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1.
J Appl Biomech ; : 1-5, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34784581

RESUMO

Field studies have evaluated the accuracy of sensors to measure head impact exposure using video analysis, but few have studied false negatives. Therefore, the aim of the current study was to investigate the proportion of potential false negatives in high school soccer head impact data. High school athletes (23 females and 31 males) wore headband-mounted Smart Impact Monitor-G impact sensors during competitive soccer games. Video footage from 41 varsity games was analyzed by 2 independent reviewers to identify head contact events, which were defined as visually observed contact to the head. Of the 1991 video-identified head contact events for which sensors were functioning and worn by the players, 1094 (55%) were recorded by the sensors. For female players, 45% of video-identified head contact events were recorded by the sensor compared with 59% for male players. For both females and males, sensitivity varied by impact mechanism. By quantifying the proportion of potential false negatives, the sensitivity of a sensor can be characterized, which can inform the interpretation of previous studies and the design of future studies using head impact sensors. Owing to the difficulty in obtaining ground truth labels of head impacts, video review should be considered a complementary tool to head impact sensors.

3.
Lancet Child Adolesc Health ; 5(11): 792-799, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34600629

RESUMO

BACKGROUND: Sport-related concussion is a public health problem, particularly in adolescents. Quality of life is reduced in adolescents with persistent post-concussive symptoms (symptoms >28 days). We replicated a previous randomised controlled trial to validate the safety, efficacy, and generalisability of, and objective adherence to, prescribed early targeted heart rate subsymptom threshold aerobic exercise compared with placebo-like stretching exercise for adolescent recovery from sport-related concussion and for reducing the risk of persistent post-concussive symptoms. METHODS: This randomised controlled trial was done at three community and hospital-affiliated sports medicine concussion centres in the USA. Male and female adolescent athletes (aged 13-18 years) presenting within 10 days of sport-related concussion were randomly assigned to individualised subsymptom threshold aerobic or stretching exercise at least 20 min daily, for up to 4 weeks after injury. Exercise adherence and intensity were measured by heart rate monitors. The primary outcome was clinical recovery (ie, return to baseline symptoms, normal exercise tolerance, and a normal physical examination) within the 4-week intervention period, and development of persistent post-concussive symptoms beyond 28 days after injury. This study is registered with ClinicalTrials.gov, NCT02959216. FINDINGS: Between Aug 1, 2018, and March 31, 2020, 118 adolescents were recruited (61 were randomly assigned to the aerobic exercise group and 57 to the stretching exercise group) and included in the intention-to-treat analysis. On survival analysis, controlling for sex, site, and mean daily exercise time, patients assigned to aerobic exercise were more likely to recover within 4 weeks after injury compared with those assigned to stretching exercise, with a 48% reduced risk of persistent post-concussive symptoms (hazard ratio for stretching vs aerobic exercise of 0·52 [95% CI 0·28-0·97], p=0·039). No adverse events were reported. INTERPRETATION: This multicentre study found that early treatment with subsymptom threshold aerobic exercise safely speeds recovery from sport-related concussion and reduces the risk for persistent post-concussive symptoms, an important result given the impact of delayed recovery on adolescent quality of life. Adherence was good and there were no adverse events from this non-pharmacological treatment. These results suggest that physicians should not only permit, but consider prescribing, early subsymptom threshold physical activity to adolescents as treatment for sport-related concussion and to reduce the risk of persistent post-concussive symptoms. FUNDING: American Medical Society for Sports Medicine.

