Standard regression-based methods for measuring recovery after sport-related concussion

Neuroscience Center, Waukesha Memorial Hospital, Waukesha, WI 53188, USA.
Journal of the International Neuropsychological Society (Impact Factor: 2.96). 02/2005; 11(1):58-69. DOI: 10.1017/S1355617705050083
Source: PubMed

ABSTRACT Clinical decision making about an athlete's return to competition after concussion is hampered by a lack of systematic methods to measure recovery. We applied standard regression-based methods to statistically measure individual rates of impairment at several time points after concussion in college football players. Postconcussive symptoms, cognitive functioning, and balance were assessed in 94 players with concussion (based on American Academy of Neurology Criteria) and 56 noninjured controls during preseason baseline testing, and immediately, 3 hr, and 1, 2, 3, 5, and 7 days postinjury. Ninety-five percent of injured players exhibited acute concussion symptoms and impairment on cognitive or balance testing immediately after injury, which diminished to 4% who reported elevated symptoms on postinjury day 7. In addition, a small but clinically significant percentage of players who reported being symptom free by day 2 continued to be classified as impaired on the basis of objective balance and cognitive testing. These data suggest that neuropsychological testing may be of incremental utility to subjective symptom checklists in identifying the residual effects of sport-related concussion. The implementation of neuropsychological testing to detect subtle cognitive impairment is most useful once postconcussive symptoms have resolved. This management model is also supported by practical and other methodological considerations.

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Available from: William B Barr, Sep 28, 2015
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    • "We used a version of Graded Symptoms Checklist or GSC. The GSC is commonly used for early assessment of head trauma in children and adolescents (e.g., Grubenhoff et al. 2010) and in college football players (McCrea et al. 2005). "
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    ABSTRACT: Athletic head trauma (both concussive and sub-concussive) is common among adolescents. Head trauma often is followed by motion sickness-like symptoms, by changes in cognitive performance, and by changes in standing body sway. We evaluated adolescent female boxers who did and did not report motion sickness after a bout (i.e., a boxing match), together with a control group of non-boxers. We asked whether pre-bout body sway would differ between boxers who experienced post-bout motion sickness and those who did not. In addition, we asked whether pre-bout cognitive performance would differ between non-boxers and boxers with and without post-bout motion sickness. Seven of twenty boxers reported motion sickness after a bout. Pre-bout measures of cognitive performance and body sway were different in boxers who reported post-bout motion sickness than in boxers without post-bout sickness or controls. The results suggest that susceptibility to motion sickness-like symptoms in adolescent female boxers may be manifested in characteristic patterns of body sway and cognitive performance. It may be possible to use pre-bout data to predict susceptibility to post-bout symptoms.
    Experimental Brain Research 03/2014; 232(8). DOI:10.1007/s00221-014-3910-4 · 2.04 Impact Factor
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    • "Scoring System (BESS) is a component of the Sport Concussion Assessment Tool 2 (SCAT2) that reveals static balance deficits immediately after concussion; however these deficits typically recover within 3–5 days post injury [2]. Recent evidence suggests that learning effects [4] and decreased sensitivity over time [5] challenge the BESS reliability [3]. More objective measures to assess the recovery of balance impairments post-concussion are therefore warranted. "
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    ABSTRACT: The purpose of this study was to use centre of pressure (COP) measurements to determine if static balance deficits had recovered when concussed athletes were cleared to return to play. Nine concussed varsity football players were matched with nine teammates who served as controls. Static balance in the anterior-posterior (A/P) and medial-lateral (M/L) directions was assessed during quiet stance with eyes open and eyes closed. Results showed that concussed football players displayed greater A/P COP displacements in the acute phase, which recovered by RTP; however, COP velocity remained elevated compared to controls even at RTP, particularly in the A/P direction. This balance control deficit in the A/P direction may suggest vestibular impairment, likely due to poor sensorimotor integration of the lateral vestibulospinal tract. The observed persistence of balance control deficits in concussed football players at RTP are usually undetected by traditional assessments because the current study used higher-order COP analysis. Future RTP balance measures may want to incorporate higher-order measures of balance.
    Gait & posture 06/2013; 39(1). DOI:10.1016/j.gaitpost.2013.05.026 · 2.75 Impact Factor
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    • "In general, the findings on acute recovery have been favorable. A 2003 report was the first to plot the continuous time course of acute recovery within several days after concussion, indicating that more than 90% of athletes reported a symptom recovery within 1 week (McCrea et al., 2003, 2005). Several other prospective studies have since consistently demonstrated that the overwhelming majority of athletes achieve a complete recovery in symptoms, cognitive functioning, postural stability, and other functional impairments over a period of approximately one to two weeks following concussion (Belanger & Vanderploeg, 2005; Broglio & Puetz, 2008; Collins et al., 1999; Guskiewicz et al., 2003; Macciocchi, Barth, Alves, Rimel, & Jane, 1996). "
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    ABSTRACT: Sport-related concussion (SRC) is typically followed by clinical recovery within days, but reports of prolonged symptoms are common. We investigated the incidence of prolonged recovery in a large cohort (n = 18,531) of athlete seasons over a 10-year period. A total of 570 athletes with concussion (3.1%) and 166 controls who underwent pre-injury baseline assessments of symptoms, neurocognitive functioning and balance were re-assessed immediately, 3 hr, and 1, 2, 3, 5, 7, and 45 or 90 days after concussion. Concussed athletes were stratified into typical (within 7 days) or prolonged (> 7 days) recovery groups based on symptom recovery time. Ten percent of athletes (n = 57) had a prolonged symptom recovery, which was also associated with lengthier recovery on neurocognitive testing (p < .001). At 45-90 days post-injury, the prolonged recovery group reported elevated symptoms, without deficits on cognitive or balance testing. Prolonged recovery was associated with unconsciousness [odds ratio (OR), 4.15; 95% confidence interval (CI) 2.12-8.15], posttraumatic amnesia (OR, 1.81; 95% CI, 1.00-3.28), and more severe acute symptoms (p < .0001). These results suggest that a small percentage of athletes may experience symptoms and functional impairments beyond the typical window of recovery after SRC, and that prolonged recovery is associated with acute indicators of more severe injury. (JINS, 2012, 18, 1-12).
    Journal of the International Neuropsychological Society 10/2012; 19(1):1-12. DOI:10.1017/S1355617712000872 · 2.96 Impact Factor
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