Diagnosis and Management of Mild TBI via Eye Tracking

ObjectiveThe purpose of this study is to expose the prevalence of mild traumatic brain injuries among high school football players and to explore the possibility of implementing eye tracking performance as an objective way to assess cases of potential concussion.BackgroundConcussions are one of the most common forms of traumatic brain injury (TBI). Unfortunately, current research suggests that mild TBIs cannot always be accurately diagnosed via routine neurologic examination. Also, most evaluations, such as ImPACT, are survey-style assessments that are time intensive and subjective. Lack of an objective method to rapidly assess concussions on the field raises concern for second-impact syndrome (SIS), which can lead to permanent brain damage or even fatality.Design/MethodsThis multi-part study included a population of 849 high school athletes in from Lubbock, TX. Student athletes filled out a baseline concussion survey, then assessed their eye tracking performance with the EyeGuide Focus, a 10-second test that involves visually tracking a continuous, figure-8 shape. A vector-based system was used to measure the eye-tracking deviation.ResultsForty-two athletes were recorded with a baseline eye-tracking score, and a subsequent eye-tracking score that was labelled as a suspected concussion by a physician. Of those 42, 17 had a follow-up eye-tracking test 2 weeks later. Test scores labelled with suspected concussion had a significantly higher mean raw score than the baseline score. Higher scores indicate greater vector deviation from accurately tracing the figure-8 with the eyes.ConclusionsThe survey results show underdiagnosing of concussions at lower levels of youth sports, which may indicate a lack of resources. As the data shows marked changes between the concussed, baseline, and follow-up scores, eye-tracking promises to be a quick and efficient tool to assess sports-related concussions.

The Effect of Test Setting Upon Test-Retest Reliability of ImPACT Baseline Tests in High School Athletes

ObjectiveTo determine the test-retest reliability of ImPACT baseline tests across different schools within the same larger concussion management program.BackgroundImPACT is the most widely used concussion management cognitive testing tool. Baseline testing is often required for high school sports participation. Typically, testing occurs every 2 years based on test-retest reliability statistics in previous studies. Demographic and environmental factors, such as age, sex, number of participants, and supervision, all impact baseline performance. Studies to date have not examined test-retest differences across testing sites, such as between school differences.Design/MethodsCross-sectional retrospective design. Valid baseline tests from high school athletes over a 2-year interval were included. Participants who experienced concussions prior to or between tests were excluded. A total of 979 student athletes from 5 schools were included. The Intra-class correlations were determined over a 2-year period for each ImPACT composite score and school.ResultsICC estimates averaged between schools reflected good reliability for visual-motor speed (0.833), visual memory (0.673) and reaction time (0.615) over the two-year period. Verbal memory (0.586) and impulse control (0.556) were less reliable. Between schools a greater range of composite reliability was observed for reaction time (0.484–0.730) and impulse control (0.461–0.655) compared to verbal memory (0.534–0.637), visual memory (0.61–0.719), and visual-motor speed (0.769–914).ConclusionsAs previously established, reliability of ImPACT baselines vary by composite. This study revealed that reliability also varies by setting, as different schools yielded different ICCs. Consistent with the literature, the most reliable measure was visual-motor speed. The greatest difference in reliability between schools was for reaction time. These results suggest that test setting and environment affect reliability of ImPACT baseline scores, with varying effects per composite. Attention must be paid to environmental setting to improve reliability of baseline cognitive test performance to maximize athlete safety.

Relationships among High School Student-Athletes' Mental Health, Stressors, and Social Support during the COVID-19 Pandemic in Japan

Objectives: The impact of the spread of COVID-19 on the mental health and its mitigating factors of high school athletes is not fully understood. The aims of this study were 1) to describe the psychological distress and stressors experienced by high school athletes during the COVID-19 pandemic and to elucidate the relationships between them and 2) to determine the relationship between psychological distress and social support. Methods: Participants of this cross-sectional study were recruited from public high schools in East Japan. We conducted either an online or paper-based questionnaire survey from July 12 to 31, 2020, and used data collected from 3017 high school student athletes (valid response rate: 88.7%) for the analyses. We evaluated psychological distress (K6 ≥10), stressors to athletes during the COVID-19 pandemic (SAC-19), and perceived social support from others. Logistic regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for developing psychological distress. Results: Among the participants, 764 (25.3%) experienced psychological distress. Among the five factors extracted from the SAC-19, self-restraint requests (OR = 1.03, 95% CI: 1.01–1.04), pressure from the surrounding environment (OR = 1.15, 95% CI: 1.12–1.18), and difficulties in maintaining athletic activities (OR = 1.16, 95% CI: 1.12–1.21) increased the risk of psychological distress. On the other hand, participants who were satisfied with the support from family members (OR = 0.77, 95% CI: 0.67–0.90), teammates (the same grade) (OR = 0.81, 95% CI: 0.67–0.98), and coaches and instructors (OR = 0.77, 95% CI: 0.65–0.91) showed lower psychological distress. Conclusions: During the COVID-19 pandemic, high school athletes experienced more psychological distress than usual. Stressors such as self-restraint requests, pressure from the surrounding environment, and difficulties in maintaining athletic activities increased the risk. On the other hand, social support from family members, teammates (the same grade), and coaches and instructors can help alleviate these stressors.

The Association of COVID-19 Incidence with Sport and Face Mask Use in United States High School Athletes

Context: The relationships between different sports, face mask use and COVID-19 risk among high school athletes remains unknown. Objective: The purpose of this study was to evaluate the influence of sport characteristics and face mask use on COVID-19 incidence among high school athletes. Design: Descriptive Epidemiology Study Setting: United States High School Athletic Departments Participants: Athletic Directors Interventions: None Main Outcome Measures: Surveys were completed regarding sport re-initiation, COVID-19 cases, and risk reduction procedures in fall 2020. Separate mixed effects Poisson regression models were developed to evaluate the associations between reported COVID-19 incidence and 1) sport characteristics (contact/non-contact, individual/team, indoor/outdoor) and 2) face mask use while playing (yes/no). Results: 991 schools had restarted fall sports, representing 152,484 athletes on 5,854 teams. 2,565 cases of COVID-19 were reported, representing a case rate of 1,682 cases per 100,000 athletes and an incidence rate of 24.6 cases per 100,000 player-days. COVID-19 incidence was lower among outdoor versus indoor sports (incidence rate ratio [IRR]=0.54, 95% CI=0.49–0.60, p<0.001) and non-contact versus contact sports (IRR=0.78 [0.70–0.87], p<0.001), but not team versus individual sports (IRR=0.96 [0.84–1.1], p=0.49). Face mask use was associated with a decreased incidence in girls' volleyball (IRR=0.53 [0.37–0.73], p<0.001), boys' basketball (IRR=0.53 [0.33–0.83], p=0.008) and girls' basketball (IRR=0.36 [0.19–0.63], p<0.001), and approached statistical significance in football (IRR=0.79 [0.59–1.04], p=0.10) and cheer/dance (IRR=0.75 [0.53–1.03], p=0.081). Conclusions: In this nationwide survey of high school athletes, lower COVID-19 incidence was independently associated with participation in outdoor versus indoor and non-contact versus contact sports, but not team versus individual sports. Face mask use was associated with decreased COVID-19 incidence among indoor sports, and may be protective among outdoor sports with prolonged close contact between participants.