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Context: Coupling theory, based on a tight-loose continuum, describes the nature of a connection, relationship, or interaction between entities. Understanding the nature of an ATEP's relationship with intercollegiate athletic departments is important to their growth and responsiveness to environmental change. Objective: To determine program directors' general perceptions of coupling, as well as perceptions of coupling relative to personnel, physical resources, and financial resources. Design: Descriptive, exploratory. Setting: CAATE accredited undergraduate ATEPs. Participants: The participants were 151 program directors from CAATE accredited undergraduate ATEPs. Data Collection and Analysis: Program directors were queried regarding their perceptions of coupling between the ATEP and the host institution's athletic department relative to 5 subscales: general perceptions, personnel, equipment, facilities, and financial resources.Descriptive statistics were used to provide institutional and program director profiles. Composite means were used to determine the perceived degree of coupling relative to the 5 subscales. ANOVA (post-hoc analysis, p < 0.05) and independent paired samples t tests determined differences in program directors' perceptions of coupling based on individual and institutional characteristics. Results: Program directors perceived moderate generalized, equipment, and personnel coupling, and slight coupling relative to facilities and financial resources. Significant differences were related to years of program direction experience, role orientation, institutional athletic affiliation, school or college affiliation, and funding source. Conclusions: Program directors perceive a tighter degree of generalized coupling than coupling specific to equipment, facilities, personnel, or financial resources. Institutional and program director characteristics may influence perceptions of coupling.

Context: Concussions remain misunderstood, underreported, and undiagnosed. Although most concussion symptoms resolve within 2 weeks, some patients experience persistent symptoms that adversely affect physical, emotional, social, or cognitive functioning or a combination of these. Minimal evidence delineating the effect of concussions on recently retired collegiate athletes currently exists. Objective: To examine the lived experiences of retired collegiate athletes with a history of 1 or more concussions to discern individual concussion histories, knowledge and perceptions of concussions, and postconcussion quality of life. Design: Qualitative study. Setting: Telephone interviews. Patients or Other Participants: Former National Collegiate Athletic Association Division I athletes (n=14) with a history of 1 or more concussions and retired from 1 to 5 years. Data Collection and Analysis: Fourteen semistructured telephone interviews (8 men and 6 women) were audiotaped. Interviews were transcribed and inductively analyzed by 3 athletic trainers with 34 combined years of professional experience. Themes were negotiated through consensual review. Participant checks were completed to ensure trustworthiness of the findings. Results: Participants sustained their first concussion during adolescence and often experienced difficulties transitioning back into the postconcussion academic environment. Judgments of injury severity were clearly evident in participants' knowledge and perceptions of concussions. Participants experienced an array of emotional, physical, cognitive, and social challenges during the immediate postconcussion period but did not feel their concussion history decreased their current quality of life. Conclusions: Adolescent exposure to concussions is of concern due to the risk imposed on the developing brain and the potential for adverse outcomes later in life. Although a graduated return to play is heavily emphasized in concussion management, researchers need to investigate barriers inhibiting the implementation of return-to-learn protocols. Concussion education should aim to modify indifferent attitudes toward concussive injuries. Additionally, investigators should continue to assess how a history of concussion affects quality of life in recently retired collegiate athletes. [ABSTRACT FROM AUTHOR]

An 18-year-old NCAA Division I women's softball player presented with a sudden onset of pain in her left wrist during a strength and conditioning workout. Initial examination revealed pain, loss of AROM, decreased muscle strength, and paresthesia. The patient experienced symptomology for 12+ weeks. Corticosteroid injections were administered which finally confirmed diagnosis, reduced pain, and paresthesia. Intersection syndrome is generally an overuse condition which resolves within approximately 2 weeks. This case demonstrates that examination findings, imaging, immobilization, and a therapeutic exercise plan may not be sufficient to decrease patient symptomology. [ABSTRACT FROM AUTHOR]

Context: Moderate to severe traumatic brain injuries can negatively influence health-related quality of life (HRQOL) in adolescent patients. The effect of sport-related concussion on adolescent HRQOL remains unclear. Objective: To investigate the perceptions of adolescent student-athletes and their parents regarding the adolescents' HRQOL 1 year after sport-related concussion. Design: Qualitative study. Setting: Secondary school. Patients or Other Participants: Seven adolescent student-athletes (age range, 12-16 years) who sustained a sport-related concussion at least 1 year (15.3 ± 2.8 months) before the study participated along with their primary care-giving parents (n = 7). Data Collection and Analysis: Fourteen semistructured face-to-face interviews (7 adolescents, 7 parents) were completed. Interviews were transcribed and inductively analyzed by a team of 3 athletic trainers with 32 combined years of professional experience. Themes were negotiated through a consensual review process. Participant checks were completed to ensure trustworthiness of the results. Results: Four major themes emerged from the interviews: (1) significant effect of symptoms, (2) feelings of frustration, (3) influence on school attendance and activities, and (4) nature of interpersonal and team relationships. Participants indicated that the physical symptoms of the concussion substantially affected their emotional and academic function. The influence of the concussion on social interactions seemed to depend on the nature of interpersonal relationships. Conclusions: Sport-related concussion can negatively influence physical and emotional function, academics, and interpersonal interactions as perceived by adolescent student-athletes and their parents. Education of parents and their children, school professionals, coaches, and teammates remains critical to effectively recognize and manage sport-related concussion. Secondary school districts also play a critical role in the concussion-management process by establishing and implementing accommodation policies that alleviate student concerns about falling behind while ensuring a healthy return to normal school routines. Furthermore, adolescent support systems must be considered throughout the recovery process. [ABSTRACT FROM AUTHOR]

Context: Depression, which affects millions of Americans each year, among them collegiate student-athletes, can be caused by a wide range of circumstances, including sportrelated injuries. Objective: To longitudinally examine the extent to which National Collegiate Athletic Association Division I studentathletes demonstrated postinjury depressive symptoms. Design: Descriptive epidemiologic study. Setting: National Collegiate Athletic Association Division I collegiate athletics. Patients or Other Participants: Concussed, injured/nonconcussed, and healthy Division I collegiate student-athletes (aged 18-22 years) competing in men's basketball, football, and wrestling and women's basketball, soccer, and volleyball. Main Outcome Measure(s): Participants completed the Center for Epidemiologic Studies Depression Scale at baseline and at 1 week, 1 month, and 3 months postinjury. We measured differences in depressive scores among concussed, injured/ nonconcussed, and healthy participants. Longitudinal changes in postconcussion depressive symptoms were also examined. Results: No differences in baseline depressive symptoms among subgroups were noted. After an increase between baseline and 1 week (4.3, 95% confidence interval [CI] = 0.41, 8.16, P = .02), depressive symptoms in the concussion group decreased between 1 week and 1 month (-2.7, 95% CI=-4.96, -0.47, P = .01) and between 1 week and 3 months (-4.0, 95% CI =-6.50, -1.49, P = .004). The injured/nonconcussed group showed differences between baseline and 1 week (4.6, 95% CI =1.08, 8.17, P =.009) and between baseline and 1 month (3.2, 95% CI =-0.05, 6.30, P = .03). No significant differences were present in depressive symptoms between concussed participants and injured/nonconcussed participants at any of the postinjury time points. Conclusions: Depression may present as a postinjury sequela in Division I collegiate athletes. Athletes who sustain a concussion or other injury resulting in time lost from practice or competition need to be observed carefully for signs and symptoms that may indicate depression. Tools such as the Center for Epidemiologic Studies Depression Scale can be valuable in helping clinicians to recognize and manage depressive symptoms in these individuals. [ABSTRACT FROM AUTHOR]