Search

The National Collegiate Athletic Association and Department of Defense (NCAA-DoD) Mind Matters Challenge created "useful and feasible" consensus recommendations to improve concussion care-seeking behavior in collegiate athletes and military cadets. Given athletic trainers' (ATs') role as providers of concussion education and medical care, it is important to understand if they agree with the expert panel that the recommendations are useful and feasible. To describe and compare the perceptions of ATs in the secondary school (SS) and collegiate settings of the utility and feasibility of the NCAA-DoD Mind Matters Challenge recommendations on improving concussion education. Cross-sectional study. Electronic survey. Five hundred fifteen (515) ATs (age = 40.7 ± 12.4 years, 53.1% female gender) practicing in the SS (60.6%) or collegiate (38.4%) setting. An online survey asked participants about their awareness of the statement followed by 17 pairs of Likert-item questions regarding each recommendation's utility and feasibility with responses ranging from no (1) to yes (9). Mimicking the consensus process, we defined consensus as a mean rating of ≥7.00. We compared utility and feasibility rating responses between SS and collegiate setting participants using Mann-Whitney U tests with α =.05. Two-thirds (66.6%) of participants were unaware of the consensus statement. Participants felt all recommendations were useful (all means ≥ 7.0); however, 4 recommendations related to collaborating with stakeholders did not meet the feasibility cutoff (mean range = 6.66–6.84). Secondary school ATs rated lower feasibility related to educational content (P value range =.001–.014), providing patient education throughout recovery (P =.002), and promoting peer intervention (P =.019) but higher utility (P =.007) and feasibility (P =.002) for providing parent education than collegiate ATs. The NCAA-DoD Mind Matters Challenge recommendations require further dissemination. Athletic trainers rated collaboration with stakeholders as a feasibility barrier. Secondary school ATs require more resources for educational content, messaging, and promoting peer intervention but find educating athletes' parents more useful and feasible than collegiate ATs. [ABSTRACT FROM AUTHOR]

To obtain a comprehensive understanding of the implications of environmental and climate factors on sport-related concussion incidence in outdoor contact sports. MEDLINE (via Ovid), Embase (via Elsevier), CINAHL Complete (via EBSCOhost), SPORTDiscus (via EBSCOhost), and Scopus (via Elsevier). Studies that report incidence of sport-related concussion, assess data from athletes participating in outdoor contact sports, report on 1 or more climate or environmental factors, and report a diagnosis of concussion performed by a licensed medical professional were included. Reasons for exclusion included no report on extrinsic or environmental factors, no data on sport-related concussion incidence, and self-report of concussion diagnosis. This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using 2 reviewers at each phase and a third reviewer for conflict resolution. A total of 7558 articles were reviewed, and 20 met the inclusion criteria. There was moderate to strong strength of evidence concluding no difference between surface type (grass versus artificial) on sport-related concussion risk. Moderate to strong strength of evidence was found supporting no difference in sport-related concussion incidence based on game location (home versus away). There was no consensus on the effects of altitude or temperature on sport-related concussion incidence. One high-quality study found a decreased risk of sport-related concussion when playing in wet versus dry conditions. Heterogenous populations and data collection methods prevented extraction and meta-analysis. Although a consensus on specific environmental and climate factors that influence sport-related concussion incidence was limited, the majority of studies were of high quality and gave insight into opportunities for future investigation. Administrators of large injury surveillance databases should consider including specific environmental and climate factors to provide investigators with robust data sets to better understand potential associations with sport-related concussion. [ABSTRACT FROM AUTHOR]

