Search

Introduction Military service members (SMs) are exposed to repetitive head impacts (RHIs) in combat and training that are purported to adversely affect brain health, including cognition, behavior, and function. Researchers have reported that RHI from blast-related exposure may affect both vestibular and ocular function, which in turn may be related to symptomology. As such, an examination of the effects of RHI on exposed military SMs should incorporate these domains. To date, researchers have not compared groups of exposed special operations forces (SOF) operators on combined clinical vestibular/ocular and eye-tracker-based outcomes. Therefore, the primary purpose of this study was to compare participant-reported symptoms and performance on the Vestibular/Ocular Motor Screening (VOMS) tool with performance on the computerized RightEye tracking system between SOF operators exposed to blast-related RHI and healthy controls without blast-related exposure. In addition, the study aimed to compare subgroups of snipers and breachers exposed to RHI to controls on the preceding metrics, as well as identify a subset of individual (demographic) factors, participant-reported symptoms, and performance metrics on VOMS and RightEye that best identify SOF operators exposed to RHI from unexposed controls. Materials and Methods The study involved a cross-sectional design including 25 Canadian SOF SMs comprised of breachers (n  = 9), snipers (n  = 9), and healthy, unexposed controls (n  = 7). The former 2 groups were combined into an RHI group (n  = 18) and compared to controls (n  = 7). Participants provided demographics and completed a self-reported concussion-related symptom report via the Military Acute Concussion Evaluation 2, the VOMS, and RightEye computerized eye-tracking assessments. Independent samples t -tests and ANOVAs were used to compare the groups on the outcomes, with receiver operating characteristic curve and area under the curve (AUC) analyses to identify predictors of blast exposure. This study was approved by the Defence Research Development Canada Human Research Ethics Committee and the Canadian Forces Surgeon General/Special Forces Command. Results The results from t -tests supported group differences for age (P  = .012), participant-reported symptoms (P  = .006), and all VOMS items (P range = <.001-.02), with the RHI group being higher than healthy controls on all variables. ANOVA results supported group differences among snipers, breachers, and controls for age (P  = .01), RightEye saccades (P  = .04), participant-reported total symptom severity (P  = .03), and VOMS total scores (P  = .003). The results of the receiver operating characteristic curve analyses supported age (AUC = 0.81), Military Acute Concussion Evaluation 2 participant-reported total symptom severity (AUC = 0.87), and VOMS total scores (AUC = 0.92) as significant predictors of prior blast exposure. Conclusions Participant-reported concussion symptoms, VOMS scores, and age were useful in identifying SOF operators exposed to RHI from controls. RightEye metrics were not useful in differentiating RHI groups from controls. Differences between snipers and breachers warrant further research. Overall, the findings suggest that VOMS may be a useful tool for screening for the effects of exposure to RHI in SOF operators. Future investigations should be conducted on a larger sample of military SMs, consider additional factors (e.g. RHI exposure levels, medical history, and sex), and include additional assessment domains (e.g. balance, cognitive, and psychological). [ABSTRACT FROM AUTHOR]

