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Waltzman D, Peterson AB, Chang D, Daugherty J. Description of School Outcomes Among Children With Traumatic Brain Injuries, Centers for Disease Control and Prevention's National Concussion Surveillance System Pilot. THE JOURNAL OF SCHOOL HEALTH 2025; 95:227-234. [PMID: 39721803 DOI: 10.1111/josh.13532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 11/18/2024] [Accepted: 11/24/2024] [Indexed: 12/28/2024]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a common injury in children. Though research on youth TBI has largely focused on high school students, this study describes selected school outcomes after TBI in the past 12 months among children aged 5-17 years. METHODS Data from parent-proxy respondents from the pilot administration of the National Concussion Surveillance System (a random-digit-dial telephone survey with over 10,000 adult respondents) were examined. Descriptive statistics of demographic and injury characteristics of children who sustained a TBI were calculated. The association between TBI signs/symptoms and selected school outcomes were determined by multinomial logistic regressions. RESULTS Among the 3557 children sampled via parent-proxy-reporting, 9.9% sustained a TBI in the past year. Changes in sleep or being more tired than usual, trouble concentrating, sensitivity to light or noise, and difficulty learning or remembering new things were associated with a greater risk of worse school outcomes following a TBI. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY To promote a positive return to learn (RTL) experience among children following TBI, school districts may prioritize accommodations (e.g., breaks in learning, extra time for assignments) and implement existing ascending levels of academic support where warranted. CONCLUSION These findings may inform stakeholders seeking to enhance RTL and provide needed support or services for school-aged children who sustain a TBI.
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Affiliation(s)
- Dana Waltzman
- Division of Injury Prevention, Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Atlanta, Georgia, USA
| | - Alexis B Peterson
- Division of Injury Prevention, Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Atlanta, Georgia, USA
| | - Daniel Chang
- Division of Injury Prevention, Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Atlanta, Georgia, USA
| | - Jill Daugherty
- Division of Injury Prevention, Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Atlanta, Georgia, USA
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Kramer A, Foley J, Hansen C, Teramoto M. Parent-Reported Academic Outcomes After a Mild Traumatic Brain Injury in the Pediatric Population. THE JOURNAL OF SCHOOL HEALTH 2025; 95:5-16. [PMID: 39103203 PMCID: PMC11739546 DOI: 10.1111/josh.13502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/29/2024] [Accepted: 07/15/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Millions of children are diagnosed with a traumatic brain injury (TBI) each year, most being mild TBI (mTBI). The effect of mTBIs on academic performance is of significant importance. We investigate mTBI's impact on parent-reported academic outcomes in school-aged pediatric participants. METHODS This cross-sectional survey study queried parents (N = 285) regarding letter grade performance and the presence or absence of academic accommodations before and after an mTBI, including complicated mTBI (c-mTBI, or mTBI with radiographic abnormality). RESULTS We found a parent-reported decline in letter grades following c-mTBI (p < .001), with no significant change following uncomplicated mTBIs. Degree and length of recovery were also associated with grade changes (p < .05). Those with no academic accommodations prior to the injury showed significant decreases in grades after injury regardless of post-injury accommodation status (p < .05). IMPLICATIONS OF SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY This study underscores the need for an improved framework of support to maximize academic performance of children following mTBI, especially in those with a c-mTBI and still recovering from their injury. CONCLUSION Our study identifies children who are at risk for adverse academic outcomes following mTBI. We encourage efforts to better support school nurses in this effort, including improved communication between health care teams and school teams.
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Roberts J, Wilson JC, Halstead ME, Miller SM, Santana JA, McLeod TCV, Zaslow TL, Master CL, Grady MF, Snedden TR, Fazekas ML, Coel RA, Howell DR. Variables associated with days of school missed following concussion: results from the Sport Concussion Outcomes in PEdiatrics (SCOPE) study. PHYSICIAN SPORTSMED 2024; 52:592-600. [PMID: 38648009 PMCID: PMC11493847 DOI: 10.1080/00913847.2024.2344435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To understand factors associated with missed academic time after concussion to improve support for patients. Our goal was to assess patient-specific predictors of total school time lost after pediatric/adolescent concussion. STUDY DESIGN We performed a prospective cohort study of children and adolescents (8-18 years of age) seen within 14 days of concussion from seven pediatric medical centers across the United States. We collected outcomes via the Concussion Learning Assessment & School Survey (CLASS) and constructed a multivariable predictive model evaluating patient factors associated with school time loss. RESULTS 167 patients participated (mean age = 14.5 ± 2.2 years; 46% female). Patients were assessed initially at 5.0 ± 3.0 days post-injury and had a final follow-up assessment 24.5 ± 20.0 days post-concussion. Participants missed a median of 2 days of school (IQR = 0.5-4), and 21% reported their grades dropped after concussion. Higher initial symptom severity rating (β = 0.06, 95% CI = 0.03-0.08, p < 0.001) and perception of grades dropping after concussion (β = 1.37, 95% CI = 0.28-2.45, p = 0.01) were significantly associated with more days of school time missed after concussion. Those who reported their grades dropping reported missing significantly more school (mean = 5.0, SD = 4.7 days missed of school) than those who reported their grades did not drop (mean = 2.2, SD = 2.6 days missed of school; p < 0.001; Cohen's d = 0.87). CONCLUSIONS Children and adolescents reported missing a median of 2 days of school following concussion, and more missed school time after a concussion was associated with more severe concussion symptoms and perception of grades dropping. These findings may support recommendations for minimal delays in return-to-learn after concussion.
