Pub Date : 2021-01-01DOI: 10.1177/2059700221992952
J. Reneker, J. Slaughter, A. Scruggs, W. Pannell
Background Technology for concussion identification and management is rapidly expanding across the continuum of care. Although many technologies offer a range of services around concussion, there is an absence of a non-commercial online location for medical providers to access regarding the functionality of the various technologies used in concussion identification and management. Objective The purpose of this review is to present research findings on technology for concussion identification and management. Methods Searches for eligible studies were conducted using the PubMed, EMBASE, and Scopus databases with specific search criteria. Through a stepwise process, full-text articles were selected for inclusion if they described clinically useful electronic technologies (i.e. electronics able to be used in standard clinical environments including telehealth) by healthcare providers or end users (i.e. parents or athletes). Results A total of 29 articles were included in this review and described technology used to measure symptoms (3), neurocognitive performance (7), the visual system (4), and balance or dual task performance (18). Within the results, various technologies demonstrated increased utility for concussion identification, often detecting subtle deficits not possible with current low-tech clinical methods, differentiating those with concussion from those without concussion, with strong reliability and validity. Conclusion Innovative technologies included in this review demonstrate enhanced ability to identify and manage symptoms of concussion, neurocognitive deficits, visual deficits, and balance and dual-task deficits.
{"title":"Technology and concussion: A scoping review","authors":"J. Reneker, J. Slaughter, A. Scruggs, W. Pannell","doi":"10.1177/2059700221992952","DOIUrl":"https://doi.org/10.1177/2059700221992952","url":null,"abstract":"Background Technology for concussion identification and management is rapidly expanding across the continuum of care. Although many technologies offer a range of services around concussion, there is an absence of a non-commercial online location for medical providers to access regarding the functionality of the various technologies used in concussion identification and management. Objective The purpose of this review is to present research findings on technology for concussion identification and management. Methods Searches for eligible studies were conducted using the PubMed, EMBASE, and Scopus databases with specific search criteria. Through a stepwise process, full-text articles were selected for inclusion if they described clinically useful electronic technologies (i.e. electronics able to be used in standard clinical environments including telehealth) by healthcare providers or end users (i.e. parents or athletes). Results A total of 29 articles were included in this review and described technology used to measure symptoms (3), neurocognitive performance (7), the visual system (4), and balance or dual task performance (18). Within the results, various technologies demonstrated increased utility for concussion identification, often detecting subtle deficits not possible with current low-tech clinical methods, differentiating those with concussion from those without concussion, with strong reliability and validity. Conclusion Innovative technologies included in this review demonstrate enhanced ability to identify and manage symptoms of concussion, neurocognitive deficits, visual deficits, and balance and dual-task deficits.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2059700221992952","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44554332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1177/20597002211046459
Marquise M Bonn, L. Alvarez, Laura Graham, James W. G. Thompson, J. Dickey
Background Case reports indicate that low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback may improve physiological functioning in individuals with persistent post-concussive symptoms. However, it is unclear whether larger-scale studies are feasible. Purpose To evaluate the feasibility of a combined low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback intervention for individuals with persistent post-concussive symptoms. Methods Individuals with persistent post-concussive symptoms were randomized into intervention and control groups, and their baseline and post-test assessments were compared to a healthy control group. Outcomes included self-report questionnaires, resting electroencephalograph and electrocardiograph recordings, and a driving simulation task. Participants in the intervention group completed three 20 min low-resolution electromagnetic tomography neurofeedback sessions per week and at-home heart rate variability biofeedback training every morning and night for 8 weeks. Feasibility was evaluated according to recruitment capability and sample characteristics, data collection procedures, suitability of the intervention and study procedures, management and implementation of the study intervention, and preliminary participant responses to the intervention. Results Thirty-three individuals were recruited and 24 completed this study (seven intervention participants, nine persistent post-concussive symptoms control participants, and eight healthy control participants). One-quarter of participants (four intervention participants and three persistent post-concussive symptoms control participants) experienced simulator sickness during the driving simulator task and had to withdraw from the study. Intervention participants had an 88% and 86% compliance rate for the low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback sessions, respectively. Low-resolution electromagnetic tomography neurofeedback sessions took approximately 1 h to complete per participant. Preliminary analysis indicated that the intervention reduced electroencephalograph z-score deviation with a very large effect size (d = 1.36) compared to the other study groups. Conclusions Pilot studies evaluating the efficacy of low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback should be performed to confirm these preliminary findings. However, the protocol should be modified to reduce participant fatigue and withdrawal. This trial was registered with Clinicialtrials.gov (NCT03338036; https://clinicaltrials.gov/ct2/show/NCT03338036?term=03338036&draw=2&rank=1).