4.
Phys Sportsmed ; : 1-9, 2021 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-34521303

RESUMO

OBJECTIVE: To evaluate pre - to post-season differences in individual subtests of the Visio-Vestibular Examination (VVE) in healthy middle and high school athletes. METHODS: This prospective cohort study recruited participants from a private suburban United States secondary school. Participants completed a demographic questionnaire prior to the start of their season. A proxy for head impact exposure was estimated by incorporating previously published head impact frequencies by team and sport. The VVE was completed pre - and post-season and consisted of 9 subtests: smooth pursuit, horizontal/vertical saccades and gaze stability, binocular convergence, left/right monocular accommodation, and complex tandem gait. Generalized estimating equations were employed to assess the relative risk of an abnormal VVE outcome based on testing session (pre - vs. post-season). RESULTS: Participants included middle and high school athletes (n = 115; female = 59 (51.3%); median age at first assessment = 14.9 years, [IQR = 13.6, 16.0]) during 2017/18 - 2019/20 school years. During pre-season testing, accommodation (10.0%) and complex tandem gait (9.2%) had the largest proportion of abnormal outcomes, while smooth pursuits (10.6%) and convergence (9.5%) had the largest proportion of abnormal outcomes post-season. When assessing the effect of testing session on the relative risk of any abnormal VVE subtest, there were no significant findings (P ≥ 0.25). Additionally, there were no significant effects of testing session when adjusting for estimated head impact exposure for any VVE subtest (P ≥ 0.25). CONCLUSIONS: Visio-vestibular function as measured by the VVE does not change from pre - to post-season in otherwise healthy adolescent athletes. Our findings suggest that the VVE may be stable and robust to typical neurodevelopment occurring in this dynamic age group and help inform post-injury interpretation of visio-vestibular impairments.

5.
Optom Vis Sci ; 98(7): 826-832, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34328459

RESUMO

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.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Futebol Americano , Adolescente , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Tecnologia de Rastreamento Ocular , Humanos , Masculino , Testes Neuropsicológicos , Instituições Acadêmicas
6.
Pediatr Emerg Care ; 37(7): 371-379, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34180858

RESUMO

ABSTRACT: Concussion, a type of mild traumatic brain injury, is a common injury encountered by providers caring for pediatric patients in the emergency department (ED) setting. Our understanding of the pathophysiologic basis for symptom and recovery trajectories for pediatric concussion continues to rapidly evolve. As this understanding changes, so do recommendations for optimal management of concussed youth. As more and more children present to EDs across the country for concussion, it is imperative that providers caring for children in these settings remain up-to-date with diagnostic recommendations and management techniques. This article will review the definition, epidemiology, pathophysiology, diagnosis, and management of pediatric concussion in the ED setting.


Assuntos
Concussão Encefálica , Adolescente , Concussão Encefálica/diagnóstico , Concussão Encefálica/epidemiologia , Concussão Encefálica/terapia , Criança , Serviço Hospitalar de Emergência , Humanos
7.
Clin J Sport Med ; 2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34173781

RESUMO

OBJECTIVE: To determine the relationship between patient characteristics and performance on the visio-vestibular examination (VVE) in a cohort of healthy youth athletes and explore the potential association between the VVE and other standardized concussion batteries. DESIGN: Cross-sectional. SETTING: Suburban middle and high school. PATIENTS: One hundred ninety subjects age 11 to 18 enrolled before their respective scholastic sport season between August 2017 and March 2020. ASSESSMENT OF INDEPENDENT VARIABLES: Patient age, sex, concussion history, comorbidities, hours of weekly exercise, Sport Concussion Assessment Tool, 5th edition (SCAT-5), King-Devick (K-D), Postconcussion Symptom Inventory (PCSI). MAIN OUTCOME MEASURES: Visio-vestibular examination abnormalities (smooth pursuit, horizontal and vertical saccades, horizontal and vertical gaze stability, convergence, right and left monocular accommodation, complex tandem gait). RESULTS: Overall, 29.5% of subjects had at least one of 9 VVE elements abnormal, 7.9% at least 2, and 3.2% at least 3. None of 72 comparisons of the VVE elements, when stratified by age, sex, concussion history, history of headaches, attention deficit hyperactivity disorder, learning issues, psychiatric problems, motion sickness, or weekly hours of exercise, reached significance using the Benjamini-Hochberg procedure at a false discovery rate of 5%. There were no significant associations between VVE elements and the SCAT-5, K-D, or PCSI. CONCLUSIONS: The VVE is robust across multiple patient characteristics. Although healthy subjects may have one abnormal element, multiple abnormal elements are a less common feature, making multiple abnormal elements more indicative of concussion, highlighting the use of this assessment in the setting of injury. The VVE tests unique domains when compared with the PCSI, SCAT-5, and K-D.