• From 2010 to 2018, over 7 million visits to Emergency Departments (EDs) were due to concussion. • The vast majority of concussions diagnosed in EDs were not sport-related. • Most concussions were diagnosed in the South, followed by West, Midwest, and Northeast. • The Midwest and Northeast regions of the US had lower odds of concussion diagnoses in EDs. • Geographic region and mechanism of injury patterns inform future concussion efforts. Background : Concussion is a type of traumatic brain injury (TBI) that can be sustained through sport-related and non-sport-related (e.g., motor vehicle accidents, falls, assaults) mechanisms of injury (MOI). Variations in concussion incidence and MOI may be present throughout the four geographic regions (Midwest, Northeast, South, West) of the United States. However, there is limited evidence exploring concussion cause and diagnosis patterns based on geographic region and MOI. These factors have implications for better understanding the burden of concussion and necessary efforts that can translate to the mitigation of safety concerns. Purpose: The purpose of this study was to identify patterns of sport-related concussion (SRC) and non-sport-related concussion (NSRC) across the four geographic regions of the United States. Methods: A descriptive epidemiology study of patient visits to the emergency department (ED) for concussion between 2010 and 2018, using publicly available data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) was conducted. The exposure of interest was geographic region while the main outcome measures were concussion diagnosis and MOI. Descriptive statistics were calculated using population-weighted frequencies and percentages. The association between geographic region and MOI (SRC vs. NSRC) was analyzed using logistic regression models. Odds ratios (OR) presented with 95% confidence intervals (CI) were included. Univariate analyses were conducted followed by multivariable analyses adjusting for sex, age, race/ethnicity, and primary source of payment. Statistical significance was set a priori at p < 0.05 for all analyses. Results: From 2010 to 2018, 1,161 visits resulted in a concussion diagnosis, representing an estimated 7,111,856 visits nationwide. A greater proportion of concussion diagnoses occurred within EDs in the South (38.2%) followed by the West (25.8%), Midwest (21.4%), and Northeast (14.6%). Compared to the West region, patients visiting the ED in the Midwest (OR = 0.75, 95% CI = 0.57–0.98) and Northeast (OR = 0.71, 95% CI = 0.51–0.98) had a lower odds of being diagnosed with a concussion. More patients sustained a NSRC MOI (94.3%) compared to SRC MOI (5.7%). For both mechanisms, the South region had the highest population-weighted frequency of SRC (n = 219,994) and NSRC diagnoses (n = 2,495,753). Univariate and multivariable logistic regression analyses did not reveal statistically significant associations for geographic region and MOI (p > 0.05). Conclusion: Our findings showed that the Midwest and Northeast regions had a lower odds of concussion diagnoses in EDs. Overall, the vast majority of concussions were not sport-related, which has public health implications. These findings improve our understanding of how concussion injuries are being sustained geographically nationwide and help to explain care-seeking patterns for concussion in the ED setting. [ABSTRACT FROM AUTHOR]

Context: Knee self-efficacy and injury-related fear are associated with poor self-reported knee function and decreased physical activity (PA) after ACL reconstruction (ACLR). Limited research has explored contextual factors that may influence psychological responses in this population, such as history of sport-related concussion (SRC). After SRC, individuals may experience increased negative emotions, such as sadness and nervousness. However, it is unknown how SRC history may influence knee-self efficacy and injury-related fear in individuals with ACLR. The purpose of this study was to compare knee self-efficacy and injury-related fear in individuals after ACLR who present with and without history of SRC. Design: Cross-sectional study. Methods: Forty participants ≥1 year postunilateral ACLR were separated by history of SRC (no SRC = 29, SRC = 11). The Knee Self-Efficacy Scale (KSES) and subscales measured certainty regarding performance of daily activities (KSES-ADL), sports/leisure activities (KSES-Sport), physical activities (KSES-PA), and future knee function (KSES-Future). The Tampa Scale of Kinesiophobia-11 measured injury-related fear. Mann–Whitney U tests were used to examine between-group differences. Hedges g effect sizes and 95% confidence interval were used to examine clinically meaningful group differences. Results: Individuals with a history of ACLR and SRC demonstrated worse KSES-PA (7.5 [5.3]) compared with those without a history of SRC (8.1 [6.1], P =.03). No other statistically significant differences were observed. A medium effect size was present for the KSES-PA (0.62), KSES-ADL (0.42), KSES-Present (ADL + PA + Sport) (0.48), KSES-Total (0.53), and Tampa Scale of Kinesiophobia-11 (0.61) but must be interpreted with caution as 95% confidence interval crossed 0. Conclusions: This exploratory study indicated that individuals with a history of ACLR and SRC had worse knee self-efficacy for PA compared with those without history of SRC. Rehabilitation specialists should monitor knee self-efficacy deficits in the post-ACLR population and recognize the potential influence of cumulative injury history on rehabilitative outcomes. [ABSTRACT FROM AUTHOR]

