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Cross-sectional survey data were used to test whether personality traits were associated with a self-reported history of diagnosed sport-related concussions (SRC) and undiagnosed SRCs. A total of 1,398 of 2,055 (68%) collegiate student-athletes from four National Collegiate Athletic Association (NCA

The physical effects of sport-related concussion (SRC) on the health and well-being of youth and collegiate athletes have been well documented. However, the psychological aspects of SRC in youth and collegiate athletes continue to be largely unknown due to scant research on the subject matter. The m

Context: Comprehensive, multidomain assessment is the standard of care after sport-related concussion. However, the relationship between performance on sideline concussion-assessment tools and in-office computerized neurocognitive testing has received little attention, and the prognostic utility of sideline measures is unknown. Objective: To evaluate concurrent impairment on commonly used concussion measures 24 to 48 hours postinjury while also determining the predictive utility of sideline measures on computerized neurocognitive testing in the acute to subacute recovery periods postinjury. Design: Case-control study. Setting: High school and collegiate athletics. Patients or Other Participants: A total of 125 high school and college-aged athletes (85 males, 40 females) 14 to 23 (16.8 ± 2.21) years old. Main Outcome Measure(s): Participants were administered sideline concussion-assessment measures (ie, Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT], Standardized Assessment of Concussion [SAC], and Balance Error Scoring System [BESS]) 24 to 48 hours postinjury and completed ImPACT and the Post-Concussion Symptom Scale 5 to 7 and 10 to 14 days postinjury. Outcome measures were the ImPACT composite (verbal memory, visual memory, reaction time, visual-motor speed), SAC, and BESS scores and total symptom score on the Post-Concussion Symptom Scale. Results: Participants demonstrated heterogeneous patterns of impairment on measures 24 to 48 hours postinjury, with the most common pattern being impairment on ImPACT and the SAC. Performance on the SAC and BESS at 24 to 48 hours after injury did not distinguish between those with and those without impairment on ImPACT at 5 to 7 days postinjury (χ2 = 5.076, P = .079) or 10 to 14 days postinjury (χ2 = 2.04, P = .361). Conclusions: More than 90% of athletes were impaired on at least 1 sideline or neurocognitive measure 24 to 48 hours after sport-related concussion. Although sideline measures are useful for concussion diagnosis, they are not suitable for prognostication of impairment or the presence of symptoms 1 to 2 weeks postinjury.

Background The prevalence of primary headache disorders in the general population provides a unique challenge in the evaluation of headache occurring in the context of sport. Despite a wealth of studies exploring the epidemiology of headache in the layperson, little is known about the prevalence and nature of headaches in collegiate student-athletes. These scenarios are challenging in the return to play context, as it is often unclear whether an athlete has an exacerbation of a primary headache disorder, new onset headache unrelated to trauma, or has suffered a concussive injury. Purpose To establish the prevalence and nature of headaches in collegiate student-athletes. Study design Retrospective cross-sectional survey. Methods This cross-sectional survey evaluated the characteristics and prevalence of headache in 834 student-athletes from four NCAA Division-I institutions. Because headache occurrence may vary by sport (collision, contact, non-contact), by sex, and medical history, our sample included male and female athletes in a variety of sports, with differing degrees of contact exposure. The 20 question survey collected data on personal and family history of headache, as well as concussion history. Results A total of 23.7% (n = 198) of participants reported having a personal history of migraine, 25.2% (n = 210) history of sinus headache, and 12.3% (n = 103) history of tension type headache. Among athletes with a prior history of concussion, 46.3% (n = 25) of females reported a history of migraine, while only 32.2% of males reported history of migraine (χ2 = 3.421, P = .064). Conclusions The etiology of increased prevalence of migraine in our study is unclear. Whether this is due to increased awareness of headache disorders, a consequence of contact exposure, or a predisposition for migraine development in this age group remains unclear. Further studies are indicated.

OBJECTIVE: To examine sex differences in vestibular and oculomotor symptoms and impairment in athletes with sport-related concussion (SRC). The secondary purpose was to replicate previously reported sex differences in total concussion symptoms, and performance on neurocognitive and balance testing. DESIGN: Prospective cross-sectional study of consecutively enrolled clinic patients within 21 days of a SRC. SETTING: Specialty Concussion Clinic. PARTICIPANTS: Included male (n = 36) and female (n = 28) athletes ages 9 to 18 years. INTERVENTIONS: Vestibular symptoms and impairment was measured with the Vestibular/Ocular Motor Screening (VOMS). Participants completed the Immediate Post-concussion Assessment and Cognitive Test (ImPACT), Post-concussion Symptom Scale (PCSS), and Balance Error Scoring System (BESS). MAIN OUTCOMES MEASURES: Sex differences on clinical measures. RESULTS: Females had higher PCSS scores (P = 0.01) and greater VOMS vestibular ocular reflex (VOR) score (P = 0.01) compared with males. There were no sex differences on BESS or ImPACT. Total PCSS scores together with female sex accounted for 45% of the variance in VOR scores. CONCLUSIONS: Findings suggest higher VOR scores after SRC in female compared with male athletes. FINDINGS did not extend to other components of the VOMS tool suggesting that sex differences may be specific to certain types of vestibular impairment after SRC. Additional research on the clinical significance of the current findings is needed. Language: en

Background:A sport-related concussion (SRC) is a heterogeneous injury that requires a multifaceted and comprehensive approach for diagnosis and management, including symptom reports, vestibular/ocular motor assessments, and neurocognitive testing.Purpose:To determine which acute (eg, within 7 days) vestibular, ocular motor, neurocognitive, and symptom impairments predict the duration of recovery after an SRC.Study Design:Cohort study (prognosis); Level of evidence, 2.Methods:Sixty-nine patients with a mean age of 15.3 ± 1.9 years completed a neurocognitive, vestibular/ocular motor, and symptom assessment within 7 days of a diagnosed concussion. Patients were grouped by recovery time: ≤14 days (n = 27, 39.1%), 15-29 days (n = 25, 36.2%), and 30-90 days (n = 17, 24.6%). Multinomial regression was used to identify the best subset of predictors associated with prolonged recovery relative to ≤14 days.Results:Acute visual motor speed and cognitive-migraine-fatigue symptoms were associated with an increased likelihood of recovery times of 30-90 days and 15-29 days relative to a recovery time of ≤14 days. A model with visual motor speed and cognitive-migraine-fatigue symptoms within the first 7 days of an SRC was 87% accurate at identifying patients with a recovery time of 30-90 days.Conclusion:The current study identified cognitive-migraine-fatigue symptoms and visual motor speed as the most robust predictors of protracted recovery after an SRC according to the Post-concussion Symptom Scale, Immediate Post-concussion Assessment and Cognitive Testing, and Vestibular/Ocular Motor Screening (VOMS). While VOMS components were sensitive in identifying a concussion, they were not robust predictors for recovery. Clinicians may consider particular patterns of performance on clinical measures when providing treatment recommendations and discussing anticipated recovery with patients.

