Concussion symptom presentation and clinical recovery among pediatric athletes: comparing concussions sustained during school and summer months.

OBJECTIVE: We examined post-concussion symptom presentation, exercise, and sleep among pediatric athletes who sustained concussion during the school year vs. summer months. METHODS: We evaluated athletes 6-18 years old within 21-days of concussion. They reported symptoms (Health and Behavior Inventory), with cognitive/somatic domain sub-scores calculated, and indicated if they had exercised or experienced sleep problems since injury. We grouped patients by injury season: summer months (June-August) vs. school year (September-May). RESULTS: 350 patients (14.4 ± 2.4 years old; 37% female; initial visit 8.8 ± 5.3 days post-concussion) were seen for care: 24% sustained a concussion during summer months, 76% during the school year. Lower cognitive (median = 7 [IQR = 1, 15] vs. 9.5 [4, 17]; p = 0.01), but not somatic (7 [2.5, 11] vs. 8 [4, 13]; p = 0.06), HBI scores were observed for patients injured during the summer. Groups were similar in proportion exercising (16% vs 17%) and endorsing sleep problems (29% vs 31%). After adjustments, sustaining a concussion during the summer predicted total (ß=-3.43; 95%CI = -6.50, -0.36; p = 0.029) and cognitive (ß = -2.29; 95%CI = -4.22, -0.36; p = 0.02), but not somatic (ß=-1.46; 95%CI = -2.84, -0.08; p = 0.04), symptom severity. CONCLUSION: Pediatric patients with concussion may present with greater cognitive symptoms during the school year, compared to summer months.

Double Vision and Light Sensitivity Symptoms are Associated With Return-to-School Timing After Pediatric Concussion.

OBJECTIVE: To determine the association between academic time loss postconcussion and vision symptoms/impairments among pediatric patients. DESIGN: Cross-sectional. SETTING: Sports medicine clinic. PATIENTS: Pediatric patients seen for care in a sports medicine clinic between the ages 6 and 18 years (n = 212; mean age = 14.3, SD = 2.4 years; 48% female) were evaluated within 21 days of concussion (mean = 9.8, SD = 5.7 days). INDEPENDENT VARIABLE: Patients were grouped based on academic time loss (missed >5 days vs ≤5 days of school) at their initial postconcussion evaluation. OUTCOME MEASURES: Patients rated concussion symptoms using the Health and Behavior Inventory (HBI) and underwent near point of convergence (NPC) testing. We compared groups on specific HBI symptom ratings of dizziness, blurry vision, seeing double, and light sensitivity, as well as NPC break and recovery point distances. RESULTS: Two hundred twelve patients were included; n = 36 (17%) who reported missing >5 days of school. After adjusting for time since injury, parental education level, mechanism of injury, and preinjury anxiety, patients who reported missing >5 days of school had higher ratings of double vision (ß = 0.27; 95% confidence interval [CI], 0.01-0.53; P = 0.04) and light sensitivity (ß = 0.506; 95% CI, 0.061-0.951; P = 0.02), but not dizziness (ß = 0.390; 95% CI, -0.047 to 0.827; P = 0.08) or blurry vision (ß = 0.026; 95% CI, -0.352 to 0.404; P = 0.89). CONCLUSION: Missing >5 days of school was associated with worse double vision and light sensitivity symptoms. Given the importance of vision in learning, assessing postconcussion vision symptoms may facilitate a successful return to school. Clinicians should assess a wide spectrum of vision-specific symptoms to ensure appropriate support during the return-to-school process.

Patient Characteristics Predictive of Immediate and Delayed Word Recall Performance Following Adolescent Concussion.

Clinicians rely on objective concussion assessments that may be influenced by patient characteristics, creating difficulties in isolating the effect of concussion on patient function. The purpose of our study was to identify characteristics associated with performance on the Sport Concussion Assessment Tool 5th edition (SCAT5) 10-word recall test following adolescent concussion. We evaluated patients seen for care within 14 days of concussion (n=125; 15.2±1.6 years of age, range=11-18 years; 46% female; 6.9±3.4 days post-concussion). Patient demographic (age, sex, medical and concussion history, etc.), injury (timing of presentation, symptom severity, sport-type, etc.), and clinical test (Modified Balance Error Scoring System [mBESS], tandem gait) characteristics were assessed, in addition to SCAT5 immediate and delayed memory testing using the 10-word recall list. Immediate and delayed recall performance was significantly associated with concussion symptom burden and cognitive accuracy during tandem gait, although effect sizes were notably small. Specific variables such as age, sex, diagnosis of ADD/ADHD, and performance on other clinical assessments were not significantly associated with recall performance after controlling for covariates. Further, the 10-word recall list demonstrates specific advantages over previously used 5-word lists by way of decreased ceiling effects and reduced interference of inherent patient characteristics.