Persistent postconcussion symptoms (PPCSs) are associated with lower health-related quality of life (HRQoL) in children and adolescents. Despite commonly cited criteria for PPCSs involving 3 or more complaints, many individuals experience just 1 or 2 symptoms that may still negatively affect HRQoL. To determine differences in HRQoL between children and adolescents with 0, 1 to 2, or 3+ parent-reported persistent symptoms at 1 month postconcussion. Prospective cohort study. Community practice clinics. Individuals aged 8 to 18 years presented for the initial visit within 3 days of a sport- or recreation-related concussion. One month later, parents or guardians reported persistent symptoms using the Rivermead Post Concussion Symptoms Questionnaire (RPQ). Individuals with complete symptom data were analyzed (n = 236/245, n = 97 females, age = 14.3 ± 2.1 years). Participants were grouped by the number of discrete RPQ symptoms reported as worse than preinjury (0, 1–2, or 3+). Total summary and subscale scores on the Pediatric Quality of Life Inventory (PedsQL) 23-item HRQoL inventory and 18-item Multidimensional Fatigue Scale (MDFS). Kruskal-Wallis rank sum tests highlighted differences in PedsQL HRQoL and MDFS total scores across symptom groups (PedsQL HRQoL: χ22 = 85.53, P <.001; MDFS: χ22 = 93.15, P <.001). Dunn post hoc analyses indicated all 3 groups were statistically significantly different from each other (P <.001). The median (interquartile range) values for the Peds QL Inventory HRQoL totals were 93.5 (84.2–98.8) for those with 0 symptoms; 84.8 (73.9–92.4) for those with 1 to 2 symptoms; and 70.7 (58.7–78.0) for those with 3+ symptoms. The median (interquartile range) values for the MDFS totals were 92.4 (76.4–98.6) for those with 0 symptoms; 78.5 (65.6–88.9) for those with 1 to 2 symptoms; and 54.2 (46.2–65.3) for those with 3+ symptoms. Similar group differences were observed for each PedsQL HRQoL and MDFS subscale score. Children and adolescents whose parents reported 1 to 2 PPCSs had lower HRQoL and more fatigue than those with 0 symptoms. Across all 3 groups, those with 3+ persistent symptoms had the lowest HRQoL and most fatigue. These findings indicate the continued need for intervention in this age group to prevent and address PPCSs. [ABSTRACT FROM AUTHOR]

Concussion induces the rapid onset of a short-lived neurophysiological disturbance that often results in autonomic nervous system dysfunction. This dysfunction affects both cardiovascular functioning and higher cognitive processing, inducing postconcussion clinical symptoms (somatic, cognitive, or emotional or a combination) and functional disturbances (impaired balance, cognition, and visual-vestibular performance). Current concussion rehabilitation paradigms using aerobic exercise may improve concussion symptoms. Additionally, cognitive training–focused rehabilitation interventions may enhance cognitive function postinjury. Though aerobic exercise and cognitive training–based concussion rehabilitation are successful independently, the multifaceted nature of concussion suggests the potential benefit of integrating both to improve concussion outcomes and clinician implementation. To support this clinical recommendation, we critiqued the existing research in which authors investigated aerobic exercise and cognitive training as postconcussion rehabilitation modalities, identified keys gaps in the literature, and proposed a practical clinical recommendation to integrate both modalities during concussion rehabilitation. [ABSTRACT FROM AUTHOR]

After a sport-related concussion, many athletes experience persisting neurophysiological alterations. These alterations may be absent at rest but emerge during moments of physiological stress. Unnoticed and untreated neurophysiological dysfunction may negatively affect long-term neurologic health in adolescent athletes, as they are at a critical point in development. To assess cardio-autonomic functioning in athletes with and those without a history of concussion by quantifying measures of heart rate variability (HRV) during times of physical and mental exertion. Case-control study. Research laboratory. Thirty-four male Hockey Quebec Midget-AAA hockey players were separated into those with (n = 16; age = 16.06 ± 0.73 years, body mass index = 23.29 ± 1.79) and those without (n = 18; age = 15.98 ± 0.62 years, body mass index = 23.60 ± 2.49) a history of concussion. All athletes underwent a series of HRV recording sessions (1) at rest, (2) while completing a cognitive task at rest, and (3) while completing a cognitive task after a bout of submaximal aerobic exercise. Time-domain measures of HRV, including mean NN intervals, SD of NN intervals, and root mean square of successive NN interval differences, were quantified for each assessment. No differences in characteristics were evident between groups. No between-groups differences in HRV at rest were observed. However, during the cognitive task at rest and after aerobic exercise, athletes with a history of concussion demonstrated a higher SD of NN intervals (78.1 ± 4.3 versus 63.2 ± 4.1 milliseconds and 71.2 ± 4.3 versus 65.2 ± 3.8 milliseconds, respectively; F1,31 = 4.31, P =.046) and root mean square of successive NN interval differences (75.8 ± 6.0 versus 59.0 ± 5.6 milliseconds and 74.0 ± 5.5 versus 59.0 ± 5.2 milliseconds, respectively; F1,31 = 4.88, P =.04) than athletes without a history of concussion. Concussive injuries may result in long-term cardio-autonomic dysfunction. These deficits may not be present at rest but may be triggered by physiological stress. [ABSTRACT FROM AUTHOR]

