PEERS® Curriculum for Children with Autism Spectrum Disorder: A Scoping Review.

AIMS: The Program for the Education and Enrichment of Relational Skills (PEERS®), designed to enhance social skills and relationships for individuals with autism spectrum disorder (ASD) and their caregivers, has primarily been implemented with older children and adolescents ages 11-19, leaving a gap in research on its effectiveness in young children. This scoping review assesses evidence of the effectiveness of the PEERS® program for children with ASD. METHODS: A literature search was conducted, resulting in 97 articles. Following the implementation of inclusion and exclusion criteria, four articles of Level III and IV evidence based on CEBM guidelines were included in this review. RESULTS: All studies demonstrated positive findings regarding social skills development with one study revealing statistically significant results in increasing social skills and decreasing problem behaviors after participation in the PEERS® program. CONCLUSIONS: This scoping review found improvements in the PEERS® programs for social skills in young children (ages 4-7) with ASD. However, further research is warranted, emphasizing larger sample sizes, consideration of external factors, and implementation of randomization and blinding in future studies.

Non-Time-Loss and Time-Loss Injuries in Secondary School Girls' Volleyball Athletes: A Report From the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program.

CONTEXT: Volleyball is a popular sport with a risk of injury to the entire body. Insight into non-time-loss (NTL) and time-loss (TL) injuries is needed to inform seasonal injury trends that may lead to appropriate prevention and management strategies. This study provides a descriptive analysis of volleyball injuries among secondary school athletes. STUDY DESIGN: Descriptive epidemiology study. METHODS: Data were collected from 72 secondary schools, representing 135 team seasons of data from the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program (2014-2015 to 2018-2019 academic years). Injury counts, injury rates (IR) per 1000 athlete exposures (AEs), and incidence rate ratios (IRR) were reported with 95% confidence intervals (CIs). RESULTS: In total, 529 injuries over 193,858 AEs for girls' volleyball were captured, producing an IR of 2.73/1000AEs (95% CI = 2.50-2.96). The overall IR was highest during the preseason compared with regular season (IRR = 1.31, 95% CI = 1.09-1.59). Overall IRs were higher in competition (IR: 3.56, 95% CI = 3.07-4.05) compared with practice (IR: 2.38, 95% CI = 2.12-2.64; IRR = 1.49, 95% CI = 1.25-1.79). Common body locations injured were ankle (n = 141, 26.7%; NTL: n = 56, 21.7%; TL: n = 85, 31.7%), knee (n = 61, 11.5%; NTL: n = 33, 12.8%, TL: n = 28, 10.5%), hand/wrist (n = 59, 11.2%; NTL: n = 32, 12.4%, TL: n = 27, 10.1%), and head/face (n = 62, 11.7%; NTL: n = 14, 5.4%; TL: n = 47, 17.5%). CONCLUSIONS: Volleyball IRs were highest in preseason and during competition. Most injuries affected the lower-extremity which is notable considering the high upper-extremity load in volleyball. Consideration of strategies to reduce injuries prior to the start of the formal sports season may be needed to help reduce the incidence of preseason injuries.

Evaluating Multiple Domains of Health in High School Athletes With Sport-Related Concussion.

