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Objective: To provide healthcare professionals guidance on youth at risk for prolonged recovery and post‐traumatic headache (PTH), and on pharmacologic and non‐pharmacologic management of PTH due to concussion and mild traumatic brain injury. Background: Headache is the most common persistent post‐concussive symptom affecting 8% of youth for >3 months after concussion. Over the past decade, many studies have explored the treatment of PTH in youth, but there are no established guidelines. Methods: This white paper is based on a synthesis of an updated systematic review of the literature on treatment of PTH and a narrative review of the literature on risk factors for prolonged recovery and health disparities. Results were interpreted by a group of expert providers in PTH in children and adolescents through collaboration of the PTH and pediatric special interest groups of the American Headache Society. Results: Factors that consistently were associated with prolonged recovery from concussion and persistent PTH included female sex, a high number of acute symptoms, and adolescent age. Social determinants of health also likely play an important role in PTH and deserve consideration in the clinical and research settings. A total of 33 studies met the criteria for inclusion in the systematic review of PTH treatment in youth, although most were retrospective and of fair‐to‐poor quality. Treatment strategies included acute and preventive pharmacologic management, procedures, neuro‐modulatory devices, physical therapy, physical activity, and behavioral health support. A collaborative care approach that includes a thoughtful combination of these management strategies is likely most effective. Conclusions: This white paper provides a roadmap for tailoring the treatment of PTH based on factors influencing prolonged headache, the timing of therapies, and therapies with the most evidence for treating PTH in youth. We also highlight research needed for developing more definitive guidelines on PTH management in youth. Plain Language Summary: Post‐traumatic headache (PTH) following concussion is a common and potentially disabling condition impacting youth, yet there are no standards for treatment. This article reviews current evidence and identifies knowledge gaps to guide future research. Based on the limited available evidence and expert opinion, we offer a roadmap for the treatment of PTH in children. [ABSTRACT FROM AUTHOR]

Background: Sport-related concussion is a public concern with between 1.6 and 3.8 million sport- and recreationrelated injuries occurring annually. An estimated 65% to 90% of concussed athletes show oculomotor disruption such as difficulty with saccades, accommodation, smooth pursuit, and fixation. A rapid number-naming saccade test, the King-Devick (K-D) test, has shown promising results as part of a multifaceted concussion assessment tool. Purpose: The purpose of the current study was to evaluate the two versions of the K-D in collegiate aged (18-24) athletes to determine the agreement between versions. A secondary purpose was to investigate the association of K-D scores with sport, sex, use of glasses or contacts, and age of the athlete. Study design: Descriptive laboratory study. Methods: Division 1 NCAA collegiate athletes across ten sports were recruited to participate in baseline concussion assessments at the beginning of their respective athletic season. Correlations and multivariable logistic regression analyses were used to investigate the association of K-D scores with sex and age. Results: One-hundred and nine athletes (69 males, 40 females; mean age =20.40±1.38 years) were baseline tested. There was excellent agreement (ICC=0.93, 95% CI: 0.90, 0.95) between the paper and computer version. Preseason K-D scores were statistically different (r2=0.873, p<0.05) with athletes scoring a mean of 37.58 seconds on the paper version (95% CI, 36.21, 38.96) and athletes scoring a mean of 41.48 seconds for the computerized tablet version (95% CI, 40.17, 42.91). There were no significant differences in sex, sport, or use of glasses noted for both versions. Age differences were identified; eighteen-year-old athletes took statistically longer than their peers for both K-D versions. Pairwise comparisons showed statistically significant differences between 18-year olds up to the age of 21-year-olds (p<0.05) for the computer version and statistically significant differences between 18-year olds up to 22-year-olds (p<0.05) for the paper version. Conclusion: This study supports the use of either version of the K-D test as a potential part of a multifaceted concussion assessment. The age of the athlete influences scores and therefore a K-D baseline should be repeated annually for collegiate athletes. Clinicians should not substitute K-D versions (computer vs. paper) in comparing baseline to a post-concussion K-D score as the scores are quite different. [ABSTRACT FROM AUTHOR]

