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Papers by Jamie McAllister Deitrick

Oxford Research Encyclopedia of Psychology, 2017

Concussions affect millions of athletes of all ages each year in a variety of sports. Athletes in... more Concussions affect millions of athletes of all ages each year in a variety of sports. Athletes in certain sports such as American football, ice hockey, rugby, soccer, and combative sports like boxing are at higher risk for concussion. Direct or indirect mechanical forces acting on the skull and brain cause a concussion, which is a milder form of brain injury. Conventional neuroimaging (e.g., computerized tomography [CT], magnetic resonance imaging [MRI]) for concussion is typically negative. Concussions involve both neurometabolic and subtle structural damage to the brain that results in signs (e.g., loss of consciousness [LOC], amnesia, confusion), symptoms (e.g., headache, dizziness, nausea), and functional impairment (e.g., cognitive, balance, vestibular, oculomotor). Symptoms, impairment, and recovery time following concussion can last from a few days to weeks or months, based on a variety of risk factors, including younger age, female sex, history of concussion, and history of ...

Journal of Safety Research, 2020

INTRODUCTION Concussion is a type of traumatic brain injury that can be sustained through partici... more INTRODUCTION Concussion is a type of traumatic brain injury that can be sustained through participation in different sports. It is important that a parent be able to identify common and uncommon symptoms of a concussion to ensure the safety and good health of their child. The purpose of this study was to compare knowledge of concussion scores among White and African American parents and guardians. METHODOLOGY This cross-sectional study consisted of a single survey of 53 questions that was given to parents/guardians of high school athletes at a preseason parent meeting. Parent and guardian knowledge of concussion was assessed through a series of 45 questions. Participants were asked to correctly identify signs and symptoms of concussion, answer questions regarding the anatomy of a concussion (i.e. a concussion is an injury to the brain), answer true/false questions about general concussion knowledge, select from a list the consequences of multiple concussions and select from a list the consequences of returning to play too soon from a concussion. Knowledge of concussion was calculated by summing correct responses for the 45 knowledge questions. Racial differences were calculated using an ANCOVA, controlling for socioeconomic school type. The statistical significance level was set a priori p ≤ 0.05 for all analyses. RESULTS Participants of this study consisted of 176 [115 (65.3%) White, 61 (34.7%) African American] parents/guardians of high school athletes. Significant differences in knowledge of concussion scores between White parents/guardians [38.50 ± 4.55 (85.6% correct)], and African American parents/guardians [35.15 ± 4.97, 78.1% correct)] were identified (F(1,172) = 4.82, p = 0.03). CONCLUSION Knowledge of concussion disparities exist between African American and White parents/guardians. This disparity could cause complications from concussion to surface among children and adolescents participating in sport as their parents/guardians may not be able to correctly identify the signs and symptoms in order to seek proper medical care. Practical Application: Findings from this study highlight quantitative differences in concussion knowledge of parents from different demographics. These findings underline disparities and inequities in access to concussion-health resources that need to be addressed.

Journal of health disparities research and practice, 2020

Objective: Objective: Studies related to attitudes of concussion have been growing in athletic po... more Objective: Objective: Studies related to attitudes of concussion have been growing in athletic populations. While racial and socioeconomic disparities exist in knowledge and awareness of concussion, it remains unclear the effect of disparities on attitudes of concussion and reporting behaviors. The purpose of this study was to examine racial and socioeconomic disparities on attitudes towards concussion and the decision to remain in play with a suspected concussion. Design: Design: This cross-sectional study included 577 athletes between the ages of 13-19 (16.0 ± 1.2) years from 14 high schools. Participants completed a knowledge and attitudes instrument assessing general attitudes of concussion using 7 Likert-scale attitude questions followed by 2 additional questions assessing the decision to continue play while symptomatic. Differences in attitudes of concussion between race and socioeconomic school type were examined using independent t-tests. A multivariable linear regression model was utilized to determine which demographic factors were associated with athletes' attitude scores. Multivariable logistic regression models were utilized to determine what demographic variables were associated with athletes' continuation of play in a practice or a game. Results: Results: Differences in attitude scores between race were observed, with black athletes demonstrating lower scores than white athletes (pp=.04) and sex (OR: 0.59, 95% CI [0.36,0.96], p=.03) were, with females less likely to remain in a practice than males. Further, race and socioeconomic school type were not significantly associated with remaining in a game; however, attitude (OR: 0.97, 95% CI [0.95,0.99], p=.01) and sex (OR: 0.56 95% CI [0.35,0.90], p=.02) were, with females less likely to remain in a game than males. Conclusions: Conclusions: Disparities exist between race and socioeconomic school type on attitude of concussion. Black athletes and athletes attending Title I high schools had poorer attitude scores compared to white athletes and athletes attending non-Title I schools. Race was significantly associated with lower concussion attitude scores. The poorer, yet moderate concussion attitude scores suggest concussion education efforts be concentrated towards closing the disparity gap. Further, addressing concussion attitudes would likely also help to shift athletes' decisions to remain in a practice or game while symptomatic.