Background: The current evidence for acute management practices of sport-related concussion (SRC) is often limited to in-clinic visits, with limited studies identifying professionals in early SRC care and the association with prolonged recovery outcomes. Purpose: To describe acute SRC management practices (ie, the personnel in the initial evaluations, removal from activity) and test the association with prolonged return to sport (RTS) time. Study Design: Descriptive epidemiology study. Methods: We conducted a retrospective cohort study of 17,081 high school SRCs accrued between the 2015-2016 and 2020-2021 academic years. We reported acute management practices and RTS time as frequencies stratified by sex, sport, and event type and compared athletic trainer (AT) access in initial evaluation with chi-square tests (P <.05). Separate logistic regressions estimated odds ratios (ORs) and 95% CIs for removal from activity and prolonged RTS >21 days by acute management practices. Results: Most SRCs (n = 12,311 [72.1%]) had complete initial evaluation by an AT. Boys had an AT evaluation in 75.5% (n = 2860/3787) of practice-related and 74.8% (n = 5551/7423) of competition-related events. Girls had an AT evaluation in 61.3% (n = 1294/2110) of practice-related and 69.3% (n = 2606/3761) of competition-related events. In sex-comparable sports (n = 6501), there was no difference between boys (n = 1654/2455 [67.4%]) and girls (n = 2779/4046 [68.7%]) having an AT involved in the first evaluation (χ2 = 1.21; P =.27). Notably, 25.3% of girls' SRCs were evaluated by a coach alone, and we observed differences in personnel in initial evaluations by sport. The odds of immediate removal were higher when an AT made the initial evaluation (OR, 2.8 [95% CI, 2.54-3.08]). The odds of prolonged RTS >21 days was lower for those with an AT in the initial evaluation (OR, 0.74 [95% CI, 0.65-0.84]) adjusting for significant factors from univariate analyses, boys relative to girls (OR, 0.85 [95% CI, 0.76-0.96]), specialty care relative to PCP (OR, 2.16 [95% CI, 1.90-2.46]), specialty care relative to urgent or ready care (OR, 0.99 [95% CI, 0.82-1.22]) concussion history (OR, 1.41 [95% CI, 1.22-1.63]), and removal from activity (OR, 0.90 [95% CI, 0.78-1.05]). Conclusion: This study found variability in personnel involved in initial SRC evaluations, with higher percentages of athletes with SRCs having ATs make the initial evaluation during competitive events. There was no association between sex and AT involvement in comparable sports. There was an association between prolonged RTS and AT involvement, sex, concussion history, and location of follow-up care. [ABSTRACT FROM AUTHOR]

Researchers have indicated that individuals may experience anxiety symptoms after concussion. A potential mechanism for these presentations is shifts in anxiety throughout recovery. To examine the levels of state and trait anxiety in individuals after concussion throughout recovery compared with the levels in individuals serving as uninjured matched control participants. Prospective cohort study. University laboratory. Seventy-eight high school- and college-aged individuals (concussion group = 39, age = 18.4 ± 2.3 years; matched control group = 39, age = 18.4 ± 2.3 years) were enrolled. The State-Trait Anxiety Inventory was administered within 72 hours of injury (day 0: first test session), 5 days (±1 day) after the first test session (day 5), and at the time of full medical clearance (+2 days). Separate 2 × 3 repeated-measures analyses of variance were used to investigate differences in state and trait anxiety for each group throughout recovery. State and trait anxiety were higher in the concussion group than in the control group at day 0, day 5, and full medical clearance. For state anxiety, we observed a group × time interaction (F2,150 = 10.45, P <.001, ƞp2 = 0.12). For trait anxiety, we did not note an interaction (F1.74,150 = 1.5, P =.22, ƞp2 = 0.02) but did find main effects for time (F1.74,150 = 25.7, P <.001, ƞp2 = 0.3) and group (F1,75 = 7.23, P =.01, ƞp2 = 0.09). Participants with concussion experienced higher levels of state anxiety throughout recovery than matched control individuals. Although trait anxiety was higher in the concussion group and decreased over time, no interaction was seen, demonstrating that concussion may not affect this aspect of personality. Postinjury anxiety may result from increased state anxiety, and clinicians should screen for and manage these symptoms throughout recovery. [ABSTRACT FROM AUTHOR]