CONTEXT: Concussions are shown to hinder multiple health dimensions, including health-related quality of life (HRQOL), suggesting a need for a whole-person approach to assessment and treatment. Patient-reported outcome measures are one method to gather the patient's perspective regarding their HRQOL. OBJECTIVE: To evaluate perceived HRQOL using the Patient-Reported Outcomes Measurement Information System Pediatric-25 subscale in patients throughout concussion recovery. DESIGN: Prospective cohort, descriptive survey. SETTING: There were 9 high school athletic training facilities. PARTICIPANTS: A total of 70 patients with diagnosed concussions (51 males, 7 females, 12 unreported; age = 15.7 [0.9] y, height = 174.6 [8.4] cm, mass = 72.8 [14.8] kg, grade = 10.0 [0.9] level). INTERVENTIONS: Patient-Reported Outcomes Measurement Information System Pediatric-25 was administered at 3 days, 10 days postconcussion, and return to play (RTP). MAIN OUTCOME MEASURES: Patient-Reported Outcomes Measurement Information System Pediatric-25 subscale T scores and self-reported concussion history (yes/no). RESULTS: A total of 70 patients completed the study. For the Pediatric-25 subscales, the severity of problems associated with Physical Function Mobility, Anxiety, Depression, Fatigue, and Pain Interference were highest 3 days postconcussion, decreasing at 10 days and RTP (all p < .05). No differences were found between days 3 and 10 for Peer Relationship scores, but improvements were identified at RTP (p < .05). Pediatric-25 subscale scores at the 3 measurements were not statistically associated with concussion history (all p > .05). Ceiling and floor effects were present in all subscales throughout each timepoint, except for Physical Function Mobility (14.7%), and pain interference (11.8%) at day 3 postinjury. CONCLUSIONS: Patients who had suffered a concussion improved from day 3 through RTP on multiple health domains as demonstrated through the Pediatric-25 subscales. These findings highlight the need for health care professionals to serially monitor HRQOL and social factors that may affect the patient postconcussion as part of a multifactorial assessment. Ceiling effects in high functioning adolescent athletes were present; thus, efforts should be made to identify appropriate scales for use in managing recovery in athletic populations.

Test-Retest Reliability and Practice Effects of the Stability Evaluation Test.

CONTEXT: Postural control plays an essential role in concussion evaluation. The Stability Evaluation Test (SET) aims to objectively analyze postural control by measuring sway velocity on the NeuroCom VSR portable force platform (Natus, San Carlos, CA). OBJECTIVE: To assess the test-retest reliability and practice effects of the SET protocol. DESIGN: Cohort. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: 50 healthy adults (20 men, 30 women, age 25.30 ± 3.60 y, height 166.60± 12.80 cm, mass 68.80 ± 13.90 kg). INTERVENTIONS: All participants completed 4 trials of the SET. Each trial consisted of six 20-s balance tests with eyes closed, under the following conditions: double-leg firm (DFi), single-leg firm (SFi), tandem firm (TFi), double-leg foam (DFo), single-leg foam (SFo), and tandem foam (TFo). Each trial was separated by a 5-min seated rest period. MAIN OUTCOME MEASURES: The dependent variable was sway velocity (deg/s), with lower values indicating better balance. Sway velocity was recorded for each of the 6 conditions as well as a composite score for each trial. Test-retest reliability was analyzed across 4 trials with intraclass correlation coefficients (ICCs). Practice effects analyzed with repeated measures analysis of variance, followed by Tukey post hoc comparisons for any significant main effects (P < .05). RESULTS: Sway-velocity reliability values were good to excellent: DFi (ICC = .88; 95%CI: .81, .92), SFi (ICC = .75; 95%CI: .61, .85), TFi (ICC = .84; 95%CI: .75, .90), DFo (ICC = .83; 95%CI: .74, .90), SFo (ICC = .82; 95%CI: .72, .89), TFo (ICC = .81; 95%CI: .69, .88), and composite score (ICC = .93; 95%CI: .88, .95). Significant practice effects (P < .05) were noted on the SFi, DFo, SFo, TFo conditions and composite scores. CONCLUSIONS: Our results suggest the SET has good to excellent reliability for the assessment of postural control in healthy adults. Due to the practice effects noted, a familiarization session is recommended (ie, all 6 conditions) before data are recorded. Future studies should evaluate injured patients to determine meaningful change scores during various injuries.

The Adolescent Patient Perspective on Activity Limitations Following Sport-Related Concussion.

