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Context: Mindfulness interventions (yoga, meditation) in traumatic brain injury populations show promising improvements in injury outcomes. However, most studies include all injury severities and use in-person, general programming lacking accessibility and specificity to the nuance of concussion. Therefore, this study investigated the feasibility and preliminary effectiveness of an online, concussion-focused meditation intervention among young adults with a concussion history. Design: Unblinded, single-arm, pilot intervention. Methods: Fifteen young adults aged 18 to 30 with a concussion history within the past 5 years completed 10 to 20 minutes per day of online, guided meditations for 6 weeks. Feasibility was assessed using the Feasibility of Intervention Measure. Concussion symptoms were measured using the Rivermead Post-Concussion Symptom Questionnaire, perceived stress the Perceived Stress Scale-10, and mindfulness the Five Facet Mindfulness Questionnaire. Descriptive statistics described the study sample and determined intervention adherence and feasibility. Paired sample t tests were used to examine preintervention/postintervention changes in concussion symptoms, perceived stress, and mindfulness, with descriptive statistics further detailing significant t tests. Results: Fifteen participants were enrolled, and 12 completed the intervention. The majority completed 5+ days per week of the meditations, and Feasibility of Intervention Measure (17.4 [1.8]) scores indicated high feasibility. Concussion symptom severity significantly decreased after completing the meditation intervention (11.3 [10.3]) compared with before the intervention (24.5 [17.2]; t[11] = 3.0, P =.01). The number of concussion symptoms reported as worse than before their concussion significantly decreased after completing the meditation intervention (2.7 [3.9]) compared with before the intervention (8.0 [5.7]; t[11] = 3.7, P =.004). Postintervention, 83.33% (n = 10) reported lower concussion symptom severity, and 75.00% (n = 9) reported less concussion symptoms as a mild, moderate, or severe problem (ie, worse than before injury). Conclusions: Findings suggest positive adherence and feasibility of the meditation intervention, with the majority reporting concussion symptom improvement postintervention. Future research is necessary to expand these pilot findings into a large trial investigating concussion-specific meditation programming. [ABSTRACT FROM AUTHOR]

While research advancements have substantially improved concussion management efforts, consideration for the psychological and social aspects of concussive injuries have remained largely absent from concussion protocols. The present study was undertaken to identify elite athletes' psychological and social needs during the recovery process. Elite athletes with a history of concussion and mental performance consultants who work with concussed elite athletes participated in focus group interviews to shed light on these needs. A thematic analysis of these focus groups revealed six psychological and social needs: acceptance, normality, confidence, self-efficacy, trust in relationships, and social support. These themes are framed within concussion literature to help initiate a conversation on how psychological and social needs should be addressed as part of multifaceted efforts to improve concussion recovery. [ABSTRACT FROM AUTHOR]

Every state in the United States mandates concussion education annually or biennially for those involved in organized youth sports to improve awareness, knowledge, and attitudes toward concussions. The purpose of this study was to examine Texas high school and junior high school coaches' knowledge of and attitudes toward concussions using the Rosenbaum Concussion Knowledge and Attitudes Survey—Coaches Version. Among all analyzed participants, the mean overall concussion knowledge index (Concussion Knowledge Index = 0–25) was 21 (SD = 1.79), while the overall concussion attitude index (Concussion Attitude Index = 15–75) was 63 (SD = 5.69). No significant differences for knowledge or attitude were found between gender, coaching level, sport type, geographical location, or school size (all p >.10). Mandatory concussion education has resulted in high levels of knowledge about and favorable attitudes toward concussions in Texas junior high school and high school coaches, with similar findings to other research in this area. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Objective: This study summarizes findings from a cross-sectional survey conducted among National Collegiate Athletic Association (NCAA) Division 1 football programs, focusing on sport-related concussion (SRC) protocols for the 2018 season. Design: Cross-sectional survey study. Setting: 65 football programs within the Autonomy Five (A5) NCAA conferences. Participants: Athletic trainers and team physicians who attended a football safety meeting at the NCAA offices June 17 to 18, 2019, representing their respective institutions. Intervention: Electronic surveys were distributed on June 14, 2019, before the football safety meeting. Main Outcome Measures: Results for 16 unique questions involving SRC protocols and resources were summarized and evaluated. Results: The survey garnered responses from 46 of 65 programs (response rate = 71%). For baseline testing , 98% measured baseline postural stability and balance, 87% used baseline neurocognitive testing, while only 61% assessed baseline vestibular and/or ocular function. Regarding concussion prevention , 51% did not recommend additional measures, while 4% and 24% recommended cervical compression collars and omega-3 supplementation, respectively. In postconcussion treatment , 26% initiated aerobic exercise 1 day postconcussion if symptoms were stable, 24% waited at least 48 hours, 4% waited for the athlete to return to baseline, 11% waited until the athlete became asymptomatic, and 35% determined procedures on a case-by-case basis. Conclusions: Most institutions assessed postural stability/balance and neurocognitive functioning at baseline and introduced light aerobic exercise within 48 h postconcussion. There was variation in baseline assessment methods and concussion prevention recommendations. These survey findings deepen our understanding of diverse SRC protocols in NCAA football programs. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Objective: Approximately 20% of students with sport-related concussion (SRC) report new symptoms of anxiety and depression which may be associated with delayed recovery and increased risk for developing a mood disorder. Early prescribed aerobic exercise facilitates recovery in athletes with concussion-related exercise intolerance. We studied the effect of aerobic exercise treatment on new mood symptoms early after SRC. Design: Exploratory secondary analysis of 2 randomized controlled trials (RCT). Setting: Sports medicine clinics associated with UB (Buffalo, NY), CHOP (Philadelphia, PA), and Boston Children's Hospital (Boston, MA). Participants: Male and female adolescents (aged 13-18 years) diagnosed with SRC (2-10 days since injury). Interventions: Participants were randomized to individualized targeted heart rate aerobic exercise (n = 102) or to a placebo intervention designed to mimic relative rest (n = 96). Main Outcome Measures: Incidence of Persisting Post-Concussive Symptoms (PPCS, symptoms ≥28 days). Results: First RCT recruited from 2016 to 2018 and the second from 2018 to 2020. Of 198 adolescents, 156 (79%) reported a low burden (mean 1.2 ± 1.65/24) while 42 (21%) reported a high burden (mean 9.74 ± 3.70/24) of emotional symptoms before randomization. Intervention hazard ratio for developing PPCS for low burden was 0.767 (95% CI, 0.546-1.079; P = 0.128; β = 0.085) and for high burden was 0.290 (95% CI, 0.123-0.683; P = 0.005; β = 0.732). Conclusions: High burden of mood symptoms early after injury increases risk for PPCS, but the sports medicine model of providing early targeted aerobic exercise treatment reduces it. Nonsports medicine clinicians who treat patients with a high burden of new mood symptoms after concussion should consider prescribing aerobic exercise treatment to reduce the risk of PPCS and a mood disorder. [ABSTRACT FROM AUTHOR]

Diagnosis of sports-related concussion (SRC) primarily relies on an athlete’s self-report of injury and associated symptoms. Social pressures and attitudes surrounding SRC influence athlete reporting behavior. Unfortunately, underreporting of SRC symptoms is an issue among adolescent athletes. Nondisclosure of SRC symptoms may lead to premature return-to-play and potential persistent symptoms. This scoping review summarizes prevailing theories that explain SRC symptom reporting intent and behavior among adolescent athletes. Literature was reviewed following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for Scoping Review guidelines. Inter-rater reliability was calculated at each stage. Thirty-four articles published between 2013–2024 were included. Inter-rater reliability was fair to perfect across all review stages. Of the 16 unique theories described, the Theory of Reasoned Action/Theory of Planned Behavior (TRA/TPB) was the most frequently cited theory explaining SRC symptom reporting behavior. Although the TRA/TPB framework was useful when predicting SRC symptom reporting intent, it did not adequately predict reporting behavior, consistent with the broader health behavior literature which has established that intention is not a good predictor of behavior. In light of these findings, new frameworks must be considered that consider neurodevelopmental, cognitive, and cultural factors, as these may be more useful for understanding SRC symptom reporting behavior in adolescence. [ABSTRACT FROM AUTHOR]

