Concussion Recovery Timeline of High School Athletes Using A Stepwise Return-to-Play Protocol: Age and Sex Effects

Context Implementation of a stepwise return-to-play (RTP) protocol has become the standard management strategy for high school athletes to ensure a safe RTP after concussion. The detailed characteristics of the recovery timeline throughout the steps of an RTP protocol have not been delineated among the adolescent population. Objective To investigate the days spent in each step of the stepwise RTP protocol in an adolescent population and examine the effects of age and sex on recovery time. Design Cross-sectional study. Setting Local schools. Patients or Other Participants Student-athletes from 57 schools. Intervention(s) A total of 726 patients with concussion (age = 15.5 ± 1.2 years, males = 454, females = 272) were included. The 7-step RTP protocol consists of the following steps: (1) complete cognitive rest, (2) full return to school, (3) light exercise, (4) running progression, (5) noncontact training drills and weight training, (6) full-contact practice or training, and (7) return to game play. The data were obtained by certified athletic trainers as a part of the statewide standardized concussion-management protocol. Main Outcome Measure(s) Days spent in steps 0 to 6 as well as a breakdown of days by sex and age. Results The average total RTP days were 20.2 ± 13.9. Half of this time was spent in the return-to-school phase (steps 2–3: 10.2 ± 10.0 days). Compared with 17-year-old participants, younger participants (age = 14–16 years) took 3 or 4 days longer to start step 3 and to reach step 6 (P < .05). Females took longer to reach step 6 than males (21.6 ± 15.5 versus 19.3 ± 12.7 days) because they took longer to reach step 3 (14.7 ± 11.4 days) than males (13.0 ± 10.0 days; P < .05). Conclusions Our study provides an estimated stepwise concussion recovery timeline for adolescent student-athletes. Clearance to start step 3 was the benchmark for the recovery timeline, as the duration of the exercise portion of the protocol was consistent across the age and sex groups.

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Sport-Related Concussion Knowledge and Occurrence: A Survey of High School and College Athletes in South Korea

International Journal of Athletic Therapy & Training ◽

10.1123/ijatt.2014-0087 ◽

2016 ◽

Vol 21 (2) ◽

pp. 53-60 ◽

Cited By ~ 2

Author(s):

Hyung Rock Lee ◽

Jacob E. Resch ◽

Tae Kyung Han ◽

Jessica D. Miles ◽

Michael S. Ferrara

Keyword(s):

High School ◽

South Korea ◽

Student Athletes ◽

College Athletes ◽

Signs And Symptoms ◽

Return To Play ◽

Cross Sectional Survey ◽

Cross Sectional ◽

South Korean ◽

History Of

Few studies have been conducted on individuals’ knowledge of sport-related concussions (SRCs) in South Korea. The purpose of this study was to examine South Korean athletes’ knowledge and recognition of SRC. A cross-sectional survey assessing (a) the recognition of specific signs and symptoms associated with SRC; (b) history of SRC; and (c) knowledge of the return-to-play decision (RTP) process after SRC was distributed to 410 high school and collegiate student-athletes from a variety of sports. No participants correctly identified all 9 items on the checklist of SRC signs and symptoms. While 8.9% reported a history of SRC, approximately 50% of those never reported their postconcussion signs and symptoms. Furthermore, 63.9% of the athletes who reported SRC made RTP decisions on their own. These results reflect the lack of knowledge in South Korean athletics of common signs, symptoms, and appropriate RTP decisions following concussion.

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Return-to-play probabilities following new versus recurrent ankle sprains in high school athletes

Journal of Science and Medicine in Sport ◽

10.1016/j.jsams.2013.04.006 ◽

2014 ◽

Vol 17 (1) ◽

pp. 23-28 ◽

Cited By ~ 49

Author(s):

Jennifer M. Medina McKeon ◽

Heather M. Bush ◽

Ashley Reed ◽

Angela Whittington ◽

Timothy L. Uhl ◽

...

Keyword(s):

High School ◽

Return To Play ◽

Ankle Sprains ◽

High School Athletes

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Assessment and Management of Sport-Related Concussions in United States High Schools

The American Journal of Sports Medicine ◽

10.1177/0363546511423503 ◽

2011 ◽

Vol 39 (11) ◽

pp. 2304-2310 ◽

Cited By ~ 91

Author(s):

William P. Meehan ◽

Pierre d’Hemecourt ◽

Christy L. Collins ◽

R. Dawn Comstock

Keyword(s):