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Affiliation(s)
- Jeremy Roberts
- Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Julie C. Wilson
- Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Mark E. Halstead
- St. Louis Children’s Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Shane M. Miller
- Scottish Rite for Children and UT Southwestern Medical Center, Dallas, TX, USA
| | - Jonathan A. Santana
- Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | | | - Christina L. Master
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Matthew F. Grady
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Traci R. Snedden
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | | | - Rachel A. Coel
- Kapi’olani Medical Center for Women and Children, University of Hawai’i John A. Burns School of Medicine, Honolulu, HI, USA
| | - David R. Howell
- Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
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Shata AR, Shata AR, Bogari DF, Alhazzazi TY. The Impact of Sports Injuries on the Academic Performance and Mental Health of High School Students in Jeddah. Cureus 2024; 16:e73912. [PMID: 39559437 PMCID: PMC11572598 DOI: 10.7759/cureus.73912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2024] [Indexed: 11/20/2024] Open
Abstract
Objectives This study aimed to investigate the effects of sports injuries on the academic performance and mental health of high school students in Jeddah. Materials and methods This cross-sectional study utilized a closed-ended electronic questionnaire (e-questionnaire) sent to students from four international high schools in Jeddah. The e-questionnaire included questions assessing the level of academic courses, the frequency and types of sports injuries encountered, and the impact of these injuries on both academic performance and mental health. The chi-square test was used to establish relationships between categorical variables, with a p-value threshold of <0.05 determining statistical significance. Results Of the 117 high school students who participated in the study, 56.4% (n=66) were male and 43.6% (n=51) were female. Approximately 83.8% (n=98) of students engaged in sports. Interestingly, 65.0% (n=76) reported experiencing a sports injury during their high school years, with 73.7% (n=56) of these injuries occurring during school-related activities. These sports injuries significantly affected students' academic performance and mental health, impacting 65.8% (n=50) and 76.1% (n=51) of respondents, respectively. Major consequences included delayed assignments (96%, n=48 ), missed exams (88%, n=44), suicidal thoughts (56.9%, n=29), and self-harm thoughts (23.5%, n=12). Surprisingly, only 25.4% (n=17) of students received support from their schools. Furthermore, when support was provided, it was primarily in the form of medical assistance, with a notable lack of mental health support. Conclusion Our study revealed a significant gap in the school support system for students, which requires urgent attention. High school students are highly active and often experience sports-related injuries, particularly during school activities. These injuries can profoundly affect students' academic performance and mental health. Therefore, the findings of our study are essential for raising awareness among students, parents, and teachers about sports injury management. Additionally, although our study focused solely on private international schools, it is crucial for stakeholders in both government and private education sectors to address this issue at a broader level, ensuring adequate support for students facing such injuries. This will help protect the well-being and safety of future students.
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Affiliation(s)
- Alwaleed R Shata
- Medicine, AS Sports Medicine Club, American International School of Jeddah, Jeddah, SAU
| | - Aya R Shata
- Medicine, AS Sports Medicine Club, American International School of Jeddah, Jeddah, SAU
| | - Dania F Bogari
- Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Turki Y Alhazzazi
- Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
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Sicard V, Ledoux AA, Tang K, Yeates KO, Brooks BL, Anderson P, Keightley M, Desire N, Beauchamp MH, Zemek R. The association between symptom burden and processing speed and executive functioning at 4 and 12 weeks following pediatric concussion. J Int Neuropsychol Soc 2024; 30:533-545. [PMID: 38273645 DOI: 10.1017/s1355617724000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVES Symptoms and cognition are both utilized as indicators of recovery following pediatric concussion, yet their interrelationship is not well understood. This study aimed to investigate: 1) the association of post-concussion symptom burden and cognitive outcomes (processing speed and executive functioning [EF]) at 4 and 12 weeks after pediatric concussion, and 2) the moderating effect of sex on this association. METHODS This prospective, multicenter cohort study included participants aged 5.00-17.99 years with acute concussion presenting to four Emergency Departments of the Pediatric Emergency Research Canada network. Five processing speed and EF tasks and the Post-Concussion Symptom Inventory (PCSI; symptom burden, defined as the difference between post-injury and retrospective [pre-injury] scores) were administered at 4 and 12 weeks post-concussion. Generalized least squares models were conducted with task performances as dependent variables and PCSI and PCSI*sex interaction as the main predictors, with important pre-injury demographic and injury characteristics as covariates. RESULTS 311 children (65.0% males; median age = 11.92 [IQR = 9.14-14.21 years]) were included in the analysis. After adjusting for covariates, higher symptom burden was associated with lower Backward Digit Span (χ2 = 9.85, p = .043) and Verbal Fluency scores (χ2 = 10.48, p = .033) across time points; these associations were not moderated by sex, ps ≥ .20. Symptom burden was not associated with performance on the Coding, Continuous Performance Test, and Color-Word Interference scores, ps ≥ .17. CONCLUSIONS Higher symptom burden is associated with lower working memory and cognitive flexibility following pediatric concussion, yet these associations were not moderated by sex. Findings may inform concussion management by emphasizing the importance of multifaceted assessments of EF.
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Affiliation(s)
- Veronik Sicard
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Andrée-Anne Ledoux
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ken Tang
- Independent Statistical Consultant, Richmond, BC, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Brian L Brooks
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Peter Anderson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Mental Health Neuropsychology Program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Michelle Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, TorontoON, Canada
- Departments of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Naddley Desire
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Ste-Justine Hospital Research Center, Montreal, QC, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
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Blaabæk EH, Andersen LH, Fallesen P. From unequal injuries to unequal learning? Socioeconomic gradients in childhood concussions and the impact on children's academic performance. Soc Sci Med 2024; 341:116524. [PMID: 38160605 DOI: 10.1016/j.socscimed.2023.116524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
Previous research identifies stark socioeconomic disparities in child injuries, yet research on the repercussions hereof on other aspects of children's lives remains sparse. This paper tests whether social gradients in minor traumatic brain injuries (mTBIs or concussions) contribute to corresponding inequalities in children's academic performance. Previous research on this topic is mostly based on small samples and confounded by non-random selection into experiencing mTBIs. We improve on prior research by using high quality, large N, administrative registry data. Further, we control for selection into having an mTBI via comparing the test score progression of children having an mTBI with children who experience an mTBI in later years (staggered difference-in-differences). Based on Danish ER/hospital records and national test score data, we find that children from families with lower earnings and less education are more likely to experience an mTBI and that having an mTBI negatively correlates with reading test scores. However, comparing present with future mTBI cases, we show that having an mTBI within a year before a test does not negatively affect children's reading scores. Our findings suggest that negative correlations between mTBIs and academic performance more likely reflect socioeconomic gradients in mTBI incidents rather than a direct causal effect. Further, socioeconomic gradients in mTBI incidents do not significantly contribute to corresponding disparities in academic performance.
