Pub Date : 2024-07-06DOI: 10.1093/arclin/acae052.02
A. S. Mathew, A. Datoc, D. M. Choi, C. R. Tak, J. P. Abt
Physical therapy (PT) is an effective treatment approach for sports-related concussion (SRC) for patients with high symptom reporting, cervicogenic dysfunction, or vestibular/oculomotor deficits. The purpose of this study was to compare clinical indicators of concussion patients referred to PT who had protracted recovery (PR) and normal recovery (NR). 108 patients (28 NR, 80 PR) were evaluated at a pediatric specialty concussion clinic between April 2021 and December 2023. Patients were between 12–18 years, diagnosed with SRC, evaluated for concussion within one week of injury, referred to PT, completed more than one PT session, and received medical clearance at follow-up appointment. Patients were divided based on PR (>21 days) and NR (‚⧠21 days) and compared via days since injury to PT, days from concussion evaluation to PT, and number of PT sessions. Compared to the NR group, the PR group had greater days since injury to PT (MdnPR = 12.00; MdnNR = 3.00; U = 322.00,p < 0.001), days from concussion evaluation to PT (MdnPR = 6.00; MdnNR = 0.50; U = 517.50, p < 0.001), and engaged in a higher number of PT sessions than the NR group (MdnPR = 4.00; MdnNR = 3.00; U = 787.50, p = 0.02). The PR group also had a greater number of recovery days from PT evaluation compared to the NR group (MdnPR = 27.00; MdnNR = 10.00; U = 108.00, p < 0.001). Previous studies have also shown that time to concussion evaluation is an important prognostic indicator of recovery. Correspondingly, prompt referral to PT should be promoted by providers, athletic trainers, and parents for patients who require higher escalation of concussion care to improve recovery outcomes.
物理治疗（PT）是治疗运动相关脑震荡（SRC）的一种有效方法，适用于症状报告较多、颈源性功能障碍或前庭/运动障碍的患者。本研究的目的是比较转诊至PT治疗的脑震荡患者中，恢复期较长（PR）和恢复正常（NR）的患者的临床指标。 2021 年 4 月至 2023 年 12 月期间，儿科脑震荡专科门诊对 108 名患者（28 名 NR，80 名 PR）进行了评估。患者年龄在 12-18 岁之间，被诊断为 SRC，在受伤后一周内接受了脑震荡评估，被转诊至康复训练中心，完成了一次以上的康复训练，并在复诊时获得了医生的许可。患者分为PR组（>21天）和NR组（'§ 21天），并通过受伤后到康复训练的天数、脑震荡评估后到康复训练的天数以及康复训练的次数进行比较。 与NR组相比，PR组受伤后开始运动训练的天数（MdnPR = 12.00; MdnNR = 3.00; U = 322.00,p<0.001）、脑震荡评估后开始运动训练的天数（MdnPR = 6.00; MdnNR = 0.50; U = 517.50, p < 0.001），并且参与治疗的次数高于 NR 组（MdnPR = 4.00; MdnNR = 3.00; U = 787.50, p = 0.02）。与 NR 组相比，PR 组从 PT 评估中恢复的天数也更多 (MdnPR = 27.00; MdnNR = 10.00; U = 108.00, p < 0.001)。 以往的研究还表明，脑震荡评估时间是一个重要的康复预后指标。因此，对于需要更高级脑震荡治疗的患者，医疗服务提供者、运动训练师和家长应促进其及时转诊至康复治疗师，以改善康复效果。
{"title":"A - 02 Time to Physical Therapy in Pediatric Concussion Patients Influences Recovery Outcomes","authors":"A. S. Mathew, A. Datoc, D. M. Choi, C. R. Tak, J. P. Abt","doi":"10.1093/arclin/acae052.02","DOIUrl":"https://doi.org/10.1093/arclin/acae052.02","url":null,"abstract":"\u0000 \u0000 \u0000 Physical therapy (PT) is an effective treatment approach for sports-related concussion (SRC) for patients with high symptom reporting, cervicogenic dysfunction, or vestibular/oculomotor deficits. The purpose of this study was to compare clinical indicators of concussion patients referred to PT who had protracted recovery (PR) and normal recovery (NR).\u0000 \u0000 \u0000 \u0000 108 patients (28 NR, 80 PR) were evaluated at a pediatric specialty concussion clinic between April 2021 and December 2023. Patients were between 12–18 years, diagnosed with SRC, evaluated for concussion within one week of injury, referred to PT, completed more than one PT session, and received medical clearance at follow-up appointment. Patients were divided based on PR (>21 days) and NR (‚⧠21 days) and compared via days since injury to PT, days from concussion evaluation to PT, and number of PT sessions.\u0000 \u0000 \u0000 \u0000 Compared to the NR group, the PR group had greater days since injury to PT (MdnPR = 12.00; MdnNR = 3.00; U = 322.00,p < 0.001), days from concussion evaluation to PT (MdnPR = 6.00; MdnNR = 0.50; U = 517.50, p < 0.001), and engaged in a higher number of PT sessions than the NR group (MdnPR = 4.00; MdnNR = 3.00; U = 787.50, p = 0.02). The PR group also had a greater number of recovery days from PT evaluation compared to the NR group (MdnPR = 27.00; MdnNR = 10.00; U = 108.00, p < 0.001).\u0000 \u0000 \u0000 \u0000 Previous studies have also shown that time to concussion evaluation is an important prognostic indicator of recovery. Correspondingly, prompt referral to PT should be promoted by providers, athletic trainers, and parents for patients who require higher escalation of concussion care to improve recovery outcomes.\u0000","PeriodicalId":8176,"journal":{"name":"Archives of Clinical Neuropsychology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141672102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-06DOI: 10.1093/arclin/acae052.25
K. Berkey, G. Thomas, P. Arnett