8.
Med Sci Sports Exerc ; 53(6): 1245-1251, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33986230

RESUMO

INTRODUCTION: Repetitive head impacts in soccer have been linked to short-term neurophysiological deficits, and female soccer players have higher concussion rates than males. These findings have inspired investigation into gender differences in head impact exposure and how head impact rate contributes to the cumulative effect of head impact exposure on neurological outcomes. Various periods of exposure have been used to calculate head impact rates, including head impacts per season, game, and player-hour. PURPOSE: The aim of this study was to apply different methodological approaches to quantify and compare head impact rates by gender for two seasons of high school varsity soccer. METHODS: Video review was used to confirm all events recorded by a headband-mounted impact sensor and calculate playing time for all players. Impact rates were calculated per athlete exposure (presence and participation) and per player-hour (scheduled game time, individual play time, and absolute time). RESULTS: Impact rates per athlete exposure ranged from 2.5 to 3.2 for males and from 1.4 to 1.6 for females, and impact rates per player-hour ranged from 2.7 to 3.8 for males and from 1.0 to 1.6 for females. The exposure calculation method significantly affected head impact rates; however, regardless of approach, the head impact rate for males was higher, up to threefold, than for females. Individual head impact exposure varied substantially within a team with one in five players experiencing no impacts. CONCLUSIONS: Overall, the gender differences found in this study indicate that males experience higher head impact exposure compared with females. Future studies are needed to understand potential clinical implications of variability in head impact exposure and reconcile higher female concussion rates with the reduced head impact rates presented herein.


Assuntos
Cabeça/fisiologia , Futebol/fisiologia , Concussão Encefálica/epidemiologia , Concussão Encefálica/fisiopatologia , Feminino , Humanos , Masculino , Pennsylvania/epidemiologia , Estudos Prospectivos , Instituições Acadêmicas , Distribuição por Sexo , Fatores Sexuais , Futebol/lesões , Fatores de Tempo , Estudos de Tempo e Movimento
9.
Vision Res ; 185: 58-67, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33895648

RESUMO

This study sought to test the hypothesis that significant differences would be observed in clinical measures, symptoms, and objective assessments of vergence eye movements between children with typically developing convergence insufficiency (TYP-CI) and children with persistent post-concussion symptoms with convergence insufficiency (PPCS-CI). Data from age-matched binocularly normal controls (BNC) were used for comparison. Data from three groups of children 11 to 17 years of age are presented: BNC (N = 11), TYP-CI (N = 10), and PPCS-CI (N = 15). Clinical measures of vergence, accommodation, and symptom severity were collected. Symmetrical 4° disparity vergence eye movements were quantified with an eye tracker integrated into a head-mounted display (Oculus DK2). Peak velocity and final response amplitude of convergence and divergence eye movement responses were assessed. The mean near point of convergence (break) was more receded (worse), the amplitude of accommodation more deficient, and convergent and divergent peak velocities slower in the PPCS-CI group compared with the TYP-CI and BNC groups. These results suggest that PPCS-CI may be a different clinical entity than TYP-CI. Hence, more research is warranted to determine whether the therapeutic interventions that are effective for TYP-CI can also be used for PPCS-CI populations.

10.
Orthop J Sports Med ; 9(3): 2325967120984423, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33738313

RESUMO

Background: Repeated head impacts sustained by athletes have been linked to short-term neurophysiologic deficits; thus, there is growing concern about the number of head impacts sustained in sports. Accurate head impact exposure data obtained via head impact sensors may help identify appropriate strategies across sports and between genders to mitigate repetitive head impacts. Purpose: To quantify sport- and gender-based differences in head impact rate and mechanism for adolescents. Study Design: Cohort study; Level of evidence, 2. Methods: High school female and male varsity soccer, basketball, lacrosse, and field hockey (female only) teams were instrumented with headband-mounted impact sensors during games over 2 seasons of soccer and 1 season of basketball, lacrosse, and field hockey. Video review was used to remove false-positive sensor-recorded events, and the head impact rate per athlete-exposure (AE) was calculated. Impact mechanism was categorized as equipment to head, fall, player to head, or head to ball (soccer only). Results: Male players had significantly higher head impact rates as compared with female players in soccer (3.08 vs 1.41 impacts/AE; rate ratio, 2.2 [95% CI, 1.8-2.6]), basketball (0.90 vs 0.25; 3.6 [2.6-4.6]), and lacrosse (0.83 vs 0.06; 12.9 [10.1-15.8]). Impact mechanism distributions were similar within sports between boys and girls. In soccer, head to ball represented 78% of impacts, whereas at least 88% in basketball were player-to-player contact. Conclusion: Across sports for boys and girls, soccer had the highest impact rate. Male high school soccer, basketball, and lacrosse teams had significantly higher head impact rates than did female teams of the same sport. For girls, basketball had a higher head impact rate than did lacrosse and field hockey, and for boys, basketball had a similar impact rate to lacrosse, a collision sport. Sport differences in the distribution of impact mechanisms create sport-specific targets for reducing head impact exposure.

