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Kelly M. Cheever, Jane McDevitt and Jacqueline Phillips

Key Points ▸ All three studies selected demonstrated a delay in symptom recovery in patients suffering from cervicogenic symptoms. ▸ Cervicogenic symptoms were identified in 32–70% of participants with diagnosed sport-related concussion. ▸ In one randomized controlled trial, patients with symptoms

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Jeffrey J. Milroy, Stephen Hebard, Emily Kroshus and David L. Wyrick

seeking is delayed ( Asken, McCrea, Clugston, Snyder, & Houck, 2016 ). At present time, it is estimated that between 12% and 60% of athletes delay seeking care after sustaining a concussion. Differences in sport-related concussion (SRC) care seeking have been attributed to a number of different immutable

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Ryan D. Henke, Savana M. Kettner, Stephanie M. Jensen, Augustus C.K. Greife and Christopher J. Durall

Clinical Scenario Historically, adolescent athletes with sport-related concussion (SRC) have been advised to abstain from physical activity until asymptomatic, at which point they may begin a graduated return to sport protocol. 1 Some researchers, however, have proposed that subsymptom

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Kyle M. Petit and Tracey Covassin

Sport-related concussions (SRC) are a major health concern due to their high prevalence and potential for serious health impacts. Athletes with an SRC may present with neurocognitive impairments, balance deficits, and various symptoms associated with the injury. 1 Despite these health impairments

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Michael McCrea and Matthew R. Powell

This article reviews the essential components of a practical, evidenced-based approach to the management of sport-related concussion in an ambulatory care setting. The model presented is based on the core philosophy that concussion assessment and management be approached from the biopsychosocial perspective, which recognizes the medical/physiological, psychological, and sociological factors that influence recovery and outcome following concussion. Based on the biopsychosocial paradigm, we outline a care delivery model that emphasizes an interdisciplinary approach in which the clinical neuropsychologist is a key participant. We discuss the importance of nonmedical, psychoeducational interventions introduced during the acute phase to facilitate recovery after sport-related concussion. Finally, using the local experience of our “Concussion Clinic” as a backdrop, we offer two separate case studies that demonstrate the value of this model in evaluating and managing athletes after sport-related concussion. The overall objective of this paper is to provide an adaptable template that neuropsychologists and other healthcare providers can use to improve the overall care of athletes with sport-related concussion and civilians with mild traumatic brain injury.

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Hyung Rock Lee, Jacob E. Resch, Tae Kyung Han, Jessica D. Miles and Michael S. Ferrara

Few studies have been conducted on individuals’ knowledge of sport-related concussions (SRCs) in South Korea. The purpose of this study was to examine South Korean athletes’ knowledge and recognition of SRC. A cross-sectional survey assessing (a) the recognition of specific signs and symptoms associated with SRC; (b) history of SRC; and (c) knowledge of the return-to-play decision (RTP) process after SRC was distributed to 410 high school and collegiate student-athletes from a variety of sports. No participants correctly identified all 9 items on the checklist of SRC signs and symptoms. While 8.9% reported a history of SRC, approximately 50% of those never reported their postconcussion signs and symptoms. Furthermore, 63.9% of the athletes who reported SRC made RTP decisions on their own. These results reflect the lack of knowledge in South Korean athletics of common signs, symptoms, and appropriate RTP decisions following concussion.

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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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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