Erin Reynolds | VA - Academia.edu (original) (raw)

Papers by Erin Reynolds

Archives of Clinical Neuropsychology, 2015

Objective: The Vestibular/Ocular Motor Screening (VOMS) exam was developed to assess vestibular a... more Objective: The Vestibular/Ocular Motor Screening (VOMS) exam was developed to assess vestibular and oculomotor impairment and symptoms post-concussion (Mucha, et. al., 2014). Risk factors including sex, on-field dizziness, and post-traumatic migraine (PTM) are associated with concussion outcomes, but little is known about their association to vestibular and oculomotor outcomes. The current study investigated the association of these risk factors and post-concussion VOMS clinical cutoffs. Method: Participants included 85 (50 males, 38 females) adolescent athletes assessed with the VOMS exam one week post-concussion. Primary (sex, concussion history, migraine history) and secondary (on-field dizziness, LOC, PTM, fogginess) risk factors were obtained from each participant. Chi-square analyses with odds ratios were used to identify significant risk factors. Results: Chi-square analyses demonstrated that sex [x 2 ¼ 4.9, p ¼ .03, OR ¼ 3.4], on-field dizziness [x 2 ¼ 7.1, p ¼ .008, OR ¼ 3.9], post-traumatic migraine [x 2 ¼ 10.9, p ¼ .001, OR ¼ 15.9] and fogginess [x 2 ¼ 10.3, p ¼ .001, OR ¼ 6.2] were associated with the presence of at least one post-concussion VOMS cutoff score (.2/10 severity). On-field dizziness [x 2 ¼ 3.8, p ¼ .05, OR ¼ 2.5], post-traumatic migraine [x 2 ¼ 10.5, p ¼ .001, OR ¼ 4.9] and fogginess [x 2 ¼ 7.9, p ¼ .005, OR ¼ 3.7] were associated with the presence of a post-concussion near point convergence cutoff score (.5cm). Conclusion: Athletes with certain risk factors may be predisposed to develop vestibular and oculomotor symptoms post-concussion. Clinicians should consider these risk factors in the management of patients following concussion.

The Psychology of Sub-Culture in Sport and Physical Activity, 2014

Archives of Clinical Neuropsychology, 2021

Athletes with ADHD may experience longer and/or more complicated recoveries following SRC; howeve... more Athletes with ADHD may experience longer and/or more complicated recoveries following SRC; however, previous research has focused on neurocognitive outcomes. The objective of this study was to investigate the relationship between a history of ADHD among adolescent athletes and vestibular impairments following SRC. Participants included 166 athletes aged 15.9 +/− 1.5 who sustained an SRC, including 25 with a documented history of ADHD. Appropriate summary statistics were used to describe the data. ADHD and non-ADHD groups were compared using t-tests and Mann–Whitney U tests for continuous variables and Chi-square tests for categorical variables. A linear regression model analyzed the relationship between a history of ADHD and vestibular outcomes including horizontal and vertical vestibulo-ocular reflex (hVOR; vVOR), visual motion sensitivity (VMS), and Dizziness Handicap Index (DHI), while referral to vestibular therapy (VT) was analyzed using logistic regression. Athletes with ADHD ...

APA handbook of sport and exercise psychology, volume 1: Sport psychology (Vol. 1)., 2019

British Journal of Sports Medicine, 2021

ObjectivesTo (1) determine if wearing a cloth face mask significantly affected exercise performan... more ObjectivesTo (1) determine if wearing a cloth face mask significantly affected exercise performance and associated physiological responses, and (2) describe perceptual measures of effort and participants’ experiences while wearing a face mask during a maximal treadmill test.MethodsRandomised controlled trial of healthy adults aged 18–29 years. Participants completed two (with and without a cloth face mask) maximal cardiopulmonary exercise tests (CPETs) on a treadmill following the Bruce protocol. Blood pressure, heart rate, oxygen saturation, exertion and shortness of breath were measured. Descriptive data and physical activity history were collected pretrial; perceptions of wearing face masks and experiential data were gathered immediately following the masked trial.ResultsThe final sample included 31 adults (age=23.2±3.1 years; 14 women/17 men). Data indicated that wearing a cloth face mask led to a significant reduction in exercise time (−01:39±01:19 min/sec, p<0.001), maximal...