Injury or illness can affect individual perceptions of health status and health-related quality of life (HRQOL). Concussion can result in different symptoms, impairments, and functional limitations that have been found to lower HRQOL. Furthermore, concussion is known to influence the emotional and behavioral dyscontrol domains of HRQOL in pediatric populations; however, this has yet to be explored in other populations. To compare individuals with and those without a concussion history and (1) HRQOL and (2) the emotional and behavioral dyscontrol domains of HRQOL in college students. Cross-sectional study. University laboratory setting. Of a total of 252 participants (155 women; age = 19.95 ± 1.53 years), 76 (30.2%) had a history of concussion and 176 (69.8%) did not. For participants with a history of concussion, the mean time since injury was 5.29 ± 2.77 years. The Patient-Reported Outcome Measures Information System (PROMIS) Global Health, version 1.1, and Quality of Life in Neurological Disorders Emotional and Behavioral Dyscontrol Short Form (Neuro-QOL). No differences were seen between median scores in individuals with and those without a history of concussion in the PROMIS Physical Health (13.0 versus 14.0; P =.24), PROMIS Mental Health (12.0 versus 12.0; P =.99), and Neuro-QOL (16.0 versus 16.0; P =.47) scores. Additionally, when gender was controlled, the associations between a history of concussion and PROMIS Physical Health score (odds ratio [OR] = 1.04; 95% CI = 0.43, 2.52), PROMIS Mental Health score (OR = 0.66; 95% CI = 0.13, 3.25), and Neuro-QOL score (OR = 1.16; 95% CI = 0.66, 2.04) were not significant. Preliminary findings suggested that the emotional and behavioral dyscontrol domains were not influenced by a concussion history of > 1 year in college-aged participants. Future researchers should continue to explore specific HRQOL domains affected by concussion as well as the influences of prior mental health conditions and behavioral dysfunction after a subsequent injury. [ABSTRACT FROM AUTHOR]

The objective was to examine the use of docosahexaenoic acid (DHA) for the treatment of sport-related concussion (SRC) in adolescent athletes. We hypothesize that participants who intake 2 g of DHA daily will not experience differences in recovery compared with participants who take a placebo. This double-blind, randomized controlled pilot trial was performed in a tertiary pediatric sports medicine clinic from 2013 to 2017 in adolescents (14-18 years) presenting with diagnosed SRC within 4 days of injury. Forty participants were randomized into DHA or PLACEBO group and were instructed to take 2 capsules twice daily for 12 weeks. Participants in the DHA group were symptom-free earlier than the PLACEBO group (11.0 vs 16.0 days, P =.08) and were cleared to begin the Return to Sport progression (14.0 vs 19.5 days, P =.12) sooner. The use of 2 g/day of DHA was well-tolerated and did not significantly affect recovery times in adolescent athletes following SRC. Clinical Trial Registration: ClincalTrials.gov, NCT01903525 [ABSTRACT FROM AUTHOR]

Background: There is limited epidemiologic data on pediatric basketball injuries and the comparison of these injuries before and after adolescence and between male and female athletes. Purpose: To assess common sex- and age-based injury patterns in pediatric basketball players. Study Design: Descriptive epidemiology study. Methods: Injury data from the National Electronic Injury Surveillance System (NEISS) and participation data from the National Sporting Goods Association were used to complete this study. Data on pediatric basketball injuries between January 2012 and December 2018 in patients aged 7 to 11 years (childhood) and 12 to 17 years (adolescence) were extracted and used to calculate national injury incidence rates with 95% CIs. Sex and age group patterns were examined utilizing Pearson chi-square tests. Z tests were conducted for the comparison of injury rates between female and male athletes in each age group and overall injury rate across age groups. Results: An average of 9582 basketball injuries were reported annually in the NEISS, which calculated to an annual national estimate of 294,920 injuries. The most common diagnoses were ankle strain/sprain (17.7%), finger strain/sprain/fracture (12.1%), concussion/head injury (9.4%), knee strain/sprain (4.5%), and facial laceration (3.3%). There was a significant increase in injury prevalence in adolescents (12- to 17-year-old category: 238,678 injuries per year) when compared with childhood (7- to 11-year-old category: 56,242 injuries per year) (P <.0001). Concussions/head injuries occurred at a high rate in childhood, second only to finger strain/sprain/fracture, and at a similar rate in females and males (injuries per 100,000 athlete-days: 4.9 [95% CI, 3.1-6.7] vs. 5.9 [4.3-7.5], respectively; P =.41). From childhood to adolescence, injury prevalence increased for all areas and across both sexes, except for female finger strain/sprain/fracture; however, the rate of increase for concussion/head injuries and knee injuries was significantly higher in female compared with male athletes (P <.0001 for both). In adolescents, ankle injuries were the most common injury overall. Conclusion: Ankle injuries continue to be the most predominant pediatric basketball injury. However, disproportionate rates of both knee and concussion/head injuries in female athletes during adolescent basketball are of concern and have implications for injury prevention. [ABSTRACT FROM AUTHOR]