Brain Injury, 2021

ABSTRACT Objective To investigate factors associated with collegiate athletes’ beliefs regarding ... more ABSTRACT Objective To investigate factors associated with collegiate athletes’ beliefs regarding chronic traumatic encephalopathy (CTE) mechanism. Design Cross-sectional study. Methods A total of 838 collegiate athletes (61.9% men) from seven institutions completed a 10-minute survey that captured information relative to demographics, diagnosed concussion history, formal sport-related concussion education, additional sources of concussion information, and beliefs about multiple concussions and premature return-to-play following a head impact as mechanisms for CTE. Results More than half of collegiate athletes believed that multiple concussions (58.2%) and premature return-to-play (59.1%) may cause CTE. Those who reported getting concussion information from sports news had higher odds of believing multiple concussions and premature return-to-play were CTE mechanisms compared to those who did not get information from sports news sources. Additionally, CTE mechanism beliefs were significantly greater in collegiate athletes who were male, had sustained a previous diagnosed concussion, or had acquired concussion information from the NCAA. Conclusions Sports news’ reporting of CTE storylines, which highlight former male athletes with complex brain injury histories, may influence collegiate athletes’ beliefs about concussion. Therefore, it is recommended that concussion awareness initiatives incorporate information related specifically to CTE to empower collegiate athletes with evidence-based, patient-oriented information and knowledge regarding this condition.

The American Journal of Sports Medicine, 2020

Background: Given the high participation of Black/African American individuals in high school spo... more Background: Given the high participation of Black/African American individuals in high school sports, especially high-risk sports for concussion, it is important to note if racial and socioeconomic status (SES) differences exist in baseline performance on clinical measures of concussion. Purpose: To explore the association between race and SES on baseline concussion assessments of neurocognitive performance and oculomotor function in adolescent athletes. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: A total of 564 high school athletes (mean ± SD age, 15.33 ± 1.1 years) completed the baseline Immediate Post-Concussion Assessment and Cognitive Test and King-Devick (KD) battery before the start of their competitive season. Race was defined as either White/non-Hispanic or Black/African American. SES status was determined by whether the individual’s participating high school was a Title I or non–Title I school. A series of multivariable linear regression analyses...

Concussion, 2020

Aim: To examine the effects of maximal exercise on symptoms, vestibular/ocular motor screening (V... more Aim: To examine the effects of maximal exercise on symptoms, vestibular/ocular motor screening (VOMS) and postural stability. Methodology: A total of 17 college-aged individuals completed a symptom scale, VOMS and the modified Clinical Test for Sensory Interaction and Balance (m-CTSIB), followed by a graded maximal exercise treadmill test. Assessments were repeated post exercise, 20 and 40 min post-exercise. Results: Significant increases in total symptoms, symptom severity scores and m-CTSIB scores from baseline to immediate post exercise were reported. Following 20-min recovery, improvements were noted on symptoms, visual motion sensitivity on VOMS and m-CTSIB. Conclusion: Symptoms and postural stability are influenced by exercise and following 20 min of rest, returned to baseline, indicating that a period of 20 min following a suspected concussion may be needed to negate exercise effects.

The American Journal of Sports Medicine, 2020

Background: Symptoms, cognition, balance, and other domains are commonly assessed at baseline tes... more Background: Symptoms, cognition, balance, and other domains are commonly assessed at baseline testing as part of comprehensive preseason evaluations among collegiate student-athletes. Although approximately 27% of college students have at least 1 sleep disorder, researchers have yet to examine the role of a preexisting sleep disorder on preinjury baseline performance. Purpose: To compare athletes with and without a reported history of diagnosed sleep disorders on commonly used baseline concussion assessments. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 666 National Collegiate Athletic Association student-athletes completed baseline measures including the Balance Error Scoring System (BESS), Brief Symptom Inventory–18 (BSI-18), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Post-Concussion Symptom Scale (PCSS), Sport Concussion Assessment Tool–5th Edition (SCAT5), and Standardized Assessment of Concussion (SAC). There were 333 ...

Clinical Journal of Sport Medicine, 2019

OBJECTIVE To investigate the association between risk factors and vestibular-oculomotor outcomes ... more OBJECTIVE To investigate the association between risk factors and vestibular-oculomotor outcomes after sport-related concussion (SRC). STUDY DESIGN Cross-sectional study of patients seen 5.7 ± 5.4 days (range 0-30 days) after injury. SETTING Specialty clinic. PARTICIPANTS Eighty-five athletes (50 male athletes and 35 female athletes) aged 14.1 ± 2.8 years (range 9-24 years) seeking clinical care for SRC. INTERVENTIONS Participants completed a clinical interview, history questionnaire, symptom inventory, and vestibular/ocularmotor screening (VOMS). Chi-square tests with odds ratios and diagnostic accuracy were used to examine the association between risk factors and VOMS outcomes. MAIN OUTCOME MEASURES The VOMS. RESULTS Female sex (χ = 4.9, P = 0.03), on-field dizziness (χ = 7.1, P = 0.008), fogginess (χ = 10.3, P = 0.001), and post-traumatic migraine (PTM) symptoms including headache (χ = 16.7, P = 0.001), nausea (χ = 10.9, P = 0.001), light sensitivity (χ = 14.9, P = 0.001), and noise sensitivity (χ = 8.7, P = 0.003) were associated with presence of one or more postconcussion VOMS score above clinical cutoff. On-field dizziness (χ = 3.8, P = 0.05), fogginess (χ = 7.9, P = 0.005), and PTM-like symptoms including nausea (χ = 9.0, P = 0.003) and noise sensitivity (χ = 7.2, P = 0.007) were associated with obtaining a postconcussion near-point convergence (NPC) distance cutoff >5 cm. The likelihood ratios were 5.93 and 5.14 for VOMS symptoms and NPC distance, respectively. CONCLUSIONS Female sex, on-field dizziness, fogginess, and PTM symptoms were predictive of experiencing vestibular-oculomotor symptoms/impairment after SRC.