This study investigates whether post-concussion sleep symptoms affect return-to-play timelines following sports-related concussion. We predict that athletes in the prolonged recovery group will report higher sleep cluster (reflecting worse sleep) scores. 53 athletes (F = 9.4%) completed a comprehensive neuropsychological battery within 14 days of being diagnosed with concussion. Symptomology was assessed using the Post- Concussion Symptom Scale (PCSS). Previous research demonstrated the utility of examining symptom clusters on the PCSS; PCSS Sleep Cluster was used to examine sleep disturbances in the current study. Athletes were divided into 3 groups based on their return-to-play timeline: Early (<14 days), Normal (14–28 days), and Prolonged (>28 days). Players were cleared to return-to-play by sports medicine. ANOVA results showed no differences between the Early, Normal, and Prolonged recovery groups in terms of sleep cluster symptoms, F(50) = 1.10, p = 0.34. These results are consistent with some previous research showing that athletes reporting high levels of sleep complaints do not perform worse on cognitive testing, which may explain, in part, why there are no differences in terms of return-to-play timelines. Athletes with poor sleep at post-concussion did not show significant risk for an abnormal return-to-play time as there were no group differences. These findings are important as sleep complaints may not be a strong predictor for prolonged recovery. Instead, results suggest that poor sleep may influence symptom reporting but does not impede return-to-play timelines.
{"title":"A - 25 Relationship between Post-Concussion Sleep Disturbances and Return-to-Play Timeline","authors":"K. Berkey, G. Thomas, P. Arnett","doi":"10.1093/arclin/acae052.25","DOIUrl":"https://doi.org/10.1093/arclin/acae052.25","url":null,"abstract":"\u0000 \u0000 \u0000 This study investigates whether post-concussion sleep symptoms affect return-to-play timelines following sports-related concussion. We predict that athletes in the prolonged recovery group will report higher sleep cluster (reflecting worse sleep) scores.\u0000 \u0000 \u0000 \u0000 53 athletes (F = 9.4%) completed a comprehensive neuropsychological battery within 14 days of being diagnosed with concussion. Symptomology was assessed using the Post- Concussion Symptom Scale (PCSS). Previous research demonstrated the utility of examining symptom clusters on the PCSS; PCSS Sleep Cluster was used to examine sleep disturbances in the current study. Athletes were divided into 3 groups based on their return-to-play timeline: Early (<14 days), Normal (14–28 days), and Prolonged (>28 days). Players were cleared to return-to-play by sports medicine.\u0000 \u0000 \u0000 \u0000 ANOVA results showed no differences between the Early, Normal, and Prolonged recovery groups in terms of sleep cluster symptoms, F(50) = 1.10, p = 0.34. These results are consistent with some previous research showing that athletes reporting high levels of sleep complaints do not perform worse on cognitive testing, which may explain, in part, why there are no differences in terms of return-to-play timelines.\u0000 \u0000 \u0000 \u0000 Athletes with poor sleep at post-concussion did not show significant risk for an abnormal return-to-play time as there were no group differences. These findings are important as sleep complaints may not be a strong predictor for prolonged recovery. Instead, results suggest that poor sleep may influence symptom reporting but does not impede return-to-play timelines.\u0000","PeriodicalId":8176,"journal":{"name":"Archives of Clinical Neuropsychology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141673057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-06DOI: 10.1093/arclin/acae052.31
A. Datoc, G. D. Sanders, T. Tarkenton Allen, J. Schaffert, N. Didehbani, C. Cullum
Long-term concussion sequelae have been increasingly studied in former professional athletes, and less is known about those who participated in sport at the collegiate level. This study explores the relationship between concussion history and cognition/mood in former collegiate athletes in middle-to-later adulthood. 422 former collegiate athletes over age 50 (M = 61.5; 62% male) completed the College Level Aging Athlete Study (CLEAATS) including the Cognitive Function Instrument (CFI), Telephone Interview for Cognitive Status-Modified (TICSm), and self-report questionnaires including concussion history and current mood. Pearson correlations and multiple regression analyses examined the relationship between concussion history, subjective and objective cognitive status, and mood. 54% of the sample reported a history of concussion (M = 1.2, SD = 1.7). Number of concussions was marginally associated with subjective cognitive complaints (r = 0.13, p = 0.004) and depression (r = 0.14, p = 0.002), but not objective cognition (p = 0.39) or anxiety (p = 0.33). Regression models including demographic factors and mood were significant and explained 32% and 17% of the variance in subjective and objective cognition, respectively. Concussion history was not a significant predictor in either model, whereas depression (Β = -0.12) was associated with poorer subjective cognition only. Concussion history was not associated with subjective or objective cognitive changes in former collegiate athletes. Although a very small relationship between concussion history and depression was found, depression was associated with more subjective cognitive complaints. This suggests mood symptoms have greater impact on subjective cognitive status than concussion history. These findings highlight the importance of considering the effect of current mood symptoms when evaluating former athletes who present with cognitive complaints.