CONTEXT: Assessment of sport-related concussion (SRC) has begun to include patient- reported outcome measures (PROMs). However, there is a limited understanding of which health limitations are most meaningful to adolescents following SRC. OBJECTIVE: To explore patient-perceived activity limitations following SRC and throughout recovery to return-to-play (RTP) and mapped according to the International Classification of Functioning, Disability, and Health (ICF) model. DESIGN: Longitudinal. SETTING: Secondary school athletic training facilities. PATIENTS OR OTHER PARTICIPANTS: Fifty patients (41 males, 5 females, 4 sex not reported, age=14.9±3.5 years, grade=10.2±0.93 level) with a medically diagnosed SRC. INTERVENTIONS: The Patient Specific Functional Scale (PSFS) was used to assess changes in the patient's condition and the impact the injury posed on their ability to perform activities. The PSFS is a self-reported assessment of health used to identify activity limitations and rate the difficulty of performing those tasks. The PSFS was administered to patients on days 3 (D3) and 10 (D10) following SRC and at RTP. MAIN OUTCOME MEASURES: Activities impacted by injury were coded into common categories and themes by a three-person research team for subsequent analysis. The coded themes were also mapped to the ICF domains, chapters, and categories. The dependent variables were the PSFS themes, number of activities endorsed, PSFS scores, ICF domains, chapters, and categories. Descriptive analyses and frequencies were reported for the dependent variables. RESULTS: A total of 157 different activities were identified at D3 and coded into 28 categories that fit into six themes: activities of daily living (ADLs), cognitive and school (COG), sports and physical activity (SPA), screen time (SCR), sleep (SLP) and social (SOC). On D3, all patients (50/50) identified at least one activity limitation. The majority related to SPA (37.6%) and COG (31.2%). Sixty percent of patients endorsed activity limitations at D10, primarily in COG (38.6%) and SPA (36.6%). All (100%) response categories were mapped to the ICF, with most (75%) fitting the activities and participation (AP) domain. CONCLUSION: Our primary findings suggest that sport-related concussion influences many facets of the lives of adolescent athletes. Specifically, adolescent athletes identified activity restrictions primarily related to physical activity and sports participation.

Impact of Teaching Social Determinants of Health on PIF in the Health Professions.

OBJECTIVE: To address the lack of methods for assessing learning on social determinants of health, particularly from a health systems perspective. Using a conceptual framework of professional identity formation applied across 3 professions (athletic training, occupational therapy, and pharmacy), the study aimed to describe students' level of professional identity when applying knowledge of structural factors' impact on health. METHODS: This study was a deductive content analysis of students' written reflections. Identified themes explored how students explained sociopolitical influences on health as well as their assessed level of professional identity. RESULTS: Students were inclined to author narratives focused on the ways in which structural factors influence individual outcomes and aspects within the health care system. Most students were assessed to be at the initial levels of professional identity formation, but those with a comparatively higher level of professional identity expressed a commitment to professional behaviors that address social determinants of health. CONCLUSION: This analysis created a foundation for future pedagogical work in health care system-related structural learning outcomes within and between different health professions. Findings suggest that across professions, most first-year students demonstrated the ability to reconcile different perspectives and were in the early stages of aligning personal values with professional values. The use of reflection has the potential to assess professional identity formation among a range of health professional students.

Athletic Administrators' Reporting of Emergency Preparedness Regarding Policies and Procedures in Iowa Secondary Schools.

CONTEXT: Secondary schools that offer school-sponsored athletic events should follow best-practice guidelines to provide policies that promote student health and safety. OBJECTIVE: To assess emergency preparedness from the perspective of athletic administrators (AAs) in Iowa secondary schools. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: Ninety-eight AAs from Iowa completed the survey (age = 45.33 ± 10.22 years, years as an AA = 9.37 ± 8.14, years in current role = 7.72 ± 7.09). MAIN OUTCOME MEASURES(S): The 6-section survey contained with questions about access to athletic trainers (ATs), emergency action plans (EAPs), cardiopulmonary resuscitation (CPR), automated external defibrillators (AEDs), concussions, heat illness, and other general policies. Descriptive statistics (percentages and frequencies) were reported. Relative risk was calculated to compare schools with and those without access to ATs (P < .05). RESULTS: Most respondents (76.5%, n = 75/98) reported their school had access to a licensed AT. The majority had a written EAP (83.3%, n = 70/84), but fewer than half (39.2%, n = 31/79) reviewed it annually and fewer than 10% (n = 6/85) reported practicing it each year. All respondents (100%, N = 78/78) stated they had an AED on campus. All respondents (N = 77/77) indicated that they were familiar with the Iowa High School Athletic Association's (IHSAA's) concussion policy and had a concussion guideline in place. Many respondents (95.9%, n = 71/74) described being familiar with the IHSAA's heat illness policy, but more than half (62.1%, n = 41/66) noted they did not have a heat illness policy in place at their school. CONCLUSIONS: Most respondents indicated their school had access to ATs, followed the state-mandated concussion guidelines, and had an AED. Although participants reported having written EAPs in place, levels of annual EAP review and practice were low. These results suggest that schools would benefit from educational opportunities to improve safety policies.