Objective: There is greater risk of musculoskeletal (MSK) injury after clinical recovery from sport-related concussion (SRC). We determined whether aerobic exercise treatment within 10 days of SRC reduced the proportion of MSK injury in recovered adolescent athletes at 4 months since injury. Design: Planned secondary analysis of a randomized trial of aerobic exercise versus stretching exercise in adolescents after SRC. Setting: Outpatient and hospital-based sports medicine centers. Participants: Aerobic exercise (n 5 38, 58% male, 15.6 years) and stretching exercise (n 5 25, 64% male, 15.9 years) participants completed a questionnaire at 3.5 and 3.3 months since recovery, respectively. Interventions: Individualized subthreshold aerobic exercise versus placebo-like stretching. Main OutcomeMeasures: Proportion of MSK injury, subsequent concussion, and return to exercise training, school, and sport determined 3 months after clinical recovery from SRC. Results: Overall, 24% of participants randomized to stretching experienced an MSK injury versus 5.3% of participants randomized to aerobic exercise. There was no difference in time to return to school, sport, or incidence of subsequent concussion. Stretching participants were 6.4 times (95% confidence interval 1.135-36.053) more likely to sustain MSK injury than aerobic exercise participants when controlling for the duration of exposure to sport and return to preinjury sport participation. All injuries were in male participants. Conclusion: Adolescent male athletes prescribed aerobic exercise within 10 days of SRC had a significantly lower proportion of individuals injured in the 3 months following clinical recovery when compared with stretching. This may be due to a habituation/rehabilitation effect of aerobic activities to improve autonomic, vestibular, and/or oculomotor function after SRC. [ABSTRACT FROM AUTHOR]

The Modified Balance Error Scoring System (mBESS) remains the standard balance tool for evaluating sport-related concussion. Discrepancies between error and objective sway scoring remain a topic of assessment measures. The purpose was to examine sex differences between error and sway index scores and association between scores on the mBESS in collegiate and high school athletes. 119 athletes completed the mBESS on a Biodex BioSway. Measures consisted of mBESS errors and sway index scores produced by the BioSway. No sex differences were observed on mBESS errors and sway index scores by competition level and the overall sample. Moderate associations were observed between error and sway index scoring for single and tandem stances. [ABSTRACT FROM AUTHOR]

Objective: The goal of this study was to characterize normative scores for the Brief Symptom Inventory (BSI-18) in collegiate athletes to inform decision making about the need for psychological health services in this group. Methods: Collegiate student-athletes (N = 20,034) from 25 universities completed the BSI-18 at their preseason baseline assessment. A subgroup (n = 5,387) underwent multiple baseline assessments. Global Severity Index (GSI) scores were compared to community norms and across multiple timepoints. Results: Collegiate athletes reported significantly lower GSI scores than published community norms (p<.001). Published GSI threshold scores for "caseness", identified only 2 per 100 athletes (≥ the 98th percentile) as needing further evaluation. Using a GSI score ≥ than the cohort's 90th percentile, 11.4 per 100 athletes would merit additional evaluation. These individuals were more likely to report a history of psychiatric diagnosis (Odds ratio [95% CI] 2.745 [2.480, 3.039]), as well as ≥ 2 prior concussions (p<.001). GSI scores were not highly correlated across timepoints. Suicidal ideation was rare (n = 230; 1.15%). Conclusions: For collegiate student-athletes, published BSI-18 threshold scores identify only extreme outliers who might benefit from additional behavioral health evaluation. Alternatively, use of threshold scores ≥ the 90th percentile identifies a more realistic 11.4% of the population, with higher likelihood of prior concussion and/or psychiatric disorders. [ABSTRACT FROM AUTHOR]

Background: Return to play (RTP) protocols are an important part of recovery management following a sport-related concussion (SRC) and can prevent athletes from returning to competition too early and thereby avoid prolonged recovery times. To assist sporting organizations in the development of RTP guidelines, the Concussion in Sports Group (CISG) provides scientific-based recommendations for the management of SRC in its consensus statement on concussion in sport. Objectives: This study investigates commonalities and differences among current RTP protocols of international sporting organizations and examines the implementation of the most recent CISG recommendations. Methods: Concussion guidelines and medical rules of 12 international sporting organizations from contact, collision and combat sports were accessed via the organizations websites and compared regarding the management of SRC and the RTP decision. Results: Only six of the included organizations developed and published their own concussion guidelines, which included an RTP protocol on their website. The number of steps until RTP was similar across the different protocols. Each protocol required at least one medical examination before clearing an athlete to RTP. A high variation among organizations was found for initial resting period after injury, the implementation of sport-specific training drills and the time needed to complete the protocol before returning to competition. At the date of this study (9 September 2023), none of the accessible RTP protocols were updated to include the latest version of the CISG consensus statement. Conclusion: To improve the safety of athletes after a head injury, sporting organizations should develop sport-specific guidelines according to the latest CISG consensus statement, and this should be updated regularly. Implementation is especially important in combat sports, where there is a high incidence of head injury. Thus, there is a requirement for the most up-to-date concussion management protocols in these sports. [ABSTRACT FROM AUTHOR]

The recovery trajectories of collegiate athletes with sport-related concussion (SRC) are well characterized in contact/collision sports but are less well understood in limited contact sports with lower risk, reducing the ability of clinicians to effectively manage the return-to-play (RTP) process. The current study investigated the time to asymptomatic and RTP across a broad range of male and female collegiate sports and sought to group sports by recovery intervals. Data from the Concussion Assessment, Research and Education (CARE) Consortium included 1049 collegiate athletes who sustained a SRC while participating in game or practice/training of their primary sport. Injury setting and subsequent clinical presentation data were obtained. Survival analysis using the Cox Proportional Hazard model estimated the median recovery times for each sport. Optimal univariate K-means clustering grouped sports into recovery categories. Across all sports, median time to asymptomatic following SRC ranged from 5.9 (female basketball) to 8.6 days (male wrestling). Median RTP protocol duration ranged from 4.9 days (female volleyball) to 6.3 days (male wrestling). Median total RTP days ranged from 11.2 days (female lacrosse) to 16.9 days (male wrestling). Sport clusters based on recovery differences in time to asymptomatic (3) and RTP protocol duration (2) were identified. The findings from this study of a large sample of more than 1000 NCAA collegiate athletes with SRC show there exists ranges in recovery trajectories. Clinicians can thus manage athletes with similar guidelines, with individualized treatment and recovery plans. [ABSTRACT FROM AUTHOR]

Background: The 6th International Consensus Statement on Concussion in Sport guidelines identified that measuring autonomic nervous system dysfunction using orthostatic vital signs (VSs) is an important part of the clinical evaluation; however, there are limited data on the frequency of autonomic nervous system dysfunction captured via orthostatic VSs after concussion. Purpose: To compare orthostatic changes in heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) between athletes with acute sport-related concussion (SRC) and control athletes. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We compared 133 athletes (mean age, 15.3 years; age range, 8-28 years; 45.9% female) with acute SRC (<30 days after injury) with 100 control athletes (mean age, 15.7 years; age range, 10-28 years; 54.0% female). Given the broad age range eligible for study inclusion, participants were subdivided into child (younger than 13 years of age), adolescent (13-17 years of age), and adult (18 years of age and older) age groups for subanalyses. Participants completed a single standard orthostatic VS evaluation including HR, SBP, and DBP in the supine position then immediately and 2 minutes after standing. Linear regression was used to compare delayed supine-to-standing changes in HR, SBP, and DBP as a continuous variable (ΔHR, ΔSPB, and ΔDBP) between groups, and logistic regression was used to compare patients with positive orthostatic VS changes (sustained HR increase ≥30 beats per minute [bpm], SBP decrease ≥20 mm Hg, and DBP ≥10 mm Hg at 2 minutes) between groups, accounting for age and sex. Results: Between-group differences were present for delayed ΔHR (18.4 ± 12.7 bpm in patients with SRC vs 13.2 ± 11.0 bpm in controls; P =.002) and ΔSPB (–3.1 ± 6.6 bpm in patients with SRC vs –0.4 ± 6.5 bpm in controls; P =.001), with positive orthostatic HR changes present more frequently in patients with SRC (18% vs 7%; odds ratio, 2.79; P =.027). In the SRC group, a weak inverse relationship was present between age and ΔHR (r = –0.171; P =.049), with positive orthostatic HR findings occurring primarily in the child and adolescent SRC subgroups. Conclusion: Patients with acute SRC had greater orthostatic VS changes compared with controls, the most prominent being sustained HR elevations. Clinical evaluation of autonomic change after SRC via standard orthostatic VS assessment may be a helpful clinical biomarker in the assessment of SRC, especially in children and adolescents. [ABSTRACT FROM AUTHOR]

