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Sharma B, Obeid J, DeMatteo C, Noseworthy MD, Timmons BW. New Insights Into Accelerometer-Measured Habitual Physical Activity and Sedentary Time During Early Recovery in Pediatric Concussion. Pediatr Exerc Sci 2024; 36:58-65. [PMID: 37591503 DOI: 10.1123/pes.2023-0016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/26/2023] [Accepted: 05/25/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Concussion management is shifting away from a rest-is-best approach, as data now suggest that exercise-is-medicine for this mild brain injury. Despite this, we have limited data on habitual physical activity following concussion. Therefore, our objective was to quantify accelerometer-measured physical activity and sedentary time in children with concussion (within the first month of injury) and healthy controls. We hypothesized that children with concussion would be less active than their healthy peers. METHODS We performed a secondary analysis of prospectively collected accelerometer data. Our sample included children with concussion (n = 60, 31 females) and historical controls (n = 60) matched for age, sex, and season of accelerometer wear. RESULTS Children with concussion were significantly more sedentary than controls (mean difference [MD], 38.3 min/d, P = .006), and spent less time performing light physical activity (MD, -19.5 min/d, P = .008), moderate physical activity (MD, -9.8 min/d, P < .001), and vigorous physical activity (MD, -12.0 min/d, P < .001); these differences were observed from 8:00 AM to 9:00 PM. Sex-specific analyses identified that girls with concussion were less active and more sedentary than both boys with concussion (P = .010) and healthy girls (P < .010). CONCLUSION There is an activity deficit observed within the first month of pediatric concussion. Physical activity guidelines should address this while considering sex effects.
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Affiliation(s)
- Bhanu Sharma
- Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, ON,Canada
| | - Joyce Obeid
- Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, ON,Canada
| | - Carol DeMatteo
- School of Rehabilitation Science, McMaster University, Hamilton, ON,Canada
- CanChild Center for Childhood Disability Research, McMaster University, Hamilton, ON,Canada
| | - Michael D Noseworthy
- Imaging Research Center, St. Joseph's Healthcare, Hamilton, ON,Canada
- Department of Electrical & Computer Engineering, McMaster University, Hamilton, ON,Canada
- McMaster School of Biomedical Engineering, McMaster University, Hamilton, ON,Canada
- Department of Radiology, McMaster University, Hamilton, ON,Canada
| | - Brian W Timmons
- Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, ON,Canada
- CanChild Center for Childhood Disability Research, McMaster University, Hamilton, ON,Canada
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Roberts J, Wilson JC, Halstead ME, Miller SM, Santana JA, Valovich McLeod TC, 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 2024:1-9. [PMID: 38648009 DOI: 10.1080/00913847.2024.2344435] [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] [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
- Sports Medicine Center, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Julie C Wilson
- Sports Medicine Center, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Mark E Halstead
- School of Medicine, Departments of Orthopedics and Pediatrics, 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
| | | | - Tracy L Zaslow
- Cedars Sinai Kerlan Jobe Institute, Los Angeles, CA, USA
| | - Christina L Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Matthew F Grady
- Center for Injury Research and Prevention, 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
- Sports Medicine Center, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
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Corwin DJ, Mandel F, McDonald CC, Barnett I, Arbogast KB, Master CL. Optimizing the Combination of Common Clinical Concussion Batteries to Predict Persistent Postconcussion Symptoms in a Prospective Cohort of Concussed Youth. Am J Sports Med 2024; 52:811-821. [PMID: 38305042 PMCID: PMC11033620 DOI: 10.1177/03635465231222936] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Studies have evaluated individual factors associated with persistent postconcussion symptoms (PPCS) in youth concussion, but no study has combined individual elements of common concussion batteries with patient characteristics, comorbidities, and visio-vestibular deficits in assessing an optimal model to predict PPCS. PURPOSE To determine the combination of elements from 4 commonly used clinical concussion batteries and known patient characteristics and comorbid risk factors that maximize the ability to predict PPCS. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS We enrolled 198 concussed participants-87 developed PPCS and 111 did not-aged 8 to 19 years assessed within 14 days of injury from a suburban high school and the concussion program of a tertiary care academic medical center. We defined PPCS as a Post-Concussion Symptom Inventory (PCSI) score at 28 days from injury of ≥3 points compared with the preinjury PCSI score-scaled for younger children. Predictors included the individual elements of the visio-vestibular examination (VVE), Sport Concussion Assessment Tool, 5th Edition (SCAT-5), King-Devick test, and PCSI, in addition to age, sex, concussion history, and migraine headache history. The individual elements of these tests were grouped into interpretable factors using sparse principal component analysis. The 12 resultant factors were combined into a logistic regression and ranked by frequency of inclusion into the combined optimal model, whose predictive performance was compared with the VVE, initial PCSI, and the current existing predictive model (the Predicting and Prevention Postconcussive Problems in Pediatrics (5P) prediction rule) using the area under the receiver operating characteristic curve (AUC). RESULTS A cluster of 2 factors (SCAT-5/PCSI symptoms and VVE near point of convergence/accommodation) emerged. A model fit with these factors had an AUC of 0.805 (95% CI, 0.661-0.929). This was a higher AUC point estimate, with overlapping 95% CIs, compared with the PCSI (AUC, 0.773 [95% CI, 0.617-0.912]), VVE (AUC, 0.736 [95% CI, 0.569-0.878]), and 5P Prediction Rule (AUC, 0.728 [95% CI, 0.554-0.870]). CONCLUSION Among commonly used clinical assessments for youth concussion, a combination of symptom burden and the vision component of the VVE has the potential to augment predictive power for PPCS over either current risk models or individual batteries.
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Affiliation(s)
- Daniel J. Corwin
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Francesca Mandel
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Catherine C. McDonald
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ian Barnett
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christina L. Master
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Broglio SP, Register-Mihalik JK, Guskiewicz KM, Leddy JJ, Merriman A, Valovich McLeod TC. National Athletic Trainers' Association Bridge Statement: Management of Sport-Related Concussion. J Athl Train 2024; 59:225-242. [PMID: 38530653 DOI: 10.4085/1062-6050-0046.22] [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] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To provide athletic trainers and team physicians with updated recommendations to the 2014 National Athletic Trainers' Association (NATA) concussion position statement regarding concussion management, specifically in the areas of education, assessment, prognostic factors, mental health, return to academics, physical activity, rest, treatment, and return to sport. BACKGROUND Athletic trainers have benefited from the 2 previous NATA position statements on concussion management, and although the most recent NATA position statement is a decade old, knowledge gains in the medical literature warrant updating several (but not all) recommendations. Furthermore, in various areas of the body of literature, current evidence now exists to address items not adequately addressed in the 2014 statement, necessitating the new recommendations. This document therefore serves as a bridge from the 2014 position statement to the current state of concussion evidence, recommendations from other organizations, and discrepancies between policy and practice. RECOMMENDATIONS These recommendations are intended to update the state of the evidence concerning the management of patients with sport-related concussion, specifically in the areas of education; assessment advances; prognostic recovery indicators; mental health considerations; academic considerations; and exercise, activity, and rehabilitation management strategies.
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Affiliation(s)
| | - Johna K Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science and Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Kevin M Guskiewicz
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science and Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - John J Leddy
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY
| | | | - Tamara C Valovich McLeod
- Athletic Training Program, A.T. Still University, Mesa, AZ. Dr Guskiewicz is now at the Department of Kinesiology, Michigan State University, East Lansing
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Macknofsky B, Fomunung CK, Brown S, Baran JV, Lavin AC, Sabesan V. Concussion Rates in Youth Lacrosse Players and Comparison With Youth American Football. Orthop J Sports Med 2024; 12:23259671231223169. [PMID: 38390398 PMCID: PMC10883126 DOI: 10.1177/23259671231223169] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/31/2023] [Indexed: 02/24/2024] Open
Abstract
Background There has been little focus on concussions in youth lacrosse players in the United States. Purpose To provide a descriptive analysis of the epidemiology and incidence of concussions in youth lacrosse and compare the results with well-documented analyses of concussions in youth American football. Study Design Descriptive epidemiology study. Methods Data on concussions in pediatric patients playing lacrosse from 2006 to 2019 were collected using the National Electronic Injury Surveillance System (NEISS). Weighted calculations and combined participation data obtained from membership in USA Lacrosse were used to estimate injury incidence. A comparison dataset was created using the NEISS data on youth football-related concussions. The cause of concussion was categorized into player-to-player, player-to-stick, player-to-ball, or player-to-ground contact. Results A total of 37,974 concussion injuries related to lacrosse were identified in players with a mean age of 14.5 ± 3.5 years; 70% of concussions occurred in boys. National participation in lacrosse increased from 2006 to 2011 by a mean of 10.3% annually, followed by a lower annual growth rate of 2.5% from 2012 to 2019. The overall incidence of concussion injuries increased over the study period (r = 0.314), with the incidence rate in boys being greater than that of girls from 2009 to 2013. The most common cause of concussion was player-to-ground contact for boys and player-to-ball or player-to-stick contact for girls. The mean annual concussion incidences in youth lacrosse and youth football were 443 and 355 per 100,000 participants, respectively. Conclusion Over the study period, 16% of lacrosse injuries were diagnosed as concussions, a higher mean annual incidence per 100,000 participants than that of youth football (443 vs 355). The cause of concussion was different based on sex, with higher rates of player-to-ball or player-to-stick contact in female players versus player-to-ground contact in male players.
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Affiliation(s)
- Brandon Macknofsky
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
| | - Clyde K Fomunung
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
| | - Shimron Brown
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
| | - Jessica V Baran
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
| | - Alessia C Lavin
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
| | - Vani Sabesan
- JFK Palm Beach Orthopedic Surgery Residency Program, Palm Beach, Florida, USA
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Kossman MK, Kerr ZY, DeFreese JD, Kucera KL, Petschauer MA, Ribisl KM, Register-Mihalik JK. Concussion-Related Decision-Making by Certified Athletic Trainers: Implications for Concussion Prevention and Care. Int J Environ Res Public Health 2024; 21:82. [PMID: 38248545 PMCID: PMC10815082 DOI: 10.3390/ijerph21010082] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/21/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024]
Abstract
Concussions are a common sport-related injury that require appropriate initial care. Athletic trainers, often a primary source of healthcare for student-athletes, are key individuals involved in initial concussion diagnostic and management decisions. Challenges exist within the athletic environment that may hinder the consistency, efficacy, and/or effectiveness of concussion-related decision-making by athletic trainers, thereby impacting secondary concussion prevention and patient health. The purpose of this study was to identify factors that impact the intentions of athletic trainers to make appropriate concussion-related decisions under various circumstances. Overall, 1029 participants completed a survey examining educational precursors (quantity and quality of healthcare communication educational focus), demographic precursors (age, gender, educational degree, and employment setting), theory-based mediators (attitudes, perceived norms, and personal agency), and external mediators (knowledge, salience, and communication/collaboration practices) on appropriate concussion-related decision-making intentions. Data were analyzed using a two-step structural equation modeling approach. Quality of healthcare communication educational focus indirectly impacted appropriate concussion-related decision-making intentions via perceived behavioral control and communication/collaboration practices. Additionally, several factors impacted intentions to make appropriate concussion-related decisions directly including employment setting, self-efficacy, and general attitudes towards decision-making and concussions. Concussion prevention is aided by the initial and appropriate action taken by a healthcare professional to reduce immediate consequences; however, this action may be influenced by stakeholder relationships. These influential factors of decision-making may place athletes at further injury risk and negatively impact overall athlete health. As such, a sound theoretical framework incorporating the complexity of factors that may influence decision-making is needed.
