Factors Associated With Return to Activity After Concussion Among Female Service Academy Members: Findings From the NCAA-DoD CARE Consortium.

Introduction: Service academy members are at high risk for concussions as a result of participation in both sports and military-specific training activities. Approximately 17% of active duty service members are female, and they face unique challenges in achieving timely recovery from concussions. Understanding the unique characteristics affecting return to unrestricted activity (RTA) among female service academy members is imperative for the ever-growing proportion of females across the U.

Comparison of Urban versus Industry Normative Values of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT™).

Unlabelled: Concussion baseline testing has been advocated for the assessment of pre-morbid function. When individual baseline scores are unavailable, utilizing normative values is recommended. However, the validity of generalizing normative data across multiple socioeconomic environments is unknown.

The Effect of Social Determinants of Health on Clinical Recovery Following Concussion: A Systematic Review.

Context: Concussion evaluations include a multifaceted approach; however, individual differences can influence test score interpretations and validity. Social determinants of health (SDoH) differentially affect disease risk and outcomes based upon social and environmental characteristics. Efforts to better define, diagnose, manage, and treat concussion have increased, but minimal efforts have focused on examining SDoH that may affect concussion recovery.

Sex Differences in Recovery Trajectories of Assessments for Sport-Related Concussion Among NCAA Athletes: A CARE Consortium Study.

Objectives: The purpose of this study was to determine sex differences in recovery trajectories of assessments for sport-related concussion using Concussion Assessment, Research and Education (CARE) Consortium data.

Methods: National Collegiate Athletic Association athletes (N = 906; 61% female) from sex-comparable sports completed a pre-season baseline assessment and post-sport-related concussion assessments within 6 h of injury, 24-48 h, when they initiated their return to play progression, when they were cleared for unrestricted return to play, and 6 months post-injury. Assessments included the Standardized Assessment of Concussion, Balance Error Scoring System, Brief Symptom Inventory-18, Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), Sport Concussion Assessment Tool-3 symptom evaluation, Clinical Reaction Time, King-Devick test, Vestibular Ocular Motor Screen, 12-item Short-Form Health Survey, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale.

Initial Mild Traumatic Brain Injury Characteristics and Recovery Patterns Among Females Across the United States Military Service Academies: A Report from the NCAA-DoD CARE Consortium.

Mild traumatic brain injury (mTBI) has been described in the United States (US) military service academy cadet population, but female-specific characteristics and recovery outcomes are poorly characterized despite sex being a confounder. Our objective was to describe female cadets' initial characteristics, assessment performance, and return-to-activity outcomes post-mTBI. Female cadets (n = 472) from the four US military service academies who experienced a mTBI completed standardized mTBI assessments from pre-injury to acute initial injury and unrestricted return-to-duty (uRTD).

Postinjury Outcomes After Non-Sport-Related Concussion: A CARE Consortium Study.

Context: Concussion research has primarily focused on sport-related mechanisms and excluded non-sport-related mechanisms. In adult populations, non-sport-related concussions (non-SRCs) demonstrated worse clinical outcomes compared with sport-related concussions (SRCs); however, investigations of non-SRCs in college-aged patients are limited.

Objectives: To examine clinical outcomes in collegiate athletes with non-SRCs compared with SRCs and explore sex differences in outcomes among collegiate athletes with non-SRCs.

The Influence of Athletic Identity on Mental Health Symptoms During Retirement From Sport.

Clinical Scenario: Athletic identity (AI) can be defined as, "the degree to which an individual identifies with an athlete role, and the values, and social networks associated with that identity," and can pose a problem when athletes do not explore themselves outside of sport. This lack of identity development beyond athletics has the potential to lead to the development of a high AI. High AI in athletes can have positive effects in areas such as performance, however, high AI may also pose negative consequences.

Concussion education for youth athletes using Pre-Game Safety Huddles: a cluster-randomised controlled trial.

Objectives: Determine whether Pre-Game Safety Huddles, a novel and low-resource approach to concussion education, increase the expected likelihood of concussion reporting for youth athletes.

Methods: A cluster-randomised trial compared Safety Huddles to usual care. Safety Huddles bring together athletes and coaches from both teams before the start of each game for coaches to briefly affirm the importance of speaking up if a concussion is suspected.

Stakeholder-Engaged Development of a Theory-Driven, Feasible, and Acceptable Approach to Concussion Education.

Concussion education is widely mandated and largely ineffective. Recent consensus guidance on concussion education asserts the importance of (1) theory-driven programming that targets the team as a system and (2) working with end users throughout the development process, and considering issues such as feasibility, acceptability, and sustainability. Consistent with this guidance, and in collaboration with youth sport stakeholders in two regions of the United States, we developed a novel approach to concussion education: Pre-game safety huddles.

Development of a scale to measure expected concussion reporting behavior.