Objective: To examine whether a personal history of migraines is associated with worse acute symptom burden after sport-related concussion (SRC). Design: Retrospective cohort study. Setting: National Collegiate Athletic Association Division III collegiate programs. Participants: Collegiate athletes from a prospective concussion surveillance system between 09, 2014, and 01, 2023. Intervention: Preinjurymigraines (yes/no) were self-reported by athletes. MainOutcomeMeasures: Post-Concussion Symptom Scale (PCSS) were collected within 3 days postinjury. Mann-Whitney U tests compared total PCSS scores and individual symptom scores between athletes with andwithout preinjurymigraines. Chi-squared testswere used to compare proportions of athletes endorsing individual symptoms (ie, item score $1) between 2 groups. Multivariable regression analyzed potential predictors of PCSS scores. Results: Of 1190 athletes with SRC, 93 (7.8%) reported a preinjury history of migraines. No significant difference in total PCSS scores was found between athletes with and without preinjury migraines (22.0 616.4 vs 20.5 615.8, U 5 48 719.0, P 5 0.471). Athletes with preinjurymigraines reported greater severity of "sensitivity to light" (1.5961.59 vs 1.2361.41, P50.040) and "feelingmore emotional" (0.91 6 1.27 vs 0.70 6 1.30; P 5 0.008) and were more likely to endorse "feeling more emotional" (45.2% vs 29.5%, P 5 0.002). No differences were found across all other symptoms, including headaches (migraine 5 87.1% vs no migraine 5 86.3%, P 5 0.835). In amultivariable model, a history of migraine was not a significant predictor of acute PCSS scores, but those with a history of psychological disorders (b 5 0.12, P ,0.001) and greater number of days to symptom evaluation (b 5 0.08, P 5 0.005) had higher PCSS scores. Conclusions: Collegiate athletes with a pre-existing history of migraines did not have higher acute symptom burden after SRC. [ABSTRACT FROM AUTHOR]

The identification, management, and prevention of concussion across all competitive sports and athletic populations has been a notable topic of research over the last decade. Soccer is no exception, with over a billion participants worldwide. In soccer, 3 distinct subsets of head injuries are often the contributors to concussion: head-to-equipment, head-to-surface, and head-to-player collisions. Recognition of concussion is crucial, and ideally made on the sideline during competitive play. Recently updated screening tools include the SCAT6 and ChildSCAT6, which are widely utilized at all levels of play. Management of concussion is divided into on-field and in clinic management. initial management includes removal from the field of play. There is increased emphasis on earlier incorporation of exercise prescription as a means to improve recovery in the concussed athlete. while few objective diagnostic tests exist to identify concussion, many are in development, most notably advanced imaging and biomarker modalities. [ABSTRACT FROM AUTHOR]

Although research on sport-related concussion has grown substantially in the last decade, research on concussion in para sports remains limited. The aim of this scoping review is to synthesize and describe the current literature on the incidence, assessment, and management of sport-related concussion in para athletes. The literature search was conducted in CINAHL, Google Scholar, MEDLINE, SPORTDiscus, and Web of Science databases and identified 22 studies that addressed one of our research questions. A majority of studies addressed concussion in elite athletes; youth and collegiate para athletes were largely underrepresented. Fewer studies addressed concussion assessment and management, in part due to limitations in accessibility of current assessment tools for athletes with varying disabilities. Moving forward, there is a need to capture a larger range of incidence data, create modified assessment tools with para-specific normative data, and develop risk prevention strategies for para athletes. [ABSTRACT FROM AUTHOR]

Pre-injury migraines might be a risk factor for prolonged recovery after sport-related concussion (SRC). We sought to examine whether a pre-injury history of migraines is associated with worse recovery following SRC in collegiate athletes. Data were collected through a prospective concussion surveillance system in 11 National Collegiate Athletic Association (NCAA) Division III college athletic programs between September 2014 and March 2020. Our primary independent variable, pre-injury migraines, were self-reported by the athletes. Between those with and without migraines, the outcomes of days to return-to-learn (RTL) without academic accommodations and return-to-play (RTP) were compared using Mann–Whitney U tests. Each athlete's RTL and RTP status was dichotomized (i.e., returned vs. not returned) at various time points for RTL (i.e., 7/14/21/28 days) and RTP (i.e., 14/21/28/56 days). Chi-squared tests were performed to compare the proportions of RTL and RTP status between groups. Multivariable regressions analyzed potential predictors of RTL and RTP adjusting for age, gender, prior concussions, other health conditions, and symptom severity. Of 1409 athletes with an SRC, 111 (7.9%) had a pre-injury history of migraines. Compared with those without migraines, those with migraines had longer median (interquartile range [IQR]) days to RTL (migraines = 7.0 [3.0–12.3] vs. no migraines = 5.0 [2.0–10.0], U = 53,590.5, p = 0.022). No differences were found in RTP between the two groups (migraines = 16.0 [10.0–33.0] vs. nχo migraines 15.0 [11.0–23.0], U = 38,545.0, p = 0.408). Regarding RTL, significantly lower proportions of athletes in the migraine group had fully RTL, without accommodations, at ≤14 days (77.5% vs. 85.2%, χ2 = 4.33, p = 0.037), ≤21 days (85.3% vs. 93.0%, χ2 = 7.99, p = 0.005), and ≤28 days (88.2% vs. 95.6%, χ2 = 10.60, p = 0.001). Regarding RTP, a significantly lower proportion of athletes in the migraine group RTP at ≤28 days (72.0% vs. 82.7%, χ2 = 5.40, p = 0.020) and ≤56 days (84.0% vs. 93.0%, χ2 = 8.19, p = 0.004). In a multivariable model predicting RTL that was adjusted for age, gender, acute concussion symptoms, and other health variables (e.g., attention-deficit/hyperactivity disorder [ADHD], history of mental health difficulties), pre-injury history of migraine was associated with longer RTL (β = 0.06, p = 0.030). In a multivariable model predicting RTP, pre-injury history of migraine was not associated with RTP (β = 0.04, p = 0.192). In collegiate athletes, pre-injury migraine history was independently associated with longer RTL but not RTP. When comparing the proportions of those with successful RTP by days, significantly lower proportions of those with migraines showed successful RTP at ≤28 days and ≤56 days. Futures studies should study the generalizability of our findings in other school levels. [ABSTRACT FROM AUTHOR]

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

Youth soccer participation, particularly among females, continues to grow worldwide. With the high incidence of sport-related concussion (SRC) in soccer, it is important to investigate if SRC occurs disproportionally by positions. Our hypothesis was to see no positional differences in SRCs, SRC-related characteristics, and outcomes among in female youth soccer athletes. Data were prospectively collected from participants at a single sports medicine institution between August 2015-April 2021. Female participants aged 8–18 diagnosed with SRC sustained during an organized soccer practice, scrimmage, or game were separated into 4 groups based on position: Forward, Midfielder, Defender, and Goalkeeper. Demographics, medical history, injury-related details, and outcomes were reviewed. A chi-square test or Fisher's exact test was used for categorical variables. Continuous variables were compared with Mann-Whitney or Kruskal-Wallis test. Two hundred fourteen participants were included: 52 Forwards, 65 Midfielders, 63 Defenders, and 34 Goalkeepers. There were no significant differences between the groups in age, race, ethnicity, or previous concussion history. Differences in mechanism existed with Goalkeepers most commonly reporting Head to Body Part. Goalkeepers, which make up 1/11 of the total positions on the field, had a significantly higher proportion of SRCs compared to Field Positions. (9.1% vs 15.9%) At 3-month post-enrollment, there were no significant differences in reported symptoms or return-to-play between the different positions. In youth female soccer players, goalkeepers sustained a higher proportion of sport-related concussions compared to field players based upon the composition of a soccer team. The mechanism of injury also differed among the different soccer positions. However, no differences in concussion characteristics, outcomes, or RTP were seen across the different soccer positions. [ABSTRACT FROM AUTHOR]