Computed Tomography ◽

High School ◽

Primary Care ◽

Neuropsychological Testing ◽

Return To Play ◽

Categorical Variables ◽

Fisher Exact Test ◽

Medical Studies ◽

High School Athletes ◽

Medical Provider

Background: Little existing data describe which medical professionals and which medical studies are used to assess sport-related concussions in high school athletes. Purpose: To describe the medical providers and medical studies used when assessing sport-related concussions. To determine the effects of medical provider type on timing of return to play, frequency of imaging, and frequency of neuropsychological testing. Study Design: Descriptive epidemiology study. Methods: All concussions recorded by the High School Reporting Information Online (HS RIO) injury surveillance system during the 2009 to 2010 academic year were included. χ2 analyses were conducted for categorical variables. Fisher exact test was used for nonparametric data. Logistic regression analyses were used when adjusting for potential confounders. Statistical significance was considered for P < .05. Results: The HS RIO recorded 1056 sport-related concussions, representing 14.6% of all injuries. Most (94.4%) concussions were assessed by athletic trainers (ATs), 58.8% by a primary care physician. Few concussions were managed by specialists. The assessment of 21.2% included computed tomography. Computerized neuropsychological testing was used for 41.2%. For 50.1%, a physician decided when to return the athlete to play; for 46.2%, the decision was made by an AT. After adjusting for potential confounders, no associations between timing of return to play and the type of provider (physician vs AT) deciding to return the athlete to play were found. Conclusion: Concussions account for nearly 15% of all sport-related injuries in high school athletes. The timing of return to play after a sport-related concussion is similar regardless of whether the decision to return the athlete to play is made by a physician or an AT. When a medical doctor is involved, most concussions are assessed by primary care physicians as opposed to subspecialists. Computed tomography is obtained during the assessment of 1 of every 5 concussions occurring in high school athletes.

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The Effect of Olive Leaf Extract on Upper Respiratory Illness in High School Athletes: A Randomised Control Trial

Nutrients ◽

10.3390/nu11020358 ◽

2019 ◽

Vol 11 (2) ◽

pp. 358 ◽

Cited By ~ 8

Author(s):

Vaughan Somerville ◽

Rachel Moore ◽

Andrea Braakhuis

Keyword(s):

High School ◽

Leaf Extract ◽

Respiratory Illness ◽

Return To Play ◽

Randomised Control Trial ◽

Olive Leaf ◽

High School Athletes ◽

Olive Leaf Extract ◽

Significant Difference ◽

Upper Respiratory

Upper respiratory illness (URI) has a major impact on both training and competition in an athletic setting. High school athletes are a sub-category who have reported higher illness rates than professional and sub-elite high school athletes of the same sport. Olive leaf extract (OLE) is an over-the-counter supplement that contains polyphenols, notably oleuropein and hydroxytyrosol, that have antiviral, antibacterial, anti-inflammatory and antioxidant properties that may reduce URI rates. Thirty-two high school students who play sport for the elite team at their school were recruited to a randomised controlled trial and allocated to a daily placebo or OLE (extent equivalent to 20 g of olive leaf, containing 100 mg oleuropein) supplementation for nine weeks during their competitive season. Twice weekly measures of wellbeing, training load and respiratory illness (sporting upper respiratory illness (SUPPRESS) questionnaire) were recorded at trainings, meetings or games. There was no significant difference in illness incidence (odds ratio (OR): 1.02 (95% confidence interval (CI) 0.21–4.44)), but there was a significant 28% reduction in sick days (OR: 0.72 (95% CI 0.56–0.93) p-value = 0.02) when supplemented with OLE. The dietary intakes of the athletes were sub-optimal with regard to immune support. OLE supplementation over a season did not significantly reduce URI incidence, but did decrease duration in high school athletes, potentially aiding return to play.

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Event-related Differences in the Cross-sectional Areas and Torque Generation Capabilities of Quadriceps Femoris and Hamstrings in Male High School Athletes

Journal of PHYSIOLOGICAL ANTHROPOLOGY ◽

10.2114/jpa2.29.13 ◽

2010 ◽

Vol 29 (1) ◽

pp. 13-21 ◽

Cited By ~ 12

Author(s):

Yoshihiro Hoshikawa ◽

Masataka Muramatsu ◽

Tomomi Iida ◽

Akiko Uchiyama ◽

Yoshiharu Nakajima ◽

...

Keyword(s):

High School ◽

Quadriceps Femoris ◽

High School Athletes ◽

Cross Sectional ◽

Torque Generation ◽

Male High School ◽

The Cross

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Potential factors influencing recovery from concussion in collegiate student-athletes

Journal of Concussion ◽

10.1177/2059700217707084 ◽

2017 ◽

Vol 1 ◽

pp. 205970021770708 ◽

Cited By ~ 1

Author(s):

Kayla P Harvey ◽

Eric E Hall ◽

Kirtida Patel ◽

Kenneth P Barnes ◽

Caroline J Ketcham

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Attention Deficit Disorder ◽