Dizziness Is Associated With Neck/Shoulder Pain Following Pediatric Concussion.

OBJECTIVE: To examine the association between dizziness and neck/shoulder pain after concussion and if differences in postural stability and oculomotor function exist among patients reporting dizziness with or without concurrent neck/shoulder pain. DESIGN: Cross sectional. SETTING: Sports medicine clinic. PATIENTS: Pediatric patients ≤14 days post concussion. INTERVENTIONS: N/A. OUTCOME MEASURES: Patients completed the Health and Behavior Inventory (HBI) symptom rating and separately rated neck/shoulder pain (scale 0-3; 0 = no pain). We grouped patients by HBI dizziness rating (0 = not-dizzy; 1-3 = dizzy) and compared neck/shoulder pain ratings between the groups. We then compared oculomotor and postural stability outcomes between dizzy patients with and without neck/shoulder pain. RESULTS: We included 153 patients: dizzy (n = 100; age = 14.6 ± 2.2 years; 48% female) and not-dizzy (n = 53, age = 14.4 ± 3.1 years; 38% female). The dizzy group reported significantly higher neck/shoulder pain (1.4 ± 1.1 vs 0.5 ± 0.9 points, P < 0.001) and total symptom score (25.7 ± 11.2 vs 11.7 ± 9.3 points, P < 0.001) than the not-dizzy group. After adjusting for total symptom score and preinjury anxiety, depression, and migraines, dizziness was associated with higher odds of neck/shoulder pain (odds ratio = 1.9, 95% CI, 1.2-3.0; P = 0.004). No differences were observed between dizzy patients with and without neck/shoulder pain for near point of convergence (10.0 ± 7.5 vs 8.5 ± 6.7 cm, P = 0.43), modified Balance Error Scoring System (8.9 ± 5.5 vs 6.8 ± 4.7 errors, P = 0.09), or tandem gait (single-task: 26.0 ± 12.3 vs 24.2 ± 11.9 seconds, P = 0.56; dual-task: 35.1 ± 14.3 vs 35.6 ± 18.6 seconds, P = 0.90). CONCLUSIONS: In concussion patients experiencing dizziness, evaluating neck/shoulder pain may help identify individuals who would benefit from cervical spine rehabilitation. However, other potential causes of dizziness should also be evaluated to facilitate timely recovery.

The Association between Baseline Eye Tracking Performance and Concussion Assessments in High School Football Players.

SIGNIFICANCE: Concussions are complex injuries that require a multifaceted testing battery. Vision impairments are common after concussion, but it is unknown exactly how eye tracking may be affected after injury and how it is associated with other clinical concussion assessments. PURPOSE: This study aimed to (1) examine the relationship between eye tracking performance (BOX score) and other common concussion evaluations, (2) identify if eye tracking adds novel information that augments baseline concussion evaluations, and (3) examine the effect of age, concussion history, and attention-deficit/hyperactivity disorder on eye tracking and other ophthalmological measures. METHODS: A total of 102 male high school football athletes (age, 16.0 years; 95% confidence interval, 15.8 to 16.2 years) completed a series of visual and neurocognitive tests during their pre-season baseline assessment. The main outcome measures were BOX score, near point of convergence (NPC) distance, binocular accommodative amplitude (BAA) distance, Standardized Assessment of Concussion score, and Immediate Post-Concussion Assessment and Cognitive Testing composite scores. RESULTS: BOX score was not significantly associated with symptoms, Standardized Assessment of Concussion score, NPC distance, BAA distance, or any Immediate Post-Concussion Assessment and Cognitive Testing composite scores. Age, concussion history, attention-deficit/hyperactivity disorder, and number of prior years playing football were not significantly associated with BOX score or NPC distance, but there was a significant association between concussion history and greater BAA distance (ß = 1.60; 95% confidence interval = 0.19 to 3.01; P < .03). The BOX score cutoff of 10 resulted in a 12% false-positive rate. CONCLUSIONS: Eye tracking was not significantly associated with the commonly used clinical concussion assessments. These results suggest that an objective eye tracking variable may be a valuable addition to the current concussion battery.