{"title":"Biofeedback as an intervention for persistent post-concussive symptoms: A randomized feasibility trial","authors":"Marquise M Bonn, L. Alvarez, Laura Graham, James W. G. Thompson, J. Dickey","doi":"10.1177/20597002211046459","DOIUrl":"https://doi.org/10.1177/20597002211046459","url":null,"abstract":"Background Case reports indicate that low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback may improve physiological functioning in individuals with persistent post-concussive symptoms. However, it is unclear whether larger-scale studies are feasible. Purpose To evaluate the feasibility of a combined low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback intervention for individuals with persistent post-concussive symptoms. Methods Individuals with persistent post-concussive symptoms were randomized into intervention and control groups, and their baseline and post-test assessments were compared to a healthy control group. Outcomes included self-report questionnaires, resting electroencephalograph and electrocardiograph recordings, and a driving simulation task. Participants in the intervention group completed three 20 min low-resolution electromagnetic tomography neurofeedback sessions per week and at-home heart rate variability biofeedback training every morning and night for 8 weeks. Feasibility was evaluated according to recruitment capability and sample characteristics, data collection procedures, suitability of the intervention and study procedures, management and implementation of the study intervention, and preliminary participant responses to the intervention. Results Thirty-three individuals were recruited and 24 completed this study (seven intervention participants, nine persistent post-concussive symptoms control participants, and eight healthy control participants). One-quarter of participants (four intervention participants and three persistent post-concussive symptoms control participants) experienced simulator sickness during the driving simulator task and had to withdraw from the study. Intervention participants had an 88% and 86% compliance rate for the low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback sessions, respectively. Low-resolution electromagnetic tomography neurofeedback sessions took approximately 1 h to complete per participant. Preliminary analysis indicated that the intervention reduced electroencephalograph z-score deviation with a very large effect size (d = 1.36) compared to the other study groups. Conclusions Pilot studies evaluating the efficacy of low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback should be performed to confirm these preliminary findings. However, the protocol should be modified to reduce participant fatigue and withdrawal. This trial was registered with Clinicialtrials.gov (NCT03338036; https://clinicaltrials.gov/ct2/show/NCT03338036?term=03338036&draw=2&rank=1).","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43378110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1177/20597002211040723
{"title":"Correction notice to Concussion in cricket: Clinical findings using Sport Concussion Assessment Tool and recovery timeframes","authors":"","doi":"10.1177/20597002211040723","DOIUrl":"https://doi.org/10.1177/20597002211040723","url":null,"abstract":"","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43793968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01Epub Date: 2021-04-06DOI: 10.1177/20597002211007271
John K Yue, Ryan Rl Phelps, Debra D Hemmerle, Pavan S Upadhyayula, Ethan A Winkler, Hansen Deng, Diana Chang, Mary J Vassar, Sabrina R Taylor, David M Schnyer, Hester F Lingsma, Ava M Puccio, Esther L Yuh, Pratik Mukherjee, Michael C Huang, Laura B Ngwenya, Alex B Valadka, Amy J Markowitz, David O Okonkwo, Geoffrey T Manley
Introduction: Return to work (RTW) is an important milestone of mild traumatic brain injury (mTBI) recovery. The objective of this study was to evaluate whether baseline clinical variables, three-month RTW, and three-month postconcussional symptoms (PCS) were associated with six-month RTW after mTBI.
Methods: Adult subjects from the prospective multicenter Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with mTBI (Glasgow Coma Scale 13-15) who were employed at baseline, with completed three-and six-month RTW status, and three-month Acute Concussion Evaluation (ACE), were extracted. Univariate and multivariable analyses were performed for six-month RTW, with focus on baseline employment, three-month RTW, and three-month ACE domains (physical, cognitive, sleep, and/or emotional postconcussional symptoms (PCS)). Odds ratios (OR) and 95% confidence intervals [CI] were reported. Significance was assessed at p < 0.05.