11.
Vision Res ; 183: 73-80, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33735759

RESUMO

The purpose of the study was to determine the frequency of vision diagnoses after concussion in adolescents and evaluate the sensitivity and specificity of physician-administered screening for detecting convergence and accommodative disorders post-concussion. We enrolled participants 11 to 17 years old, assessed 4 to 12 weeks following a diagnosed concussion. During the initial concussion examination, a sports medicine physician measured the near point of convergence (NPC), monocular accommodative amplitude (AA), and symptoms using the Convergence Insufficiency Symptom Survey (CISS). A comprehensive oculomotor evaluation was performed by an optometrist. One hundred and thirteen adolescents were enrolled, with a mean age of 15.2 years. Seventy-nine of the 113 (70%) participants had at least one oculomotor diagnosis after concussion, with the most common problems being vergence disorders (60%) and accommodative disorders (57%). The most common vergence disorder was convergence insufficiency (35%). Among accommodative disorders, the most common problem was accommodative insufficiency (35%). In all, 47% of the participants had more than one oculomotor diagnosis following concussion. The sensitivity of physician screening using measures of NPC, AA, and CISS for detecting convergence and accommodative insufficiency was 63%, 43%, 48%, respectively. The results of this study provide additional evidence that vision problems are common in adolescents with persistent concussion symptoms in the sub-acute phase 4 to 12 weeks post-concussion, and current physician screening methods using the NPC, AA, or the CISS underperform. Thus, it is prudent that adolescents with post-concussion symptoms lasting more than 4 weeks post injury receive a comprehensive oculomotor examination.

12.
Brain Inj ; 35(2): 226-232, 2021 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-33459038

RESUMO

Objective: Concussion is associated with dysautonomia, altered blood pressure (BP) control, and may cause Orthostatic Hypotension (OH). We measured prevalence of OH using the 1-minute supine-to-standing OH Test in adolescents with concussion and controls.Participants: Adolescents within 10 days of injury (Concussion Group, n = 297, 15.0 ± 1.7 years, 59% male) were compared with controls (Control Group, n = 214, 15.0 ± 1.5 years, 58% male).Methods: BP, heart rate (HR), and complaints of lightheadedness/dizziness were measured after 2-minute supine and 1-minute standing. Control Group was assessed once. Concussion Group was assessed twice; (1) initial visit (mean 6.0 ± 3 days-since-injury) and (2) after clinical recovery (mean 46.3 ± 42 days-since-injury).Results: Initial visit; Concussion Group reported feeling lightheaded/dizzy on postural change more often than the Control Group (37% vs 4%, p < .001) but did not differ in meeting standard OH criteria (3% vs 5%, p = .32). Experiencing symptoms did not correlate with meeting OH criteria, but correlated with abnormal vestibulo-ocular reflex. After clinical recovery; Concussion Group did not differ in experiencing lightheaded/dizziness on postural change than controls (4%, p = .65).Conclusion: Adolescents commonly experience orthostatic intolerance after concussion without meeting the standard criteria for OH.


Assuntos
Concussão Encefálica , Hipotensão Ortostática , Adolescente , Pressão Sanguínea , Concussão Encefálica/complicações , Tontura/etiologia , Feminino , Frequência Cardíaca , Humanos , Hipotensão Ortostática/etiologia , Masculino
13.
Clin Nurs Res ; 30(2): 104-109, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32441131

RESUMO

Head injuries in childhood can result in concussion. Families of a child with a head injury often seek medical advice through telephone triage call systems. It is important to understand if patients follow telephone triage recommendations and what proportion of triage calls result in subsequent concussion diagnosis. We used a one-year retrospective cohort of triage calls screened with the Barton Schmitt Pediatric Head Injury Telephone Triage Protocol. The objectives were to estimate the proportion who followed up with urgent recommendations to see a provider and determine prevalence of diagnoses of concussion. Out of 2,454 calls with recommendations to be seen urgently, the estimated proportion of being seen in the medical home network or an outside health care facility was 84.1%. Estimated overall diagnoses of concussion among those who were seen was 39.5%. These data can be used to improve patient education and follow-up, as well as the utility of the telephone triage system.


