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Streicher NS, Popovich M, Almeida A, Alsalaheen B, Ichesco IK, Freeman J, Lorincz M, Eckner JT. Understanding Abnormal Examination Findings During Concussion Recovery: A Retrospective Chart Review. Neurol Clin Pract 2024; 14:e200284. [PMID: 38699600 PMCID: PMC11065325 DOI: 10.1212/cpj.0000000000200284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/22/2024] [Indexed: 05/05/2024]
Abstract
Background and Objective Physical examination findings in athletes with sport-related concussion (SRC) are not well described in the literature. The objective of this study was to describe physical examination findings during the first month following concussion in athletes, with a focus on the effect of sex, age, and time since injury. Methods This was a retrospective electronic medical record (EMR) review of physical examination findings in 500 patients aged 6-24 who were initially seen within 15 days of SRC at a multidisciplinary outpatient academic concussion clinic between 2017 and 2019. A standardized concussion examination built in the EMR recorded mental status, cranial nerve, vestibulo-ocular motor screen, and balance findings for all patients. The primary outcome was the frequency of abnormal examination findings during the first 30 days postinjury, which was further analyzed by sex, age, and time since injury using mixed logistic regression models. Results The most common abnormal examination findings overall were eyes-closed single-leg stance, vestibular-ocular reflex, visual motion sensitivity, the neck examination, and eyes-closed tandem stance. Abnormal findings were more frequent in female athletes for vestibular ocular reflex and visual motion sensitivity. The frequency of abnormal findings increased with age for vestibulo-ocular reflex, visual motion sensitivity, the neck examination, convergence testing, and eyes-open single-leg stance, whereas abnormalities decreased in frequency with age for eyes-open tandem stance and tandem gait. The frequency of abnormal findings generally decreased with time over the first 4 weeks following injury. Discussion A comprehensive physical examination is pivotal for evaluation of athletes with concussion. These findings highlight high-yield components of the concussion examination and support use of these examination components as injury markers. Future work should investigate associations between physical examination findings and postconcussion symptoms and recovery outcomes. Classification of Evidence This retrospective cohort study provides Class IV evidence that neurologic examination with specifically designed clinical tests are helpful for diagnosis of traumatic brain injury in young athletes at age 6-24.
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Affiliation(s)
- Nicholas S Streicher
- Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor
| | - Michael Popovich
- Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor
| | - Andrea Almeida
- Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor
| | - Bara Alsalaheen
- Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor
| | - Ingrid K Ichesco
- Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor
| | - Jeremiah Freeman
- Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor
| | - Matt Lorincz
- Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor
| | - James T Eckner
- Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor
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Moore S, Musgrave C, Sandler J, Bradley B, Jones JRA. Early intervention treatment in the first 2 weeks following concussion in adults: A systematic review of randomised controlled trials. Phys Ther Sport 2024; 65:59-73. [PMID: 38065015 DOI: 10.1016/j.ptsp.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE International guidelines support a repertoire of therapeutic interventions that may assist recovery following concussion. We aimed to systematically review the efficacy of early pharmacological and non-pharmacological interventions initiated within two weeks of injury on symptoms and functional recovery of adults with concussion. METHODS We conducted a Systematic Review (SR) of Randomised Controlled Trials (RCTs) without meta-analysis utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed of four databases. Study inclusion criteria were adult participants diagnosed with concussion and commencing active intervention within 14 days of injury. RESULTS AND CONCLUSIONS Of 7531 studies identified, 11 were included in the final review. Six studies were rated as high-risk of bias, three with some concerns and two as low-risk of bias. We found no evidence to support specific pharmacotherapeutic management to hasten the natural recovery time-course. Two studies reported significant improvement in selected concussion symptoms following manual therapy (at 48-72 hours post-treatment) or telephone counselling interventions (at 6 months post-injury). No high quality RCTs demonstrate superior effects of early therapeutic interventions on concussion recovery in the first 2 weeks. We advocate future research to examine impacts of health-clinician contact points aligned with symptom-specific interventions.
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Affiliation(s)
- Sonya Moore
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia.
| | - Chris Musgrave
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
| | - Jonathan Sandler
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
| | - Ben Bradley
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer R A Jones
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia; Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia; Institute of Breathing and Sleep, Heidelberg, Victoria, Australia
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Lempke LB, Boltz AJ, Garcia GGP, Syrydiuk RA, Pandey HS, Pasquina PF, McCrea MA, McAllister TW, Broglio SP. Optimizing baseline and post-concussion assessments through identification, confirmation, and equivalence of latent factor structures: findings from the NCAA-DoD CARE Consortium. Clin Neuropsychol 2023:1-19. [PMID: 37859434 DOI: 10.1080/13854046.2023.2271614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023]
Abstract
Objective: Concussion evaluations use a multidimensional assessment to evaluate unique patient function dimensions (e.g., subjective symptoms differ from balance assessments), but the overarching latent factor structure has not been empirically substantiated. Our objective was to determine the cumulative latent factor structure of pre-injury baseline and acute (<48-h) post-concussion assessment battery outcomes, and determine measurement equivalence among common factors in collegiate student-athletes. Methods: Collegiate student-athletes at baseline (n = 21,865) and post-concussion (n = 1,537) across 25-institutions completed standardized assessments. Individual items were used from the baseline and post-concussion assessments and consisted of: Sport Concussion Assessment Tool, Brief Symptom Inventory-18, Standardized Assessment of Concussion, Balance Error Scoring System, Immediate Post-Concussion Assessment and Cognitive Test, and vestibular-ocular motor screening. Exploratory factor analysis was used on half the baseline data, and confirmatory factor analysis on the remaining baseline data and post-concussion data separately. Measurement equivalence was assessed between sex, sport contact classification, concussion history, and time. Results: A 10-factor exploratory model was established and comprised of: depression, somatic, vestibulo-ocular, headache, postural stability, neurocognition, emotional, fatigue, cognitive, consciousness clouding. The 10-factor model was confirmed at baseline and post-concussion with strong measurement equivalence between timepoints. Strong to strict measurement equivalence was observed for sex, sport contact classification, and concussion history at both timepoints separately. Conclusion: Our findings established a robust 10-factor latent factor model equivalent across timepoints and common factors among healthy and concussed collegiate athletes. Clinicians can use these findings to target specific factors while reducing redundant elements to provide efficient, comprehensive post-concussion assessments.