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Affiliation(s)
- Ea Hoppe Blaabæk
- ROCKWOOL Foundation Research Unit, Ny Kongens Gade 6, 1472 København, Denmark; Department of Sociology, University of Copenhagen, Øster Farimagsgade 5, 1357, København, Denmark.
| | | | - Peter Fallesen
- ROCKWOOL Foundation Research Unit, Ny Kongens Gade 6, 1472 København, Denmark; Swedish Institute of Social Research, Stockholm University, 106 91, Stockholm, Sweden
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Sudhakaran P. Traumatic Brain Injury: Acupuncture Treatment. Med Acupunct 2023; 35:251-256. [PMID: 37900878 PMCID: PMC10606947 DOI: 10.1089/acu.2023.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Traumatic brain injury (TBI) is a significant cause of morbidity and mortality worldwide. It is estimated that half of the people in the world will experience at least 1 episode of TBI during their lifetimes. While the primary injury to the brain parenchyma is usually irreversible, the secondary effects, which involve cellular dysfunction, derangement of blood flow, and blood-brain barrier changes in ionic flux and elevated levels of free radicals are potentially amenable to treatment. At present, there are no neuroprotective agents in mainstream medicine to interrupt these secondary processes and improve the patient's neurologic outcome. Acupuncture holds promise to fill this gap and scientific evidence to that effect is presented. Sports-related brain injury is discussed in detail.
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Robins L, Taras J, Ippolito C, Reed N. Online youth concussion resources for Canadian teachers and school staff: A systematic search strategy. Brain Inj 2023; 37:1179-1186. [PMID: 36949653 DOI: 10.1080/02699052.2023.2192525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/01/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023]
Abstract
INTRODUCTION Teachers and school staff (i.e., principals, coaches, trainers, educational assistants, guidance counselors, school healthcare professionals, etc.) are well positioned to support students' return-to-school post-concussion. Teachers and school staff may access concussion resources online as they are readily available; however, their quality and accuracy are unknown. OBJECTIVE To identify accurate online concussion resources suitable for Canadian teachers and school staff. METHODS A five-phased systematic search strategy was conducted: 1) initial identification of resources; 2) consultation of pediatric concussion experts; 3) inclusion and exclusion criteria; 4) content review; and, 5) material evaluation. RESULTS A total of 837 resources were identified initially and 40 resources were included in the final list. Across all resources, 310 (37%) resources were excluded as they were not designed primarily for teachers and school staff. Thirty-four (43%) of 80 resources reviewed for content accuracy were excluded. Among resources reviewed for readability, usability and suitability, six (13%) were excluded. CONCLUSIONS The 40 resources identified in this study can enable teachers and school staff to educate themselves about concussion and how to optimally support a student's return-to-school post-concussion.
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Affiliation(s)
- Lauren Robins
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jennifer Taras
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Christina Ippolito
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Nick Reed
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
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Pei Y, Kemp AM, O'Brien KH. Investigating the Student in Returning to Learn After Concussion: A Systematic Review and Meta-Analysis. THE JOURNAL OF SCHOOL HEALTH 2023; 93:594-620. [PMID: 36852558 DOI: 10.1111/josh.13307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/14/2022] [Accepted: 02/05/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE Examine concussion effects on academic outcomes, including student perspectives. METHODS This study included a systematic review and meta-analysis examining post-concussion school attendance, academic performance, perceptions of academic difficulty, and accommodations for students in elementary through college settings. The analysis considered pre- and post-injury factors, along with injury factors that contribute to post-concussion academic outcomes. RESULTS The systematic review showed that students with concussion miss more school days and perceive higher levels of academic difficulty, but results about academic performance varied. Meta-analysis yielded small concussion effects on school absence and academic performance and moderate effects on perceptions of academic difficulty. Female sex, older age, history of migraine, prior concussions, severe or persistent symptoms, vestibular-ocular motor, and cognitive disruptions are risk factors, but these moderators were not identified in the meta-analysis due to lack of effect sizes. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY This study confirmed negative concussion effects on academic absences, performance, and perceptions of academic difficulty. Identified contributing factors will guide future practices to support students returning to learn after concussion. CONCLUSIONS Negative impacts to academics from concussion may be amplified by complicating factors. Future investigations are needed to confirm risk factors and mitigating effects of early identification and post-injury supports.