Implementation Science: Lessons Learned From Evaluating Practice Recommendations for the Care of Patients With Spine Injuries.

Health care providers are encouraged to provide care according to practice recommendations because these suggestions should improve patient care and promote optimal patient outcomes. The goals of these practice recommendations are to improve patient care and promote optimal patient outcomes. However, without integration into clinical practice, the value of practice recommendations in supporting patient care is lost. Unfortunately, little is known about the success of integrating practice recommendations into clinical practice, and targeted efforts to promote integration are likely needed. Implementation research is a broad area of study that focuses on how guidelines, programs, or interventions are put into practice and delivered. The Translating Research Into Injury Prevention Practice (TRIPP) framework consists of 6 stages that support implementation science, and the framework has been used to assist in integrating injury-prevention programs into patient care. The structure of the TRIPP framework makes it applicable to other programs that would benefit from implementation science, including practice recommendations. Stages 5 and 6 of the TRIPP framework emphasize the need to explore the implementation context and factors related to uptake of a program by end users. This commentary highlights our efforts to use methods for implementation research to evaluate stage 5 of the TRIPP framework as it relates to acute care for patients with suspected spine injuries and provides 6 lessons learned that may assist in future efforts to better implement practice recommendations in patient care. Targeted efforts to assist clinicians in implementing practice recommendations may promote their use and ultimately enhance the care provided for patients with a variety of health conditions. An essential component of any implementation effort is understanding end users via stages 5 and 6 of the TRIPP framework, and this understanding may maximize knowledge translation and encourage practice change and advancement.

Epidemiology of Secondary School Boys' and Girls' Basketball Injuries: National Athletic Treatment, Injury and Outcomes Network.

CONTEXT: Little is known about non-time-loss (NTL) injury patterns in basketball athletes. Knowledge of these patterns may aid in the development of prevention and management strategies for patients with these injuries. OBJECTIVE: To describe the epidemiology of time-loss (TL) and NTL injuries sustained by secondary school boys' and girls' basketball athletes. DESIGN: Descriptive epidemiology study. SETTING: Eighty-six unique schools provided data, with 84 and 83 contributing to boys' and girls' basketball, respectively. PATIENTS OR OTHER PARTICIPANTS: Athletes participating in secondary school-sponsored boys' and girls' basketball. MAIN OUTCOME MEASURE(S): Boys' and girls' basketball data from the National Athletic Treatment, Injury and Outcomes Network (NATION) injury-surveillance program (2011-2012 through 2013-2014 years) were analyzed. Injury counts, rates, and rate ratios (IRRs) were reported with 95% confidence intervals (CIs). RESULTS: The NATION captured 2653 injuries over 364 355 athlete-exposures (AEs) for boys' basketball and 2394 injuries over 288 286 AE for girls' basketball, producing rates of 7.28/1000 AEs (95% CI = 7.00, 7.56) for boys and 8.30/1000 AEs (95% CI = 7.97, 8.64) for girls. The overall injury rates were slightly lower for boys (IRR = 0.88; 95% CI = 0.83, 0.93). For boys, 559 (21.1%) injuries were TL and 2094 (78.9%) were NTL, producing a TL injury rate of 1.53/1000 AEs (95% CI = 1.40, 1.66) and an NTL injury rate of 5.75/1000 AEs (95% CI = 5.50, 5.99). For girls, 499 (20.8%) injuries were TL and 1895 (79.2%) were NTL, producing a TL injury rate of 1.73/1000 AEs (95% CI = 1.58, 1.88) and an NTL injury rate of 6.57/1000 AEs (95% CI = 6.28, 6.87). Rates of TL injuries were similar between boys' and girls' basketball (IRR = 0.89; 95% CI = 0.79, 1.00); NTL injury rates were lower for boys (IRR = 0.87; 95% CI = 0.82, 0.93). CONCLUSIONS: When NTL injuries were included, the rates of injury in boys' and girls' secondary school basketball were higher than previously reported.