Brain Injury, 2021

ABSTRACT Primary objective – To discuss how the underlying neuroanatomy and neurobiology of five ... more ABSTRACT Primary objective – To discuss how the underlying neuroanatomy and neurobiology of five sport-related concussion (SRC) clinical profiles impacts assessment and treatment. Research design – Narrative review. Methods and procedures – Based on the current literature and clinical experience, arguments against the traditional SRC protocol and for a clinical profiles-based SRC protocol are made. Main outcomes and results – While the clinical profiles-based SRC protocol is widely used and accepted, there has been little published regarding the link to the underlying neuropathology. Our narrative review describes the five SRC clinical profiles: vestibular, ocular, mood, post-traumatic migraine, and cognitive/fatigue. For these profiles, the underlying neuroanatomy and neurobiology is outlined, as well as how that anatomy and biology impact the profiles’ etiology, assessment, and treatment. The cervical and sleep modifiers are also briefly covered. Conclusions – Utilizing this model, clinicians are able to provide an individualized assessment, conceptualization, and treatment plan for SRC, leading to improved outcomes and clinical experiences for athletes.

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 following sport-related concussion (SRC). Study Design-Cross-sectional study of patients seen 5.7 +/− 5.4 days (range, 0-30 days) postinjury. Setting-Specialty clinic Participants-Eighty-five athletes (50 males, 35 females) 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/ocular-motor screening (VOMS). Chi-square with odds ratios (OR) and diagnostic accuracy were used to examine the association between risk factors and VOMS outcomes. Main Outcome Measures-Vestibular and ocular-motor screening (VOMS) Results-Female sex [χ 2 = 4.9, p = .03], on-field dizziness [χ 2 = 7.1, p = .008], fogginess [χ 2 = 10.3, p = .001], and post-traumatic migraine (PTM) symptoms including headache [χ 2 = 16.7, p = .001], nausea [χ 2 = 10.9, p = .001], light sensitivity [χ 2 = 14.9, p = .001] and noise sensitivity [χ 2 = 8.7, p = .003] were associated with presence of one or more post-concussion VOMS score

Archives of Clinical Neuropsychology, 2016

Objective: Convergence insufficiency (CI) (i.e., abnormal near point of convergence [NPC]) follow... more Objective: Convergence insufficiency (CI) (i.e., abnormal near point of convergence [NPC]) following sport-related concussion (SRC) has been reported in 45% of athletes and linked to neurocognitive impairments (Pearce et al., 2015). This study expanded prior research to examine the relationship between CI and neurocognitive data at multiple time intervals during the recovery period following SRC. Method: Patients (n = 72 males, n = 34 females) 16.2 +/-1.9 years old diagnosed with SRC were assigned to normal near point of convergence (NPC) (n = 77; mean convergence ≤ 5 cm) and CI (n = 29; mean convergence > 5 cm) groups, and administered Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and Vestibular/Ocular-Motor Screening (VOMS) at first evaluation 5.06 +/-3.8 days post injury and at clearance for return to play 34.1 +/-32.7 days post injury. Results: Repeated measures ANOVAs were significant for a group (NPC/CI) x time (initial and clearance evaluation) interaction for verbal memory (p = .002, ƞ2 = .086), visual motor speed (p = .033, ƞ2 = .043), reaction time (p = .044, ƞ2 = .038) and symptoms (p = .034, ƞ2 = .042). There was no difference between groups (NPC/CI) for days until clearance (p = .90). Conclusion: Concussion assessment and management should include NPC assessment. Although CI in the acute stage post injury is associated with impairments on computerized neurocognitive testing, CI does not seem to affect recovery duration or performance on neurocognitive testing at clearance.

Sport, Exercise, and Performance Psychology, 2017

Conceptual models for assessing and treating sport-related concussion (SRC) have evolved from a h... more Conceptual models for assessing and treating sport-related concussion (SRC) have evolved from a homogenous approach to include different clinical profiles that reflect the heterogeneous nature of this injury and its effects. There are six identified clinical profiles, or subtypes from SRC, and one such clinical profile is the anxiety/mood profile. Athletes with this profile experience predominant emotional disturbance and anxiety following SRC. The purpose of this targeted review was to present an overview of the empirical evidence to support factors contributing to the anxiety/mood profile, along with methods of evaluation and treatment of this clinical profile following SRC. We discuss the potential underlying mechanisms and risk factors for this clinical profile, describe comprehensive assessments to evaluate concussed athletes with an anxiety/mood clinical profile, and explore behavioral and other interventions for treating these athletes. Although there is limited, but growing empirical evidence for the anxiety/mood clinical profile following SRC, understanding this clinical profile is germane for clinicians who are treating athletes with emotional sequelae after SRC.

