Thomas Buckley

• Ed.D.
• Professor (Associate) at University of Delaware

Objective: To evaluate the effectiveness of an acute period of cognitive and physical rest on concussion. Participants: Fifty consecutive patients with a diagnosis of concussions. Design: Participants were evaluated before (n = 25) and after (n = 25) a policy change that incorporated cognitive and physical rest. Patients in the rest group were wi...

Background: A history of 3 or more concussions is frequently associated with numerous short- and long-term neuropathologies. Impairments in postural control are a known acute consequence of concussion; however, limited evidence exists on the effects of multiple concussions on gait. The purpose of this study was to assess gait stepping characterist...

Background: Concussions are a common pathology in football and multiple misconceptions exist amongst the players and managers. To address these misconceptions, and potentially reduce concussion associated sequela, effective educational interventions need to be developed. However, the current knowledge and attitude status must be ascertained to appr...

In an effort to further our understanding of postural control in Parkinson's disease, we biomechanically evaluated the sit to walk task and its component tasks, sit to stand (STS) and gait initiation (GI) in 12 healthy older adults and 12 persons with Parkinson's disease (PWP). Performance was evaluated utilizing motion capture and two force plates...

Objectives The purpose of this study was to assess gait related dual task cost (DTC) changes over the course of a collegiate athletic career in both repetitive head impact (RHI) exposed and non-RHI exposed athletes. Setting University Research Laboratory. Participants We recruited 47 NCAA intercollegiate athletes and grouped by RHI exposed (N = 2...

Background Emerging evidence indicates an elevated risk of post-concussion musculoskeletal injuries in collegiate athletes; however, identifying athletes at highest risk remains to be elucidated. Objective The purpose of this study was to model post-concussion musculoskeletal injury risk in collegiate athletes by integrating a comprehensive set of...

Context : The Balance Error Scoring System (BESS) is the most commonly used balance test during concussion assessment; however, the test has known limitations related to fatigue. Jumping and landing along with running are common athletic activities that adversely affect postural control. However, the effect of neither subexertional running nor jump...

Background: Emerging evidence indicates an elevated risk of post-concussion musculoskeletal (MSK) injuries in collegiate athletes; however, identifying athletes at highest risk remains to be elucidated. Objective: The purpose of this study was to model post-concussion MSK injury risk in collegiate athletes by integrating a comprehensive set of vari...

Objectives: To cross-sectionally determine 1) the association between lifetime diagnosed concussion and upper extremity musculoskeletal injury (UE-MSI) amongst a novel cohort of community rugby union players and 2) the sex specific risk of UE-MSI given concussion history among these rugby players. Methods: 1,037 (31.0% female, 31.6 + 11.3 years)...

Objectives: A multifaceted assessment battery is recommended for testing suspected concussed athletes; however, the individual tests have limitations and potentially may lead to false positive outcomes. Therefore, the purpose of this study was to psychometrically evaluate concussion assessment tools used for intercollegiate student-athletes, with...

Purposeful heading, in which players may use their heads to advance the ball in play, is a unique part of soccer. Clinical outcome measures used to aid in the diagnosis of a concussion have long been a cornerstone of the contemporary measurements associated with the short- and long-term effects of monitoring repetitive head impacts (RHI) and soccer...

Objective To describe sex differences in concussion characteristics in US Service Academy cadets. Design Descriptive epidemiology study. Setting Four US service academies. Participants 2209 cadets (n = 867 females, n = 1342 males). Independent Variable Sex. Outcome Measures Injury proportion ratios (IPR) compared the proportion of injuries by...

Context: Emerging evidence indicates that individuals with a concussion history display altered jump-landing biomechanics that are associated with ACL injury risk.1 Traditional biomechanical techniques involving jump-landing require advanced equipment, specialized training, and time-consuming data analysis, making it impractical for “just-in-time”...

Objective: The purpose of this study was to assess changes in concussion knowledge and attitudes amongst incoming intercollegiate student-athletes over the course of a decade (2010-2012 vs 2021-2023). Methods: There were 592 student-athletes from 2 cohorts (2010-2012, 2021-2023) who completed the Rosenbaum Concussion Knowledge and Attitudes Surv...

Objective To determine base rates of postconcussional syndrome (PCS) diagnostic categorization in National Collegiate Athletic Association (NCAA) student-athletes with no recent concussion. Design Cross-sectional, observational study. Setting Participants were recruited from 26 civilian schools as part of the NCAA-U.S. Department of Defense Grand...