Background: Research has demonstrated that female athletes are more likely to report their sports-related concussion (SRC) symptoms compared with male athletes; however, it is unknown if these reporting behaviors correspond to immediate removal from activity in sex-comparable sports. Purpose: To compare the incidence of high school student-athletes removed and not removed from activity after SRC in sex-comparable sports in Michigan. Study Design: Descriptive epidemiology study. Methods: Participants included student-athletes diagnosed with SRC participating in Michigan High School Athletic Association–sponsored athletic activities (22 sex-comparable sports) between 2016 and 2019. All SRCs were recorded in the association's Head Injury Reporting System (HIRS) by certified athletic trainers, administrators, or coaches. Removal from activity indicated that the student-athlete was removed from play at the time of an injury event. If the student-athlete reported that his or her suspected injury event occurred earlier during activity or if symptom onset was delayed, "not removed from activity" was entered into the HIRS. Incidence proportions were calculated by dividing SRCs not removed by total SRCs in each sport. Risk ratios were calculated by dividing the incidence proportions of girls not removed by boys not removed in each sport. Results: A total of 4418 (2773 female, 1645 male) SRCs were reported, with the most occurring in female soccer players (n = 1023). Overall, 515 girls and 243 boys were not removed from activity, resulting in incidences of 0.19 (95% CI, 0.17-0.20) and 0.15 (95% CI, 0.13-0.17), respectively. Across all sports, girls were 1.26 (95% CI, 1.09-1.45) times as likely to not be removed from activity compared with boys. Of the sports with the most SRCs—soccer, basketball, baseball/softball, and lacrosse—girls had 1.37 (95% CI, 1.09-1.72), 1.15 (95% CI, 0.89-1.47), 1.19 (95% CI, 0.77-1.84), and 1.35 (95% CI, 0.94-1.95) times the risk of not being removed, respectively. Conclusion: Girls were at greater risk of not being removed from activity compared with boys in sex-comparable sports. Results from this study should be incorporated into SRC education in Michigan and potentially elsewhere to inform affiliated personnel of potential sex differences and protect female student-athletes from further harm. [ABSTRACT FROM AUTHOR]

Return to play after sport-related concussion (SRC) requires authorized clearance from a health care provider (HCP). The variability in HCPs and facilities where athletes seek care may influence return time. To identify the initial examiner, HCPs who authorize clearance to return to play, and medical facilities that authorize clearance to return to play for high school student-athletes after SRC and compare authorized clearance time by HCPs and medical facilities. Prospective cohort study. High school. Student-athletes (n = 16 001) with SRC participating in athletics sponsored by the Michigan High School Athletic Association. Frequencies of initial examiner and authorized clearance for each HCP (doctor of osteopathic medicine, medical doctor, nurse practitioner, physician assistant) and medical facility (neurologist's office; team physician, primary care physician or pediatrician's office [PCP]; hospital; urgent/ready care) for each case of SRC. We calculated Kaplan-Meier curves and Peto tests to evaluate differences in the median time to authorized clearance between HCPs and facilities. Only cases with a date on which clearance to return to play was authorized (80.3%; n = 12 856) were included in the authorized clearance and time-to-return analyses. An athletic trainer was at least 1 of the initial examiners in 71.3% (n = 11 404) of SRC cases; 81.2% (n = 12 990) had only 1 initial examiner. We observed an association between the initial examiner and the medical facility providing clearance for athletic director (χ2 = 52.6, P <.001, V =.06), athletic trainer (χ2 = 172.0, P <.001, V =.12), coach (χ2 = 161.5, P <.001, V =.11), doctor of osteopathic medicine (χ2 = 59.4, P <.001, V =.07), and nurse practitioner (χ2 = 10.0, P =.04, V =.12). Clearance was authorized most frequently by a medical doctor (63.9%, n = 8218) and at a PCP (70.8%, n = 9099). Median (interquartile range) time to authorized clearance varied by facility (urgent/ready care = 7 days [4–11 days], hospital = 9 days [6–14 days], PCP = 10 days [6–14 days], team physician = 12 days [8–16 days], neurologist's office = 13 days [9–20 days]; P <.001). An athletic trainer was the initial examiner more often for males (74.1%) than for females (65.8%). The medical facility where clearance to return to play was authorized also differed between males (PCP = 69.3%, team physician = 11.3%, neurologist's office = 8.4%) and females (PCP = 73.6%, team physician = 8.5%, neurologist's office = 8.3%). Clearance to return to play after SRC was frequently provided by a medical doctor and at a PCP. The median time to return to unrestricted participation after SRC varied by HCP and medical facility. Future researchers should elucidate the reasons for these differences and determine why athletes seek care at different types of medical facilities. [ABSTRACT FROM AUTHOR]