IntroductionResearch on head impact characteristics, especially position-specific investigations in football, has predominantly focused on collegiate and professional levels, leaving a gap in understanding the risks faced by high school players. Therefore, this study aimed to investigate the effect of three factors—player position, impact location, and impact type—on the frequency, severity, and characteristics of impacts in high school American football. Additionally, we examined whether and how player position influences the distribution of impact locations and types.MethodsSixteen high school football players aged 14 to 17 participated in this study. Validated mouthguard sensors measured head impact kinematics, including linear acceleration, angular acceleration, and angular velocity across ten games, and were used to identify impact locations on the head. Video recordings verified true impacts, player position, and impact type at the moment of each recorded impact. Head impact kinematics were input into a head finite element model to determine the 95th percentile of the maximum principal strain and strain rate. Several novel and systematic approaches, such as normalization, binning, and clustering, were introduced and utilized to investigate the frequency and severity of head impacts across the three aforementioned factors while addressing some of the limitations of previous methodologies in the field. To that end, the number of recorded impacts for each player position during each game was divided by the number of players in that position, and then averaged across ten games. Instead of averaging, impacts were categorized into four severity bins: low, mid-low, mid-high and high. Clusters for the three factors were also identified according to the characteristics of impacts.Results and DiscussionResults revealed that offensive linemen and running backs experienced a higher normalized frequency and more severe impacts across all head kinematics and brain tissue deformation parameters. Frontal impacts, resulting from “head-to-head” impacts, were the most frequent and severe impact locations. The distributions of impact location and type for each specific position were distinct. Offensive linemen had the highest proportion of frontal impacts, while quarterbacks and centerbacks had more impacts at the rear location. These findings can inform interventions in game regulations, training practices, and helmet design to mitigate injury risks in high school football.

The Long-term Impact of Military-relevant Brain Injury Consortium-Military and Tactical Athlete Research Study (LIMBIC MATARS) program established in 2020 is comprised of 22 universities and health systems across the United States. The LIMBIC MATARS Consortium's goal is to increase understanding of the complexities of concussion in collegiate athletes by leveraging extant retrospective and novel prospective data sets through the application of innovative research designs. The manuscripts in this special issue represent findings from clinical data sets based on consensus-derived common data elements collected from the 2015–2016 to 2019–2020 sport seasons that include 1311 cases of collegiate athletes diagnosed with concussion. Using these data, LIMBIC MATARS investigators addressed hypotheses that included (1) factors, including access to athletic trainers, biological sex, and ADHD, that may influence recovery from concussion, (2) predisposing risks associated with reinjury after return-to-sport, such as sport type, and (3) therapeutic targets for intervention including language barriers, physical activity, return-to-learn, and sleep. This commentary introduces the methodology and 10 descriptive studies highlighting initial findings from the Consortium. [ABSTRACT FROM AUTHOR]

Objective: It has been suggested that sport-related concussion (SRC) occurs more commonly on natural grass compared with artificial turf in contact sports. As playing surface is a potentially modifiable risk factor, this study sought to identify differences in symptoms following SRC on these 2 surfaces in a sample of young American football players. Design: Prospective. Setting: Part of the multi-institutional North Texas Concussion Registry (ConTex) research project. Participants: Ten-year-old to 24-year-old male American football players (n = 62) who had sustained a helmet-to-ground SRC and presented to a specialty concussion clinic within 14 days of injury. Independent variables: Helmeted impact with grass (n = 33) or artificial turf (n = 29). Main outcome measures: Severity and number of symptoms endorsed on the Sport Concussion Assessment Tool 5th Edition (SCAT5) Symptom Evaluation at the time of initial clinical evaluation. Results: Both groups were similar in mean time since injury, concussion history, and history of headache, but the artificial turf group was slightly older, with a mean age of 14.6 versus 13.6 years ( P = 0.039). Athletes who sustained a SRC on grass reported significantly higher mean total symptom severity scores (26.6 vs 11.6, P = 0.005) and total number of symptoms (10.3 vs 5.9, P = 0.006) compared with those who were injured on artificial turf. Conclusions: This may be the first study to examine postconcussive symptoms after SRC as they relate to playing surface. This small sample of young American football players reported higher symptom severity scores and higher total number of symptoms after SRC on natural grass compared with artificial turf. [ABSTRACT FROM AUTHOR]

Background: A sport-related concussion (SRC) is a common injury that affects multiple clinical domains such as cognition, balance, and nonspecific neurobehavioral symptoms. Although multidimensional clinical assessments of concussion are widely accepted, there remain limited empirical data on the nature and clinical utility of distinct clinical profiles identified by multimodal assessments. Purpose: Our objectives were to (1) identify distinct clinical profiles discernible from acute postinjury scores on the Sport Concussion Assessment Tool (SCAT), composed of a symptom checklist, a cognitive assessment (Standardized Assessment of Concussion), and a balance assessment (Balance Error Scoring System), and (2) evaluate the clinical utility of the identified profiles by examining their association with injury characteristics, neuropsychological outcomes, and clinical management–related outcomes. Study Design: Cohort study (Prognosis); Level of evidence, 2. Methods: Up to 7 latent profiles were modeled for 1885 collegiate athletes and/or military cadets who completed the SCAT at 0 to 12 hours after an injury. Chi-square tests and general linear models were used to compare identified profiles on outcomes at 12 to 72 hours after the injury. Kaplan-Meier analysis was used to investigate associations between clinical profiles and time to return to being asymptomatic and to return to play. Results: There were 5 latent profiles retained: low impairment (65.8%), high cognitive impairment (5.4%), high balance impairment (5.8%), high symptom severity (16.4%), and global impairment (6.5%). The latent profile predicted outcomes at 12 to 72 hours in expectable ways (eg, the high balance impairment profile demonstrated worse balance at 12 to 72 hours after the injury). Time to return to being asymptomatic and to return to play were different across profiles, with the high symptom severity and global impairment profiles experiencing the longest recovery and the high balance impairment profile experiencing an intermediate-length recovery (vs low impairment profile). Conclusion: An SRC is a heterogeneous injury that presents in varying ways clinically in the acute injury period and results in different recovery patterns. These data support the clinical prognostic value of diverse profiles of impairment across symptom, cognitive, and balance domains. By identifying distinct profiles of an SRC and connecting them to differing outcomes, the findings support more evidence-based use of accepted multimodal clinical assessment strategies for SRCs. [ABSTRACT FROM AUTHOR]

In adolescent and collegiate athletes with sport-related concussion (SRC), we sought to evaluate the prevalence and predictors of long-term psychological symptoms. A cohort study was conducted of athletes 12–24-year-old diagnosed with SRC between November 2017 and April 2022. Athletes/proxies were interviewed on psychological symptoms (i.e. anger, anxiety, depression, and stress). Participants who scored ≥75th percentile on one or more PROMIS (Patient-Reported Outcomes Measurement System) measures were operationalized to have subclinical, long-term psychological symptoms. Uni/multivariable regressions were used. Of 96 participants (60.4% male), the average age was 16.6 ± 2.6 years. The median time from concussion to interview was 286 days (IQR: 247–420). A total of 36.5% athletes demonstrated subclinical, long-term psychological symptoms. Univariate logistic regression revealed significant predictors of these symptoms: history of psychiatric disorder (OR = 7.42 95% CI 1.37,40.09), substance use (OR = 4.65 95% CI 1.15,18.81), new medical diagnosis since concussion (OR = 3.43 95% CI 1.27,9.26), amnesia (OR = 3.42 95% CI 1.02,11.41), other orthopedic injuries since concussion (OR = 3.11 95% CI 1.18,8.21), age (OR = 1.24 95% CI 1.03,1.48), days to return-to-play (OR = 1.02 95% CI 1.00,1.03), and psychiatric medication use (OR = 0.19 95% CI 0.05,0.74). Multivariable model revealed significant predictors: orthopedic injuries (OR = 5.17 95% CI 1.12,24.00) and return-to-play (OR = 1.02 95% CI 1.00,1.04). Approximately one in three athletes endorsed long-term psychological symptoms. Predictors of these symptoms included orthopedic injuries and delayed RTP. [ABSTRACT FROM AUTHOR]