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Affiliation(s)
- Yalian Pei
- Communication Sciences and Special Education, University of Georgia, 110 Carlton Street, Athens, GA, 30602
| | - Amy M Kemp
- Communication Sciences and Special Education, University of Georgia, 110 Carlton Street, Athens, GA, 30602
| | - Katy H O'Brien
- Communication Sciences and Special Education, University of Georgia, 110 Carlton Street, Athens, GA 30602; Courage Kenny Rehabilitation Institute Allina Health, 800 E 28th St, Minneapolis, MN, 55407
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Fisher M, Wiseman-Hakes C, Obeid J, DeMatteo C. Does Sleep Quality Influence Recovery Outcomes After Postconcussive Injury in Children and Adolescents? J Head Trauma Rehabil 2023; 38:240-248. [PMID: 35997760 DOI: 10.1097/htr.0000000000000811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether objective parameters of sleep quality differ throughout recovery between children and adolescents who experienced an early return to school (RTS) and those who had a delayed RTS or did not return at all during the study period. SETTING Sleep parameters reflective of sleep quality were evaluated in participants' natural sleeping habitat throughout 9 weeks postinjury. PARTICIPANTS Ninety-four children and adolescents (aged 5-18 years) with diagnosed concussion. DESIGN Prospective cohort. Participants followed RTS protocols. MAIN MEASURES Actigraphy-derived estimates of total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), average arousal length (AAL), and number of arousals (NOAs) per hour were assessed. The length of time from injury until RTS was determined for each participant. Participants were categorized into an early RTS or delayed RTS group based on their time to RTS. RESULTS Both TST and SE were significantly greater in the early RTS group. WASO duration, AAL, and NOAs were significantly greater in the delayed RTS group. Differences between RTS groups were most apparent during weeks 1 to 5 postinjury. CONCLUSIONS AND CLINICAL IMPLICATIONS Participants who returned to school earlier had significantly better objective sleep quality than participants who experienced a delayed RTS. This study provides evidence in support of a relationship between sleep quality and time to RTS in children and adolescents with concussion. Considering early monitoring of sleep, education regarding sleep hygiene, and access to age-appropriate sleep interventions may be helpful in pediatric concussion recovery.
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Affiliation(s)
- Michael Fisher
- School of Rehabilitation Science (Mr Fisher and Ms DeMatteo), Department of Speech Language Pathology (Dr Wiseman-Hakes), and Department of Pediatrics (Dr Obeid), McMaster University, Hamilton, Ontario, Canada
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Ippolito C, Cogliano A, Patel A, Shear S, Provvidenza C, Wilson KE, Reed N. Delivering concussion education to pre-service teachers through the SCHOOLFirst website: Evaluating usability and satisfaction. NeuroRehabilitation 2023:NRE220207. [PMID: 37125568 DOI: 10.3233/nre-220207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Return-to-school processes indicate 'when' to initiate activities and 'what' activities should be accomplished, but are missing 'how' to implement the process. The SCHOOLFirst website provides the 'how' through building concussion knowledge, creating a supportive culture and defining roles. Due to the involvement of pre-service teachers in schools during training and imminent transition to becoming teachers, it is important that pre-service teachers are trained in concussion and can optimally support current and future students. OBJECTIVE To determine: 1) pre-service teachers' knowledge and confidence surrounding the return-to-school process before and after using the SCHOOLFirst website; 2) the usability, intended use and satisfaction of the SCHOOLFirst website from the perspective of pre-service teachers. METHODS Thirty pre-service teachers completed the demographic survey, knowledge and confidence survey, System Usability Scale, and satisfaction and intended use survey after participating in a workshop. RESULTS Significant increases in concussion knowledge (Z = -4.093, p < 0.001) and confidence in helping students return-to-school (Z = -4.620, p < 0.001) were measured after using the SCHOOLFirst website. Participants were satisfied with the SCHOOLFirst website (93.4%) and intend to use it in the future when supporting a student post-concussion (96.4%). CONCLUSION The SCHOOLFirst website is a valuable tool for pre-service teachers to support students' return-to-school post-concussion.
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Affiliation(s)
- Christina Ippolito
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Alexandra Cogliano
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Alexandra Patel
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sara Shear
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Christine Provvidenza
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Katherine E Wilson
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Nick Reed
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
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DeMatteo CA, Jakubowski J, Randall S, Stazyk K, Lin CY, Yakubov R. School performance in youth after a concussion. Front Sports Act Living 2022; 4:1008551. [PMID: 36619354 PMCID: PMC9813779 DOI: 10.3389/fspor.2022.1008551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022] Open
Abstract
Objective This study aimed to identify school problems and levels of cognitive activity in youths aged 5-18 years with a concussion during the recovery stages of return to school (RTS). Study Design In a prospective cohort, participants completed in-person assessments at three time points: First Visit Post-injury, Symptom Resolution Visit, and Follow-Up Visit. These time points varied based on the participants' recovery progress. The post-concussion symptom scale (PCSS) and a cognitive activity scale were completed every 2 days until symptom resolution was achieved. Participants and their parents completed a school questionnaire detailing how their concussion had impacted their school learning/performance and their level of concern about their injury as well as the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Results Sixty-three percent (N = 44/70) of participants returned to school by the First Visit Post-injury (average 7.7 days following injury), and of these, 50% (N = 22) were experiencing school problems. Sixty-five participants (out of 70) returned to school at the Follow-Up Visit, and of these, 18% reported school problems. There was a significant difference in the school problems reported by parents and youth. At the First Visit Post-injury, the youth reported more problems (p = 0.02), and the In-Person Symptom Resolution Visit with parents reported more problems (p = 0.01). The cognitive activity score increased, while the PCSS score decreased from RTS Stage 1 to Stage 5. Conclusions This study identified that 50% of youth experienced school problems at the First Visit Post-injury, whereas only 18% reported school problems at the Follow-Up Visit. There is a significant difference in the perception of school problems reported by youth and their parents at different stages of recovery. The amount and complexity of cognitive activity increased with decreasing symptoms and increasing RTS stage. Findings can guide youth with a concussion and their parents in supporting a cautious return to school with accommodations. Healthcare providers and researchers can use this knowledge to better support youth in their return to school and understand the importance of gathering information from youth and their parents to gain the best insight into recovery.