Demographic, Parental, and Personal Factors and Youth Athletes' Concussion-Related Knowledge and Beliefs.

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 < .10). In the multivariable model, geographic location (North Carolina versus Arizona, mean difference [MD] = 2.2, 95% confidence interval [CI] = 1.1, 3.2), sport (girls' soccer versus girls' lacrosse, MD = 2.2, 95% CI = 0.7, 3.6), more favorable parental attitudes toward concussion (MD = 1.2 for a 2-standard deviation shift; 95% CI = 0.3, 2.1), and older age (>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 athlete's age influenced athletes' concussion-related perceptions, indicating the need to address multiple levels of the socioecological model when targeting youth sport interventions. Parental interventions that translate to an improved culture of youth sport by improving youth athletes' perceptions and experiences are key areas for future work.

Parents' and Child's Concussion History as Predictors of Parental Attitudes and Knowledge of Concussion Recognition and Response.

BACKGROUND: Parents' knowledge of and attitudes toward concussions are often vital factors that affect care for injured adolescent athletes. It is important to understand the role that parents' personal experiences with concussions play with regard to current concussion knowledge and attitudes so that clinicians may tailor their educational approaches. PURPOSE/HYPOTHESIS: The purpose of this study was to determine an association between parents' personal experiences and their child's experiences with concussions as well as parental concussion knowledge and attitudes. We hypothesized that parents who have personally experienced symptoms or have a child who has experienced symptoms would have better knowledge and more favorable attitudes toward concussions. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Parents of youth sport athletes (N = 234 [82 male, 144 female, 8 unreported]; mean age, 44.0 ± 6.3 years) completed a prevalidated survey for concussion knowledge (maximum score possible, 29) and attitudes (maximum score possible, 49). Higher scores indicated better knowledge and more favorable attitudes toward concussive injuries. Parents reported the frequency of concussion diagnoses and/or experiences of concussion-related symptoms and whether their child had suffered a diagnosed concussion or experienced concussion symptoms (yes/no). Spearman rank correlation and multivariable regression were used to examine the association between experience of symptom clusters (self or child) and concussion knowledge and attitudes. RESULTS: Knowledge was moderate (mean, 23.3 ± 2.5 of 29), while attitudes prioritized disclosure (mean, 46.3 ± 3.7 of 49). Parents' experience of the sleep-arousal symptom cluster was positively associated with concussion attitudes (r = 0.22, P = .002; ß = -3.301, P = .011). Parents with children who experienced sleep-arousal and vestibular-somatic symptom clusters were weakly associated with parental concussion knowledge (sleep-arousal: r = 0.15, P = .041; vestibular-somatic: r = 0.17, P = .020; ß = 0.540, P = .012). CONCLUSION: Our findings suggest that parents' personal experiences with concussion-related symptoms have little effect on parental knowledge and attitudes as a whole. However, clinicians should consider particular symptom clusters that may provide insight into targets for future concussion education. According to these findings, parents of youth sport participants would benefit from increased concussion education focusing on the types of symptoms as well as the consequences of suffering a concussion.

Head Impact Measurement Devices.

CONTEXT: Concussive injuries are at the forefront of sports medicine research. Recently, researchers have used a variety of head- and helmet-based impact-monitoring devices to quantify impacts sustained during contact sport participation. This review provides an up-to-date collection of head accelerometer use at the youth, high school, and collegiate levels. EVIDENCE ACQUISITION: PubMed was searched for articles published between 1980 and 2015 using the terms accelerometer and concussion, impact sensor and concussion, head impact telemetry system, head impact telemetry, and linear acceleration and concussion. An additional Google search was performed to capture devices without publications. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4. RESULTS: Twenty-four products track and/or record head impact for clinical or research use. Ten of these head impact devices have publications supporting their utility. CONCLUSION: Head impact measuring devices can describe athlete exposure in terms of magnitude and/or frequency, highlighting their utility within a multimodal approach for concussion assessment and diagnosis.

