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Ryan T. Tierney

Column-editor : Carl G. Mattacola

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Karlee Burns, Ryan Tierney, and Jane McDevitt

Clinical Question: In individuals with posttraumatic headache following concussion, what impact does medication have? Clinical Bottom Line: Prescription medications may be beneficial for those suffering posttraumatic headache following concussion by decreasing headache symptoms and improving cognitive function, though long-term outcomes were similar between those taking and not taking medications.

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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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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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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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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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Jonathan I. Hochstetler, Anne C. Russ, Ryan Tierney, and Jamie L. Mansell

Focused Clinical Question: In athletic training, what is the percentage of workplace bullying compared to the percentage in nursing? Clinical Bottom Line: There is evidence that workplace bullying is prevalent in the athletic training and nursing professions.

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Alyson Hansbarger, Ryan Thomson, Jamie L. Mansell, and Ryan T. Tierney

Clinical Scenario: Sport-related concussions are common injuries during sport-related activities. Evaluations of these injuries involve symptom reporting. Unfortunately, concussion symptoms are widely underreported by athletes, and can lead to longer recovery times. Concussion education programs were created to encourage reporting of symptoms by athletes. Clinical Question: Does concussion education impact injury disclosure in high school athletes? Summary of Key Findings: Three studies were included in this appraisal. Two studies utilized an educational lecture, and one study utilized an informational video providing the concussion education. All three studies found significant increases in injury history disclosure from pre-education to immediate post-education. Clinical Bottom Line: There is moderate evidence to support the idea that education has a positive impact on concussion reporting behaviors. These studies found positive results immediately following concussion education therefore it may be beneficial to provide concussion education several times a year. Strength of Recommendation: There is Level B evidence to support the idea that implementing concussion education will impact concussion reporting behaviors as it pertains to injury history disclosure.

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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.