Introduction: Initially developed by New Zealand Rugby in 2014, the Blue Card initiative in rugby enables match officials to remove athletes from play if they are suspected to have sustained a concussion. Considerable attention has been paid by sport and health advocates to the possibilities and limitations of this initiative in safeguarding athlete health. However, little if any attention has been paid to the well-being of those responsible for administering the Blue Card (i.e., match officials). The aim of this paper was to examine match officials’ experiences with and perspectives on implementing the Blue Card initiative in Ontario, Canada, with focused attention on the tensions around their ability to manage games and participants (e.g., athletes, coaches) while attempting to safeguard athlete well-being. Methods: Using Relational Coordination Theory (RCT) as a guiding framework and qualitative research method, we highlight the rich accounts of 19 match officials’ perspectives and experiences regarding sport-related concussion (SRC) management and the Blue Card protocol. Results: Four themes were derived from the data, reflecting latent assumptions embedded within the concussion management process, which include: assumptions of trust, respect, and cooperation; assumptions of shared responsibility; assumptions of shared understanding; and assumptions of harassment-free sport. Discussion: Our findings emphasize the need to attend to social relations in concussion management and provide insight into match officials’ fraught experiences on the frontlines of concussion management. We identify factors affecting match official well-being and provide considerations for concussion management initiatives designed to improve athlete safety, such as the Blue Card. [ABSTRACT FROM AUTHOR]

The Blue Card protocol was introduced to domestic amateur rugby competitions to bring Rugby Canada into compliance with provincial concussion legislation. The Blue Card protocol formalises how match officials can remove an athlete with a suspected concussion from play and prevents athletes from returning to sport without medical clearance. This exploratory study examined the experiences of Canadian rugby match officials with the novel Blue Card process. Semi-structured interviews conducted with six Canadian rugby match officials were subjected to Interpretive Phenomenological Analysis. Findings revealed interpersonal (e.g. stakeholder collaboration and peer support) and intrapersonal (e.g. concerns about personal liability and comfort with the administration of the Blue Card) factors related to the successful implementation of concussion management protocols. Match officials distinguished actions from members of the rugby community as either supporting (e.g. information sharing) or actively resisting (e.g. questioning match official decisions regarding the Blue Card) efforts to implement the Blue Card protocol. Those who had personal experience removing an athlete from play due to a suspected concussion or who administered a Blue Card during the 2019 season reported feeling more comfortable with the process than less experienced peers. However, in this early policy implementation phase, 50% of participants expressed concerns about their personal liability associated with the Blue Card process. Implications for the design and implementation of sport-related concussion research and policy at the amateur level are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Literature indicating that transcranial photobiomodulation (tPBM) may enable the brain to recover normal function after concussion, resulting in symptoms reduction, and improved cognitive function after concussion is limited by small sample sizes and lack of controls. Methods: We conducted a randomized, double-blind, placebo-controlled trial examining the effect of 6 wk of tPBM in patients 11 yr or older who received care for persistent postconcussion symptoms between September 2012 and December 2015. Our primary outcome measure was the mean difference in Postconcussion Symptom Scale total score and the raw Immediate Postconcussion Assessment and Cognitive Testing composite scores between study entry and treatment completion. Participants received two, 10-min sessions either with tPBM units or via two placebo units, three times per week. We screened for potential confounding variables using univariable analyses. We entered covariables that differed between the two groups on univariable screening into a regression analysis. We considered adjusted odds ratio that did not cross one statistically significant. Results: Forty-eight participants completed the study. Most were female (63%), and a majority sustained their injury during sports or exercise (71%). Despite randomization, those that received tPBM therapy reported a greater number of previous concussions. After adjusting for the effect of previous concussions and multiple comparisons, there were no significant differences between tPBM and placebo groups at 3 or 6 wk of treatment. Conclusions: Despite showing promise in previous investigations, our study did not show benefit to tPBM over placebo therapy in patients experiencing persistent postconcussion symptoms. Further investigation is needed to determine if varying the dose or timing alters the efficacy of tPBM after concussion. [ABSTRACT FROM AUTHOR]

Background: Few previous studies have investigated how different injury mechanisms leading to sport-related concussion (SRC) in soccer may affect outcomes. Purpose: To describe injury mechanisms and evaluate injury mechanisms as predictors of symptom severity, return to play (RTP) initiation, and unrestricted RTP (URTP) in a cohort of collegiate soccer players. Study Design: Cohort study; Level of evidence, 2. Methods: The Concussion Assessment, Research and Education (CARE) Consortium database was used. The mechanism of injury was categorized into head-to-ball, head-to-head, head-to-body, and head-to-ground/equipment. Baseline/acute injury characteristics—including Sports Concussion Assessment Tool–3 total symptom severity (TSS), loss of consciousness (LOC), and altered mental status (AMS); descriptive data; and recovery (RTP and URTP)—were compared. Multivariable regression and Weibull models were used to assess the predictive value of the mechanism of injury on TSS and RTP/URTP, respectively. Results: Among 391 soccer SRCs, 32.7% were attributed to a head-to-ball mechanism, 27.9% to a head-to-body mechanism, 21.7% to a head-to-head mechanism, and 17.6% to a head-to-ground/equipment mechanism. Event type was significantly associated with injury mechanism [χ2(3) = 63; P <.001), such that more head-to-ball concussions occurred in practice sessions (n = 92 [51.1%] vs n = 36 [17.1%]) and more head-to-head (n = 65 [30.8%] vs n = 20 [11.1]) and head-to-body (n = 76 [36%] vs n = 33 [18.3%]) concussions occurred in competition. The primary position was significantly associated with injury mechanism [χ2(3) = 24; P <.004], with goalkeepers having no SRCs from the head-to-head mechanism (n = 0 [0%]) and forward players having the least head-to-body mechanism (n = 15 [19.2%]). LOC was also associated with injury mechanism (P =.034), with LOC being most prevalent in head-to-ground/equipment. Finally, AMS was most prevalent in head-to-ball (n = 54 [34.2%]) and head-to-body (n = 48 [30.4%]) mechanisms [χ2(3) = 9; P =.029]. In our multivariable models, the mechanism was not a predictor of TSS or RTP; however, it was associated with URTP (P =.044), with head-to-equipment/ground injuries resulting in the shortest mean number of days (14 ± 9.1 days) to URTP and the head-to-ball mechanism the longest (18.6 ± 21.6 days). Conclusion: The mechanism of injury differed by event type and primary position, and LOC and AMS were different across mechanisms. Even though the mechanism of injury was not a significant predictor of acute symptom burden or time until RTP initiation, those with head-to-equipment/ground injuries spent the shortest time until URTP, and those with head-to-ball injuries had the longest time until URTP. [ABSTRACT FROM AUTHOR]

Concussion is one of the most challenging injuries for sports medicine clinicians. It is crucial that students develop high self-efficacy for concussion-relevant skills during professional education, as it impacts the quality of their patient care. This study aimed to explore Irish final year athletic therapy students' self-efficacy in concussion assessment and management and the factors that impact its development. Participants level of self-efficacy varied, from low to high, depending on the skill assessed. Lack of practice and lecturer's positive feedback impacted student self-efficacy the most. Educators should provide students with an opportunity to practice their skills in an environment that facilitates feedback. [ABSTRACT FROM AUTHOR]