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Affiliation(s)
- Melissa K. Kossman
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
- Sports Medicine and Community Health Research Lab, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Z.Y.K.); (K.L.K.)
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - J. D. DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Z.Y.K.); (K.L.K.)
- Center for Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kristen L. Kucera
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Z.Y.K.); (K.L.K.)
- National Center for Catastrophic Sport Injury Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Meredith A. Petschauer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Z.Y.K.); (K.L.K.)
| | - Kurt M. Ribisl
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Johna K. Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Z.Y.K.); (K.L.K.)
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- STAR Heel Performance Laboratory, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Fabiano F, Takagi M, Anderson N, Babl FE, Bressan S, Clarke C, Davies K, Davis GA, Dunne K, Hearps S, Ignjatovic V, Rausa VC, Seal M, Anderson V. Fatigue recovery and connected factors following paediatric concussion. Br J Sports Med 2024; 58:59-65. [PMID: 37699656 DOI: 10.1136/bjsports-2023-106894] [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] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE Using a biopsychosocial framework and the three-factor fatigue model, we aimed to (1) plot recovery of fatigue over the 3 months following paediatric concussion and (2) explore factors associated with persisting fatigue during the first 3 months postconcussion. METHODS 240 children and adolescents aged 5-18 years (M=11.64, SD=3.16) completed assessments from time of injury to 3 months postinjury. Separate linear mixed effects models were conducted for child and parent ratings on the PedsQL-Multidimensional Fatigue Scale to plot recovery across domains (General, Cognitive, Sleep/Rest) and Total fatigue, from 1 week to 3 months postinjury. Two-block hierarchical regression analyses were then conducted for parent and child ratings of fatigue at each time point, with age, sex and acute symptoms in block 1 and child and parent mental health variables added to block 2. RESULTS There was a significant reduction in both child and parent ratings across the 3 months postinjury for all fatigue domains (all p<0.001). For both child and parent fatigue ratings, child mental health was the most significant factor associated with fatigue at all time points. Adding child and parent mental health variables in the second block of the regression substantially increased the variance explained for both child and parent ratings of fatigue. CONCLUSION Our findings confirm that fatigue improves during the first 3 months postconcussion and highlights the importance of considering child and parent mental health screening when assessing patients with persisting postconcussive symptoms.
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Affiliation(s)
- Fabian Fabiano
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Michael Takagi
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Silvia Bressan
- Department of Women's and Children's Health, Università degli Studi di Padova, Padova, Italy
| | - Cathriona Clarke
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Katie Davies
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gavin A Davis
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Cabrini Health, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Rehabilitation, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vera Ignjatovic
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
- Departments of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vanessa C Rausa
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Marc Seal
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Glendon K, Pain MTG, Hogervorst E, Belli A, Blenkinsop G. Musculoskeletal injury or Sports-Related Concussion (SRC) in a season of rugby union does not affect performance on concussion battery testing in university-aged student-athletes. Phys Ther Sport 2024; 65:137-144. [PMID: 38181564 DOI: 10.1016/j.ptsp.2023.12.005] [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: 09/11/2023] [Revised: 12/08/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Sub-concussive and concussive impacts sustained during contact sports such as rugby may affect neurocognitive performance, vestibular-ocular-motor function, symptom burden and academic ability. METHOD Student-athletes (n = 146) participating in rugby union British Universities or domestic competitions were assessed on the Immediate Post-Concussion and Cognitive Test, Post-Concussion Symptom Scale, vestibular-oculo-motor screening tool and revised perceived academic impact tool. Individual change from pre-season (July-September 2021) to 2-weeks following last exposure to contact (April-July 2022) was analysed. RESULTS Symptom burden significantly worsened (p=0.016) over the season. Significant improvements on verbal memory (p=0.016), visual memory (p=0.008) and motor processing speed (p=0.001) suggest a possible learning effect. Surprisingly, the number of days lost to concussion significantly and positively affected performance on verbal memory (p = 0.018) and reaction time (p = 0.027). Previous concussive events significantly predicted a worsening in symptom burden (p < 0.028), as did in-season concussive events, predicting improved verbal memory (p = 0.033) and symptom burden change (p = 0.047). Baseline performance significantly affected change on several neurocognitive tests, with low-scorers showing more improvement over the season. CONCLUSION Participation in rugby union was not associated with deleterious effects on brain function. Previous concussive events and in-season factors, possibly related to learning effects, may explain improvement in cognitive function across the season.
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Affiliation(s)
- K Glendon
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
| | - M T G Pain
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - E Hogervorst
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A Belli
- Institute of Inflammation and Ageing, University of Birmingham, UK
| | - G Blenkinsop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [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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10
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Waltzman D, DePadilla L, Breiding M, Pierpoint L, Collins C. The Role of Level of Play in Concussions in High School Athletes. J Public Health Manag Pract 2024; 30:99-110. [PMID: 37566801 DOI: 10.1097/phh.0000000000001791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
OBJECTIVES To examine level of play (LOP) as a risk factor for concussion severity and recovery-related outcomes among high school athletes, stratified by sex, and among boys, by sport (football, non-football male sports). DESIGN/SETTING Secondary analysis of data collected through the High School Reporting Information Online surveillance system for academic years 2007-2008 through 2018-2019. PARTICIPANTS A total of 9916 concussions were reported between the academic years 2007-2008 and 2018-2019 from 9 sports (5189 from football; 2096 from non-football male sports; 2631 from female sports). MAIN OUTCOME MEASURE Examined the association between LOP (Freshman, Junior Varsity [JV], and Varsity teams) and concussion outcomes (number of concussion symptoms, symptom resolution time [SRT], and time to return to play [RTP]). RESULTS Compared with Varsity football athletes, concussed JV football athletes had on average 0.19 fewer concussion symptoms, longer SRT (>1 week vs <1 week: odds ratio [OR] = 1.3; 95% confidence interval [CI], 1.1-1.5), and longer RTP (1-3 weeks vs <1 week: OR = 1.5; 95% CI, 1.2-1.9; >3 weeks vs <1 week: OR = 1.6; 95% CI, 1.1-2.3). Compared with Varsity football athletes, Freshman football athletes had on average 0.48 fewer concussion symptoms, longer SRT (OR = 1.3; 95% CI, 1.1-1.5), and longer RTP (1-3 weeks vs <1 week: OR = 1.5; 95% CI, 1.1-2.0; >3 weeks vs <1 week: OR = 2.0; 95% CI, 1.3-3.0). Similarly, compared with female athletes on Varsity teams, concussed JV female athletes had longer RTP (1-3 weeks vs <1 week: OR = 1.8; 95% CI, 1.2-2.7). Trend analyses revealed an increase in the number of concussion symptoms between 2015-2016 and 2018-2019, a decrease between 2009-2010 and 2018-2019 for SRT of less than 1 week, and an increase between 2014-2015 and 2018-2019 for RTP of less than 1 week among Varsity football athletes. Among Varsity female athletes, there was a linear decrease during the study period for RTP of less than 1 week. CONCLUSIONS Despite a higher number of symptoms overall and in recent years, Varsity football players had shorter RTP than Freshman and JV athletes.
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Affiliation(s)
- Dana Waltzman
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Waltzman, DePadilla, and Breiding); Colorado School of Public Health, and University of Colorado School of Medicine, Aurora, Colorado (Dr Pierpoint); and Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, Indiana (Dr Collins)
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Mallory KD, Hickling A, Wilson KE, Di Leonardo K, Kroshus E, Colquhoun H, Hutchison MG, Zemek R, Reed N. Youth intentions to provide social support to a peer with a concussion. Brain Inj 2023; 37:1310-1325. [PMID: 37553812 DOI: 10.1080/02699052.2023.2242249] [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: 02/13/2023] [Revised: 06/20/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVES 1) To describe demographic factors, concussion knowledge, attitudes, subjective norms, self-efficacy and intentions to provide social support to a peer with a concussion and 2) to examine if demographic factors and concussion knowledge are associated with components of the Theory of Planned Behavior. METHODS The survey was completed between October 2018 and February 2019 by 200 youth (M = 15.30 years, SD = 1.52). Questions were designed for athletes and non-athletes and inquired about various types of social support. Data analysis included descriptive statistics, Wilcoxon Rank Sum Tests and Spearman's Rank-Order Correlation Coefficients. RESULTS More favorable attitudes and intentions to provide social support were observed among females (W = 2576, p ≤ 0.001; W = 2411, p ≤ 0.001), older youth (rho = 0.32, p ≤ 0.001; rho = 0.41, p ≤ 0.001) and those with higher concussion knowledge (rho = 0.29, p ≤ 0.001; rho = 0.22; p ≤ 0.001). Participating in sports with a high-risk of concussion was associated with lower attitudes and intentions to provide social support (W = 6677; p ≤ 0.001; W = 6721; p ≤ 0.001). Self-reported concussion history or knowing someone with a concussion history was not significantly associated with social support intentions. CONCLUSION This study identified characteristics of youth who had positive intentions to provide social support. These findings identify individuals who may model providing social support to a peer, as well as opportunities for future concussion education.
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Affiliation(s)
- Kylie D Mallory
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Andrea Hickling
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katherine E Wilson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kiera Di Leonardo
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Emily Kroshus
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Center for Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Heather Colquhoun
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael G Hutchison
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Roger Zemek
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Howland J, Campbell J, Thomas R, Smyth S, Chaneco A, Torres A, Olshaker J. An Evaluation of Post-Concussion Return to School Guidelines: A Survey of Massachusetts School Nurses. J Sch Nurs 2023; 39:422-430. [PMID: 34287070 DOI: 10.1177/10598405211032210] [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] [Indexed: 11/16/2022] Open
Abstract
Although all states have legislation pertaining to youth sports concussion, most of these laws focus on return-to-play procedures; only a few address return-to-learn (RTL) accommodations for students who have experienced a concussion. To address this gap in the legislation, some states and nongovernmental organizations have developed RTL guidelines to advise school personnel, parents, and health care providers on best practices for accommodating students' postconcussion reintegration into academic activity. In 2018, the Massachusetts Department of Public Health (MDPH) developed RTL guidelines which were disseminated to school nurses (SNs) at all public and nonpublic middle and high schools in the state. In 2020, the MDPH engaged the Injury Prevention Center at Boston Medical Center to survey Massachusetts SNs to assess the usefulness of the guidelines. The response rate was 63%; 92% found the booklet extremely useful or moderately useful; and 70% endorsed that the booklet fostered collaboration among stakeholders.