Results: In 152 patients aged 40.7 ± 15.0years, 72% were employed full-time at baseline. Three- and six-month RTW were 77.6% and 78.9%, respectively. At three months, 59.2%, 47.4%, 46.1% and 31.6% scored positive for ACE physical, cognitive, sleep, and emotional PCS domains, respectively. Three-month RTW predicted six-month RTW (OR = 19.80, 95% CI [7.61-51.52]). On univariate analysis, scoring positive in any three-month ACE domain predicted inability for six-month RTW (OR = 0.10-0.11). On multivariable analysis, emotional symptoms predicted inability to six-month RTW (OR = 0.19 [0.04-0.85]). Subjects who scored positive in all four ACE domains were more likely to be unable to RTW at six months (4 domains: 58.3%, vs. 0-to-3 domains: 9.5%; multivariable OR = 0.09 [0.02-0.33]).
Conclusions: Three-month post-injury is an important time point at which RTW status and PCS should be assessed, as both are prognostic markers for six-month RTW. Clinicians should be particularly vigilant of patients who present with emotional symptoms, and patients with symptoms across multiple PCS categories, as these patients are at further risk of inability to RTW and may benefit from targeted evaluation and support.
{"title":"Predictors of six-month inability to return to work in previously employed subjects after mild traumatic brain injury: A TRACK-TBI pilot study.","authors":"John K Yue, Ryan Rl Phelps, Debra D Hemmerle, Pavan S Upadhyayula, Ethan A Winkler, Hansen Deng, Diana Chang, Mary J Vassar, Sabrina R Taylor, David M Schnyer, Hester F Lingsma, Ava M Puccio, Esther L Yuh, Pratik Mukherjee, Michael C Huang, Laura B Ngwenya, Alex B Valadka, Amy J Markowitz, David O Okonkwo, Geoffrey T Manley","doi":"10.1177/20597002211007271","DOIUrl":"10.1177/20597002211007271","url":null,"abstract":"<p><strong>Introduction: </strong>Return to work (RTW) is an important milestone of mild traumatic brain injury (mTBI) recovery. The objective of this study was to evaluate whether baseline clinical variables, three-month RTW, and three-month postconcussional symptoms (PCS) were associated with six-month RTW after mTBI.</p><p><strong>Methods: </strong>Adult subjects from the prospective multicenter Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with mTBI (Glasgow Coma Scale 13-15) who were employed at baseline, with completed three-and six-month RTW status, and three-month Acute Concussion Evaluation (ACE), were extracted. Univariate and multivariable analyses were performed for six-month RTW, with focus on baseline employment, three-month RTW, and three-month ACE domains (physical, cognitive, sleep, and/or emotional postconcussional symptoms (PCS)). Odds ratios (OR) and 95% confidence intervals [CI] were reported. Significance was assessed at p < 0.05.</p><p><strong>Results: </strong>In 152 patients aged 40.7 ± 15.0years, 72% were employed full-time at baseline. Three- and six-month RTW were 77.6% and 78.9%, respectively. At three months, 59.2%, 47.4%, 46.1% and 31.6% scored positive for ACE physical, cognitive, sleep, and emotional PCS domains, respectively. Three-month RTW predicted six-month RTW (OR = 19.80, 95% CI [7.61-51.52]). On univariate analysis, scoring positive in any three-month ACE domain predicted inability for six-month RTW (OR = 0.10-0.11). On multivariable analysis, emotional symptoms predicted inability to six-month RTW (OR = 0.19 [0.04-0.85]). Subjects who scored positive in all four ACE domains were more likely to be unable to RTW at six months (4 domains: 58.3%, vs. 0-to-3 domains: 9.5%; multivariable OR = 0.09 [0.02-0.33]).</p><p><strong>Conclusions: </strong>Three-month post-injury is an important time point at which RTW status and PCS should be assessed, as both are prognostic markers for six-month RTW. Clinicians should be particularly vigilant of patients who present with emotional symptoms, and patients with symptoms across multiple PCS categories, as these patients are at further risk of inability to RTW and may benefit from targeted evaluation and support.</p>","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":"5 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d1/6f/nihms-1700030.PMC8153496.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38957870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1177/20597002211044879
A. Ventura, Fausto Romano, M. Bizzini, A. Palla, Nina Feddermann
Objective Dysfunction of the autonomic cardiovascular system after a concussion is known to cause exercise intolerance due to symptoms exacerbation. The aim of this study was to compare athletes with symptoms of a sport-related concussion and healthy controls with regard to their heart rate during a graded exercise test and their heart rate recovery during the 5 min cool-down after the graded exercise test. Methods Sport-related concussion patients (N = 61; 31% female) and controls (N = 16; 50% female) participated in a graded exercise test on a cycle ergometer followed by 5 min active cool-down. Based on the results of graded exercise tests they were divided into four groups: (1) patients who reached the symptom threshold and had to stop the graded exercise test (symptom threshold; N = 39; 33.3% female), (2) patients with symptoms who finished the graded exercise test (S; N = 16; 25% female), (3) patients without symptoms (NS; N = 6; 33.3% female), (4) controls (N = 16; 50% female). Main outcome measures Heart rate, severity of headache and dizziness during graded exercise test, heart rate recovery (median (heart rate