Journal of racial and ethnic health disparities, Jan 2, 2017

National Collegiate Athletic Association (NCAA) concussion guidelines state that all NCAA athlete... more National Collegiate Athletic Association (NCAA) concussion guidelines state that all NCAA athletes must have a concussion baseline test prior to commencing their competitive season. To date, little research has examined potential racial differences on baseline neurocognitive performance among NCAA athletes. The purpose of this study was to investigate differences between Black and White collegiate athletes on baseline neurocognitive performance and self-reported symptoms. A total of 597 collegiate athletes (400 White, 197 Black) participated in this study. Athletes self-reported their race on the demographic section of their pre-participation physical examination and were administered the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) neurocognitive battery in a supervised, quiet room. Controlling for sex, data were analyzed using separate one-way analyses of covariance (ANCOVAs) on symptom score, verbal and visual memory, visual motor processing speed, and reactio...

Medicine & Science in Sports & Exercise, 2017

CONCLUSION: As concussion management requires serial testing, high test-retest reliability is nee... more CONCLUSION: As concussion management requires serial testing, high test-retest reliability is needed. Although ICC2,k values were similar between time intervals, a higher number of domains in the 1-year interval met the reliability standards required for clinical care (ICC>0.70) and no domains displayed low levels of reliability (ICC<0.40). Should clinicians choose to complete multiple healthy baselines, a 1-year interval between assessments is recommended. Supported by the NOCSAE

Journal of Athletic Training, 2017

Context: Comprehensive, multidomain assessment is the standard of care after sport-related concu... more Context: Comprehensive, multidomain assessment is the standard of care after sport-related concussion. However, the relationship between performance on sideline concussion-assessment tools and in-office computerized neurocognitive testing has received little attention, and the prognostic utility of sideline measures is unknown. Objective: To evaluate concurrent impairment on commonly used concussion measures 24 to 48 hours postinjury while also determining the predictive utility of sideline measures on computerized neurocognitive testing in the acute to subacute recovery periods postinjury. Design: Case-control study. Setting: High school and collegiate athletics. Patients or Other Participants: A total of 125 high school and college-aged athletes (85 males, 40 females) 14 to 23 (16.8 ± 2.21) years old. Main Outcome Measure(s): Participants were administered sideline concussion-assessment measures (ie, Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT], Standa...

The Journal of head trauma rehabilitation, Jan 17, 2017

To determine whether family history of migraine increased the likelihood of posttraumatic migrain... more To determine whether family history of migraine increased the likelihood of posttraumatic migraine (PTM) symptom presentation in adolescents following concussion, and examine the influence of family history of migraine and PTM on postinjury outcomes. Outpatient concussion clinic. A total of 153 patients with concussion (103 males and 50 females) aged 15.72 ± 1.48 years (range 12-18 years). Cross-sectional, observational study of patients presenting for initial evaluation 4.72 ± 3.05 days (range 1-14) postinjury. Computerized neurocognitive testing, symptom report, and vestibular/oculomotor screening. Patients with a family history of migraine were 2.6 times (odds ratio = 2.60, confidence interval = 1.35-5.02, P = .003) more likely to present with PTM compared with patients without a family history. Results of multivariate analyses of covariance, controlling for concussion history, revealed significant main effects for PTM on (1) Immediate Post-Concussion Assessment and Cognitive Tes...

Journal of athletic training, 2017

Vestibular and oculomotor impairment and symptoms may be associated with worse outcomes after spo... more Vestibular and oculomotor impairment and symptoms may be associated with worse outcomes after sport-related concussion (SRC), including prolonged recovery. In this review, we evaluate current findings on vestibular and oculomotor impairments as well as treatment approaches after SRC, and we highlight areas in which investigation is needed. Clinical researchers have intimated that recovery from SRC may follow certain clinical profiles that affect the vestibular and oculomotor pathways. Identifying clinical profiles may help to inform better treatment and earlier intervention to reduce recovery time after SRC. As such, screening for and subsequent monitoring of vestibular and oculomotor impairment and symptoms are critical to assessing and informing subsequent referral, treatment, and return to play. However, until recently, no brief-screening vestibular and oculomotor tools were available to evaluate this injury. In response, researchers and clinicians partnered to develop the Vestib...

British journal of sports medicine, Jan 21, 2016

The objective of this study was to provide a meta-analysis examining the effects of football head... more The objective of this study was to provide a meta-analysis examining the effects of football heading. Meta-analytical review on football heading effects on neurocognitive performance, cognition and symptom reports. Combinations of the key terms were entered into the following electronic database search engines: Cochrane Libraries, PyscARTICLE, PyscINFO, PubMed, ProQuest, SPORTDiscus and Web of Science on 7 July 2016. The following inclusion criteria were used to determine eligibility for studies: (1) the study examined and reported on soccer athletes; (2) the population's age, sex and sport position was described; (3) cognitive function, symptoms, balance or other outcomes were quantitatively measured; (4) football heading exposure was quantitatively measured between at least two groups and (5) the study was written in the English language after December 1979. The literature search process identified 467 unique studies. After applying exclusion criteria, 28 studies remained. Inc...