Training volume recommendations and psychosocial outcomes in adolescent athletes.

OBJECTIVES: Researchers have recommended that youth athletes limit their practice volume to the number of hours/week that they are old in years. We examined sport perceptions, burnout, anxiety, and depressive symptoms among youth athletes who did and did not report playing more hours/week of organized sports than their age. METHODS: Uninjured athletes aged 13-18 years old completed questionnaires documenting demographics, sport participation volume, health and injury history, depressive symptoms, anxiety, burnout, and sport perceptions during a pre-participation physical examination. We grouped participants as those who reported more hours/week in organized sports than their age (exceeds age/volume recommendation) vs. those who reported equal/less hours/week in organized sports than their age (meets age/volume recommendation). RESULTS: Of 161 participants, 21% (n = 33) were in the 'exceeds age/volume recommendation' group (age = 15.2 ± 1.3 years; 55% female; 18.7 ± 4.0 hours/week) and 79% (n = 128) were in the 'meets age/volume recommendation' group (age = 15.6 ± 1.2 years; 50% female; 10.2 ± 3.4 hours/week). A higher proportion of the 'exceeds age/volume recommendation' group agreed with the statement 'youth in my sport play too many games before college' than the 'meets age/volume recommendation' group (33% vs. 16%; p = 0.03). After adjusting for the effect of age, sport specialization level, and weight, exceeding age/volume recommendations was associated with the perception that youth in sports play too many games before college (aOR = 3.24; 95% CI = 1.26, 8.29; p = 0.01), while burnout (aOR = 0.99; 95% CI = 0.94, 1.06; p = 0.93), anxiety (aOR = 0.97; 95% CI = 0.84, 1.11; p = 0.65), and depressive symptoms (aOR = 0.90; 95% CI = 0.74, 1.10; p = 0.30) were not significantly related. CONCLUSION: Athletes who spend more hours in sport than their age appear to perceive their competition load during youth sports to be excessive. Coaches and providers should monitor athlete's training hours and perceptions of competition load to offer support and potentially prevent burnout development.

Athlete Burnout Is Associated With Perceived Likelihood of Future Injury Among Healthy Adolescent Athletes.

We examined perceived risk of future sports injury and athlete burnout among uninjured adolescent athletes. Uninjured high school athlete participants completed the Athlete Burnout Questionnaire (ABQ) and a questionnaire assessing attitudes toward likelihood of sustaining a future sport-related injury. We compared ABQ responses between injury risk perception groups: those who expected injury versus those who did not. Half of the participants reported a somewhat/very high likelihood of future sport-related injury (n = 98; 52% female; age = 15.3 ± 1.9 years), while the other half reported it was unlikely/not possible (n = 98; 45% female; age = 15.3 ± 1.3 years). A significantly greater proportion of those in the expected injury group reported a history of bone/muscle/ligament/tendon injury (56% vs 24%; P < .001). Those in the expected injury group reported higher athlete burnout scores (median = 28 [interquartile range = 25-34] vs 25 [23-30]; P = .002). Adolescent athletes who reported they were likely to experience a future injury in their sport also reported greater levels of burnout.

Changes in Quality of Life, Sleep, and Physical Activity During COVID-19: A Longitudinal Study of Adolescent Athletes.

