The Ability of Vestibular and Oculomotor Screenings to Predict Recovery in Patients After Concussion: A Systematic Review of the Literature.

OBJECTIVE: The objective of this systematic review was to investigate if a positive vestibular or oculomotor screening is predictive of recovery in patients after concussion. DATA SOURCES: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search through PubMed, Ovid MEDLINE, SPORTDiscus, and the Cochrane Central Register of Controlled Trials (CENTRAL) and hand searches of included articles. STUDY SELECTION: Two authors evaluated all articles for inclusion and assessed their quality using the Mixed Methods Assessment Tool. DATA EXTRACTION: After quality assessment was completed, the authors extracted recovery time, vestibular or ocular assessment results, study population demographics, number of participants, inclusion and exclusion criteria, symptom scores, and any other outcomes of assessments reported in the included studies. DATA SYNTHESIS: Data were critically analyzed by 2 of the authors and categorized into tables regarding the ability of researchers of each article to answer the research question. Many patients who have vision, vestibular, or oculomotor dysfunction appear to have longer recovery times than patients who do not. CONCLUSIONS: Researchers routinely reported that vestibular and oculomotor screenings are prognostic of time to recovery. Specifically, a positive Vestibular Ocular Motor Screening test appears to consistently predict longer recovery.

Recommendations for Medical Discharge Documentation and Academic Supports for University Students Recovering From Concussion.

OBJECTIVE: This study sought to (1) collate the experiences of university students with concussion history and academic stakeholders through interviews and (2) develop concussion management recommendations for institutions of higher learning using a multidisciplinary Delphi procedure. SETTING: Remote semistructured interviews and online surveys. PARTICIPANTS: The first aim of this study included undergraduate university students with concussion history who did not participate in varsity athletics ( n = 21; 57.1% female), as well as academic faculty/staff with experience assisting university students with their postconcussion academic needs ( n = 7; 71.4% female). The second aim enrolled 22 participants (54.5% female) to serve on the Delphi panel including 9 clinicians, 8 researchers, and 5 academic faculty/staff. DESIGN: An exploratory-sequential mixed-methods approach. MAIN MEASURES: Semistructured interviews were conducted to unveil barriers regarding the return-to-learn (RTL) process after concussion, with emergent themes serving as a general framework for the Delphi procedure. Panelists participated in 3 stages of a modified Delphi process beginning with a series of open-ended questions regarding postconcussion management in higher education. The second stage included anonymous ratings of the recommendations, followed by an opportunity to review and/or modify responses based on the group's consensus. RESULTS: The results from the semistructured interviews indicated students felt supported by their instructors; however, academic faculty/staff lacked information on appropriate academic supports and/or pathways to facilitate the RTL process. Of the original 67 statements, 39 achieved consensus (58.2%) upon cessation of the Delphi procedure across 3 main categories: recommendations for discharge documentation (21 statements), guidelines to facilitate a multidisciplinary RTL approach (10 statements), and processes to obtain academic supports for students who require them after concussion (8 statements). CONCLUSIONS: These findings serve as a basis for future policy in higher education to standardize RTL processes for students who may need academic supports following concussion.

Achieving Consensus Through a Modified Delphi Technique to Create the Post-concussion Collegiate Return-to-Learn Protocol.

BACKGROUND: Sport-related concussions (SRCs) affect millions of adolescents and young adults annually in the USA; however, current SRC consensus statements provide limited guidance on academic support for students within higher education. OBJECTIVE: To generate consensus on appropriate academic recommendations for clinicians, students, and academic stakeholders to support university students during their recovery. METHODS: Panelists participated in three stages of a modified Delphi procedure: the first stage included a series of open-ended questions after reviewing a literature review on post-SRC return-to-learn (RTL) in higher education; the second stage asked panelists to anonymously rate the recommendations developed through the first Delphi stage using a 9-point scale; and the final stage offered panelists the opportunity to change their responses and/or provide feedback based on the group's overall ratings. RESULTS: Twenty-two panelists including clinicians, concussion researchers, and academic stakeholders (54.5% female) from 15 institutions and/or healthcare systems participated in a modified Delphi procedure. A total of 42 statements were developed after round one. Following the next two rounds, 27 statements achieved consensus amongst the panel resulting in the four-stage Post-Concussion Collegiate RTL Protocol. CONCLUSION: There are several unique challenges when assisting university students back to the classroom after SRC. Explicit guidelines on when to seek additional medical care (e.g., if they are experiencing worsening or persistent symptoms) and how to approach their instructor(s) regarding academic support may help the student self-advocate. Findings from the present study address barriers and provide a framework for universities to facilitate a multidisciplinary approach amongst medical and academic stakeholders.

Going Beyond the State Law: Investigating High School Sport-Related Concussion Protocols.