Objective To determine base rates of postconcussional syndrome (PCS) diagnostic categorization in service academy cadets with no recent concussion Design Cross-sectional, observational study Setting Participants were recruited from 3 U.S. service academies as part of the National Collegiate Athletic Association and U.S. Department of Defense Gran...

Objective Common computerized neurocognitive tests are widely used yet are limited by test re-test reliability as well as effort concerns, thus gamification of testing is an emerging approach. However, the critical determinant of sex and concussion history is unknown. Therefore, this study aimed to examine the relationship between concussion histor...

Objective To determine if light exercise initiation timing associated with symptom recovery and unrestricted return-to-play (RTP) time among collegiate student-athletes. Design Prospective, longitudinal cohort. Setting Thirty National College Athletic Association institutions. Participants Student-athletes experiencing concussion (n=1228; age=18...

Objective To examine the association between estimated age of first exposure to American football (AFE) and concussion history in National Collegiate Athletic Association (NCAA) football players Design Cross-sectional, observational study Setting Participants were recruited from 30 colleges/universities as part of the NCAA-U.S. Department of Defe...

Concussions are a serious public health problem, with significant healthcare costs and risks. One of the most serious complications of concussions is an increased risk of subsequent musculoskeletal injuries (MSKI). However, there is currently no reliable way to identify which individuals are at highest risk for post-concussion MSKIs. This study pro...

Objectives The purpose of this study was to determine sex differences in recovery trajectories of assessments for sport-related concussion using Concussion Assessment, Research and Education (CARE) Consortium data. Methods National Collegiate Athletic Association athletes (N = 906; 61% female) from sex-comparable sports completed a pre-season base...

Concussion has been described in the United States (US) collegiate student–athlete population, but female-specific findings are often underrepresented and underreported. Our study aimed to describe female collegiate student–athletes’ initial injury characteristics and return to activity outcomes following concussion. Female collegiate student–athle...

Mild traumatic brain injury (mTBI) has been described in the United States (US) military service academy cadet population, but female-specific characteristics and recovery outcomes are poorly characterized despite sex being a confounder. Our objective was to describe female cadets’ initial characteristics, assessment performance, and return-to-acti...

Since the implementation of the US Soccer heading guidelines released in 2015, little to no research on ball-head impact exposure in the United States youth soccer population has been conducted. The purpose was to compare ball-head impact exposure across sex and age in youth soccer players over a weekend tournament. Ten male and female games for ea...

This prospective cohort study aimed to determine whether pre-injury characteristics and performance on baseline concussion assessments predicted future concussions among collegiate student-athletes. Participant cases (concussed = 2,529; control = 30,905) completed pre-injury: demographic forms (sport, concussion history, sex), Immediate Post-Concus...

Background Growing evidence indicates early exercise may improve symptoms and reduce clinical recovery time after concussion, but research examining collegiate student-athletes is scarce. Objective The aim of this study was to compare symptom recovery time, clinical recovery time, and persisting post-concussion symptom (i.e., symptoms ≥ 28 days) p...

Background There is a broad and diverse range of symptoms after a concussion, from irritability to nausea. This heterogeneity of symptoms is a challenge for clinicians managing the different presentations among injuries. Prior research has investigated the structure of postconcussive symptoms to determine if they can be grouped into clusters of rel...

Context: Data on the early- to mid-life effects of repetitive neurotrauma on patient reported outcomes have been delimited to homogeneous samples of male athletes with failure to utilize comparison groups or account for modifying factors such as physical activity. Objective: To determine the effect of contact/collision sport participation on pat...

Background: Understanding individual limb contributions to standing postural control is valuable when evaluating populations with asymmetric function (e.g., stroke, amputations). We propose a method of quantifying three contributions to controlling the net anteroposterior center of pressure (CoP) during quiet standing: CoP moving under left and ri...

Background Normative student-athlete concussion assessment data may not be appropriate for service academy members (SAMs), particularly rugby players, because of the uniqueness of their academic/military training environment. Having accurate baseline data for this population is important because of their high risk for concussion and frequent lack o...

Background: Persistent concussion symptoms (PCS) negatively affects common activities of daily living including deficits in both single and dual-task (DT) gait. DT gait deficits are present post-concussion; however, task prioritization and the effects of differing cognitive challenge remain unexplored in the PCS population. Research question: Th...