Our objective was to determine the association between sleep quality, symptom severity, and recovery following sport-related concussion in pediatric athletes. A review of data from the North Texas Concussion Network Prospective Registry (ConTex) was performed. Participants were diagnosed with a sport-related concussion and were ≤18 years old. Participants were categorized based on their initial clinic visit Pittsburgh Sleep Quality Index composite score (0-21) into good sleep quality (GS≤5) and poor sleep quality (PS>5) groups. The PS group reported higher median total symptom scores at 3-month follow-up (3.0 vs 0.0, P <.01) and took more than a median of 2 weeks longer to recover compared to the GS group (35.0 days vs 20.0 days, P <.01). Poor sleep quality was strongly associated with greater symptom severity and longer time to recovery following sport-related concussion. Early recognition of concussed athletes with poor sleep quality at initial clinic visit may help predict prolonged recovery. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to investigate differences in propensity for risk-taking between college-aged individuals with and without a history of concussion. Methods A cross-sectional study of individuals ages 18-30 years was conducted. Participants were administered a brief survey that included demographics, medical history, and the General Risk Propensity Scale (GRiPS). The GRiPS is an 8-item, self-report measure that assesses an individual's general propensity to take risks (e.g. "I would take a risk even if it meant I might get hurt"). A score of 20 or higher indicates high propensity for risk taking while a score lower than 20 indicates low propensity for risk-taking. An independent samples t-test compared the mean scores of the GRiPS between individuals with and without a concussion history. Statistical significance was set at p<0.05. Results One hundred eighty-one participants (92 female; μ age=20.65 years; SD=2.56 years) were included in this study. Ninety-six (53.0%) participants had no concussion history, while 85 (47.0%) had a history of concussion. No significant differences in GRiPS mean scores was noted between groups (no concussion history: μ=23.97, SD=5.96; concussion history: μ=23.68, SD=6.72, p=.73). Conclusions These results suggest that an individual's propensity for risk-taking is not influenced by concussion history, which conflicts with previous research. Future research may consider developing a survey to assess specific risk-taking behaviors that may be associated with a concussion (e.g. "I do not report symptoms of a concussion") or if a propensity for risk-taking is higher in individuals currently with a concussion or a specific number of previous concussions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the relationship between concussion history and emotional and behavioral dyscontrol domains of health-related quality of life (HRQoL) in college-aged individuals. Methods: A cross-sectional survey study of individuals ages 18–25 years was conducted. Participants completed demographics, medical history, and the Neuro-QOL Emotional and Behavioral Dyscontrol Short Form (Neuro-QOL). A t-score > 50 on the Neuro-QOL indicated better outcomes for emotional and behavioral dyscontrol. A Mann–Whitney U Test compared scores on the Neuro-QOL between individuals with and without self-reported concussion history. Logistic regression was used to analyze the relationship between concussion history on the probability of higher or lower Neuro-QOL scores. Statistical significance was set at p < 0.05. Results: Two hundred fifty-two participants (155 female; age = 19.95 years; SD = 1.53 years) were included, 76 (30.2%) with concussion history and 176 (69.8%) without concussion history. No significant difference in Neuro-QOL t-scores was noted between groups (concussion history: t = 49.4, SE = 2.4; no concussion history; t = 49.4, SE = 2.4; p = 0.47). Individuals with reported concussion history were 1.16 times more likely to score higher on the Neuro-QOL than those without concussion history when controlling for gender (95% CI [0.66, 2.04]); however, this was not significant (p = 0.61). Conclusions: Preliminary findings suggest that emotional and behavioral dyscontrol domains are not influenced by prior concussion history. Future research should continue to explore HRQoL domains (e.g. physical health, psychological health, social relationships, environment) most impacted by concussion, as well as the influence of prior mental health conditions or behavioral dysfunction following a subsequent injury. [ABSTRACT FROM AUTHOR]