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Affiliation(s)
- Landon B Lempke
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
- Exercise and Sport Science Initiative, University of Michigan, Ann Arbor, MI, USA
| | - Adrian J Boltz
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - Gian-Gabriel P Garcia
- H. Milton School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Reid A Syrydiuk
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - Himadri S Pandey
- H. Milton School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Paul F Pasquina
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Michael A McCrea
- Center for Neurotrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
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Patricios JS, Schneider GM, van Ierssel J, Purcell LK, Davis GA, Echemendia RJ, Fremont P, Fuller GW, Herring SA, Harmon KG, Holte K, Loosemore M, Makdissi M, McCrea M, Meehan WP, O'Halloran P, Premji Z, Putukian M, Shill IJ, Turner M, Vaandering K, Webborn N, Yeates KO, Schneider KJ. Beyond acute concussion assessment to office management: a systematic review informing the development of a Sport Concussion Office Assessment Tool (SCOAT6) for adults and children. Br J Sports Med 2023; 57:737-748. [PMID: 37316204 DOI: 10.1136/bjsports-2023-106897] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To systematically review the scientific literature regarding the assessment of sport-related concussion (SRC) in the subacute phase (3-30 days) and provide recommendations for developing a Sport Concussion Office Assessment Tool (SCOAT6). DATA SOURCES MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, CINAHL, SPORTDiscus and Web of Science searched from 2001 to 2022. Data extracted included study design, population, definition of SRC diagnosis, outcome measure(s) and results. ELIGIBILITY CRITERIA (1) Original research, cohort studies, case-control studies, diagnostic accuracy and case series with samples >10; (2) SRC; (3) screening/technology that assessed SRC in the subacute period and (4) low risk of bias (ROB). ROB was performed using adapted Scottish Intercollegiate Guidelines Network criteria. Quality of evidence was evaluated using the Strength of Recommendation Taxonomy classification. RESULTS Of 9913 studies screened, 127 met inclusion, assessing 12 overlapping domains. Results were summarised narratively. Studies of acceptable (81) or high (2) quality were used to inform the SCOAT6, finding sufficient evidence for including the assessment of autonomic function, dual gait, vestibular ocular motor screening (VOMS) and mental health screening. CONCLUSION Current SRC tools have limited utility beyond 72 hours. Incorporation of a multimodal clinical assessment in the subacute phase of SRC may include symptom evaluation, orthostatic hypotension screen, verbal neurocognitive tests, cervical spine evaluation, neurological screen, Modified Balance Error Scoring System, single/dual task tandem gait, modified VOMS and provocative exercise tests. Screens for sleep disturbance, anxiety and depression are recommended. Studies to evaluate the psychometric properties, clinical feasibility in different environments and time frames are needed. PROSPERO REGISTRATION NUMBER CRD42020154787.
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Affiliation(s)
- Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Geoff M Schneider
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Laura K Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Ruben J Echemendia
- Psychology, University of Missouri, Kansas City, Missouri, USA
- University Orthopedics Concussion Care Clinic, State College Area School District, State College, Pennsylvania, USA
| | - Pierre Fremont
- Rehabilitation, Laval University, Quebec, Quebec, Canada
| | - Gordon Ward Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stanley A Herring
- Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | | | - Mike Loosemore
- Institute for Sport Exercise and Health, University Collage Hospital London, London, UK
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William P Meehan
- Sports Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
- Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Patrick O'Halloran
- Neurotrauma and Ophthalmology Research Group, University of Birmingham, Birmingham, UK
- Health Education England West Midlands, Edgbaston, UK
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | | | - Isla Jordan Shill
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
| | - Michael Turner
- International Concussion and Head Injury Research Foundation, London, UK
- University College London, London, UK
| | - Kenzie Vaandering
- University of Calgary Faculty of Kinesiology, Calgary, Alberta, Canada
| | - Nick Webborn
- Medical Committee, International Paralympic Committee, Bonn, Germany
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Viswanathan S, Port N, Master CL, Pardue MT. Impact of traumatic brain injury on vision. Vision Res 2023; 204:108176. [PMID: 36566559 PMCID: PMC10695695 DOI: 10.1016/j.visres.2022.108176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Suresh Viswanathan
- Department of Biological and Vision Sciences, State University of New York College of Optometry, New York, NY, United States of America
| | - Nicholas Port
- Indiana University School of Optometry, United States of America
| | - Christina L Master
- Divisions of Orthopedics and General Pediatrics, The Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States of America; Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Machelle T Pardue
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA, United States of America; Department of Biomedical Engineering, Georgia Institute of Technology, Emory University School of Medicine, Atlanta, GA, United States of America
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