Background: The clinical diagnosis and management of patients with sport-related concussion is largely dependent on subjectively reported symptoms, clinical examinations, cognitive, balance, vestibular and oculomotor testing. Consequently, there is an unmet need for objective assessment tools that can identify the injury from a physiological perspective and add an important layer of information to the clinician’s decision-making process. Objective: The goal of the study was to evaluate the clinical utility of the EEG-based tool named Brain Network Activation (BNA) as a longitudinal assessment method of brain function in the management of young athletes with concussion. Methods: Athletes with concussion (n = 86) and age-matched controls (n = 81) were evaluated at four time points with symptom questionnaires and BNA. BNA scores were calculated by comparing functional networks to a previously defined normative reference brain network model to the same cognitive task. Results: Subjects above 16 years of age exhibited a significant decrease in BNA scores immediately following injury, as well as notable changes in functional network activity, relative to the controls. Three representative case studies of the tested population are discussed in detail, to demonstrate the clinical utility of BNA. Conclusion: The data support the utility of BNA to augment clinical examinations, symptoms and additional tests by providing an effective method for evaluating objective electrophysiological changes associated with sport-related concussions.

Objectives: To describe multivariate base rates (MBRs) of low scores and reliable change (decline) scores on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in college athletes at baseline, as well as to assess MBR differences among demographic and medical history subpopulations. Methods: Data were reported on 15,909 participants (46.5% female) from the NCAA/DoD CARE Consortium. MBRs of ImPACT composite scores were derived using published CARE normative data and reliability metrics. MBRs of sex-corrected low scores were reported at Results: Base rates of low scores and reliable decline scores on individual composites approximated the normative distribution. Athletes obtained ≥1 low score with frequencies of 63.4% (Low Average), 32.0% (Borderline), and 9.1% (Impaired). Athletes obtained ≥1 reliable decline score with frequencies of 66.8%, 32.2%, 18%, and 3.8%, respectively. Comparatively few athletes had low scores or reliable decline on ≥2 composite scores. Black/African American athletes and athletes with ADHD/LD had higher rates of low scores, while greater concussion history was associated with lower MBRs (p < .01). MBRs of reliable decline were not associated with demographic or medical factors. Conclusions: Clinical interpretation of low scores and reliable decline on ImPACT depends on the strictness of the low score cutoff, the reliable change criterion, and the number of scores exceeding these cutoffs. Race and ADHD influence the frequency of low scores at all cutoffs cross-sectionally.

Recent studies have concluded that athletes have increased risk of musculoskeletal injury following sport-related concussion. While an underlying explanation is still unknown, perceptual-motor control may be implicated in this increased risk. Some authors have purported that indirect perception (i.e., a “top-down” view of neuromuscular control) may be disrupted following sport-related concussion. Direct perception theory states that the athlete and environment are inextricably linked in a continuous perception–action coupling loop. That is, the athlete is able to directly perceive opportunities for action (e.g., “affordances”) in the environment. Based on these notions, the aim of the current paper was to introduce a theoretical model that argues that sport-related concussion may dysregulate the direct perception process, potentially increasing behavioral risk of musculoskeletal injury during sport. Our model is integrated with a sport-related concussion clinical treatment model, which highlights individualized profiles that characterize the heterogeneous response to sport-related concussion. These profiles have a typical constellation of symptoms (e.g., anxiety, fatigue, ocular dysfunction, etc.), which themselves have been associated with disrupted perception–action coupling, independent of sport-related concussion. Therefore, we argue that athletes who have not re-established perception–action coupling loops following sport-related concussion may be at increased risk of subsequent musculoskeletal injury.

Objective To investigate a dose-response relationship between continuing to play following concussion and outcomes. Participants A total of 130 athletes (age 11-19 years). Design Repeated-measures design comparing symptoms, neurocognitive performance, and recovery time between 52 athletes immediately removed from play (Removed), 24 who continued to play for 15 minutes or less (Short-Play), and 32 who continued to play for more than 15 minutes (Long-Play). Main measures Recovery was the number of days from injury to clearance. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) measured neurocognitive outcomes and the Post-Concussion Symptom Scale (PCSS) measured symptom severity. Results Long-Play (44.09 ± 27.01 days) took longer to recover than Short-Play (28.42±12.74 days) and Removed (18.98 ± 13.76 days). Short-Play was 5.43 times more likely, and Long-Play 11.76 times more likely, to experience protracted recovery relative to Removed. Both Play groups had worse neurocognitive performance and higher symptom scores than Removed at days 1 to 7, with Long-Play demonstrating worse reaction time than Short-Play. At days 8 to 30, both Play groups performed worse than Removed on visual memory and visual motor speed, while only Long-Play performed worse on verbal memory and reaction time. Conclusions Results provide initial evidence of a dose-response effect for continuing to play on recovery from concussion, highlighting the importance of removal from play.

One of the consistent threads throughout the special issue was the relative dearth of research regarding psychological issues associated with concussion. Psychological issues such as changes in behavior and mood following a concussion may emanate from micro-structural, connectivity, and metabolic changes to the brain following injury. In contrast, some patients may experience psychological responses to changes associated with their concussion such as disrupted schedules, social isolation, and frustration with longer than expected recovery. Sleep difficulties may be a symptom of or result in psychological issues following concussion. An emerging personality trait that may influence psychological responses to concussion and overall symptom burden following injury is somatization. Most concussion symptom inventories such as the Post-Concussion Symptom Scale include very few items that assess psychological symptoms such as anxiety, sadness, and irritability. Although licensed mental health professionals, such as psychologists and social workers, often provide the bulk of psychological care for athletes following a concussion, psychiatrists may also serve as a referral.

