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Sports Med ; 51(5): 1087-1105, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33428120


BACKGROUND: Symptom resolution is a key marker in determining fitness for return to activity following concussion, but in some cases, distinguishing persistent symptoms due to concussion versus symptoms related to other factors can be challenging. OBJECTIVE: To determine base rates of postconcussional syndrome (PCS) diagnostic categorization in healthy cadets and student athletes with no recent concussion. METHODS: 13,009 cadets and 21,006 student athletes completed baseline preseason testing. After inclusion/exclusion criteria were applied, the final sample included 12,039 cadets [9123 men (75.8%); 2916 women (24.2%)] and 18,548 student athletes [10,192 men (54.9%); 8356 women (45.1%)]. Participants completed the Sport Concussion Assessment Tool-3rd Edition (SCAT3) symptom evaluation as part of baseline preseason testing. The PCS diagnostic categorization was classified by the International Classification of Diseases, 10th Revision (ICD-10) symptom criteria for PCS. RESULTS: In the absence of recent concussion, subgroups of cadets (17.8% of men; 27.6% of women) and student athletes (11.4% of men; 20.0% of women) reported a cluster of symptoms that would meet the ICD-10 symptom criteria for PCS. Participants with insufficient sleep and/or preexisting conditions (e.g., mental health problems), freshmen cadets, and cadets at the U.S. Coast Guard Academy and at the U.S. Air Force Academy (freshmen were tested during basic cadet training) were more likely to report a cluster of symptoms that would meet the ICD-10 symptom criteria for PCS. CONCLUSION: The ICD-10 symptom criteria for PCS can be mimicked by preexisting conditions, insufficient sleep, and/or stress. Findings support person-specific assessment and management of symptoms following concussion.

Traumatismos em Atletas , Concussão Encefálica , Síndrome Pós-Concussão , Atletas , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Feminino , Humanos , Masculino , Estudantes
Neurology ; 95(21): e2935-e2944, 2020 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-32907967


OBJECTIVE: To examine the association between estimated age at first exposure (eAFE) to American football and clinical measures throughout recovery following concussion. METHODS: Participants were recruited across 30 colleges and universities as part of the National Collegiate Athletic Association (NCAA)-Department of Defense Concussion Assessment, Research and Education Consortium. There were 294 NCAA American football players (age 19 ± 1 years) evaluated 24-48 hours following concussion with valid baseline data and 327 (age 19 ± 1 years) evaluated at the time they were asymptomatic with valid baseline data. Participants sustained a medically diagnosed concussion between baseline testing and postconcussion assessments. Outcome measures included the number of days until asymptomatic, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) composite scores, Balance Error Scoring System (BESS) total score, and Brief Symptom Inventory 18 (BSI-18) subscores. The eAFE was defined as participant's age at the time of assessment minus self-reported number of years playing football. RESULTS: In unadjusted regression models, younger eAFE was associated with lower (worse) ImPACT Visual Motor Speed (R 2 = 0.031, p = 0.012) at 24-48 hours following injury and lower (better) BSI-18 Somatization subscores (R 2 = 0.014, p = 0.038) when the athletes were asymptomatic. The effect sizes were very small. The eAFE was not associated with the number of days until asymptomatic, other ImPACT composite scores, BESS total score, or other BSI-18 subscores. CONCLUSION: Earlier eAFE to American football was not associated with longer symptom recovery, worse balance, worse cognitive performance, or greater psychological distress following concussion. In these NCAA football players, longer duration of exposure to football during childhood and adolescence appears to be unrelated to clinical recovery following concussion.

Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Futebol Americano/lesões , Adolescente , Adulto , Distribuição por Idade , Atletas , Traumatismos em Atletas/complicações , Concussão Encefálica/diagnóstico , Humanos , Masculino , Testes Neuropsicológicos , Estudantes , Estados Unidos , Universidades , Adulto Jovem
J Sci Med Sport ; 23(9): 814-819, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32336568


OBJECTIVES: To test whether 1) concussed athletes demonstrate slower tandem gait times compared to controls and 2) concussed female athletes display greater post-injury deficits than males. DESIGN: Prospective longitudinal METHOD: Fifty concussed collegiate student-athletes (32% female, age=20.18±1.27 years) completed tandem gait tests during pre-season (Time 1) and acutely (<72hours) post-concussion (Time 2), and twenty-five controls (52% female, age=21.08±2.22 years) completed tandem gait at two time points, 1.96±0.46 days apart. Participants completed four single-task (ST) and dual-task (DT) trials. During DT trials, they simultaneously completed a cognitive assessment. The best ST and DT times were recorded, along with cognitive accuracy, and the change score between the two assessments was calculated. A positive change in tandem gait time was indicative of worsening performance. A 2×2 (group*sex) ANOVA was used to examine change between pre-injury and post-injury tests for ST/DT tandem gait time and DT cognitive accuracy. RESULTS: The change in tandem gait time from Time 1 to Time 2 was significantly higher for the concussion group relative to controls during both ST (Concussion: 1.36±2.6 seconds, Controls: -1.16±0.8 seconds, p<0.001) and DT (Concussion: 1.70±3.8 seconds, Controls: -0.94±1.7 seconds, p=0.002) tandem gait. There were no interactions or main effects of sex for tandem gait time or cognitive accuracy. CONCLUSIONS: There were no sex-specific differences in the change in tandem gait performance among concussed collegiate athletes or controls. However, all concussed participants, regardless of sex, performed significantly worse on tandem gait than male and female controls, who both improved between testing time points.

Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/fisiopatologia , Marcha , Equilíbrio Postural , Adolescente , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Estudos Prospectivos , Fatores Sexuais , Adulto Jovem
J Athl Train ; 54(5): 527-533, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30933609


CONTEXT: Postconcussion deficits in neurocognitive performance and postural control may persist at the time of return to sport participation. How these deficits, if present, affect athletic performance is largely unknown, with prior studies showing mixed results. OBJECTIVE: To evaluate postconcussion National Hockey League player performance using advanced hockey metrics over short- (5 games), medium- (10 games), and long-term (remainder of the season) seasonal performance. DESIGN: Retrospective cohort study. PATIENTS OR OTHER PARTICIPANTS: National Hockey League players who sustained a sport-related concussion (SRC; n = 93) and returned during the same season and players (n = 51) who missed time for non-injury-related reasons. MAIN OUTCOME MEASURE(S): Six performance metrics were used: (1) points per 60 minutes, (2) Corsi percentage, (3) personal Fenwick shooting percentage, (4) scoring chances per 60 minutes, (5) penalty difference, and (6) PDO (not an acronym but sometimes referred to as SVSP% [save percentage shooting percentage]). Performance was compared using 2 (group) × 2 (time) repeated-measures analyses of variance for 3 time windows: (1) ±5 games, (2) ±10 games, and (3) the remainder of the season postconcussion. Alpha values were set at a conservative .01 to account for the lack of independence among dependent variables. RESULTS: No significant interactions were present for any of the 6 dependent variables at any of the 3 time windows. Overall, none of the secondary variables differed. CONCLUSIONS: Using advanced, sport-specific metrics, we found that National Hockey League players did not display worse seasonal performance during 3 postinjury time frames after they sustained an SRC. Whereas laboratory studies have identified lingering neurologic deficits after concussion, our results suggest that these deficits, if present, either do not translate to worse athletic performance or were not captured by these 44 metrics. Further, prospective efforts are needed to accurately quantify performance after SRC among professional hockey players.

Traumatismos em Atletas , Desempenho Atlético , Concussão Encefálica , Hóquei/lesões , Volta ao Esporte , Adulto , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/psicologia , Desempenho Atlético/fisiologia , Desempenho Atlético/psicologia , Concussão Encefálica/etiologia , Concussão Encefálica/fisiopatologia , Concussão Encefálica/psicologia , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Equilíbrio Postural , Estudos Retrospectivos , Volta ao Esporte/fisiologia , Volta ao Esporte/psicologia , Volta ao Esporte/normas