accepted model of risk stratification and return to play for training a specialized youth athlete through periods of injury and maturation. In this review, we present individualized training models for specialized youth athletes that (1) prioritize performance for healthy, resilient youth athletes and (2) are adaptable through vulnerable maturational periods and injury. Evidence Acquisition: Nonsystematic review with critical appraisal of existing literature. Study Design: Clinical review. Level of Evidence: Level 4. Results: A number of factors must be considered when developing training programs for young athletes: (1) the effect of sport specialization on athlete development and injury, (2) biological maturation, (3) motor and coordination deficits in specialized youth athletes, and (4) workload progressions and response to load. Conclusion: Load-sensitive athletes with multiple risk factors may need medical evaluation, frequent monitoring, and a program designed to restore local tissue and sport-specific capacity. Load-naive athletes, who are often skeletally immature, will likely benefit from serial monitoring and should train and compete with caution, while load-tolerant athletes may only need occasional monitoring and progress to optimum loads. Strength of Recommendation Taxonomy (SORT): B.

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

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

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

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