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Affiliation(s)
- Carol A. DeMatteo
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada,Correspondence: Carol A. DeMatteo
| | - Josephine Jakubowski
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Sarah Randall
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Kathy Stazyk
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Chia-Yu Lin
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Rebecca Yakubov
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
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13
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Tang AR, Davis PJ, Williams KL, Grusky AZ, Hajdu KS, Hou BQ, Yengo-Kahn AM, Zuckerman SL, Terry DP. Use of acute cognitive symptom cluster to predict return-to-learn duration following a sport-related concussion. J Neurosurg Pediatr 2022; 30:378-385. [PMID: 35907196 DOI: 10.3171/2022.6.peds22182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/17/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Adolescents sustaining sport-related concussion often experience difficulties with the return-to-learn (RTL) process. Whereas the initial symptom burden has predicted prolonged RTL, no studies have established a relationship between acute cognitive symptoms and RTL duration. The authors sought to evaluate the relationship between initial cognitive symptoms and RTL duration. METHODS A retrospective single-institution cohort study of adolescent athletes aged 12-23 years who were evaluated within 5 days of a diagnosed sport-related concussion between November 2017 and October 2020 was conducted. Athletes missing cognitive symptom ratings and RTL data were excluded. The primary exposure variable was the Cognitive Symptom Ratio (CSR), defined as total cognitive symptom cluster score divided by total Post-Concussion Symptom Scale (PCSS) score from the initial clinic visit. Primary and secondary outcomes were time to RTL and total length of care, respectively. Multivariable Cox proportional hazards modeling was used to assess the effect of CSR on RTL duration. RESULTS Of 653 athletes evaluated within 5 days of injury, 346 patients were included in the final cohort. Athletes reported a median initial PCSS score of 21 (interquartile range [IQR] 6-37) and a median cognitive symptom score of 4 (IQR 0-9). Most patients endorsed some degree of difficulty concentrating (n = 212, 61.3%). The median CSR was 0.18 (IQR 0.00-0.27). On multivariable regression analysis, a higher CSR was associated with prolonged RTL duration (HR 0.30, 95% CI 0.13-0.69, p = 0.004). When initial PCSS score was added to the model, the previously significant association between CSR and RTL was no longer significant (HR 0.67, 95% CI 0.29-1.59, p = 0.367). When dichotomized based on frequency distribution, a higher proportion of patients with low CSR achieved RTL by 7 days postinjury (82.2% vs 69.9%, p = 0.007), a difference not seen at 14 days (92.2% vs 87.3%, p = 0.133). CONCLUSIONS An acute ratio of cognitive symptoms may predict patients at increased risk for prolonged RTL and those with normal PCSS scores who may experience difficulties once resuming school activities.
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Affiliation(s)
- Alan R Tang
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Philip J Davis
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Kristen L Williams
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alan Z Grusky
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Katherine S Hajdu
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Brian Q Hou
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Aaron M Yengo-Kahn
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott L Zuckerman
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas P Terry
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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14
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Takagi-Stewart J, Qiu Q, Mills B, Avery AD, Muma A, Vavilala MS. Association of concussion with high school academic standing: sex, school grade and race as stratifiers. Inj Prev 2022; 28:476-479. [PMID: 36096655 DOI: 10.1136/ip-2022-044568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/06/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The purpose was to examine the association between concussion history and academic standing among high school students, and whether the association varies by sex, school grade and race/ethnicity. METHODS Data from the 2019 Youth Risk Behaviour Survey were used for our cross-sectional study. Exposure was self-reported history of concussions in the past 12 months. Outcome was self-reported academic standing in the past 12 months. Poisson regression was used to analyse the exposure-outcome association, and whether there were differences by our stratifying variables. RESULTS Having a history of concussion in the past 12 months was significantly associated with a higher risk of poor academic standing during the same period, and the association varied by race/ethnicity. DISCUSSION Youth with a history of concussion may be at risk for poorer academic standing, indicating to the importance of prevention. Future studies are needed to examine the interaction of race/ethnicity on the presented association.
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Affiliation(s)
| | - Qian Qiu
- Harborview Injury Prevention & Research Center, Seattle, Washington, USA.,Pediatrics, University of Washington, Seattle, Washington, USA
| | - Brianna Mills
- Harborview Injury Prevention & Research Center, Seattle, Washington, USA.,Epidemiology, University of Washington, Seattle, Washington, USA
| | - Aspen D Avery
- Harborview Injury Prevention & Research Center, Seattle, Washington, USA.,Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Amy Muma
- Harborview Injury Prevention & Research Center, Seattle, Washington, USA.,Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Monica S Vavilala
- Harborview Injury Prevention & Research Center, Seattle, Washington, USA.,Pediatrics, University of Washington, Seattle, Washington, USA.,Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.,Neurological Surgery and Radiology, University of Washington, Seattle, Washington, USA
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15
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Barden DC, Thain DPK. Injury surveillance in English youth basketball: A 5-season cohort study to inform injury prevention strategies. Phys Ther Sport 2022; 58:34-40. [DOI: 10.1016/j.ptsp.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 11/28/2022]
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16
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Takagi-Stewart J, Johnson AM, Smith MB, Wang J, Marcynyszyn LA, Zatzick DF, McCarty CA, Rivara FP, Vavilala MS. Physician recommended school accommodations and student outcomes following a mild traumatic brain injury among youth with persistent post-concussive symptoms. NeuroRehabilitation 2022; 50:467-476. [PMID: 35180137 PMCID: PMC9277683 DOI: 10.3233/nre-210324] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Post-concussion return-to-learn (RTL) guidelines include implementation of school accommodations. Yet, little is known about physician recommendations for school accommodations and their impact, particularly among youth experiencing persistent post-concussive symptoms (PPCS). OBJECTIVE We examined the association between physician recommended school accommodations and student outcomes among youth experiencing PPCS. METHODS Data from a randomized comparative effectiveness trial was used. Physician recommended school accommodations (≤90 days post-injury) were collected via chart abstraction. Grade point average was extracted from school records. Reports of problems at school, concussion symptoms, health-related quality of life (HRQOL), anxiety symptoms, and depressive symptoms were collected by survey (at baseline, three months, and 12 months post study entry). RESULTS Of 200 participants (Mage = 14.7, 62% female), 86% were recommended school accommodations. Number of recommended school accommodations was positively associated with number of school problems at three months (aRR 1.18, 95% CI:1.12-1.24) and 12 months (aRR 1.11, 95% CI:1.05-1.18). No significant associations were found between recommended school accommodations and GPA, HRQOL, anxiety symptoms, or depressive symptoms. CONCLUSIONS Physicians recommend more school accommodations for students experiencing more school problems post-concussion. Appropriate implementation of RTL recommendations made by physicians by fostering partnerships among physicians, students, and schools may be needed to achieve student-centered RTL.