Sport-related concussion (SRC) is a heterogeneous injury that involves varied symptoms and impairment that presents a significant clinical challenge to sports medicine professionals. In response to this challenge, clinical researchers have proposed clinical profiles or subtype models for assessing and treating athletes with SRC. One such model emphasizes five concussion clinical profiles including cognitive/fatigue, vestibular, ocular, migraine, and anxiety/mood. Sleep is a common modifier that co-occurs across these clinical profiles. A combination of medical history, risk factors, injury information, clinical characteristics, and assessment outcomes can inform each clinical profile. Preliminary data involving 236 patients from a concussion specialty clinic indicate that the migraine (26%) and anxiety/mood (24%) profiles are the most common, with vestibular and ocular profiles combined representing more than one third (35%) of clinical profiles. Findings also support several relationships among different clinical profiles including vestibular and migraine, suggesting that many athletes present with multiple clinical profiles. Targeted, active treatments for each profile are discussed.

Concussions are common in military personnel and may result in increased risk of musculoskeletal injury. One plausible explanation for this risk could be that neuromotor deficiencies enhance injury risk after a concussion through altered muscular activation/contraction timing.To compare military personnel with at least one concussion during the past 1 month to 2 yr (CONCUSSED) to military branch-matched, age-matched, and Special Operations Forces group-matched controls (CONTROL) on physiological, musculoskeletal, and biomechanical performance.A total of 48 (24 CONCUSSED, 24 CONTROL) male Air Force and Naval Special Warfare Operators age 19 to 34 yr participated in the study. Participants self-reported demographics/injury history and completed the following assessments: 1) physiological-body composition, anaerobic power and capacity, aerobic capacity and lactate threshold; 2) musculoskeletal-lower extremity isokinetic strength testing, including time to peak torque; and 3) biomechanical-single-leg jump and landing task, including landing kinematics of the hip, knee and ankle. A machine learning decision tree algorithm (C5.0) and one-way ANOVA were used to compare the two groups on these outcomes.Despite nonsignificant differences using ANOVA, the C5.0 algorithm revealed CONCUSSED demonstrated quicker time to peak knee flexion angle during the single-leg landing task (≤0.170 s; CONCUSSED: n = 22 vs CONTROL: n = 14), longer time to peak torque in knee extension isokinetic strength testing (500 ms; CONCUSSED: n = 18 vs CONTROL: n = 4) and larger knee flexion angle at initial contact (7.7°; CONCUSSED: n = 18 vs CONTROL: n = 2).The findings supported the hypothesis that CONCUSSED military personnel would demonstrate altered neuromuscular control in landing strategies and muscular activation. Future research should assess prospectively neuromuscular changes after a concussion and determine if these changes increase risk of subsequent musculoskeletal injuries.

BACKGROUND After a concussion, athletes may be at increased risk of musculoskeletal injuries. Altered perception of action boundaries (ABP), or the limits of one's action capabilities, is one possible mechanism for this increase in injury risk after concussion. OBJECTIVE To evaluate differences in symptoms, neurocognitive, vestibular/oculomotor, and action boundary function between subjects with no concussion history (NoHx) and concussion history (ConcHX). DESIGN Cross-sectional study. SETTING Laboratory at the University of Pittsburgh. PARTICIPANTS ConcHx (n = 22; age: 21.8 ± 3.0 years, height: 174.0 ± 8.3 cm, and mass: 77.8 ± 14.8 kg) and NoHx athletes (n = 24; age: 21.6 ± 2.0 years, height: 176.0 ± 10.0 cm, and mass: 72.0 ± 15.3 kg). INTERVENTION Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) and Post-Concussion Symptom Scale (PCSS), Vestibular-Ocular Motor Screening (VOMS) tool, and the Perception-Action Coupling Task (PACT). The PACT measures the accuracy of ABP. MAIN OUTCOME MEASURES Neurocognitive domain scores, PCSS, VOMS subdomain symptom gain, ABP accuracy, and actualization. RESULTS ConcHx reported 2.7 ± 1.5 previous concussions occurring on average 263.8 ± 228.9 days prior. ConcHx was higher on several VOMS items including vertical/horizontal saccades (P = 0.001; P = 0.05), vertical/horizontal vestibular-ocular reflex (P < 0.001; P = 0.04), and visual motion sensitivity (P < 0.001). Average PACT movement time (P = 0.01) and reaction time (P = 0.01) were longer in ConcHx. CONCLUSIONS These findings provide preliminary support for impaired vestibular/oculomotor function and ABP in ConcHx compared with NoHx. The current results may enhance our understanding of the mechanisms for increased musculoskeletal injury risk after concussion.

BACKGROUND Concussion is a heterogeneous mild traumatic brain injury (mTBI) characterized by a variety of symptoms, clinical presentations, and recovery trajectories. By thematically classifying the most common concussive clinical presentations into concussion subtypes (cognitive, ocular-motor, headache/migraine, vestibular, and anxiety/mood) and associated conditions (cervical strain and sleep disturbance), we derive useful definitions amenable to future targeted treatments. OBJECTIVE To use evidence-based methodology to characterize the 5 concussion subtypes and 2 associated conditions and report their prevalence in acute concussion patients as compared to baseline or controls within 3 d of injury. METHODS A multidisciplinary expert workgroup was established to define the most common concussion subtypes and their associated conditions and select clinical questions related to prevalence and recovery. A literature search was conducted from January 1, 1990 to November 1, 2017. Two experts abstracted study characteristics and results independently for each article selected for inclusion. A third expert adjudicated disagreements. Separate meta-analyses were conducted to do the following: 1) examine the prevalence of each subtype/associated condition in concussion patients using a proportion, 2) assess subtype/associated conditions in concussion compared to baseline/uninjured controls using a prevalence ratio, and 3) compare the differences in symptom scores between concussion subtypes and uninjured/baseline controls using a standardized mean difference (SMD). RESULTS The most prevalent concussion subtypes for pediatric and adult populations were headache/migraine (0.52; 95% CI = 0.37, 0.67) and cognitive (0.40; 95% CI = 0.25, 0.55), respectively. In pediatric patients, the prevalence of the vestibular subtype was also high (0.50; 95% CI = 0.40, 0.60). Adult patients were 4.4, 2.9, and 1.7 times more likely to demonstrate cognitive, vestibular, and anxiety/mood subtypes, respectively, as compared with their controls (P

This chapter provides an overview of vestibular-related symptoms and disorders that can occur after a mild traumatic brain injury (mTBI). After a brief introduction to the vestibular system, a review the reported prevalence of vestibular disorders and symptoms, such as dizziness and imbalance, will be examined. Methods of assessment of vestibular-related dysfunction include the domains of vestibulo-ocular reflex function, provoked vestibular and oculomotor symptoms, and balance and gait. Differences in function between individuals who have had a mTBI and healthy controls will be detailed. A comprehensive assessment of vestibular-related problems can assist in the management of mTBI.