Assuntos
Traumatismos Craniocerebrais , Triagem , Criança , Traumatismos Craniocerebrais/diagnóstico , Seguimentos , Humanos , Estudos Retrospectivos , Telefone
14.
J Sch Nurs ; 37(1): 17-27, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33043755

RESUMO

Concussion is a common injury among adolescents. It is unknown how a concussion affects driving behavior and performance in adolescents. Although there are guidelines for return to learn, exercise, and sports that school nurses can help support in school, little is known about return to driving after concussion. The goal of this integrative review was to summarize the current literature on return to driving after concussion in adolescents. Six articles published between 2016 and 2020 were included in the review. Physicians and nurse practitioners find providing driving recommendations to adolescents to be appropriate; however, they are unclear what metrics to use to determine whether a patient is fit to drive. Future studies should explore clinical predictors of readiness to return to driving in adolescents. School nurses have an opportunity to support adolescents in their resumption of typical activities after concussion including school, sports, and, as more evidence becomes available, driving.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Esportes , Adolescente , Exercício Físico , Humanos , Instituições Acadêmicas
15.
J Adolesc Health ; 69(1): 108-113, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33339732

RESUMO

PURPOSE: Although return to learn, exercise, and sports have evidence-based guidelines, there is limited research investigating return to driving after concussion. The purpose was to characterize and compare adolescent driving behaviors after concussion. METHODS: Using the Minds Matter Concussion Registry, we queried data of adolescents, aged 16-19 years, diagnosed with a concussion ≤28 days of injury and seen between January 31, 2017 and August 31, 2018 at the specialty care concussion program. Outcomes included patient report of: changes postinjury driving behaviors; Post-Concussion Symptom Inventory; return to school, and exercise and sports. Provider recommendations for return to school after initial clinical assessment were also examined. Descriptive statistics, analysis of covariance, and chi-square tests were performed. RESULTS: Of the 332 drivers (46.1% female; mean age 17.5 years, 95% confidence interval [CI], 17.4-17.6), 46.9% had returned to driving since injury. Of those who returned to driving, 58.9% reported "Driving with No Changes." The Post-Concussion Symptom Inventory score was higher among "Driving with Changes" (48.7, 95% CI: 42.2-55.2) than "Driving with No Changes" (27.4, 95% CI: 22.3-32.5, p < .01) and "Has Not Driven Since Injury" (42.3, 95% CI: 38.4-46.3, p < .01). Among the 332 drivers, few had returned to exercise (15.4%) or organized sports (6.0%). Of those in school (n = 291), only 8.9% were provider recommended to return to full school days after clinical assessment. CONCLUSION: Many adolescents continued to drive after concussion, despite not yet having returned to exercise or sport. Nine of 10 were advised to return to school with accommodations to begin a gradual increase in cognitive activity, suggesting a gradual increase in driving may be justified.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Síndrome Pós-Concussão , Esportes , Adolescente , Exercício Físico , Feminino , Humanos , Masculino , Síndrome Pós-Concussão/diagnóstico
16.
Br J Sports Med ; 55(24): 1387-1394, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33355211

RESUMO

OBJECTIVES: To examine sex differences in sport-related concussion (SRC) across comparable sports. METHODS: Prospective cohort of collegiate athletes enrolled between 2014 and 2017 in the Concussion Assessment, Research and Education Consortium study. RESULTS: Among 1071 concussions (females=615; 57.4%), there was no difference in recovery (median days to full return to play) (females=13.5 (IQR 9.0, 23.1) vs males=11.8 (IQR 8.1, 19.0), p=0.96). In subgroup analyses, female recovery was longer in contact (females=12.7 days (IQR 8.8, 21.4) vs males=11.0 days (IQR 7.9, 16.2), p=0.0021), while male recovery was longer in limited contact sports (males=16.9 days (IQR 9.7, 101.7) vs females=13.8 days (IQR 9.1, 22.0), p<0.0001). There was no overall difference in recovery among Division I schools (females=13.7 (IQR 9.0, 23.1) vs males=12.2 (IQR 8.2 19.7), p=0.5), but females had longer recovery at the Division II/III levels (females=13.0 (IQR 9.2, 22.7) vs males=10.6 (IQR 8.1, 13.9), p=0.0048). CONCLUSION: Overall, no difference in recovery between sexes across comparable women's and men's sports in this collegiate cohort was found. However, females in contact and males in limited contact sports experienced longer recovery times, while females had longer recovery times at the Division II/III level. These disparate outcomes indicate that, while intrinsic biological sex differences in concussion recovery may exist, important, modifiable extrinsic factors may play a role in concussion outcomes.