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Affiliation(s)
- Jonathan Howland
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA
- Injury Prevention Center, Boston Medical Center, Boston, MA, USA
| | - Julia Campbell
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
- Injury Prevention Center, Boston Medical Center, Boston, MA, USA
| | - Rebekah Thomas
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Steven Smyth
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Alcy Torres
- Injury Prevention Center, Boston Medical Center, Boston, MA, USA
- Departments of Pediatrics and Neurology, Boston Medical Center, Boston, MA, USA
| | - Jonathan Olshaker
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA
- Injury Prevention Center, Boston Medical Center, Boston, MA, USA
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Crane A, Roccaforte A, Webbe F, LoGalbo A. Does Frequency of Baseline Testing Influence Concussion Diagnostic Decision Making Among College Athletes. Arch Clin Neuropsychol 2023; 38:1635-1645. [PMID: 37348054 DOI: 10.1093/arclin/acad047] [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] [Accepted: 05/16/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVE Concussion is a growing public health concern given the large number of youth and collegiate athletes participating in collision sports. Sport-related concussions can have an adverse impact on student-athletes' health and academic performance. Athletic programs within academic organizations are motivated to employ the most effective and efficient diagnostic and recovery procedures to minimize the duration and impact of these symptoms on student-athletes' functioning. The present study sought to further our understanding regarding the value and frequency of conducting baseline assessments when evaluating sport-related concussions. METHOD A total of 41 athletes (24 men, 17 women) between the ages of 18 and 22 were evaluated following suspected concussive injury between 2015 and 2018. Post-injury test results were compared to baselines that had been collected either 1 or 2 years prior, and to normative data, to determine consistency in diagnostic outcomes. RESULTS Baseline test/retest reliability using Pearson's bivariate correlations revealed modest correlations on measures of verbal and visual memory (0.437-0.569) and very strong correlations on measures of reaction time and visual-motor speed (0.811-0.821). Meanwhile, minimal if any differences in clinical decision-making regarding the diagnostic outcome was observed when comparing post-injury test results to different baselines and to normative data. CONCLUSIONS Findings indicate that yearly baseline testing may not improve diagnostic accuracy, and in many cases, normative data may be adequate for decision-making. Additional research should evaluate the potential benefit of baseline testing in return-to-play decision-making among broader athletic populations.
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Affiliation(s)
- Andrew Crane
- Concussion Management Program, Florida Institute of Technology, 150 W University Blvd, Melbourne, FL 32901
| | - Analise Roccaforte
- Concussion Management Program, Florida Institute of Technology, 150 W University Blvd, Melbourne, FL 32901
| | - Frank Webbe
- Concussion Management Program, Florida Institute of Technology, 150 W University Blvd, Melbourne, FL 32901
| | - Anthony LoGalbo
- Concussion Management Program, Florida Institute of Technology, 150 W University Blvd, Melbourne, FL 32901
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Musto S, Hazard Vallerand A. Exploring the uses of yoga nidra: An integrative review. J Nurs Scholarsh 2023; 55:1164-1178. [PMID: 37489597 DOI: 10.1111/jnu.12927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/13/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 07/26/2023]
Abstract
AIM The purpose of this paper was to review and synthesize published research articles that have utilized yoga nidra as an intervention. BACKGROUND Yoga nidra is a form of guided meditation that has emerged in the literature in the past two decades as an intervention for a variety of medical conditions such as stress and mental health. It differs from traditional yoga, in that it does not require yoga poses. It is a noninvasive, cost-effective approach that is also easily accessible so it can be done in the privacy and comfort of the home. DESIGN The integrative review methodology by Whittemore and Knafl (2005) provided the framework for this review. METHODS The databases CINAHL, PubMed, SCOPUS, and PsycINFO were used to search for articles. Inclusion criteria consisted of journal articles in English with no limitations on dates of publication. Studies were excluded if any form of traditional yoga requiring poses was used as an intervention. Also excluded were all types of meditation that were not yoga nidra, systematic reviews, studies that utilized multiple intervention types (i.e., traditional yoga and yoga nidra), and commentaries/brief reports. Twenty-nine studies met the inclusion criteria. Quality appraisal was completed for each study. RESULTS The 29 studies that were reviewed consisted of 12 randomized controlled trials, 13 quasi-experimental studies, 3 mixed-methods studies, and 1 qualitative study. Outcome variables were categorized according to themes and results were systemically synthesized and reported by theme: (a) stress, (b) mood, (c) well-being, (d) psychologic dysfunction, (e) biomarkers, (f) sleep, and (g) miscellaneous. CONCLUSION Yoga nidra was found to be effective in most of these studies. However, there was some clinical heterogeneity in the sample populations and intervention session lengths, frequencies, and durations, making it difficult to draw conclusions about yoga nidra intervention based solely on the findings presented in this review. More studies are needed overall, particularly ones with larger sample sizes and stronger experimental designs. CLINICAL RELEVANCE Yoga nidra has the potential to be a useful, noninvasive, nonpharmacologic treatment or adjunct for a variety of conditions, particularly mental health.
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Affiliation(s)
- Susan Musto
- College of Nursing, Wayne State University, Detroit, Michigan, USA
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Abstract
BACKGROUND Rates of sports-related concussion (SRC) are high in adolescents. Ambiguity exists regarding the effect of SRC on cognitive function in adolescents. PURPOSE To rigorously examine adolescents' cognitive function after SRC. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS Web of Science, Scopus, and PubMed were searched from database inception until September 2021. Studies were included if participants were adolescents aged 13 to 18 years, if the definition of SRC was fully consistent with the Berlin Consensus Statement on Concussion in Sport, if the study included a control group or in-group baseline test, and if the study reported cognitive outcomes (eg, visual memory, processing speed) that could be separately extracted. RESULTS A total of 47 studies were included in the systematic review, of which 31 were included in the meta-analysis, representing 8877 adolescents with SRC. Compared with individuals in the non-SRC group, individuals with SRC had worse performance in cognitive function and reported more symptoms not only in the acute phase but also in the prolonged phase (1-6 months after injury) (visual memory: d = -0.21, 95% CI, -0.37 to -0.05, P = .012; executive function: d = -0.56, 95% CI, -1.07 to -0.06, P = .028; and symptoms: d = 1.17, 95% CI, 0.13 to 2.22, P = .028). Lower scores in most of the outcomes of cognitive function were observed at <3 days and at 3 to 7 days, but higher scores for verbal memory (d = 0.10; 95% CI, 0.03 to 0.17; P = .008) and processing speed (d = 0.17; 95% CI, 0.10 to 0.24; P < .001) were observed at 7 to 14 days after SRC relative to baseline. The effects of SRC on cognitive function decreased over time (100% of the variance in reaction time, P < .001; 99.94% of the variance in verbal memory, P < .001; 99.88% of the variance in visual memory, P < .001; 39.84% of the variance in symptoms, P = .042) in control group studies. Study design, participant sex, measurement tools, and concussion history were found to be modulators of the relationship between cognitive function and SRC. CONCLUSION This study revealed that adolescent cognitive function is impaired by SRC even 1 to 6 months after injury. Results of this study point to the need for tools to measure cognitive function with multiple parallel versions that have demographically diversiform norms in adolescents. Effective prevention of SRC, appropriate treatment, and adequate evaluation of cognitive function before return to play are needed in adolescent SRC management. Moreover, caution is warranted when using the baseline-to-postconcussion paradigm in return-to-play decisions.
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Affiliation(s)
- Xianyun Hou
- School of Psychology, Beijing Sport University, Beijing, China
| | - Yu Zhang
- School of Psychology, Beijing Sport University, Beijing, China
| | - Xueyin Fei
- Sport Science School, Beijing Sport University, Beijing, China
| | - Qian Zhou
- School of Psychology, Beijing Sport University, Beijing, China
| | - Jie Li
- Center for Cognition and Brain Disorders, the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Philipson EB, Machamer J, Dikmen S, Temkin N. Traumatic Brain Injuries Impact on School One Month and One Year After Injury. Neurotrauma Rep 2023; 4:507-514. [PMID: 37771425 PMCID: PMC10523406 DOI: 10.1089/neur.2022.0069] [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] [Indexed: 09/30/2023] Open
Abstract
Traumatic brain injury (TBI) is a major cause of death and disability among the American population, but the impact TBIs have on the school experience of high school, and post-secondary students, is poorly understood. In this study, a cohort of 79 students, ages 15-22, with mild-to-severe TBIs, were retrospectively identified from the University of Washington Traumatic Brain Injury Database and Sample Repository. The Sickness Impact Profile (SIP) was used to determine the frequency at which schooling was impacted by a TBI and identify the most common self-reported issues students faced in their return to school. At 1 month post-injury, 70% of students either had not returned to school as a result of their TBI or had returned to school but experienced issues related to their TBI. The most-reported issues at 1 month were a difficulty keeping up with school work as a result of it taking longer to complete assignments, tiring easily, having to take frequent rests, and grades that were not as good as they used to be. At 1 year post-injury, the number of students whose TBIs were affecting their school situation dropped 20 percentage points to 49%. The most reported issues at 1 year were forgetting more quickly what was learned in class and having more difficulty understanding new concepts and material. These findings indicate that TBIs have a profound effect on a student's school experiences up to at least 1 year post-injury.
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Affiliation(s)
- Erik B. Philipson
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Joan Machamer
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
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Dichiaro M, Baker D, Tlustos SJ. Return to Learn After Traumatic Brain Injury. Pediatr Clin North Am 2023; 70:445-460. [PMID: 37121636 DOI: 10.1016/j.pcl.2023.01.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
A successful return of youth back to school after traumatic brain injury (TBI) is an important aspect of post-injury management. Regardless of the severity of the injury, returning to school is an important aspect of improving recovery and outcomes. Often temporary informal school adjustments suffice in supporting children returning to school after concussion. For those with more a significant TBI, often formal school supports and interventions are important. Given the resiliency and recovery often seen after pediatric brain injury, close monitoring, serial evaluations, and fluid supports are important in accurately identifying what specific sequelae require support in the school setting.
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Affiliation(s)
- Michael Dichiaro
- Department of Rehabilitation, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 13th Avenue B 285, Aurora, CO, USA.
| | - David Baker
- Department of Rehabilitation, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 13th Avenue B 285, Aurora, CO, USA
| | - Sarah J Tlustos
- Department of Rehabilitation, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 13th Avenue B 285, Aurora, CO, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Avery A, Takagi-Stewart J, Qiu Q, Philipson EB, Moore M, Kroshus E, Weiner BJ, Graves JM, Glang A, Jinguji T, Coppel DB, Sidhu M, Vavilala MS. Effect of RISE bundle implementation on school adoption of a student-centered return-to-learn program in Washington state. NeuroRehabilitation 2023:NRE220200. [PMID: 37125566 DOI: 10.3233/nre-220200] [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] [Indexed: 05/02/2023]
Abstract
BACKGROUND Appropriate concussion care in school is vital for full recovery, but school return-to-learn (RTL) programs are lacking and vary in quality. Establishing student-centered RTL programs may reduce disparities in RTL care. OBJECTIVE To examine the effect of RISE Bundle (Return to Learn Implementation Bundle for Schools) implementation on high school adoption of a student-centered RTL program. METHODS A convenience sample of fourteen (4 rural and 10 urban) small and large Washington (WA) State public high schools were enrolled in a stepped-wedge study with baseline, end of study, and monthly measures over the 2021-2022 academic year. Schools identified an RTL champion who led RISE Bundle implementation in 6-week steps. Concussion knowledge and impact of RTL program on concussion care were examined. RESULTS Ten schools (71.4%) successfully completed RISE Bundle implementation and established a functional RTL program. Self-reported concussion knowledge from RTL Champions increased post intervention. Establishing RTL programs facilitated provision of tailored accommodations, and perceived variation and inequities in RTL care were reduced. CONCLUSION RISE Bundle implementation proved feasible, supported the establishment of a functional RTL program, and perceived to reduce disparities in concussion care in rural and urban WA State public high schools of varying sizes.
