Concussion

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William P. Meehan - One of the best experts on this subject based on the ideXlab platform.

  • Treatment of Pediatric Concussion.
    Seminars in pediatric neurology, 2019
    Co-Authors: Karameh Kuemmerle, William P. Meehan
    Abstract:

    Concussions have gained attention in medical literature, legal literature, and lay media over the past several years as a public health affecting children, particularly those who do not improve in the first few days after an injury. We discuss strategies for acute management immediately after a Concussion and an introduction to medical and non-medical options for treatment of the complex symptoms that persist in some patients with Concussions. We examine the role of rest and exercise during recovery. We briefly discuss the role of the multidisciplinary approach to Concussion in a setting that engages multiple specialists. Finally, we address policy changes related to sport-Concussions and their efficacy in improving long term outcomes.

  • The effect of prior Concussion history on dual-task gait following a Concussion
    British Journal of Sports Medicine, 2017
    Co-Authors: David R. Howell, Michael A. Beasley, Lisa Vopat, William P. Meehan
    Abstract:

    Objective To examine gait characteristics among patients following their first lifetime Concussion, second or greater lifetime Concussion, and individuals with no Concussion history. Design Prospective observational study. Setting Regional sport-Concussion clinic. Participants Fourteen patients presented following their first lifetime Concussion (57% female; 15.6 [95% CI:=13.0, 17.2] years of age; 11.1 [8.3, 13.9] days post-Concussion), 21 following their second or greater lifetime Concussion (52% female; 16.9 [15.5, 18.4] years of age; 8.6 [6.2, 11.1] days post-Concussion), and thirty-one controls without a Concussion history (65% female; 15.0 [14.2, 15.8] years of age). Exclusion criteria included a current lower extremity injury or diagnosed learning disability. Interventions/independent variables Participants completed gait evaluations and medical history questionnaires. MANCOVAs evaluated between-group gait differences; correlations were calculated between the number of lifetime Concussions and gait. Outcome measures Participants recorded their number of prior Concussions. Three inertial sensors quantified single and dual-task gait; variables included average gait speed, cadence, and stride length. Main results During dual-task gait, patients reporting for their ≥ second lifetime Concussion walked significantly slower (0.81 [0.75, 0.89] m/s vs. 0.92 [0.86, 0.97] m/s; p=0.009) and with smaller stride lengths (0.98 [0.92, 1.04] m vs. 1.08 [1.04, 1.13] m; p=0.02) compared to controls. A moderate correlation was detected between dual-task gait speed and the number of prior Concussions (ρ= 0.44, p= 0.04). Conclusions Patients with a prior Concussion history demonstrated altered dual-task gait strategies relative to controls. Dual-task gait velocity and number of prior Concussions were moderately correlated, suggesting a worsening effect from multiple Concussions across the lifetime. Competing interests None. Dr. Meehan receives royalties from ABC-Clio publishing for the sale of his book, Kids, Sports, and Concussion: A guide for coaches and parents, and royalties from Wolters Kluwer for working as an author for UpToDate. He is under contract with ABC-Clio publishing for a future book entitled, Concussions, and with Springer International publishing for a future book entitled, Head and Neck Injuries in Young Athletes. His research is funded, in part, by a grant from the National Football League Players Association and by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament. Drs. Howell, Beasley, and Vopat have no conflicts of interest to report.

  • The effect of prior Concussion history on dual-task gait following a Concussion
    Journal of neurotrauma, 2016
    Co-Authors: David R. Howell, Michael A. Beasley, Lisa Vopat, William P. Meehan
    Abstract:

    Abstract Sustaining repeated Concussions has been associated with worse outcomes after additional injuries. This effect has been identified using symptom inventories and neurocognitive tests; however, few investigations have examined how a prior Concussion history affects gait soon after a subsequent Concussion. We examined the gait characteristics of athletes with no documented Concussion history (n = 31), athletes recovering from their first lifetime Concussion (n = 15), and athletes recovering from their second or greater lifetime Concussion (n = 22). All participants completed a single-task and dual-task gait examination, a medical history questionnaire, and a postConcussion symptom scale. Multivariate analyses of covariance (MANCOVA) models were used to evaluate mean gait differences among groups, and Spearman's ρ analyses were used to assess correlations between the number of lifetime Concussions and gait characteristics. Patients reporting to the clinic with their second or greater lifetime concuss...