Archives of Clinical Neuropsychology, 2015

Objective: Using diffusion tensor imaging (DTI), researchers have reported decreased in fractiona... more Objective: Using diffusion tensor imaging (DTI), researchers have reported decreased in fractional anisotropy (FA) in the brain immediately following sport-related concussion (SRC), whereas others have reported increased FA at later time points following SRC. The purpose of the current study was to compare DTI in relation to functional impairment at sub-acute and recovered time points following SRC. Method: Fourteen athletes (9 males, 5 females) aged 17.1 years +/2 3.1 with a diagnosed SRC participated in the study. Participants completed the Sideline Assessment of Concussion (SAC), Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), Post-concussion Symptom Scale (PCSS), Vestibular/Ocular Motor Screen (VOMS), Dizziness Handicap Inventory (DHI), Balance Error Scoring System (BESS), Functional Gait Assessment (FGA) and also underwent DTI between 1-14 days post injury (i.e., sub-acute; n¼ 9) or when medically cleared for full activity (i.e., recovered; n¼ 5). A p , .05 was used for t-tests and correlations. Results: FA in the left thalamus was lower in the sub-acute (.37 +/2.02) compared to the recovered (.40 +/-.03) group. Correlations were supported for decreased FA in the thalamus and increased DHI (2.60), convergence distance (-.60), and reaction time (-.54); and decreased visual memory (.54) and processing speed (.61). Positive correlations were supported for recovery time and FA in the cerebellum (.98) and hippocampus (.95). Conclusion: Decreased FA in the thalamus was associated with functional impairment and symptoms. Reported decreases in FA for the subacute compared to the recovered group as well as the associations between recovery time and FA suggest that DTI may be dependent on time since injury.

Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists, Jan 15, 2016

Computerized neurocognitive tests are frequently used to assess pediatric sport-related concussio... more Computerized neurocognitive tests are frequently used to assess pediatric sport-related concussions; however, only 1 study has focused on the test-retest reliability of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in high school athletes and age influences have largely been ignored. Therefore, the purpose was to investigate the test-retest reliability of ImPACT and underlying age influences in a pediatric population. Two hundred (169 men and 31 women) youth ice hockey players completed ImPACT before/after a 6-month season. Reliability was assessed using Pearson correlation coefficients, intraclass correlation coefficients (ICCs), and regression-based methods (RBz). ICCs for the sample ranged from .48 to .75 (single)/.65 to .86 (average). In general, the older athletes (15-18: Single/Average ICCs = .35-.75/.52-.86) demonstrated greater reliability across composites than the younger athletes (11-14: Single/Average ICCs = .54-.63/.70-.77). Although there was ...

Applied neuropsychology. Child, Jan 15, 2016

With youth sports participation and concern about sports-related concussions both on the rise, it... more With youth sports participation and concern about sports-related concussions both on the rise, it is important to properly measure cognitive function to ensure the clinical utility of baseline testing. Computerized testing batteries are often employed as baseline and postinjury measures of cognitive function, with the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) being the most used of all the current testing platforms. The current study compared 10- to 12-year-old children across the composite scores yielded by the ImPACT and provided normative data on each of the subtests used to calculate the composite scores. Normative data are separated by gender for athletes aged 10 to 12 years old, as this is the current age bracket used by the ImPACT. These norms may be helpful in the interpretation of the ImPACT clinical report and further delineation of areas of neurocognitive dysfunction.

Neurosurgery, 2014

The clinical management of sports-related concussions is a specialized area of interest with a la... more The clinical management of sports-related concussions is a specialized area of interest with a lack of empirical findings regarding best practice approaches. The University of Pittsburgh Medical Center Sports Concussion Program was the first of its kind; 13 years after its inception, it remains a leader in the clinical management and research of sportsrelated concussions. This article outlines the essential components of a successful clinical service for the management of sports-related concussions, using the University of Pittsburgh Medical Center Sports Concussion Program as a case example. Drawing on both empirical evidence and anecdotal conclusions from this high-volume clinical practice, this article provides a detailed account of the inner workings of a multidisciplinary concussion clinic with a comprehensive approach to the management of sportsrelated concussions. A detailed description of the evaluation process and an in-depth analysis of targeted clinical pathways and subtypes of sports-related concussions effectively set the stage for a comprehensive understanding of the assessment, treatment, and rehabilitation model used in Pittsburgh today.