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Affiliation(s)
- Aspen Avery
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Julian Takagi-Stewart
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Qian Qiu
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Erik B Philipson
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Megan Moore
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Emily Kroshus
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Janessa M Graves
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- College of Nursing, Washington State University, Spokane, WA, USA
| | - Ann Glang
- Department of Psychology, University of Oregon, Eugene, O, USA
| | - Thomas Jinguji
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - David B Coppel
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | | | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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21
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Mohammed FN, Master CL, Arbogast KB, McDonald CC, Sharma S, Kang B, Corwin DJ. Disparities in Adherence to Concussion Clinical Care Recommendations in a Pediatric Population. J Head Trauma Rehabil 2023; 38:147-155. [PMID: 36731016 PMCID: PMC9998329 DOI: 10.1097/htr.0000000000000823] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To characterize the relationship of sociodemographic factors to adherence to provider recommendations for pediatric concussion. SETTING Primary care (PC) practices within the Children's Hospital of Philadelphia network. PARTICIPANTS Patients aged 5 to 18 years old who presented to any PC site for concussion from September 26, 2019, to December 31, 2019. DESIGN Retrospective medical record review. MAIN MEASURES The primary outcome was adherence to follow-up recommendations as defined by (1) continued follow-up until provider clearance to return to full activity; (2) no more than 2 no-show visits; and (3) for those referred to specialty care (SC), attending at least 1 visit. We compared adherence by race/ethnicity, insurance, age, sex, injury mechanism, and repeat head injury using bivariate and multivariate analyses. A secondary outcome of referral to SC was compared by sociodemographic factors. RESULTS A total of 755 patients were included. Overall, 80.5% of the patients met adherence criteria. Following adjustment, non-Hispanic Black patients and publicly insured/self-pay patients were less likely to adhere to recommendations than non-Hispanic White patients (adjusted odds ratio [AOR] = 0.60; 95% CI, 0.37-1.00) and privately insured patients (AOR = 0.48; 95% CI, 0.30-0.75), respectively. When assessing differences in referral to SC, non-Hispanic Black patients and publicly insured/self-pay patients were more likely to receive a referral than their non-Hispanic White peers (OR = 1.56; 95% CI, 1.00-2.45) and privately insured patients (OR = 1.56; 95% CI, 1.05-2.32), respectively. CONCLUSION This study highlights disparities in adherence to concussion care recommendations, with non-Hispanic Black and publicly insured/self-pay patients less likely to adhere to follow-up recommendations than non-Hispanic White and privately insured patients, respectively. These disparities may impact recovery trajectories. Future studies should aim to identify specific individual- and system-level barriers preventing adherence to care in order to ultimately inform targeted interventions to achieve equity in care delivery and outcomes.
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Affiliation(s)
- Fairuz N Mohammed
- Center for Injury Research and Prevention (Mrs Mohammed, Drs Master, Arbogast, McDonald, and Corwin, and Mss Sharma and Kang), Sports Medicine and Performance Center (Dr Master), and Division of Emergency Medicine (Drs Arbogast and Corwin), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine (Drs Master, Arbogast, McDonald, and Corwin) and School of Nursing (Dr McDonald), University of Pennsylvania, Philadelphia
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22
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Sharma B, Nowikow C, DeMatteo C, Noseworthy MD, Timmons BW. Sex-specific differences in resting-state functional brain activity in pediatric concussion. Sci Rep 2023; 13:3284. [PMID: 36841854 PMCID: PMC9968337 DOI: 10.1038/s41598-023-30195-w] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/17/2023] [Indexed: 02/27/2023] Open
Abstract
Pediatric concussion has a rising incidence and can lead to long-term symptoms in nearly 30% of children. Resting state functional magnetic resonance imaging (rs-fMRI) disturbances are a common pathological feature of pediatric concussion, though no studies have explicitly examined sex-differences with respect to this outcome, precluding a sex-specific understanding of the functional neuropathology of pediatric concussion. Therefore, we performed a secondary data analysis of rs-fMRI data collected on children with concussion (n = 29) recruited from in a pediatric hospital setting, with greater than 12:1 matched control data accessed from the open-source ABIDE-II database. Seed-based and region of interest (ROI) analyses were used to examine sex-based rs-fMRI differences; threshold-free cluster enhancement (TFCE) and a family-wise error (FWE) corrected p-values were used to identify significantly different clusters. In comparing females with concussion to healthy females, groupwise differences were observed irrespective of seed selected. Notably, we observed (in order of largest effect) hypo-connectivity between the anterior cingulate cortex of the salience network and the thalamus and precuneus (TFCE = 1473.5, p-FWE < 0.001) and the cingulate gyrus (TFCE = 769.3, p-FWE = 0.009), and the seed (posterior cingulate cortex (PCC)) of the default mode network and the paracingulate gyrus (TFCE = 1275.7, p-FWE < 0.001), occipital pole right (TFCE = 1045.0, p-FWE = 0.001), and sub-callosal cortex (TFCE = 844.9, p-FWE = 0.005). Hyper-connectivity was observed between the salience network seed and the cerebellum (TFCE = 1719.3, p-FWE < 0.001) and the PCC and the thalamus (TFCE = 1198.3, p-FWE < 0.001), cuneal cortex (1070.9, p-FWE = 0.001), and lateral occipital cortex left (TFCE = 832.8, p-FWE = 0.006). ROI analyses showed 10 and 5 significant clusters of hypo- and hyper-connectivity in females, respectively. Only one cluster of difference was found between males with concussion and healthy males on seed-based analyses, and 3 clusters on ROI analyses. There are alterations in rs-fMRI in females with concussion at one-month post-injury that are minimally present in males, which provides further evidence that recovery timelines in pediatric concussion may differ by sex.
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Affiliation(s)
- Bhanu Sharma
- grid.25073.330000 0004 1936 8227Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON L8S4L8 Canada ,grid.416721.70000 0001 0742 7355Imaging Research Centre, St. Joseph’s Healthcare, Hamilton, ON Canada ,grid.25073.330000 0004 1936 8227Department of Electrical & Computer Engineering, McMaster University, Hamilton, Canada
| | - Cameron Nowikow
- grid.416721.70000 0001 0742 7355Imaging Research Centre, St. Joseph’s Healthcare, Hamilton, ON Canada ,grid.25073.330000 0004 1936 8227McMaster School of Biomedical Engineering, McMaster University, Hamilton, Canada
| | - Carol DeMatteo
- grid.25073.330000 0004 1936 8227School of Rehabilitation Science, McMaster University, Hamilton, Canada ,grid.25073.330000 0004 1936 8227CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Michael D. Noseworthy
- grid.416721.70000 0001 0742 7355Imaging Research Centre, St. Joseph’s Healthcare, Hamilton, ON Canada ,grid.25073.330000 0004 1936 8227Department of Electrical & Computer Engineering, McMaster University, Hamilton, Canada ,grid.25073.330000 0004 1936 8227McMaster School of Biomedical Engineering, McMaster University, Hamilton, Canada ,grid.25073.330000 0004 1936 8227Department of Radiology, McMaster University, Hamilton, Canada
| | - Brian W. Timmons
- grid.25073.330000 0004 1936 8227Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON L8S4L8 Canada ,grid.25073.330000 0004 1936 8227CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
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23
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Marcynyszyn LA, McCarty CA, Chrisman SP, Zatzick DF, Johnson AM, Wang J, Hilt RJ, Rivara FP. Psychometric Properties and Validation of the General Anxiety Disorder 7-Item Scale Among Adolescents With Persistent Post-Concussive Symptoms. Neurotrauma Rep 2023; 4:276-283. [PMID: 37139182 PMCID: PMC10150728 DOI: 10.1089/neur.2022.0075] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
The General Anxiety Disorder 7-Item (GAD-7) scale is commonly used in primary care as a self-report measure of general anxiety symptoms with adult populations. There is little psychometric research on this measure with adolescent populations, particularly those with persistent post-concussive symptoms (PPCS). This study examined the psychometrics properties of the GAD-7 among youth with PPCS. We used baseline data from a randomized controlled trial of collaborative care for treatment of PPCS among 200 sports-injured adolescents 11-18 years of age (Mage = 14.7 years, standard deviation = 1.7). Eligible adolescents had three or more PPCS that lasted for ≥1 month and spoke English. Adolescents reported on their anxious (GAD-7 and Revised Child Anxiety and Depression Scale-Short Version [anxiety subscale]; RCADS) and depressive (Patient Health Questionnaire-9; PHQ-9) symptoms. Parents used the RCADS to report on their adolescents' anxious symptoms. The GAD-7 had good internal validity (Cronbach's alpha = 0.87), and significant (p < 0.001) correlations were detected between the GAD-7 and youth and parent report of anxiety on RCADS (r = 0.73 and r = 0.29) and PHQ-9 (r = 0.77) scores. Confirmatory factor analysis suggested a one-factor solution. These results suggest that the GAD-7 is a valid measure of anxiety with good psychometric properties for youth experiencing PPCS. ClinicalTrials.gov identifier: NCT03034720.
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Affiliation(s)
- Lyscha A. Marcynyszyn
- ICF International, Reston, Virginia, USA
- Address correspondence to: Lyscha A. Marcynyszyn, PhD, ICF International, 1902 Reston Metro Plaza, Reston, VA 20190, USA.
| | - Carolyn A. McCarty
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Sara P.D. Chrisman
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Douglas F. Zatzick
- Harborview Medical Center, University of Washington School of Medicine, Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Ashleigh M. Johnson
- College of Health and Human Services, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
| | - Jin Wang
- Harborview Injury Prevention and Research Center, Department of Pediatrics, Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Robert J. Hilt
- Psychiatry and Behavioral Sciences, University of Washington, Seattle Children's Hospital, Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Frederick P. Rivara
- Department of Pediatrics, Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
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24
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Mylabathula S, Macarthur C, Mylabathula S, Colantonio A, Guttmann A, Tator CH. Concussion Public Policy in Elementary and High Schools in Ontario, Canada: A Cross-Sectional Survey to Examine Implementation Compliance, Barriers, and Facilitators. J Sch Health 2023; 93:14-24. [PMID: 36004639 PMCID: PMC10087845 DOI: 10.1111/josh.13245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/14/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Concussion public policies have been developed to address the burden of concussions. The aim of the present study was to examine implementation compliance, barriers, and facilitators of Canada's first concussion public policy, Ontario's Policy/Program Memorandum 158: School Board Policies on Concussion (PPM158). METHODS An electronic survey was sent to 515 randomly selected elementary and high school principals across specific geographic, language, and publicly funded school types in Ontario. Data were analyzed using both qualitative and quantitative methods. RESULTS One hundred and thirty-five principals responded to the survey (26%). Concussion education was provided to teachers in 81% of schools, to students in 83%, and coaches in 79%. Additionally, 89% reported having a return-to-learn protocol in place and 90% reported having a return-to-play protocol. Implementation barriers included difficulties in providing concussion education to parents (42%), obtaining notes from physicians, and maintaining the volume of documentation. Eighty-seven percent of respondents believed that PPM158 improves student well-being. CONCLUSIONS Identified implementation barriers and facilitators can inform concussion policy practices to improve student well-being. We recommend: (1) an appointed concussion policy lead at each school, (2) electronic documentation, (3) determining the optimal education format to improve parent/guardian education, (4) fostering relationships between schools and health care professionals, and (5) student concussion education in every grade in Ontario schools.