17.
Clin Sports Med ; 40(1): 147-158, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33187605

RESUMO

Pediatric patients with concussions have different needs than adults throughout the recovery process. Adolescents, in particular, may take longer to recover from concussion than adults. Initially, relative rest from academic and physical activities is recommended for 24 to 48 hours to allow symptoms to abate. After this time period, physicians should guide the return to activity and return to school process in a staged fashion using published guidelines. Further concussion research in pediatric patients, particularly those younger than high-school age, is needed to advance the management of this special population.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Esportes Juvenis/lesões , Adolescente , Adulto , Traumatismos em Atletas/complicações , Concussão Encefálica/complicações , Criança , Terapia por Exercício , Humanos , Aprendizagem , Síndrome Pós-Concussão/diagnóstico , Síndrome Pós-Concussão/terapia , Volta ao Esporte , Fatores de Tempo
18.
Clin J Sport Med ; 31(2): 139-144, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30475245

RESUMO

OBJECTIVE: Many schools and sports leagues provide preseason concussion education to parents/guardians, and in some jurisdictions, it is required for interscholastic sports participation. However, directives about content are absent or vague. The purpose of this study was to obtain expert consensus about what parents/guardians need to know to about concussion. DESIGN: A modified Delphi process with nationally recognized expert panel members was used to obtain consensus about parent/guardian behaviors relevant to concussion prevention, identification, and management and knowledge domains relevant to performance of those behaviors. RESULTS: Sixteen parent/guardian behaviors and 24 knowledge domains were identified. However, consensus was not achieved regarding whether it is realistic to expect parents/guardians to perform approximately one-third of the behaviors that experts agreed mattered. This variability may reflect underlying uncertainty about the capacities of some parents/guardians to put knowledge into action or the belief that there are other barriers to action. Furthermore, for most knowledge domains, there was a lack of agreement about whether or not there could be a "correct" answer on the basis of current scientific knowledge. CONCLUSIONS: These findings raise practical and ethical questions: how can we expect parents/guardians to help prevent, identify, or manage concussion if they cannot have all the information required to engage in these behaviors due to lack of scientific consensus? This issue is not unique to concussion. Best practices for risk communication and shared decision-making can inform how we think about educating parents/guardians about concussion inside and outside of the health care setting.


Assuntos
Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/prevenção & controle , Consenso , Informação de Saúde ao Consumidor , Conhecimentos, Atitudes e Prática em Saúde , Pais/psicologia , Tomada de Decisão Compartilhada , Técnica Delfos , Prova Pericial , Humanos , Estados Unidos
19.
Ann Biomed Eng ; 48(11): 2497-2507, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33051746

RESUMO

To further the understanding of long-term sequelae as a result of repetitive head impacts in sports, in vivo head impact exposure data are critical to expand on existing evidence from animal model and laboratory studies. Recent technological advances have enabled the development of head impact sensors to estimate the head impact exposure of human subjects in vivo. Previous research has identified the limitations of filtering algorithms to process sensor data. In addition, observer and/or video confirmation of sensor-recorded events is crucial to remove false positives. The purpose of the current study was to conduct a systematic review to determine the proportion of published head impact sensor data studies that used filtering algorithms, observer confirmation and/or video confirmation of sensor-recorded events to remove false positives. Articles were eligible for inclusion if collection of head impact sensor data during live sport was reported in the methods section. Descriptive data, confirmation methods and algorithm use for included articles were coded. The primary objective of each study was reviewed to identify the primary measure of exposure, primary outcome and any additional covariates. A total of 168 articles met the inclusion criteria, the publication of which has increased in recent years. The majority used filtering algorithms (74%). The majority did not use observer and/or video confirmation for all sensor-recorded events (64%), which suggests estimates of head impact exposure from these studies may be imprecise.


Assuntos
Algoritmos , Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/fisiopatologia , Modelos Biológicos , Medicina Esportiva , Animais , Traumatismos em Atletas/patologia , Concussão Encefálica/patologia , Humanos
20.
Curr Psychiatry Rep ; 22(12): 64, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33006692

RESUMO

In the recently published article "Mental Health in the Young Athlete" the following author name was inadvertently misspelled as Christine L. Master. The correct spelling of the author's name is: Christina L. Master as shown above.

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