RESUMO
CONTEXT: Sports-related concussions are commonly occurring injuries as a result of sports and recreation that may cause alterations in brain functioning. It is important to be able to evaluate the impact of these injuries on function to manage the injury recovery and ensure recovery. Recent literature suggests the use of objective evaluation strategies in a multifaceted approach to evaluate and manage these injuries. It is important to understand the relationships between the assessments and how best to utilize each assessment. The purpose of this study was to investigate if relationships exist between measures of vestibular function at baseline in assessments that may be used following sports-related concussions. Additionally, a secondary purpose was to determine if self-reported symptoms were related to performance on the assessments. This study aimed to identify if these assessments measured independent functions of the vestibulo-ocular reflex or if some redundancy existed among the assessment strategies. DESIGN: A cross-sectional study design was used in a cohort of collegiate athletes ages 18-24. METHODS: Participants completed demographics questionnaires, the Post-Concussion Symptom Scale, Gaze Stabilization Test, and Concussion Balance Test. Spearman rho correlations were used to examine the relationships between the measures. RESULTS: One hundred and thirty-five collegiate athletes (82 males and 53 females) were included, representative of 3 sports (cheerleading, soccer, and football) with a mean age of 19.77 (1.42) years old. There were weak to moderate, significant relationships between measures of Gaze Stabilization Test and Concussion Balance Test errors (r = .20-.31, P = .001-.03). CONCLUSIONS: The direction of these relationships indicated that greater Concussion Balance Test errors were associated with greater Gaze Stabilization Test performance. These relationships may be attributed to the difficulty created by the foam conditions and the integration of more complex sensory tasks required to maintain balance during the more difficult conditions.
RESUMO
CONTEXT: Concussion evaluations include a multifaceted approach; however, individual differences can influence test score interpretations and validity. Social determinants of health (SDoH) differentially affect disease risk and outcomes based upon social and environmental characteristics. Efforts to better define, diagnose, manage, and treat concussion have increased, but minimal efforts have focused on examining SDoH that may affect concussion recovery. OBJECTIVE: This review examined previous research that examined the effect of SDoH on concussion recovery of athletes. EVIDENCE ACQUISITION: CINAHL, MEDLINE, PsycInfo, and SPORTDiscus databases were used to search the terms "concussion" AND "recovery," "youth, adolescent, teen and/or adult," and "social determinants of health" and variations of these terms. The evidence level for each study was evaluated using the 2011 Oxford Center for Evidence-Based Medicine Guide. EVIDENCE SYNTHESIS: Seven thousand nine hundred and twenty-one articles were identified and screened for inclusion. Five studies met the inclusion criteria and were included in this systematic review. Using the Downs and Black Quality Index, the studies included in this review were deemed high quality. CONCLUSION: Though limited literature exists, there is preliminary evidence to suggest that SDoH (specifically, economic stability, education access and quality, and social and community context) may have an impact on the clinical recovery from concussion. The dimensions evaluated varied between studies and the results were inconsistent. No single factor consistently affected clinical recovery; however, private insurance and race appear to have an association with the speed of recovery. Unfortunately, the potential intersection of these variables and other preinjury factors limits the ability to make clear recommendations. While most of the studies in this review are retrospective in nature, future efforts should focus on training clinicians to prospectively evaluate the effect of SDoH on concussion recovery and injury outcomes. Funding and registration for this systematic review were not obtained nor required.
RESUMO
BACKGROUND: Recent literature has identified that the vestibular system is often involved following a sport-related concussion. Furthermore, the consequences of vestibular and ocular/oculomotor involvement have been explored and identified as potential predictors for prolonged recovery. Although vestibular and ocular/oculomotor involvement is common following head injury, the clinical assessment strategies for vestibular function are less commonly practiced in the sports medicine setting and have limited research. Therefore, despite the suspected link between vestibular consequences of concussion and prolonged recovery time, there is limited understanding on how these consequences affect outcomes following concussion and how to properly assess these functions. OBJECTIVES: The objectives of this scoping review were to: (1) outline the current clinical assessment strategies for vestibular and ocular/oculomotor function in sports medicine to identify the best strategies for assessment, and (2) investigate the evidence regarding the influence of vestibular and ocular/oculomotor function on outcomes for patients with a sport-related concussion. METHODS: Two separate and independent reviews of the current literature were conducted to provide evidence for each specified objective. Studies for potential inclusion were identified through electronic database searches. Inclusion criteria for each objective were used to identify the most effective studies and inquiries to address the outlined objectives. RESULTS: The identified and included studies provided evidence-based information regarding the current assessment strategies as well as outcomes following concussion. CONCLUSION: Despite agreement among studies, there was limited evidence to support each aim, identifying a need for further exploration into these objectives.
