Suchergebnisse

BACKGROUND: Concussion is the most common type of TBI, yet reliable objective measures related to these injuries and associated recovery processes remain elusive, especially in military personnel. The purpose of this study was to characterize the relationship between cytokines and recovery from acute brain injury in active duty service members. Inflammatory cytokines (IL-6, IL-10, and TNFα) were measured acutely in blood samples within 8 h following a medically diagnosed concussion and then 24 h later. METHODS: Participants (n = 94) were categorized into two groups: 1) military personnel who sustained provider-diagnosed concussion, without other major medical diagnosis (n = 45) and 2) healthy control participants in the same deployment environment who did not sustain concussion or other illness or injuries (n = 49). IL-6, IL-10, and TNFα concentrations were measured using an ultrasensitive single-molecule enzyme-linked immunosorbent assay. Differences in cytokine levels between concussed and healthy groups were evaluated at two time points (time point 1 ≤ 8 h after injury; time point 2 = 24 h following time point 1). RESULTS: At time point 1, IL-6 median (IQR) concentrations were 2.62 (3.62) in the concussed group, which was greater compared to IL-6 in the healthy control group (1.03 (0.90); U = 420.00, z = − 5.12, p 0.05). At time point 2, no differences were detected between concussed and healthy controls for IL-6, IL-10, or TNFα (p's > 0.05). The median difference between time points 1 and 2 were compared between the concussed and healthy control groups for IL-6, IL-10, and TNFα. Change in IL-6 across time was greater for the concussed group than healthy control (− 1.54 (3.12); U = 315.00, z = − 5.96, p 0.05). CONCLUSION: Reported here is a significant elevation of IL-6 levels in ...

Discussions surrounding concussion have made their way into the public sphere over the previous decade with media attention and coverage of the injury fueling public debate. These conversations have devolved into discussions on banning contact and collision sports and raised legal questions surrounding injury management. Questions raised about concussion eclipse what science can answer, but the University of Michigan Injury Center (MI, USA) hosted a Concussion Summit in September 2015 as a means to condense, solidify and disseminate what is currently known on the topic. Areas for discussion included concussion incidence and prevention, diagnosis and management, legislation and education, legal and social aspects and future directions. A summary of those presentations are included within.

Context: Concussions have been declared an epidemic in sport participation by the Centers for Disease Control. While concussions cannot be prevented, researchers and clinicians believe concussion education is the cornerstone for early recognition and management. Concussion education has been mandated by state legislation and governing athletic bodies as a part of concussion management strategies at both secondary and post-secondary levels. However, neither of these entities have specified how concussion education should be delivered to the student athlete population. Purpose: Evaluate the effectiveness of a multimodal approach to concussion education on knowledge and retention in collegiate athletes. Methods: A multimodal concussion education that included a PowerPoint lecture, video, and discussion was conducted by the head athletic trainer during pre-season team meetings. The ROCKI survey was administered to examine concussion knowledge during three time points, pre-intervention, immediate post-intervention and three months later. Repeated Measures Analyses of Variance (ANOVA) was used to compare the knowledge scores over time (pre-, post-, retention). Semi-structured interviews examined (1) attitudes towards the intervention and (2) perceived increase in knowledge of the athletes during the intervention using content analysis. Credibility and trustworthiness were established through member checks and using the Certified Athletic Trainer as an auditor. Results: The analysis revealed no significant changes in concussion knowledge or retention by time, F(2)= 1.95, p= 0.147, n2= 0.034. Thirteen teams were examined and yielded a total of 57 participants. Ten interviews were conducted (six freshmen, four returners) and four main themes emerged: (1) no perception of formal education in high school, (2) intervention enabled respondents to recall symptoms, (3) perceived increase in knowledge, and (4) multimodal approach was perceived as successful. Conclusion: A multimodal concussion education intervention did not significantly increase student-athlete knowledge, however qualitative analysis revealed student-athletes liked the multimodal approach and all respondents had a perceived increase in concussion knowledge after the intervention. Further studies should examine the use of a multimodal approach with active learning strategies to increase student-athlete knowledge on concussions.

Objective: Approximately 1.6 to 3.8 million sports-related concussions occur each year in the United States, and there was a four-fold increase in the number of sports-related concussions in high school athletes from 2000 to 2011.This study assessed the knowledge of coaches from rural (population 10,000) counties in Montana with regard to sports-related concussion management and return-to-play guidelines. It was hypothesized that there would be a higher amount of deficits in sports-related concussion management practices for youth sports in rural counties. Participants and Methods: Individuals involved in overseeing youth sports (including coaches, assistant coaches, and athletic directors) were surveyed regarding sports-related concussion management and return-to-play guidelines. Of these participants, 48.1% were from rural counties and 51.9% were from non-rural counties. These data were collected prior to the first sports season in which the Dylan Steigers Protection of Youth Athletes Act became effective in Montana. Results: Differences were apparent between rural and non-rural counties in all aspects of concussion management addressed in this survey. Significantly more respondents from non-rural counties indicated that their organizations have individuals trained in the evaluation and management of concussions. Additionally, significantly more respondents from non-rural counties reported that they have an individual specialized in recognition and treatment of concussions present during sporting events. Conclusions: These findings highlight a significant discrepancy between concussion management practices in rural and non-rural counties in Montana. Montana was one of the last states in the nation to implement a law regarding concussion management in youth sports, and it is imperative that all counties within our state receive the education and resources necessary to protect youth athletes from the devastating consequences of poor concussion management. With these baseline findings, the overall effectiveness of concussion legislation to protect youth athletes in Montana can be monitored.