OBJECTIVES: The current study investigated the role of persistent vestibular-ocular symptoms and impairment following sport-related concussion on recovery time and clinical outcomes among adolescents. DESIGN: Prospective cohort METHODS: 50 (F-22/M-28) adolescents aged 12–20 years completed a vestibular-ocular motor screening, neurocognitive assessment, and the Post-Concussion Symptom Scale (PCSS) at clinical assessments conducted at 0–10 and 11–21 days after concussion. Participants were assigned to: 1) persistent vestibular-ocular (PERSIST), 2) vestibular-ocular improvement (IMPROVE), or 3) no vestibular-ocular impairment (NONE) groups based on vestibular-ocular motor screening conducted during each assessment. A 3 (GROUP) X 2 (TIME) ANOVA was performed on neurocognitive and symptom scores, and a between-subjects ANOVA was performed for recovery time. RESULTS: 49 subjects were identified among the PERSIST (n=17), IMPROVE (n=12) and NONE (n=20) groups. There were no neurocognitive performance differences between groups at 0–10 days post-concussion, but groups differed on PCSS at 11–21 days (p=. 001), with the PERSIST (29.0±24.9) group reporting higher symptoms than the NONE (5.45±10.0; p=.005) group. The PERSIST group took significantly longer to recover (34.9±11.6 days) than the NONE (22.9±14.9 days) group (p=.03). All groups improved on verbal (p

Objective To compare VOMS item scores between a fixed and randomized administration order in a sample of nonconcussed high school athletes. Design Post-test only, quasi-experimental design. Setting Local high schools in a mid-west region of the United States. Patients Fifty nonconcussed high school athletes (M = 15.64; SD = 1.12 years) completed the VOMS in a randomized testing order (RANDOM), and 49 (M = 15.64; SD = 1.12 years) completed the VOMS in the fixed testing order (FIXED). The groups were matched on age, sex, learning disorder, attention-deficit/hyperactivity disorder, concussion history, and baseline concussion symptoms. Interventions The Vestibular/Ocular Motor Screening (VOMS) tool comprises pretest symptoms, smooth pursuit (SP), horizontal/vertical saccade (HSAC/VSAC), average near-point of convergence (NPC) distance, convergence symptoms, horizontal/vertical vestibular ocular reflex (HVOR/VVOR), and visual motion sensitivity (VMS). Main outcome measures Mann-Whitney U tests were performed to examine differences between FIXED and RANDOM groups on VOMS items. RANDOM scores were rearranged in order of administration and combined with the FIXED group scores, and a Freidman test was performed for repeated measures. Results There were no significant differences between FIXED and RANDOM groups on VOMS pretest symptoms (U = 1171, P = 0.57), SP (U = 1122.5, P = 0.35), HSAC (U = 1128.5, P = 0.44), VSAC (U = 1055.5, P = 0.16), convergence symptoms (U = 1129.0, P = 0.41), average NPC distance (U = 979.0, P = 0.06), HVOR (U = 1085.0, P = 0.25), VVOR (U = 1126.0, P = 0.41), and VMS scores (U = 1101.0, P = 0.32). When VOMS items were rearranged and the sample was combined, there were no differences for repeated measures [χ (6) = 9.92, P = 0.13]. Conclusions There were no significant differences on VOMS items between FIXED and RANDOM groups for repeated measures. The testing order of VOMS items does not affect VOMS scores in nonconcussed high school athletes.

Objective To investigate the magnitude of postural sway induced by different balance tasks in adolescents with concussion and to examine the associations of postural sway with concussion symptoms. Design Cross-sectional study. Patients or Other Participants Fifty-six adolescents (20 girls, 36 boys) between 13 and 17 years of age who sustained a concussion within the past 44 days and were still symptomatic. Main Outcome Measure(s) Anterior-posterior postural sway was measured using an accelerometer attached to the participant's lower back while he or she performed 6 static-balance tasks that varied the visual input, type of surface, and foot stance. Participants self-reported symptoms that occurred at the time of the concussion (eg, dizziness, confusion, amnesia) as well as at the time of balance testing (eg, eye and head movement–induced dizziness). Results The normalized path length of postural sway during the different balance tasks was greater with the eyes closed (mean = 19.3 mG/s) compared with the eyes open (mean = 12.4 mG/s; P < .001). Furthermore, sway while standing with the feet together on a foam surface (mean = 17.9 mG/s) or while tandem standing on a firm surface (mean = 19.4 mG/s) was greater than sway while standing with the feet together on a firm surface (mean = 10.3 mG/s; P < .001). Greater sway was associated with dizziness and confusion reported at the time of injury (P < .05). Dizziness and headache symptoms at rest were positively correlated with sway (P < .05). Conclusions Using accelerometers to measure postural sway during different challenging balance conditions in adolescents with concussion may provide an objective means of quantifying balance impairments in clinical environments. Furthermore, the association of these measurements with symptoms suggests a need to account for symptom severity at the time of testing.

Objective The examine the utility of neuropsychological assessment in differentiating older adults with mild traumatic brain injury (mTBI) from controls. Methods Fifty-two older adults (40% male) aged 60–76 (M = 66.44, SD = 4.74) years were included in the study; 27 diagnosed with mTBI within three months of injury (33.07+/−18.86 days) and 25 age-group and sex-matched controls. Participants completed the following procedures: clinical interview, Repeatable Battery for the Assessment of Neuropsychological Status [RBANS], Wide Range Achievement Test [WRAT], Clock drawing, Post-Concussion Symptom Scale [PCSS], Short Fall Efficacy Scale [SFES], Generalized Anxiety Disorder- 7 Item Scale [GAD-7], Geriatric Depression Scale- 5 Item [GDS-5], and Vestibular/Oculomotor Screening [VOMS]. Statistical comparisons were performed using paired t-tests and chi-square analyses with significance of p Results There were no significant differences on demographics, aside from participants in the mTBI group being more likely to have a history of sleep disorder (χ2 = 10.26, p = 0.001). The groups significantly differed on RBANS subtests (list-learning, list recall, list recognition, and semantic fluency), VOMS Total Score and near point of convergence, PCSS, GAD-7, and the SFES, with the mTBI group consistently performing more poorly on cognitive testing and endorsing more symptoms. The mTBI group performed better on clock drawing. Conclusions The present study represents an initial investigation of the utility of a multidomain evaluation for mTBI in the subacute phase in older adults. Findings support the use of the RBANS immediate, delay, and recognition memory subtests and the RBANS semantic fluency subtest, as well as the VOMS, PCSS, GAD-7, and SFES for differentiating older adults with mTBI from controls.

