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Search Results
Drop Landing Biomechanics in Individuals With and Without a Concussion History
Eric J. Shumski, Tricia M. Kasamatsu, Kathleen S. Wilson, and Derek N. Pamukoff
Validation of a Noninvasive System for Measuring Head Acceleration for Use during Boxing Competition
Jonathan G. Beckwith, Jeffrey J. Chu, and Richard M. Greenwald
Although the epidemiology and mechanics of concussion in sports have been investigated for many years, the biomechanical factors that contribute to mild traumatic brain injury remain unclear because of the difficulties in measuring impact events in the field. The purpose of this study was to validate an instrumented boxing headgear (IBH) that can be used to measure impact severity and location during play. The instrumented boxing headgear data were processed to determine linear and rotational acceleration at the head center of gravity, impact location, and impact severity metrics, such as the Head Injury Criterion (HIC) and Gadd Severity Index (GSI). The instrumented boxing headgear was fitted to a Hybrid III (HIII) head form and impacted with a weighted pendulum to characterize accuracy and repeatability. Fifty-six impacts over 3 speeds and 5 locations were used to simulate blows most commonly observed in boxing. A high correlation between the HIII and instrumented boxing headgear was established for peak linear and rotational acceleration (r 2 = 0.91), HIC (r 2 = 0.88), and GSI (r 2 = 0.89). Mean location error was 9.7 ± 5.2°. Based on this study, the IBH is a valid system for measuring head acceleration and impact location that can be integrated into training and competition.
A Six Degree of Freedom Head Acceleration Measurement Device for Use in Football
Steven Rowson, Jonathan G. Beckwith, Jeffrey J. Chu, Daniel S. Leonard, Richard M. Greenwald, and Stefan M. Duma
The high incidence rate of concussions in football provides a unique opportunity to collect biomechanical data to characterize mild traumatic brain injury. The goal of this study was to validate a six degree of freedom (6DOF) measurement device with 12 single-axis accelerometers that uses a novel algorithm to compute linear and angular head accelerations for each axis of the head. The 6DOF device can be integrated into existing football helmets and is capable of wireless data transmission. A football helmet equipped with the 6DOF device was fitted to a Hybrid III head instrumented with a 9 accelerometer array. The helmet was impacted using a pneumatic linear impactor. Hybrid III head accelerations were compared with that of the 6DOF device. For all impacts, peak Hybrid III head accelerations ranged from 24 g to 176 g and 1,506 rad/s2 to 14,431 rad/s2. Average errors for peak linear and angular head acceleration were 1% ± 18% and 3% ± 24%, respectively. The average RMS error of the temporal response for each impact was 12.5 g and 907 rad/s2.
The Concussion Clinic: A Practical, Evidence-Based Model for Assessment and Management of Sport-Related Concussion
Michael McCrea and Matthew R. Powell
This article reviews the essential components of a practical, evidenced-based approach to the management of sport-related concussion in an ambulatory care setting. The model presented is based on the core philosophy that concussion assessment and management be approached from the biopsychosocial perspective, which recognizes the medical/physiological, psychological, and sociological factors that influence recovery and outcome following concussion. Based on the biopsychosocial paradigm, we outline a care delivery model that emphasizes an interdisciplinary approach in which the clinical neuropsychologist is a key participant. We discuss the importance of nonmedical, psychoeducational interventions introduced during the acute phase to facilitate recovery after sport-related concussion. Finally, using the local experience of our “Concussion Clinic” as a backdrop, we offer two separate case studies that demonstrate the value of this model in evaluating and managing athletes after sport-related concussion. The overall objective of this paper is to provide an adaptable template that neuropsychologists and other healthcare providers can use to improve the overall care of athletes with sport-related concussion and civilians with mild traumatic brain injury.
The Relationship Between Postinjury Symptomatology and Days Postinjury for the Graded Symptom Scale in Concussed Adolescent Athletes
Richelle M. Williams, R. Curtis Bay, and Tamara C. Valovich McLeod
Concussion symptoms are important self-reported indicators of recovery. The purpose of this study was to describe the symptom burden in the first 3 weeks postconcussion and estimate the strength of relationship between symptomatology and days postconcussion. Headache was the most commonly endorsed symptom during weeks 1 (71.1%), 2 (37.6%), and 3 (32.6%). Severity scores were negatively correlated with days postconcussion, p < .01. While headache is commonly reported following a concussion, and decreases with time, it was still endorsed 3 weeks postinjury. Clinicians should be aware that lingering symptoms may suggest a prolonged recovery that requires an active treatment approach.
Baseline Concussion Symptom Scores Vary by Method of Collection
Andrea E. Cripps and Mikaela D. Boham
Context:
The vast majority of athletic trainers administer preseason computerized inventories to document the presence of baseline symptoms; however, immediately following a concussion, athletic trainers frequently assess an athlete verbally or using a paper-based concussion symptom scale. The verbal or paper-based results are then compared with the preseason computer results. Little research is available regarding whether the methodology in which these symptoms are collected has an impact on the report given by the athlete.
