Recognizing the Symptoms of Mental Illness following Concussions in the Sports Community: A Need for Improvement

Exploring Gaps in Concussion Knowledge and Knowledge Translation Among Coaches of Youth Female Hockey

OBJECTIVE

To better understand the level of concussion knowledge of youth female hockey coaches and to identify preferred methods of knowledge translation for this population.

DESIGN

Cross-sectional survey.

SETTING

Participants independently completed written surveys before in-person concussion information sessions or online surveys through link provided in emails.

PARTICIPANTS

Convenience sampling yielded 130 coaches of youth female hockey from Canada.

MAIN OUTCOME MEASURES

Knowledge level on concussion, resources from which coaches obtained information on concussion, opinions on the current level of concussion knowledge, and knowledge translation.

RESULTS

Coaches demonstrated adequate knowledge on concussion, achieving 84% correct on true-false questions and 92% correct on symptom identification accuracy. However, coaches showed limited awareness of concussion specific to mechanisms for injury (identification) and postconcussion symptoms. Internet resources were rated as the most used resources for concussion yet were not rated very helpful. Nonetheless, coaches indicated online courses and web sites as the most preferred method for concussion knowledge translation.

CONCLUSIONS

Youth female hockey coaches have overall adequate knowledge of concussion; however, gaps in knowledge do exist. Future efforts to raise the concussion knowledge among coaches of female youth hockey should include information specific to the mechanism of injury, along with sign and symptom identification, with particular attention paid to emotional symptoms. Given the reported preferences and the widespread availability of the Internet, further exploration and research validation of online courses and web sites tailored to the youth female hockey community is encouraged.

Assessing concussion knowledge and awareness in faculty and staff in a collegiate setting

Purpose

To examine faculty and academic support staff members’ awareness and knowledge regarding concussions.

Design

Cross-sectional, web-based questionnaire.

Setting

Division II collegiate setting.

Subjects

A total of 123 collegiate faculty, administrative and academic support staff participated in the study. Measure(s): Participants completed the Faculty and Staff Concussion Awareness and Knowledge Survey. Analysis: Descriptive statistics were compiled for demographic information within the survey. Analysis of variance was performed on concussion awareness and concussion knowledge survey questions.

Results

The majority of the sample had teaching responsibilities in the University (75%). There was a significant effect of college departments within the university on individuals’ level of awareness (F (5, 117) = 9.74, p < .001). The Athletics department scored the highest in awareness of concussion symptomology, while the Business department scored the lowest. Females demonstrated significantly more awareness of concussion symptoms than males (F (1, 121) = 10.488, p = .002). University department significantly impacted knowledge of concussion treatments (F (5, 117) = 3.67, p < .004). The Health Sciences department scored the highest in knowledge of concussion treatments, while the Business department scored the lowest. Past experience with academic accommodations was associated with respondents’ knowledge of concussion treatment (F (1, 121) = 4.046, p = .047).

Conclusions

Concussion management in a collegiate setting should include the faculty and academic support staff. Colleges and Universities should consider educational programming regarding etiology and recovery from concussions for effective management when student experience a concussion.

Mental Health in Equestrian Sport

Equestrian media is showing an increasing interest in the impact of mental health on performance and general wellbeing of equestrian athletes. This study explores the awareness of mental health difficulties and psychological wellbeing within equestrian sport from the perspectives of equestrian athletes, instructors/coaches and parents. The exploratory nature of the research offered opportunity to use a dual approach including e-surveys and semi-structured interviews. Analysis of the qualitative data identified five key themes (Emotional WellbeinginBalance; Emotional WellbeingImbalance; WellbeingImbalance—Impact on Equestrian Sportspeople; Impact of Equestrian Sport on Wellbeing; Regaining Balance) and 22 sub-themes. The findings determine a compelling need for education, promotion of sharing experiences, facilitation of specialist (clinical and sport) professional training and intervention as well as a review of regulations from equestrian Governing Bodies.