British Journal of Sports Medicine, 2015

Concussion is a heterogeneous injury involving a myriad of physical (eg, dizziness, headache), co... more Concussion is a heterogeneous injury involving a myriad of physical (eg, dizziness, headache), cognitive (eg, memory problems, difficulty concentrating), sleep-related and affective (eg, depression, anxiety) symptoms, and impairment (eg, cognitive, vestibular, oculomotor). Consequently, clinical researchers have advocated for a more comprehensive and targeted approach to assessing and treating sport-related concussion (SRC).1 Some athletes experience mood-related consequences including anxiety and depression following SRC.2 In the extreme, these consequences if ignored or improperly managed can lead to clinical depression, anxiety, and even suicidal ideation and intent. As such, it is important to assess mood-related changes following SRC in all athletes and to properly treat those athletes who may be experiencing more pervasive affective symptoms. In this paper, we aim to highlight the current research on the mental health consequences of SRC and explore their implications for assessment and treatment of SRC. We also discuss potential directions for future research on mental health-related outcomes following SRC. Affective symptoms (eg, depression, anxiety) following traumatic brain injuries including concussion are common.2 However, it is estimated that only 6% of patients experience some form of depression following the concussion.3 Recent consensus statements on SRC have called for more research exploring the emotional sequelae that may accompany SRC as well as appropriate assessment and treatment approaches.2 ,4 Researchers have indicated that affective responses, particularly depression, are common following concussion.5–9 However, it is important to note that most affective responses occur at a subclinical level that does not meet diagnostic criteria for a clinical disorder. Additionally, it is important for the clinician to be aware of any pre-existing psychological conditions that may affect the emotional responses following SRC. Both psychosocial and neurobiological factors may help to explain affective responses following SRC. For example, individuals with clinical depression have been found …

Athletic Training & Sports Health Care, 2014

ADHD Attention Deficit and Hyperactivity Disorders, 2014

Objectives Alcohol use disorder (AUD) is closely associated with attention-deficit/hyperactivity ... more Objectives Alcohol use disorder (AUD) is closely associated with attention-deficit/hyperactivity disorder (ADHD). However, the mechanism involved in this association remains unclear. Impulsivity is one of the core traits of ADHD, and an elevated level of impulsivity increases the risk of onset of AUD. Our study focused on impulsivity as the common trait factor of these disorders. We examined the effects of ADHD symptoms and impulsivity on the abstinence period of patients with AUD. Methods Male participants with AUD completed the contents of the Adult ADHD Self-Report Scale and the Barratt Impulsiveness Scale. We investigated participant alcohol abstinence period to evaluate severity and frequency of relapse. Results Both ADHD symptom presence and abstinence period were significantly correlated with impulsivity. Motor impulsivity showed the highest correlations with ADHD and abstinence. The results of hierarchical regression analysis showed that impulsivity is a predictor of abstinence period, while ADHD had a moderating effect on the relationships between impulsivity and abstinence period. Moreover, we undertook hierarchical regression analysis of motor, cognitive, and non-planning impulsivity ; only motor impulsivity and ADHD symptom showed a statistically significant interaction with abstinence period. Conclusion The results indicate a possible causal relationship between the treatment of ADHD symptoms and the extension of AUD abstinence period. In other words, treatment of ADHD symptoms may prevent AUD relapse. Impulsivity, especially motor impulsivity has an important role in the base mechanisms of these two disorders.

Clinical Journal of Sport Medicine, 2020

OBJECTIVE The purpose of the current study was to explore knowledge surrounding sport-related con... more OBJECTIVE The purpose of the current study was to explore knowledge surrounding sport-related concussions (SRCs) and the impact on reporting behaviors in collegiate athletes, including sex differences. DESIGN Cross-sectional. SETTING Institutional. PARTICIPANTS Participants were 986 collegiate athletes (607 men), aged 19.7 years (SD = 1.4) from 6 institutions, who completed a survey, including items on personal/sport demographics and SRC knowledge and reporting behaviors. INTERVENTIONS Athletes were given a short (15-minute) survey to complete during team meetings and preparticipation physicals. MAIN OUTCOME MEASURES Athletes' scores on the survey, and reporting behaviors (ie, whether or not they failed to report a suspected SRC and reasons for not reporting SRCs), were examined. RESULTS Independent samples t tests revealed female athletes scored significantly higher than male athletes on total SRC knowledge [t (926.6) = -10.6, P < 0.01] and symptom knowledge (t (859) = -7.0, P < 0.01). Approximately one-quarter of athletes reported continuing to play after sustaining a suspected SRC. Chi-square analyses exposed significant differences between male and female athletes failing to report a suspected SRC (χ = 7.69, P < 0.01). CONCLUSIONS Given the current findings, educational efforts aimed at collegiate athletes may not be enough. Furthermore, it is apparent that sex differences exist in SRC knowledge and reporting behaviors among collegiate athletes.

