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David R. Howell, Jessie R. Oldham, Melissa DiFabio, Srikant Vallabhajosula, Eric E. Hall, Caroline J. Ketcham, William P. Meehan III and Thomas A. Buckley

Gait impairments have been documented following sport-related concussion. Whether preexisting gait pattern differences exist among athletes who participate in different sport classifications, however, remains unclear. Dual-task gait examinations probe the simultaneous performance of everyday tasks (ie, walking and thinking), and can quantify gait performance using inertial sensors. The purpose of this study was to compare the single-task and dual-task gait performance of collision/contact and noncontact athletes. A group of collegiate athletes (n = 265) were tested before their season at 3 institutions (mean age= 19.1 ± 1.1 years). All participants stood still (single-task standing) and walked while simultaneously completing a cognitive test (dual-task gait), and completed walking trials without the cognitive test (single-task gait). Spatial-temporal gait parameters were compared between collision/contact and noncontact athletes using MANCOVAs; cognitive task performance was compared using ANCOVAs. No significant single-task or dual-task gait differences were found between collision/contact and noncontact athletes. Noncontact athletes demonstrated higher cognitive task accuracy during single-task standing (P = .001) and dual-task gait conditions (P = .02) than collision/contact athletes. These data demonstrate the utility of a dual-task gait assessment outside of a laboratory and suggest that preinjury cognitive task performance during dual-tasks may differ between athletes of different sport classifications.

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Melissa C. Kay, Cailee E. Welch and Tamara C. Valovich McLeod

Clinical Scenario:

Concussions are one of the most common sport-related injuries affecting athletes participating at all levels across a variety of sports. It has been reported that up to 3.8 million concussive events occur per year that are sports-related. One significant issue with identifying concussions is that a clinical diagnosis is based on the presence of signs and symptoms, which are self-reported by the patient. In the adolescent population, injury to the brain is possible with even the slightest insult, which can affect recovery and predispose them to subsequent concussions. Recent legislative efforts have included athlete education as a means to improve concussion reporting. More specifically, all 50 US states and the District of Columbia have implemented concussion legislation that includes some type of concussion education protocol, but there is still little evidence to suggest that enhanced knowledge levels result in behavior changes, including improved concussion-reporting practices. It is unclear what factors make an adolescent athlete more or less likely to report the symptoms of a concussion.

Focused Clinical Question:

What factors positively or negatively influence secondary school athletes’ likelihood of reporting symptoms of sport-related concussions?

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Jaclyn B. Caccese, Thomas A. Buckley and Thomas W. Kaminski

The Balance Error Scoring System (BESS) is often used for sport-related concussion balance assessment. However, moderate intratester and intertester reliability may cause low initial sensitivity, suggesting that a more objective balance assessment method is needed. The MobileMat BESS was designed for objective BESS scoring, but the outcome measures must be validated with reliable balance measures. Thus, the purpose of this investigation was to compare MobileMat BESS scores to linear and nonlinear measures of balance. Eighty-eight healthy collegiate student-athletes (age: 20.0 ± 1.4 y, height: 177.7 ± 10.7 cm, mass: 74.8 ± 13.7 kg) completed the MobileMat BESS. MobileMat BESS scores were compared with 95% area, sway velocity, approximate entropy, and sample entropy. MobileMat BESS scores were significantly correlated with 95% area for single-leg (r = .332) and tandem firm (r = .474), and double-leg foam (r = .660); and with sway velocity for single-leg (r = .406) and tandem firm (r = .601), and double-leg (r = .575) and single-leg foam (r = .434). MobileMat BESS scores were not correlated with approximate or sample entropy. MobileMat BESS scores were low to moderately correlated with linear measures, suggesting the ability to identify changes in the center of mass–center of pressure relationship, but not higher-order processing associated with nonlinear measures. These results suggest that the MobileMat BESS may be a clinically-useful tool that provides objective linear balance measures.

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Charles H. Tator

There has been a remarkable increase in the past 10 years in the awareness of concussion in the sports and recreation communities. Just as sport participants, their families, coaches, trainers, and sports organizations now know more about concussions, health care professionals are also better prepared to diagnose and manage concussions. As has been stated in the formal articles in this special issue on sport-related concussion, education about concussion is one of the most important aspects of concussion prevention, with the others being data collection, program evaluation, improved engineering, and introduction and enforcement of rules. Unfortunately, the incidence of concussion appears to be rising in many sports and thus, additional sports-specific strategies are required to reduce the incidence, short-term effects, and long term consequences of concussion. Enhanced educational strategies are required to ensure that individual participants, sports organizations, and health care professionals recognize concussions and manage them proficiently according to internationally recognized guidelines. Therefore, this paper serves as a “brief report” on a few important aspects of concussion education and prevention.

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Introduction Introduction to the Special Issue: Concussion Management in Sport Maureen R. Weiss * 5 2015 4 2 129 130 10.1123/kr.2015-0013 Original Research A Pediatric Perspective on Sport-Related Concussion Tamara C. Valovich McLeod * Megan N. Houston * Cailee E. Welch * 5 2015 4 2 131 155

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Paul M. Pedersen

championships) balances tradition and commercialism, how media coverage of sport-related concussions and chronic traumatic encephalopathy influences public perceptions, and how the media and the National Collegiate Athletic Association (NCAA, with signage for its organizational headquarters featured in the

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2012 6 4 363 384 10.1123/jcsp.6.4.363 Technology Report The Human-Computer Interface in Computer-Based Concussion Assessment John L. Woodard * Annalise A.M. Rahman * 12 2012 6 4 385 408 10.1123/jcsp.6.4.385 Epilogue A Concussion Tale: Epilogue for the JCSP Special Series on Sport-Related

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* Michael Hutchison * Paul Camper * Doug Richards * 9 2012 6 3 247 274 10.1123/jcsp.6.3.247 The Concussion Clinic: A Practical, Evidence-Based Model for Assessment and Management of Sport-Related Concussion Michael McCrea * Matthew R. Powell * 9 2012 6 3 275 292 10.1123/jcsp.6.3.275 Brief Report

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Katrina G. Ritter, Matthew J. Hussey and Tamara C. Valovich McLeod

Clinical Scenario It is estimated that approximately 1.1 to 1.9 million sport-related concussions occur in patients 18 years or younger in the United States annually. 1 Most adult patients who suffer from a concussion experience full relief from symptoms within 7 to 10 days of injury. 2 However

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

Clinical Scenario Concussions are a major public health concern, with an incidence of 1.6 to 4 million sport-related concussions (SRC) reported each year in the United States 1 – 3 ; although, a large number of SRC may still go unreported and/or undiagnosed. 4 Even with improvements in awareness