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Caroline Westwood, Carolyn Killelea, Mallory Faherty and Timothy Sell

index; VSI, vertical stability index. Discussion The association between concussion and lower-extremity injury suggests the need for an assessment specific to post-concussion RTS decisions. Therefore, a test to reliably measure both static and dynamic postural stability paired with cognitive function

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Krista M. Hixson, Alex N. Allen, Andrew S. Williams and Tamara C. Valovich McLeod

Clinical Scenario:

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.

Clinical Question:

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.

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Kelsey Logan

Edited by Verle Valentine

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

the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT; Lovell, Collins, Podell, Powell, & Maroon, 2000 ), both before his previous season started, as well as following his recent concussion, the results of these evaluations were discussed. Specifically, Trent was able to meet his

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Jay L. Alberts and Susan M. Linder

The acute and long-term effects of concussive and subconcussive head impacts on brain health have gained tremendous attention over the past five years. The treatment and management of concussion involves multiple providers from multiple disciplines and backgrounds. Varied backgrounds and approaches to assessing cognitive and motor function before and post-concussion are limiting factors in the efficient and effective management of concussion as discipline-specific rating scales and assessments serve as a barrier to effective patient hand-offs between providers. Combining principles of motor behavior with biomechanical approaches to data analysis has the potential to improve the continuity of care across the multiple providers managing athletes with concussion. Biomechanical measures have been developed and validated using mobile devices to provide objective and quantitative assessments of information processing, working memory, set switching, and postural stability. These biomechanical outcomes are integral to a clinical management algorithm, the Concussion Care Path, currently used across the Cleveland Clinic Health System. The objective outcomes provide a common data set that all providers in the spectrum of care can access which facilitates communication and the practice of medicine and in understanding the acute and long-term effects of concussion and subconcussive exposure on neurological function.

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Tracey Covassin, Bryan Crutcher, R.J. Elbin, Scott Burkhart and Anthony Kontos

The present study explored the relationship of neurocognitive performance and symptoms to coping responses at 3 and 8 days postconcussion. A total of 104 concussed athletes (M = 16.41, SD = 2.19 years) completed the Immediate Post Concussion Assessment Cognitive Testing (ImPACT) at baseline and the ImPACT and Brief Cope inventory at 3 and 8 days postconcussion. Concussed athletes reported more frequent use of selfdistraction, behavioral disengagement, religion, and self-blame 3 days postconcussion compared with 8 days. Concussed athletes reported more use of avoidance coping at 3 days than 8 days (Wilks’s Lambda =.95, F [1, 100] =4.71, p = .032, η2=.046) post-injury. Total symptoms were also a significant (p = .001) predictor of avoidance coping 3 days postconcussion and decreased visual memory was associated with increased avoidance coping (p = .03) 8 days post-injury. Time since injury likely impacts neurocognitive performance, symptomology, and coping. Clinicians should be aware of higher reported symptoms early and lingering visual memory deficits 1-week post-injury.

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Alicia M. Kissinger-Knox, Nicole J. Norheim, Denise S. Vagt, Kevin P. Mulligan and Frank M. Webbe

; (b) athlete independently self-reporting via completion of computerized symptom checklist as with the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) 5 ; (c) completion of PCSS items in response to inquiry by clinician in a structured interview format, and (d) responses to clinician

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Mindi Fisher, Ryan Tierney, Anne Russ and Jamie Mansell

/22 PEDro 14/22 Support for the Answer? No No Yes Abbreviations: ADHD = attention deficit hyperactivity disorder; Child-SCAT3 = Sport Concussion Assessment Tool, 3rd Edition for Children; ImPACT = Immediate Post-Concussion Assessment and Cognitive Testing; LD = learning difficulties; SAC-C = Standardized

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Nicholas Hattrup, Hannah Gray, Mark Krumholtz and Tamara C. Valovich McLeod

-ocular and cervicogenic post-concussion disorders: an evidence-based classification system with directions for treatment . Brain Inj . 2015 ; 29 ( 2 ): 238 – 248 . PubMed ID: 25314613 doi: 10.3109/02699052.2014.965207 25314613 10. Schneider KJ , Leddy JJ , Guskiewicz KM , et al . Rest and

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

-disciplinary management of athletes with post-concussion syndrome: an evolving pathophysiological approach . Front Neurol . 2016 ; 7 : 136 . PubMed ID: 27605923 doi:10.3389/fneur.2016.00136 27605923 10.3389/fneur.2016.00136 6. Leddy JJ , Willer B . Use of graded exercise testing in concussion and return