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Ryan T. Tierney

Column-editor : Carl G. Mattacola

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Lindsey C. McGuire, Yvette M. Ingram, Michael L. Sachs and Ryan T. Tierney

Depression rates in collegiate student-athletes in the literature are varied and inconclusive, and data have only explored depression symptoms utilizing a crosssectional design. The purpose of the current study was to evaluate the temporal course of depression symptoms in student-athletes. Student-athletes (N = 93) from a Division II institution completed six administrations of a brief depression symptom screen once every 2 weeks throughout the fall athletic season. Ten (10.8%) student-athletes’ PHQ-9 surveys were red-flagged for moderate to severe depression symptoms at least once throughout the season. A mixed between-within subjects analysis of variance (ANOVA) revealed a significant interaction effect for time and sex in depression symptom scores, F(3.69, 335.70) = 10.36, p ≤ .001. The repeated-measures design of this study suggests that there are clinical benefits for screening for depression symptoms in student-athletes at multiple intervals throughout an athletic season.

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Jacqueline Phillips, Kelly Cheever, Jamie McKeon and Ryan Tierney

Near point of convergence (NPC) is an emerging concussion assessment tool and researchers have reported NPC scores using different administration methods which may influence assessment interpretation. The purpose of this study is to investigate the effect of different administrative methods on NPC scores in healthy, active young adults. NPC was measured using two different accommodative rulers and a fingertip, with three different placements. No significant difference in NPC score was observed between rulers. Significant differences were observed between ruler placements. Furthermore, fingertip use was significantly different compared to all ruler placements.

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Melissa Jack, Ryan Tierney, Jamie Mansell and Anne Russ

Focused Clinical Question: In patients with myofascial trigger point pain, does dry needling result in greater decreases in pain compared to sham needling? Clinical Bottom Line: The evidence supporting dry needling as more effective than sham needling in reducing patients’ pain is mixed.

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Ian McGinnis, Justin Cobb, Ryan Tierney and Anne Russ

Clinical Question: What is the efficacy of vestibular rehabilitation for treating imbalance and self-reported dizziness in patients experiencing prolonged symptoms of concussion? Clinical Bottom Line: There is consistent, but low-level, evidence supporting that vestibular rehabilitation can have a positive effect on self-reported dizziness (dizziness severity, Dizziness Handicap Inventory [DHI], Activities-Specific Balance Confidence Scale [ABC]) and objective balance (Sensory Organization Test [SOT], Balance Error Scoring System [BESS]) in patients with prolonged symptoms following concussion. Vestibular rehabilitation is not for every concussed patient. Several, though few, patients did not improve or became worse with the implementation of vestibular rehabilitation. Many of the vestibular rehabilitation exercises utilized in these studies are easily accessible to athletic trainers and, with informed decision making and proper oversight, could be implemented in the athletic training room.

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Jamie L. Mansell, Ryan T. Tierney, Jeffrey B. Driban, Shannon M. Clegg, Michael J. Higgins, Anurag K. Mishra and Evgeny Krynetskiy

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Timothy A. Kulpa, Jamie Mansell, Anne Russ and Ryan Tierney

Context: Patients who do not fully recover from a concussion in 7–14 days may require an impairment-based rehabilitation program. Recent evidence indicates improved outcomes with active rehabilitation compared to passive physical and cognitive rest. Clinical Question: In patients with persistent symptoms (greater than 4 weeks) following concussion, how does aerobic exercise affect postconcussion symptoms? Clinical Bottom Line: There is moderate and sufficient SORT Level B evidence to support the inclusion of subsymptom threshold (SST) exercise in the multimodal treatment plan for patients suffering from persistent symptoms after concussion. All five included studies reported moderate to very large effects ranging from d = 0.72 to d = 10.64 in reducing symptoms after the implementation of SST aerobic exercise. Additionally, two studies also identified moderate and very large effects (d = 0.77, d = 2.56) favoring aerobic exercise over stretching interventions. These results indicate that this treatment has potential clinical utility and is a viable option to reduce symptoms in patients with postconcussion syndrome and persistent symptoms following concussion.

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Mindi Fisher, Ryan Tierney, Anne Russ and Jamie Mansell

Clinical Question: In concussed patients, will having attention deficit hyperactivity disorder (ADHD) or learning difficulties (LD) versus not having ADHD or LD cause higher symptom severity scores or invalid baseline protocols? Clinical Bottom Line: Research supports the concept that there is a difference at baseline for individuals with ADHD and/or LD compared with those who do not.