  • Sports-related Concussions - media, science and policy.
    Nature reviews. Neurology, 2016
    Co-Authors: Rebekah Mannix, William P. Meehan, Alvaro Pascual-leone
    Abstract:

    Although growing awareness about the potential long-term deleterious effects of sport-related Concussion has led to increased attention to the risks of collision sports, calls to ban these sports, such as American football, might be premature. Collision sports have a relatively high incidence of Concussions, but participation in these sports also confers a host of benefits. In addition, the associated risks of participation, including Concussion, have not been definitively shown to outweigh the benefits they provide, and the risk-benefit ratio might vary among individuals. The risks of Concussion and repetitive Concussions associated with collision sports are unknown in the general population and not well characterized even in elite athlete populations. In this article, we discuss current knowledge on sports-related Concussion, its neurological consequences, and implications for regulation of the practice of collision sports. Language: en

  • time interval between Concussions and symptom duration
    Pediatrics, 2013
    Co-Authors: Matthew A Eisenberg, William P. Meehan, John Andrea, Rebekah Mannix
    Abstract:

    OBJECTIVE: To test the hypothesis that children with a previous history of Concussion have a longer duration of symptoms after a repeat Concussion than those without such a history. METHODS: Prospective cohort study of consecutive patients 11 to 22 years old presenting to the emergency department of a children9s hospital with an acute Concussion. The main outcome measure was time to symptom resolution, assessed by the Rivermead Post-Concussion Symptoms Questionnaire (RPSQ). Patients and providers completed a questionnaire describing mechanism of injury, associated symptoms, past medical history, examination findings, diagnostic studies, and the RPSQ. Patients were then serially administered the RPSQ for 3 months after the Concussion or until all symptoms resolved. RESULTS: A total of 280 patients were enrolled over 12 months. Patients with a history of previous Concussion had a longer duration of symptoms than those without previous Concussion (24 vs 12 days, P = .02). Median symptom duration was even longer for patients with multiple previous Concussions (28 days, P = .03) and for those who had sustained a Concussion within the previous year (35 days, P = .007) compared with patients without those risk factors. In a multivariate model, previous Concussion, absence of loss of consciousness, age ≥13, and initial RPSQ score >18 were significant predictors of prolonged recovery. CONCLUSIONS: Children with a history of a previous Concussion, particularly recent or multiple Concussions, are at increased risk for prolonged symptoms after Concussion. These findings have direct implications on the management of patients with Concussion who are at high risk for repeat injuries.

Kevin M. Guskiewicz - One of the best experts on this subject based on the ideXlab platform.

  • Relationship Between Concussion History and Concussion Knowledge, Attitudes, and Disclosure Behavior in High School Athletes.
    Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 2017
    Co-Authors: Johna K. Register-mihalik, Kevin M. Guskiewicz, Tamara C. Valovich Mcleod, Laura A. Linnan, Stephen W Marshall
    Abstract:

    OBJECTIVE: Examine the association between self-reported Concussion history and measures of Concussion knowledge, attitude, and disclosure behavior. DESIGN: Cross-sectional survey. SETTING: Classroom. PARTICIPANTS: A convenience sample of high school athletes (n = 167; mean age = 15.7 years) from multiple sports completed a validated survey. INDEPENDENT VARIABLES: Concussion history (main predictor) was defined as the number of self-recalled Concussions during participants' high school career. MAIN OUTCOME MEASURES: The outcomes were recalled Concussion disclosure behavior (3 measures) and scales assessing both Concussion knowledge and Concussion attitude. RESULTS: A greater number of previous Concussions was associated with worse attitude to Concussion and negative Concussion disclosure behavior. For every 3 additional self-recalled Concussions, there was a mean decrease of 7.2 points (range of possible scores = 14-98) in Concussion attitude score (P = 0.002), a 48% decrease in the self-reported proportion of Concussion events disclosed (P = 0.013), and an increased prevalence of self-reported participation in games (67%) and practices (125%) while experiencing signs and symptoms of Concussion (P CONCLUSIONS: Negative trends in Concussion disclosure behavior were identified in youth athletes with a positive history of Concussion. Improving disclosure in this subgroup will require targeted efforts addressing negative attitude to Concussion. Language: en

  • Concussion frequency associates with musculoskeletal injury in retired nfl players
    Medicine and Science in Sports and Exercise, 2015
    Co-Authors: Brian G Pietrosimone, Yvonne M Golightly, Jason P. Mihalik, Kevin M. Guskiewicz
    Abstract:

    OBJECTIVE: Concussion is commonly associated with immediate and persistent alterations in motor function affecting postural control and gait. Patients with lower extremity joint injury have demonstrated functional alterations in the cerebral cortex suggesting that musculoskeletal injury may be linked to alterations in brain function. Therefore we examined the associations between Concussion frequency and lower extremity musculoskeletal injury sustained during professional careers of National Football League (NFL) American Football players in a cross-sectional study. METHODS: An inclusive health history survey was mailed to 3647 NFL players who retired during 1930-2001. Respondents reported total Concussion frequency (0, 1, 2, or 3+) and presence (yes/no) of specific knee and ankle musculoskeletal injury during their NFL career. Separate logistic regression models were used to estimate associations between Concussion frequency and each musculoskeletal injury type, adjusting for number of years played in the NFL, body mass index while playing in the NFL, and playing position. RESULTS: Data from 2429 players (66.6% response rate) were available for analysis. Nearly 61% reported suffering a Concussion while competing in the NFL. Meniscal tear was the most commonly reported musculoskeletal injury (32%). Compared to NFL players who did not sustain a Concussion, retired NFL players with 1, 2, or 3+ Concussions had between 18-63%, 15-126%, and 73-165% higher odds of reporting various musculoskeletal injuries, respectively. CONCLUSION: A history of Concussions was associated with a history of musculoskeletal injuries during NFL careers. These data suggest that a higher number of Concussions is linked with a higher odds of reporting a musculoskeletal injury. Language: en

  • epidemiology of sports related Concussion in seven us high school and collegiate sports
    Injury Epidemiology, 2015
    Co-Authors: Stephen W Marshall, Kevin M. Guskiewicz, Michael Mccrea, Viswanathan Shankar, Robert C Cantu
    Abstract:

    The epidemiology of sports-related Concussion is not well-described in the literature. This paper presents a descriptive epidemiology of Concussion in seven high school and collegiate sports. We used the data from Concussion Prevention Initiative (CPI), which enrolled 8905 athletes at 210 high schools and 26 colleges in a prospective cohort study of 7 sports (football, men’s and women’s soccer, men’s and women’s lacrosse, and men’s and women’s ice hockey) between 1999 and 2001. Injury risks and injury rates were used to characterize the incidence of Concussion, and changes in symptoms over time were described. A total of 375 Concussions were observed. The incidence of Concussion was highest in football, followed by women’s lacrosse, men’s lacrosse, men’s soccer, and women’s soccer (only 10 ice hockey teams were included, too few to quantify incidence). The rate of incident Concussion was strongly associated with history of Concussion in the previous 24 months (rate ratio = 5.5; 95 %CI: 3.9, 7.8, for 2 or more Concussions relative to no previous Concussion). The most common symptoms at time of injury were headache (87 %), balance problems/dizziness (77 %), and feeling “in a fog” (62 %). Loss of consciousness and amnesia were present in relatively few cases (9 and 30 %). The most common mechanism of injury was collision with another player. Sports-related Concussions present with a diverse range of symptoms and are associated with previous Concussion history.

  • episodic memory in former professional football players with a history of Concussion an event related functional neuroimaging study
    Journal of Neurotrauma, 2013
    Co-Authors: Jaclyn H Ford, Kelly S Giovanello, Kevin M. Guskiewicz
    Abstract:

    Abstract Previous research has demonstrated that sport-related Concussions can have short-term effects on cognitive processes, but the long-term consequences are less understood and warrant more research. This study was the first to use event-related functional magnetic resonance imaging (fMRI) to examine long-term differences in neural activity during memory tasks in former athletes who have sustained multiple sport-related Concussions. In an event-related fMRI study, former football players reporting multiple sport-related Concussions (i.e., three or more) were compared with players who reported fewer than three Concussions during a memory paradigm examining item memory (i.e., memory for the particular elements of an event) and relational memory (i.e., memory for the relationships between elements). Behaviorally, we observed that Concussion history did not significantly affect behavioral performance, because persons in the low and high Concussion groups had equivalent performance on both memory tasks, a...