It is generally accepted that we need more research into concussions and other injuries with potential long-term effects in sport because such research underpins effective, evidence-based prevention, management, support, and treatment. This paper provides an analysis of the obligations of sports federations to support and facilitate such research, as well as an analysis of the role active participants in the sport should have in the research process. The paper focuses on concussion and concussion research, though very similar arguments apply to other common sports injuries with potential long-term effects. The paper argues that sports federations have a moral obligation and a prudential interest in initiating, facilitating, and funding concussion research. This follows from their duty of care towards active participants and from considerations of reciprocity. The ability to discharge these research obligations depends on the resources available to a particular federation, but those who can discharge them should do so. The paper further argues that athletes and other active participants in sport should be involved in all aspects of the concussion research process from conception to design, i.e. that Active Participant Involvement and Engagement (APIE) should be a non-negotiable element of concussion research projects. This is supported by instrumental reasons, but also by philosophical argument based on standpoint epistemology and on ethical arguments related to the interests of active participants. Standpoint epistemology is the epistemological position that the knowledge a person has and can have depends on that person's standpoint in the world. Keywords: Concussion, funding, participant involvement, sport, sport association, sport federation [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is among the most common injuries in forensic medicine, the identification of which is of particular importance in forensic practice. To reveal the circumstances and trends of TBI in the forensic field, we used the Web of Science (WoS) database for comprehensive retrieval. We made a metrological analysis of 1,089 papers in the past 50 years (1972-2021). The United States and Germany have the most forensic research on TBI. Diffuse axonal injury (DAI) has been the focus of attention for many years, and much effort has been devoted to its diagnosis in forensic pathology. Infants and children are the subgroups of most concern, especially in infant and child abuse cases. Research on identifying shaken baby syndrome has received increasing attention in recent years. Overall, our study provides a comprehensive list and analysis of the articles regarding TBI in legal medicine, which may shed light on recognizing the trends and research hotspots in this field. [ABSTRACT FROM AUTHOR]

This paper explores, first, the common law principles of personal injury litigation explored through court decisions relating to sports injuries in (primarily) England and Wales and, second, the statutory schemes relating to concussion liability and young players in the United States. It explores the difficulties of using those strategies as a means of establishing liability for injuries arising from sports-related concussion (SRC) and explains why they are of such limited utility. While proposed class actions over historically acquired injuries or individual litigation over recent catastrophic injury may have some merit, and while future amendments to the US laws might remove some of their inherent flaws, the difficulties in establishing liability for personal injury will always be exacerbated by the specific characteristics of SRC and the legal, factual and evidential issues that arise. For those reasons, the paper considers the potential benefits of other means of concussion prevention and mitigation, including no-fault compensation and mandatory insurance, the more widespread use of effective, nuanced concussion protocols, and inter-disciplinary research that engages with doctrinal legal research. [ABSTRACT FROM AUTHOR]

In this paper, I discuss the risks of brain injuries in collision and contact sports and make a proposal to address them without limiting the autonomy of athletes. I aim to analyse the circumstances of profound uncertainty that athletes are facing in terms of the long-term impact of brain injuries. My strategy is to circumvent drastic measures in dealing with such risks, such as banning certain sports or changing their nature by introducing constitutive rule changes, and to scaffold individual autonomy instead. I will focus on two aspects. First, I address the choice whether to take up or continue to play a risky sport given the mentioned profound level of ignorance. I argue that we can scaffold autonomy to make rational choices, particularly by enabling the application of heuristics. Second, I discuss performative skills that can help to prevent brain injuries. It is important to consider collision and contact sports as instances of joint action. The performance of others is an important factor in determining the level of risk in such sports. Hence, supporting athlete's skills to prevent collisions can reduce the risk of brain injury. I conjecture ways to scaffold players' skills and performance with this aim in mind. [ABSTRACT FROM AUTHOR]