Context: Concussion-symptom education remains the primary approach used by athletic trainers to address underreporting of possible sport-related concussions. Social marketing represents an untapped approach to promote concussion reporting by communicating the benefits or consequences of reporting or not reporting, respectively. Objective: To apply expectancy value theory and identify how marketing the possible consequences of concealing concussion symptoms influenced young adults' concussionreporting beliefs to increase the likelihood of reporting. Design: Randomized controlled clinical trial. Setting: Laboratory. Patients or Other Participants: A total of 468 competitive collegiate club sport athletes at a large US university who engaged in 1 of 46 sports with various levels of concussion risk. Intervention(s): Participants were randomly assigned by team to 1 of 3 conditions. The treatment condition was a socialmarketing program focused on the possible consequences of the reporting decision. The control condition was traditional concussion-symptom education based on the National Collegiate Athletic Association's publication, "Concussion: A Fact Sheet for Student-Athletes." An additional condition mirrored the traditional symptom education but included a less clinical delivery. Main Outcome Measure(s): Positive and negative beliefs regarding concussion reporting were assessed. We applied expectancy value theory, which posits that changing beliefs in the short term will produce greater reporting intentions in the long term. Results: Club sport athletes exposed to consequencebased social marketing showed higher levels of positive reporting beliefs and lower levels of negative reporting beliefs than athletes exposed to traditional or revised symptom education. We observed no differences between the traditional and revised symptom-education programs. Exposure to consequence- based marketing decreased negative beliefs about reporting (B =-0.165, P = .01) and increased positive beliefs about reporting (B = 0.165, P=.01). Conclusions: Social marketing offers athletic trainers another strategic tool for motivating athletes to report concussion symptoms by translating scientific findings into marketable statements and then communicating the benefits of reporting or the negative consequences of concealing concussion symptoms. [ABSTRACT FROM AUTHOR]

Context: Lower extremity musculoskeletal (LEMSK) injury may be more prevalent among those with a history of sportrelated concussion (SRC). Objective: To investigate the relationship between baseline postural control metrics and the LEMSK injury incidence in National Collegiate Athletic Association Division I studentathletes with a history of SRC. Setting: National Collegiate Athletic Association Division I athletes. Design: Cohort study. Patients or Other Participants: Of 84 total athletes (62 males), 42 had been previously diagnosed with an SRC, and 42 were matched controls based on age, sex, height, weight, and sport. Main Outcome Measure(s): During the preseason baseline evaluation, all participants performed 3 trials of eyes-open and eyes-closed upright quiet stance on a force platform. Medical charts were assessed for all the LEMSK injuries that occurred from preseason baseline to 1 year later. Center-of-pressure data in the anteroposterior and mediolateral directions were filtered before we calculated root mean square and mean excursion velocity; the complexity index was calculated from the unfiltered data. Factorial analysis-of-variance models were used to examine differences between groups and across conditions for root mean square; mean excursion velocity, complexity index, and tests of association to examine between-groups LEMSK differences; and logistic regression models to predict LEMSK. Results: Concussion history and injury incidence were related in the SRC group (P = .043). The complexity index of the SRC group was lower with eyes closed (14.08 ± 0.63 versus 15.93 ± 0.52) and eyes open (10.25 ± 0.52 vs 11.80 ± 0.57) in the mediolateral direction than for the control participants (P < .05). Eyes-open root mean square in the mediolateral direction was greater for the SRC group (5.00 ± 0.28 mm) than the control group (4.10 ± 0.22 mm). Logistic regression models significantly predicted LEMSK only in control participants. Conclusions: These findings may suggest that LEMSK after SRC cannot be predicted from postural-control metrics at baseline. [ABSTRACT FROM AUTHOR]