{"title":"A - 31 Relationship between Self-Reported Concussion History, Cognition, and Mood among Former Collegiate Athletes","authors":"A. Datoc, G. D. Sanders, T. Tarkenton Allen, J. Schaffert, N. Didehbani, C. Cullum","doi":"10.1093/arclin/acae052.31","DOIUrl":"https://doi.org/10.1093/arclin/acae052.31","url":null,"abstract":"\u0000 \u0000 \u0000 Long-term concussion sequelae have been increasingly studied in former professional athletes, and less is known about those who participated in sport at the collegiate level. This study explores the relationship between concussion history and cognition/mood in former collegiate athletes in middle-to-later adulthood.\u0000 \u0000 \u0000 \u0000 422 former collegiate athletes over age 50 (M = 61.5; 62% male) completed the College Level Aging Athlete Study (CLEAATS) including the Cognitive Function Instrument (CFI), Telephone Interview for Cognitive Status-Modified (TICSm), and self-report questionnaires including concussion history and current mood. Pearson correlations and multiple regression analyses examined the relationship between concussion history, subjective and objective cognitive status, and mood.\u0000 \u0000 \u0000 \u0000 54% of the sample reported a history of concussion (M = 1.2, SD = 1.7). Number of concussions was marginally associated with subjective cognitive complaints (r = 0.13, p = 0.004) and depression (r = 0.14, p = 0.002), but not objective cognition (p = 0.39) or anxiety (p = 0.33). Regression models including demographic factors and mood were significant and explained 32% and 17% of the variance in subjective and objective cognition, respectively. Concussion history was not a significant predictor in either model, whereas depression (Β = -0.12) was associated with poorer subjective cognition only.\u0000 \u0000 \u0000 \u0000 Concussion history was not associated with subjective or objective cognitive changes in former collegiate athletes. Although a very small relationship between concussion history and depression was found, depression was associated with more subjective cognitive complaints. This suggests mood symptoms have greater impact on subjective cognitive status than concussion history. These findings highlight the importance of considering the effect of current mood symptoms when evaluating former athletes who present with cognitive complaints.\u0000","PeriodicalId":8176,"journal":{"name":"Archives of Clinical Neuropsychology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141671631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-06DOI: 10.1093/arclin/acae052.03
D. M. Choi, A. S. Mathew, J. K. Roberts, J. P. Abt
Recovery outcomes from consecutive concussions require greater empirical support. The purpose of this study was to compare recovery outcomes of patients who sustained repeated sport-related concussions (SRC) and received care at the same specialty clinic. Data were extracted from 148 patients, aged 12–18, diagnosed and evaluated in a specialty clinic for two consecutive SRCs. Comparisons between initial visits for first and second concussions included demographics, medical history, assessment scores, days since injury (DSI), and injury recovery days using paired sample t-tests. A linear regression model was built with relevant variables (age, gender, comorbidities, DSI, VOMS, PCSS) to predict recovery days for first SRC. Another model was constructed with significant variables to predict recovery days for second SRC. Individuals were evaluated within approximately one year from their first SRC (MAge = 14.61¬ ± 1.47) to their second (MAge = 15.44¬ ± 1.37, MeanDifference = 0.83, p < 0.001). There were no significant differences between other variables (p > 0.05). PCSS and overall VOMS change scores predicted recovery days for first SRC (R2 = 0.30, p < 0.001). However, the new model for second SRC accounted for much less of the variance in recovery days (R2 = 0.11). Our results show patients do not experience a worse outcome from subsequent concussion (PCSS, VOMS, DSI, recovery days). However, clinical outcomes from patients’first SRC do not seem to implicate recovery outcomes for their second SRC. Despite controlling for commonly researched predictors of recovery, our findings highlight the heterogeneous nature of SRC for the same individual receiving standardized care. Additional research is needed to examine further intraindividual differences in those who sustain consecutive SRCs.