  • summary of evidence based guideline update evaluation and management of Concussion in sports report of the guideline development subcommittee of the american academy of neurology
    Neurology, 2013
    Co-Authors: Christopher C. Giza, Kevin M. Guskiewicz, Jeffrey S. Kutcher, Stephen Ashwal, Jeffrey T Barth, Thomas S D Getchius, Gerard A Gioia, Gary S Gronseth, Steven Mandel, Geoffrey T Manley
    Abstract:

    Objective: To update the 1997 American Academy of Neurology (AAN) practice parameter regarding sports Concussion, focusing on 4 questions: 1) What factors increase/decrease Concussion risk? 2) What diagnostic tools identify those with Concussion and those at increased risk for severe/prolonged early impairments, neurologic catastrophe, or chronic neurobehavioral impairment? 3) What clinical factors identify those at increased risk for severe/prolonged early postConcussion impairments, neurologic catastrophe, recurrent Concussions, or chronic neurobehavioral impairment? 4) What interventions enhance recovery, reduce recurrent Concussion risk, or diminish long-term sequelae? The complete guideline on which this summary is based is available as an online data supplement to this article. Methods: We systematically reviewed the literature from 1955 to June 2012 for pertinent evidence. We assessed evidence for quality and synthesized into conclusions using a modified Grading of Recommendations Assessment, Development and Evaluation process. We used a modified Delphi process to develop recommendations. Results: Specific risk factors can increase or decrease Concussion risk. Diagnostic tools to help identify individuals with Concussion include graded symptom checklists, the Standardized Assessment of Concussion, neuropsychological assessments, and the Balance Error Scoring System. Ongoing clinical symptoms, Concussion history, and younger age identify those at risk for postConcussion impairments. Risk factors for recurrent Concussion include history of multiple Concussions, particularly within 10 days after initial Concussion. Risk factors for chronic neurobehavioral impairment include Concussion exposure and APOE e4 genotype. Data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae postConcussion. Practice recommendations are presented for preparticipation counseling, management of suspected Concussion, and management of diagnosed Concussion.

Grant L Iverson - One of the best experts on this subject based on the ideXlab platform.

  • observational review and analysis of Concussion a method for conducting a standardized video analysis of Concussion in rugby league
    Sports Medicine - Open, 2017
    Co-Authors: Grant L Iverson, Andrew Gardner, Christopher R Levi
    Abstract:

    Several professional contact and collision sports have recently introduced the use of sideline video review for club medical staff to help identify and manage Concussions. As such, reviewing video footage on the sideline has become increasingly relied upon to assist with improving the identification of possible injury. However, as yet, a standardized method for reviewing such video footage in rugby league has not been published. The aim of this study is to evaluate whether independent raters reliably agreed on the injury characterization when using a standardized observational instrument to record video footage of National Rugby League (NRL) Concussions. Video footage of 25 Concussions were randomly selected from a pool of 80 medically diagnosed Concussions from the 2013–2014 NRL seasons. Four raters (two naive and two expert) independently viewed video footage of 25 NRL Concussions and completed the Observational Review and Analysis of Concussion form for the purpose of this inter-rater reliability study. The inter-rater reliability was calculated using Cohen’s kappa (κ) and intra-class correlation (ICC) statistics. The two naive raters and the two expert raters were compared with one another separately. A considerable number of components for the naive and expert raters had almost perfect agreement (κ or ICC value ≥ 0.9), 9 of 22 (41%) components for naive raters and 21 of 22 (95%) components for expert raters. For the Concussion signs, however, the majority of the rating agreement was moderate (κ value 0.6–0.79); both the naive and expert raters had 4 of 6 (67%) Concussion signs with moderate agreement. The most difficult Concussion sign to achieve agreement on was blank or vacant stare, which had weak (κ value 0.4–0.59) agreement for both naive and expert raters. There appears to be value in expert raters, but less value for naive raters, in using the new Observational Review and Analysis of Concussion (ORAC) Form. The ORAC Form has high inter-rater agreement for most data elements, and it can be used by expert raters evaluating video footage of possible Concussion in the NRL.

  • A Systematic Review and Meta-Analysis of Concussion in Rugby Union
    Sports Medicine, 2014
    Co-Authors: Andrew J. Gardner, Grant L Iverson, W. Huw Williams, Stephanie Baker, Peter Stanwell
    Abstract:

    Background Rugby Union, a popular full-contact sport played throughout the world, has one of the highest rates of Concussion of all full-contact sports. Objective The aim of the current review was to systematically evaluate the available evidence on Concussion in Rugby Union and to conduct a meta-analysis of findings regarding the incidence of Concussion. Methods Articles were retrieved via a number of online databases. The current review examined all articles published in English up to May 2014 pertaining to Concussion in Rugby Union players. The key search terms included ‘Rugby Union’, ‘rugby’, ‘union’, and ‘football’, in combination with the injury terms ‘athletic injuries’, ‘Concussion’, ‘sports Concussion’, ‘sports-related Concussion’, ‘brain Concussion’, ‘brain injury’, ‘brain injuries’, ‘mild traumatic brain injury’, ‘mTBI’, ‘traumatic brain injury’, ‘TBI’, ‘craniocerebral trauma’, ‘head injury’, and ‘brain damage’. Results The final search outcome following the eligibility screening process resulted in the inclusion of 96 articles for this review. The meta-analysis included a total of 37 studies. The results of the meta-analysis revealed an overall incidence of match-play Concussion in men’s rugby-15s of 4.73 per 1,000 player match hours. The incidence of Concussion during training was 0.07 per 1,000 practice hours. The incidence of Concussion in women’s rugby-15s was 0.55 per 1,000 player match hours. In men’s rugby-7s match-play, Concussion incidence was 3.01 per 1,000 player match hours. The incidence of Concussion varied considerably between levels of play, with elite level play recording a rate of 0.40 Concussions per 1,000 player match hours, schoolboy level 0.62 Concussions per 1,000 player match hours, and the community or sub-elite level recording a rate of 2.08 Concussions per 1,000 player match hours. The incidence of Concussion in men’s rugby-15s as a function of playing position (forwards vs. backs) was 4.02 and 4.85 Concussions per 1,000 player match hours, respectively. Conclusions Concussion is a common injury sustained and reported in match play and to a lesser extent during practice by Rugby Union players. Based on the available published data, there appears to be a variation in risk of Concussion across level of play, with the sub-elite level having the greatest incidence of injury. Future research focused on studying the acute consequences and best management strategies in current players, and the potential longer term outcomes of Concussion in retired players, is needed. A focus on the areas of prevention, injury identification, and medical management, and risk for long-term outcomes will be of benefit to current athletes.

  • no cumulative effects for one or two previous Concussions
    British Journal of Sports Medicine, 2006
    Co-Authors: Grant L Iverson, Mark R Lovell, Brian L Brooks, Micky Collins
    Abstract:

    Background: Sports medicine clinicians and the general public are interested in the possible cumulative effects of Concussion. Objective: To examine whether athletes with a history of one or two previous Concussions differed in their preseason neuropsychological test performances or symptom reporting. Method: Participants were 867 male high school and university amateur athletes who completed preseason testing with ImPACT version 2.0. They were sorted into three groups on the basis of number of previous Concussions. There were 664 athletes with no previous Concussions, 149 with one previous Concussion, and 54 with two previous Concussions. Multivariate analysis of variance was conducted using the verbal memory, visual memory, reaction time, processing speed, and postConcussion symptom composite scores as dependent variables and group membership as the independent variable. Results: There was no significant multivariate effect, nor were there any significant main effects for individual scores. There was no measurable effect of one or two previous Concussions on athletes’ preseason neuropsychological test performance or symptom reporting. Conclusion: If there is a cumulative effect of one or two previous Concussions, it is very small and undetectable using this methodology.

  • cumulative effects of Concussion in amateur athletes
    Brain Injury, 2004
    Co-Authors: Grant L Iverson, Michael Gaetz, Mark R Lovell, Michael W Collins
    Abstract:

    Primary objective: To examine the possibility that athletes with multiple Concussions show cumulative effects of injury. Methods and procedures: Amateur athletes with a history of three or more Concussions were carefully matched (gender, age, education and sport) with athletes with no prior Concussions. All completed a computerized neuropsychological test battery at preseason (ImPACT) and then within 5 days of sustaining a Concussion (mean = 1.7 days). Main outcomes and results: There were differences between groups in symptom reporting and memory performance. At baseline (i.e. preseason), athletes with multiple Concussions reported more symptoms than athletes with no history of Concussion. At approximately 2 days post-injury, athletes with multiple Concussions scored significantly lower on memory testing than athletes with a single Concussion. Athletes with multiple Concussions were 7.7 times more likely to demonstrate a major drop in memory performance than athletes with no previous Concussions. Conclus...