Michelle L Gutierrez,1 Jennifer B Christy,2 Susan L Whitney3 1Doctor of Physical Therapy Program, The University of Texas at El Paso, El Paso, TX, USA; 2Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA; 3Departments of Physical Therapy and Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA Purpose: The objective of this study was to develop and establish content validity of a new instrument titled the Military Concussion Readiness Inventory for Dizziness and Balance (MCRI-DB). The MCRI-DB was intended to recognize functional impairments and predict readiness for return-to-duty in service members who experienced mild traumatic brain injury (mTBI). Methods: Nineteen male service members were included in a nominal group technique (NGT) process to produce items for the MCRI-DB. Items were categorized according to the International Classification of Functioning, Disability and Health (ICF) and were sent to 13 physical therapy experts through a Delphi survey to determine content validity. The consensus to include an item was defined as an agreement of at least 70% of the participants. Results: The NGT produced 222 items with 108 duplicates removed. The ICF categorization linked 84 of the items to 36 unique ICF Codes, 9 items were not linkable to the ICF due to the complex nature of the activity, and 21 items were removed. After three rounds of the Delphi survey, 68 items were included in this instrument. Conclusion: In this study, we successfully combined the use of service members' experiences with expert opinion to determine content validity of the MCRI-DB. This instrument may be used for assessment of service members who have experienced mTBI to help identify environmental factors, functional activities, and body functions that may reduce the safe and efficient fulfillment of their duties and determine their ability to return-to-duty. Further research is needed to develop the psychometric properties of the instrument fully. Keywords: blast injury, questionnaire, return-to-duty, service member

CONTEXT: Approximately half of individuals who sustain a concussion do not immediately report their injuries. Motivators for not reporting include thinking the suspected concussion was not a serious injury and wanting to continue participating in activity. Additionally, military personnel have concerns about how concussions may affect their careers. However, delayed reporting can prolong neurobehavioral recovery. Understanding the frequency of delayed reporting and contributing factors will aid in identifying individuals who may be more likely to delay reporting. OBJECTIVE: To describe the frequency of delayed concussion reporting by service academy cadets and determine if sex, injury setting, sport level, or medical history is capable of predicting delayed reporting. DESIGN: Cohort study. SETTING: Service academies. PATIENTS OR OTHER PARTICIPANTS: A total of 316 patients with concussions were observed from January 2014 to August 2016. MAIN OUTCOME MEASURE(S): All cadets completed an annual concussion baseline collection of demographic, medical history, and sports participation information. Delayed concussion reporting served as the outcome variable. Predictor variables were sex, injury setting, and sport level, as well as concussion, headache, and learning disorder history. Frequencies were calculated to describe the proportion of participants who delayed reporting. Univariable and multivariable logistic regression models were used to assess if the predictor variables were associated with delayed concussion reporting. Odds ratios (ORs) and 95% confidence intervals were calculated for all variables included in the final model. RESULTS: Of the patients with concussion, 51% were classified as delayed reporting. In univariable models, females (OR = 1.70) and National Collegiate Athletic Association cadet-athletes (OR = 1.98) were more likely to delay reporting than males and intramural cadet-athletes, respectively. The multivariable model yielded similar findings. CONCLUSIONS: Roughly half of the cadets who ...

Using a cross-sectional survey concussion knowledge was evaluated among forty university-level athletes (n = 20, rugby union players; n = 20, Gaelic football players) and eight experienced team coaches (n = 2, rugby union; n = 2, Gaelic football; n = 1, soccer; n = 1, hockey; n = 1, netball; n = 1, basketball). Levels of knowledge of concussion were high across all participants. Coaches had higher knowledge scores for almost all areas; however, there was evidence of important gaps even in this group. Knowledge was not sufficient in identifying concussion, and when it is safe to return to play following a concussion. Impaired knowledge of how to recognise a concussion, and misunderstanding the need for rest and rehabilitation before return to play presents a hazard to health from second impact and more catastrophic brain injury. We discuss reasons for these guideline misconceptions, and suggest that attitude issues on the significance of concussion may underlie a willingness to want to play with a concussion. This suggests the current education on sport-related concussion needs to be expanded for the appropriate management of university-level contact sports.