{"title":"A - 03 Outcomes of Standardized Care on Recovery for Repeated Concussion","authors":"D. M. Choi, A. S. Mathew, J. K. Roberts, J. P. Abt","doi":"10.1093/arclin/acae052.03","DOIUrl":"https://doi.org/10.1093/arclin/acae052.03","url":null,"abstract":"\u0000 \u0000 \u0000 Recovery outcomes from consecutive concussions require greater empirical support. The purpose of this study was to compare recovery outcomes of patients who sustained repeated sport-related concussions (SRC) and received care at the same specialty clinic.\u0000 \u0000 \u0000 \u0000 Data were extracted from 148 patients, aged 12–18, diagnosed and evaluated in a specialty clinic for two consecutive SRCs. Comparisons between initial visits for first and second concussions included demographics, medical history, assessment scores, days since injury (DSI), and injury recovery days using paired sample t-tests. A linear regression model was built with relevant variables (age, gender, comorbidities, DSI, VOMS, PCSS) to predict recovery days for first SRC. Another model was constructed with significant variables to predict recovery days for second SRC.\u0000 \u0000 \u0000 \u0000 Individuals were evaluated within approximately one year from their first SRC (MAge = 14.61¬ ± 1.47) to their second (MAge = 15.44¬ ± 1.37, MeanDifference = 0.83, p < 0.001). There were no significant differences between other variables (p > 0.05). PCSS and overall VOMS change scores predicted recovery days for first SRC (R2 = 0.30, p < 0.001). However, the new model for second SRC accounted for much less of the variance in recovery days (R2 = 0.11).\u0000 \u0000 \u0000 \u0000 Our results show patients do not experience a worse outcome from subsequent concussion (PCSS, VOMS, DSI, recovery days). However, clinical outcomes from patients’first SRC do not seem to implicate recovery outcomes for their second SRC. Despite controlling for commonly researched predictors of recovery, our findings highlight the heterogeneous nature of SRC for the same individual receiving standardized care. Additional research is needed to examine further intraindividual differences in those who sustain consecutive SRCs.\u0000","PeriodicalId":8176,"journal":{"name":"Archives of Clinical Neuropsychology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141672377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-06DOI: 10.1093/arclin/acae052.45
G. D. Sanders, L. S. Hynan, S. Bunt, C. Cullum
Accurate measurement of latent abilities is essential for valid inference. The Brief Resilience Scale (BRS) assesses the “ability to bounce back”from stressful situations, and resilience may play a role in concussion recovery. Questions regarding the factor structure of the BRS have been explored in other populations, but evidence of its measurement quality in concussion is lacking. The present study investigated the psychometric properties of the BRS in concussed adolescents within a Rasch framework. 927 participants aged 12 to 18 (M = 14.7; 50.3% female) underwent clinical evaluation within 30 days of injury in the ConTex study. The BRS contains 6 items rated on a 5-point Likert scale (Strongly Disagree to Strongly Agree), half of which are reverse scored. The Rasch Rating Scale Model was applied and item fit statistics and dimensionality were examined to assess the degree of fit of the data to the Rasch model. Item difficulties ranged −0.82 to 0.77. Item fit was adequate based on mean-square infit and outfit values. The BRS demonstrated sufficient targeting except for participants at the highest and lowest range of latent ability. Unidimensionality testing indicated the presence of a secondary dimension. The BRS showed suboptimal fit with the Rasch model based on lack of unidimensionality. However, violations likely reflect item wording effects and not a substantive dimension that merits scale modification. Application of Rasch and other item response theory methodologies can enable development of more psychometrically sound and clinically informative tools for use in the context of concussion outcomes.
{"title":"A - 45 Rasch Analysis of the Brief Resilience Scale in Adolescents with Sports-Related Concussion","authors":"G. D. Sanders, L. S. Hynan, S. Bunt, C. Cullum","doi":"10.1093/arclin/acae052.45","DOIUrl":"https://doi.org/10.1093/arclin/acae052.45","url":null,"abstract":"\u0000 \u0000 \u0000 Accurate measurement of latent abilities is essential for valid inference. The Brief Resilience Scale (BRS) assesses the “ability to bounce back”from stressful situations, and resilience may play a role in concussion recovery. Questions regarding the factor structure of the BRS have been explored in other populations, but evidence of its measurement quality in concussion is lacking. The present study investigated the psychometric properties of the BRS in concussed adolescents within a Rasch framework.\u0000 \u0000 \u0000 \u0000 927 participants aged 12 to 18 (M = 14.7; 50.3% female) underwent clinical evaluation within 30 days of injury in the ConTex study. The BRS contains 6 items rated on a 5-point Likert scale (Strongly Disagree to Strongly Agree), half of which are reverse scored. The Rasch Rating Scale Model was applied and item fit statistics and dimensionality were examined to assess the degree of fit of the data to the Rasch model.\u0000 \u0000 \u0000 \u0000 Item difficulties ranged −0.82 to 0.77. Item fit was adequate based on mean-square infit and outfit values. The BRS demonstrated sufficient targeting except for participants at the highest and lowest range of latent ability. Unidimensionality testing indicated the presence of a secondary dimension.\u0000 \u0000 \u0000 \u0000 The BRS showed suboptimal fit with the Rasch model based on lack of unidimensionality. However, violations likely reflect item wording effects and not a substantive dimension that merits scale modification. Application of Rasch and other item response theory methodologies can enable development of more psychometrically sound and clinically informative tools for use in the context of concussion outcomes.\u0000","PeriodicalId":8176,"journal":{"name":"Archives of Clinical Neuropsychology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141671845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-06DOI: 10.1093/arclin/acae052.42
C. Burley, A. J. Zynda, F. Kehinde, A. Trbovich, C. Holland, M. Womble, M. Collins, R. Elbin, A. Kontos
This study examined differences in clinical profiles (e.g., post-traumatic migraine, vestibular, anxiety/mood, oculomotor, and cognitive) between exercise tolerance groups determined by the Buffalo Concussion Bike Test (BCBT). We hypothesized the exercise-intolerant group would be more likely to have anxiety and/or vestibular profiles. Patients (18–49 years; 8 days to 6 months from concussion) completed demographic and medical history, the Clinical Profile Screen, Brief Symptom Inventory-18, and BCBT. Participants were adjudicated into one or more clinical profiles and classified as exercise tolerant or intolerant. Independent-sample t-tests and chi-square tests were used to compare demographics, clinical profiles, reasons for stopping the BCBT, and ANS metrics. One hundred six participants (mean age = 27.9¬ ± 8.1, 62.3% female) were included in the study (71 exercise-intolerant; 35 exercise-tolerant). No demographic or medical history differences were noted between groups. The exercise-intolerant group had significantly lower odds of having an adjudicated headache profile (OR = 0.39, 95%CI = 0.16–0.93, p = 0.03) and significantly greater odds of having an adjudicated autonomic profile (OR = 2.28, 95%CI = 1.01–5.21, p = 0.04). A greater proportion of those with the vestibular profile stopped the BCBT due to symptom exacerbation than those without (90.5% vs. 9.5%, p = 0.04). Adjudicated clinical profiles and ANS metrics were similar between exercise-tolerant and intolerant groups. Vestibular sensitivities have a considerable contribution to symptom provocation during the BCBT, as a significant proportion of participants with the vestibular profile discontinued the BCBT due to symptom exacerbation. These findings corroborate previous research and suggest that exercise intolerance is pervasive across all concussion clinical profiles and should be considered in all evaluations.