Objective:
To determine if baseline self-reported concussion symptom scores varied among collection methods.
Design:
Crossover study design.
Setting:
University research laboratory.
Participants:
Fifty-two healthy subjects (36 males, 16 females; age 20.27 ± 1.36 years; mass 72.68 ± 14.88 kg; height 175.05 ± 8.50 cm).
Interventions:
All subjects completed, as part of routine preseason baseline testing, the postconcussion scale revised symptom inventory scale in three ways: (1) using a computer, (2) verbally, and (3) on paper.
Main Outcome Measures:
Descriptive statistics were calculated. One-way ANOVAs were conducted to determine the difference in overall symptom score between the inventory methods and sexes as well. Alpha level was set a priori at .05.
Results:
Overall, participants reported a significantly higher number of symptoms on computer-based symptom inventories compared with either verbal- (t51 = 3.014, P = .004, 95% confidence interval [CI], 0.668 to 3.32) or paper-based inventories (t51 = 3.004, P = .004, 95% CI 0.765 to 3.850). No signifcant differences were found between verbal- and paper-based inventories (t51 = 1.129, P = .264, 95% CI –0.240 to 0.855).
Conclusions:
Computer-based symptom inventories were significantly different than verbal- or paper-based symptom inventories. Participants may report a higher number of symptoms at baseline when reporting electronically compared with verbal- or paper-based reporting methods. The method in which symptom inventory is obtained may alter the postconcussion diagnosis and warrants further investigation.
Unique Contributions of the King-Devick and Vestibular/Ocular Motor Screening: A Critically Appraised Topic
Ty B. Bigelow, Meredith E. Joyce, and Ashley L. Santo
Focused Clinical Question: Is there a relationship between performance on the King-Devick test and the vestibular/ocular motor screening in youth and young adults? Clinical Bottom Line: There was insufficient evidence to definitively determine if there is a relationship between performance on the King-Devick test and vestibular/ocular motor screening in youth and young adults.
Clinical Outcomes Assessment for the Management of Sport-Related Concussion
Tamara C. Valovich McLeod and Johna K. Register-Mihalik
Patient Scenario:
An adolescent female youth soccer athlete, with a previous concussion history, suffered a second concussion 4 wk ago. Her postconcussive symptoms are affecting her school performance and social and family life.
Clinical Outcomes Assessment:
Concussion is typically evaluated via symptoms, cognition, and balance. There is no specific patient-oriented outcomes measure for concussion. Clinicians can choose from a variety of generic and specific outcomes instruments aimed at assessing general health-related quality of life or various concussion symptoms and comorbidities such as headache, migraine, fatigue, mood disturbances, depression, anxiety, and concussion-related symptoms.
Clinical Decision Making:
The data obtained from patient self-report instruments may not actively help clinicians make return-to-play decisions; however, these scales may be useful in providing information that may help the athlete return to school, work, and social activities. The instruments may also serve to identify issues that may lead to problems down the road, including depression or anxiety, or serve to further explore the nature of an athlete’s symptoms.
Clinical Bottom Line:
Concussion results in numerous symptoms that have the potential to linger and has been associated with depression and anxiety. The use of outcomes scales to assess health-related quality of life and the effect of other symptoms that present with a concussion may allow clinicians to better evaluate the effects of concussion on physical, cognitive, emotional, social, school, and family issues, leading to better and more complete management.
Factors Influencing Concussion Reporting Intention in Adolescent Athletes
Natalie Cook and Tamerah N. Hunt
Clinical Scenario: Concussions are severely underreported, with only 47.3% of high school athletes reporting their concussion. The belief was that athletes who were better educated on the signs and symptoms and potential dangers of concussion would be more likely to report. However, literature has shown inconsistent evidence on the efficacy of concussion education, improving reporting behaviors. Factors such as an athlete’s attitude, subjective norms, and perceived behavioral control have shown promise in predicting intention to report concussions in athletes. Focused Clinical Question: Do attitudes, subjective norms, and perceived behavioral control influence adolescent athletes’ intention to report? Summary of Key Findings: Three studies (1 randomized control and 2 cross-sectional surveys) were included. Across the 3 studies, attitudes, subjective norms, and perceived behavioral control positively influenced athletes’ reporting intention. The studies found that attitude toward concussion reporting and perceived behavioral control were the most influential predictors of reporting intention. Clinical Bottom Line: There is moderate evidence to suggest that positive attitudes, supportive subjective norms, and increased perceived behavioral control influence reporting intention in secondary school athletes. Strength of Recommendation: Grade B evidence exists that positive attitudes, supportive subjective norms, and increased perceived behavioral control positively influence concussion reporting intention in secondary school athletes.
Is the Sky Falling? The Persistent Effects of Concussion
Steven P. Broglio
Sport concussion has been thrust into the national spotlight with growing concern over both the acute and chronic risk for injury. While much has been learned and applied to medical practice in the previous decade, how the injury may affect individuals years later remains largely unknown. The opaqueness of the unknown has led some to ask if certain sports should be banned. Without immediate answers, what is currently known must be extrapolated and the risks and benefits of sport participation must be balanced.