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Affiliation(s)
- Swapna Mylabathula
- Temerty Faculty of MedicineUniversity of TorontoToronto, Canada; Canadian Concussion Centre, Toronto Western Hospital, Toronto, Canada; Krembil Brain InstituteTorontoCanada
| | - Colin Macarthur
- The Hospital for Sick Children Research Institute, Toronto, Canada; The Institute of Health Policy, Management, and EvaluationUniversity of TorontoTorontoCanada
| | - Sandhya Mylabathula
- Faculty of Kinesiology and Physical EducationUniversity of TorontoTorontoCanada
| | - Angela Colantonio
- Temerty Faculty of MedicineUniversity of TorontoToronto, Canada; The Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; Rehabilitation Sciences Institute, Department of Occupational Sciences and Occupational Therapy, Dalla Lana School of Public Health, University of TorontoTorontoCanada
| | - Astrid Guttmann
- Temerty Faculty of MedicineUniversity of TorontoToronto, Canada; The Hospital for Sick Children Research Institute, Toronto, Canada; The Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Canada; Leong Centre for Healthy Children, University of TorontoTorontoCanada
| | - Charles H. Tator
- Temerty Faculty of MedicineUniversity of TorontoToronto, Canada; Canadian Concussion Centre, Toronto Western Hospital, Toronto, Canada; Krembil Brain InstituteTorontoCanada
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25
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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: 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] [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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26
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McAvoy K, Halstead M, Radecki L, Shah A, Emanuel A, Domain S, Daugherty J, Waltzman D. Return to Learn ECHO: Telementoring for School Personnel to Help Children Return to School and Learning After Mild Traumatic Brain Injury. J Sch Health 2022; 92:1194-1201. [PMID: 36375807 PMCID: PMC9680044 DOI: 10.1111/josh.13221] [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] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 06/06/2022] [Accepted: 07/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Return to learn (RTL) after mild traumatic brain injury (mTBI) presents unique challenges for school professionals. A multidisciplinary team approach is necessary yet training school professionals is logistically difficult. This paper describes an innovative pilot RTL program and its evaluation. METHODS Utilizing the telehealth/telementoring program Project ECHO® (Extension for Community Healthcare Outcomes), this study utilized a multidisciplinary team of subject matter experts to deliver five 1-hour sessions across 5 cohorts of school-based professionals (total of 133 participants). The evaluation used a mixed-methods approach of post-session and post-program participant surveys and post-program participant focus groups. RESULTS Participants who completed a post-program survey reported statistically significant improvements in essential aspects of RTL knowledge and self-efficacy. This included improvements in how to manage a student with an mTBI (44.8% to 86.9%), benefits of early return to school for students following mTBI (31.8% to 86.9%), and the importance of written RTL policies/procedures (55.1% to 97.1%). CONCLUSIONS This study demonstrates that RTL training via a telementoring approach may be a positive and effective way to train school-based professionals and improve knowledge and self-efficacy, especially when attending face-to-face trainings are difficult. This model has the potential to produce programmatic and systematic improvements for RTL education.
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Affiliation(s)
- Karen McAvoy
- Brain Injury Educational Consulting Colorado LLC631 Peterson StreetFort CollinsCO80524USA
| | - Mark Halstead
- Departments of Pediatrics and Orthopedic SurgeryWashington University20 Progress Point Parkway, Suite 114O'FallonMO63368USA
| | | | - Amy Shah
- ECHO InitiativesAmerican Academy of Pediatrics345 Park BlvdItascaIL60143USA
| | - Anjie Emanuel
- Child Safety, Health and WellnessAmerican Academy of Pediatrics345 Park BlvdItascaIL60143USA
| | - Stephanie Domain
- Child Safety, Health and WellnessAmerican Academy of Pediatrics345 Park BlvdItascaIL60143USA
| | - Jill Daugherty
- Centers for Disease Control and Prevention4770 Buford HighwayAtlantaGA30341USA
| | - Dana Waltzman
- Centers for Disease Control and Prevention4770 Buford HighwayAtlantaGA30341USA
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Broggi M, Ready RE. Academic skills, self-perceptions, and grades in university students with a history of multiple concussions: The mediating roles of processing speed and psychological symptoms. Clin Neuropsychol 2022; 36:2188-2204. [PMID: 34402398 DOI: 10.1080/13854046.2021.1958924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study determined if university students with a history of multiple concussions may be at risk for academic difficulties and poor academic performance. We investigated if executive functioning, processing speed, and/or psychological symptoms might partially account for differences in academic performance of students with and without a history of multiple concussions. University students with a history of three or more concussions (n = 58), one concussion (n = 57), or no concussion (n = 57) completed academic, cognitive, and psychological assessments. Students with a history of multiple concussions read fewer words per minute and reported more learning difficulties than the no concussion group. Processing speed mediated the association between concussion status and reading rate. Psychological symptoms mediated the association between concussion status and self-reported learning difficulties. University students with a history of multiple concussions may be at risk for poor academic outcomes due, at least in part, to slower processing speed and psychological symptoms.Treatment of psychological symptoms, cognitive rehabilitation to augment processing speed, and academic accommodations might improve academic outcomes for students with a history of three or more concussions.
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Affiliation(s)
- Michael Broggi
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Rebecca E Ready
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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28
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Green KE, Purtzki J, Chapman A, Oberlander TF, Silverberg ND, Dhariwal AK. Somatization in Adolescents With Persistent Symptoms After Concussion: A Retrospective Chart Review. J Neuropsychiatry Clin Neurosci 2022; 34:378-385. [PMID: 35414192 DOI: 10.1176/appi.neuropsych.21070169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE After concussion, approximately 30% of adolescents experience symptoms that persist beyond 1 month postinjury. For some, these symptoms affect functioning, development, and quality of life. Somatization, where psychological distress contributes to physical symptoms, may contribute to persistent symptoms after concussion in some adolescents. Understanding how clinicians identify somatization in adolescents with persistent symptoms after concussion in practice is a critical next step in improving our understanding, identification, and subsequent treatment of somatization in this patient population. To address this, the investigators assessed and compared characteristics of adolescents with persistent symptoms after concussion with and without clinician-identified somatization. METHODS Participants were adolescents (N=94) referred for persistent symptoms after concussion to a specialty youth concussion clinic between January 2016 and May 2018. A retrospective chart review extracted demographic and injury characteristics, symptoms after concussion, school attendance, premorbid experiences, mental health, and medical service use. Participants with physician-identified somatization were compared with those without physician-identified somatization on these measures. RESULTS Adolescents with identified somatization had more severe and atypical neurological and psychiatric symptoms after concussion and more postinjury impairment in school attendance, were more likely to have a history of premorbid chronic pain or medically unexplained symptoms, and obtained more neuroimaging and health care after injury compared with those unaffected by somatization. They did not differ in mood or anxiety symptom self-reports. CONCLUSIONS This study identified characteristic differences and similarities in adolescents with and without clinician-identified somatization after a prolonged concussion recovery. These findings have the potential to improve clinical identification of somatization in youths following a concussion and may aid in treatment among this demographic group.
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Affiliation(s)
- Katherine E Green
- Faculty of Medicine (Green), Division of Physical Medicine and Rehabilitation (Purtzki), and Departments of Psychiatry (Chapman, Dhariwal), Pediatrics (Oberlander), and Psychology (Silverberg), University of British Columbia, Vancouver; and British Columbia Children's Hospital Research Institute, Vancouver (Oberlander, Dhariwal)
| | - Jacqueline Purtzki
- Faculty of Medicine (Green), Division of Physical Medicine and Rehabilitation (Purtzki), and Departments of Psychiatry (Chapman, Dhariwal), Pediatrics (Oberlander), and Psychology (Silverberg), University of British Columbia, Vancouver; and British Columbia Children's Hospital Research Institute, Vancouver (Oberlander, Dhariwal)
| | - Andrea Chapman
- Faculty of Medicine (Green), Division of Physical Medicine and Rehabilitation (Purtzki), and Departments of Psychiatry (Chapman, Dhariwal), Pediatrics (Oberlander), and Psychology (Silverberg), University of British Columbia, Vancouver; and British Columbia Children's Hospital Research Institute, Vancouver (Oberlander, Dhariwal)
| | - Tim F Oberlander
- Faculty of Medicine (Green), Division of Physical Medicine and Rehabilitation (Purtzki), and Departments of Psychiatry (Chapman, Dhariwal), Pediatrics (Oberlander), and Psychology (Silverberg), University of British Columbia, Vancouver; and British Columbia Children's Hospital Research Institute, Vancouver (Oberlander, Dhariwal)
| | - Noah D Silverberg
- Faculty of Medicine (Green), Division of Physical Medicine and Rehabilitation (Purtzki), and Departments of Psychiatry (Chapman, Dhariwal), Pediatrics (Oberlander), and Psychology (Silverberg), University of British Columbia, Vancouver; and British Columbia Children's Hospital Research Institute, Vancouver (Oberlander, Dhariwal)
| | - Amrit K Dhariwal
- Faculty of Medicine (Green), Division of Physical Medicine and Rehabilitation (Purtzki), and Departments of Psychiatry (Chapman, Dhariwal), Pediatrics (Oberlander), and Psychology (Silverberg), University of British Columbia, Vancouver; and British Columbia Children's Hospital Research Institute, Vancouver (Oberlander, Dhariwal)
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Abstract
CONTEXT After a sport-related concussion, many athletes experience persisting neurophysiological alterations. These alterations may be absent at rest but emerge during moments of physiological stress. Unnoticed and untreated neurophysiological dysfunction may negatively affect long-term neurologic health in adolescent athletes, as they are at a critical point in development. OBJECTIVE To assess cardio-autonomic functioning in athletes with and those without a history of concussion by quantifying measures of heart rate variability (HRV) during times of physical and mental exertion. DESIGN Case-control study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty-four male Hockey Quebec Midget-AAA hockey players were separated into those with (n = 16; age = 16.06 ± 0.73 years, body mass index = 23.29 ± 1.79) and those without (n = 18; age = 15.98 ± 0.62 years, body mass index = 23.60 ± 2.49) a history of concussion. INTERVENTION(S) All athletes underwent a series of HRV recording sessions (1) at rest, (2) while completing a cognitive task at rest, and (3) while completing a cognitive task after a bout of submaximal aerobic exercise. MAIN OUTCOME MEASURE(S) Time-domain measures of HRV, including mean NN intervals, SD of NN intervals, and root mean square of successive NN interval differences, were quantified for each assessment. RESULTS No differences in characteristics were evident between groups. No between-groups differences in HRV at rest were observed. However, during the cognitive task at rest and after aerobic exercise, athletes with a history of concussion demonstrated a higher SD of NN intervals (78.1 ± 4.3 versus 63.2 ± 4.1 milliseconds and 71.2 ± 4.3 versus 65.2 ± 3.8 milliseconds, respectively; F1,31 = 4.31, P = .046) and root mean square of successive NN interval differences (75.8 ± 6.0 versus 59.0 ± 5.6 milliseconds and 74.0 ± 5.5 versus 59.0 ± 5.2 milliseconds, respectively; F1,31 = 4.88, P = .04) than athletes without a history of concussion. CONCLUSIONS Concussive injuries may result in long-term cardio-autonomic dysfunction. These deficits may not be present at rest but may be triggered by physiological stress.