recoveries/maximal heart rate) ± median absolute deviation (MAD)) 30, 60 and 300 s after the start of cool-down. Results Heart rate recovery at 30 s was significantly slower in symptom (0.95 ± 0.01) compared to all other groups (p < 0.002; symptom threshold: 0.92 ± 0.02, NS: 0.91 ± 0.02, controls: 0.93 ± 0.02). Heart rate recovery at 60 s was significantly slower in symptom (0.90 ± 0.02) compared to the symptom threshold and controls (p < 0.041; 0.86 ± 0.03, 0.85 ± 0.04). Heart rate recovery at 300 s was significantly slower in symptom threshold (0.72 ± 0.05) compared to controls (p = 0.003; 0.66 ± 0.02). Conclusions Heart rate measurements in athletes with symptoms of sport-related concussion should be continued during cool-down after the graded exercise test, as dysfunction of the autonomic cardiovascular system might manifest also during cool-down.
{"title":"Autonomic cardiovascular response during and after a graded exercise test in concussed athletes and healthy controls","authors":"A. Ventura, Fausto Romano, M. Bizzini, A. Palla, Nina Feddermann","doi":"10.1177/20597002211044879","DOIUrl":"https://doi.org/10.1177/20597002211044879","url":null,"abstract":"Objective Dysfunction of the autonomic cardiovascular system after a concussion is known to cause exercise intolerance due to symptoms exacerbation. The aim of this study was to compare athletes with symptoms of a sport-related concussion and healthy controls with regard to their heart rate during a graded exercise test and their heart rate recovery during the 5 min cool-down after the graded exercise test. Methods Sport-related concussion patients (N = 61; 31% female) and controls (N = 16; 50% female) participated in a graded exercise test on a cycle ergometer followed by 5 min active cool-down. Based on the results of graded exercise tests they were divided into four groups: (1) patients who reached the symptom threshold and had to stop the graded exercise test (symptom threshold; N = 39; 33.3% female), (2) patients with symptoms who finished the graded exercise test (S; N = 16; 25% female), (3) patients without symptoms (NS; N = 6; 33.3% female), (4) controls (N = 16; 50% female). Main outcome measures Heart rate, severity of headache and dizziness during graded exercise test, heart rate recovery (median (heart rate recoveries/maximal heart rate) ± median absolute deviation (MAD)) 30, 60 and 300 s after the start of cool-down. Results Heart rate recovery at 30 s was significantly slower in symptom (0.95 ± 0.01) compared to all other groups (p < 0.002; symptom threshold: 0.92 ± 0.02, NS: 0.91 ± 0.02, controls: 0.93 ± 0.02). Heart rate recovery at 60 s was significantly slower in symptom (0.90 ± 0.02) compared to the symptom threshold and controls (p < 0.041; 0.86 ± 0.03, 0.85 ± 0.04). Heart rate recovery at 300 s was significantly slower in symptom threshold (0.72 ± 0.05) compared to controls (p = 0.003; 0.66 ± 0.02). Conclusions Heart rate measurements in athletes with symptoms of sport-related concussion should be continued during cool-down after the graded exercise test, as dysfunction of the autonomic cardiovascular system might manifest also during cool-down.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43001926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1177/20597002211017405
M. Paniccia, C. Provvidenza, S. Kingsnorth, C. Ippolito, R. Zemek, N. Reed
Background Clinical practice guidelines are systematically developed statements that assist clinicians in making evidence informed decisions regarding patient care. Within pediatric concussion, the Ontario Neurotrauma Foundation released the Guidelines for Diagnosing and Managing Pediatric Concussion in 2014. The purpose of this study was to evaluate the 2014 guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool, in addition to a brief knowledge translation survey, and to utilize the collected feedback from end users to inform improvements to support an updated version. An integrated knowledge translation approach was employed using clinical experts as guideline appraisers. Methods A purposive sample of researchers, physicians, allied health professionals, policy makers, educators and knowledge translation experts involved in updating the guidelines (N = 31) completed the AGREE II Likert scale survey regarding the 2014 guideline, and provided written justifications for their ratings. Domain and item AGREE II scaled scores were reported stratified by demographic factors, and written justifications were synthesized using content analysis to determine areas of improvement for the 2014 guideline. Results Appraisers scored the editorial independence (88.9%) and scope and purpose (80.8%) domains the highest, indicating high quality. The guidelines scored the lowest in the applicability domain (69.3%). Participants with less than 10 years of experience in their respective disciplines, as well as physicians and allied health professionals consistently provided higher ratings across domains compared to other professions. Conclusions The process of evaluating the 2014 guideline resulted in these important outcomes: (1) identified areas of the guideline that may have affected the lack of previous clinical uptake while abiding by a clinical practice guideline development framework; (2) shared and informed decision making regarding content and format of the revised clinical practice guideline; and (3) targeted content, clinical questions and dissemination strategies, which are key to clinical uptake.
