Key Points ▸ Adolescents and young adults with sport-related mild traumatic brain injury (i.e., 9 days to 12 months postinjury) performed worse on memory tests than healthy controls. ▸ There is low-level evidence suggesting structural changes (e.g., cortical thinning) are occurring following sport
Memory Impairments Associated With Mild Traumatic Brain Injury: A Critically Appraised Topic
Karlee Burns, Leah Sanford, Ryan Tierney, and Jane McDevitt
Do Cognitive Behavioral Therapy Techniques Reduce Symptom Duration in Children and Adolescents Who Have Sustained a Mild Traumatic Brain Injury?
Carlie K. Elmer and Tamara C. Valovich McLeod
therapy and its effect on symptoms in children and adolescents with diagnosed concussions. Focused Clinical Question Does CBT reduce concussion symptoms among children and adolescents following mild traumatic brain injury? Search Strategy A comprehensive search of PubMed, CINAHL, MEDLINE, SPORTDiscus
Is State Anxiety, Trait Anxiety, or Anxiety Sensitivity a Clinical Predictor of Symptoms in Those Presenting With Mild Traumatic Brain Injury or Concussion?
Krista M. Hixson, Alex N. Allen, Andrew S. Williams, and Tamara C. Valovich McLeod
Mild traumatic brain injury, or concussion, has been associated with physical, cognitive, and emotional sequelae. Little is understood in regard to many characteristics, such as anxiety, and their effect on post-concussion symptoms.
Is state anxiety, trait anxiety, or anxiety sensitivity a clinical predictor of symptoms in those presenting with mild traumatic brain injury or concussion?
Summary of Key Findings:
A literature search returned 3 possible studies; 3 studies met inclusion criteria and included. One study reported in athletes that greater social support was associated with decreased state-anxiety, lower state anxiety post-concussion was associated with increased social support, and that those with greater social support may experience reduced anxiety, regardless of injury type sustained. One study reported baseline trait anxiety in athletes was not significantly associated with post-concussion state anxiety, but that symptoms of depression at baseline was the strongest predictor for post-concussion state anxiety. Three studies reported that state and trait anxiety are not related to increased post-concussion symptom scores. One study reported that greater anxiety sensitivity is related to higher reported post-concussion symptom scores, which may manifest as somatic symptoms following concussion, and revealed that anxiety sensitivity may be a risk factor symptom development.
Clinical Bottom Line:
There is low-level to moderate evidence to support that anxiety sensitivity is linked to post-concussion symptoms. State and trait anxiety do not appear to be related to post-concussion symptoms alone. Post-concussion state anxiety may occur if post-concussion symptoms of depression are present or if baseline symptoms of depression are present. Better social support may improve state anxiety post-concussion.
Strength of Recommendation:
There is grade B evidence to support that state and trait anxiety are not risk factors for post-concussion symptom development. There is grade C evidence to support anxiety sensitivity as a risk factor for developing post-concussion symptoms.
Emotional Reaction of Varsity Athletes to Sport-Related Concussion
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.
Differentiating Concussion From Intracranial Pathology in Athletes
Andrea Cripps and Scott C. Livingston
A cerebral concussion is a traumatically induced transient disturbance of brain function characterized by a complex pathophysiologic process and is classified as a subset of mild traumatic brain injury. The occurrence of intracranial lesions after sport-related head injury is relatively uncommon, but the possibility of serious intracranial injury (ICI) should be included in the differential diagnosis. ICIs are potentially life threatening and necessitate urgent medical management; therefore, prompt recognition and evaluation are critical to proper medical management. One of the primary objectives of the initial evaluation is to determine if the concussed athlete has an acute traumatic ICI. Athletic trainers must be able promptly recognize clinical signs and symptoms that will enable them to accurately differentiate between a concussion (ie, a closed head injury not associated with significant ICI) and an ICI. The identification of predictors of intracranial lesions is, however, relatively broad.
Focused Clinical Question:
Which clinical examination findings (ie, clinical signs and symptoms) indicate possible intracranial pathology in individuals with acute closed head injuries?
Near Point of Convergence Deficits and Treatment Following Concussion: A Systematic Review
Ashley L. Santo, Melissa L. Race, and Elizabeth F. Teel
Traumatic brain injury (TBI) is a public health concern. TBI is common in sports and can be difficult to diagnose. Concussion, a form of mild traumatic brain injury (mTBI), can be defined as “a complex pathophysiological process” 1 in which damage occurs to the brain, causing a wide variety of
Exercise Parameters for Postconcussion Symptom Rehabilitation: A Systematic Review
Kannan Singaravelu Jaganathan, Karen A. Sullivan, Sally Kinmond, Sara Berndt, Steve Street, Catherine Haden, Jaimi Greenslade, Katie McMahon, Gary Mitchell, and Graham Kerr
an expert librarian (Haden). Evidence Acquisition A combination of subject headings and keywords on mild traumatic brain injury, PCSs, and exercise were searched in the following databases from inception to June 2022: CINAHL (EBSCOhost), PsycINFO (EBSCOhost), MEDLINE (Ovid), Embase (Embase
Dietary Supplements for Health, Adaptation, and Recovery in Athletes
Eric S. Rawson, Mary P. Miles, and D. Enette Larson-Meyer
these compounds could be recommended to athletes. Abbreviations: CFU = colony forming units; DOMS = delayed onset muscle soreness; GIT = gastrointestinal tract; mTBI = mild traumatic brain injury; PCr = phosphorylcreatine; PTH = parathyroid hormone; RDA = recommended dietary allowance; URTI = upper
Consequences of Sport-Related Concussion on Health-Related Quality of Life in Adolescents: A Critically Appraised Topic
Mary Margaret Williamson and Jessica Wallace
HRQoL that have been studied previously in pediatric concussion or mild traumatic brain injury populations include cognitive, physical, psychosocial, school, sleep, and overall or general HRQoL. 8 A systematic review of adolescents with SRCs found that a subgroup of adolescents who were diagnosed with
The Nocebo Effect and Pediatric Concussion
Michael W. Kirkwood, David R. Howell, Brian L. Brooks, Julie C. Wilson, and William P. Meehan III
that he has edited that cover TBI-related topics: (1) Mild Traumatic Brain Injury in Children and Adolescents, (2) Validity Testing in Child and Adolescent Assessment, and (3) Neuropsychology Study Guide & Board Review (First and Second Editions) . Dr D.R.H. has received research support from the