Background To determine the effect of contact/collision sport participation on measures of single-task (ST) and dual-task (DT) gait among early- to middle-aged adults. Methods The study recruited 113 adults (34.9 ± 11.8 years, 53.0% female) representing 4 groups. Groups included: (a) former non-contact/collision athletes and non-athletes who are n...

Objective: (1) To determine test-retest reliability of individual Sport Concussion Assessment Tool-Third Edition (SCAT-3) symptom scores and symptom severity scores, (2) to examine the specificity/sensitivity of individual SCAT-3 symptom severity scores acutely (24-48 hours) postconcussion, and (3) to develop a model of symptoms best able to diffe...

Purpose: The purpose of this study was to determine changes in neurocognitive, psychosocial, and balance functioning in collegiate male and female soccer players across three consecutive years of baseline testing compared to a control group of non-contact athletes. Methods: Generalized estimating equations were used to compare changes in annual,...

Background: An association has been identified between concussion and lower extremity musculoskeletal injury (LEMSKI) after return to sports participation. However, the collegiate student-athlete studies have relied on relatively small single-institution studies, which limits generalizability. Purpose: To assess odds of, and time to, LEMSKI afte...

Objectives : The primary purpose of this study was to assess Athletic Trainers (ATs) report of NCAA member institutions compliance with the Arrington settlement, the concussion lawsuit vs the NCAA, and to elucidate compliance predictors. A secondary purpose was to provide a contemporary concussion management clinical practice patterns description a...

The use of head kinematic measurement devices has recently proliferated owing to technology advances that make such measurement more feasible. In parallel, demand to understand the biomechanics of head impacts and injury in sports and the military has increased as the burden of such loading on the brain has received focused attention. As a result,...

Objectives To assess whether the King-Devick (KD) test is useful as a prognostic test for prolonged concussion symptoms by examining the relationship between a) change in performance on KD test from baseline to within two days post-injury and b) the absolute KD time at post-concussion testing, with an outcome of time to return to play (RTP). Desig...

Objective Concussions are common among youth athletes and could disrupt critical neurodevelopment. This study examined the association between age of first concussion (AFC) and neurocognitive performance, psychological distress, postural stability, and symptoms commonly associated with concussion in healthy collegiate men and women student athletes...

Context: There is an elevated rate of post-concussion lower extremity musculoskeletal injury (LE MSK), however the underlying mechanism has not been elucidated. Existing approaches have investigated physical characteristics despite poorer mental health being a common post-concussion complaint and linked to musculoskeletal injuries. Objective: Th...

Background: Investigations of estimated age of first exposure to repetitive head impacts from collision and contact sports have shown no associations with neurocognitive or neurobehavioral function at the collegiate level, but the effect of career duration may be a more comprehensive factor. Understanding whether longer career duration influences...

Objectives The objectives of this study were to (1) examine the relationship between the number of head impacts sustained in a season of men's collegiate club ice hockey and behavioral traits of aggression and sensation seeking, and (2) explore the neural correlates of these behaviors using neuroimaging. Design Retrospective cohort study. Methods...

Objective: Emerging evidence has identified an ~2x elevated risk of musculoskeletal (MSK) injury in the year following a concussion. Most of these studies have examined a single college/university athletic department and may lack generalizability to professional sports. Therefore, the purpose this study was to assess the odds of post-concussion MS...

Sustaining sports-related head impacts has been reported to result in neurological changes that potentially lead to later-life neurological disease. Advanced neuroimaging techniques have been used to detect subtle neurological effects resulting from head impacts, even after a single competitive season. The current study used resting-state functiona...

Background: Early sport specialization has been associated with an increased risk of musculoskeletal injuries and unfavorable psychological outcomes; however, it is unknown whether sport specialization is associated with worse cognitive, postural, and psychological functions in first-year collegiate student-athletes. Methods: First-year collegia...

Background Sport-related concussion is recognized as a significant injury with variable recovery rates.Objective This study defined the acute natural history of sport concussion in male and female collegiate athletes participating in a broad array of sports.Methods We conducted a prospective, longitudinal investigation among collegiate student athl...

Objective To determine the relationship between prolonged exposure to repetitive head impacts (RHI) through contact sports, as assessed by cumulative years contact sport participation, and quality of life outcomes in current/former contact sport athletes. Background Cumulative lifetime RHI exposure may be a more meaningful measure than age of firs...