背景临床实践指南是系统开发的声明，有助于临床医生就患者护理做出基于证据的决策。在儿童脑震荡方面，安大略省神经创伤基金会于2014年发布了《儿童脑震荡诊断和管理指南》。本研究的目的是使用研究与评估指南评估II（AGREE II）评估工具以及简短的知识翻译调查来评估2014年的指南，并利用从最终用户收集的反馈来告知改进，以支持更新版本。采用综合知识翻译方法，由临床专家作为指导评估人员。方法对参与更新指南的研究人员、医生、专职卫生专业人员、政策制定者、教育工作者和知识翻译专家进行有针对性的抽样（N = 31）完成了关于2014年指南的AGREE II Likert量表调查，并为其评级提供了书面理由。报告领域和项目AGREE II量表得分按人口统计因素分层，并使用内容分析综合书面理由，以确定2014年指南的改进领域。结果评价者对编辑独立性（88.9%）、范围和目的领域（80.8%）的评分最高，表明评价质量较高。该指南在适用领域得分最低（69.3%） 与其他职业相比，在各自学科的多年经验，以及医生和专职卫生专业人员在各个领域的评分始终较高。结论评估2014年指南的过程产生了以下重要结果：（1）在遵守临床实践指南制定框架的同时，确定了指南中可能影响先前临床吸收不足的领域；（2） 关于修订后的临床实践指南的内容和格式的共享和知情决策；以及（3）有针对性的内容、临床问题和传播策略，这是临床接受的关键。
{"title":"Engaging target users to appraise and refine clinical practice guidelines in pediatric concussion: An integrated knowledge translation approach","authors":"M. Paniccia, C. Provvidenza, S. Kingsnorth, C. Ippolito, R. Zemek, N. Reed","doi":"10.1177/20597002211017405","DOIUrl":"https://doi.org/10.1177/20597002211017405","url":null,"abstract":"Background Clinical practice guidelines are systematically developed statements that assist clinicians in making evidence informed decisions regarding patient care. Within pediatric concussion, the Ontario Neurotrauma Foundation released the Guidelines for Diagnosing and Managing Pediatric Concussion in 2014. The purpose of this study was to evaluate the 2014 guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool, in addition to a brief knowledge translation survey, and to utilize the collected feedback from end users to inform improvements to support an updated version. An integrated knowledge translation approach was employed using clinical experts as guideline appraisers. Methods A purposive sample of researchers, physicians, allied health professionals, policy makers, educators and knowledge translation experts involved in updating the guidelines (N = 31) completed the AGREE II Likert scale survey regarding the 2014 guideline, and provided written justifications for their ratings. Domain and item AGREE II scaled scores were reported stratified by demographic factors, and written justifications were synthesized using content analysis to determine areas of improvement for the 2014 guideline. Results Appraisers scored the editorial independence (88.9%) and scope and purpose (80.8%) domains the highest, indicating high quality. The guidelines scored the lowest in the applicability domain (69.3%). Participants with less than 10 years of experience in their respective disciplines, as well as physicians and allied health professionals consistently provided higher ratings across domains compared to other professions. Conclusions The process of evaluating the 2014 guideline resulted in these important outcomes: (1) identified areas of the guideline that may have affected the lack of previous clinical uptake while abiding by a clinical practice guideline development framework; (2) shared and informed decision making regarding content and format of the revised clinical practice guideline; and (3) targeted content, clinical questions and dissemination strategies, which are key to clinical uptake.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/20597002211017405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49253048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-01DOI: 10.1177/2059700220975605
L. Parrington, Bryana Popa, Douglas N. Martini, J. Chesnutt, L. King
Often the Balance Error Scoring System (BESS) is used to assess balance during a clinical evaluation of a patient presenting with mild Traumatic Brain Injury (mTBI). Although recent research has shown the benefits of using inertial sensor measures such as the Root Mean Square (RMS) of the acceleration in place of clinical scoring, few normative data are available for clinicians to reference. The purpose of this paper was to provide normative data collected using wearable sensors for healthy controls across three age groups, as well as providing cohort data for mTBI participants across three stages following injury (acute, sub-acute and chronic). The RMS in the Medio-Lateral direction (ML RMS sway) of each condition (double stance – DS; single stance – SS; and tandem stance – TS) was extracted per participant for analysis. The average ML RMS sway across all conditions was also calculated (ML RMS-Av). Percentiles were calculated to provide normative data, and two multivariate general linear models were used to evaluate differences between 1) non-athlete controls, athlete controls, and athletes with acute mTBI, and 2) non-athletic cohorts of control, sub-acute and chronic mTBI groups across young, middle-aged, and older adults. Model 1 revealed athletes with acute mTBI had more ML RMS sway than athlete controls the for the DS condition (p < 0.001), but no differences with non-athlete controls. Athlete controls also had less ML