Knee Surgery, Sports Traumatology, Arthroscopy, 2013

Purpose The purpose of this paper is to discuss risk and prognostic factors for concussion outcom... more Purpose The purpose of this paper is to discuss risk and prognostic factors for concussion outcomes, review comprehensive approaches to assessment, and describe a new method for conceptualizing treatment for sport-related concussion using clinical experience. Methods Based on the current literature of sport-related concussion and clinical experience, an approach for conceptualizing concussion care using clinical trajectories and targeted treatments was developed. Results A comprehensive approach to assessment and targeted treatments for sport-related concussion was developed using specific clinical trajectories. Conclusion Sport-related concussions are heterogeneous and require an individualized clinical approach. The use of a comprehensive approach for assessing specific clinical trajectories following a sport-related concussion will help clinicians better conceptualize this injury. Clinicians can then match targeted treatment pathways to specific clinical trajectories to accelerate safe return to play for athletes following a sport-related concussion. Level of evidence V.

Neuropsychology, Jan 20, 2015

The imagination inflation effect is a type of memory distortion defined as an increased tendency ... more The imagination inflation effect is a type of memory distortion defined as an increased tendency to falsely remember that an item has been seen, or an action has been performed, when it has only been imagined. For patients with very mild Alzheimer's disease (AD), susceptibility to the imagination inflation effect could have significant functional consequences in daily life. We assessed whether patients with very mild AD were more or less susceptible to the imagination inflation effect when compared with healthy older adults. In the first session, participants were read an action statement such as "fill the pillbox" and engaged in 1 of 3 activities: listened to the statement being read, performed the action, or imagined performing the action. During the second session, participants imagined action statements from the first session, as well as new action statements. During the recognition test, participants were asked to determine whether action statements were or were n...

Archives of Clinical Neuropsychology, 2015

Objective: The Vestibular/Ocular Motor Screening (VOMS) exam was developed to assess vestibular a... more Objective: The Vestibular/Ocular Motor Screening (VOMS) exam was developed to assess vestibular and oculomotor impairment and symptoms post-concussion (Mucha, et. al., 2014). Risk factors including sex, on-field dizziness, and post-traumatic migraine (PTM) are associated with concussion outcomes, but little is known about their association to vestibular and oculomotor outcomes. The current study investigated the association of these risk factors and post-concussion VOMS clinical cutoffs. Method: Participants included 85 (50 males, 38 females) adolescent athletes assessed with the VOMS exam one week post-concussion. Primary (sex, concussion history, migraine history) and secondary (on-field dizziness, LOC, PTM, fogginess) risk factors were obtained from each participant. Chi-square analyses with odds ratios were used to identify significant risk factors. Results: Chi-square analyses demonstrated that sex [x 2 ¼ 4.9, p ¼ .03, OR ¼ 3.4], on-field dizziness [x 2 ¼ 7.1, p ¼ .008, OR ¼ 3.9], post-traumatic migraine [x 2 ¼ 10.9, p ¼ .001, OR ¼ 15.9] and fogginess [x 2 ¼ 10.3, p ¼ .001, OR ¼ 6.2] were associated with the presence of at least one post-concussion VOMS cutoff score (.2/10 severity). On-field dizziness [x 2 ¼ 3.8, p ¼ .05, OR ¼ 2.5], post-traumatic migraine [x 2 ¼ 10.5, p ¼ .001, OR ¼ 4.9] and fogginess [x 2 ¼ 7.9, p ¼ .005, OR ¼ 3.7] were associated with the presence of a post-concussion near point convergence cutoff score (.5cm). Conclusion: Athletes with certain risk factors may be predisposed to develop vestibular and oculomotor symptoms post-concussion. Clinicians should consider these risk factors in the management of patients following concussion.