This study compared post-concussion symptom endorsements on the Post-Concussion Symptom Scale (PCSS) between a clinical open-ended interview, clinician-guided PCSS, parent-report PCSS, and computer-based PCSS in youth athletes with sport-related concussion (SRC). Participants included 54 patients aged 13-17 years (M = 15.19, SD = 1.29, 51.8% male) with a diagnosed SRC seen at a concussion clinic. Participants were administered a computer-based version (COMP) of the PCSS followed by clinical open-ended symptom interview (OPEN) and clinician-guided PCSS (GUIDED). Participants' parents concurrently and independently endorsed their children's symptoms by completing the PCSS in the waiting room (PARENT). Total number of symptoms reported and total symptom severity score were analyzed and compared across the four PCSS administration methods. Results revealed significantly lower total number of symptoms for OPEN compared to GUIDED (p = .002), PARENT (p

Computerized neurocognitive tests are frequently used to assess pediatric sport-related concussions; however, only 1 study has focused on the test-retest reliability of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in high school athletes and age influences have largely been ignored. Therefore, the purpose was to investigate the test-retest reliability of ImPACT and underlying age influences in a pediatric population. Two hundred (169 men and 31 women) youth ice hockey players completed ImPACT before/after a 6-month season. Reliability was assessed using Pearson correlation coefficients, intraclass correlation coefficients (ICCs), and regression-based methods (RBz). ICCs for the sample ranged from .48 to .75 (single)/.65 to .86 (average). In general, the older athletes (15-18: Single/Average ICCs = .35-.75/.52-.86) demonstrated greater reliability across composites than the younger athletes (11-14: Single/Average ICCs = .54-.63/.70-.77). Although there was variation in athletes' performance across two test administrations, RBz revealed that only a small percentage of athletes performed beyond 80%, 90%, and 95% confidence intervals. Statistical metrics demonstrated reliability coefficients for ImPACT composites in a pediatric sample similar to previous studies, and also revealed important age-related influences.

Background: The Vestibular/Ocular Motor Screening (VOMS) is a newly developed screening tool that evaluates vestibular and ocular motor symptom (eg, headache, dizziness, nausea, fogginess) provocation after a sport-related concussion. Baseline data on the VOMS are needed to extend the application of this measure to broad age groups and to document normal variations in performance. Purpose: The primary purpose of this study was to examine the internal consistency of the VOMS in a large sample of healthy, nonconcussed collegiate athletes. The secondary purpose was to investigate the effects of patient sex and history of motion sickness, migraines, and concussions on baseline VOMS scores. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 263 National Collegiate Athletic Association Division I athletes (mean ± SD age, 19.85 ± 1.35 years) completed self-reported demographic and medical history at preseason physical examinations and baseline screening. Internal consistency of the VOMS was assessed with Cronbach α. A series of univariate nonparametric tests (χ2 with odds ratios [ORs] and 95% CIs) were used to examine the associations among medical history risk factors and VOMS clinical cutoff scores (score of ≥2 for any individual VOMS symptom, near point of convergence [NPC] distance of ≥5 cm), with higher scores representing greater symptom provocation. Results: Internal consistency of the VOMS was high (Cronbach α = .97), and 89% of athletes scored below cutoff levels (ie, 11% false-positive rate). Female athletes (OR, 2.99 [95% CI, 1.34-6.70]; P = .006) and those with a personal history of motion sickness (OR, 7.73 [95% CI, 1.94-30.75]; P = .009) were more likely to have ≥1 VOMS scores above cutoff levels. No risk factors were associated with increased odds of an abnormal NPC distance. Conclusion: The VOMS possesses internal consistency and an acceptable false-positive rate among healthy Division I collegiate student-athletes. Female sex and a history of motion sickness were risk factors for VOMS scores above clinical cutoff levels among healthy collegiate student-athletes. Results support a comprehensive baseline evaluation approach that includes an assessment of premorbid vestibular and oculomotor symptoms.

Context College sport organizations and associations endorse concussion-management protocols and policies. To date, little information is available on concussion policies and practices at community college institutions. Objective To assess and describe current practices and policies regarding the assessment, management, and return-to-play criteria for sport-related concussion (SRC) among member institutions of the California Community College Athletic Association (CCCAA). Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants A total of 55 head athletic trainers (ATs) at CCCAA institutions. Main Outcome Measure(s) Data about policies, procedures, and practices regarding SRC were collected over a 3-week period in March 2012 and analyzed using descriptive statistics, the Fisher exact test, and the Spearman test. Results Almost half (47%) of ATs stated they had a policy for SRC assessment, management, and return to play at their institution. They reported being in compliance with baseline testing guidelines (25%), management guidelines (34.5%), and return-to-play guidelines (30%). Nearly 31% of ATs described having an SRC policy in place for academic accommodations. Conference attendance was positively correlated with institutional use of academic accommodations after SRC (r = 0.44, P = .01). The number of meetings ATs attended and their use of baseline testing were also positively correlated (r = 0.38, P = .01). Conclusions At the time of this study, nearly half of CCCAA institutions had concussion policies and 31% had academic-accommodation policies. However, only 18% of ATs at CCCAA institutions were in compliance with all of their concussion policies. Our findings demonstrate improvements in the management of SRCs by ATs at California community colleges compared with previous research but a need for better compliance with SRC policies.