RMS sway for the SS condition and ML RMS-Av (p ≤ 0.022) compared with non-athlete controls. Model 2 revealed less ML RMS sway in the control group than the sub-acute and chronic mTBI groups for DS (p ≤ 0.004), but no differences between the sub-acute and chronic group, while more ML RMS sway occurred in the chronic group compared with the control and sub-acute groups for the TS condition and ML RMS-Av (p ≤ 0.013). Older adults had more ML RMS sway than young and middle-aged adults for SS, TS and ML RMS-Av (p ≤ 0.019), while there were no differences between the young and middle-aged adults. Normative values presented here can help increase the practical application of instrumented balance assessment of mTBI patients through wearable sensors. ML RMS sway in the DS condition provided the clearest distinction between control and mTBI groups, but we caution that young adult athletes need to be assessed against athletic peers in the absence of baseline normative values. In non-athlete cohorts, age and gender norms may not be necessary to consider when assessing DS performance; however, age may be an important factor to consider when accessing norms for other stance conditions or the average performance across all conditions.
{"title":"Instrumented balance assessment in mild traumatic brain injury: Normative values and descriptive data for acute, sub-acute and chronic populations","authors":"L. Parrington, Bryana Popa, Douglas N. Martini, J. Chesnutt, L. King","doi":"10.1177/2059700220975605","DOIUrl":"https://doi.org/10.1177/2059700220975605","url":null,"abstract":"Often the Balance Error Scoring System (BESS) is used to assess balance during a clinical evaluation of a patient presenting with mild Traumatic Brain Injury (mTBI). Although recent research has shown the benefits of using inertial sensor measures such as the Root Mean Square (RMS) of the acceleration in place of clinical scoring, few normative data are available for clinicians to reference. The purpose of this paper was to provide normative data collected using wearable sensors for healthy controls across three age groups, as well as providing cohort data for mTBI participants across three stages following injury (acute, sub-acute and chronic). The RMS in the Medio-Lateral direction (ML RMS sway) of each condition (double stance – DS; single stance – SS; and tandem stance – TS) was extracted per participant for analysis. The average ML RMS sway across all conditions was also calculated (ML RMS-Av). Percentiles were calculated to provide normative data, and two multivariate general linear models were used to evaluate differences between 1) non-athlete controls, athlete controls, and athletes with acute mTBI, and 2) non-athletic cohorts of control, sub-acute and chronic mTBI groups across young, middle-aged, and older adults. Model 1 revealed athletes with acute mTBI had more ML RMS sway than athlete controls the for the DS condition (p < 0.001), but no differences with non-athlete controls. Athlete controls also had less ML RMS sway for the SS condition and ML RMS-Av (p ≤ 0.022) compared with non-athlete controls. Model 2 revealed less ML RMS sway in the control group than the sub-acute and chronic mTBI groups for DS (p ≤ 0.004), but no differences between the sub-acute and chronic group, while more ML RMS sway occurred in the chronic group compared with the control and sub-acute groups for the TS condition and ML RMS-Av (p ≤ 0.013). Older adults had more ML RMS sway than young and middle-aged adults for SS, TS and ML RMS-Av (p ≤ 0.019), while there were no differences between the young and middle-aged adults. Normative values presented here can help increase the practical application of instrumented balance assessment of mTBI patients through wearable sensors. ML RMS sway in the DS condition provided the clearest distinction between control and mTBI groups, but we caution that young adult athletes need to be assessed against athletic peers in the absence of baseline normative values. In non-athlete cohorts, age and gender norms may not be necessary to consider when assessing DS performance; however, age may be an important factor to consider when accessing norms for other stance conditions or the average performance across all conditions.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2059700220975605","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47168807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-01DOI: 10.1177/2059700220983165
A. Walter, Madeleine Scaramuzzo, T. Bream, P. Seidenberg, Scott A. Lynch, S. Slobounov