{"title":"A - 42 Differences in Exercise Tolerance and Autonomic Function Based on Concussion Clinical Profile","authors":"C. Burley, A. J. Zynda, F. Kehinde, A. Trbovich, C. Holland, M. Womble, M. Collins, R. Elbin, A. Kontos","doi":"10.1093/arclin/acae052.42","DOIUrl":"https://doi.org/10.1093/arclin/acae052.42","url":null,"abstract":"\u0000 \u0000 \u0000 This study examined differences in clinical profiles (e.g., post-traumatic migraine, vestibular, anxiety/mood, oculomotor, and cognitive) between exercise tolerance groups determined by the Buffalo Concussion Bike Test (BCBT). We hypothesized the exercise-intolerant group would be more likely to have anxiety and/or vestibular profiles.\u0000 \u0000 \u0000 \u0000 Patients (18–49 years; 8 days to 6 months from concussion) completed demographic and medical history, the Clinical Profile Screen, Brief Symptom Inventory-18, and BCBT. Participants were adjudicated into one or more clinical profiles and classified as exercise tolerant or intolerant. Independent-sample t-tests and chi-square tests were used to compare demographics, clinical profiles, reasons for stopping the BCBT, and ANS metrics.\u0000 \u0000 \u0000 \u0000 One hundred six participants (mean age = 27.9¬ ± 8.1, 62.3% female) were included in the study (71 exercise-intolerant; 35 exercise-tolerant). No demographic or medical history differences were noted between groups. The exercise-intolerant group had significantly lower odds of having an adjudicated headache profile (OR = 0.39, 95%CI = 0.16–0.93, p = 0.03) and significantly greater odds of having an adjudicated autonomic profile (OR = 2.28, 95%CI = 1.01–5.21, p = 0.04). A greater proportion of those with the vestibular profile stopped the BCBT due to symptom exacerbation than those without (90.5% vs. 9.5%, p = 0.04).\u0000 \u0000 \u0000 \u0000 Adjudicated clinical profiles and ANS metrics were similar between exercise-tolerant and intolerant groups. Vestibular sensitivities have a considerable contribution to symptom provocation during the BCBT, as a significant proportion of participants with the vestibular profile discontinued the BCBT due to symptom exacerbation. These findings corroborate previous research and suggest that exercise intolerance is pervasive across all concussion clinical profiles and should be considered in all evaluations.\u0000","PeriodicalId":8176,"journal":{"name":"Archives of Clinical Neuropsychology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141673051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-06DOI: 10.1093/arclin/acae052.26
R. Scolaro Moser, K. Riegler, C. Uhrig, D. Choi, S. Broglio, B. Mayer, A. Boltz, C. L. Master, P. Schatz
To identify criteria used by sports concussion specialists in determining recovery from sport-related concussion. We hypothesized differences in use of decision-making criteria among neuropsychologists, physicians, and certified athletic trainers (ATCs). 143 sports concussion specialists (neuropsychologists = 45, physicians = 41, and certified athletic trainers (ATCs) = 57) completed a survey rating the importance of specific criteria for determining concussion recovery in youth and adult athletes. Differences between specialist groups were examined with Kruskal-Wallis tests. There were significant differences in criteria ratings across specialist groups regarding youth and adults for “use of neurocognitive test scores,”“balance testing,”“physical examination,”“no symptom provocation with neurocognitive testing,”“athlete report of anxiety about return to sport,“and “family member’s report of recovery,“all p’s < 0.001. For youth and adults, physicians ranked “use of neurocognitive test scores”and “no symptom provocation with neurocognitive testing”as less important than other providers, while “physician examination”was ranked as more important. Neuropsychologists ranked “balance testing”and “athlete report of anxiety about return to sport”as less important than other providers; and ATCs ranked “family member’s report of recovery”as less important than other providers. Our results advance understanding of multidisciplinary standards of care in determining recovery from sports concussion and suggest the importance of collaboration in establishing clinical criteria common to all sports concussion health care providers.