CONTEXT: The abrupt cessation of school and sport participation during the COVID-19 pandemic may have negative implications for adolescent mental health. OBJECTIVES: To (1) compare mental, physical, and social health and behaviors during pandemic-related stay-at-home mandates with the same measures collected 1 to 2 years earlier and (2) evaluate the relationships between physical activity and sleep during the pandemic and changes in anxiety, fatigue, and peer relationships between assessment times. DESIGN: Cohort study. SETTING: Pediatric sports medicine center. PATIENTS OR OTHER PARTICIPANTS: A total of 39 high school athletes (25 adolescent girls, 14 adolescent boys; age = 16.2 ± 0.9 years). MAIN OUTCOME MEASURE(S): Patient-Reported Outcome Measurement System anxiety, fatigue, and peer relationships short forms and the Pittsburgh Sleep Quality Index were completed twice (initial assessment in May 2018 or 2019, follow-up assessment in May or June 2020). Frequency and duration of physical activity and frequency of interaction with other individuals (family, peers, sport coaches, etc) were self-reported at follow-up assessment for the 2 weeks before school or sport closure and the 2 weeks before questionnaire completion. RESULTS: Higher levels of anxiety (5.5 ± 4.0 versus 3.6 ± 3.4 points; P = .003) and fatigue (5.4 ± 3.7 versus 2.3 ± 2.5 points; P < .001) and worse sleep quality (6.6 ± 2.9 versus 4.3 ± 2.3 points; P < .001) were observed during the pandemic compared with previous assessments. Reductions in physical activity were noted between assessments (exercise duration: 86.4 ± 41.0 versus 53.8 ± 30.0 minutes; P < .001). Sleep quality but not physical activity during the pandemic predicted changes in fatigue (P = .03, ß = 0.44 [95% CI = 0.06, 0.83]) and peer relationships (P = .01, ß = -0.65 [95% CI = -1.16, -0.15]) from initial to follow-up assessment. CONCLUSIONS: Mental and physical health declined during stay-at-home mandates compared with assessments 1 to 2 years earlier. Physical activity behaviors and sources of social interaction underwent changes after school and sport cessation. Sleep quality may have provided some protection against declining adolescent mental health during the pandemic, although this relationship requires further investigation.

Transitory kinesiophobia after sport-related concussion and its correlation with reaction time.

OBJECTIVES: To examine kinesiophobia (i.e. fear of movement) among adolescent athletes with concussion compared to controls, and correlations of kinesiophobia with symptoms and reaction time. DESIGN: Prospective cohort study. METHODS: We evaluated 49 adolescent athletes twice. The concussion group was assessed within 14 days of injury and at return-to-play clearance. The control group was tested initially and approximately 28 days later. Participants completed Tampa Scale of Kinesiophobia, Post-Concussion Symptom Inventory, and clinical reaction time assessments. RESULTS: We included 32 concussion participants (15 ± 2 years; 50% female) and 17 controls (16 ± 1 years; 47% female). Acutely (<14 days post-injury), the concussion group reported greater Tampa Scale of Kinesiophobia scores (38.5 ± 5.4 vs. 29.4 ± 6.7; p < 0.001; Cohen's d = 1.54), and a greater proportion of "high" (≥37) scores than controls (69% vs. 6%; p < 0.001). At return-to-play, there were no significant between-group differences (33.3 ± 6.5 vs. 30.8 ± 7.4; p = 0.23; Cohen's d = 0.36); 28% of the concussion group reported "high" Tampa Scale of Kinesiophobia scores. At return-to-play, kinesiophobia was significantly/moderately correlated with clinical reaction time for the concussion group (r = 0.50; p = 0.01). CONCLUSIONS: Adolescents recovering from concussion commonly reported high kinesiophobia initially postconcussion, while 28% continued to report high kinesiophobia at return-to-play clearance. Additionally, a correlation between Tampa Scale of Kinesiophobia scores and clinical reaction time was observed for the concussion group. This finding would benefit from further study to determine potential perception-behavior relationships following concussion.

Sport specialization, sleep, fatigue, and psychosocial ratings: do highly specialized athletes differ from their less specialized peers?