Context In collision sports, particularly American football, athletes can accumulate thousands of subconcussive impacts, or head acceleration events (HAEs), across a single season; however, the short-term consequences of these impacts are not well understood. Objective To investigate the effects of the accumulation of impacts during practices on cognitive functions over a single football season. Design Prospective observational study. Setting Athletic training room and University laboratory. Participants Twenty-three NCAA Football Bowl Subdivision players. Main outcome measures Helmet accelerometers during practices and virtual reality testing (VR; balance, reaction time, spatial memory) before and after the season. Results Preseason had the majority of ≥80 G impacts while during the season had the majority of ≥25 G to <80 G impacts and positional differences showed that linemen had the majority of both types. Virtual reality analysis revealed that scores significantly decreased after the season for spatial navigation (p < 0.05) but not for balance or reaction time. Significant correlations (p < 0.05) were found between cognitive measures and player demographic variables. Conclusions Even in the absence of clinical symptoms and concussion diagnosis, repetitive impacts may cause cognitive alterations. Documenting the distribution of impact quantity and intensity as a function of time and position may be considered by coaches and clinicians to reduce the accumulation of impacts in athletes exposed in contact sports.
{"title":"Effect of subconcussive impacts on functional outcomes over a single collegiate football season","authors":"A. Walter, Madeleine Scaramuzzo, T. Bream, P. Seidenberg, Scott A. Lynch, S. Slobounov","doi":"10.1177/2059700220983165","DOIUrl":"https://doi.org/10.1177/2059700220983165","url":null,"abstract":"Context In collision sports, particularly American football, athletes can accumulate thousands of subconcussive impacts, or head acceleration events (HAEs), across a single season; however, the short-term consequences of these impacts are not well understood. Objective To investigate the effects of the accumulation of impacts during practices on cognitive functions over a single football season. Design Prospective observational study. Setting Athletic training room and University laboratory. Participants Twenty-three NCAA Football Bowl Subdivision players. Main outcome measures Helmet accelerometers during practices and virtual reality testing (VR; balance, reaction time, spatial memory) before and after the season. Results Preseason had the majority of ≥80 G impacts while during the season had the majority of ≥25 G to <80 G impacts and positional differences showed that linemen had the majority of both types. Virtual reality analysis revealed that scores significantly decreased after the season for spatial navigation (p < 0.05) but not for balance or reaction time. Significant correlations (p < 0.05) were found between cognitive measures and player demographic variables. Conclusions Even in the absence of clinical symptoms and concussion diagnosis, repetitive impacts may cause cognitive alterations. Documenting the distribution of impact quantity and intensity as a function of time and position may be considered by coaches and clinicians to reduce the accumulation of impacts in athletes exposed in contact sports.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2059700220983165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47974329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1177/2059700220972584
A. Walter, Christian Nelson Kaschak, W. Sebastianelli, P. Arnett, S. Slobounov
Context After concussion, many different symptoms can occur and persist that can affect daily functioning. Many of these symptoms could have implications in an athlete’s ability to return to academics. Unlike return to play, return to academics is less studied and less regulated. There is little research examining the effects of concussion on grade point average (GPA) and results have been inconsistent. Objective To examine the effects of concussion on college GPA. Design Retrospective observational study Setting University laboratory Participants Division I athletes after their first concussion (n = 26) and Division I athletes without a history of concussion (n = 30). Main Outcome Measures GPA and demographic information was obtained for the semester before injury, the semester of injury, and the semester after injury. Results Statistical analysis using generalized linear mixed model analysis revealed a significant interaction (p < 0.05) of group (concussion vs. control) by time, with the concussed group having a significant decrease in GPA from semester before injury to semester of injury, and a significant main effect for sex (p < 0.05) with females having higher GPAs than males. Conclusions Since the cognitive demands of academics can potentially exacerbate symptomology of concussion, the identification of students at risk for difficulties is critical.