Student Athletes ◽

Return To Play ◽

Hyperactivity Disorder ◽

Previous Diagnosis ◽

History Of ◽

Concussion Recovery ◽

Potential Factors

Background Factors including sex, previous diagnosis of migraines, previous diagnosis of Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder, and a history of concussion may influence the length of recovery from concussion in collegiate student-athletes. Purpose To better understand factors that may influence recovery from concussion in collegiate-student athletes. Methods A total of 91 student-athletes from a Division I NCAA University who sustained concussions from the fall of 2011 to the spring of 2015 were evaluated. They were considered recovered from their concussion when neurocognitive and symptom scores returned to baseline and they were cleared by their physician. Analyses of variance were conducted to determine if potential factors influenced concussion recovery ( p < .0125). Results No significant differences were found for sex (males = 7.4 ± 5.9; females = 8.3 ± 4.8 days; p = 0.417), previous diagnosis of migraines (diagnosis = 8.0 ± 5.7; no diagnosis = 7.8 ± 5.4 days; p = 0.926), or history of concussion (history = 8.3 ± 5.7; no history = 5.6 ± 3.4 days; p = 0.088). However, a significant difference in the length of recovery was found between those with a previous diagnosis of Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder and those without (diagnosis = 13.3 ± 7.3; no diagnosis = 7.3 ± 4.9 days; p = 0.002). Conclusion Student-athletes with Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder show significantly longer recovery from concussions than those without. Further investigation of this and other factors that influence recovery from concussion may help in concussion recovery and return-to-play guidelines that improve student-athlete well-being.

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Adolescents With ADHD Do Not Take Longer to Recover From Concussion

Frontiers in Pediatrics ◽

10.3389/fped.2020.606879 ◽

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.

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Relationship between Ethics and Self-management Behaviors in the High School Student Athletes

International Journal of Recent Technology and Engineering - 2 ◽

10.35940/ijrte.b1036.0782s619 ◽

2019 ◽

Vol 8 (2S6) ◽

pp. 190-195

Keyword(s):

High School ◽

High School Student ◽

Student Athletes ◽

Interpersonal Relationship ◽

Self Management ◽

High School Athletes ◽

Management Behavior ◽

Statistical Program ◽

Positive Correlations ◽

Management Behaviors

This study was conducted to investigate the relationship between ethics and self-management behaviors in high school student athletes. To do so, the survey was performed on 189 high school athletes that were registered in the Korean Olympic Committee in 2018. The surveyed data was processed using SPSS 21.0 statistical program with frequency, explorative factor, reliability test, correlation and multiple regression analysis. The conclusions of the study were as follows: First, positive correlations were found in respect to opponent, manners/consideration and sense of responsibility on every sub-factor of self-management behavior upon the correlation results between ethics and self-management behavior on the athletes. Positive correlations were found to cause negative psychology, judge’s decision and social norms on mentality, life, unique behavior, exercise and interpersonal relationship controls. Additionally, positive correlations were found in consideration for peers and relationship with seniors on unique behavior, exercise and body controls. Second, causing negative psychology, judge’s decision and social norm showed positive influences on mentality control. Respect to Opponent’s respect and judge’s decision showed positive influences on life control. Respect to opponent and consideration for peers showed positive influences on unique behavior and exercise controls. Causing negative psychology and respect to opponent showed positive influences on interpersonal relationship control. On the other hand, respect to opponent, consideration for peers and relationship with seniors showed positive influences on body control. In conclusion, it is suggested that ethics of the high school student athletes have a positive correlation with self-management behavior as well as partial influences.

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Concussion Bingo: Taking an active learning approach to concussion education with vulnerable populations

Health Education Journal ◽

10.1177/0017896918806935 ◽

2018 ◽

Vol 78 (3) ◽

pp. 315-327 ◽

Cited By ~ 4

Author(s):

Jessica Wallace ◽

Tracey Covassin ◽

Erica Beidler

Keyword(s):

High School ◽

Active Learning ◽

Title I ◽

Low Socioeconomic Status ◽

Sleep Problems ◽

Cross Sectional Study ◽

Analysis Of Covariance ◽

Educational Activity ◽

Return To Play ◽

Cross Sectional

Objective: The ability of athletes in underserved communities to recognise sport-related concussion (SRC) may be complicated by the lack of a qualified professional, such as an athletic trainer, present. An active learning educational activity (Concussion Bingo) was developed to assist in SRC identification. This study examined learning outcomes following the use of this activity by athletes in two US Title I (low socioeconomic status) high schools. Design: Cross-sectional study. Setting: High school sports. Methods: Participants ( n = 102 athletes) completed 10-minute SRC knowledge of concussion surveys before and after participating in a Concussion Bingo activity. The 45-question survey assessed SRC knowledge through questions about SRC signs/symptoms, general injury information relating to loss of consciousness, the injured anatomical structure, complications of multiple SRCs and premature return to play. Participants had to mark key SRC terms on a Bingo card as they appeared throughout an SRC presentation including content from published consensus/position statements. Descriptive and parametric statistics were used to analyse the data. Results: Analysis of covariance revealed significant differences between pre- and post-Concussion Bingo scores. Athletes had the greatest knowledge increase of fogginess ( n = 30, 29.5%), mood changes ( n = 29, 28.5%), nausea ( n = 27; 26.5%) and sleep problems ( n = 27, 29.5%). On questions pertaining to the injury itself, athletes had the greatest increase on ‘you have to be hit in the head to get a concussion’ ( n = 51, 50%), ‘what kind of an injury is a concussion’ ( n = 31, 40.2%) and a concussion only occurs if you ‘black out’ ( n = 24, 23.4%). Conclusion: Concussion Bingo increased Title I high school athletes’ knowledge of SRCs, suggesting that it may be an effective active learning tool for increasing SRC knowledge.

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