Introduction: Exertional tests have become a promising tool to assist clinicians in the management of concussions, however require expensive equipment, extensive spaces, and specialized clinician expertise. As such, we developed a test with minimal resource requirements encompassing key elements of sport and physical activity. The purpose of this study was to pilot test the Multimodal Exertional Test (MET) protocol in a sample of healthy interuniversity athletes. Methods: The MET comprises four stages, each featuring three distinct tasks. The test begins with engaging in squats, alternating reverse lunges, and hip hinges (Stage 1). The next stage progressively evolves into executing these tasks within specified time limits (Stage 2). Following this, the test advances to a stage that incorporates cognitive tasks (Stage 3), and the final stage demands greater levels of physical exertion, cognition, and multi-directional movements (Stage 4). Heart rate (HR) was obtained during each stage of the MET and participants' symptom severity scores were recorded following each task. Results: Fourteen healthy interuniversity athletes (n = 8 female, n = 6 male) participated in the study. HR was obtained for 10 of the 14 athletes (females: n = 6, males: n = 4). Increases in average and maximum HR were identified between pre-MET and Stage 1, and between Stages 3 and 4. Consistent with the tasks in each stage, there were no increases in average and maximum HR observed between MET Stages 1 to 3. Female athletes exhibited higher average and maximum HRs compared to male athletes during all four stages. All 14 athletes reported minimal changes in symptom severity following each task. Conclusion: Among healthy athletes, the MET elicits an increase in average and maximum HR throughout the protocol without symptom provocation. Female athletes exhibit higher HRs during all four stages in comparison to male athletes. [ABSTRACT FROM AUTHOR]

This paper provides a comprehensive overview of sport-related concussions, highlighting the critical importance of understanding their mechanisms, diagnosis, and management. Sport-related concussion is a frequent and complex pathology whose physiopathological mechanisms are not completely understood yet. Concussions, a subset of traumatic brain injuries, are prevalent in contact sports and pose significant risks to athletes' long-term health. The review covers the pathophysiology of concussions, emphasizing the biomechanical forces involved and the resultant neurological disruptions. Athletes seldom report concussive symptoms, which makes the diagnosis a challenge. Therefore, diagnostic challenges are explored, with a focus on clinical assessment tools, neuroimaging, and biomarkers. Additionally, the paper discusses current management strategies, including return-to-play protocols, and the role of education in concussion prevention. The review underscores the need for ongoing research to enhance diagnostic accuracy, improve treatment outcomes, and establish more effective prevention strategies, ultimately aiming to safeguard athletes' well-being.

Sport-related concussion (SRC) is an important public health issue. White-matter alterations after SRC are widely studied by neuroimaging approaches, such as diffusion magnetic resonance imaging (MRI). Although the exact anatomical location of the alterations may differ, significant white-matter alterations are commonly observed in long fiber tracts, but are never proven. In the present study, we performed streamline tractography to characterize the association between tract length and white-matter microstructural alterations after SRC. Sixty-eight collegiate athletes diagnosed with acute concussion (24-48 h post-injury) and 64 matched contact-sport controls were included in this study. The athletes underwent diffusion tensor imaging (DTI) in 3.0 T MRI scanners across three study sites. DTI metrics were used for tract-based spatial statistics to map white-matter regions-of-interest (ROIs) with significant group differences. Whole-brain white-mater streamline tractography was performed to extract affected white-matter streamlines (i.e., streamlines passing through the identified ROIs). In the concussed athletes, streamline counts and DTI metrics of the affected white-matter fiber tracts were summarized and compared with unaffected white-matter tracts across tract length in the same participant. The affected white-matter tracts had a high streamline count at length of 80-100 mm and high length-adjusted affected ratio for streamline length longer than 80 mm. DTI mean diffusivity was higher in the affected streamlines longer than 100 mm with significant associations with the Brief Symptom Inventory score. Our findings suggest that long fibers in the brains of collegiate athletes are more vulnerable to acute SRC with higher mean diffusivity and a higher affected ratio compared with the whole distribution.

Sport-related concussions can result from a single high magnitude impact that generates concussive symptoms, repeated subconcussive head impacts aggregating to generate concussive symptoms, or a combined effect from the two mechanisms. The array of symptoms produced by these mechanisms may be clinically interpreted as a sport-related concussion. It was hypothesized that head impact exposure resulting in concussion is influenced by severity, total number, and frequency of subconcussive head impacts. The influence of total number and magnitude of impacts was previously explored, but frequency was investigated to a lesser degree. In this analysis, head impact frequency was investigated over a new metric called 'time delta', the time difference from the first recorded head impact of the day until the concussive impact. Four exposure metrics were analyzed over the time delta to determine whether frequency of head impact exposure was greater for athletes on their concussion date relative to other dates of contact participation. Those metrics included head impact frequency, head impact accrual rate, risk weighted exposure (RWE), and RWE accrual rate. Athletes experienced an elevated median number of impacts, RWE, and RWE accrual rate over the time delta on their concussion date compared to non-injury sessions. This finding suggests elevated frequency of head impact exposure on the concussion date compared to other dates that may precipitate the onset of concussion.

Abstract Background Sport-related concussion (SRC) is a heterogenous injury that often presents with varied symptoms and impairment. Recently, research has focused on identifying subtypes, or clinical profiles of concussion to be used in assessing and treating athletes with SRC. The purpose of this study was to investigate sex differences in clinical profiles, recovery duration, and initial symptom severity after SRC in a cohort of collegiate athletes in the Pacific-12 Conference (Pac-12). Methods This prospective cohort study examined post-SRC symptoms, recovery, and return-to-play times using data from the Pac-12 CARE Affiliated Program and Pac-12 Health Analytics Program. Clinical profiles reported by student-athletes were defined by the number (> 50%) of specific symptoms frequently reported for each profile. Generalized linear mixed models were used to examine associations among sex, clinical profiles, time-to-recovery, and return-to-play times. Results 479 concussion incidents met inclusion criteria. The probabilities of initial presentation of each clinical profile, initial injury severity scores, and recovery times within a profile did not differ between sexes (p = 0.33–0.98). However, both males and females had > 0.75 probabilities of exhibiting cognitive and ocular profiles. Initial injury severity score was a strong nonlinear predictor of initial number of clinical profiles (p

Concussions result in a multitude of somatic, cognitive, and/or emotional symptoms as well as physical and behavior changes and disturbances in balance, cognition, and sleep. Moreover, some concussed athletes can experience these symptoms, changes, and disturbances for extended periods of time. This qualitative study explored the coping skills used by five female university athletes who suffered persistent concussion symptoms for more than 6 weeks. Our analysis of the interview data indicated that the athletes used emotion-focused coping strategies, such as avoidance and acceptance, throughout their recovery. In addition, the lack of perceived control over their injuries, a lack of a symptom-specific treatment protocol, and the type of social support they received influenced their coping abilities. These results add to the limited, yet growing, body of literature on the psychology of sport-related concussions, particularly with respect to identifying the types of resources that athletes may use to cope and manage concussion symptoms. [ABSTRACT FROM AUTHOR]

Background: Assessing sport-related concussions in athletes presents challenges due to symptom variability. This study aimed to explore the relationship between acute concussion symptoms and athlete fear avoidance, pain catastrophizing, depression, and anxiety. Anxiety and depression have previously been associated with the number of symptoms after a concussion, but no prior research has examined the possible link between athlete fear avoidance and acute concussion symptoms. Methods: Thirty-four collegiate athletes (mean age = 20.9 ± 1.8 years) were assessed within 48 h of a concussion using the Sport Concussion Assessment Tool 5, Athlete Fear Avoidance Questionnaire (AFAQ), Pain Catastrophizing Scale, and Hospital Anxiety and Depression Scale. Results: Results showed a significant association between the athlete fear avoidance and the number of concussion symptoms (r = 0.493, p = 0.003), as well as depression and anxiety measured by HADS (r = 0.686, p < 0.001). Athlete fear avoidance and HADS scores were predictors of symptom severity, explaining 41% of the variance (p = 0.001). Athletes with higher fear avoidance tended to report more symptoms post concussion. Conclusions: This study underscores the link between athlete fear avoidance, anxiety, depression, and the severity of concussion symptoms. Administering the AFAQ to assess athlete fear avoidance at the initial assessment of a concussion may be helpful in interpreting the symptoms of an acute concussion. [ABSTRACT FROM AUTHOR]