OBJECTIVES: To determine if sleep quality, fatigue, anxiety, depressive symptoms, or perceptions of sport participation differ between high-, moderate-, and low-specialized high school athletes with or without prior injuries. METHODS: During pre-participation physical examinations (PPE), high school athletes completed questionnaires on sport specialization level, history of time-loss orthopedic injury, perceptions of sport participation, as well as sleep quality (Pittsburgh Sleep Quality Index (PSQI)), fatigue, anxiety, and depressive symptoms (Patient-Reported Outcomes Measurement Information System (PROMIS®)). Athletes were grouped according to sport specialization level and history of prior time-loss orthopedic injury. RESULTS: A total of 186 athletes completed the study: 49% (n = 92; mean age = 15.3 ± 2.0 yrs; 50% female) were low specialized, 34% (n = 64; mean age = 15.3 ± 1.3 yrs; 47% female) were moderately specialized, and 16% (n = 30; mean age = 15.7 ± 1.1 yrs; 57% female) were highly specialized. Groups were similar for demographics, training volume, and injury history. Compared to the moderate-specialization group, highly specialized athletes reported higher levels of fatigue (3.1 ± 3.7 vs. 1.5 ± 2.2; p = 0.02), anxiety (3.6 ± 4.1 vs. 1.8 ± 2.6; p = 0.02), and depressive symptoms (2.4 ± 4.0 vs. 0.8 ± 2.0; p = 0.02). No differences in psychometric ratings, sleep quality, or perceptions of sport participation were observed between the low/moderate- or low/high-specialization groups. We did not observe any significant differences between groups who did and did not report a history of prior time-loss orthopedic injury. CONCLUSIONS: Highly specialized high school athletes report higher levels of fatigue, more anxiety symptoms, and more depressive symptoms than their moderately specialized peers, despite no differences in training volume or injury history. Low specialized athletes did not differ from moderately specialized or highly specialized athletes in the aforementioned domains, and there were no differences in sleep quality across specialization groups. These findings add to the current body of literature on early sport specialization by illustrating the distinctive psychosocial implications of sport specialization and demonstrating the need for further prospective research.

An 8-Week Neuromuscular Training Program After Concussion Reduces 1-Year Subsequent Injury Risk: A Randomized Clinical Trial.

BACKGROUND: Existing data suggest that after concussion, athletes experience an increased risk of subsequent injury. Exploring methods that may reduce injury risk after successful postconcussion return to play may lead to new treatment approaches. PURPOSE: To examine the efficacy of a neuromuscular training (NMT) intervention on acute sports-related time-loss injury over the subsequent year relative to standard of care. STUDY DESIGN: Randomized clinical trial; Level of evidence, 1. METHODS: A total of 27 youth athletes were assessed initially postconcussion (median, 7 days postconcussion; interquartile range [IQR], 5-10) and after return-to-play clearance (median, 40 days postconcussion; IQR, 15-52). After return-to-play clearance, they were randomly assigned to NMT intervention (n = 11; mean ± SD age, 14.7 ± 1.7 years; 36% female) or standard of care (n = 16; mean ± SD age, 15.3 ± 1.8 years; 44% female). The intervention (duration, 8 weeks; frequency, 2 times per week) included guided strength exercises with landing stabilization focus. Standard of care received no recommendations. For the subsequent year, athletes prospectively completed a monthly log of sports-related injuries and organized sports competitions. RESULTS: During the first year after postconcussion return-to-play clearance, sports-related time-loss injuries were more common among standard of care relative to NMT intervention (75% [95% CI, 48%-93%] vs 36% [95% CI, 11%-69%]). After adjusting for age and sex, the hazard of subsequent injury in the standard-of-care group was 3.56 times (95% CI, 1.11-11.49; P = .0334) that of the NMT intervention group. Sports participation was similar between NMT intervention and standard of care during the year-long monitoring period (hours of organized sports per month; median, 12 [IQR, 2.6-32.1] vs 15.6 [IQR, 3.5-105.9]; P = .55). The age- and sex-adjusted incidence of injuries was 10.2 per 1000 competitive exposures (95% CI, 3.7-28.4) in the standard-of-care group as opposed to 3.4 per 1000 (95% CI, 0.9-13.4) in the NMT intervention group. After adjusting for age and sex, incidence of injuries was higher for standard of care vs NMT intervention (rate ratio, 2.96 [95% CI, 0.89-9.85]; P = .076). CONCLUSION: Although preliminary, our findings suggest that an NMT intervention initiated after return-to-play clearance may significantly reduce sports-related time-loss injuries over the subsequent year. REGISTRATION: NCT03917290 (ClinicalTrials.gov identifier).

Socioeconomic status and injury history in adolescent athletes: Lower family affluence is associated with a history of concussion.