Objective To determine the influence of nap frequency on daily symptom severity and recovery time following concussion in college students. Method A prospective study of college students within 72 hours of a diagnosed concussion was performed. Participants reported nap occurrence (yes/no) and daily concussion symptoms using the Post-Concussion Symptom Scale (PCSS) for six days. Participants were categorized into frequent (>2 naps) and infrequent (<3 naps) nap groups. Recovery time was defined as total days from injury to unrestricted medical clearance. A mixed between-within ANOVA evaluated changes in daily symptom severity between nap groups, while Spearman's Rank Correlation assessed the relationship between the number of days napping and recovery time. Results Thirty-four participants (23 female, 11 male; age = 19.91 ± 1.38 years) were included, with 22 in the infrequent nap group and 12 in the frequent nap group. Average recovery time for the infrequent nap group was 13.85 days compared to 18.8 days in the frequent nap group. There was no significant group x time interaction for daily symptom severity (Wilks' λ = 0.85, F(5,24) = 0.85, p = 0.53, η2 = 0.15). There was a significant main effect for time, with daily symptom severity improving following concussion (Wilks' λ = 0.31, F(5,24) = 10.66, p < 0.001, η2 = 0.69), but there was no significant group effect (F(1,28) = 0.79, p = 0.38, η2 = 0.03). Overall, the more naps taken, the longer the recovery time (Rs = 0.46, p = 0.01). Conclusions Findings from the present study suggest that frequent napping does not affect symptom severity following concussion. Further research is needed to elucidate the association between the number of naps and recovery time. [ABSTRACT FROM AUTHOR]

Objective To evaluate the relationship between self-reported cognitive activity and recovery outcomes (symptom reporting, recovery time) in college students following concussion. Method Cognitive activity was defined as self-reported minutes spent in class and studying during the first 5 days following concussion. Self-reported symptoms were reported at day 5 post-injury using the Post-Concussion Symptom Scale (PCSS). The PCSS evaluates 22 symptoms on a 7-point Likert Scale from 0 (none) to 6 (severe). Recovery time was defined as total days from injury to unrestricted medical clearance. Separate Spearman's rank correlations assessed the relationship between total cognitive activity (minutes in class and studying) and recovery outcomes (symptom total (22), symptom severity (132), and recovery time). Alpha level set a priori at 0.05. Results Twenty-one participants (14 female, 7 male, 19.5 ± 1.3 years) averaged a total of 653[IQR = 348] minutes of cognitive activity during the first 5 days after concussion (334[IQR = 149] minutes in class, 273[IQR = 313] minutes studying). Five days after injury, participants self-reported 3[IQR = 8] total symptoms yielding a severity of 4[IQR = 12]. Participants took 15 [IQR = 8] days to reach unrestricted medical clearance. No associations were found between total cognitive load and any post-concussion recovery outcomes (symptom total: Rs = −.299, p = .19; symptom severity: Rs = −.230, p = .32; recovery time: Rs = −.041, p = .86). Conclusions Preliminary analyses suggest that concussed college students can be encouraged to gradually return to normal levels of cognitive activity, as it may not be associated with future symptom reporting or recovery time. Future research is needed to assess specific cognitive activities immediately influence on post-concussion symptom reporting. [ABSTRACT FROM AUTHOR]