Exploring Sex-Based Differences in Concussion Knowledge, Attitudes and Resources in Young First Nations Hockey Players: A Cross-Sectional Survey from Ontario, Canada

Objective:

Indigenous youth are vulnerable to concussion when playing hockey. A clear characterisation of sex differences among Indigenous youth could assist in tailoring future education programmes for prevention and management of concussion. The purpose of this study was to compare and contrast concussion knowledge, attitudes and resources in First Nations girls and boys playing recreational hockey.

Method:

The cross-sectional survey was conducted in partnership with a First Nations’ chief, other Indigenous community leaders and a tertiary care head injury clinic. In Canada, researchers engaging with Indigenous peoples are expected to adhere to principles of Ownership, Control, Access and Possessions. The study included Indigenous boys and girls between the ages of 10 and 18 years of age.

Results:

More girls attending the hockey tournament participated in the study as compared to boys (girlsn= 46, boysn= 29). More girls reported they had never experienced a concussion (73.9%), as compared to boys (58.6%) self-reports. Less than half of all study participants were able to identify some signs and symptoms of concussion such as vomiting/nausea, memory problems, fatigue and blurred vision and recognition of several concussion symptoms varied by sex.

Conclusions:

We created a unique partnership between Indigenous leaders and tertiary care clinic staff. Among Indigenous youth reasons for not reporting concussion symptoms to the coach varied by sex (although not reaching statistical significance), suggesting concussion education warrants tailoring for girls and boys.

Pros and Cons of 19 Sport-Related Concussion Educational Resources in Canada: Avenues for Better Care and Prevention

Objective: The goal of this research was to assess the effectiveness of available concussion educational resources in Canada, the means used to disseminate this knowledge and the impact of these educational resources on players' concussion prevention knowledge. Methods: We assessed concussion knowledge before and after exposure to one or more of 19 resources introduced through a national program aimed to increase awareness and knowledge of concussion. The effectiveness of the mode of delivery was measured by changes in concussion knowledge scores (CKS) between pre and pro scores. Measures: Concussion knowledge scores (CKS) were calculated for pre- and post- exposure to concussion educational resources and used as a measure of both, the effectiveness of each resource as well as the effectiveness of the delivery method. The effectiveness of each educational resource was also measured by the respondents' rating of each concussion educational resource. Results: Respondents in post-survey had higher CKS than those in pre-survey. Two out of the 19 newly developed concussion educational resources were effective in improving the resource users' CKS. Linear regression showed that using more resources further increased CKS. Four out of six modes of delivery enhanced respondents' concussion knowledge. Conclusion: Our findings demonstrate that the newly developed Canadian concussion educational resources were effective at improving users' concussion knowledge. Our data demonstrates that using three or more resources further enhanced the users' concussion knowledge. Future research, however, is critical to assess whether concussion prevention knowledge is sufficient to reduce injuries and factors influencing it.

Concussions in Sledding Sports and the Unrecognized "Sled Head": A Systematic Review

Background: Sport-related concussion is a significant public health concern. Little research has been conducted on sport-related concussion and injury prevention strategies in competitive sledding sports like bobsleigh, luge, and skeleton. Athletes have identified “sled head” as a key concern due to its symptom burden.

Purpose: To summarize our knowledge of the prevalence of concussion and related symptoms in sledding sports; to utilize Haddon's Matrix to inform and define strategies for injury prevention.

Methods: An independent information specialist conducted a search for the known literature on injuries in non-recreational sledding sports, and specifically for concussion via OVID Medline, CINAHL, the Cochrane Database, EMBASE, PsycInfo, PubMed, Scopus, and the Web of Sciences from 1946 to December 2017. After iterative searches of reference sections, a total of 844 articles were assessed for inclusion.

Results: Nine articles were included for review. Concussions are a common occurrence in elite sledding sport athletes, affecting 13-18% of all sledding athletes. Significant variance exists between events, indicating a potential effect of the ice track in injury risk. The condition known as “sled head” is discussed and identified as a key point of further investigation. A number of potential injury prevention strategies are discussed.