The Psychology of Sub-Culture in Sport and Physical Activity, 2014

Archives of Clinical Neuropsychology, 2021

Athletes with ADHD may experience longer and/or more complicated recoveries following SRC; howeve... more Athletes with ADHD may experience longer and/or more complicated recoveries following SRC; however, previous research has focused on neurocognitive outcomes. The objective of this study was to investigate the relationship between a history of ADHD among adolescent athletes and vestibular impairments following SRC. Participants included 166 athletes aged 15.9 +/− 1.5 who sustained an SRC, including 25 with a documented history of ADHD. Appropriate summary statistics were used to describe the data. ADHD and non-ADHD groups were compared using t-tests and Mann–Whitney U tests for continuous variables and Chi-square tests for categorical variables. A linear regression model analyzed the relationship between a history of ADHD and vestibular outcomes including horizontal and vertical vestibulo-ocular reflex (hVOR; vVOR), visual motion sensitivity (VMS), and Dizziness Handicap Index (DHI), while referral to vestibular therapy (VT) was analyzed using logistic regression. Athletes with ADHD ...

APA handbook of sport and exercise psychology, volume 1: Sport psychology (Vol. 1)., 2019

British Journal of Sports Medicine, 2021

ObjectivesTo (1) determine if wearing a cloth face mask significantly affected exercise performan... more ObjectivesTo (1) determine if wearing a cloth face mask significantly affected exercise performance and associated physiological responses, and (2) describe perceptual measures of effort and participants’ experiences while wearing a face mask during a maximal treadmill test.MethodsRandomised controlled trial of healthy adults aged 18–29 years. Participants completed two (with and without a cloth face mask) maximal cardiopulmonary exercise tests (CPETs) on a treadmill following the Bruce protocol. Blood pressure, heart rate, oxygen saturation, exertion and shortness of breath were measured. Descriptive data and physical activity history were collected pretrial; perceptions of wearing face masks and experiential data were gathered immediately following the masked trial.ResultsThe final sample included 31 adults (age=23.2±3.1 years; 14 women/17 men). Data indicated that wearing a cloth face mask led to a significant reduction in exercise time (−01:39±01:19 min/sec, p<0.001), maximal...

Brain Injury, 2021

ABSTRACT Primary objective – To discuss how the underlying neuroanatomy and neurobiology of five ... more ABSTRACT Primary objective – To discuss how the underlying neuroanatomy and neurobiology of five sport-related concussion (SRC) clinical profiles impacts assessment and treatment. Research design – Narrative review. Methods and procedures – Based on the current literature and clinical experience, arguments against the traditional SRC protocol and for a clinical profiles-based SRC protocol are made. Main outcomes and results – While the clinical profiles-based SRC protocol is widely used and accepted, there has been little published regarding the link to the underlying neuropathology. Our narrative review describes the five SRC clinical profiles: vestibular, ocular, mood, post-traumatic migraine, and cognitive/fatigue. For these profiles, the underlying neuroanatomy and neurobiology is outlined, as well as how that anatomy and biology impact the profiles’ etiology, assessment, and treatment. The cervical and sleep modifiers are also briefly covered. Conclusions – Utilizing this model, clinicians are able to provide an individualized assessment, conceptualization, and treatment plan for SRC, leading to improved outcomes and clinical experiences for athletes.

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 following sport-related concussion (SRC). Study Design-Cross-sectional study of patients seen 5.7 +/− 5.4 days (range, 0-30 days) postinjury. Setting-Specialty clinic Participants-Eighty-five athletes (50 males, 35 females) 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/ocular-motor screening (VOMS). Chi-square with odds ratios (OR) and diagnostic accuracy were used to examine the association between risk factors and VOMS outcomes. Main Outcome Measures-Vestibular and ocular-motor screening (VOMS) Results-Female sex [χ 2 = 4.9, p = .03], on-field dizziness [χ 2 = 7.1, p = .008], fogginess [χ 2 = 10.3, p = .001], and post-traumatic migraine (PTM) symptoms including headache [χ 2 = 16.7, p = .001], nausea [χ 2 = 10.9, p = .001], light sensitivity [χ 2 = 14.9, p = .001] and noise sensitivity [χ 2 = 8.7, p = .003] were associated with presence of one or more post-concussion VOMS score