Background: While healthcare and health outcome disparities have been studied across a variety of different injuries, their relation to concussion incidence and management are relatively understudied. Aim: The aim of this study was to evaluate the association between history of concussion or musculoskeletal injury, and family affluence and/or school-level measures of socioeconomic status. Methods: We conducted a cross-sectional study of adolescent athletes in a local school district. Adolescent athletes (n = 192; mean age = 15.3, SD = 1.6 years; 49% female), who presented for a pre-participation physical evaluation reported concussion and injury history, and family affluence scale (FAS) scores. We also examined the percent of students on free/reduced lunch at each school compared to state averages. Independent variables, individual FAS score and school-based marker of socioeconomic status, were compared between those with and without a history of concussion and time-loss musculoskeletal injury. Results: Of the participants, 40 (21%) reported a history of concussion. Athletes with a concussion history had significantly lower FAS scores than athletes without a history of concussion (mean difference = 0.7, 95%CI = 0.1, 1.4; P = 0.027). There was no significant difference in FAS scores between those with and without a history of time-loss musculoskeletal injury (mean difference = 0.0, 95% CI = -0.5, 0.5; P = 0.97). Athletes with a history of concussion had a higher proportion of a prior time-loss musculoskeletal injury (68% vs. 32%; P < 0.001). After adjusting for age, school free-reduced lunch rate, and history of musculoskeletal injury, a lower FAS score was associated with concussion history (adjusted odds ratio = 0.79; 95% CI = 0.64, 0.96; P = 0.019). Concussion and musculoskeletal injury were not associated with school-level markers of socioeconomic status. Conclusion: Lower individual measures, but not school-level measures, of socioeconomic status were associated with a history of concussion in our sample of adolescent athletes. Relevance for Patients: Enhance providers' understanding of how socioeconomic factors may impact concussion history and empower providers to adequately screen for and provide concussion education to mitigate disparities.

Is near point of convergence associated with symptom profiles or recovery in adolescents after concussion?

Our purpose was to compare the clinical and injury characteristics of concussion patients with a receded near point of convergence (NPC) vs those without a receded NPC. Concussion patients were seen within 14 days of injury. We compared those with receded a NPC (>6 cm) break point distance and those with a normal NPC distance on symptom, behavioral, and clinical assessments. We also compared NPC break points between those who did/did not recover within 28 days of injury. 123 patients completed the assessment. 77/123 (63%) of participants demonstrated a receded NPC when tested within 14 days of injury. Those with receded a NPC break point (n = 77; mean = 14.9, SD = 1.5 years; 47% female) were significantly younger than those with a normal NPC break point (n = 46; mean = 15.7, SD = 1.7 years; 46% female). The receded NPC break point group had a significantly greater proportion of patients reporting headaches (86% vs. 61%), as well as significantly greater cognitive (mean = 13.4, SD = 8.7 vs. mean = 8.8, SD = 8.6), somatic (mean = 10.0, SD = 5.9 vs. mean = 6.9, SD = 6.6), and overall (mean = 23.7, SD = 13.6 vs. mean = 15.8, SD = 14.4) symptom severity. Our multivariable model indicated among all potential predictor variables, more severe somatic symptoms were significantly associated with a greater NPC break point (ß = 0.26; 95% CI = 0.01, 0.52). The group who went onto experience persistent symptoms had a significantly greater NPC break point at initial evaluation than those without persistent symptoms (mean = 9.7, SD = 7.5 cm vs. mean = 7.0, SD = 4.0 cm). Those with a receded NPC break point at initial evaluation showed an increased symptom burden, most notable with somatic symptoms, compared with those without a receded NPC break point.

More Physical Activity after Concussion Is Associated with Faster Return to Play among Adolescents.