Objective To investigate the influence of self-reported physical activity (PA) on state anxiety in athletes with concussion Method Participants were 230 athletes (mean age = 16.46, SD = 1.94; 43% female) seeking care for a concussion at a specialty clinic within 30 days of injury (M = 8.83, SD = 6.12 days). Demographic data were collected during the clinical interview: age, sex, and history of concussion, migraine, learning disability, attention deficit hyperactivity disorder, anxiety, and depression. Patients completed the State-Trait Anxiety Inventory (STAI) and self-reported current levels of PA; 113 participants reported rest or no physical activity (REST) and 117 reported at least minimal PA (ACTIVE). The groups were compared on demographic variables to ensure group equivalence. Independent samples t-test examined differences between groups on state anxiety scores and a chi-square with odds ratios (ORs) examined the relationship between PA groups and clinical levels of state anxiety (STAI > 40). Statistical significance for all analyses was (p Results The groups were similar on all demographic variables (p > .05). The NO PA/REST group exhibited significantly higher state anxiety scores at first clinic visit than the PA group (t (228) = 2.82, p = .005), and the NO PA/REST group was 2.26 times more likely to exhibit clinical levels of state anxiety than the PA group at first clinic visit (χ2 (1, N = 230) = 9.16, p = .002). Conclusions Anxiety that is secondary to concussive injury could be mitigated with physical activity. Healthcare providers should encourage individuals with concussion to engage in physical activity during recovery.

Objective To examine the influence of biopsychosocial factors on clinical outcomes and recovery time following SRC Method 59 athletes with SRC (51% male) aged 14.42, SD= 1.65 years from two concussion specialty clinics between May 2019 and January 2020. Patients completed the Behavioral Regulation Assessment for Concussion (BRAC) inventory measuring sleep, diet, hydration, physical activity and stress; on a 4-point Likert scale, ImPACT, and PCSS. Analyses included one-way ANOVAs with Tukey’s post-hoc test and chi-square analyses. Results Verbal memory scores were higher F(3,55)= 2.85, p Conclusions Findings suggest that biopsychosocial factors including sleep, stress, and hydration are associated with symptoms, cognitive function, and recovery time following SRC and should be monitored by clinicians.

Objective The purpose of this study was to apply network analyses to evaluate trends in the literature using a comprehensive search of original, peer-reviewed research articles involving human participants with sport-related concussion (SRC) published between January 1, 2010 and December 31, 2019. Data Selection Articles were identified in a comprehensive online search using key terms to encompass all forms of SRC or mTBI and entered into a clustering algorithm (vosViewer). Each cluster (e.g., journal, institution, author, keyword) is named for the hub, or most highly interconnected individual node. Data Synthesis The online search yielded 6,130 articles, 528 journals, 7,598 authors, 1,966 institutions, and 3,293 keywords. The analysis supported five thematic clusters of journals: 1. Biomechanics/Sports medicine (n = 15), 2. Pediatrics/Rehabilitation (n = 15), 3. Neurotrauma/Neurology/Neurosurgery (n = 11), 4. General Sports Medicine (n = 11), 5. Neuropsychology (n = 7). The analysis identified four institutional clusters: 1. University of North Carolina (n = 19), 2. University of Toronto (n = 19), 3. University of Michigan (n = 11), 4. University of Pittsburgh (n = 10). Five primary author clusters were identified: 1. A. Kontos (n = 32), 2. G. Iverson (n = 27), 3. M. McCrea (n = 27), 4. S. Broglio (n = 25), 5. Z. Kerr (n = 16). In regards to keywords, central topics included: 1. Epidemiology (n = 14), 2. Rehabilitation (n = 12), 3. Biomechanics (n = 11), 4. Imaging (n = 10), 5. Assessment (n = 9). Conclusions The findings suggest that during the past decade SRC research has: 1) been published primarily in sports medicine, pediatric, and neuro-focused journals, 2) involved a select group of researchers from several key institutions, and 3) focused on new topic areas including treatment/rehabilitation.

Objective In 2017, the Sport Concussion Assessment Tool-5 Child (Child SCAT-5) was introduced as a tool for clinicians to assess cognitive function and symptoms in children following a concussion (Davis, 2017; Echmendia, 2017); however, there are limited data supporting its use. The purpose of this study was to assess performance on the Child SCAT-5 among concussed pediatric patients (i.e., 5–9 years) across two clinic visits. Method Participants included 95 children (42.15% female) aged 5–9 years (7.42 +/− 1.12) who were diagnosed with a concussion within 30 days of injury (8.75 +/− 5.65 days). Patients underwent clinical interview and Child SCAT-5. Paired t-tests were used to compare measures on symptomatology, neurocognitive function, and balance performance between their first two clinical encounters (18.07 +/− 16.05 days). Results Analyses revealed significant improvements for immediate memory (p Conclusions The findings from this study indicate that the Child SCAT-5 is useful for identifying common symptoms in pediatric patients tracking symptom improvement across clinic visits. The measure was also useful in identifying improvements in neurocognitive functioning in this population, particularly memory performance. Further research should focus on how the Child SCAT-5 and other pediatric-specific measures can assess and track improvement in clinical outcomes for this at-risk population.

Objective Neuropsychological evaluation of concussion typically includes performance validity testing to assess effort. The aim of this study was to explore the usefulness of effort testing as part of initial screening for concussion rehabilitation, including determining the factors that predict effort testing and evaluate outcomes between “good effort” and “failed effort” groups. Method Records of 76 patients aged 16–66 years old (M = 40.58 years, SD = 14.18) seen for rehabilitation of non-sport concussion from 2018–2019 were reviewed. Patients completed clinical interview, neurocognitive screening (ImPACT), effort testing (Word Memory Test), vestibular/oculomotor screening (VOMS), and the post-concussion symptom scale (PCSS). A logistic regression (LR) was conducted to predict effort, with predictors including mental health history, secondary gain, work injury, days post-injury, and PCSS. A series of one-way ANOVAs evaluated outcomes from concussion rehabilitation between the good and failed effort groups. Results Failed effort occurred in 42% of cases. The LR accurately classified 81.8% of individuals, with mental health history (p = .01) and PCSS (p = .02) as the only significant predictors of effort. There were no differences in recovery time (p = .56) between effort groups, but the failed effort group took longer to return to work (p = .03). Half of individuals who failed effort were seen until discharge, and 69% of them reported no symptoms/mild symptoms at discharge. Conclusions Failure of effort testing was predicted by a history of mental health and high symptom burden. Individuals who fail effort testing at initial visit for concussion rehabilitation take longer to return to functional activity but are capable of achieving recovery with compliance and appropriate rehabilitation.