Rugby union is one of several sports that is increasingly associated with both short-term and long-term health risks related to traumatic brain injuries sustained while playing the sport. Also, in recent years, various sport governing bodies have been shown to have promoted misleading claims about injury. These issues have contributed to what is commonly referred to as a 'concussion crisis'. In 2021, World Rugby, the global governing body of the Rugby Union, released and promoted a video called 'Staying on top of your game: Rugby and brain health'. This video provides an insight into how World Rugby frames the issue of brain injury in the sport of Rugby Union in relation to brain health of players and former players. In this paper, we present an analysis of the video, guided by the principles of discourse analysis and Benoit's theory of image restoration. Our analysis critiques how rugby union is presented as positive and beneficial for brain health, with its potential to contribute towards neurodegeneration downplayed. Frames of family, inevitability of brain injury, responsibility and balance are used by World Rugby to shape thinking about brain health. Concurrently, the strategies of bolstering, as well as evasion of organisational responsibility are employed to manage the crisis. We build on discourses of washing by proposing the term brainwashing to describe the tactic of image repair employed by (sport) organisations to focus attention on positive discussions around brain health and away from negative discourses. [ABSTRACT FROM AUTHOR]

Concussions are increasingly recognized as a public health concern. This paper evaluates Canadian concussion care guidelines, advocating for the inclusion of a broader range of healthcare professionals (HCPs) in concussion assessment, diagnosis, and management. It emphasizes the role of chiropractors, in addition to medical doctors (MDs) and nurse practitioners (NPs), highlighting their extensive training in musculoskeletal and neurological disorders. Chiropractors are adept at managing symptoms like headache, neck pain, and dizziness, and employing evidence-based, comprehensive interventions including patient education, exercise therapy, manual therapy, cervicovestibular rehabilitation, and return-to-sport (RTS) protocols. The paper also addresses regional variations in chiropractors' roles, focusing on Ontario's "Rowan's Law," and argues that limiting aspects of concussion care (assessment, diagnosis, RTS clearance) to MDs and NPs may result in healthcare inefficiencies and inequities. The findings are significant for policymakers and healthcare leaders, indicating a need for updated concussion care guidelines that integrate and utilize diverse HCPs. This could lead to improved patient outcomes, healthcare efficiency, and equity in concussion management across Canada. [ABSTRACT FROM AUTHOR]

This current special issue of the Journal of Clinical Sport Psychology was conceived and developed to provide a resource for clinicians who have contact with athletes who are at risk for or have sustained a concussion during sport participation. The special issue is part of an exciting two-issue series. This first installment contains papers from leaders in the field of sport concussion who review the frequency and mechanisms of concussion, models for managing concussion, the emotional aspects of concussion in sport, practical examples from a model sport concussion clinic, and the importance of sport concussion education and prevention. As Guest Editors, we hope that this timely and unique special series will be used by clinicians who help care for athletes and their families who have experienced concussion in their sport life. [ABSTRACT FROM AUTHOR]

In 2014, an Irish parliament white paper called for greater addressing of sport-related concussions (SRCs) in Ireland, requesting the adoption of the Concussion in Sport Group's (CISGs) guidelines and greater consistency in SRC return to play (RTP) management. Ten years later, it is unclear how these requests have been addressed. Recently, the United Kingdom's government centralised guidelines to one SRC document for all grassroots sports. This study aimed to investigate all publicly available SRC guidance in Irish sports and national governing bodies (NGBs) to determine if centralised guidelines are warranted. Sport Ireland and the Irish Federation of Sports were searched for all recognised NGBs and sports in Ireland. Websites were searched for any information pertaining to SRCs and data were extracted and collated in Microsoft Excel. In total, 15 of 83 sports and/or NGBs included SRC guidance, nine of which provided RTP protocols. Various iterations of the CISGs guidance and tools were implemented. Several sports with a documented SRC risk had no guidelines present. The findings indicate disjointed and outdated guidance across Irish sport. Additionally, there are sports with a documented concussion risk that have no SRC guidance available. This study provides support for centralised guidelines to be adopted in Irish grassroots sports. [ABSTRACT FROM AUTHOR]