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Affiliation(s)
- Julian Takagi-Stewart
- Harborview Injury Prevention and Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | | | - Mallory B Smith
- Harborview Injury Prevention and Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA
| | - Jin Wang
- Harborview Injury Prevention and Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | | | | | - Carolyn A McCarty
- University of Washington, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA
| | - Frederick P Rivara
- University of Washington, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
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17
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Rivara FP, Marcynyszyn LA, Wang J, Chrisman SPD, Hilt R, Zatzick DF, Johnson AM, Jinguji T, Quitiquit C, McCarty CA. Effect of Collaborative Care for Persistent Postconcussive Symptoms on Academic Function: A Randomized Clinical Trial. THE JOURNAL OF SCHOOL HEALTH 2022; 92:261-269. [PMID: 34904238 PMCID: PMC10460270 DOI: 10.1111/josh.13123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/27/2021] [Accepted: 06/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is limited long-term data on the course of school-related problems and academic needs for youth with persistent post-concussive symptoms (PPCS). METHODS This was a randomized trial comparing collaborative care to usual care for 200 youth 11-18 years of age with PPCS. In this report, the main outcomes were academic functioning, GPA, school absences, date of return to school, and school days missed. RESULTS Youth were mean age of 14.7 (SD = 1.7), 62.0% female. New or worsening academic problems occurred in half of participants in both groups at 12 months after injury. Students were most concerned about grades and falling behind. There were no significant differences by study group on school problems or GPA, but number of days missed was lower in the collaborative care group compared at 3 months (12.5 [SD = 14.5] vs 16.1 days [20.4] adjusted relative risk [aRR] 0.67 [95% CI: 0.61, 0.74; p < .001]), 6 months (14.5 [22.1] vs 19.3 [26.6] aRR 0.77 [95% CI: 0.71, 0.84; p < .001]), and 12 months (16.9 [25.4] vs 19.6 [27.7], aRR 0.68 [95% CI: 0.62, 0.74; p < .001]). CONCLUSIONS Youth with PPCS are at high risk of school problems in the year after injury.
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Affiliation(s)
- Frederick P. Rivara
- Department of Pediatrics, University of Washington, Seattle, WA 98104; Seattle Children’s Guild Endowed Chair in Pediatric Research; Epidemiology, University of Washington, School of Public Health, Seattle, WA 98104; Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA; Harborview Injury Prevention and Research Center, Box 359960, 325 Ninth Avenue, Seattle, WA 98104
| | - Lyscha A. Marcynyszyn
- Seattle Children’s Research Institute, Center for Child Health, Behavior, and Development, Building Cure (M/S CURE-3), 1920 Terry Avenue, Seattle, WA 98101
| | - Jin Wang
- Harborview Injury Prevention and Research Center & Department of Pediatrics, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA 98104-2499
| | - Sara P. D. Chrisman
- Seattle Children’s Research Institute, Center for Child Health, Behavior, and Development, Building Cure (M/S CURE-3), 1920 Terry Avenue, Seattle, WA 98101
| | - Robert Hilt
- Behavioral Sciences, Department of Psychiatry, University of Washington, Seattle, Washington, Seattle Children’s Hospital, 4800 Sandpoint Way. Seattle, WA 98105
| | - Douglas F. Zatzick
- Behavioral Sciences, University of Washington, Harborview Medical Center 325 Ninth Avenue, Box 359911, Seattle, WA 98104-2499
| | - Ashleigh M. Johnson
- Seattle Children’s Research Institute, Center for Child Health, Behavior, and Development, Building Cure (M/S CURE-3), 1920 Terry Avenue, Seattle, WA 98101
| | - Thomas Jinguji
- Department of Pediatrics, University of Washington, Seattle Children’s Hospital, 4800 Sandpoint Way, Seattle, WA 98105
| | - Celeste Quitiquit
- Department of Pediatrics, University of Washington, Seattle Children’s Hospital, 4800 Sandpoint Way, Seattle, WA 98105
| | - Carolyn A. McCarty
- Seattle Children’s Research Institute, Center for Child Health, Behavior, and Development, Building Cure (M/S CURE-3), 1920 Terry Avenue, Seattle, WA 98101
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18
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Kemp AM, O'Brien KH. Critical Elements of Return to Learn for Students With Concussion: A Scoping Review. J Head Trauma Rehabil 2022; 37:E113-E128. [PMID: 34145156 DOI: 10.1097/htr.0000000000000695] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify critical elements of return to learn (RTL) for students with concussion and examine the state of the peer-reviewed published literature through a scoping review. METHODS Three electronic databases were systematically searched, and reference lists screened for articles addressing components of RTL protocols and accommodations for students with concussion. In total, 100 articles met inclusion criteria, including 56 empirical studies and 44 expert articles. RESULTS Four key components to RTL protocols were identified: RTL teams, management approaches, outcome measurement, and accommodations. Both bodies of literature agree on the importance of RTL teams, but evidence for specific monitoring tools and management approaches is less robust. Accommodations have been better addressed by experts than empirical evaluation. Empirical studies are largely cross-sectional, and many are survey based. Just 24 include student perspectives. Publication of expert literature has declined in frequency, as empirical studies have become more common. CONCLUSION This scoping review describes the current landscape of RTL and provides guidance toward expanding the empirical literature to systematically determine best practices to serve students with concussion.