{"title":"A - 26 A Survey of Sports Concussion Specialists’Clinical Criteria to Determine Concussion Recovery","authors":"R. Scolaro Moser, K. Riegler, C. Uhrig, D. Choi, S. Broglio, B. Mayer, A. Boltz, C. L. Master, P. Schatz","doi":"10.1093/arclin/acae052.26","DOIUrl":"https://doi.org/10.1093/arclin/acae052.26","url":null,"abstract":"\u0000 \u0000 \u0000 To identify criteria used by sports concussion specialists in determining recovery from sport-related concussion. We hypothesized differences in use of decision-making criteria among neuropsychologists, physicians, and certified athletic trainers (ATCs).\u0000 \u0000 \u0000 \u0000 143 sports concussion specialists (neuropsychologists = 45, physicians = 41, and certified athletic trainers (ATCs) = 57) completed a survey rating the importance of specific criteria for determining concussion recovery in youth and adult athletes. Differences between specialist groups were examined with Kruskal-Wallis tests.\u0000 \u0000 \u0000 \u0000 There were significant differences in criteria ratings across specialist groups regarding youth and adults for “use of neurocognitive test scores,”“balance testing,”“physical examination,”“no symptom provocation with neurocognitive testing,”“athlete report of anxiety about return to sport,“and “family member’s report of recovery,“all p’s < 0.001. For youth and adults, physicians ranked “use of neurocognitive test scores”and “no symptom provocation with neurocognitive testing”as less important than other providers, while “physician examination”was ranked as more important. Neuropsychologists ranked “balance testing”and “athlete report of anxiety about return to sport”as less important than other providers; and ATCs ranked “family member’s report of recovery”as less important than other providers.\u0000 \u0000 \u0000 \u0000 Our results advance understanding of multidisciplinary standards of care in determining recovery from sports concussion and suggest the importance of collaboration in establishing clinical criteria common to all sports concussion health care providers.\u0000","PeriodicalId":8176,"journal":{"name":"Archives of Clinical Neuropsychology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141672383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-06DOI: 10.1093/arclin/acae052.06
R. Magill, C. Vaughan, R. Echemendia, W. Kringler, C. Bailey
The 6th International Conference on Concussion in Sport distilled its main outcomes and recommendations into a consensus statement, which will likely have significant influence on the evaluation and management of sport-concussion. This abstract examines opinions on the statement among healthcare providers, including those who contributed to the conference and those who did not. A survey was designed with minor concussion-specific modifications using the Appraisal of Guidelines Research and Evaluation 2nd edition (AGREE II) framework. This framework features 6 domains evaluated on a 7-point Likert scale - Scope and Purpose, Stakeholder Involvement, Rigour of Development, Clarity of Presentation, Applicability, and Editorial Independence. 72 participants completed the survey, including neuropsychologists (29.2%), physicians (31.9%), and athletic trainers (31.9%). The majority were not involved in the statement (71.8%). The Scope and Purpose domain was most favorably endorsed (80.3%), followed by Rigour of Development (76%), Clarity of Presentation (74%), Editorial Independence (72.1%) and Stakeholder Involvement (70.7%). The Applicability domain was least favorably endorsed (69.5%). The majority of domain ratings did not differ significantly among healthcare providers, except for the Stakeholder Involvement and Applicability domains were rated higher by athletic trainers than physicians (p = 0.011, p = 0.007, respectively). No differences in opinions across the six domains were found between those who did and did not contribute to the statement. Overall, the consensus statement was rated favorably by survey participants. Lower ratings in the Applicability domain suggest an area for improvement when developing future consensus statements.