Background: Most concussion education aims to increase athlete self-report of concussive symptoms. Although the population burden of concussion is high, frequency with which this injury occurs on a given sports team in a given season is relatively low. This means that powering concussion education evaluation studies to measure change in post-injury symptom reporting behavior requires what is often a prohibitively large sample size.

Increasing the Availability of Automated External Defibrillators at Sporting Events: A Call to Action from the American College of Sports Medicine.

Given that most sudden cardiac arrests (SCAs) occur outside of a medical facility, often in association with exercise and sporting events, and given that early cardiopulmonary resuscitation (CPR) plus defibrillation is the strongest predictor of survival from SCA, this Call to Action from the American College of Sports Medicine recommends increasing the availability and effectiveness of early CPR plus defibrillation so that the time from collapse-to-first automated external defibrillator shock is less than 3 min.

Factors Influencing Concussion Reporting Intention in Adolescent Athletes.

Clinical Scenario: Concussions are severely underreported, with only 47.3% of high school athletes reporting their concussion. The belief was that athletes who were better educated on the signs and symptoms and potential dangers of concussion would be more likely to report.

Does Anxiety Affect Neuropsychological Assessment in College Athletes?

Clinical Scenario: Anxiety is a mental disorder that affects a large portion of the population and may be problematic when evaluating brain injuries such as concussion. The reliance of cognitive testing in concussion protocols call for the examination of potential cognitive alterations commonly seen in athletes with anxiety. Focused Clinical Question: Does anxiety affect neuropsychological assessments in healthy college athletes? Summary of Key Findings: Three studies were included: 1 cross-sectional study and 2 prospective cohort studies.

The effect of acute pain on executive function.

Background And Aim: Executive functions are high-level cognitive processes that allow a person to success-fully engage in an independent and self-fulfilling life. Previous literature indicates that chronic pain can affect executive function, but there are limited studies that investigate the effect of acute pain on executive function. The purpose of this study was to determine if acute pain affects executive function in recreationally active indi-viduals who sustained a musculoskeletal injury.

An Examination of Adolescent Athletes and Nonathletes on Baseline Neuropsychological Test Scores.

Context:   An estimated 15.3 million adolescent students are enrolled in US high schools, with approximately 7.8 million participating in athletics.

Psychological Impact of Cognitive Rest Following Sport-Related Concussion on Low Socioeconomic Status Adolescent Patients.

Purpose: Describe the psychological impact of cognitive rest in adolescents recovering from concussion from sport-related concussion.

Methods: Eight male football players with a previous sport concussion and full recovery completed semi-structured interviews during focus group sessions. Using content analysis, the researchers independently analyzed notes and transcriptions to identify themes associated with the psychological impact of cognitive rest.

The Role of Gender in Neuropsychological Assessment in Healthy Adolescents.

Context: Research in college athletes has revealed significant gender differences in areas of verbal memory, visual memory, and reaction time. Additionally, research has focused on differences in neuropsychological components and gender in college populations; however, such differences in gender have not been documented in healthy adolescent populations.

Purpose: To identify potential differences between males and females using different components of a common computerized neuropsychological test.

The Effectiveness of Cervical Strengthening in Decreasing Neck-Injury Risk in Wrestling.

Clinical Scenario: In wrestling, athletes often support a large amount of weight on their heads or are forced into extreme ranges of motion. These suboptimal movement conditions lead to a high prevalence of neck injuries in wrestlers. A large portion of the work done by the cervical musculature in wrestling is theorized to be eccentric or isometric types of contractions.

Concussion assessment and management.

Sport-related concussions are becoming common place in athletics and daily activity. Proper assessment and management of concussions are crucial, as repeat concussion can result in prolonged symptoms and catastrophic outcomes. New research is changing the way concussions are managed.

The reliability of the modified Balance Error Scoring System.

Objective: Study 1 investigated the intraclass reliability and percent variance associated with each component within the traditional Balance Error Scoring System (BESS) protocol. Study 2 investigated the reliability of subsequent modifications of the BESS.

Design: Prospective cross-sectional examination of the traditional and modified BESS protocols.

Age-related differences in neuropsychological testing among high school athletes.

Context: Clinicians have questioned the need to obtain annual baseline neuropsychological tests in high school athletes. If no difference among academic grades exists, annual baseline testing may not be necessary.

Objective: To examine differences at baseline testing on pencil-and-paper neuropsychological tests among grade levels in high school athletes.

The effect of effort on baseline neuropsychological test scores in high school football athletes.

Objective: Poor effort on baseline neuropsychological tests is expected to influence interpretation of post-concussion assessment scores. Our study examined effort in an athletic population to determine if poor effort effects neuropsychological test performance.

Methods: High school athletes (N=199) were administered a brief neuropsychological test battery, which included the Dot Counting Test (DCT) and the Rey 15-Item Test with recognition trial.