Interpretation: Head injuries and concussions are an important injury for elite sledding sports and a number of avenues exist for prevention. More work is required to delineate the mechanisms, characteristics, natural history and management of “sled head.”

Using Community Detection Analysis to Elucidate Caregivers’ Mental Models of Pediatric Concussion Symptoms

Due to a culture of resistance around concussion reporting, novel methods are needed to reveal implicit beliefs that could affect symptom reporting. The goal of this study was to elucidate caregivers’ mental models of pediatric concussion symptoms using an exploratory community detection analysis (CDA). Caregivers (n = 76) of adolescents 10–15 years old participated in a survey that assessed their intentions of seeking medical treatment for 12 injury symptoms following their child’s involvement in three hypothetical injury scenarios. We used a series of analyses of variance (ANOVAs) to compare injury symptoms across these scenarios and CDA to determine if caregivers implicitly group symptoms together. We then used logistic regressions to further explore associations between the CDA-identified symptom indices and known factors of injury risk. There were no differences in the likelihood to seek treatment for symptoms across injury scenarios; however, the CDA revealed distinct symptom clusters that were characterized by the degree of risk for non-treatment and symptom type. We observed associations between injury risk factors and intentions of seeking medical treatment for the higher-risk indices. Results indicate that caregivers’ mental models of concussion symptoms are nuanced, not monolithic. Therefore, it is inaccurate to measure intentions to seek treatment for concussion without taking these nuances into consideration.

Twitter and traumatic brain injury: A content and sentiment analysis of tweets pertaining to sport-related brain injury

Objectives:

Sport-related traumatic brain injuries are a significant public health burden, with hundreds of thousands sustained annually in North America. While sports offer numerous physical and social health benefits, traumatic brain injuries such as concussion can seriously impact a player’s life, athletic career, and sport enjoyment. The culture in many sports encourages winning at all costs, placing athletes at risk for traumatic brain injuries. As social media has become a central part of everyday life, the content of users’ messages often reflects the prevailing culture related to a particular event or health issue.

Methods:

We hypothesized that Twitter data might be useful for understanding public perceptions and misperceptions of sport-related traumatic brain injuries. We performed a content and sentiment analysis of 7483 Twitter^® tweets related to traumatic brain injuries in sports collected during June and July 2013.

Results:

We identified five major themes. Users tweeted about personal traumatic brain injuries experiences, reported traumatic brain injuries in professional athletes, shared research about sport-related concussions, and discussed policy and safety in injury prevention, such as helmet use. We identified mixed perceptions of and sentiment toward traumatic brain injuries in sports: both an understanding that brain injuries are serious and disregard for activities that might reduce the public burden of traumatic brain injuries were prevalent in our Twitter analysis.

Conclusion:

While the scientific and medical community considers a concussion a form of traumatic brain injuries, our study demonstrates a misunderstanding of this fact among the public. In our current digital age, social media can provide useful insight into the culture around a health issue, facilitating implementation of prevention and treatment strategies.

Head-Eye Vestibular Motion Therapy Affects the Mental and Physical Health of Severe Chronic Postconcussion Patients

Context

Approximately 1.8–3.6 million annual traumatic brain injuries occur in the United States. An evidence-based treatment for concussions that is reliable and effective has not been available.

Objective

The objective of this study is to test whether head–eye vestibular motion (HEVM) therapy is associated with decreased symptoms and increased function in postconcussive syndrome (PCS) patients that have been severely impaired for greater than 6 months after a mild traumatic brain injury.

Design

Retrospective clinical chart review.

Setting and participants

Tertiary Specialist Brain Rehabilitation Center.

Interventions

All subjects underwent comprehensive neurological examinations including measurement of eye and head movement. The seven modules of the C3 Logix Comprehensive Concussion Management System were used for pre- and postmeasurements of outcome of HEVM therapy.

