Contribution to CAT question 4 5 4 Abbreviations: CAT, Critically Appraised Topic; CT, computed tomography; ED, emergency department; ICD-10, International Classification of Diseases, 10th Revision; mTBI, mild traumatic brain injury; PCS, post-concussion syndrome; PEDro, Physiotherapy Evidence Database; RPQ
Search Results
Aerobic Exercise as an Intervention for Mild Traumatic Brain Injury: A Critically Appraised Topic
Makayla Florez, Erin Roberge, and Jennifer Ostrowski
Is State Anxiety, Trait Anxiety, or Anxiety Sensitivity a Clinical Predictor of Symptoms in Those Presenting With Mild Traumatic Brain Injury or Concussion?
Krista M. Hixson, Alex N. Allen, Andrew S. Williams, and Tamara C. Valovich McLeod
Clinical Scenario:
Mild traumatic brain injury, or concussion, has been associated with physical, cognitive, and emotional sequelae. Little is understood in regard to many characteristics, such as anxiety, and their effect on post-concussion symptoms.
Clinical Question:
Is state anxiety, trait anxiety, or anxiety sensitivity a clinical predictor of symptoms in those presenting with mild traumatic brain injury or concussion?
Summary of Key Findings:
A literature search returned 3 possible studies; 3 studies met inclusion criteria and included. One study reported in athletes that greater social support was associated with decreased state-anxiety, lower state anxiety post-concussion was associated with increased social support, and that those with greater social support may experience reduced anxiety, regardless of injury type sustained. One study reported baseline trait anxiety in athletes was not significantly associated with post-concussion state anxiety, but that symptoms of depression at baseline was the strongest predictor for post-concussion state anxiety. Three studies reported that state and trait anxiety are not related to increased post-concussion symptom scores. One study reported that greater anxiety sensitivity is related to higher reported post-concussion symptom scores, which may manifest as somatic symptoms following concussion, and revealed that anxiety sensitivity may be a risk factor symptom development.
Clinical Bottom Line:
There is low-level to moderate evidence to support that anxiety sensitivity is linked to post-concussion symptoms. State and trait anxiety do not appear to be related to post-concussion symptoms alone. Post-concussion state anxiety may occur if post-concussion symptoms of depression are present or if baseline symptoms of depression are present. Better social support may improve state anxiety post-concussion.
Strength of Recommendation:
There is grade B evidence to support that state and trait anxiety are not risk factors for post-concussion symptom development. There is grade C evidence to support anxiety sensitivity as a risk factor for developing post-concussion symptoms.
Differentiating Concussion From Intracranial Pathology in Athletes
Andrea Cripps and Scott C. Livingston
Clinical Scenario:
A cerebral concussion is a traumatically induced transient disturbance of brain function characterized by a complex pathophysiologic process and is classified as a subset of mild traumatic brain injury. The occurrence of intracranial lesions after sport-related head injury is relatively uncommon, but the possibility of serious intracranial injury (ICI) should be included in the differential diagnosis. ICIs are potentially life threatening and necessitate urgent medical management; therefore, prompt recognition and evaluation are critical to proper medical management. One of the primary objectives of the initial evaluation is to determine if the concussed athlete has an acute traumatic ICI. Athletic trainers must be able promptly recognize clinical signs and symptoms that will enable them to accurately differentiate between a concussion (ie, a closed head injury not associated with significant ICI) and an ICI. The identification of predictors of intracranial lesions is, however, relatively broad.
Focused Clinical Question:
Which clinical examination findings (ie, clinical signs and symptoms) indicate possible intracranial pathology in individuals with acute closed head injuries?
Near Point of Convergence Deficits and Treatment Following Concussion: A Systematic Review
Ashley L. Santo, Melissa L. Race, and Elizabeth F. Teel
Traumatic brain injury (TBI) is a public health concern. TBI is common in sports and can be difficult to diagnose. Concussion, a form of mild traumatic brain injury (mTBI), can be defined as “a complex pathophysiological process” 1 in which damage occurs to the brain, causing a wide variety of
Exercise Parameters for Postconcussion Symptom Rehabilitation: A Systematic Review
Kannan Singaravelu Jaganathan, Karen A. Sullivan, Sally Kinmond, Sara Berndt, Steve Street, Catherine Haden, Jaimi Greenslade, Katie McMahon, Gary Mitchell, and Graham Kerr
an expert librarian (Haden). Evidence Acquisition A combination of subject headings and keywords on mild traumatic brain injury, PCSs, and exercise were searched in the following databases from inception to June 2022: CINAHL (EBSCOhost), PsycINFO (EBSCOhost), MEDLINE (Ovid), Embase (Embase
Consequences of Sport-Related Concussion on Health-Related Quality of Life in Adolescents: A Critically Appraised Topic
Mary Margaret Williamson and Jessica Wallace
HRQoL that have been studied previously in pediatric concussion or mild traumatic brain injury populations include cognitive, physical, psychosocial, school, sleep, and overall or general HRQoL. 8 A systematic review of adolescents with SRCs found that a subgroup of adolescents who were diagnosed with
Feasibility and Preliminary Effectiveness of an Online Meditation Intervention in Young Adults With Concussion History
Christine E. Callahan, Kyla Z. Donnelly, Susan A. Gaylord, Keturah R. Faurot, J.D. DeFreese, Adam W. Kiefer, and Johna K. Register-Mihalik
, Phillips HL , Gouvier WD . Stress as a diagnostic challenge for post-concussive symptoms: sequelae of mild traumatic brain injury or physiological stress response . Clin Neuropsychol . 2001 ; 15 ( 3 ): 289 – 304 . doi: 10.1076/clin.15.3.289.10272 8. Bay EH , Liberzon I . Early stress response
Upper-Extremity Perceptual-Motor Training Improves Whole-Body Reactive Agility Among Elite Athletes With History of Sport-Related Concussion
Gary B. Wilkerson, Dustin C. Nabhan, and Ryan T. Crane
slows processing of neural signals, which may result from either mild traumatic brain injury 1 or loss of proprioceptive afference following musculoskeletal injury. 2 Detection of subtle impairment of neural processing capabilities currently relies on advanced neuroimaging and electrophysiological
Early Moderate to Vigorous Physical Activity After Concussion Is Associated With Faster Symptom Resolution Time
Jacob G. Rademacher, Mathew J. Wingerson, Katherine L. Smulligan, Casey C. Little, Julie C. Wilson, and David R. Howell
Concussion, a mild traumatic brain injury that can occur during sports or recreation-related activities, is caused by a direct blow to the head, neck, or elsewhere on the body resulting in an impulsive force being transmitted to the brain. Concussion results in neurological signs or symptoms
Use of Knowledge Translation Action Framework to Improve Physical Therapy Rehabilitation Outcomes in Concussion Management
Rebecca A. Bliss, Lindsay Holland, Caitlin Fields, and Kayley Stock
recovery process. 5 , 8 Three recent publications, the American Physical Therapy Association’s Clinical Practice Guidelines (CPG) for Concussion/Mild Traumatic Brain Injury, the Sixth Consensus Statement from the Concussion in Sport Group, and the American Medical Society for Sports Medicine Position