  • cumulative effects of Concussion in high school athletes
    Neurosurgery, 2003
    Co-Authors: Michael W Collins, Grant L Iverson, Mark R Lovell, Robert C Cantu, Joseph C Maroon, Melvin Field
    Abstract:

    OBJECTIVE A common assumption in sports medicine is that a history of Concussion is predictive of a lower threshold for, as well as a worse outcome after, subsequent concussive injury. The current study was conducted to investigate the relationship between Concussion history in high school athletes and the on-field presentation of symptoms after subsequent Concussion. METHODS One hundred seventy-three athletes who experienced sports-related Concussion composed the initial study group. Binary groups were subsequently created on the basis of Concussion history. Sixty athletes with no Concussion history were compared with 28 athletes with a history of three or more Concussions. The groups were compared in terms of the on-field presentation of symptoms after an in-study Concussion. Dependent variables included the postinjury presence of loss of consciousness, anterograde amnesia, retrograde amnesia, and confusion. RESULTS Athletes with three or more prior Concussions were more likely to experience on-field positive loss of consciousness (chi(2) = 8.0, P = 0.005), anterograde amnesia (chi(2) = 5.5, P = 0.019), and confusion (chi(2) = 5.1, P = 0.024) after a subsequent cerebral Concussion. An odds ratio revealed that athletes with a history of three Concussions were 9.3 times more likely than athletes with no history of Concussion to demonstrate three to four abnormal on-field markers of Concussion severity. CONCLUSION This study is the first to suggest a cumulative effect of Concussion in high school athletes. A more severe on-field presentation of Concussion markers is evidenced in high school athletes with a pronounced history of Concussion. This study's findings highlight the need for more long-term outcome studies in high school athletes who sustain sports-related Concussions.

Stephen W Marshall - One of the best experts on this subject based on the ideXlab platform.

  • Relationship Between Concussion History and Concussion Knowledge, Attitudes, and Disclosure Behavior in High School Athletes.
    Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 2017
    Co-Authors: Johna K. Register-mihalik, Kevin M. Guskiewicz, Tamara C. Valovich Mcleod, Laura A. Linnan, Stephen W Marshall
    Abstract:

    OBJECTIVE: Examine the association between self-reported Concussion history and measures of Concussion knowledge, attitude, and disclosure behavior. DESIGN: Cross-sectional survey. SETTING: Classroom. PARTICIPANTS: A convenience sample of high school athletes (n = 167; mean age = 15.7 years) from multiple sports completed a validated survey. INDEPENDENT VARIABLES: Concussion history (main predictor) was defined as the number of self-recalled Concussions during participants' high school career. MAIN OUTCOME MEASURES: The outcomes were recalled Concussion disclosure behavior (3 measures) and scales assessing both Concussion knowledge and Concussion attitude. RESULTS: A greater number of previous Concussions was associated with worse attitude to Concussion and negative Concussion disclosure behavior. For every 3 additional self-recalled Concussions, there was a mean decrease of 7.2 points (range of possible scores = 14-98) in Concussion attitude score (P = 0.002), a 48% decrease in the self-reported proportion of Concussion events disclosed (P = 0.013), and an increased prevalence of self-reported participation in games (67%) and practices (125%) while experiencing signs and symptoms of Concussion (P CONCLUSIONS: Negative trends in Concussion disclosure behavior were identified in youth athletes with a positive history of Concussion. Improving disclosure in this subgroup will require targeted efforts addressing negative attitude to Concussion. Language: en

  • epidemiology of sports related Concussion in seven us high school and collegiate sports
    Injury Epidemiology, 2015
    Co-Authors: Stephen W Marshall, Kevin M. Guskiewicz, Michael Mccrea, Viswanathan Shankar, Robert C Cantu
    Abstract:

    The epidemiology of sports-related Concussion is not well-described in the literature. This paper presents a descriptive epidemiology of Concussion in seven high school and collegiate sports. We used the data from Concussion Prevention Initiative (CPI), which enrolled 8905 athletes at 210 high schools and 26 colleges in a prospective cohort study of 7 sports (football, men’s and women’s soccer, men’s and women’s lacrosse, and men’s and women’s ice hockey) between 1999 and 2001. Injury risks and injury rates were used to characterize the incidence of Concussion, and changes in symptoms over time were described. A total of 375 Concussions were observed. The incidence of Concussion was highest in football, followed by women’s lacrosse, men’s lacrosse, men’s soccer, and women’s soccer (only 10 ice hockey teams were included, too few to quantify incidence). The rate of incident Concussion was strongly associated with history of Concussion in the previous 24 months (rate ratio = 5.5; 95 %CI: 3.9, 7.8, for 2 or more Concussions relative to no previous Concussion). The most common symptoms at time of injury were headache (87 %), balance problems/dizziness (77 %), and feeling “in a fog” (62 %). Loss of consciousness and amnesia were present in relatively few cases (9 and 30 %). The most common mechanism of injury was collision with another player. Sports-related Concussions present with a diverse range of symptoms and are associated with previous Concussion history.