Football Players' Head-Impact Exposure After Limiting of Full-Contact Practices.

CONTEXT: Sporting organizations limit full-contact football practices to reduce concussion risk and based on speculation that repeated head impacts may result in long-term neurodegeneration. OBJECTIVE: To directly compare head-impact exposure in high school football players before and after a statewide restriction on full-contact practices. DESIGN: Cross-sectional study. SETTING: High school football field. PATIENTS OR OTHER PARTICIPANTS: Participants were varsity football athletes from a single high school. Before the rule change, 26 athletes (age = 16.2 ± 0.8 years, height = 179.6 ± 6.4 cm, weight = 81.9 ± 13.1 kg) participated. After the rule change, 24 athletes (age = 15.9 ± 0.8 years, height = 178.3 ± 6.5 cm, weight = 76.2 ± 11.6 kg) participated. Nine athletes participated in both years of the investigation. MAIN OUTCOME MEASURE(S): Head-impact exposure was monitored using the Head Impact Telemetry System while the athletes participated in football games and practices in the seasons before and after the rule change. Head-impact frequency, location, and magnitude (ie, linear acceleration, rotational acceleration, and Head Impact Telemetry severity profile [HITsp], respectively) were measured. RESULTS: A total of 15 398 impacts (592 impacts per player per season) were captured before the rule change and 8269 impacts (345 impacts per player per season) after the change. An average 42% decline in impact exposure occurred across all players, with practice-exposure declines occurring among linemen (46% decline); receivers, cornerbacks, and safeties (41% decline); and tight ends, running backs (including fullbacks), and linebackers (39% decline). Impact magnitudes remained largely unchanged between the years. CONCLUSIONS: A rule change limiting full-contact high school football practices appears to have been effective in reducing head-impact exposure across all players, with the largest reduction occurring among linemen. This finding is likely associated with the rule modification, particularly because the coaching staff and offensive scheme remained consistent, yet how this reduction influences concussion risk and long-term cognitive health remains unknown.

Concussion recovery time among high school and collegiate athletes: a systematic review and meta-analysis.

BACKGROUND: Concussion diagnosis and management is made through the clinical exam using assessment tools that include self-report symptomatology, postural control, and cognitive evaluations. The specific timing of concussion resolution varies between individuals. However, despite a lack of research in concussion recovery, it is widely accepted that the majority of young adults will recover in 7-10 days, with youth athletes taking longer. OBJECTIVES: The purpose of this review is to directly compare the recovery duration among high school and collegiate athletes on symptom reports and cognitive assessments following concussion. DATA SOURCES: Data were collected from a literature search comprising high school or college athletes only. This included studies (n = 6) that reported symptom or cognitive performance recovery to the exact day. RESULTS: High school athletes self-reported symptom recovery at 15 days compared with 6 days in collegiate athletes. Both college and high school athletes showed cognitive recovery at similar rates of 5 and 7 days. LIMITATIONS: This review only included articles that were directly related to concussed high school or college athletes. Additionally, athletes in the high school and college setting typically receive a battery of neurocognitive tests that may not be as sensitive or as comprehensive as a full neuropsychological exam. CONCLUSION: The review finds that neurocognitive recovery rates are similar among high school and college athletes, while symptom reporting shows longer recovery time points in high school than in college. IMPLICATIONS OF KEY FINDINGS: An individualized and stepwise concussion management plan is important for proper concussion recovery regardless of age.

Athletic trainers' familiarity with and perceptions of academic accommodations in secondary school athletes after sport-related concussion.