Concussions, a prevalent public health concern in the United States, often result from mild traumatic brain injuries (mTBI), notably in sports such as American football. There is limited exploration of smart-textile-based sensors for measuring the head impacts associated with concussions in sports and recreational activities. In this paper, we describe the development and construction of a smart textile impact sensor (STIS) and validate STIS functionality under high magnitude impacts. This STIS can be inserted into helmet cushioning to determine head impact force. The designed 2 × 2 STIS matrix is composed of a number of material layered structures, with a sensing surface made of semiconducting polymer composite (SPC). The SPC dimension was modified in the design iteration to increase sensor range, responsiveness, and linearity. This was to be applicable in high impact situations. A microcontroller board with a biasing circuit was used to interface the STIS and read the sensor's response. A pendulum test setup was constructed to evaluate various STISs with impact forces. A camera and Tracker software were used to monitor the pendulum swing. The impact forces were calculated by measuring the pendulum bob's velocity and acceleration. The performance of the various STISs was measured in terms of voltage due to impact force, with forces varying from 180 to 722 N. Through data analysis, the threshold impact forces in the linear range were determined. Through an analysis of linear regression, the sensors' sensitivity was assessed. Also, a simplified model was developed to measure the force distribution in the 2 × 2 STIS areas from the measured voltages. The results showed that improving the SPC thickness could obtain improved sensor behavior. However, for impacts that exceeded the threshold, the suggested sensor did not respond by reflecting the actual impact forces, but it gave helpful information about the impact distribution on the sensor regardless of the accurate expected linear response. Results showed that the proposed STIS performs satisfactorily within a range and has the potential to be used in the development of an e-helmet with a large STIS matrix that could cover the whole head within the e-helmet. This work also encourages future research, especially on the structure of the sensor that could withstand impacts which in turn could improve the overall range and performance and would accurately measure the impact in concussion-causing impact ranges. [ABSTRACT FROM AUTHOR]

The relationship between pediatric Traumatic Brain Injury (TBI) and long-term mental health and substance use disorders is not well known, resulting in inadequate prevention and management strategies. The aim of this scoping review is to review the evidence on pediatric TBI and the development of mental health disorders and substance use later in life and to identify gaps in the literature to inform future research. We searched multiple databases for original articles published between September 2002 and September 2022 on TBI-related mental health and/or substance use disorders in children and youth. Two independent reviewers performed the screening using Arksey and O'Malley and Levac et al.'s scoping review framework. A total of six papers are included in this scoping review. Studies included are comprised of cross-sectional and prospective longitudinal cohort studies. A correlation between pediatric TBI and development of certain mental health disorders and substance use is suggested, although much of the current evidence is mixed and does not account for confounding variables. Future studies should aim to closely examine these links and identify modifiers that can influence these relationships. [ABSTRACT FROM AUTHOR]

Recent progress in technology has allowed for the development and validation of computer-based adaptations of existing pencil-and-paper neuropsychological measures and comprehensive cognitive test batteries. These computer-based assessments are frequently implemented in the field of clinical sports psychology to evaluate athletes' functioning postconcussion. These tests provide practical and psychometric advantages over their pencil-and-paper counterparts in this setting; however, these tests also provide clinicians with unique challenges absent in paper-and-pencil testing. The purpose of this article is to present advantages and disadvantages of computer-based testing, generally, as well as considerations for the use of computer-based assessments for the evaluation of concussion among athletes. Furthermore, the paper provides suggestions for further development of computerized assessment of sports concussion given the limitations of the current technology. [ABSTRACT FROM AUTHOR]