This study reveals how athletic health care teams, embedded within large bureaucratic organizations and complex social systems, negotiate and sustain multiple divergent structures. An iterative analysis of 69 in-depth interviews with National Collegiate Athletic Association (NCAA) Division I athletes' certified athletic trainers (ATCs) and coaches from four high-contact sports (i.e., women's lacrosse, men's wrestling, men's soccer, and men's football) revealed that team members coconstructed and negotiated multiple conflicting structures during concussion events. The divergent macro-, meso-, and micro-level structures include (a) formal versus hidden authority structures, (b) prevention versus inevitability discourse, (c) assigned versus enacted roles, and (d) authentic versus inauthentic injury performance. The analysis also revealed how a specific speech act, termed agentic denial, enabled members to obscure their agency within concussion events. Theoretical implications and practical recommendations are discussed.

IMPORTANCE: Concussions are a common occurrence in young athletes. Hypobaric hypoxemia, such as that experienced during airplane travel, can potentially cause alterations to cerebral blood flow and increased neuroinflammatory response. It remains unknown whether flying early after a concussion may influence the clinical course of injury. OBJECTIVE: To determine whether there is an association between concussion recovery and airplane travel in collegiate athletes and military cadets. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted by the National Collegiate Athletic Association and US Department of Defense Concussion Assessment, Research, and Education Consortium from August 3, 2014, to September 13, 2018. Participant groups were categorized by those who flew within 72 hours of injury and those who did not fly. All participants included in the final analyses had complete data of interest and only 1 injury during the study. Data analysis was performed from September 2018 to March 2020. MAIN OUTCOMES AND MEASURES: Recovery outcome measures were defined as time (in days) from injury to return to activity, school, and baseline symptoms. Symptom and headache severity scores were derived from the Sports Concussion Assessment Tool—Third Edition. Scores for both groups were taken at baseline and a median of 2 days after injury. RESULTS: A total of 92 participants who flew (mean [SD] age, 19.1 [1.2] years; 55 male [59.8%]) and 1383 participants who did not fly (mean [SD] age, 18.9 [1.3] years; 809 male [58.5%]) were included in the analysis of symptom recovery outcomes (analysis 1). Similarly, 100 participants who flew (mean [SD] age, 19.2 [1.2] years; 63 male [63.0%]) and 1577 participants who did not fly (mean [SD] age, 18.9 [1.3] years; 916 male [58.1%]) were included in the analysis of symptom severity outcomes (analysis 2). No significant group differences were found regarding recovery outcome measures. Likewise, there were no group differences in symptom (estimated mean difference, 0.029; 95% CI, ...

Background. Concussion is a significant health issue in rugby union. However, little is known about players' levels of concussion knowledgeor return-to-play (RTP) attitudes.Objectives. To determine the concussion knowledge and concussion-related RTP attitudes of subelite rugby union players in South Africa.Methods. Subelite rugby union players (n=127; mean age 24.1 years) completed a measure of concussion knowledge and a concussionrelatedRTP attitude scale. Frequencies were calculated with regard to concussion knowledge and RTP attitudes for the total sample, aswell as separately for previously concussed and non-concussed participants. Pearson's χ2 tests and t-tests for independent groups wereemployed to determine significant differences in concussion knowledge and RTP attitudes between previously concussed and nonconcussedparticipants.Results. Participants displayed varying, yet generally less than optimal levels of concussion knowledge. Knowledge of concussion-relatedRTP protocols (20 - 23%) and the efficacy of safety equipment (20 - 25%) was particularly poor. The subelite rugby players included in thesample did not hold notably conservative RTP attitudes, with the majority expressing a willingness to participate in practice (74%) andcompetition (47 - 56%) without having fully recovered from a concussion. No significant differences were apparent with regard to the RTPattitudes and concussion knowledge of the previously concussed and non-concussed players.Conclusion. The general level of concussion knowledge among subelite rugby union players appears less than optimal. Moreover, themajority of these players expressed an intention to RTP before they had fully recovered from concussion.

CONTEXT: : Currently, significant attention is focused on improving care for patients with concussions through legislative mandates that include educational interventions. Few researchers have examined young athletes' concussion knowledge and the factors that may influence their knowledge. OBJECTIVE: : To use the socioecological model to examine demographic, parental, and personal factors associated with youth athletes' knowledge of concussion. Our ultimate goal is to inform the planning and implementation of youth sport concussion-related interventions. DESIGN: : Cross-sectional survey. SETTING: : Gymnasium and classroom. PATIENTS OR OTHER PARTICIPANTS: : North Carolina and Arizona youth athletes (n = 225; age = 8 to 15 years) active in football, boys' or girls' soccer, boys' or girls' ice hockey, or boys' or girls' lacrosse in 2012–2013. MAIN OUTCOME MEASURE(S): : Participants completed a validated, self-administered survey. The intention and belief measures were guided by the theory of planned behavior. Perceptions of concussion and intention to seek care were examined using descriptive statistics. Athletes' concussion knowledge was modeled using linear regressions and generalized estimating equations, with child demographic and personal factors and parental knowledge and attitudes about concussion as predictors. RESULTS: : Geography, sport, parental attitudes toward concussion, and athlete age were associated with athlete knowledge in the univariable analyses (P 12 years, MD = 1.6; 95% CI = 0.5, 2.6) were associated with better knowledge about concussion. CONCLUSIONS: : Geographic location, sport, parental attitudes about concussion, and ...