{"title":"Concussion in collegiate athletics: A link to academic achievement","authors":"A. Walter, Christian Nelson Kaschak, W. Sebastianelli, P. Arnett, S. Slobounov","doi":"10.1177/2059700220972584","DOIUrl":"https://doi.org/10.1177/2059700220972584","url":null,"abstract":"Context After concussion, many different symptoms can occur and persist that can affect daily functioning. Many of these symptoms could have implications in an athlete’s ability to return to academics. Unlike return to play, return to academics is less studied and less regulated. There is little research examining the effects of concussion on grade point average (GPA) and results have been inconsistent. Objective To examine the effects of concussion on college GPA. Design Retrospective observational study Setting University laboratory Participants Division I athletes after their first concussion (n = 26) and Division I athletes without a history of concussion (n = 30). Main Outcome Measures GPA and demographic information was obtained for the semester before injury, the semester of injury, and the semester after injury. Results Statistical analysis using generalized linear mixed model analysis revealed a significant interaction (p < 0.05) of group (concussion vs. control) by time, with the concussed group having a significant decrease in GPA from semester before injury to semester of injury, and a significant main effect for sex (p < 0.05) with females having higher GPAs than males. Conclusions Since the cognitive demands of academics can potentially exacerbate symptomology of concussion, the identification of students at risk for difficulties is critical.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2059700220972584","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45988855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1177/2059700220974548
Heather Galbraith, Jairus J. Quesnele, Shannon Kenrick-Rochon, S. Grenier, Tara Baldisera
Background Primary care physicians and family medicine resident physicians report continued gaps in knowledge when diagnosing and managing pediatric patients with concussion. Methods A cross-sectional electronic survey of 130 primary care physicians and family medicine resident physicians in the Northeastern Ontario Local Health Integration Network (LHIN). Descriptive statistics, chi-squared Fisher exact tests, were used to compare physicians versus resident physicians with two-tailed p < 0.05 (with 95% confidence intervals). Results With a 48% response rate, when treating concussions 44% of providers either did not use any specific clinical practice guideline, standardized assessment tool, could not recall the source of a specific tool/guideline or omitted answering the question. However, 61% of all respondents would refer some or all concussion patients to a specialist for treatment. At least 41% of providers indicated they lacked access to a ‘Provider Decision Support Tool’ specific to concussion, and 88% of the 25 providers were without access to discharge instructions. Conclusion Similar to other jurisdictions, Northeastern Ontario primary care physicians and family medicine resident physicians report gaps in knowledge for both diagnosis and management of pediatric concussion. Consequently, they did not use current guidelines or best practices to guide management.
{"title":"What are the knowledge, attitudes and beliefs regarding concussion of primary care physicians and family resident physicians in rural communities?","authors":"Heather Galbraith, Jairus J. Quesnele, Shannon Kenrick-Rochon, S. Grenier, Tara Baldisera","doi":"10.1177/2059700220974548","DOIUrl":"https://doi.org/10.1177/2059700220974548","url":null,"abstract":"Background Primary care physicians and family medicine resident physicians report continued gaps in knowledge when diagnosing and managing pediatric patients with concussion. Methods A cross-sectional electronic survey of 130 primary care physicians and family medicine resident physicians in the Northeastern Ontario Local Health Integration Network (LHIN). Descriptive statistics, chi-squared Fisher exact tests, were used to compare physicians versus resident physicians with two-tailed p < 0.05 (with 95% confidence intervals). Results With a 48% response rate, when treating concussions 44% of providers either did not use any specific clinical practice guideline, standardized assessment tool, could not recall the source of a specific tool/guideline or omitted answering the question. However, 61% of all respondents would refer some or all concussion patients to a specialist for treatment. At least 41% of providers indicated they lacked access to a ‘Provider Decision Support Tool’ specific to concussion, and 88% of the 25 providers were without access to discharge instructions. Conclusion Similar to other jurisdictions, Northeastern Ontario primary care physicians and family medicine resident physicians report gaps in knowledge for both diagnosis and management of pediatric concussion. Consequently, they did not use current guidelines or best practices to guide management.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2059700220974548","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41768446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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