In 2021, an expert panel of clinician-scientists published the first consensus research diagnostic criteria for traumatic encephalopathy syndrome (TES), a clinical condition thought to be associated with chronic traumatic encephalopathy neuropathological change. This study evaluated the TES criteria in older adults and assessed associations between TES criteria and a history of repetitive head impacts. This cross-sectional, survey-based study examined the symptoms of TES, previous repetitive head impacts, and a variety of current health difficulties. To meet symptom criteria for TES, participants had to report progressive changes with memory, executive functioning, and/or neurobehavioral dysregulation. To meet the criterion for substantial exposure to repetitive head impacts via contact sports, participants reported at least 5 years of contact sport exposure (with 2+ years in high school or beyond). A sample of 507 older adults (mean age = 70.0 years, 65% women) completed the survey and 26.2% endorsed having one or more of the progressive core clinical features of TES. Those who had a significant history of contact sport exposure were not significantly more likely to meet TES criteria compared with those who did not (31.3% vs. 25.3%, p = 0.46). In a binary logistic regression predicting TES status, current depression or anxiety (odds ratio [OR] = 12.55; 95% confidence interval [CI] = 4.43-35.51), history of psychiatric disorders (OR = 2.07, 95% CI = 1.22–3.49), male sex (OR = 1.87), and sleep problems (OR = 1.71, 95% CI = 1.01-2.91) were associated with meeting TES criteria. The sport exposure criterion, age, and current pain were not significantly associated with TES status (ps > 0.05). A significant minority of participants with no history of neurotrauma endorsed symptoms consistent with TES (22.0% of men and 19.8% of women). Nearly 80% of neurotrauma naïve participants with clinically significant anxiety/depression met criteria for TES. In summary, approximately one in four older adults met the symptom criteria for TES, many of whom had no history of repetitive neurotrauma. Mental health problems and sleep issues were associated with TES, whereas having a history of repetitive head impacts in contact sports was not. These data suggest that the new consensus diagnostic criteria for TES may have low specificity and may carry a higher risk of misdiagnosing those with other physical and mental health conditions as having TES. [ABSTRACT FROM AUTHOR]

Cardiac sequelae following sport-related concussion are not well understood. This study describes changes in the cardiac cycle timing intervals and contractility parameters during the acute phase of concussion. Twelve athletes (21 ± 2 years, height = 182 ± 9 cm, mass = 86 ± 15 kg, BMI = 26 ± 3 kg/m2) were assessed within 5 days of sustaining a diagnosed concussion against their own pre-season baseline. A non-invasive cardiac sensor (LLA RecordisTM) was used to record the cardiac cycle parameters of the heart for 1 minute during supine rest. Cardiac cycle timing intervals (Isovolumic relaxation and contraction time, Mitral valve open to E wave, Rapid ejection period, Atrial systole to mitral valve closure, Systole, and Diastole) and contractile forces (Twist force and Atrial systole: AS) were compared. Systolic time significantly decreased during acute concussion (p = 0.034). Magnitude of AS significantly increased during acute concussion (p = 0.013). These results imply that concussion can result in altered systolic function. [ABSTRACT FROM AUTHOR]

Concussions present with a myriad of symptomatic and cognitive concerns; however, the relationship between these functional disruptions and the underlying changes in the brain are not yet well understood. Hubs, or brain regions that are connected to many different functional networks, may be specifically disrupted after concussion. Given the implications in concussion research, we quantified hub disruption within the default mode network (DMN) and between the DMN and other brain networks. We collected resting-state functional magnetic resonance imaging data from collegiate student-athletes (n = 44) at three time points: baseline (before beginning their athletic season), acute post-injury (approximately 48h after a diagnosed concussion), and recovery (after starting return-to-play progression, but before returning to contact). We used self-reported symptoms and computerized cognitive assessments collected across similar time points to link these functional connectivity changes to clinical outcomes. Concussion resulted in increased connectivity between regions within the DMN compared with baseline and recovery, and this post-injury connectivity was more positively related to symptoms and more negatively related to visual memory performance compared with baseline and recovery. Further, concussion led to decreased connectivity between DMN hubs and visual network non-hubs relative to baseline and recovery, and this post-injury connectivity was more negatively related to somatic symptoms and more positively related to visual memory performance compared with baseline and recovery. Relationships between functional connectivity, symptoms, and cognition were not significantly different at baseline versus recovery. These results highlight a unique relationship between self-reported symptoms, visual memory performance, and acute functional connectivity changes involving DMN hubs after concussion in athletes. This may provide evidence for a disrupted balance of within- and between-network communication highlighting possible network inefficiencies after concussion. These results aid in our understanding of the pathophysiological disruptions after concussion and inform our understanding of the associations between disruptions in brain connectivity and specific clinical presentations acutely post-injury. [ABSTRACT FROM AUTHOR]

Objective: In a cohort of high-school football athletes with sport-related concussion (SRC), we sought to investigate the role of seasonality, defined as time of injury during a season, on recovery. Design: Retrospective cohort study. Setting: Regional sport concussion center. Participants: High-school football athletes ages 14 to 19-years old who sustained an SRC from 11, 2017 to 04, 2022. Intervention: Athletes were divided into 3 groups based on seasonality: early, middle, and late season. Main Outcome Measures: The primary outcomes were initial Post-Concussion Symptom Scale score and recovery, as defined by time to return-tolearn (RTL), symptomresolution, and return-to-play (RTP).Descriptive statistics, analysis-of-variance, t tests, andmultivariable regressions were performed. Results: Of our cohort of 273 high-school football playerswho sustained an SRC, 97 (35.5%) sustained anSRCduring early season, 107 (39.2%) during middle season, and 69 (25.3%) during late season. Compared with late-season concussions, early-season concussions took less days to symptom resolution (early = 11.5 ± 12.9 vs late = 25.5 ± 27.0, P = .03), but no differences were found in days to RTL (early = 5.3 ± 4.8 vs late = 7.2 ± 15.8, P = 0.51) and RTP (early = 13.5 ± 11.8 vs late = 23.0 ± 22.8, P = 0.08). Seasonality was not a significant predictor for any recoverymetric inmultivariable regressions. Conclusion: Sport-related concussions occurring in the early third of the season took significantly less time to symptom resolution than those occurring in the later third of the season; however, thiswas not statistically significant inmultivariable analyses.No association was observed between seasonality and time to RTL and RTP. A trend of worse recovery with concussions later in the season may be present. [ABSTRACT FROM AUTHOR]

Objective Investigate the relationships between concussion history and years of football participation (repetitive head impact proxy) with alcohol use across multiple decades in former professional football players. Methods Participants (n  = 348; mean age = 49.0 ± 9.4) completed health questionnaires in 2001 and 2019, which included self-reported concussion history and years of participation. Alcohol use frequency and amount per occasion were reported for three timepoints: during professional career, 2001, and 2019. Ordinal logistic regression models were fit to test associations of concussion history and years of participation with alcohol use at each timepoint. Results There were no significant associations between either concussion history or years of football participation with alcohol use (frequency and amount per occasion) at any timepoint. Effect estimates for concussion history and years of football participation with alcohol use were generally comparable across timepoints. Conclusions Later life alcohol use by former American football players is not associated with concussion history or years of exposure to football. [ABSTRACT FROM AUTHOR]

Repeat sport-related concussion (SRC) is anecdotally associated with prolonged recovery. Few studies have examined repeat concussion within the same athlete. We sought to explore differences in symptom burden and recovery outcomes in an individual athlete's initial and repeat SRC. A retrospective within-subject cohort study of athletes aged 12–23 years diagnosed with two separate SRCs from 11/2017–10/2020 was conducted. Primary outcomes were initial symptom severity and time-to-symptom-resolution. Secondary outcomes included return-to-learn (RTL) and return-to-play (RTP) duration. Of 868 athletes seen, 47 athletes presented with repeat concussions. Median time between concussions was 244 days (IQR 136–395). Comparing initial to repeat concussion, no differences were observed in time-to-clinic (4.3 ± 7.3vs.3.7 ± 4.6 days, p = 0.56) or initial PCSS (26.2 ± 25.3 vs. 30.5 ± 24.1, p = 0.32). While a difference was observed in time-to-symptom resolution between initial/repeat concussion (21.2 ± 16.3 vs. 41.7 ± 86.0 days, p = 0.30), this did not reach statistical significance. No significant differences were observed in time-to-RTL (17.8 ± 60.6 vs. 6.0 ± 8.3 days, p = 0.26) and RTP (33.2 ± 44.1 vs. 29.4 ± 39.1 days, p = 0.75). Repeat concussion was not associated with symptom resolution on univariate (HR 1.64, 95% CI 0.96–2.78, p = 0.07) and multivariable (HR 0.85, 95% CI 0.49–1.46, p = 0.55) Cox regression. No significant differences in symptom duration and RTP/RTL were seen between initial/repeat concussion. [ABSTRACT FROM AUTHOR]