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Affiliation(s)
- Adam Harrison
- Department of Exercise Science, University of South Carolina, Columbia
| | - Abbi Lane-Cordova
- Department of Exercise Science, University of South Carolina, Columbia
| | - Michael F. La Fountaine
- Department of Physical Therapy, The Institute for Advanced Study of Rehabilitation and Sports Science, Seton Hall University, Nutley, NJ
- Departments of Medical Sciences and Neurology, Hackensack Meridian School of Medicine, Seton Hall University, Nutley, NJ
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30
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Jain D, Arbogast KB, McDonald CC, Podolak OE, Margulies SS, Metzger KB, Howell DR, Scheiman MM, Master CL. Eye Tracking Metrics Differences among Uninjured Adolescents and Those with Acute or Persistent Post-Concussion Symptoms. Optom Vis Sci 2022; 99:616-625. [PMID: 35848958 PMCID: PMC9361745 DOI: 10.1097/opx.0000000000001921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Eye tracking assessments that include pupil metrics can supplement current clinical assessments of vision and autonomic dysfunction in concussed adolescents. PURPOSE This study aimed to explore the utility of a 220-second eye tracking assessment in distinguishing eye position, saccadic movement, and pupillary dynamics among uninjured adolescents, those with acute post-concussion symptoms (≤28 days since concussion), or those with persistent post-concussion symptoms (>28 days since concussion). METHODS Two hundred fifty-six eye tracking metrics across a prospective observational cohort of 180 uninjured adolescents recruited from a private suburban high school and 224 concussed adolescents, with acute or persistent symptoms, recruited from a tertiary care subspecialty concussion care program, 13 to 17 years old, from August 2017 to June 2021 were compared. Kruskal-Wallis tests were used, and Bonferroni corrections were applied to account for multiple comparisons and constructed receiver operating characteristic curves. Principal components analysis and regression models were applied to determine whether eye tracking metrics can augment clinical and demographic information in differentiating uninjured controls from concussed adolescents. RESULTS Two metrics of eye position were worse in those with concussion than uninjured adolescents, and only one metric was significantly different between acute cases and persistent cases. Concussed adolescents had larger left and right mean, median, minimum, and maximum pupil size than uninjured controls. Concussed adolescents had greater differences in mean, median, and variance of left and right pupil size. Twelve metrics distinguished female concussed participants from uninjured; only four were associated with concussion status in males. A logistic regression model including clinical and demographics data and transformed eye tracking metrics performed better in predicting concussion status than clinical and demographics data alone. CONCLUSIONS Objective eye tracking technology is capable of quickly identifying vision and pupillary disturbances after concussion, augmenting traditional clinical concussion assessments. These metrics may add to existing clinical practice for monitoring recovery in a heterogeneous adolescent concussion population.
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Affiliation(s)
| | | | | | - Olivia E Podolak
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan S Margulies
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | | | | | - Mitchell M Scheiman
- Pennsylvania College of Optometry, Salus University, Philadelphia, Pennsylvania
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Elbin RJ, Womble MN, Elbich DB, Dollar C, Fedor S, Hakun JG. Ambulatory Assessment in Concussion Clinical Care and Rehabilitation. Front Digit Health 2022; 4:924965. [PMID: 35814821 PMCID: PMC9260167 DOI: 10.3389/fdgth.2022.924965] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Concussion is a mild traumatic brain injury that is characterized by a wide range of physical, emotional, and cognitive symptoms as well as neurocognitive, vestibular, and ocular impairments that can negatively affect daily functioning and quality of life. Clinical consensus statements recommend a targeted, clinical profile-based approach for management and treatment. This approach requires that clinicians utilize information obtained via a clinical interview and a multi-domain assessment battery to identify clinical profile(s) (e.g., vestibular, mood/anxiety, ocular, migraine, cognitive fatigue) and prescribe a corresponding treatment/rehabilitation program. Despite this comprehensive approach, the clinical picture can be limited by the accuracy and specificity of patient reports (which often conflate timing and severity of symptomology), as well as frequency and duration of exposure to symptom exacerbating environments (e.g., busy hallways, sitting in the back seat of a car). Given that modern rehabilitation programs leverage the natural environment as a tool to promote recovery (e.g., expose-recover approach), accurate characterization of the patient clinical profile is essential to improving recovery outcomes. Ambulatory assessment methodology could greatly benefit concussion clinical care by providing a window into the symptoms and impairments experienced by patients over the course of their daily lives. Moreover, by evaluating the timing, onset, and severity of symptoms and impairments in response to changes in a patient's natural environment, ambulatory assessments can provide clinicians with a tool to confirm clinical profiles and gauge effectiveness of the rehabilitation program. In this perspective report, we review the motivations for utilizing ambulatory assessment methodology in concussion clinical care and report on data from a pilot project utilizing smart phone-based, ambulatory assessments to capture patient reports of symptom severity, environmental exposures, and performance-based assessments of cognition for 7 days following their initial evaluation.
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Affiliation(s)
- R. J. Elbin
- Department of Health, Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas, Fayetteville, AR, United States
| | - Melissa N. Womble
- Inova Sports Medicine Concussion Program, Fairfax, VA, United States
| | - Daniel B. Elbich
- Department of Neurology, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Christina Dollar
- Inova Sports Medicine Concussion Program, Fairfax, VA, United States
| | - Sheri Fedor
- Inova Sports Medicine Concussion Program, Fairfax, VA, United States
| | - Jonathan G. Hakun
- Department of Neurology, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
- Department of Psychology, The Pennsylvania State University, State College, PA, United States
- Center for Healthy Aging, The Pennsylvania State University, State College, PA, United States
- Translational Brain Research Center, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
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Mallory KD, Saly L, Hickling A, Colquhoun H, Kroshus E, Reed N. Concussion Education in the School Setting: A Scoping Review. J Sch Health 2022; 92:605-618. [PMID: 35259774 PMCID: PMC9311225 DOI: 10.1111/josh.13156] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 01/31/2022] [Accepted: 02/15/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Concussions are a prevalent injury among youth, and concussion education has the potential to promote positive concussion-related behaviors. Recent recommendations and legislation have increased concussion education provided in schools; however, little is known about the education context, delivery method, development, and evaluation. A scoping review was conducted to identify peer-reviewed literature on concussion education delivered in the school setting. METHODS Six databases were searched (MEDLINE, CINAHL, EMBASE, PsycINFO, SPORTDiscus, and ERIC) to identify published articles from 2002 to July 16, 2020 that delivered concussion education in the school setting. Included studies described the concussion education and were written in English. RESULTS A total of 11,373 articles were identified and screened, with 27 studies meeting eligibility criteria and therefore, included. The studies delivered education to various stakeholders including students (n = 12; 44.4%), coaches (n = 5; 18.5%), educators (n = 3; 11.1%), parents (n = 1; 3.7%), and a mixed audience (n = 6; 22.2%). The education format varied and six studies (22.2%) developed the education based on a theory, model, or framework. CONCLUSIONS This study found substantial variability in the context, delivery method, development, and evaluation of education delivered in schools and further evaluation of this education is needed to ensure it is best-suited for school-based stakeholders.
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Affiliation(s)
- Kylie D. Mallory
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, 500 University Avenue, Suite 160TorontoONCanadaM5G 1V7
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital 150 Kilgour RoadTorontoONM4G 1R8
| | - Lauren Saly
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour RoadTorontoONM4G 1R8
| | - Andrea Hickling
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital; Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto 150 Kilgour RoadTorontoONM4G 1R8
| | - Heather Colquhoun
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto 160‐500 University Avenue, Room 924TorontoOntarioM5G 1V7
| | - Emily Kroshus
- Department of Pediatrics, University of Washington; Center for Health, Behavior and Development, Seattle Children's Research Institute 1920 Terry AvenueSeattleWA98101
| | - Nick Reed
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto; Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital 160‐500 University Avenue, Room 936TorontoOntarioM5G 1V7
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Wright J, Sohlberg MM, McIntosh K, Seeley J, Hadley W, Blitz D, Lowham E. What is the effect of personalized cognitive strategy instruction on facilitating return-to-learn for individuals experiencing prolonged concussion symptoms? Neuropsychol Rehabil 2022:1-30. [PMID: 35543728 DOI: 10.1080/09602011.2022.2074467] [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] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to evaluate the degree to which personalized cognitive strategy instruction (PCSI) assisted students with prolonged concussion symptoms (PCS) to achieve functional and academic-related goals. It was hypothesized that goal attainment on collaboratively developed functional goals and selected scores on the pre/post outcome measurements would improve following the delivery of PCSI. A non-concurrent multiple baseline design was utilized across three female participants ages 13-16. The weekly status tracking measurement of participant performance served as the primary measurement analysed to determine the existence of a functional relation between the addition of PCSI to psychoeducation and the achievement of participant outcome. Although visual analysis of the plotted status tracking data did not support the existence of a functional relation, all three participants met or exceeded functional goals on their goal attainment scales. A Tau-U analysis supported a small treatment effect. The positive response to the intervention from two of the three participants in addition to goal attainment for all three participants suggests PCSI has potential to mitigate cognitive challenges in adolescents with PCS. Implications for future research and methods to promote ecological measurement of intervention effects are discussed.
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Affiliation(s)
- Jim Wright
- Department of Communication Disorders & Sciences, University of Oregon, Eugene, OR, USA
| | - McKay More Sohlberg
- Department of Communication Disorders & Sciences, University of Oregon, Eugene, OR, USA
| | - Kent McIntosh
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR, USA
| | - John Seeley
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR, USA
| | - Wendy Hadley
- Prevention Science Institute, University of Oregon, Eugene, OR, USA
| | - Devon Blitz
- Department of Communication Disorders & Sciences, University of Oregon, Eugene, OR, USA
| | - Eli Lowham
- Department of Communication Disorders & Sciences, University of Oregon, Eugene, OR, USA
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Suss SJ, Manelis A, Lima Santos JP, Holland CL, Stiffler RS, Bitzer HB, Mailliard S, Shaffer M, Caviston K, Collins MW, Phillips ML, Kontos AP, Versace A. Resting State Functional Connectivity between Dorsal Attentional Network and Right Inferior Frontal Gyrus in Concussed and Control Adolescents. J Clin Med 2022; 11. [PMID: 35566427 DOI: 10.3390/jcm11092293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 12/10/2022] Open
Abstract
Concussion among adolescents continues to be a public health concern. Yet, the differences in brain function between adolescents with a recent concussion and adolescents with no history of concussion are not well understood. Although resting state functional magnetic resonance imaging (fMRI) can be a useful tool in examining these differences, few studies have used this technique to examine concussion in adolescents. Here, we investigate the differences in the resting state functional connectivity of 52 adolescents, 38 with a concussion in the previous 10 days (mean age = 15.6; female = 36.8%), and 14 controls with no concussion history (mean age = 15.1; female = 57.1%). Independent component analysis and dual regression revealed that control adolescents had significantly greater functional connectivity between the dorsal attention network (DAN) and right inferior frontal gyrus (RIFG) compared to concussed adolescents (p-corrected < 0.001). Specifically, there was a positive DAN-RIFG connectivity in control, but not concussed, adolescents. Our findings indicate that concussion is associated with disrupted DAN-RIFG connectivity, which may reflect a general, nonspecific response to injury.
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Fried E, Balla U, Catalogna M, Kozer E, Oren-amit A, Hadanny A, Efrati S. Persistent post-concussive syndrome in children after mild traumatic brain injury is prevalent and vastly underdiagnosed. Sci Rep 2022; 12. [PMID: 35288616 PMCID: PMC8921281 DOI: 10.1038/s41598-022-08302-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Data on epidemiology and prognosticators of persistent post-concussion syndrome (PPCS) after mild traumatic brain injury (mTBI) in the pediatric population is scarce. The aim of this study was to evaluate the prevalence of PPCS in children after mTBI and to identify clinical variables in children who are at high risk for developing PPCS. A multicenter, retrospective matched cohort in which PPCS symptoms were evaluated in children 8–15-year-old, 6–60 months after being admitted to the emergency department because of mTBI. The control group included children admitted to the emergency department because of uncomplicated distal radius fractures. The children's guardians were interviewed for the presence of PPCS symptoms using the "Rivermead Post-Concussion Questionnaire". A multivariable logistic regression model was used to identify predictors of PPCS. Two-hundred and five children were included in the mTBI group and 205 in the control. The median time from the injury was 33.5 months in the mTBI group and 33.8 in the control. The prevalence of PPCS in the mTBI group was 25.3% and PPCS like symptoms in the control was 2.4%, p < 0.001. Within the 6–60 months period, the PPCS prevalence was not influenced by the time that elapsed from the injury. In the mTBI group, motor vehicle accidents and adolescence were found to be risk factors for PPCS. PPCS is underdiagnosed in the pediatric population and 25% of children admitted to the ED due to mTBI may suffer from PPCS. Screening guidelines should be implemented to identify and properly treat these children.
