potentially long-term morbidity associated with repeated mild brain trauma ( Fidan et al., 2016 ), concussions from sport are increasingly recognized as a public health threat to adolescent populations. One important approach to risk reduction is secondary prevention: ensuring that injured athletes are
Emily Kroshus, Sara P.D. Chrisman, Jeffrey J. Milroy and Christine M. Baugh
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.
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.
Lynda Mainwaring, Michael Hutchison, Paul Camper and Doug Richards
Depression, fatigue, irritability, confusion, and general mood disturbance are frequently reported after cerebral concussion in sport. Recent trends in research point to the importance of examining postconcussive emotional disturbances more thoroughly, empirically, and clinically. An overview of the complexity of human emotion and its study is provided herein, followed by a review of emotional correlates identified in the existing sparse literature. The significance and clinical implications of identifying emotional correlates of concussion in sport and athletics are discussed.
Susan C. Davies and Brenna M. Bird
Student-athletes often fail to report concussion signs and symptoms, thereby putting themselves at risk for delayed recovery and permanent impairment. The present study examined motivations for underreporting concussion symptoms among college athletes enrolled at an NCAA Division I university. One hundred and ninety-three student-athletes in high-risk sports completed a multiple-choice survey related to self-reporting of suspected concussion symptoms and reporting of teammates’ symptoms. Results indicated that 45% of participants did not report their own suspected concussions during the present season and 50% did not report suspected concussions in teammates. Responses revealed that the primary reason for underreporting a suspected concussion was the belief that the blow to the head was not serious enough. Suggestions are provided for athletes, athletic staff, and coaches to improve players’ awareness of the signs, symptoms, and consequences of concussions, as well as how to report suspected concussions appropriately.
Michael J. McNamee, Bradley Partridge and Lynley Anderson
The issue of concussion in sport is a matter of global public interest that is currently under dispute by educational, legal, and medical professionals and scientists. In this article we discuss the problem from philosophical, bioethical, and sports ethical perspectives. We articulate conceptual differences in approaches to definition and therefore diagnosis of concussion. We critically review similarities and differences in the leading consensus statements that guide the treatment of concussion diagnosis and treatment in sports. We then present a series of ethical problems including issues that relate to paternalistic intervention in the lives of athletes in order to prevent harm to athletes, conflicting and competing interests, and confidentiality.
John L. Woodard and Annalise A.M. Rahman
Recent progress in technology has allowed for the development and validation of computer-based adaptations of existing pencil-and-paper neuropsychological measures and comprehensive cognitive test batteries. These computer-based assessments are frequently implemented in the field of clinical sports psychology to evaluate athletes’ functioning postconcussion. These tests provide practical and psychometric advantages over their pencil-and-paper counterparts in this setting; however, these tests also provide clinicians with unique challenges absent in paper-and-pencil testing. The purpose of this article is to present advantages and disadvantages of computer-based testing, generally, as well as considerations for the use of computer-based assessments for the evaluation of concussion among athletes. Furthermore, the paper provides suggestions for further development of computerized assessment of sports concussion given the limitations of the current technology.
Lynda Mainwaring and Max Trenerry
This current special issue of the Journal of Clinical Sport Psychology was conceived and developed to provide a resource for clinicians who have contact with athletes who are at risk for or have sustained a concussion during sport participation. The special issue is part of an exciting two-issue series. This first installment contains papers from leaders in the field of sport concussion who review the frequency and mechanisms of concussion, models for managing concussion, the emotional aspects of concussion in sport, practical examples from a model sport concussion clinic, and the importance of sport concussion education and prevention. As Guest Editors, we hope that this timely and unique special series will be used by clinicians who help care for athletes and their families who have experienced concussion in their sport life.
Roya Saffary, Lawrence S. Chin and Robert C. Cantu
Sports-related activities account for an estimated 10% of head and spinal cord injuries. In recent years, concussion in particular has garnered more interest in the medical field as well as the media. Reports of athletes suffering from long-term cognitive deficits and Parkinsonian symptoms have sparked concern in a disease process that has often been underestimated or ignored. As more reports surface, the desperate need for a better understanding of the neuropathology has been made clear. In addition to the concern for acute injury, long-term sequelae such as chronic traumatic encephalopathy (CTE) are feared consequences of concussive injuries. Research studies have shown significant overlap in the neuropathology between CTE and chronic neurodegenerative processes such as Alzheimer’s disease (AD). In particular, tau protein deposition has been found to be present in both disease processes and may play an important part in the clinical findings observed. The present review discusses concussion and our current understanding of pathological findings that may underlie the clinical features associated with concussive injuries and resulting chronic traumatic encephalopathy.
James W.G. Thompson and David Hagedorn
Sports-related concussions are complex injuries with biomechanical and biochemical etiology that present with central and autonomic nervous system dysfunction. Current methods for assessing concussions and basing return-to-play decisions rely on symptom resolution, rating scales, and neuropsychological testing, all of which are indirect measures of injury severity and detect functional capabilities but do not directly measure injury location or severity. In addition, these downstream measures are susceptible to false negatives because compensatory mechanism, such as unmasking and redundancies in brain circuitry can return functional capabilities before injury resolution. The multifactorial nature of concussion necessitates rapid, inexpensive, and easily applied multimodal analysis methods that can offer greater sensitivity and specificity. This article discusses how new approaches utilizing electrophysiology (e.g., QEEG, ERP, ECG, HRV), quantified balance measures, and biochemistry are necessary to advance the science of concussion assessment, treatment, recovery projections, and return-to-play decisions. These additional assessment tools offer a more direct window into the severity and location of the injury, real-time measures of brain function, and the ability to measure the multiple body systems negatively affected by concussion.