  • reliability of Concussion history in former professional football players
    Medicine and Science in Sports and Exercise, 2012
    Co-Authors: Zachary Y Kerr, Stephen W Marshall, Kevin M. Guskiewicz
    Abstract:

    Purpose: The reliability of athletes to recall and self-report a Concussion history has never been quantified. This study examined the reliability of the self-report Concussion history measure and explored determinants of recall in the number of self-reported Concussions in a group of retired professional football players. Methods: In 2001, a short questionnaire was administered to a cohort of former professional football players to ascertain the number of self-reported Concussions they sustained during their professional playing careers. In 2010, the same instrument was readministered to a subset (n = 899) of the original cohort to assess reliability. Results: Overall reliability was moderate (weighted Cohen ? = 0.48). The majority (62.1%) reported the same number of Concussions in both administrations (2001 and 2010); 31.4% reported more Concussions in the second administration. Compared with the �same number reported� group, the �greater number reported� group had more deficits in the second administration in their Short Form 36 physical health (composite score combining physical functioning, role physical, bodily pain, general health) and mental health (e.g., composite score combining vitality, social functioning, role emotional) scales. Conclusions: The self-reported Concussion history had moderate reliability in former professional football players, on the basis of two administrations of the same instrument, 9 yr apart. However, changes in health status may be differentially associated with recall of Concussions.

  • incidence and risk factors for Concussion in high school athletes north carolina 1996 1999
    American Journal of Epidemiology, 2004
    Co-Authors: Mark R Schulz, Stephen W Marshall, Frederick O Mueller, Jingzhen Yang, Nancy L Weaver, William D Kalsbeek, Michael J Bowling
    Abstract:

    A prospective cohort study was used to quantify risk factors for sports Concussions. Analysis was based on a stratified cluster sample of North Carolina high school athletes followed during 1996-1999. Clustering was by school and sport, and the sample included 15,802 athletes with 1-8 seasons of follow-up per athlete. Concussion rates were estimated for 12 sports, and risk factors were quantified using generalized Poisson regression. Concussion rates ranged from 9.36 (95% confidence interval: 1.93, 16.80) per 100,000 athlete-exposures in cheerleading to 33.09 (95% confidence interval: 24.74, 41.44) per 100,000 athlete-exposures in football, where "athlete-exposure" is one athlete participating in one practice or game. The overall rate of Concussion was 17.15 (95% confidence interval: 13.30, 21.00) per 100,000 athlete-exposures. Cheerleading was the only sport for which the practice rate was greater than the game rate. Almost two thirds of cheerleading Concussions involved two-level pyramids. Concussion rates were elevated for athletes with a history of Concussion, and they increased with the increasing level of body contact permitted in the sport. After adjustment for sport, body mass index, and year in school, history of Concussion(s) remained a moderately strong risk factor for Concussion (rate ratio = 2.28, 95% confidence interval: 1.24, 4.19). The fact that Concussion history is an important predictor of Concussion incidence, even in this young population, underscores the importance of primary prevention efforts, timely identification, and careful clinical management of these injuries.

  • cumulative effects associated with recurrent Concussion in collegiate football players the ncaa Concussion study
    JAMA, 2003
    Co-Authors: Kevin M. Guskiewicz, Stephen W Marshall, Michael Mccrea, Robert C Cantu, Christopher Randolph, William B Barr, James A Onate
    Abstract:

    ContextApproximately 300 000 sport-related Concussions occur annually in the United States, and the likelihood of serious sequelae may increase with repeated head injury.ObjectiveTo estimate the incidence of Concussion and time to recovery after Concussion in collegiate football players.Design, Setting, and ParticipantsProspective cohort study of 2905 football players from 25 US colleges were tested at preseason baseline in 1999, 2000, and 2001 on a variety of measures and followed up prospectively to ascertain Concussion occurrence. Players injured with a Concussion were monitored until their Concussion symptoms resolved and were followed up for repeat Concussions until completion of their collegiate football career or until the end of the 2001 football season.Main Outcome MeasuresIncidence of Concussion and repeat concusion; type and duration of symptoms and course of recovery among players who were injured with a Concussion during the seasons.ResultsDuring follow-up of 4251 player-seasons, 184 players (6.3%) had a Concussion, and 12 (6.5%) of these players had a repeat Concussion within the same season. There was an association between reported number of previous Concussions and likelihood of incident Concussion. Players reporting a history of 3 or more previous Concussions were 3.0 (95% confidence interval, 1.6-5.6) times more likely to have an incident Concussion than players with no Concussion history. Headache was the most commonly reported symptom at the time of injury (85.2%), and mean overall symptom duration was 82 hours. Slowed recovery was associated with a history of multiple previous Concussions (30.0% of those with ≥3 previous Concussions had symptoms lasting >1 week compared with 14.6% of those with 1 previous Concussion). Of the 12 incident within-season repeat Concussions, 11 (91.7%) occurred within 10 days of the first injury, and 9 (75.0%) occurred within 7 days of the first injury.ConclusionsOur study suggests that players with a history of previous Concussions are more likely to have future concussive injuries than those with no history; 1 in 15 players with a Concussion may have additional Concussions in the same playing season; and previous Concussions may be associated with slower recovery of neurological function.