Objective The purpose of this study was to examine the relationship between vestibular and ocular motor symptoms, impairment and anxiety following sport-related concussion (SRC). Immediate post-injury assessments are predictive of symptoms and are prognostic for prolonged recovery. Although concussion is associated with increased likelihood of developing mental health issues, the relationship between post-concussion vestibular symptoms, impairment and anxiety is unknown. Method This study represented a sub-analysis of a randomized control-trial (RCT), conducted on a sample of 50 participants (40% male), aged 13–18 ([M] = 15.38, [SD] = 2.05) years within 7–21 days of a SRC between October 2018 and January 2020. Participants completed the Vestibular/Ocular Motor Screening (VOMS) and General Anxiety Disorder 7 (GAD-7) at initial visit, and 2 and 4 week follow-ups. Patients were categorized using GAD-7 scores as having mild, moderate or severe anxiety. Results Numerous positive correlations ranging from .28 to .52 among VOMS and GAD-7 scores were supported. The severe (99.6, 26.6) anxiety group scored highest on total VOMS followed by the moderate (76.5, 30.1), and mild (63.1, 45.9) anxiety groups (p = .006). Results of logistic regression indicated that total VOMS score was a significant predictor of GAD-7 generalized anxiety score (R = .389, r2 = .151 p = .001). Conclusions Higher scores on VOMS were associated with higher post-injury anxiety. Participants with higher VOMS scores following SRC may be at increased risk for developing anxiety symptoms. The current findings can help clinicians target concussion treatment to each specific patient based on their VOMS and GAD-7 scores in combination, rather than in isolation.

Objective Psychological resilience has been positively associated with sport achievement and psychological well-being, while being negatively associated with psychological distress. Lower psychological resilience may also increase the risk of protracted recovery from concussion. The purpose of this study is to examine the relationship between psychological resilience and clinical outcomes among adolescent and young adult athletes. Method Fifty-seven patients (11–22 years; m = 15.2, SD = 2.76) were diagnosed with a sport-related concussion (SRC) within two weeks of injury. Patients completed the Conner-Davidson Resilience Scale (CD-RISC-10) and the Depression Anxiety and Stress Scales (DASS-21) at first visit in addition to neurocognitive screening (ImPACT) and vestibular/oculomotor screening (VOMS). Participants were divided into “Low”, “Moderate” and “High” resilience using CD-RISC-10 tertiles. A series of one-way ANOVAS with pairwise comparisons (Tukey post-hoc test) were used to compare groups across outcomes measures. Results Significant differences were present between the High Resilience (m = 15.22 days; SD = 8.87) and Low Resilience (m = 30.95 days; SD = 23.76) groups in Days to Clearance (p = .032), DASS-21 Total score (p = 0.01), DASS-21 Depression subscale (p = 0.022), DASS-21 Anxiety subscale (p = 0.01), and DASS-21 Stress subscale (p = 0.002). No significant relationships were observed between resilience and ImPACT, VOMS, or PCSS score for any group. Conclusions Athletes with low psychological resilience immediately following concussion had a recovery time twice that of athletes with high resilience. All groups in the study exhibited recovery times within a normal time frame (i.e., ≤ 30 days), but high psychological resiliency may serve as a protective factor for recovery outcomes among athletes experiencing concussion.

Objective Previous research utilizing factor analytic methods, such as principal components analysis (PCA) has focused on concussion factors derived from symptom scales (Piland, 2003; Kontos, 2012) and neurocognitive testing (Schatz, 2013). However, researchers have yet to conduct a PCA that incorporates symptoms, cognitive, ocular, and vestibular outcomes. The purpose was to utilize PCA to examine the factor structure of concussion among adolescents within 31 days of injury. Method Participants included 238 adolescents (41.2% female) diagnosed with concussion. Average age was 14.81 ± 1.57 years (10 to 17 years). A PCA was performed on 11 variables, including PCSS (via symptom factors: cognitive/fatigue/migraine, affective, somatic, and sleep), near point of convergence (NPC), ImPACT composites, and VOMS symptoms. Items retained in the factor models on the basis of having a primary factor loading of .6 or above. Results A three-component model was supported that accounted for 65.12% of the variance: 1) cognitive, 2) symptoms, and 3) vestibular/ocular. The cognitive component included visual motor speed, reaction time, verbal, and visual memory (37.95%). Symptoms component included affective, cognitive/fatigue/migraine, and sleep (17.42%). Vestibular/ocular component included vestibular and ocular symptoms (9.75%). All items loaded into the PCA, with exception of somatic and NPC average were retained. Conclusions The current study supported three factors and extended findings of previous PCAs by including ocular and vestibular components. The current study better reflects contemporary models of concussion involving clinical profiles or subtypes (e.g., Harmon, 2019). Moving forward, researchers should examine factors across subacute and chronic time points to evaluate potential temporal changes in factors.

OBJECTIVE The purpose of this study was to determine which assessments best identify athletes with sport-related concussion (SRC) from healthy controls in the acute/early subacute phase (within 10 days of SRC) of injury. DESIGN Prospective, cohort study. SETTING Specialty concussion clinic. PARTICIPANTS Sixty-four athletes with SRC (52% male) and 59 matched (age and sex), healthy controls (56% male) aged 12 to 20 years (Mean [M] = 15.07, Standard Deviation [SD] = 2.23). ASSESSMENT Participants completed symptom, cognitive, vestibular/oculomotor, near point of convergence (NPC), and balance assessments. MAIN OUTCOME MEASURES Univariate analyses were conducted to compare athletes with SRC to healthy controls across all assessments. Assessments that significantly differed between the SRC group and healthy controls were used as predictors in an enter method logistic regression (LR) model and subsequent forward stepwise LR. RESULTS Results of LR analyses indicated that symptom inventory and symptom provocation on vestibular/oculomotor assessments significantly predicted athletes with SRC versus controls. The forward stepwise LR accurately classified 84.6% of the overall sample (78.3% of athletes with SRC and 91.2% of controls were accurately predicted) and accounted for 60.5% of the variance in predicting athletes with SRC versus controls. Total symptom inventory score (P = 0.003) and vestibular/oculomotor symptom provocation (P < 0.01) were the most sensitive and specific measures in a comprehensive, multimodal assessment for distinguishing athletes with SRC from healthy controls within 10 days of injury. CONCLUSIONS Elements within a multimodal evaluation that are the most robust at discriminating athletes with SRC from healthy controls in the acute/early subacute phase of injury include symptom report and provocation of symptoms on vestibular/oculomotor assessment. These assessments should be considered in conjunction with other objective assessments (ie, NPC measurement and cognitive testing) as part of a comprehensive evaluation of SRC.