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19
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Snedaker KP, Lundine JP, Ciccia AH, Haider MN, O'Brien KH. Gaps in concussion management across school-aged children. Brain Inj 2022; 36:714-721. [PMID: 35130810 DOI: 10.1080/02699052.2022.2034954] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Examine how demographic and injury factors impact identification and management of concussion in students. METHODS Prospective observational cohort. Pre-K - 12th grade students within a large, urban school district reported to school with concussion during 2015-2019. Participants were grouped into Elementary/Middle School (E/MS) and High School (HS) and compared by sex, concussion history, injury setting and mechanism, time to medical evaluation and clearance, absences, and recommended accommodations. RESULTS 154 E/MS and 230 HS students reported to school with physician-diagnosed concussion. E/MS students experienced fewer concussions at school and from sports than HS. More E/MS males than females sustained concussions, while this difference was reversed for HS. Time-to-evaluation was longer for E/MS, specifically female E/MS students and those injured outside of school. E/MS males were cleared more quickly than females. In contrast, no differences were found between sexes for HS by injury setting, mechanism of injury, or management factors. CONCLUSION Differences observed in E/MS students by demographic and injury factors are not observed in HS students. Younger students, particularly females or those not injured in school or sports, may be at risk for delayed identification and prolonged time to clearance. Future research should further characterize concussion management in E/MS children.
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Affiliation(s)
| | - Jennifer P Lundine
- Department of Speech & Hearing Science, The Ohio State University, Columbus, Ohio, USA.,Division of Clinical Therapies & Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Angela H Ciccia
- Department of Psychological Sciences, Communication Sciences Program, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mohammad Nadir Haider
- Department of Orthopedics and Sports Medicine, State University of New York at Buffalo, Buffalo, New York, USA
| | - Katy H O'Brien
- Department of Communication Sciences and Special Education, University of Georgia, Athens, Georgia, USA
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20
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Cabral MD, Patel DR, Greydanus DE, Deleon J, Hudson E, Darweesh S. Medical perspectives on pediatric sports medicine–Selective topics. Dis Mon 2022; 68:101327. [DOI: 10.1016/j.disamonth.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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21
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Tanabe KO, Hayden ME, Rege S, Simmons J, Holstege CP. Risk factors associated with concussions in a college student population. Ann Epidemiol 2021; 62:77-83. [PMID: 34174411 DOI: 10.1016/j.annepidem.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/27/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine risk factors associated with concussion among the general collegiate population using a unique data linkage methodology. METHODS Student health medical, counseling, and disability access service data were linked with university enrollment data to provide a comprehensive, deidentified dataset of students who sought care at the student health center for concussion from 2016-2020. Using chi-squared tests and logistic regression, characteristics of students with and without concussion were evaluated. RESULTS During the study period, 506 concussions from 474 students were identified (cumulative incidence rate of 51.7 per 10,000 students). Significant predictors of concussion included: younger age (<21 years): odds ratio (OR) = 3.52 (95% confidence intervals [CI], 2.78, 4.50), Greek affiliation: OR = 1.89 (95% CI, 1.56, 2.30), and utilization of counseling and psychological services: OR = 1.92 (95% CI 1.59, 2.32). Of the students with concussion, 47% had at least one other concussion within the preceding year. History of prior hospitalization or medical imaging for head injury increased subsequent concussion risk by 4.5 fold. CONCLUSIONS Linking unique datasets provides a richer understanding of the characteristics and risk factors associated with student concussions than analysis of a single data source. This comprehensive dataset will enable future targeted interventions to prevent and treat college student concussions.
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Affiliation(s)
- Kawai O Tanabe
- Department of Student Health & Wellness, Division of Student Affairs, University of Virginia, Charlottesville, VA
| | - Meredith E Hayden
- Department of Student Health & Wellness, Division of Student Affairs, University of Virginia, Charlottesville, VA
| | - Saumitra Rege
- Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Jessica Simmons
- Department of Student Health & Wellness, Division of Student Affairs, University of Virginia, Charlottesville, VA
| | - Christopher P Holstege
- Department of Student Health & Wellness, Division of Student Affairs, University of Virginia, Charlottesville, VA; Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA.
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22
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Toresdahl BG, Young WK, Quijano B, Scott DA. A Systematic Review of Telehealth and Sport-Related Concussion: Baseline Testing, Diagnosis, and Management. HSS J 2021; 17:18-24. [PMID: 33967637 PMCID: PMC8077975 DOI: 10.1177/1556331620975856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022]
Abstract
Background: The use of telehealth has increased as a result of the COVID-19 pandemic. As sports at all levels resume, sports medicine physicians may be interested in how telehealth can be used for concussion care. Questions/Purpose: We sought to assess how telehealth has been used in the baseline testing, diagnosis, and/or management of concussion. Secondarily, we sought to assess the strengths and weaknesses of telehealth for concussion care and identify aspects of concussion care for which telehealth has not yet been studied. Methods: A systematic review was performed in September 2020 of PubMed and Embase using the following terms: concuss*, "mild traumatic brain," "head injur*," telehealth, telemedicine, telecare, "mobile health," m-health, virtual. Studies included were original research articles investigating the use of telehealth in the care of concussion (including baseline testing, diagnosis, and management), published in English, and had full text available. Results: A total of 356 articles were screened, of which 5 were determined to meet inclusion criteria. These articles described the use of telehealth for managing concussion in military and rural settings. No articles involved the use of telehealth for baseline concussion testing of athletes or for sideline evaluation. Conclusion: Despite the limited original research on the use of telehealth for concussion care, the articles identified provide a foundation for exploring the potential value of telehealth in the office practice and sports team setting. Telehealth may expand the ability of a sports medicine physician to provide timely and effective concussion care to athletes during the COVID-19 pandemic and beyond. More rigorous research is needed.