Introduction: Pre-participation exams (PPE) in sports are vital in evaluating athlete safety and readiness for participation for the upcoming year. PPE ranges from evaluation of cardiovascular function to assessing for neurocognitive or neurological deficit. Sports-related concussion (SRC) baseline exams are a component of PPE. Computerized neurocognitive tests (CNTs) are widely used on different athletic performance platforms, although expense is a barrier, and many remain skeptical of their utility post-concussion. Neurological tests that can highlight impairment in executive functioning, short-term memory recall, complex task association, and vision perception and production are critical to consider for PPE. Stroop testing can be performed as a component of PPE and can serve as a baseline exam, as well as a sideline assessment to aid in identifying concussion impact on broader brain functions. In this paper, we combined saccadic eye movement, Stroop, and recall into a single, rapid, and costeffective assessment. Methods: A three-step Stroop panel was performed on 13 SRC patients and 167 PPE baselines. We examined the time it took to complete an 8x8 grid of Stroop words using a Hart chart saccadic eye movement task, plus a 10-word recall task. The three-step Stroop test set progressed in difficulty. The times it took to perform the tasks were assessed. Results: We found that the SRC patients performed significantly slower in performing the Stroop task, taking 84.5 ± 24.8 seconds compared to the PPE baseline of 62.3 ± 11.9 seconds (p= 0.000001). Both groups were similar in the 10-word recall of 4.0 ± 2.5 vs. 4.2 ± 1.7 correct out of ten. However, the 10 words had an undisclosed theme therein. When asked to identify the theme, the PPE baseline group recognized the theme 90% of the time compared to 31% for the SRC group (p=0.0000001). Discussion: In this paper, we present the methods for doing a three-step Stroop panel in support of using this exam as an objective tool to evaluate for concussions as a component of sideline concussion assessments. It is quantitative, cost-effective, and can be completed in about three minutes, revealing significant neurological function. The results support that the test can be used to assess memory, saccadic eye movement, and prefrontal cortex function. The regions of the brain assessed complement and extend the information that is obtained from other PPE baselines and neurologic tests post-SRC. We suggest that athletic trainers and other sports medical professionals consider using this Stroop panel in their sports concussion protocols as part of baseline and sideline assessments of concussions. [ABSTRACT FROM AUTHOR]

As researchers in communication sciences and related disciplines continue to embrace qualitative research methodologies, there will be a corresponding need for innovative methods and strategies for data collection and generation, reflexivity and knowledge translation to make qualitative research methods more inclusive. Historically, those who communicate differently from the status quo have been excluded from or spoken for in qualitative research. The resulting omission of these perspectives in the literature constitutes a critical research-to-practice gap as clinicians seek to deliver client-focused communication care. Arts-Based Research (ABR) offers researchers a means of augmenting potentially linguistically and cognitively demanding verbal interviews while inviting participants to share a window into their daily lives with researchers and knowledge users. Additionally, ABR offers participants alternative forms of expression and creates avenues for researcher reflexivity and participant-researcher reflexive dialogue. To illustrate how ABR can enhance communication research, we present reflections on a study that incorporated multi-media artistic materials in a reflexive arts-based collective case study design. Working with young people experiencing post-concussion communication changes, we used arts-based materials collected and created by participants to support and enhance data collection. These materials were analyzed as part of each case, across cases, and played a central role in sharing our findings. Additionally, arts-based materials facilitated participant-researcher reflexive dialogue and researcher reflexivity. The goals of this paper are to: 1) provide a brief overview of ABR as a method for researchers interested in communication; 2) discuss four ways to incorporate ABR in the research process; 3) provide a case example illustrating different types of creative works to illustrate the four ways ABR can enhance communication research; and 4) discuss benefits, considerations and implications of using ABR to support inclusive research design. [ABSTRACT FROM AUTHOR]