Context: Despite a high incidence of injury in their sport, rodeo athletes have been underrepresented in the concussion literature. No standard postconcussion protocols are available across rodeo organizations for evaluating fitness to return to competition. Objective: To review the literature on concussion in rodeo, examine published guidelines, and offer an active return-to-play (RTP) protocol specific to rodeo athletes. Background: Unique barriers complicate the management and treatment of rodeo athletes with concussion, such as the solo nature of the sport, lack of consistent access to health care professionals, and athletic conditioning that often occurs outside of a traditional gym-based exercise regimen. In addition, the rodeo culture encourages a swift return to competition after injury. Description: Best practices for managing concussion are removal from activity, proper diagnostic evaluation, and gradual return to sport, with medical clearance when an athlete is symptom free and able to tolerate cognitive and physical exertion. An RTP protocol for rodeo events needs to capture the distinctive features and challenges of the sport and its athletes. Clinical Advantages: Rodeo athletes would benefit from an RTP protocol that can be initiated by an athletic trainer or medical professional in the acute stage of injury, integrates exercise into activities of daily living, and is appropriate for athletes who travel frequently. At the organizational sport level, a formal RTP protocol could enhance consistency in medicalclearance techniques among providers responsible for the return to sport of rodeo athletes. Conclusions: Rodeo athletes represent a sport population that has received little formal guidance on the diagnosis, management, and RTP after concussion. A sport-specific RTP protocol sensitive to the particular culture of these athletes is an important first step in protecting the health and safety of rodeo athletes after a concussive injury. [ABSTRACT FROM AUTHOR]

Context: Student-athletes may require cognitive rest and academic support after concussion. Athletic trainers (ATs) in secondary schools are uniquely positioned to provide medical care and to collaborate with school professionals while managing concussions. However, little is known regarding return-to-learn policies and their implementation in secondary schools. Objective: To examine ATs' perspectives on return to learn, cognitive rest, and communication with school professionals after concussion. Design: Cross-sectional study. Setting: Web-based survey. Patients or Other Participants: A total of 1124 secondary school ATs completed the survey (28.5% response rate). The majority of participants were employed full time (752/1114 [67.5%]) in public schools (911/1117 [81.6%]). Main Outcome Measure(s): School and AT employment characteristics, demographics, number of concussions evaluated annually, and perceptions of school professionals' familiarity with ATs' responsibilities were independent variables. Results: Of the ATs, 44% reported having an existing return-to-learn policy. The strongest predictor of a return-to-learn policy was frequent communication with teachers after concussion (odds ratio = 1.5; 95% confidence interval =1.2, 1.7). Most ATs recommended complete cognitive rest (eg, no reading, television; 492/1087 [45.3%]) or limited cognitive activity based upon symptoms (391/1087 [36.0%]). Common academic accommodations were postponed due dates (789/954 [82.7%]), rest breaks (765/954 [80.2%]), and partial attendance (740/954 [77.6%]). Athletic trainers self-reported as primary monitors of health (764/1037 [73.7%]) and academic progression (359/1011 [35.5%]). The strongest predictor of ATs' communication with school professionals was their perception of school professionals' understanding of ATs' roles. Conclusions: Overall, ATs followed best practices for cognitive rest and return to learn after concussion. Although ATs are central to the management of student-athletes' physical health after concussion, school professionals may be better suited to monitor academic progress. Increased communication between the AT and school professionals is recommended to monitor recovery and facilitate academic support for symptomatic student-athletes. [ABSTRACT FROM AUTHOR]