OBJECTIVE To explore differences in baseline King-Devick Test (KD) completion time between 2 testing modalities: (1) spiral-bound paper cards (cards) and (2) iPad application (iPad). DESIGN Cross-sectional cohort analysis. SETTING National Collegiate Athlete Association (NCAA) institutions. PARTICIPANTS Student athletes from 13 women's and 11 men's collegiate sports who completed KD baseline testing as part of their first year in the Concussion Assessment, Research and Education (CARE) Consortium from 2014 to 2016 (n = 2003, 52.2% male). INDEPENDENT VARIABLES King-Devick Test modalities; cards or iPad. MAIN OUTCOME MEASURE Baseline KD completion time (seconds). RESULTS Mean baseline KD completion time of the iPad modality group [42.8 seconds, 95% confidence interval (CI), 42.1-43.3] was 2.8 seconds (95% CI, 2.1-3.4) greater than the cards group (40.0 seconds, 95% CI, 39.7-40.3) (t(1, 1010.7) = -8.0, P < 0.001, Cohen's d = 0.41). CONCLUSIONS Baseline KD performance is slower when tested on an iPad than when tested on spiral-bound paper cards. The 2 KD modalities should not be used interchangeably in concussion assessments because differences in the modalities can lead to time differences similar in magnitude to those used to indicate concussion. From a research perspective, modality may influence interpretation and/or synthesis of findings across studies.

After a concussion, athletes may be at increased risk of musculoskeletal injuries. Altered perception of action boundaries (ABP), or the limits of one's action capabilities, is one possible mechanism for this increase in injury risk after concussion.To evaluate differences in symptoms, neurocognitive, vestibular/oculomotor, and action boundary function between subjects with no concussion history (NoHx) and concussion history (ConcHX).Cross-sectional study.Laboratory at the University of Pittsburgh.ConcHx (n = 22; age: 21.8 ± 3.0 years, height: 174.0 ± 8.3 cm, and mass: 77.8 ± 14.8 kg) and NoHx athletes (n = 24; age: 21.6 ± 2.0 years, height: 176.0 ± 10.0 cm, and mass: 72.0 ± 15.3 kg).Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) and Post-Concussion Symptom Scale (PCSS), Vestibular-Ocular Motor Screening (VOMS) tool, and the Perception-Action Coupling Task (PACT). The PACT measures the accuracy of ABP.Neurocognitive domain scores, PCSS, VOMS subdomain symptom gain, ABP accuracy, and actualization.ConcHx reported 2.7 ± 1.5 previous concussions occurring on average 263.8 ± 228.9 days prior. ConcHx was higher on several VOMS items including vertical/horizontal saccades (P = 0.001; P = 0.05), vertical/horizontal vestibular-ocular reflex (P0.001; P = 0.04), and visual motion sensitivity (P0.001). Average PACT movement time (P = 0.01) and reaction time (P = 0.01) were longer in ConcHx.These findings provide preliminary support for impaired vestibular/oculomotor function and ABP in ConcHx compared with NoHx. The current results may enhance our understanding of the mechanisms for increased musculoskeletal injury risk after concussion.

The King–Devick (K–D) test is often used as part of a multimodal assessment to screen for sport-related concussion. However, the test involves reading numbers, and little is known about variation in baseline performance on the K–D by reading skill level. We conducted a cross-sectional study analyzing data from the Concussion Assessment, Research and Education (CARE) Consortium to assess differences in baseline performance on the K–D associated with factors that impact reading skill level (learning disorder [LD] and primary home language other than English [PHLOTE]), while controlling for covariates (gender, type of sport, attentional issues, history of concussion and modality of administration). We had a sample of 2311 student-athletes (47% female), and multivariate regression indicated an average K–D performance time of 40.4 s. Presence of LD was associated with a 3.3 s slower K–D time (95% CI 1.9–4.7, p

Through a partnership with the National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, and Department of Defense, the development of Sport-Related Concussion (SRC) Common Data Elements (CDEs) was initiated. The aim of this collaboration was to increase the efficiency and effectiveness of clinical research studies and clinical treatment outcomes, increase data quality, facilitate data sharing across studies, reduce study start-up time, more effectively aggregate information into metadata results, and educate new clinical investigators. The SRC CDE Working Group consisted of 32 worldwide experts in concussion from varied fields of related expertise divided into three Subgroups: Acute (3 months post-concussion). To develop CDEs, the Subgroups reviewed various domains, then selected from, refined, and added to existing CDEs, case report forms and field-tested data elements from national registries and funded research studies. Recommendations were posted to the NINDS CDE Website for Public Review from February 2017 to April 2017. Following an internal Working Group review of recommendations, along with consideration of comments received from the Public Review period, the first iteration (Version 1.0) of the NINDS SRC CDEs was completed in June 2017. The recommendations include Core and Supplemental–Highly Recommended CDEs for cognitive data elements and symptom checklists, as well as other outcomes and end-points (e.g., vestibular, oculomotor, balance, anxiety, depression), and sample case report forms (e.g., injury reporting, demographics, concussion history) for domains typically included in clinical research studies. The NINDS SRC CDEs and supporting documents are publicly available on the NINDS CDE website www.commondataelements.ninds.nih.gov. Widespread use of CDEs by researchers and clinicians will facilitate consistent SRC clinical research and trial design, data sharing, and metadata retrospective analysis.

OBJECTIVE Describe changes in postconcussion activity levels and sleep throughout recovery in a sample of pediatric sport-related concussion (SRC) patients, and examine the predictive value of accelerometer-derived activity and sleep on subsequent clinical outcomes at a follow-up clinic visit. SETTING Outpatient concussion clinic. PARTICIPANTS Twenty athletes aged 12 to 19 years with diagnosed SRC. METHODS Prospective study including visit 1 (

OBJECTIVE: Symptom factors present the first week following concussion may predict subsequent concussion outcomes and recovery duration. We hypothesized that a high loading on cognitive-fatigue-migraine and somatic factors would be predictive of neurocognitive impairment following concussion. We also hypothesized that the affective factor would be related to vestibular symptoms and impairment. DESIGN: Prospective repeated measures SETTING: Concussion specialty clinic PARTICIPANTS: Athletes ages 13–20 years diagnosed with a concussion within the past 7 days INDEPENDENT VARIABLE: Symptom factors at initial visit 1–7 days post-injury. MAIN OUTCOME MEASURE: Symptom factor score, neurocognitive testing, and vestibular/ocular motor assessment at second visit (2–4 weeks post-injury) RESULTS: The somatic symptom factor from initial visit was significant (p.05) at the second visit. The cognitive-migraine-fatigue and affective symptom factors predicted symptom burden at the second visit(p