Objective To examine differences in clinical measures between adolescents with dyslexia, ADD/ADHD, and those without a learning disorder (LD) following concussion. Method Data from the North Texas Concussion Registry (ConTex) were extracted. Participants ages 10–18 with a diagnosed concussion within 30 days of enrollment were included and categorized based on self-reported prior diagnosis of dyslexia, ADD/ADHD, and no history of LD. ImPACT, King-Devick (KD), SCAT-5 symptom log, Patient Health Questionnaire (PHQ-8), and Generalized Anxiety Disorder (GAD-7) scale were compared between groups using a one-way ANOVA followed by a Tukey test for multiple comparisons. Results Of 993 eligible participants, 68 had dyslexia, 141 had ADD/ADHD, and 784 had no history of LD. There were significantly more male participants in the ADD/ADHD group compared to the no LD group (64.5% vs. 50.3%, p = 0.002). No other demographic differences were noted between groups. In the dyslexia group, SCAT-5 symptom score was higher (36.22 vs. 28.27, p = 0.037) and ImPACT visual motor control was lower compared to the no LD group (28.87 vs. 32.99, p = 0.027). In the ADD/ADHD group, ImPACT symptom score was higher (30.69 vs. 20.94, p < 0.001) and visual motor control was lower compared to the no LD group (30.05 vs. 32.99, p = 0.009). KD time (62.1 sec), PHQ-8 (5.79), and GAD-7 (5.06) were higher in the ADD/ADHD group compared to the no LD group (56.5 sec, 4.32, 3.56; p = 0.022, p = 0.003, p = 0.002). Conclusions Differences in clinical measures were seen in participants with a history of dyslexia and ADD/ADHD that may aid providers in their evaluation following adolescent concussion. [ABSTRACT FROM AUTHOR]

Objective To compare state anxiety between concussed athletes with and without a history of sport related concussion (SRC). Method This study utilized a cross-sectional design. The State Trait Anxiety Inventory (STAI) was administered to athletes within 72 hours of SRC diagnosis. The STAI is a subjective, 40-item inventory that assesses state and trait anxiety; however, this study only examined the state anxiety component. Participants reported how they were feeling at the moment of testing on a 4-point Likert scale ranging from 1 (not at all) to 4 (very much so). State anxiety scores range from 20–80, with higher scores indicating higher levels of state anxiety. An independent samples t-test was used to compare state anxiety between concussed athletes with and without a history of SRC. Statistical significance was set at p < .05. Results A total of 104 (18.12 ± 2.5 years; male = 65, female = 39) high school (n = 36) and collegiate (n = 68) athletes completed the STAI within 72 hours of SRC. Fifty-nine (56.7%) concussed athletes had no history of SRC and 45 (43.3%) athletes had a history of one or more SRCs. There was no significant difference in state anxiety between concussed athletes with (37.64 ± 9.22) and without (38.47 ± 9.44) a history of SRC (p = .65). Conclusions This study suggests that concussion history does not affect state anxiety after SRC. However, clinicians should continue to assess emotional changes after SRC in order to best manage and treat SRC. [ABSTRACT FROM AUTHOR]

Although visual symptoms are common following concussion, quantitative measures of visual function are missing from concussion evaluation protocols on the athletic sideline. For the past half century, rapid automatized naming (RAN) tasks have demonstrated promise as quantitative neuro-visual assessment tools in the setting of head trauma and other disorders but have been previously limited in accessibility and scalability. The Mobile Interactive Cognitive Kit (MICK) App is a digital RAN test that can be downloaded on most mobile devices and can therefore provide a quantitative measure of visual function anywhere, including the athletic sideline. This investigation examined the feasibility of MICK App administration in a cohort of Division 1 college football players. Participants (n = 82) from a National Collegiate Athletic Association (NCAA) Division 1 football team underwent baseline testing on the MICK app. Total completion times of RAN tests on the MICK app were recorded; magnitudes of best time scores and between-trial learning effects were determined by paired t -test. Consistent with most timed performance measures, there were significant learning effects between the two baseline trials for both RAN tasks on the MICK app: Mobile Universal Lexicon Evaluation System (MULES) (p < 0.001, paired t-test, mean improvement 13.3 s) and the Staggered Uneven Number (SUN) (p < 0.001, mean improvement 3.3 s). This study demonstrated that the MICK App can be feasibly administered in the setting of pre-season baseline testing in a Division I environment. These data provide a foundation for post-injury sideline testing that will include comparison to baseline in the setting of concussion. • RAN Tasks have been studied for diagnosis of concussion across multiple settings. • The MICK (Mobile Integrated Cognitive Kit) App is a novel delivery mechanism for two well-characterized RAN Tasks • This in the first study to explore implementation of the MICK App in a Division 1 football cohort • In the future, sideline Division 1 Football testing may be attempted with updated version of the MICK App, including on a smart phone. [ABSTRACT FROM AUTHOR]