Does an Individual's Fitness Level Affect Baseline Concussion Symptoms? (original) (raw)
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The psychometric properties of concussion assessment tools in high school athletics
2006
Sports-related concussion assessment has not examined an individual's effort level during baseline testing. This research examined the level of effort in an athletic population and determined if sub-optimal effort effects neuropsychological test scores. Design: 199 high school athletes, mean age (15.54+ 1.17 years) were administered a brief neuropsychological test battery including the Dot Counting Test (DCT) and the Rey 15-item test with recognition trial. Measurement: One-way analyses of variance were calculated for each outcome measure to examine differences between effort groups. Results: 177 athletes exerted optimal effort while 22 exerted sub-optimal effort. Significant differences existed between effort groups on several of the neuropsychological tests. Conclusions: Sub-optimal effort does exist in the athletic population during baseline testing with statistically significant differences between groups on neuropsychological test scores. Adding an objective effort test is necessary to improve interpretations of scores within concussion assessment.
Archives of Clinical Neuropsychology, 2009
Objective: Self-report post-concussion symptom scales have been used for many years as a key method of monitoring recovery from sport-related concussion, to assist in medical management and return-to-play decisionmaking. To date, however, item selection and scaling metrics for these instruments have been based solely upon clinical judgment, and no one scale has been identified as the "gold standard". The goal of this project was to use a statistical approach to explore item selection and scaling from a large dataset of existing scales, in order to empirically-derive the most efficient and appropriate scale possible for this application. Setting: Data were collected as part of three separate studies of sport-related concussion, involving 129 high schools and 29 colleges.
Use of Graded Exercise Testing in Concussion and Return-to-Activity Management
Current Sports Medicine Reports, 2013
Concussion is a physiologic brain injury that produces systemic and cognitive symptoms. The metabolic and physiologic changes of concussion result in altered autonomic function and control of cerebral blood flow. Evaluation and treatment approaches based upon the physiology of concussion may therefore add a new dimension to concussion care. In this article, we discuss the use of a standard treadmill test, the Buffalo Concussion Treadmill Test (BCTT), in acute concussion and in postconcussion syndrome (PCS). The BCTT has been shown to diagnose physiologic dysfunction in concussion safely and reliably, differentiate it from other diagnoses (e.g., cervical injury), and quantify the clinical severity and exercise capacity of concussed patients. It is used in PCS to establish a safe aerobic exercise treatment program to help speed recovery and return to activity. The use of a provocative exercise test is consistent with world expert consensus opinion on establishing physiologic recovery from concussion.
Return to play following a sports concussion: The “added value” of post-exertion assessment
Neurology
Decision of return to play (RTP) after a concussion is critical given the potential consequences of premature RTP. Athletes should not be cleared for full contact activity until they demonstrate normal cognitive functioning on both rest and post-exertion assessments. Accordingly, this study aimed to examine post-exertion cognitive performance in asymptomatic collegiate athletes who were cleared to return-to-play. Twenty-two recently concussed athletes who completed step 4 of Zurich's RTP protocol and 39 teammate controls participated in the study. They completed a Switch task before and after an acute bout of moderate cardiovascular exercise (80%–85% maximal predicted maximal heart rate for 20-minute) on an ergocycle. Based on their performance on both conditions (Rest, Post-exertion), concussed athletes were categorized into the Pass or Fail group. Specifically, they were placed in the Fail group if their performance was 2 SD lower than the control group's average score. A ...
Neurology
ObjectiveThe object of this presentation is to supply the athletic trainer with data concerning a methodology that can be used to aid in designing a cardio conditioning regimen postconcussion as well as an exercise or lifting program postconcussion. This objective measure does not rely on subjective patient reports of symptoms and utilizes a reflex based assessment method.BackgroundSports concussion is a substantial concern for athletic trainers and there is a critical need to objectively and safely allow an athlete to return to play as soon as safely possible. Being able to make cogent recommendations as opposed to empirically trying something that has an intrinsic risk of eliciting symptoms or causing setbacks is urgently needed.Design/MethodsWe present data concerning 65 athletes (mean age 20.8 years) who were assessed. This was done while on an exercise bike going through a progression of exertion levels. The TERC Murmur was listened for every 2 minutes at the traditional caroti...
Frontiers in Neurology
Sport-related concussion is an important condition that can affect collegiate and professional athletes. Expert consensus guidelines currently suggest that all athletes who sustain acute concussion be managed with a conservative approach consisting of relative rest and gradual resumption of school and sport activities with active intervention reserved for those with persistent post-concussion symptoms lasting >10-14 days for adults. Unfortunately, these recommendations place little emphasis on the rapid physical deconditioning that occurs in athletes within days of exercise cessation or the pathophysiological processes responsible for acute concussion symptoms that can be successfully targeted by evidence-based rehabilitation strategies. Based on our evolving approach to patients with persistent post-concussion symptoms, we now present an updated physiological approach to the initial medical assessment, rehabilitation, and multidisciplinary management of collegiate and professional athletes with acute concussion. Utilizing the results of a careful clinical history, comprehensive physical examination and graded aerobic exercise testing, we outline how team physicians, and athletic training staff can partner with multidisciplinary experts in traumatic brain injury to develop individually tailored rehabilitation programs that target the main physiological causes of acute concussion symptoms (autonomic nervous system dysfunction/exercise intolerance, vestibulo-ocular dysfunction, and cervical spine dysfunction) while maintaining the athlete's physical fitness during the recovery period. Considerations for multidisciplinary medical clearance of collegiate and professional athletes as well as the application of this approach to non-elite athletes are also discussed.
Review of Assessment Scales for Diagnosing and Monitoring Sports-related Concussion
Cureus
Sports-related concussion has emerged as a public health crisis due to increased diagnosis of the condition and increased participation in organized and recreational athletics worldwide. Under-recognition of concussions can lead to premature clearance for athletic participation, leaving athletes vulnerable to repeat injury and subsequent short-and long-term complications. There is overwhelming evidence that assessment and management of sportsrelated concussions should involve a multifaceted approach. A number of assessment criteria have been developed for this purpose. It is important to understand the available and emerging diagnostic testing modalities for sports-related concussions. The most commonly used tools for evaluating individuals with concussion are the Post-Concussion Symptom Scale (PCSS), Standard Assessment of Concussion (SAC), Standard Concussion Assessment Tool (SCAT3), and the most recognized computerized neurocognitive test, the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). The strengths and limitations of each of these tools, and the Concussion Resolution Index (CRI), CogSport, and King-Devick tests were evaluated. Based on the data, it appears that the most sensitive and specific of these is the ImPACT test. Additionally, the King-Devick test is an effective adjunct due to its ability to test eye movements and brainstem function.
Neurology, 2018
ContextResearch on exercise for concussion rehabilitation is gaining considerable attention. However, unless adequately prescribed, exercise can induce/exacerbate symptoms and impede neurologic recovery. Therefore, the primary purpose of this investigation was to determine the metabolic rate and aerobic capacity at symptomatic threshold in concussed individuals.MethodsThirty-seven concussed individuals (men = 14, women = 23; 22.97 years, ±5.13) completed a graded exercise test on a stationary bike using a modified Balke protocol. Symptoms (SCAT-4) and physical exertion (Borg Scale) were periodically monitored throughout testing, which ceased at the induction/exacerbation of symptoms. Aerobic capacity was assessed using an estimated VO2max calculation (ACSM, 2015). Descriptive and correlation statistics were computed with an apriori alpha level of 0.05.ResultsWe observed that symptoms were induced/exacerbated at a mean power output of 95.24W (±34.30), which corresponded to a mean est...