{"title":"A - 06 Examining Consumer Feedback on the 2023 International Conference Consensus Statement on Concussion In Sport","authors":"R. Magill, C. Vaughan, R. Echemendia, W. Kringler, C. Bailey","doi":"10.1093/arclin/acae052.06","DOIUrl":"https://doi.org/10.1093/arclin/acae052.06","url":null,"abstract":"\u0000 \u0000 \u0000 The 6th International Conference on Concussion in Sport distilled its main outcomes and recommendations into a consensus statement, which will likely have significant influence on the evaluation and management of sport-concussion. This abstract examines opinions on the statement among healthcare providers, including those who contributed to the conference and those who did not.\u0000 \u0000 \u0000 \u0000 A survey was designed with minor concussion-specific modifications using the Appraisal of Guidelines Research and Evaluation 2nd edition (AGREE II) framework. This framework features 6 domains evaluated on a 7-point Likert scale - Scope and Purpose, Stakeholder Involvement, Rigour of Development, Clarity of Presentation, Applicability, and Editorial Independence. 72 participants completed the survey, including neuropsychologists (29.2%), physicians (31.9%), and athletic trainers (31.9%). The majority were not involved in the statement (71.8%).\u0000 \u0000 \u0000 \u0000 The Scope and Purpose domain was most favorably endorsed (80.3%), followed by Rigour of Development (76%), Clarity of Presentation (74%), Editorial Independence (72.1%) and Stakeholder Involvement (70.7%). The Applicability domain was least favorably endorsed (69.5%). The majority of domain ratings did not differ significantly among healthcare providers, except for the Stakeholder Involvement and Applicability domains were rated higher by athletic trainers than physicians (p = 0.011, p = 0.007, respectively). No differences in opinions across the six domains were found between those who did and did not contribute to the statement.\u0000 \u0000 \u0000 \u0000 Overall, the consensus statement was rated favorably by survey participants. Lower ratings in the Applicability domain suggest an area for improvement when developing future consensus statements.\u0000","PeriodicalId":8176,"journal":{"name":"Archives of Clinical Neuropsychology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141672605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-06DOI: 10.1093/arclin/acae052.05
H. M. Johnson, J. M. Guerin, G. A. Gioia, C. G. Vaughan
An individual’s confidence in their ability to facilitate their concussion recovery (i.e., self-efficacy [SE]) is important for outcomes. Self-efficacy may be influenced by early childhood experiences and access to environmental resources. This study explores the relationship between neighborhood opportunity and self-efficacy following pediatric concussion. Participants completed a 17-item self-efficacy measure (PACE-SE) during an initial clinic visit. The Child Opportunity Index (COI) was obtained based on each child’s home address. A stepwise linear regression was employed to examine the relationship between COI and PACE-SE accounting for symptom burden, days since injury, and sex. 431 participants aged 13–18 (M = 15.1+/−1.6; 58% female) were seen within three months of concussion (M days since injury = 19.2+/−16.2) at a specialty clinic. The majority were injured playing sports (67%). Lower PACE-SE score was associated with female sex (r = 0.180; p < 0.001), higher symptom burden (r = −0.493, p < 0.001), and more days from injury (r = −0.132; p = 0.003). There was a small but significant relationship between COI and PACE-SE, after accounting for covariates (R2 = 0.008, p = 0.033). Stepwise regressions showed associations between COI and the PACE-SE subdomains Managing my Stress (MMS; R2 = 0.008, p = 0.031), Seeking Adult Assistance (SAA; R2 = 0.015, p = 0.008), and Maintaining a Positive Outlook (MPO; R2 = 0.009, p = 0.022), but not Managing my Activity (MMA). SAA and COI were significantly associated in males (p < 0.05), while MPO and COI were significant in females (p = 0.001, <0.05). The results suggest that lower neighborhood opportunity is associated with lower overall self-efficacy in facilitating one’s recovery after concussion. Specific aspects of self-efficacy may be uniquely impacted, such as seeking adult assistance.
一个人对自己促进脑震荡康复能力的信心（即自我效能感 [SE]）对康复结果非常重要。自我效能感可能会受到儿童早期经历和环境资源的影响。本研究探讨了邻里机会与小儿脑震荡后自我效能感之间的关系。 参与者在初次就诊时完成了一项包含 17 个项目的自我效能测量（PACE-SE）。儿童机会指数（COI）是根据每个儿童的家庭住址得出的。在考虑症状负担、受伤后天数和性别的情况下，我们采用逐步线性回归法来检验 COI 与 PACE-SE 之间的关系。 431名年龄在13-18岁之间的参与者（中位数=15.1+/-1.6；58%为女性）在脑震荡后三个月内到专科门诊就诊（中位数受伤后天数=19.2+/-16.2）。大多数人是在运动中受伤的（67%）。较低的PACE-SE得分与女性性别（r = 0.180; p < 0.001）、较高的症状负担（r = -0.493, p < 0.001）和较长的受伤天数（r = -0.132; p = 0.003）有关。在考虑协变量（R2 = 0.008，p = 0.033）后，COI 与 PACE-SE 之间存在微小但显著的关系。逐步回归结果显示，COI 与 PACE-SE 子域 "管理我的压力"（MMS；R2 = 0.008，p = 0.031）、"寻求成人帮助"（SAA；R2 = 0.015，p = 0.008）和 "保持积极乐观"（MPO；R2 = 0.009，p = 0.022）之间存在关联，但与 "管理我的活动"（MMA）不相关。男性的 SAA 和 COI 显著相关（p < 0.05），而女性的 MPO 和 COI 显著相关（p = 0.001，<0.05）。 结果表明，较低的邻里机会与较低的促进脑震荡后康复的整体自我效能有关。自我效能感的某些方面可能会受到独特的影响，如寻求成人帮助。