Archives of Clinical Neuropsychology, 2016

Objective: Convergence insufficiency (CI) (i.e., abnormal near point of convergence [NPC]) follow... more Objective: Convergence insufficiency (CI) (i.e., abnormal near point of convergence [NPC]) following sport-related concussion (SRC) has been reported in 45% of athletes and linked to neurocognitive impairments (Pearce et al., 2015). This study expanded prior research to examine the relationship between CI and neurocognitive data at multiple time intervals during the recovery period following SRC. Method: Patients (n = 72 males, n = 34 females) 16.2 +/-1.9 years old diagnosed with SRC were assigned to normal near point of convergence (NPC) (n = 77; mean convergence ≤ 5 cm) and CI (n = 29; mean convergence > 5 cm) groups, and administered Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and Vestibular/Ocular-Motor Screening (VOMS) at first evaluation 5.06 +/-3.8 days post injury and at clearance for return to play 34.1 +/-32.7 days post injury. Results: Repeated measures ANOVAs were significant for a group (NPC/CI) x time (initial and clearance evaluation) interaction for verbal memory (p = .002, ƞ2 = .086), visual motor speed (p = .033, ƞ2 = .043), reaction time (p = .044, ƞ2 = .038) and symptoms (p = .034, ƞ2 = .042). There was no difference between groups (NPC/CI) for days until clearance (p = .90). Conclusion: Concussion assessment and management should include NPC assessment. Although CI in the acute stage post injury is associated with impairments on computerized neurocognitive testing, CI does not seem to affect recovery duration or performance on neurocognitive testing at clearance.

Sport, Exercise, and Performance Psychology, 2017

Conceptual models for assessing and treating sport-related concussion (SRC) have evolved from a h... more Conceptual models for assessing and treating sport-related concussion (SRC) have evolved from a homogenous approach to include different clinical profiles that reflect the heterogeneous nature of this injury and its effects. There are six identified clinical profiles, or subtypes from SRC, and one such clinical profile is the anxiety/mood profile. Athletes with this profile experience predominant emotional disturbance and anxiety following SRC. The purpose of this targeted review was to present an overview of the empirical evidence to support factors contributing to the anxiety/mood profile, along with methods of evaluation and treatment of this clinical profile following SRC. We discuss the potential underlying mechanisms and risk factors for this clinical profile, describe comprehensive assessments to evaluate concussed athletes with an anxiety/mood clinical profile, and explore behavioral and other interventions for treating these athletes. Although there is limited, but growing empirical evidence for the anxiety/mood clinical profile following SRC, understanding this clinical profile is germane for clinicians who are treating athletes with emotional sequelae after SRC.

Archives of Clinical Neuropsychology, 2015

Objective: Using diffusion tensor imaging (DTI), researchers have reported decreased in fractiona... more Objective: Using diffusion tensor imaging (DTI), researchers have reported decreased in fractional anisotropy (FA) in the brain immediately following sport-related concussion (SRC), whereas others have reported increased FA at later time points following SRC. The purpose of the current study was to compare DTI in relation to functional impairment at sub-acute and recovered time points following SRC. Method: Fourteen athletes (9 males, 5 females) aged 17.1 years +/2 3.1 with a diagnosed SRC participated in the study. Participants completed the Sideline Assessment of Concussion (SAC), Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), Post-concussion Symptom Scale (PCSS), Vestibular/Ocular Motor Screen (VOMS), Dizziness Handicap Inventory (DHI), Balance Error Scoring System (BESS), Functional Gait Assessment (FGA) and also underwent DTI between 1-14 days post injury (i.e., sub-acute; n¼ 9) or when medically cleared for full activity (i.e., recovered; n¼ 5). A p , .05 was used for t-tests and correlations. Results: FA in the left thalamus was lower in the sub-acute (.37 +/2.02) compared to the recovered (.40 +/-.03) group. Correlations were supported for decreased FA in the thalamus and increased DHI (2.60), convergence distance (-.60), and reaction time (-.54); and decreased visual memory (.54) and processing speed (.61). Positive correlations were supported for recovery time and FA in the cerebellum (.98) and hippocampus (.95). Conclusion: Decreased FA in the thalamus was associated with functional impairment and symptoms. Reported decreases in FA for the subacute compared to the recovered group as well as the associations between recovery time and FA suggest that DTI may be dependent on time since injury.

Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists, Jan 15, 2016

Computerized neurocognitive tests are frequently used to assess pediatric sport-related concussio... more Computerized neurocognitive tests are frequently used to assess pediatric sport-related concussions; however, only 1 study has focused on the test-retest reliability of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in high school athletes and age influences have largely been ignored. Therefore, the purpose was to investigate the test-retest reliability of ImPACT and underlying age influences in a pediatric population. Two hundred (169 men and 31 women) youth ice hockey players completed ImPACT before/after a 6-month season. Reliability was assessed using Pearson correlation coefficients, intraclass correlation coefficients (ICCs), and regression-based methods (RBz). ICCs for the sample ranged from .48 to .75 (single)/.65 to .86 (average). In general, the older athletes (15-18: Single/Average ICCs = .35-.75/.52-.86) demonstrated greater reliability across composites than the younger athletes (11-14: Single/Average ICCs = .54-.63/.70-.77). Although there was ...

Applied neuropsychology. Child, Jan 15, 2016

With youth sports participation and concern about sports-related concussions both on the rise, it... more With youth sports participation and concern about sports-related concussions both on the rise, it is important to properly measure cognitive function to ensure the clinical utility of baseline testing. Computerized testing batteries are often employed as baseline and postinjury measures of cognitive function, with the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) being the most used of all the current testing platforms. The current study compared 10- to 12-year-old children across the composite scores yielded by the ImPACT and provided normative data on each of the subtests used to calculate the composite scores. Normative data are separated by gender for athletes aged 10 to 12 years old, as this is the current age bracket used by the ImPACT. These norms may be helpful in the interpretation of the ImPACT clinical report and further delineation of areas of neurocognitive dysfunction.

Neurosurgery, 2014

The clinical management of sports-related concussions is a specialized area of interest with a la... more The clinical management of sports-related concussions is a specialized area of interest with a lack of empirical findings regarding best practice approaches. The University of Pittsburgh Medical Center Sports Concussion Program was the first of its kind; 13 years after its inception, it remains a leader in the clinical management and research of sportsrelated concussions. This article outlines the essential components of a successful clinical service for the management of sports-related concussions, using the University of Pittsburgh Medical Center Sports Concussion Program as a case example. Drawing on both empirical evidence and anecdotal conclusions from this high-volume clinical practice, this article provides a detailed account of the inner workings of a multidisciplinary concussion clinic with a comprehensive approach to the management of sportsrelated concussions. A detailed description of the evaluation process and an in-depth analysis of targeted clinical pathways and subtypes of sports-related concussions effectively set the stage for a comprehensive understanding of the assessment, treatment, and rehabilitation model used in Pittsburgh today.

Knee Surgery, Sports Traumatology, Arthroscopy, 2013

Purpose The purpose of this paper is to discuss risk and prognostic factors for concussion outcom... more Purpose The purpose of this paper is to discuss risk and prognostic factors for concussion outcomes, review comprehensive approaches to assessment, and describe a new method for conceptualizing treatment for sport-related concussion using clinical experience. Methods Based on the current literature of sport-related concussion and clinical experience, an approach for conceptualizing concussion care using clinical trajectories and targeted treatments was developed. Results A comprehensive approach to assessment and targeted treatments for sport-related concussion was developed using specific clinical trajectories. Conclusion Sport-related concussions are heterogeneous and require an individualized clinical approach. The use of a comprehensive approach for assessing specific clinical trajectories following a sport-related concussion will help clinicians better conceptualize this injury. Clinicians can then match targeted treatment pathways to specific clinical trajectories to accelerate safe return to play for athletes following a sport-related concussion. Level of evidence V.

Neuropsychology, Jan 20, 2015

The imagination inflation effect is a type of memory distortion defined as an increased tendency ... more The imagination inflation effect is a type of memory distortion defined as an increased tendency to falsely remember that an item has been seen, or an action has been performed, when it has only been imagined. For patients with very mild Alzheimer's disease (AD), susceptibility to the imagination inflation effect could have significant functional consequences in daily life. We assessed whether patients with very mild AD were more or less susceptible to the imagination inflation effect when compared with healthy older adults. In the first session, participants were read an action statement such as "fill the pillbox" and engaged in 1 of 3 activities: listened to the statement being read, performed the action, or imagined performing the action. During the second session, participants imagined action statements from the first session, as well as new action statements. During the recognition test, participants were asked to determine whether action statements were or were n...