Oxford Research Encyclopedia of Psychology, 2017

Concussions affect millions of athletes of all ages each year in a variety of sports. Athletes in... more Concussions affect millions of athletes of all ages each year in a variety of sports. Athletes in certain sports such as American football, ice hockey, rugby, soccer, and combative sports like boxing are at higher risk for concussion. Direct or indirect mechanical forces acting on the skull and brain cause a concussion, which is a milder form of brain injury. Conventional neuroimaging (e.g., computerized tomography [CT], magnetic resonance imaging [MRI]) for concussion is typically negative. Concussions involve both neurometabolic and subtle structural damage to the brain that results in signs (e.g., loss of consciousness [LOC], amnesia, confusion), symptoms (e.g., headache, dizziness, nausea), and functional impairment (e.g., cognitive, balance, vestibular, oculomotor). Symptoms, impairment, and recovery time following concussion can last from a few days to weeks or months, based on a variety of risk factors, including younger age, female sex, history of concussion, and history of ...

Journal of Safety Research, 2020

INTRODUCTION Concussion is a type of traumatic brain injury that can be sustained through partici... more INTRODUCTION Concussion is a type of traumatic brain injury that can be sustained through participation in different sports. It is important that a parent be able to identify common and uncommon symptoms of a concussion to ensure the safety and good health of their child. The purpose of this study was to compare knowledge of concussion scores among White and African American parents and guardians. METHODOLOGY This cross-sectional study consisted of a single survey of 53 questions that was given to parents/guardians of high school athletes at a preseason parent meeting. Parent and guardian knowledge of concussion was assessed through a series of 45 questions. Participants were asked to correctly identify signs and symptoms of concussion, answer questions regarding the anatomy of a concussion (i.e. a concussion is an injury to the brain), answer true/false questions about general concussion knowledge, select from a list the consequences of multiple concussions and select from a list the consequences of returning to play too soon from a concussion. Knowledge of concussion was calculated by summing correct responses for the 45 knowledge questions. Racial differences were calculated using an ANCOVA, controlling for socioeconomic school type. The statistical significance level was set a priori p ≤ 0.05 for all analyses. RESULTS Participants of this study consisted of 176 [115 (65.3%) White, 61 (34.7%) African American] parents/guardians of high school athletes. Significant differences in knowledge of concussion scores between White parents/guardians [38.50 ± 4.55 (85.6% correct)], and African American parents/guardians [35.15 ± 4.97, 78.1% correct)] were identified (F(1,172) = 4.82, p = 0.03). CONCLUSION Knowledge of concussion disparities exist between African American and White parents/guardians. This disparity could cause complications from concussion to surface among children and adolescents participating in sport as their parents/guardians may not be able to correctly identify the signs and symptoms in order to seek proper medical care. Practical Application: Findings from this study highlight quantitative differences in concussion knowledge of parents from different demographics. These findings underline disparities and inequities in access to concussion-health resources that need to be addressed.

Journal of health disparities research and practice, 2020

Objective: Objective: Studies related to attitudes of concussion have been growing in athletic po... more Objective: Objective: Studies related to attitudes of concussion have been growing in athletic populations. While racial and socioeconomic disparities exist in knowledge and awareness of concussion, it remains unclear the effect of disparities on attitudes of concussion and reporting behaviors. The purpose of this study was to examine racial and socioeconomic disparities on attitudes towards concussion and the decision to remain in play with a suspected concussion. Design: Design: This cross-sectional study included 577 athletes between the ages of 13-19 (16.0 ± 1.2) years from 14 high schools. Participants completed a knowledge and attitudes instrument assessing general attitudes of concussion using 7 Likert-scale attitude questions followed by 2 additional questions assessing the decision to continue play while symptomatic. Differences in attitudes of concussion between race and socioeconomic school type were examined using independent t-tests. A multivariable linear regression model was utilized to determine which demographic factors were associated with athletes' attitude scores. Multivariable logistic regression models were utilized to determine what demographic variables were associated with athletes' continuation of play in a practice or a game. Results: Results: Differences in attitude scores between race were observed, with black athletes demonstrating lower scores than white athletes (pp=.04) and sex (OR: 0.59, 95% CI [0.36,0.96], p=.03) were, with females less likely to remain in a practice than males. Further, race and socioeconomic school type were not significantly associated with remaining in a game; however, attitude (OR: 0.97, 95% CI [0.95,0.99], p=.01) and sex (OR: 0.56 95% CI [0.35,0.90], p=.02) were, with females less likely to remain in a game than males. Conclusions: Conclusions: Disparities exist between race and socioeconomic school type on attitude of concussion. Black athletes and athletes attending Title I high schools had poorer attitude scores compared to white athletes and athletes attending non-Title I schools. Race was significantly associated with lower concussion attitude scores. The poorer, yet moderate concussion attitude scores suggest concussion education efforts be concentrated towards closing the disparity gap. Further, addressing concussion attitudes would likely also help to shift athletes' decisions to remain in a practice or game while symptomatic.