{"title":"A - 05 The Relationship between Child Opportunity and Self-Efficacy Following Pediatric Concussion","authors":"H. M. Johnson, J. M. Guerin, G. A. Gioia, C. G. Vaughan","doi":"10.1093/arclin/acae052.05","DOIUrl":"https://doi.org/10.1093/arclin/acae052.05","url":null,"abstract":"\u0000 \u0000 \u0000 An individual’s confidence in their ability to facilitate their concussion recovery (i.e., self-efficacy [SE]) is important for outcomes. Self-efficacy may be influenced by early childhood experiences and access to environmental resources. This study explores the relationship between neighborhood opportunity and self-efficacy following pediatric concussion.\u0000 \u0000 \u0000 \u0000 Participants completed a 17-item self-efficacy measure (PACE-SE) during an initial clinic visit. The Child Opportunity Index (COI) was obtained based on each child’s home address. A stepwise linear regression was employed to examine the relationship between COI and PACE-SE accounting for symptom burden, days since injury, and sex.\u0000 \u0000 \u0000 \u0000 431 participants aged 13–18 (M = 15.1+/−1.6; 58% female) were seen within three months of concussion (M days since injury = 19.2+/−16.2) at a specialty clinic. The majority were injured playing sports (67%). Lower PACE-SE score was associated with female sex (r = 0.180; p < 0.001), higher symptom burden (r = −0.493, p < 0.001), and more days from injury (r = −0.132; p = 0.003). There was a small but significant relationship between COI and PACE-SE, after accounting for covariates (R2 = 0.008, p = 0.033). Stepwise regressions showed associations between COI and the PACE-SE subdomains Managing my Stress (MMS; R2 = 0.008, p = 0.031), Seeking Adult Assistance (SAA; R2 = 0.015, p = 0.008), and Maintaining a Positive Outlook (MPO; R2 = 0.009, p = 0.022), but not Managing my Activity (MMA). SAA and COI were significantly associated in males (p < 0.05), while MPO and COI were significant in females (p = 0.001, <0.05).\u0000 \u0000 \u0000 \u0000 The results suggest that lower neighborhood opportunity is associated with lower overall self-efficacy in facilitating one’s recovery after concussion. Specific aspects of self-efficacy may be uniquely impacted, such as seeking adult assistance.\u0000","PeriodicalId":8176,"journal":{"name":"Archives of Clinical Neuropsychology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141672023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-06DOI: 10.1093/arclin/acae052.34
D. Naidu, M. Mrazik, C. David, J. Hansen, Q. Ree-Fedun
To investigate differences in subjective symptom report and percentage ratings of subjective well-being (SWB) at initial post-injury concussion medical evaluations in professional football players. A retrospective, quasi-experimental design was used for the study. Participants included Canadian Football League players who underwent initial locker room post-injury medical evaluations. CFL concussion protocol requires any player suspected of a concussion to undergo a full evaluation including SCAT5. There were 2 groups including 43 players subsequently diagnosed with concussions who were compared with 22 players not diagnosed with concussion. Data included total symptom score from the SCAT5 and SWB (ratings out of 100%). T-tests and descriptive statistics evaluated differences between groups. At baseline, there were no significant differences on ratings of SWB between groups. In contrast, there was a significant difference in ratings of subjective well being between concussed players (M = 75.5%, SD = 19.5) and non concussed players (M = 92.7, SD = 7.7); t(63) = [3.8], p = [0.1]. Furthermore, significant differences on total symptom report from the SCAT5 were identified between concussed players (M = 16.9, SD = 15.4) and non concussed players (M = 3.5, SD = 5.7); t(63) - [3.9], p = [<0.01]. The sensitivity was 85% with a specificity of 63% using a post-injury SWB score of 75%. Results indicated that at initial post-injury concussion evaluations, players subsequently diagnosed with concussion have lower SWB. Further research is needed to determine whether this metric would be helpful in the diagnosis of concussion.
{"title":"A - 34 Differences in Symptom and Well-Being Report at Initial Post-Injury Concussion Medical Evaluations","authors":"D. Naidu, M. Mrazik, C. David, J. Hansen, Q. Ree-Fedun","doi":"10.1093/arclin/acae052.34","DOIUrl":"https://doi.org/10.1093/arclin/acae052.34","url":null,"abstract":"\u0000 \u0000 \u0000 To investigate differences in subjective symptom report and percentage ratings of subjective well-being (SWB) at initial post-injury concussion medical evaluations in professional football players.\u0000 \u0000 \u0000 \u0000 A retrospective, quasi-experimental design was used for the study. Participants included Canadian Football League players who underwent initial locker room post-injury medical evaluations. CFL concussion protocol requires any player suspected of a concussion to undergo a full evaluation including SCAT5. There were 2 groups including 43 players subsequently diagnosed with concussions who were compared with 22 players not diagnosed with concussion. Data included total symptom score from the SCAT5 and SWB (ratings out of 100%). T-tests and descriptive statistics evaluated differences between groups.\u0000 \u0000 \u0000 \u0000 At baseline, there were no significant differences on ratings of SWB between groups. In contrast, there was a significant difference in ratings of subjective well being between concussed players (M = 75.5%, SD = 19.5) and non concussed players (M = 92.7, SD = 7.7); t(63) = [3.8], p = [0.1]. Furthermore, significant differences on total symptom report from the SCAT5 were identified between concussed players (M = 16.9, SD = 15.4) and non concussed players (M = 3.5, SD = 5.7); t(63) - [3.9], p = [<0.01]. The sensitivity was 85% with a specificity of 63% using a post-injury SWB score of 75%.\u0000 \u0000 \u0000 \u0000 Results indicated that at initial post-injury concussion evaluations, players subsequently diagnosed with concussion have lower SWB. Further research is needed to determine whether this metric would be helpful in the diagnosis of concussion.\u0000","PeriodicalId":8176,"journal":{"name":"Archives of Clinical Neuropsychology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141672295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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