Concussion management has evolved to de-emphasize rest in favor of early introduction of post-injury physical activity. However, the optimal quantity, frequency and intensity of physical activity are unclear. Our objective was to examine the association between objective physical activity metrics and clinical recovery after concussion. We prospectively enrolled a cohort of 32 youth athletes with concussion, evaluated within 14 days of injury and after return-to-play (RTP) clearance. For two weeks after enrollment, we quantified steps/day and exercise frequency, duration, and intensity via wrist-worn actigraphy. We grouped participants by RTP clearance timing (<28 days vs. ≥28 days). Seventeen (53%) participants required ≥28 days post-concussion for RTP clearance. Groups were similar in age (14.9 ± 1.9 vs. 15.4 ± 1.5 years; p = 0.38), proportion of females (47% vs. 40%; p = 0.69), and concussion history (59% vs. 47%; p = 0.49). During the study period, the RTP ≥ 28 days group took fewer steps/day (8158 ± 651 vs. 11,147 ± 4013; p = 0.02), exercised fewer days/week (2.9 ± 2.4 vs. 5.0 ± 1.9 days/week; p = 0.01), and exercised fewer total minutes/week (117 ± 122 vs. 261 ± 219 min/week; p = 0.03). Furthermore, we observed ≥10,251 average steps/day, ≥4 exercise sessions/week, and exercising ≥134 total minutes/week were optimal cutpoints to distinguish between groups. These findings support the benefit of physical activity during concussion recovery.

Neuromuscular training after concussion to improve motor and psychosocial outcomes: A feasibility trial.

OBJECTIVE: To determine the feasibility of an 8-week neuromuscular training program initiated upon return-to-play clearance following concussion. DESIGN: Feasibility trial. SETTING: A single sports medicine center. PARTICIPANTS: We approached n = 54 patients; n = 32 agreed to participate (59%). N = 27 participants returned for their second visit at return-to-play clearance (84%) and were randomized to neuromuscular training (n = 13) or standard-of-care (n = 14). MAIN OUTCOME MEASURES: Participants completed three assessments: within 14 days post-concussion, immediately after return-to-play clearance, and 8-weeks following return-to-play clearance. The intervention aimed to achieve positive neuromuscular adaptations and occurred 2x/week for 8 weeks under supervision. RESULTS: N = 2 participants randomized to the intervention elected not to participate, both due to schedule conflicts (e.g., time required to meet with the study team). Participants began the intervention an average of 11 days after return-to-play clearance, the majority (91%) completed >75% of training sessions, and training sessions lasted an average of 18.2 ± 4.8 min. One participant stopped the intervention after 7 training sessions due to time availability. CONCLUSION: It is feasible to initiate a neuromuscular training program for most athletes shortly after returning to play following concussion. Clinicians and researchers may consider this approach to mitigate the increased musculoskeletal injury risk for concussion patients returning to sports.

Family Affluence Relationship to Sports Specialization in Youth Athletes.

Our objective was to examine the association between participant-reported family affluence and sport specialization level. We conducted a cross-sectional investigation of adolescent athletes. Specifically, participants completed a level of sport specialization (low/moderate/high) questionnaire and the Family Affluence Scale. The majority (52%) of the 195 youth athlete participants reported low, 33% reported moderate, and 15% reported high sport specialization. Sport specialization groups were similar in age (mean = 15.3 ± 1.6 years), proportion of females (49%), and time spent training (mean = 11.9 ± 5.0 hours per week). The high sport specialization group reported significantly greater family affluence than the low sport specialization group (Family Affluence Scale = 10.4 ± 1.7 vs 9.2 ± 1.9; P = .005). After covariate adjustment, higher levels of sport specialization remained significantly associated with greater family affluence (ß = 0.48, 95% confidence interval = 0.11-0.86). Understanding the relationship between family affluence and sports specialization affords an opportunity to better identify and monitor populations likely to specialize in a single sport during high school.

Age is associated with postural control performance following youth concussion.

PURPOSE: To examine the effect of age on postural control outcomes among patients being seen during their initial post-concussion clinical visit. METHODS: Youth patients were seen≤14 days post-concussion, and completed a series of postural control evaluations: tandem gait, Romberg, and Balance Error Scoring System (BESS) tests. RESULTS: We included 109 children 8-12 years of age (24% female, evaluated median = 7 [interquartile range = 4-10] days post-injury) and 353 adolescents aged 13-18 years (36% female, evaluated median = 7 [4-10] days post-injury). There was a higher proportion of children who demonstrated abnormal tandem gait relative to adolescents (26% vs. 11%; p < 0.001). They also made more BESS errors in single (median = 5 [2-10] vs. 4 [2-6] errors) and tandem (median = 3 [1-6] vs. 2 [0-4]) firm stances. After covariate adjustment, children demonstrated worse tandem gait (adjusted odds ratio = 3.05, 95% CI = 1.68-5.53) and more firm surface BESS errors (double stance ß=0.51, 95% CI = 0.22-0.80; single stance ß= 1.18, 95% CI = 0.42-1.95; tandem stance ß= 0.98, 95% CI = 0.28-1.68) than adolescents. CONCLUSIONS: Tandem gait and BESS performance following concussion differ in children compared to adolescents who present within 2 weeks of injury. Clinicians assessing and managing concussion should recognize age differences in postural control performance when assessing those with concussion.