Brain Injury, 2021

ABSTRACT Objective To investigate factors associated with collegiate athletes’ beliefs regarding ... more ABSTRACT Objective To investigate factors associated with collegiate athletes’ beliefs regarding chronic traumatic encephalopathy (CTE) mechanism. Design Cross-sectional study. Methods A total of 838 collegiate athletes (61.9% men) from seven institutions completed a 10-minute survey that captured information relative to demographics, diagnosed concussion history, formal sport-related concussion education, additional sources of concussion information, and beliefs about multiple concussions and premature return-to-play following a head impact as mechanisms for CTE. Results More than half of collegiate athletes believed that multiple concussions (58.2%) and premature return-to-play (59.1%) may cause CTE. Those who reported getting concussion information from sports news had higher odds of believing multiple concussions and premature return-to-play were CTE mechanisms compared to those who did not get information from sports news sources. Additionally, CTE mechanism beliefs were significantly greater in collegiate athletes who were male, had sustained a previous diagnosed concussion, or had acquired concussion information from the NCAA. Conclusions Sports news’ reporting of CTE storylines, which highlight former male athletes with complex brain injury histories, may influence collegiate athletes’ beliefs about concussion. Therefore, it is recommended that concussion awareness initiatives incorporate information related specifically to CTE to empower collegiate athletes with evidence-based, patient-oriented information and knowledge regarding this condition.

The American Journal of Sports Medicine, 2020

Background: Given the high participation of Black/African American individuals in high school spo... more Background: Given the high participation of Black/African American individuals in high school sports, especially high-risk sports for concussion, it is important to note if racial and socioeconomic status (SES) differences exist in baseline performance on clinical measures of concussion. Purpose: To explore the association between race and SES on baseline concussion assessments of neurocognitive performance and oculomotor function in adolescent athletes. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: A total of 564 high school athletes (mean ± SD age, 15.33 ± 1.1 years) completed the baseline Immediate Post-Concussion Assessment and Cognitive Test and King-Devick (KD) battery before the start of their competitive season. Race was defined as either White/non-Hispanic or Black/African American. SES status was determined by whether the individual’s participating high school was a Title I or non–Title I school. A series of multivariable linear regression analyses...

Concussion, 2020

Aim: To examine the effects of maximal exercise on symptoms, vestibular/ocular motor screening (V... more Aim: To examine the effects of maximal exercise on symptoms, vestibular/ocular motor screening (VOMS) and postural stability. Methodology: A total of 17 college-aged individuals completed a symptom scale, VOMS and the modified Clinical Test for Sensory Interaction and Balance (m-CTSIB), followed by a graded maximal exercise treadmill test. Assessments were repeated post exercise, 20 and 40 min post-exercise. Results: Significant increases in total symptoms, symptom severity scores and m-CTSIB scores from baseline to immediate post exercise were reported. Following 20-min recovery, improvements were noted on symptoms, visual motion sensitivity on VOMS and m-CTSIB. Conclusion: Symptoms and postural stability are influenced by exercise and following 20 min of rest, returned to baseline, indicating that a period of 20 min following a suspected concussion may be needed to negate exercise effects.

The American Journal of Sports Medicine, 2020

Background: Symptoms, cognition, balance, and other domains are commonly assessed at baseline tes... more Background: Symptoms, cognition, balance, and other domains are commonly assessed at baseline testing as part of comprehensive preseason evaluations among collegiate student-athletes. Although approximately 27% of college students have at least 1 sleep disorder, researchers have yet to examine the role of a preexisting sleep disorder on preinjury baseline performance. Purpose: To compare athletes with and without a reported history of diagnosed sleep disorders on commonly used baseline concussion assessments. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 666 National Collegiate Athletic Association student-athletes completed baseline measures including the Balance Error Scoring System (BESS), Brief Symptom Inventory–18 (BSI-18), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Post-Concussion Symptom Scale (PCSS), Sport Concussion Assessment Tool–5th Edition (SCAT5), and Standardized Assessment of Concussion (SAC). There were 333 ...

Clinical Journal of Sport Medicine, 2019

OBJECTIVE To investigate the association between risk factors and vestibular-oculomotor outcomes ... more OBJECTIVE To investigate the association between risk factors and vestibular-oculomotor outcomes after sport-related concussion (SRC). STUDY DESIGN Cross-sectional study of patients seen 5.7 ± 5.4 days (range 0-30 days) after injury. SETTING Specialty clinic. PARTICIPANTS Eighty-five athletes (50 male athletes and 35 female athletes) aged 14.1 ± 2.8 years (range 9-24 years) seeking clinical care for SRC. INTERVENTIONS Participants completed a clinical interview, history questionnaire, symptom inventory, and vestibular/ocularmotor screening (VOMS). Chi-square tests with odds ratios and diagnostic accuracy were used to examine the association between risk factors and VOMS outcomes. MAIN OUTCOME MEASURES The VOMS. RESULTS Female sex (χ = 4.9, P = 0.03), on-field dizziness (χ = 7.1, P = 0.008), fogginess (χ = 10.3, P = 0.001), and post-traumatic migraine (PTM) symptoms including headache (χ = 16.7, P = 0.001), nausea (χ = 10.9, P = 0.001), light sensitivity (χ = 14.9, P = 0.001), and noise sensitivity (χ = 8.7, P = 0.003) were associated with presence of one or more postconcussion VOMS score above clinical cutoff. On-field dizziness (χ = 3.8, P = 0.05), fogginess (χ = 7.9, P = 0.005), and PTM-like symptoms including nausea (χ = 9.0, P = 0.003) and noise sensitivity (χ = 7.2, P = 0.007) were associated with obtaining a postconcussion near-point convergence (NPC) distance cutoff >5 cm. The likelihood ratios were 5.93 and 5.14 for VOMS symptoms and NPC distance, respectively. CONCLUSIONS Female sex, on-field dizziness, fogginess, and PTM symptoms were predictive of experiencing vestibular-oculomotor symptoms/impairment after SRC.