Background Concussion pre-injury (i.e., baseline) assessments serve as a benchmark comparison point in the event an individual sustains a concussion and allows clinicians to compare to post-injury measures. However, baseline assessments must reflect the individual’s true and most optimized performance to serve as a useful comparison. Mental fatigue...

Introduction Military members’ knowledge of concussion signs and symptoms may be critical to appropriate concussion identification and health-seeking behavior, particularly for those in leadership roles. The current study aimed to characterize concussion knowledge and attitudes among future military officers undergoing U.S.-based Reserve Officers’...

Background Elevated rates (1.5 to 3.0 times) of musculoskeletal (MSK) injuries in the first year post-concussion have been recently identified in diverse athletic populations; however, clinically feasible risk factors have received limited attention. Objective To identify clinical predictors of post-concussion subsequent musculoskeletal (MSK) inju...

Context: The King-Devick (K-D) is used to identify oculomotor impairment following concussion. However, the diagnostic accuracy of the K-D over time has not been evaluated. Objective: (a) Examine the sensitivity and specificity of the K-D test at 0–6 hours of injury, 24–48 hours, asymptomatic, return-to-play, and 6-months following concussion and (...

Objective To examine how concussion may impair sensory processing for control of upright stance.Methods Participants were recruited from a single university into 3 groups: 13 participants (8 women, 21 ± 3 years) between 2 weeks and 6 months post-injury who initiated a return-to-play progression (under physician management) by the time of testing (r...

Introduction: Physical and mental activity post-concussion has received renewed attention to improve concussion management, however most protocols start after several days and do not assess the acute window. Therefore, the purpose of this study was to assess physical and mental activity in the first 48 hours post-concussion on the time to symptom...

The 5th International Consensus Statement on Concussions in Sport reports that most athletes recover from concussion and return to sports within a few weeks post-injury. Impairments in postural control are a cardinal symptom following sports-related concussion; however, many studies suggest that these impairments resolve within 3–5 days post-injury...

The purpose of this study was to examine the association between sports participation history, including estimated age of first exposure (eAFE) to high-risk sports, and concussion history in first year (i.e., freshmen) collegiate athletes. Athletes increased their odds of sustaining a pre-college concussion by 5% [odds ratio(OR) = 1.05 (95%CI:1.05–...

Context Preseason testing can be time intensive and cost prohibitive. Therefore, using normative data for postconcussion interpretation in lieu of preseason testing is desirable. Objective To establish the recovery trajectory for clinical reaction time (RTclin) and assess the usefulness of changes from baseline (comparison of postconcussion scores...

Background: It is currently unknown what specific neuronal deficits influence postural instability following SRC; however, the modulation of postural control relies heavily on the appropriate integration of sensory information from the visual, vestibular, and somatosensory system. It is possible symptom provocation of vestibular or ocular function...

Background Vestibular and ocular motor screening tools, such as the Vestibular/Ocular Motor Screening (VOMS), are recognized as important components of a multifaceted evaluation of sport-related concussion. Previous research has supported the predictive utility of the VOMS in identifying concussion, but researchers have yet to examine the predictiv...

Background Symptom resolution is a key marker in determining fitness for return to activity following concussion, but in some cases, distinguishing persistent symptoms due to concussion versus symptoms related to other factors can be challenging.Objective To determine base rates of postconcussional syndrome (PCS) diagnostic categorization in health...

Sport-related brain injury is very common, and the potential long-term effects include a wide range of neurological and psychiatric symptoms, and potentially neurodegeneration. Around the globe, researchers are conducting neuroimaging studies on primarily homogenous samples of athletes. However, neuroimaging studies are expensive and time consuming...

Purpose: To determine the relationship between age of first exposure (AFE) to repetitive head impacts (RHI) through contact/collision sports and patient-reported outcomes in community rugby players. Methods: We recruited community rugby players over the age of 18 with at least 1-year of contact rugby participation to complete an online survey. P...

Background Since concussion is the most common injury in ice hockey, the objective of the current study was to elucidate risk factors, specific mechanisms, and clinical presentations of concussion in men's and women's ice hockey. Methods Ice hockey players from 5 institutions participating in the Concussion Assessment, Research and Education (CARE...

Context: Pre-season testing is often used to establish baseline scores for post-concussion interpretation. However, pre-season testing can be time-intensive and cost-prohibitive, in which case normative data may be used for post-injury interpretation. Objective: To compare change from baseline and normative-based cutoff scores in interpreting clini...