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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. J Sch 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ratiu I, Fissel-Brannick S, Whiting M, Murnion L, Azuma T. The impact of mild traumatic brain injury on reading comprehension and eye movements: preliminary results. J Commun Disord 2022; 96:106197. [PMID: 35151226 DOI: 10.1016/j.jcomdis.2022.106197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 12/21/2021] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Individuals who sustain a mild traumatic brain injury (mTBI) can suffer from executive function, working memory, and attention deficits, which can impact functional task performance, including reading comprehension. Individuals with mTBI commonly report reading difficulties, but such difficulties have been historically difficult to capture using behavioral measures. The current study examined reading performance in those with and without mTBI using eye-tracking measures, which may be more sensitive to reading impairment in mTBI. METHOD/RESULTS In Experiment 1, 26 participants with a history of mTBI and 26 healthy control participants completed working memory (WM) and reading comprehension tasks. We found no differences in behavioral measures but found that spontaneous eye-blinking frequency was lower during the reading task in the mTBI group. In Experiment 2, we explored the impact of auditory distraction (e.g., multi-talker babble) on reading and memory performance. Twenty-three new participants with a history of mTBI and 26 healthy control participants completed a short-term memory (STM) task, a WM task, and a reading comprehension task under two distraction conditions. As in Experiment 1, we found no differences on behavioral measures, but observed significant differences on spontaneous eye-blinking frequency between those with and without mTBI. Group differences in distraction effects were also observed and performance on the WM task predicted reading comprehension performance. CONCLUSIONS The lack of differences on behavioral measures between groups, but lower frequencies of spontaneous eye blinking in the mTBI group suggests that while these individuals successfully completed the reading comprehension task, they may require more cognitive resources to do so.
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Affiliation(s)
- Ileana Ratiu
- Midwestern University, USA; Arizona State University, USA.
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Tucker PW, Bull R, Hall A, Moran TP, Jain S, Sathian U, Simon HK, Gioia GA, Ratcliff JJ, Wright DW. Application of the RE-AIM Framework for the Pediatric Mild Traumatic Brain Injury Evaluation and Management Intervention: A Study Protocol for Program Evaluation. Front Public Health 2022; 9:740238. [PMID: 35252108 PMCID: PMC8891162 DOI: 10.3389/fpubh.2021.740238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background Children who experience a mild Traumatic Brain Injury (mTBI) may encounter cognitive and behavioral changes that often negatively impact school performance. Communication linkages between the various healthcare systems and school systems are rarely well-coordinated, placing children with an mTBI at risk for prolonged recovery, adverse impact on learning, and mTBI re-exposure. The objective of this study is to rigorously appraise the pediatric Mild Traumatic Brain Injury Evaluation and Management (TEaM) Intervention that was designed to enhance diagnosis and management of pediatric mTBI through enhanced patient discharge instructions and communication linkages between school and primary care providers. Methods This is a combined randomized and 2 × 2 quasi-experimental study design with educational and technology interventions occurring at the clinician level with patient and school outcomes as key endpoints. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework will be utilized as a mix methods approach to appraise a multi-disciplinary, multi-setting intervention with the intent of improving outcomes for children who have experienced mTBI. Discussion Utilization of the RE-AIM framework complemented with qualitative inquiry is suitable for evaluating effectiveness of the TEaM Intervention with the aim of emphasizing priorities regarding pediatric mTBI. This program evaluation has the potential to support the knowledge needed to critically appraise the impact of mTBI recovery interventions across multiple settings, enabling uptake of the best-available evidence within clinical practice.
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Affiliation(s)
- Paula W. Tucker
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
- *Correspondence: Paula W. Tucker
| | - Rachel Bull
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Alex Hall
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Tim P. Moran
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Shabnam Jain
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Usha Sathian
- Urgent Care and Community Care Services, Children's Healthcare of Atlanta: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Harold K. Simon
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Gerard A. Gioia
- Division of Pediatric Neuropsychology, Children's National Hospital, Rockville, MD, United States
| | - Jonathan J. Ratcliff
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - David W. Wright
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
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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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Sullivan L, Wysong M, Yang J. Concussion Recovery in Children and Adolescents: A Qualitative Study of Parents' Experiences. J Sch Health 2022; 92:132-139. [PMID: 34806778 PMCID: PMC8792299 DOI: 10.1111/josh.13114] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/08/2021] [Accepted: 05/20/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Although parents play an instrumental role in youth concussion management, few studies have qualitatively explored youth concussion recovery from the parents' perspective. This study explored parents' experiences with and perceptions of their child's recovery from concussion, particularly with regards to the return-to-school process. METHODS We conducted 11 face-to-face semi-structured interviews with the parents of concussed youth aged 11 to 17 years between October 2018 and April 2019. We used the methods of open coding, axial coding, and selective coding to analyze the data. RESULTS We identified 7 themes during data analysis, which we divided into 2 categories: at home (prior to school re-entry) and at school (during the school reintegration process). The at-home category included 4 themes: (1) physical and cognitive rest; (2) child-led decision-making; (3) the role of parent-child communication in recovery; and (4) feelings about returning to school following concussion. The at-school category included 3 themes: (1) availability and utilization of academic accommodations; (2) return-to-school policies and procedures; and (3) support from school officials and teachers. CONCLUSIONS Parents' experiences of their child's return-to-school post-concussion underscore the need for evidence-based guidelines for cognitive rest post-concussion and a collaborative, team-based approach to concussion management.
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Affiliation(s)
- Lindsay Sullivan
- Discipline of Children's Studies, School of Education, College of Arts, Social Sciences, & Celtic Studies, National University of Ireland, Galway, University Road, Arts Millenium Building, Room 342, Galway, Ireland
| | - Matthew Wysong
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43205
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, 43205
| | - Jingzhen Yang
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43205
- The Ohio State University, College of Medicine, Columbus, OH, 43205
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Seligman E, Aslam U, Psoter KJ, Ryan LM, Nasr IW. Factors Associated With Repeat Emergency Department Visits in a State-wide Cohort of Pediatric Patients With Mild Traumatic Brain Injury. Pediatr Emerg Care 2022; 38:e683-e689. [PMID: 35100767 DOI: 10.1097/pec.0000000000002368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe demographic, injury, and clinical characteristics of pediatric patients treated in the ED for mild traumatic brain injury (mTBI), and to evaluate characteristics associated with mTBI-related return emergency department (ED) visit within 1 month of initial presentation. METHODS Retrospective cohort study from April 1, 2012, to September 30, 2017, of children 19 years or younger presenting to any Maryland ED for mTBI identified in the Maryland Health Services Cost Review Commission database using ICD-9/10 codes. Demographic, injury, and clinical characteristics of individuals were collected. The primary outcome was mTBI-related return ED visit within 4 weeks. Multiple logistic regression tested the associated of individual demographic, injury, and clinical characteristics with mTBI-related return ED visit. RESULTS There were 25,582 individuals who had an ED visit for mTBI, of which 717 (2.8%) returned to the ED within 4 weeks and 468 (1.8%) within 1 week with a mTBI-related diagnosis. In multivariable logistic regression analyses, public insurance (adjusted odds ratio [aOR], 1.44; 95% confidence interval [CI], 1.21-1.72) and female sex (aOR, 1.34; 95% CI, 1.15-1.56) were associated with increased odds of return to the ED within 4 weeks. Age younger than 2 years (aOR, 0.39; 95% CI, 0.21-0.72) was associated with decreased odds of return visit. There was a trend toward decreased odds of return patients receiving computed tomography head imaging (aOR, 0.86; 95% CI, 0.74-1.01). CONCLUSIONS Although return to the ED for mTBI-related complaints is uncommon, girls, older children, and publicly insured individuals may be at increased risk. Future targeted study may identify areas to improve access to appropriate longitudinal care and justify ED programs to better coordinate follow-up for mTBI.
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Affiliation(s)
- Eva Seligman
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Usman Aslam
- Department of Surgery, St. John's Episcopal Hospital, Far Rockaway, NY
| | - Kevin J Psoter
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics
| | - Leticia Manning Ryan
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Isam W Nasr
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Finn C. Effects of a faculty training program on knowledge and awareness of student concussion and academic performance. J Am Coll Health 2022; 70:453-460. [PMID: 32407248 DOI: 10.1080/07448481.2020.1754220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 01/14/2020] [Accepted: 03/06/2020] [Indexed: 06/11/2023]
Abstract
Objective The purpose of this pilot study was to determine the feasibility of implementing a concussion educational program to college faculty and to explore the effect of the program on faculty knowledge regarding concussion and the effect on learning and return to school. Methods: The study utilized a mixed method design, with a pretest and post-test to measure concussion knowledge before and after a didactic presentation on concussion and academic performance. Semi-structured interviews gathered information on faculty's perception of concussion and academic performance. Results: Faculty demonstrated improved scores on post-test knowledge assessment of concussion and academic performance. Faculty reported that they would be more likely to observe for signs of concussion in students, and would be more willing to adhere to recommendations for academic accommodations. Conclusions: The results of the study indicate that a didactic presentation on concussion and academics may be a feasible method for training college faculty.
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Affiliation(s)
- Christina Finn
- Department of Occupational Therapy, New York Institute of Technology, Old Westbury, New York, USA
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Berz K, Rhine T, Pomerantz WJ, Zhang Y, Loftus K, Lyons S, Logan K. An intervention to improve knowledge and increase comfort of concussion management among school medical staff. Nurse Educ Today 2022; 109:105247. [PMID: 34968933 DOI: 10.1016/j.nedt.2021.105247] [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] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 11/03/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Concussion can negatively impact a child's ability to learn. School-based health professional staff have a unique opportunity to monitor students during recovery and mitigate the potential negative impact. Little is known about school health professional staff's knowledge and comfort with concussion diagnosis and management. OBJECTIVES We aimed to evaluate whether a tailored concussion education session could improve school health professional staff's knowledge about pediatric concussions. A secondary aim was to determine their knowledge retention and comfort with concussion management over the following year, including the impact of periodic follow-up education. We hypothesized that there would be sustained improvement in concussion knowledge and self-reported comfort in concussion management. STUDY DESIGN This study was a pre/post-intervention assessment with longitudinal follow-up. The study investigators provided a three-hour educational presentation about concussions in school-aged children. A survey on knowledge and management of pediatric concussions was administered immediately before and after this educational intervention. Knowledge retention and comfort with management was assessed at six months and at one year post-intervention. PARTICIPANTS AND SETTING Participants included Cincinnati Health Department school health professional staff in attendance at their Back to School in-service, prior to the start of the 2017-2018 school year. RESULTS Sixty school health professional staff from thirty-three schools completed the baseline knowledge survey, and forty completed all four assessments. Among the 40 participants with complete data, on average, the correct response rate (mean number correct, SD) was 82.3% (18.1/22, 11.0) pre-education, 91.8% (20.2/22, 10.3) immediate post-education, 86.4% (19.0/22, 10.8) 6-month follow-up, and 87.3% (19.2/22, 10.9) one-year follow-up. CONCLUSIONS A brief didactic educational intervention improved pediatric concussion knowledge and management skills among school health care providers. Periodic and in-person education is likely necessary to optimize knowledge retention.
