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Zachary C. Merz, Joanne E. Perry and Michael J. Ross

practice by describing a process in which individuals with sport-related concussion or a mTBI are acutely evaluated and treated. Referrals for follow-up care are provided depending on the needs of the individual. However, given that the clinical sport neuropsychologist reflects a clinician with specialized

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Enda F. Whyte, Nicola Gibbons, Grainne Kerr and Kieran A. Moran

Context: Determination of return to play (RTP) after sport-related concussion (SRC) is critical given the potential consequences of premature RTP. Current RTP guidelines may not identify persistent exercise-induced neurocognitive deficits in asymptomatic athletes after SRC. Therefore, postexercise neurocognitive testing has been recommended to further inform RTP determination. To implement this recommendation, the effect of exercise on neurocognitive function in healthy athletes should be understood. Objective: To examine the acute effects of a high-intensity intermittent-exercise protocol (HIIP) on neurocognitive function assessed by the Symbol Digits Modality Test (SDMT) and Stroop Interference Test. Design: Cohort study. Setting: University laboratory. Participants 40 healthy male athletes (age 21.25 ± 1.29 y, education 16.95 ± 1.37 y). Intervention: Each participant completed the SDMT and Stroop Interference Test at baseline and after random allocation to a condition (HIIP vs control). A mixed between-within-subjects ANOVA assessed time- (pre- vs postcondition) -by-condition interaction effects. Main Outcome Measures: SDMT and Stroop Interference Test scores. Results: There was a significant time-by-condition interaction effect (P < .001, η 2 = .364) for the Stroop Interference Test scores, indicating that the HIIP group scored significantly lower (56.05 ± 9.34) postcondition than the control group (66.39 ± 19.6). There was no significant time-by-condition effect (P = .997, η 2 < .001) for the SDMT, indicating that there was no difference between SDMT scores for the HIIP and control groups (59.95 ± 10.7 vs 58.56 ± 14.02). Conclusions: In healthy athletes, the HIIP results in a reduction in neurocognitive function as assessed by the Stroop Interference Test, with no effect on function as assessed by the SDMT. Testing should also be considered after high-intensity exercise in determining RTP decisions for athletes after SRC in conjunction with the existing recommended RTP protocol. These results may provide an initial reference point for future research investigating the effects of an HIIP on the neurocognitive function of athletes recovering from SRC.

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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.

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Lynda M. Mainwaring, Sean M. Bisschop, Robin E.A. Green, Mark Antoniazzi, Paul Comper, Vicki Kristman, Christine Provvidenza and Doug W. Richards

Despite suggestions that emotions influence recovery from injury, there is little research into the emotional sequelae of mild traumatic brain injury (MTBI), or “concussion,” in sport. This examination compares emotional functioning of college athletes with MTBI to that of uninjured teammates and undergraduates. A short version of the Profile of Mood States (POMS; Grove & Prapavessis, 1992) assessed baseline emotions in all groups, and serial emotional functioning in the MTBI and undergraduate groups. Whereas preinjury profiles were similar across groups, the MTBI group showed a significant postinjury spike in depression, confusion, and total mood disturbance that was not seen for the other groups. The elevated mood disturbances subsided within 3 weeks postinjury. Given that concussed athletes were highly motivated to return to play, these data could be used as a benchmark of normal emotional recovery from MTBI. Findings are discussed in relation to current literature on emotional reaction to injury and directions for future research.

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Kevin Guskiewicz and Elizabeth Teel

In order to promote the most successful outcomes following concussion, a multifaceted team of individuals is required for appropriate injury diagnosis and management. This review explores the primary roles of sports medicine personnel in the concussion diagnosis and management process. We will discuss the psychometric properties, including sensitivity, specificity, and clinical utility, of on-field/sideline, laboratory, and neurophysiological assessment tools. Additionally, we will discuss the roles of other kinesiology experts in concussion management and recovery, and their importance to concussion research. By developing a thorough and consistent roadmap for concussion management, clinicians and researchers will be capable of providing athletes with the most successful outcomes.

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Jacqueline Phillips, Kelly Cheever, Jamie McKeon and Ryan Tierney

mild traumatic brain injury patients. 2 , 7 , 8 More recently, it has also been reported to be receded in sport-related concussion patients. 3 , 9 – 11 Although an abnormally receded NPC measurement has been identified as a clinical sign of sport-related concussion, there have been conflicting

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Nikolaus A. Dean

personal narratives with Erving Goffman’s ( 1959 ) presentation of self theory. Through this application, I attempt to analyze and make sense of the (re)negotiation of my athletic identity due to the formidable impacts of sustaining a sport-related concussion (SRC). As Brewer, Van Raalte, and Linder ( 1993

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Shelly L. Massingale, Amy D. Alexander, Steven M. Erickson, Elizabeth S. McQueary, Richard D. Gerkin, Sarah B. Schodrof, Haroon M. Kisana and Jamie E. Pardini

dizziness are common symptoms of concussion. 3 , 4 Dizziness at the time of injury has been found to be one of the top three risk factors for a prolonged recovery in sport-related concussions. 4 Vestibular dysfunction has been detected during acute, subacute, and chronic phases of recovery. Disruption to

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John M. Rosene, Christian Merritt, Nick R. Wirth and Daniel Nguyen

Subconcussive head impacts in sport may have a greater impact on neurological degradation versus concussive hits given the repetitive nature of these head impacts. The purpose of this investigation was to quantify the frequency, magnitude, and location of head impacts in an NCAA Division III men’s lacrosse team. There was no significant difference (p ≤ .05) in peak linear acceleration, peak rotational acceleration, and peak rotational velocity between games and practices. There was no significant difference (p ≤ .05) for PLA among player position and location of head impact. The quantity and intensity of subconcussive head impacts between practices and games were similar. These multiple subconcussive head impacts have the potential to lead to future neurological impairments.