Objective To examine neurocognitive performance of persistent concussion symptom patients using a novel sensorimotor technology. Background In patients with persistent concussion symptoms, neurocognitive deficits have been routinely identified; however, most of the current literature focuses on athletes and military veterans. Middle aged community...

Objective To assess the association between the Brief Symptom Inventory 18 (BSI-18) response at post-concussion return to play (RTP) and subsequent lower extremity musculoskeletal injury (LE-MSI). Background Concussion evaluation includes a multifaceted neurologic assessment at baseline and post-injury. Despite emotional sequelae after concussion,...

Objective This study examined the association between age of first concussion (AFC) and neurocognitive performance, psychological distress, postural stability, and concussion symptoms in healthy collegiate student athletes. Background Concussions are common among youth athletes, yet the long-term clinical consequences are largely unknown. We hypot...

Objective To determine the relationship between exposure to repetitive head impacts (RHI) through collision sports prior to the age of 12 and quality of life measures in community rugby players. Background It is suggested that RHI incurred before age 12 may be associated with later life neurologic impairments. However, research on age of first exp...

Objective To determine the effect of concussion history on the electronic version of the Trail Making Test (TMT) A and TMT-B performance. Background The effects of concussion history on cognitive performance when the individual is still young has received limited attention. There are inconsistent results in prior studies using computerized neuroco...

Objective To examine sex differences between concussion and lower-extremity musculoskeletal injury (LE-MSI) in community male and female rugby players. Background There is an ∼2x elevated risk of post-concussion subsequent MSI in high school through professional athletes. However, the effect of sex on risk is inconsistent and sparse, and rugby pro...

Introduction: Concussions have been associated with an increased risk of lower-extremity musculoskeletal injury (LE-MSI) in athletes and US Army soldiers, creating an added economic, physical and social burden. Yet, there is a paucity of evidence on this relationship among Reserve Officers' Training Corps (ROTC) cadets, a group which engages in ac...

Objectives To determine (1) the association between lifetime diagnosed concussion and lower extremity musculoskeletal injury (LE-MSI) among community rugby union players and (2) the sex specific risk of LE-MSI given concussion history among males and females. Design Retrospective survey. Methods 1037 (59.0% male, (612/1037), age: 31.6 ± 11.3 year...

Objectives: The purpose of our study was to investigate the association between repetitive head impact (RHI) exposure and postural control. Design: Systematic review Methods: PubMed, Embase and PsycInfo were searched using a self-developed search term including the keywords balance OR postural control AND repetitive OR sub-concussive head impacts....

Objectives: The purpose of our study was to investigate the association between repetitive head impact (RHI) exposure and postural control. Design: Systematic review Methods: PubMed, Embase and PsycInfo were searched using a self-developed search term including the keywords balance OR postural control AND repetitive OR subconcussive head impacts. T...

Objective: To examine the association between estimated age of first exposure (eAFE) to American football and clinical measures throughout recovery following concussion. Methods: Participants were recruited across 30 colleges and universities as part of the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium. There were 294...

Background Identifying separate dimensions of concussion symptoms may inform a precision medicine approach to treatment. It was previously reported that a bifactor model identified distinct acute postconcussion symptom dimensions. Purpose To replicate previous findings of a bifactor structure of concussion symptoms in the Concussion Assessment Res...

Objective: To determine the length of time after concussion that impaired tandem gait performance is observed. Design: Clinical measurement, prospective longitudinal. Setting: NCAA collegiate athletic facility. Participants: Eighty-eight concussed NCAA Division I student-athletes and 30 healthy controls. Independent variables: Group (concu...

The purpose of this study was to assess gait initiation (GI) performance longitudinally across clinical concussion recovery milestones through return to participation (RTP). We recruited 54 collegiate student-athletes, 27 with concussions and 27 matched controls (15 Female and 12 Male per group). Participants performed 5 trials of GI at baseline an...

Background Collegiate football players who started playing tackle football before age 12 years did not show worse neuropsychological test performance than those who started playing tackle football after age 12 years. It is unknown if beginning other contact sports, such as lacrosse, at a younger age is associated with worse neurocognitive performan...

The use of virtual reality (VR) technology continues to grow in the areas of clinical assessment and rehabilitation. Both researchers and health-care providers are exploring ways to incorporate VR in clinical practice as an emerging technology. VR postural control and neuropsychological testing represent a promising next step in sport-related concu...