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Affiliation(s)
- Kate Berz
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, United States of America; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, United States of America.
| | - Tara Rhine
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, United States of America
| | - Wendy J Pomerantz
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, United States of America
| | - Yin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, United States of America
| | - Kirsten Loftus
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, United States of America; Division of Pediatric Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, United States of America
| | - Stephanie Lyons
- Comprehensive Children's Injury Center, Division of Trauma Services, Cincinnati Children's Hospital Medical Center, United States of America
| | - Kelsey Logan
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, United States of America; Department of Internal Medicine, University of Cincinnati College of Medicine, United States of America
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44
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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: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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46
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Germann D, Cancelliere C, Kazemi M, Marshall C, Hogg-Johnson S. Characteristics of adolescent athletes seeking early versus late care for sport-related concussion. J Can Chiropr Assoc 2021; 65:260-274. [PMID: 35197643 PMCID: PMC8791547] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES 1) To determine which characteristics of adolescent athletes with SRC are associated with 'early' versus 'late' presentation for multimodal treatment; 2) to build a propensity score to investigate the effects of treatment timing during the management of SRCs. METHODS Associations between early (0-7 days) versus late (8-28 days) presentation for treatment and pre-specified sociodemographic, pre-injury and injury characteristics were investigated in a historical cohort study of 2949 multi-sport athletes across Canada aged 12-18 years diagnosed with a SRC in community-based healthcare clinics. RESULTS Early presentation was associated with being male, completing a pre-injury baseline assessment, and responding 'yes' or 'no' to having a diagnosed learning disability. Older athletes who reported previous SRCs were less likely to present early. The propensity score demonstrated an area under the curve of 0.71 (95% CI, 0.69 to 0.73). CONCLUSIONS Male athletes with a completed baseline assessment were more likely to seek early treatment following a SRC, and older athletes who reported a greater number of previous SRCs were less likely to present early. External validation of the propensity score is needed before examining the impact of treatment timing on adolescent athlete recovery outcomes.
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Affiliation(s)
- Darrin Germann
- Department of Graduate Studies, Canadian Memorial Chiropractic College
| | - Carol Cancelliere
- Faculty of Health Sciences, Ontario Tech University
- Institute for Disability and Rehabilitation Research, Ontario Tech University and Canadian Memorial Chiropractic College
| | - Mohsen Kazemi
- Department of Graduate Studies, Canadian Memorial Chiropractic College
| | | | - Sheilah Hogg-Johnson
- Faculty of Health Sciences, Ontario Tech University
- Institute for Disability and Rehabilitation Research, Ontario Tech University and Canadian Memorial Chiropractic College
- Department of Research and Innovation, Canadian Memorial Chiropractic College
- Dalla Lana School of Public Health, University of Toronto
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47
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Philipson EB, Gause E, Conrick KM, Erickson S, Muma A, Liu Z, Ayyagari RC, Vavilala MS. Concussion symptoms and temporary accommodations using a student-centered return to learn care plan. NeuroRehabilitation 2021; 49:655-662. [PMID: 34776424 DOI: 10.3233/nre-210182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many students return to school after concussion with symptoms but without formal support. OBJECTIVE To examine concussion symptoms and temporary academic accommodations during school use of a four-week student-centered return to learn (RTL) care plan. METHODS Five public high schools used the RTL care plan and contributed student-level data after student report of concussion. Data on concussion symptoms, temporary academic accommodations corresponding to reported symptoms, and accommodations provided during RTL care plan use were examined. RESULTS Of 115 students, 55%used the RTL care plan for three (34%) or four (21%) weeks. Compared to students whose symptoms resolve within the first two weeks, students who used the RTL care plan for three or four weeks reported more unique symptoms (P = 0.038), higher total severity score (P = 0.005), and higher average severity per symptom (P = 0.007) at week one. Overall, 1,127 weekly accommodations were provided. While least reported, emotional symptoms received corresponding accommodations most often (127/155 reports: 82%of occurrences). CONCLUSIONS Use of an RTL care plan can facilitate the RTL of students with a concussion and may aid in the identification of students who are in need of longer-term support.
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Affiliation(s)
- Erik B Philipson
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, WA, USA.,The Undergraduate Program in Neuroscience, University of Washington, Seattle, WA, USA
| | - Emma Gause
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, WA, USA
| | - Kelsey M Conrick
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, WA, USA.,School of Social Work, University of Washington, Seattle, WA, USA
| | | | - Amy Muma
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, WA, USA
| | - Zhinan Liu
- Department of Biochemistry, University of Washington, Seattle, WA, USA
| | - Rajiv C Ayyagari
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, WA, USA.,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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48
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Ransom DM, Caldwell CT, DiVirgilio EK, McNally KA, Peterson RL, Ploetz DM, Sady MD, Slomine BS. Pediatric mTBI during the COVID-19 pandemic: considerations for evaluation and management. Child Neuropsychol 2021; 28:355-373. [PMID: 34615434 DOI: 10.1080/09297049.2021.1985101] [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] [Indexed: 10/20/2022]
Abstract
The COVID-19 pandemic has changed healthcare utilization patterns and clinical practice, including pediatric mTBI evaluation and management. Providers treating pediatric mTBI, including neuropsychologists, have a unique role in evaluating and managing an already complex injury in the context of the COVID-19 pandemic with limited empirically based guidelines. In the present paper, we review usual, evidence-based pediatric mTBI care, highlight changes experienced by healthcare providers since the onset of the pandemic, and provide possible considerations and solutions. Three primary challenges to usual care are discussed, including changes to post-injury evaluation, management, and treatment of persistent symptoms. Changing patterns of healthcare utilization have created unique differences in mTBI identification and evaluation, including shifting injury frequency and mechanism, reluctance to seek healthcare, and increasing access to telemedicine. Typical injury management has been compromised by limited access to usual systems/activities (i.e., school, sports, social/leisure activities). Patients may be at higher risk for prolonged recovery due to pre-injury baseline elevations in acute and chronic stressors and reduced access to rehabilitative services targeting persistent symptoms. Considerations and solutions for addressing each of the three challenges are discussed. Neuropsychologists and other pediatric healthcare providers will need to continue to flexibly adapt to the changing needs of youth recovering from mTBI through the duration of the pandemic and beyond. Consistent with pre-pandemic consensus statements, neuropsychologists remain uniquely qualified to evaluate and manage mTBI and provide an increasingly integral role as members of multidisciplinary teams in the context of the global pandemic.Abbreviations: AAP: American Academy of Pediatrics; CDC: Centers for Disease Control and Prevention; COVID-19: coronavirus disease 19; ED: emergency department; mTBI: Mild traumatic brain injury.
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Affiliation(s)
- Danielle M Ransom
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,Center for Behavioral Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carolyn T Caldwell
- Center for Behavioral Health, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Emily K DiVirgilio
- Center for Behavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kelly A McNally
- Center for Behavioral Health, Nationwide Children's Hospital, Columbus, OH, USA.,Center for Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Robin L Peterson
- Center for Behavioral Health, Children's Hospital Colorado, Aurora, CO, USA.,Center for Behavioral Health, University of Colorado School of Medicine, Aurora, CO, USA
| | - Danielle M Ploetz
- Center for Behavioral Health, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Maegan D Sady
- Center for Behavioral Health, Psychological Assessment Resources, Inc, Lutz, FL, USA
| | - Beth S Slomine
- Center for Behavioral Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Behavioral Health, Kennedy Krieger Institute, Baltimore, MD, USA
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49
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Knollman-Porter K, Brown JA, Wallace T, Spitz S. First-Line Health Care Providers' Reported Knowledge of and Referrals to Speech-Language Pathologists for Clients With Mild Traumatic Brain Injury. Am J Speech Lang Pathol 2021; 30:2214-2227. [PMID: 34293269 DOI: 10.1044/2021_ajslp-20-00373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose People with mild traumatic brain injury (mTBI) may experience deficits in cognition or communication that go unnoticed by first-line health care providers (FHPs). Speech-language pathologists (SLPs) assess and treat these domains yet are often underrepresented on mTBI multidisciplinary teams. This study's aim was to evaluate FHPs' reported knowledge of and referral practices to SLPs for individuals across the life span with mTBI. Method Physicians, physician assistants, nurse practitioners, nurses, and athletic trainers (n = 126) completed an online survey, including two Likert scale questions and one free response question relating to SLPs' role in mTBI. Results More than half of FHPs rate their knowledge of the SLP's role in mTBI management as low (somewhat knowledgeable, 29%; not very knowledgeable, 23%). Similarly, nearly two thirds of FHPs indicated rarely (19%) or never (44%), referring to SLPs for management of patients with mTBI. The majority of FHPs' open responses on the role of the SLP in mTBI management were incomplete, with many including domains that were not relevant to an SLP's role in the management of mTBI (e.g., dysphagia). Within the article, we provide results overall and according to individual profession. Conclusions Results suggest a majority of FHPs lack knowledge in the role of the SLP in the management of mTBI, which may underpin the low referral patterns reported by FHPs for SLP services. Future educational efforts for FHPs regarding the role of SLPs in mTBI care are necessary.
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Affiliation(s)
| | - Jessica A Brown
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
| | | | - Shelby Spitz
- Department of Speech Pathology and Audiology, Miami University, Oxford, OH
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Yengo-Kahn AM, Hibshman N, Bezzerides M, Feldman MJ, Vukovic AA, Mummareddy N, Zhao S, Penrod CH, Bonfield CM, Vance EH. Improving Discharge Instructions Following a Concussion Diagnosis in the Pediatric Emergency Department: A Pre-post Intervention Study. Pediatr Qual Saf 2021; 6:e456. [PMID: 34476308 DOI: 10.1097/pq9.0000000000000456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 03/24/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Many children are discharged from the pediatric emergency department (PED) with incomplete or inappropriate instructions following a concussion. Our objective was to evaluate the effectiveness of a simple intervention in improving discharge instruction disbursement and completeness following PED diagnosis of concussion. Methods A pre/post intervention study of 935 patients (375 preintervention and 560 postintervention) ages 5-19, diagnosed with a concussion and discharged from the PED between July 2016 and November 2019, was performed at a single United States pediatric tertiary-care center. Dedicated provider education sessions were held, and a consensus guideline-based set of discharge instructions were implemented in the electronic health record. Primary outcomes included the presence of return-to-play (RTP) instructions, return-to-learn (RTL) instructions, follow-up recommendations, and "complete" discharge (ie, all 3 components present). Statistical process control charts were generated and tested for special cause variation. Results More patients received instructions for RTP (87% versus 59%) and RTL (60% versus 3%), and a complete discharge was more frequent (45% versus 2%), following the conclusion of the intervention. Only the improvement in RTP instructions was completely sustained into the following academic year, whereas RTL and complete discharge rates declined to 27% and 20%, respectively. Conclusions A simple, low-cost intervention such as peer-to-peer education and consensus guideline-based discharge instruction templates can significantly improve discharge readiness after pediatric concussion. Further work is needed to maintain progress and continue improvements, at our large academic trauma center.
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