David R. Howell - One of the best experts on this subject based on the ideXlab platform.

  • The effect of prior Concussion history on dual-task gait following a Concussion
    British Journal of Sports Medicine, 2017
    Co-Authors: David R. Howell, Michael A. Beasley, Lisa Vopat, William P. Meehan
    Abstract:

    Objective To examine gait characteristics among patients following their first lifetime Concussion, second or greater lifetime Concussion, and individuals with no Concussion history. Design Prospective observational study. Setting Regional sport-Concussion clinic. Participants Fourteen patients presented following their first lifetime Concussion (57% female; 15.6 [95% CI:=13.0, 17.2] years of age; 11.1 [8.3, 13.9] days post-Concussion), 21 following their second or greater lifetime Concussion (52% female; 16.9 [15.5, 18.4] years of age; 8.6 [6.2, 11.1] days post-Concussion), and thirty-one controls without a Concussion history (65% female; 15.0 [14.2, 15.8] years of age). Exclusion criteria included a current lower extremity injury or diagnosed learning disability. Interventions/independent variables Participants completed gait evaluations and medical history questionnaires. MANCOVAs evaluated between-group gait differences; correlations were calculated between the number of lifetime Concussions and gait. Outcome measures Participants recorded their number of prior Concussions. Three inertial sensors quantified single and dual-task gait; variables included average gait speed, cadence, and stride length. Main results During dual-task gait, patients reporting for their ≥ second lifetime Concussion walked significantly slower (0.81 [0.75, 0.89] m/s vs. 0.92 [0.86, 0.97] m/s; p=0.009) and with smaller stride lengths (0.98 [0.92, 1.04] m vs. 1.08 [1.04, 1.13] m; p=0.02) compared to controls. A moderate correlation was detected between dual-task gait speed and the number of prior Concussions (ρ= 0.44, p= 0.04). Conclusions Patients with a prior Concussion history demonstrated altered dual-task gait strategies relative to controls. Dual-task gait velocity and number of prior Concussions were moderately correlated, suggesting a worsening effect from multiple Concussions across the lifetime. Competing interests None. Dr. Meehan receives royalties from ABC-Clio publishing for the sale of his book, Kids, Sports, and Concussion: A guide for coaches and parents, and royalties from Wolters Kluwer for working as an author for UpToDate. He is under contract with ABC-Clio publishing for a future book entitled, Concussions, and with Springer International publishing for a future book entitled, Head and Neck Injuries in Young Athletes. His research is funded, in part, by a grant from the National Football League Players Association and by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament. Drs. Howell, Beasley, and Vopat have no conflicts of interest to report.

  • The effect of prior Concussion history on dual-task gait following a Concussion
    Journal of neurotrauma, 2016
    Co-Authors: David R. Howell, Michael A. Beasley, Lisa Vopat, William P. Meehan
    Abstract:

    Abstract Sustaining repeated Concussions has been associated with worse outcomes after additional injuries. This effect has been identified using symptom inventories and neurocognitive tests; however, few investigations have examined how a prior Concussion history affects gait soon after a subsequent Concussion. We examined the gait characteristics of athletes with no documented Concussion history (n = 31), athletes recovering from their first lifetime Concussion (n = 15), and athletes recovering from their second or greater lifetime Concussion (n = 22). All participants completed a single-task and dual-task gait examination, a medical history questionnaire, and a postConcussion symptom scale. Multivariate analyses of covariance (MANCOVA) models were used to evaluate mean gait differences among groups, and Spearman's ρ analyses were used to assess correlations between the number of lifetime Concussions and gait characteristics. Patients reporting to the clinic with their second or greater lifetime concuss...