The diagnostic and prognostic utility of the dual-task tandem gait test for pediatric concussion.

BACKGROUND: The tandem gait test has gained interest recently for assessment of concussion recovery. The purpose of our study was to determine the prognostic and diagnostic use of the single- and dual-task tandem gait test, alongside other clinical measures, within 10 days of pediatric concussion. METHODS: We assessed 126 patients post-concussion (6.3 ± 2.3 days post-injury, mean ±â€¯SD) at a pediatric sports medicine clinic and compared them to 58 healthy controls (age: 15.6 ± 1.3 years; 43% female). We also compared the 31 patients with concussion who developed persistent post-concussion symptoms (PPCS) (age = 14.9 ± 2.0 years; 48% female) to the 81 patients with concussion who did not develop PPCS following the initial assessment (age: 14.1 ± 3.0 years; 41% female). All subjects completed a test battery, and concussion patients were monitored until they experienced concussion-symptom resolution. The test battery included tandem gait (single-task, dual-task (performing tandem gait while concurrently completing a cognitive test) conditions), modified Balance Error Scoring System (mBESS), and concussion symptom assessment (Health and Behavior Inventory). We defined PPCS as symptom resolution time > 28 days post-concussion for the concussion group. Measurement outcomes included tandem gait time (single- and dual-task), dual-task cognitive accuracy, mBESS errors (single/double/tandem stances), and symptom severity. RESULTS: The concussion group completed the single-task (mean difference = 9.1 s, 95% confidential interval (95%CI): 6.1-12.1) and dual-task (mean difference = 12.7 s, 95%CI: 8.7-16.8) tandem gait test more slowly than the control group. Compared to those who recovered within 28 days of concussion, the PPCS group had slower dual-task tandem gait test times (mean difference = 7.9 s, 95%CI: 2.0-13.9), made more tandem-stance mBESS errors (mean difference = 1.3 errors, 95%CI: 0.2-2.3), and reported more severe symptoms (mean difference = 26.6 Health and Behavior Inventory rating, 95%CI: 21.1-32.6). CONCLUSION: Worse dual-task tandem gait test time and mBESS tandem stance performance predicted PPCS in pediatric patients evaluated within 10 days of concussion. Tandem gait assessments may provide valuable information augmenting common clinical practices for concussion management.

Sports participation volume and psychosocial outcomes among healthy high school athletes.

OBJECTIVES: We assessed the association between hours/week of sports participation and psychosocial outcomes among high school athletes. We hypothesized that more hours of participation would be associated with the lower levels of anxiety and depressive symptoms. METHODS: Participants completed the Patient-reported Outcomes Measurement Information System (PROMIS) Pediatric Profile 25 quality of life and other questionnaires to assess sports participation, socioeconomic status, and health history. We evaluated the multivariable relationship between hours/week in sport and PROMIS scores while adjusting for the independent effect of age and varsity team status. RESULTS: A total of 230 high school athletes participated in this study (mean=15.4±1.2 years of age). More hours/week playing sports were significantly associated with the lower levels of depressive symptoms (coefficient=-0.073, 95% CI=-0.137, -0.010; P=0.02). Sports participation was not significantly associated with any other psychosocial domain scores on the PROMIS questionnaire. CONCLUSION: More hours of sports participation were significantly associated with the lower depressive symptoms, but no other psychosocial domain. While our findings are cross-sectional, sport participation may play a role in attenuating symptoms of depression in high school athletes. RELEVANCE FOR PATIENTS: Sports participation may play a beneficial role in lessening depressive symptoms among healthy high school students.

Direct imaging through scattering media by use of efficient third-harmonic generation in organic materials.

We report on real-time, time-gated, direct imaging through scattering media with an attenuation of 14 mean-free paths by use of third-harmonic generation in the eye-safe and telecommunication-compatible near-IR spectral region (1550 nm).