CONTEXT: State laws provide general guidelines for sport-related concussion (SRC) management, but do not comprehensively address the multiple layers of management for this complex injury. While high schools are encouraged to develop a SRC protocol that includes both state law tenets and additional management practices, the execution of this warrants examination. OBJECTIVE: To investigate state law compliance and practice components included in high school SRC protocols, and determine whether the degree of sports medicine coverage influenced protocol quality. DESIGN: Qualitative document analysis. SETTING: High school athletics. PARTICIPANTS: In total, 184 Pennsylvania high schools [24.3% of schools statewide; full-time athletic trainer=149, part-time athletic trainer=13, missing=21] voluntarily provided copies of their protocol from the 2018-2019 academic year. MAIN OUTCOME MEASURES: Four athletic trainers conducted document analyses using a 67-item component analysis guide. Frequencies were computed for included protocol components related to the state law, preparticipation and prevention, recognition and assessment, and management. The difference in the total number of included components (max 60) by sports medicine coverage was assessed using a Mann-Whitney U test. RESULTS: There was heterogeneity in components included in the submitted protocols. Only 23.4% included all mandatory state law tenets. Immediate removal from play was noted in 67.4% of protocols, while only 1.6% contained prevention strategies. Return-to-play was addressed more frequently than return-to-learn (74.5% versus 32.6%). The sample had a mean of 15.5±9.7 total components per protocol. Schools with full-time sports medicine coverage had significantly more protocol components than those with part-time athletic trainers (15 [8.5-22.5] versus 6 [3-10.5] median components; U = 377.5, p < .001) Conclusions: School-level written SRC protocols were often missing components of the state law and additional best practice recommendations. Full-time sports medicine coverage in high schools is recommended to increase SRC protocol and healthcare quality.

Sport Participation and Specialization Characteristics Among Pediatric Soccer Athletes.

BACKGROUND: Soccer is an increasingly popular sport for children and adolescents in the United States. Little is known about participation patterns related to sport specialization. PURPOSE: To investigate soccer participation levels and sport specialization characteristics among youth soccer athletes. STUDY DESIGN: Cross-sectional study. METHODS: Adolescent athletes aged between 12 and 18 years completed an online survey addressing participant demographics, sports and soccer participation history, and level of specialization. Descriptive analyses characterized participation, while chi-square and Kruskal-Wallis tests assessed the influence of specialization, sex, and grade on survey variables. RESULTS: Overall, 83.7% of 746 respondents participated in an organized soccer league outside of school, and 37% played in multiple leagues concurrently. Nearly three-quarters of respondents trained in soccer more than 8 months of the year, with those who participated in club soccer being more likely to train more than 8 months of the year. More respondents were classified as high specialization (37.5%), followed by moderate (35.6%) and low (28.6%) specialization. No differences between sexes were noted for level of specialization or quitting other sports to specialize in soccer, but male athletes were more likely to train more than 8 months per year compared with female athletes. Respondents in older grades (9th-10th and 11th-12th grades) were more likely to be highly specialized and quit other sports to focus on soccer. No differences between grade levels were found among respondents training more than 8 months per year. CONCLUSION: The study findings suggest that many youth soccer athletes participated in multiple teams or leagues at the same time and trained more than 8 months of the year. Characteristics including participation on a club team, level of specialization, and male sex were associated with a greater likelihood of exceeding the 8-month training recommendation.

School Nurses' Management and Collaborative Practices for Student-Athletes Following Sport-Related Concussion.

The purpose of this study was to examine school nurses' management and collaboration with health-care providers (HCPs) for student-athletes following a concussion. Secondary school nurses accessed an online survey titled the Beliefs, Attitudes, and Knowledge of Pediatric Athletes with Concussions (access rate = 15.6%; n = 1,246/8,000). Approximately 40% of schools where nurses were employed administered baseline and postinjury concussion assessments. No significant differences were found between employment model (single vs. multiple sites) in regard to conducting baseline (p = .908) administration at their site; however, those employed at a single school more frequently offered postinjury assessments at their site than those at multiple sites (p = .019). School nurses most frequently reported relationships with an athletic trainer (38.8%, n = 483/1,246) compared to other HCPs. A concussion management team, including school nurses, and other recommended members should develop comprehensive concussion management plans. Plans should comprise of multiple concussion assessments to aid in the return-to-learn/play processes.

Examining Academic Support After Concussion for the Adolescent Student-Athlete: Perspectives of the Athletic Trainer.

CONTEXT: Student-athletes may require cognitive rest and academic support after concussion. Athletic trainers (ATs) in secondary schools are uniquely positioned to provide medical care and to collaborate with school professionals while managing concussions. However, little is known regarding return-to-learn policies and their implementation in secondary schools. OBJECTIVE: To examine ATs' perspectives on return to learn, cognitive rest, and communication with school professionals after concussion. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 1124 secondary school ATs completed the survey (28.5% response rate). The majority of participants were employed full time (752/1114 [67.5%]) in public schools (911/1117 [81.6%]). MAIN OUTCOME MEASURE(S): School and AT employment characteristics, demographics, number of concussions evaluated annually, and perceptions of school professionals' familiarity with ATs' responsibilities were independent variables. RESULTS: Of the ATs, 44% reported having an existing return-to-learn policy. The strongest predictor of a return-to-learn policy was frequent communication with teachers after concussion (odds ratio = 1.5; 95% confidence interval = 1.2, 1.7). Most ATs recommended complete cognitive rest (eg, no reading, television; 492/1087 [45.3%]) or limited cognitive activity based upon symptoms (391/1087 [36.0%]). Common academic accommodations were postponed due dates (789/954 [82.7%]), rest breaks (765/954 [80.2%]), and partial attendance (740/954 [77.6%]). Athletic trainers self-reported as primary monitors of health (764/1037 [73.7%]) and academic progression (359/1011 [35.5%]). The strongest predictor of ATs' communication with school professionals was their perception of school professionals' understanding of ATs' roles. CONCLUSIONS: Overall, ATs followed best practices for cognitive rest and return to learn after concussion. Although ATs are central to the management of student-athletes' physical health after concussion, school professionals may be better suited to monitor academic progress. Increased communication between the AT and school professionals is recommended to monitor recovery and facilitate academic support for symptomatic student-athletes.