Up to 30% of youth with concussion experience PPCSs (PPCS) lasting 4 weeks or longer, and can significantly impact quality of life. Magnetic resonance imaging (MRI) has the potential to increase understanding of causal mechanisms underlying PPCS. However, there are no clear modalities to assist in detecting PPCS. This scoping review aims to synthesize findings on utilization of MRI among children and youth with PPCS, and summarize progress and limitations. Thirty-six studies were included from 4907 identified papers. Many studies used multiple modalities, including (1) structural (n = 27) such as T1-weighted imaging, diffusion weighted imaging, and susceptibility weighted imaging; and (2) functional (n = 23) such as functional MRI and perfusion-weighted imaging. Findings were heterogeneous among modalities and regions of interest, which warrants future reviews that report on the patterns and potential advancements in the field. Consideration of modalities that target PPCS prediction and sensitive modalities that can supplement a biopsychosocial approach to PPCS would benefit future research. [ABSTRACT FROM AUTHOR]

In the field of pediatric concussion, little to no scholarship has examined how clinical practice is shaped by patterned ways of thinking, talking about, and coming to understand concussion and young people (or "discourses of concussion in young people"). In this paper, we examine the ways in which one such discourse, the Pediatric Concussion Discourse (PCD), shapes how young people with concussion, their parents, and clinicians can think about, act in relation to, and experience concussion. This critical rehabilitation research is informed by the post-structuralist theory of Michel Foucault (1926-1984), and the key concepts of power/knowledge, discourse, and the subject. Circulating through clinical guidelines for the management of pediatric concussion, the PCD re/produces the expectation that young people with concussion and their parents will behave as "responsible" subjects who follow the recommendations of so-called experts without question. If recommendations are not implemented, the PCD has the potential to constitute these same groups as "nonadherent", re/producing problematic discourses of medical compliance. By examining the effects of the PCD, it becomes possible to imagine how clinical practice and research might evolve in new ways that respect the knowledges and experiences of young people with concussion and their parents. Engaging in critical examination of clinical rehabilitative practice creates opportunity to imagine how we might approach commonly adopted clinical approaches, including the delivery of health education, differently. Implications for clinical rehabilitation practice include delivering health education in the context of supportive therapeutic relationships that respect the knowledges and experience of young people with concussion and their parents. Implications for rehabilitation research include engaging with critical scholarship within and beyond field and disciplinary boundaries, engaging in formal educational opportunities, and connecting with less formal but invaluable communities of practice. [ABSTRACT FROM AUTHOR]

Head impact measurement devices enable opportunities to collect impact data directly from humans to study topics like concussion biomechanics, head impact exposure and its effects, and concussion risk reduction techniques in sports when paired with other relevant data. With recent advances in head impact measurement devices and cost-effective price points, more and more investigators are using them to study brain health questions. However, as the field's literature grows, the variance in study quality is apparent. This brief paper aims to provide a high-level set of key considerations for the design and analysis of head impact measurement studies that can help avoid flaws introduced by sampling biases, false data, missing data, and confounding factors. We discuss key points through four overarching themes: study design, operational management, data quality, and data analysis. [ABSTRACT FROM AUTHOR]

Physical reconstructions are a valuable methodology for quantifying head kinematics in sports impacts. By recreating the motion of human heads observed in video using instrumented test dummies in a laboratory, physical reconstructions allow for in-depth study of real-world head impacts using well-established surrogates such as the Hybrid III crash test dummy. The purpose of this paper is to review all aspects of the physical reconstruction methodology and discuss the advantages and limitations associated with different choices in case selection, study design, test surrogate, test apparatus, text matrix, instrumentation, and data processing. Physical reconstructions require significant resources to perform and are therefore typically limited to small sample sizes and a case series or case–control study design. Their accuracy may also be limited by a lack of dummy biofidelity. The accuracy, repeatability, and sensitivity of the reconstruction process can be characterized and improved by good laboratory practices and iterative testing. Because wearable sensors have their own limitations and are not available or practical for many sports, physical reconstructions will continue to provide a useful and complementary approach to measuring head acceleration in sport for the foreseeable future. [ABSTRACT FROM AUTHOR]