CONTEXT: Sport-related concussion can affect athletes' sport participation and academic success. With the recent emphasis on cognitive rest, student-athletes may benefit from academic accommodations (AA) in the classroom; however, athletic trainers' (ATs') perceived familiarity with, and use of, AA is unknown. OBJECTIVE: To assess secondary school ATs' perceived familiarity with, attitudes and beliefs about, and incorporation of AA for student-athletes after sport-related concussion. A secondary purpose was to determine whether employment status altered familiarity and use of AA. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: Of 3286 possible respondents, 851 secondary school ATs accessed the survey (response rate = 25.9%; 308 men [36.2%], 376 women [44.2%], 167 respondents [19.6%] with sex information missing; age = 37.3 ± 10.1 years). MAIN OUTCOME MEASURE(S): Participants were solicited via e-mail to complete the Beliefs, Attitudes and Knowledge Following Pediatric Athlete Concussion among Athletic Trainers employed in the secondary school setting (BAKPAC-AT) survey. The BAKPAC-AT assessed ATs' perceived familiarity, perceptions, and roles regarding 504 plans, Individualized Education Programs (IEPs), and returning student-athletes to the classroom. Independent variables were employment status (full time versus part time), employment model (direct versus outreach), years certified, and years of experience in the secondary school setting. The dependent variables were participants' responses to the AA questions. Spearman rank-correlation coefficients were used to assess relationships and Mann-Whitney U and χ(2) tests (P < .05) were used to identify differences. RESULTS: Respondents reported that approximately 41% of the student-athletes whose sport-related concussions they managed received AA. Respondents employed directly by the school were more familiar with 504 plans (P < .001) and IEPs (P < .001) and had a greater belief that ATs should have a role in AA. Both the number of years certified and the years of experience at the secondary school were significantly correlated with perceived familiarity regarding 504 plans and IEPs. CONCLUSIONS: The ATs employed directly by secondary schools and those with more experience as secondary school ATs were more familiar with AA. Understanding AA is important for all ATs because cognitive rest and "return to learn" are becoming more widely recommended in concussion management.

Current and emerging rehabilitation for concussion: a review of the evidence.

Concussion is one of the most hotly debated topics in sports medicine today. Research surrounding concussion has experienced significant growth recently, especially in the areas of incidence, assessment, and recovery. However, there is limited research on the most effective rehabilitation approaches for this injury. This review evaluates the current literature for evidence for and against physical and cognitive rest and the emerging areas targeting vestibular, oculomotor, and pharmacologic interventions for the rehabilitation of sport-related concussion.

Athletic trainers' management practices and referral patterns for adolescent athletes after sport-related concussion.

BACKGROUND: Athletic trainers (ATs) play an important role in the evaluation, management, and referral of student-athletes after sport-related concussion. Understanding factors that influence ATs' patient care decisions is important to ensure best practices are followed. PURPOSE: To identify ATs' current concussion management practices and referral patterns for adolescent student-athletes after sport-related concussion as well as the factors associated with those practices. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 851 participants from a convenience sample of 3286 ATs employed in the secondary school setting (25.9% response rate) completed the Athletic Trainers' Beliefs, Attitudes, and Knowledge of Pediatric Athletes with Concussions (BAKPAC-AT) survey. The BAKPAC-AT consists of several questions to assess ATs' concussion management, referral practices, and established relationships with other health care professionals. RESULTS: The majority of ATs had a written concussion policy (82.4%, n = 701) and standing orders approved by their directing physician (67.3%, n = 573); 75.1% (n = 639) of ATs conduct baseline testing, with the majority using computerized neurocognitive tests (71.2%, n = 606). Follow-up concussion testing was employed by 81.8% (n = 696). Years of certification (P = 0.049) and type of secondary school (P = 0.033) predicted ATs' use of baseline testing. Nearly half of the respondents (48.8%, n = 415) refer 100% of concussion cases to a physician. The most influential factors that lead to a referral were state law (40.3%, n = 343), personal preference (34.7%, n = 295), and school district policy (24.8%, n = 211). CONCLUSION: Of the ATs surveyed, most were engaged in baseline and follow-up testing, primarily with neurocognitive tests. Most ATs refer patients to physicians after concussion. While state regulation and personal preference were primary factors influencing referral decisions, it is unclear at what point of care the referral occurs.