Materials and methods

We utilized an objective validated measurement of physical and mental health characteristics of our patients before and after a 1-week HEVM rehabilitation program. We included only PCS patients that were disabled from work or school for a period of time exceeding 6 months after suffering a sports concussion. These subjects all were enrolled in a 5-day HEVM rehabilitation program at our Institutional Brain Center with pre- and post-C3 Logix testing outcomes.

Results

There were statistical and substantive significant decreases in PCS symptom severity after treatment and statistical and substantive significant increases in standardized assessment of concussion scores. The outcomes were associated with positive changes in mental and physical health issues. This is a retrospective review and no control group has been included in this study. These are major limitations with retrospective reviews and further investigations with prospective designs including a randomized controlled study are necessary to further our understanding.

Conclusion

Head–eye vestibular motion therapy of 5 days duration is associated with statistical and substantive significant decreases of symptom severity associated with chronic PCS.

Evaluating the test-retest reliability of symptom indices associated with the ImPACT post-concussion symptom scale (PCSS)

OBJECTIVE

The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a commonly used tool in sports concussion assessment. While test-retest reliabilities have been established for the ImPACT cognitive composites, few studies have evaluated the psychometric properties of the ImPACT's Post-Concussion Symptom Scale (PCSS). The purpose of this study was to establish the test-retest reliability of symptom indices associated with the PCSS.

PARTICIPANTS AND METHODS

Participants included 38 undergraduate students (50.0% male) who underwent neuropsychological testing as part of their participation in their psychology department's research subject pool. The majority of the participants were Caucasian (94.7%) and had no history of concussion (73.7%). All participants completed the ImPACT at two time points, approximately 6 weeks apart. The PCSS was the main outcome measure, and eight symptom indices were calculated (a total symptom score, three symptom summary indices, and four symptom clusters).

RESULTS

Pearson correlations (r) and intraclass correlation coefficients (ICCs) were computed as measures of test-retest reliability. Overall, reliabilities ranged from low to high (r = .44 to .80; ICC = .44 to .77). The cognitive symptom cluster exhibited the highest test-retest reliability (r = .80, ICC = .77), followed by the positive symptom total (PST) index, an indicator of the total number of symptoms endorsed (r = .71, ICC = .69). In contrast, the commonly used total symptom score showed lower test-retest reliability (r = .67, ICC = .62). Paired-samples t tests revealed no significant differences between test and retest for any of the symptom variables (all p > .01). Finally, reliable change indices (RCI) were computed to determine whether differences observed between test and retest represented clinically significant change. RCI values were provided for each symptom index at the 80%, 90%, and 95% confidence intervals.

CONCLUSION

These results suggest that evaluating additional symptom indices beyond the total symptom score from the PCSS is beneficial. Findings from this study can be applied to athlete samples to assess reliable change in symptoms following concussion.

Factors affecting the concussion knowledge of athletes, parents, coaches, and medical professionals

OBJECTIVES

To determine the predictors of knowledge and awareness of concussion symptoms and outcomes through a survey of athletes, parents of players and coaches in sports settings in Canada.

METHODS

A cross-sectional survey of athletic communities in Canada was conducted. Respondents' concussion knowledge score consists of responses to questions about the symptoms, diagnosis, and treatment of a concussion and the timing of return-to-sport post-concussion. The percentage of correct responses was defined as the "identification rate." The extent to which participant factors affected the scores was examined by univariate and multivariate analyses.

RESULTS

Respondents were able to identify a mean of 80.6% of symptoms. Cognitive symptoms were most commonly known, and mental health symptoms associated with concussion were least known, and health professionals, coaches, and those with a personal history of concussion had the highest levels of overall knowledge. Language, age, educational level, annual household income, and traumatic brain injury history were good predictors of better concussion knowledge.

CONCLUSION

Those designing and implementing interventions aimed at concussion management and prevention should ensure that younger, lower income, lower educational, non-English-speaking persons, and those without experience of traumatic brain injury or concussion be specifically accounted for in the design and implementation of interventions to prevent and treat concussion and mild traumatic brain injury.