Journal of racial and ethnic health disparities, Jan 2, 2017

National Collegiate Athletic Association (NCAA) concussion guidelines state that all NCAA athlete... more National Collegiate Athletic Association (NCAA) concussion guidelines state that all NCAA athletes must have a concussion baseline test prior to commencing their competitive season. To date, little research has examined potential racial differences on baseline neurocognitive performance among NCAA athletes. The purpose of this study was to investigate differences between Black and White collegiate athletes on baseline neurocognitive performance and self-reported symptoms. A total of 597 collegiate athletes (400 White, 197 Black) participated in this study. Athletes self-reported their race on the demographic section of their pre-participation physical examination and were administered the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) neurocognitive battery in a supervised, quiet room. Controlling for sex, data were analyzed using separate one-way analyses of covariance (ANCOVAs) on symptom score, verbal and visual memory, visual motor processing speed, and reactio...

Medicine & Science in Sports & Exercise, 2017

CONCLUSION: As concussion management requires serial testing, high test-retest reliability is nee... more CONCLUSION: As concussion management requires serial testing, high test-retest reliability is needed. Although ICC2,k values were similar between time intervals, a higher number of domains in the 1-year interval met the reliability standards required for clinical care (ICC>0.70) and no domains displayed low levels of reliability (ICC<0.40). Should clinicians choose to complete multiple healthy baselines, a 1-year interval between assessments is recommended. Supported by the NOCSAE

Journal of Athletic Training, 2017

Context: Comprehensive, multidomain assessment is the standard of care after sport-related concu... more Context: Comprehensive, multidomain assessment is the standard of care after sport-related concussion. However, the relationship between performance on sideline concussion-assessment tools and in-office computerized neurocognitive testing has received little attention, and the prognostic utility of sideline measures is unknown. Objective: To evaluate concurrent impairment on commonly used concussion measures 24 to 48 hours postinjury while also determining the predictive utility of sideline measures on computerized neurocognitive testing in the acute to subacute recovery periods postinjury. Design: Case-control study. Setting: High school and collegiate athletics. Patients or Other Participants: A total of 125 high school and college-aged athletes (85 males, 40 females) 14 to 23 (16.8 ± 2.21) years old. Main Outcome Measure(s): Participants were administered sideline concussion-assessment measures (ie, Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT], Standa...

The Journal of head trauma rehabilitation, Jan 17, 2017

To determine whether family history of migraine increased the likelihood of posttraumatic migrain... more To determine whether family history of migraine increased the likelihood of posttraumatic migraine (PTM) symptom presentation in adolescents following concussion, and examine the influence of family history of migraine and PTM on postinjury outcomes. Outpatient concussion clinic. A total of 153 patients with concussion (103 males and 50 females) aged 15.72 ± 1.48 years (range 12-18 years). Cross-sectional, observational study of patients presenting for initial evaluation 4.72 ± 3.05 days (range 1-14) postinjury. Computerized neurocognitive testing, symptom report, and vestibular/oculomotor screening. Patients with a family history of migraine were 2.6 times (odds ratio = 2.60, confidence interval = 1.35-5.02, P = .003) more likely to present with PTM compared with patients without a family history. Results of multivariate analyses of covariance, controlling for concussion history, revealed significant main effects for PTM on (1) Immediate Post-Concussion Assessment and Cognitive Tes...

Journal of athletic training, 2017

Vestibular and oculomotor impairment and symptoms may be associated with worse outcomes after spo... more Vestibular and oculomotor impairment and symptoms may be associated with worse outcomes after sport-related concussion (SRC), including prolonged recovery. In this review, we evaluate current findings on vestibular and oculomotor impairments as well as treatment approaches after SRC, and we highlight areas in which investigation is needed. Clinical researchers have intimated that recovery from SRC may follow certain clinical profiles that affect the vestibular and oculomotor pathways. Identifying clinical profiles may help to inform better treatment and earlier intervention to reduce recovery time after SRC. As such, screening for and subsequent monitoring of vestibular and oculomotor impairment and symptoms are critical to assessing and informing subsequent referral, treatment, and return to play. However, until recently, no brief-screening vestibular and oculomotor tools were available to evaluate this injury. In response, researchers and clinicians partnered to develop the Vestib...

British journal of sports medicine, Jan 21, 2016

The objective of this study was to provide a meta-analysis examining the effects of football head... more The objective of this study was to provide a meta-analysis examining the effects of football heading. Meta-analytical review on football heading effects on neurocognitive performance, cognition and symptom reports. Combinations of the key terms were entered into the following electronic database search engines: Cochrane Libraries, PyscARTICLE, PyscINFO, PubMed, ProQuest, SPORTDiscus and Web of Science on 7 July 2016. The following inclusion criteria were used to determine eligibility for studies: (1) the study examined and reported on soccer athletes; (2) the population's age, sex and sport position was described; (3) cognitive function, symptoms, balance or other outcomes were quantitatively measured; (4) football heading exposure was quantitatively measured between at least two groups and (5) the study was written in the English language after December 1979. The literature search process identified 467 unique studies. After applying exclusion criteria, 28 studies remained. Inc...