Sport-related concussion (SRC) is known to disrupt neurohemodynamic activity, cardiac function, and blood pressure (BP) autoregulation. This study aims to observe changes in cerebrovascular and cardiovascular responses during controlled respiration after sustaining an SRC. University varsity athletes (n = 81) completed a preseason physiological assessment and were followed up within 5 days of sustaining an SRC. During preseason and follow-up assessments, participants' continuous beat-to-beat BP was collected by finger photoplethysmography, and right prefrontal cortex oxygenation was collected using near-infrared spectroscopy (NIRS). Participants completed 5 min of seated rest and 5 min of a 6-breaths per minute controlled breathing protocol (5 s inhale and 5 s exhale; 0.10 Hz). Wavelet transformation was applied to the NIRS and BP signals, separating them into respiratory (0.10-0.6 Hz) and cardiac (0.6-2 Hz) frequency intervals. Of the 81 participants, 74 had a usable BP signal, 43 had usable NIRS signals, and 28 had both usable BP and NIRS signals. Wavelet amplitudes were calculated and coherence between NIRS and BP on the 28 participants were assessed. There was a significant (P < 0.05) decrease in oxygenated hemoglobin amplitude from 0.062 to 0.054 Hz and hemoglobin difference amplitude from 0.059 to 0.051 Hz, both at the respiratory (0.10-0.6 Hz) frequency interval, from preseason to acute SRC, respectively. Therefore, during controlled respiration, there was a reduction in intensity at the respiratory band, suggesting a protective, reduced respiratory contribution to cerebral hemodynamic activity following acute SRC. NEW & NOTEWORTHY This study investigated cerebral hemodynamic activity following sport-related concussion. Prefrontal cortex oxygenation was assessed by near-infrared spectroscopy (NIRS) during a controlled breathing protocol. Wavelet transformation of the NIRS signals showed significant decreases in HbO2 and HbD amplitude at the respiratory frequency interval (0.10-0.6 HZ) from preseason baseline to acute concussion. These results suggest a decreased respiratory contribution to cerebral hemodynamic activity following acute concussion. [ABSTRACT FROM AUTHOR]

Concussion in para athletes with vision impairment (VI) is poorly understood. Recently published studies have suggested that athletes with VI may be more likely to sustain sport-related concussions compared to non-disabled athletes and athletes with other impairment types. There is a critical need for objective concussion incidence measures to determine concussion injury rates and risks more accurately. The aim of this review was to examine the limited available evidence of concussion incidence rates across six different para sports for athletes with VI and encourage the future collection of concussion incidence data and the adoption of injury prevention strategies in VI para sport. A literature search was conducted using four unique databases, which formed the basis of this narrative review. Injury prevention strategies such as modifying sport rules, introducing protective equipment, and incorporating additional safety measures into the field of play have been introduced sporadically, but the effectiveness of most strategies remains unknown. More prospective, sport-specific research examining mechanisms of injury and risk factors for concussion injuries in athletes with VI in both training and competition is needed. This research will help inform the development of targeted injury prevention strategies to reduce the likelihood of concussion for athletes with VI. [ABSTRACT FROM AUTHOR]

Sport-related concussions (SRCs) are a mild traumatic brain injury (mTBI) that induces transient symptoms in athletes. These symptoms provide avenues for developing emerging technologies to diagnose SRCs, in particular ocular and vestibular dysfunction. The following study aims to assess the reliability of visual smooth-pursuit technology (EyeGuide Focus) in amateur field-sport athletes. A convenience sample of 30 mixed-gender athletes (mean age = 24.89 ± 6.81 years) completed two testing sessions separated by 2–7 days. Participants were tested at rest, free from distraction, and completed a 10 s smooth pursuit while seated. Participants completed 2–4 practice trials before completing three tests at each session. Appropriate difference, reliability, and repeatability tests were performed in Statistical Packages for the Social Sciences. No significant difference existed between the time points (p > 0.05). The reliability between sessions was poor (ICC = 0.24; 95% CI = 0.03–0.42), and the mean coefficients of variation were 20% and 21% for each session, indicating poor repeatability. However, the implementation of practice trials did prevent the familiarization effects that are evident in the previous literature (p > 0.05). The within-session reliability of EyeGuide Focus has varied from poor (ICC ≤ 0.50) to good (ICC = 0.75–0.90) in the previous literature, indicating the fact that greater research is required before this tool can be implemented in applied settings. [ABSTRACT FROM AUTHOR]

Background: Considering the multifaceted consequences of improperly managed sport-related concussions (SRCs) in American football, identifying efficacious prevention measures for enhancing player safety is crucial. Purpose: To investigate the association of primary prevention measures (no-tackle practices and using a mobile tackling dummy in practice) with the frequency of SRCs within college football programs in the United States. Study Design: Descriptive epidemiology study. Methods: In this pilot study, we analyzed the frequency of new SRCs recorded during various settings (total, in preseason, in season, in practice, and game) across 14 seasons (2007-2019 and 2021) for Dartmouth College and across 7 seasons (2013-2019) for the 7 other teams in the Ivy League men's athletic football conference. Trends between seasons and the number of SRCs sustained were examined using correlations and basic descriptive statistics. We also examined SRC frequency in relation to primary prevention measures (no-tackle practices, use of mobile tackling dummies during practice) in the Dartmouth College football program, and we compared SRCs with regard to the no-tackle practice policy in the other Ivy League teams. Results: There was a statistically significant reduction in the number of SRCs over the seasons studied, with the strongest finding observed for Dartmouth College in-game SRCs (r = −0.52; P =.029). Relatedly, the strongest between-season effect was seen for the Dartmouth College practice policy on in-game SRCs (η2 = 0.510; P =.01). The use of mobile tackling dummies was found to be independently associated (adjusting for no-tackle practice) with a lower number total (β = −0.53; P =.049), in-season (β = −0.63; P =.023), and in-game (β = −0.79; P =.003) SRCs. While seasons with the no-tackle practice were not meaningfully associated with SRCs for Dartmouth College, stronger trends were observed in the other Ivy League teams, such that seasons with this policy were associated with lower SRC prevalence. Conclusion: Our data indicate that the use of the mobile tackling dummy in practice was related to the reduced number of SRCs sustained at multiple settings during the football season. To a lesser extent, the no-tackle practice policy was also associated with a reduced number of SRCs. [ABSTRACT FROM AUTHOR]

IntroductionInitially developed by New Zealand Rugby in 2014, the Blue Card initiative in rugby enables match officials to remove athletes from play if they are suspected to have sustained a concussion. Considerable attention has been paid by sport and health advocates to the possibilities and limitations of this initiative in safeguarding athlete health. However, little if any attention has been paid to the well-being of those responsible for administering the Blue Card (i.e., match officials). The aim of this paper was to examine match officials' experiences with and perspectives on implementing the Blue Card initiative in Ontario, Canada, with focused attention on the tensions around their ability to manage games and participants (e.g., athletes, coaches) while attempting to safeguard athlete well-being.MethodsUsing Relational Coordination Theory (RCT) as a guiding framework and qualitative research method, we highlight the rich accounts of 19 match officials' perspectives and experiences regarding sport-related concussion (SRC) management and the Blue Card protocol.ResultsFour themes were derived from the data, reflecting latent assumptions embedded within the concussion management process, which include: assumptions of trust, respect, and cooperation; assumptions of shared responsibility; assumptions of shared understanding; and assumptions of harassment-free sport.DiscussionOur findings emphasize the need to attend to social relations in concussion management and provide insight into match officials' fraught experiences on the frontlines of concussion management. We identify factors affecting match official well-being and provide considerations for concussion management initiatives designed to improve athlete safety, such as the Blue Card.