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23
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Paniccia M, Ippolito C, McFarland S, Murphy J, Reed N. Health-Related Quality of Life in Non-Concussed Children: A Normative Study to Inform Concussion Management. Dev Neurorehabil 2020; 23:534-541. [PMID: 32156189 DOI: 10.1080/17518423.2020.1736683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: There has been a shift to consider pediatric concussion recovery beyond symptom management by considering how health-related quality of life (HRQoL) affects recovery. This study investigated normative ranges of HRQoL in children and explored its relationship with common pediatric concussion variables. Methods: A cross-sectional study of 1,722 non-concussed children 8-12 years old (M = 10.52 ± 1.23 years; 1,335 males, 387 females) was conducted by secondary analysis of clinical baseline concussion data. Demographic information, concussion-like symptoms (PCSI-C), and HRQoL (KIDSCREEN-10 Index) were self-reported. Results: The most reported concussion-like symptoms were common stress symptoms and were significantly negatively correlated with HRQoL. Premorbid histories of attention deficit hyperactivity disorder, mental health challenges, headaches/migraines, and concussion significantly lowered HRQoL. The number of diagnosed concussions and PCSI-C scores were significantly negatively correlated with HRQoL. Conclusions: The normative ranges and model can indicate HRQoL levels to inform clinicians how children may respond to concussion and streamline care beyond traditional assessment models.
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Affiliation(s)
- M Paniccia
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - C Ippolito
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - S McFarland
- Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - J Murphy
- Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - N Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto , Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto, Canada
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24
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Neelakantan M, Ryali B, Cabral MD, Harris A, McCarroll J, Patel DR. Academic Performance Following Sport-Related Concussions in Children and Adolescents: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7602. [PMID: 33086755 PMCID: PMC7589260 DOI: 10.3390/ijerph17207602] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/29/2020] [Accepted: 10/15/2020] [Indexed: 11/21/2022]
Abstract
Sport-related concussions (SRC) are an increasingly common concern in young athletes, with long-term cognitive, physiological, behavioral, and psychological adverse outcomes. An estimated 1.1 million to 1.9 million SRCs occur per year in children <18 years old in the United States. The post-concussive state has demonstrated consequences in several domains, including athletics and academics, although much more research has been conducted on the former. The objective of this scoping review was to ascertain findings from published studies on the effects of SRCs on academic performance and quality of life of young student athletes. A total of 175 articles were screened within the PubMed and CINAHL databases, along with a Google search. Fourteen papers fulfilled the inclusion criteria and were analyzed in the review. Quantitative and qualitative data were collated and demonstrated the heterogeneity with which, post-concussion academic performance outcomes were measured; only 4 of the 14 studies utilized formal academic metrics such as changes in grade point average (GPA) or examination scores. While the results overall did show statistically significant implications on academic performance decline after SRC, it is clear that there remains a paucity of research determining the consequences of SRCs on academic performance in the school environment. Further research is needed to better understand how to implement accommodations in the student's learning environment and guide return-to-learn protocols for student athletes following SRC.
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Affiliation(s)
- Mekala Neelakantan
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (M.N.); (B.R.); (M.D.C.)
| | - Brinda Ryali
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (M.N.); (B.R.); (M.D.C.)
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (M.N.); (B.R.); (M.D.C.)
| | - Ann Harris
- Department of Library, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (A.H.); (J.M.)
| | - Juli McCarroll
- Department of Library, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (A.H.); (J.M.)
| | - Dilip R. Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (M.N.); (B.R.); (M.D.C.)
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Paniccia M, Ippolito C, McFarland S, Murphy J, Reed N. Self-efficacy in non-concussed youth: a normative study. Brain Inj 2020; 34:1532-1540. [PMID: 32910683 DOI: 10.1080/02699052.2020.1792983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In pediatric concussion, there has been a shift to consider how pre-injury profiles, such as self-efficacy, affect the recovery trajectory. The aim of this study was to investigate normal ranges of self-efficacy (overall, academic, social, emotional) in youth and to explore its relationship with the effects of daily stressors, operationalized as concussion-like symptoms, demographic factors, pre-injury/learning related factors, and concussion history. METHODS A cross-sectional study of 1300 uninjured youth 13-18 years old (1111 males, 189 females) was conducted by secondary analysis of clinical pre-injury/baseline concussion data. Demographic information, concussion-like symptoms (Post-concussion Symptom Inventory), and self-efficacy (Self-efficacy Questionnaire for Children) were self-reported. RESULTS The most reported concussion-like symptoms were common stress symptoms and there was a strong negative relationship with self-efficacy. Males reported higher self-efficacy than females, but no age effects were observed. Pre-injury factors including learning disability, ADHD, special education, IEP, mental health challenges, history of headaches/migraines, and concussion history were associated with significantly lower overall self-efficacy. CONCLUSIONS These normative ranges and predictive model can be used to provide a benchmark of self-efficacy to indicate how youth may respond to a concussion, and to inform clinical care during recovery.
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Affiliation(s)
- M Paniccia
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - C Ippolito
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - S McFarland
- Concussion Centre, Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - J Murphy
- Concussion Centre, Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - N Reed
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto , Toronto, Canada
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