British Journal of Sports Medicine, 2015

Concussion is a heterogeneous injury involving a myriad of physical (eg, dizziness, headache), co... more Concussion is a heterogeneous injury involving a myriad of physical (eg, dizziness, headache), cognitive (eg, memory problems, difficulty concentrating), sleep-related and affective (eg, depression, anxiety) symptoms, and impairment (eg, cognitive, vestibular, oculomotor). Consequently, clinical researchers have advocated for a more comprehensive and targeted approach to assessing and treating sport-related concussion (SRC).1 Some athletes experience mood-related consequences including anxiety and depression following SRC.2 In the extreme, these consequences if ignored or improperly managed can lead to clinical depression, anxiety, and even suicidal ideation and intent. As such, it is important to assess mood-related changes following SRC in all athletes and to properly treat those athletes who may be experiencing more pervasive affective symptoms. In this paper, we aim to highlight the current research on the mental health consequences of SRC and explore their implications for assessment and treatment of SRC. We also discuss potential directions for future research on mental health-related outcomes following SRC. Affective symptoms (eg, depression, anxiety) following traumatic brain injuries including concussion are common.2 However, it is estimated that only 6% of patients experience some form of depression following the concussion.3 Recent consensus statements on SRC have called for more research exploring the emotional sequelae that may accompany SRC as well as appropriate assessment and treatment approaches.2 ,4 Researchers have indicated that affective responses, particularly depression, are common following concussion.5–9 However, it is important to note that most affective responses occur at a subclinical level that does not meet diagnostic criteria for a clinical disorder. Additionally, it is important for the clinician to be aware of any pre-existing psychological conditions that may affect the emotional responses following SRC. Both psychosocial and neurobiological factors may help to explain affective responses following SRC. For example, individuals with clinical depression have been found …

Athletic Training & Sports Health Care, 2014

ADHD Attention Deficit and Hyperactivity Disorders, 2014

Objectives Alcohol use disorder (AUD) is closely associated with attention-deficit/hyperactivity ... more Objectives Alcohol use disorder (AUD) is closely associated with attention-deficit/hyperactivity disorder (ADHD). However, the mechanism involved in this association remains unclear. Impulsivity is one of the core traits of ADHD, and an elevated level of impulsivity increases the risk of onset of AUD. Our study focused on impulsivity as the common trait factor of these disorders. We examined the effects of ADHD symptoms and impulsivity on the abstinence period of patients with AUD. Methods Male participants with AUD completed the contents of the Adult ADHD Self-Report Scale and the Barratt Impulsiveness Scale. We investigated participant alcohol abstinence period to evaluate severity and frequency of relapse. Results Both ADHD symptom presence and abstinence period were significantly correlated with impulsivity. Motor impulsivity showed the highest correlations with ADHD and abstinence. The results of hierarchical regression analysis showed that impulsivity is a predictor of abstinence period, while ADHD had a moderating effect on the relationships between impulsivity and abstinence period. Moreover, we undertook hierarchical regression analysis of motor, cognitive, and non-planning impulsivity ; only motor impulsivity and ADHD symptom showed a statistically significant interaction with abstinence period. Conclusion The results indicate a possible causal relationship between the treatment of ADHD symptoms and the extension of AUD abstinence period. In other words, treatment of ADHD symptoms may prevent AUD relapse. Impulsivity, especially motor impulsivity has an important role in the base mechanisms of these two disorders.

Clinical Journal of Sport Medicine, 2020

OBJECTIVE The purpose of the current study was to explore knowledge surrounding sport-related con... more OBJECTIVE The purpose of the current study was to explore knowledge surrounding sport-related concussions (SRCs) and the impact on reporting behaviors in collegiate athletes, including sex differences. DESIGN Cross-sectional. SETTING Institutional. PARTICIPANTS Participants were 986 collegiate athletes (607 men), aged 19.7 years (SD = 1.4) from 6 institutions, who completed a survey, including items on personal/sport demographics and SRC knowledge and reporting behaviors. INTERVENTIONS Athletes were given a short (15-minute) survey to complete during team meetings and preparticipation physicals. MAIN OUTCOME MEASURES Athletes' scores on the survey, and reporting behaviors (ie, whether or not they failed to report a suspected SRC and reasons for not reporting SRCs), were examined. RESULTS Independent samples t tests revealed female athletes scored significantly higher than male athletes on total SRC knowledge [t (926.6) = -10.6, P < 0.01] and symptom knowledge (t (859) = -7.0, P < 0.01). Approximately one-quarter of athletes reported continuing to play after sustaining a suspected SRC. Chi-square analyses exposed significant differences between male and female athletes failing to report a suspected SRC (χ = 7.69, P < 0.01). CONCLUSIONS Given the current findings, educational efforts aimed at collegiate athletes may not be enough. Furthermore, it is apparent that sex differences exist in SRC knowledge and reporting behaviors among collegiate athletes.