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1.
Ann Emerg Med ; 77(3): 327-337, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33618811

RESUMO

STUDY OBJECTIVE: We measure the effect of video discharge instructions on postconcussion symptoms in patients with mild traumatic brain injury in the emergency department. METHODS: A multicenter randomized controlled trial was conducted in which patients with mild traumatic brain injury were randomly assigned to either intervention (verbal, written, and video discharge information) or control (verbal and written discharge information only). All patients were interviewed 1 week and 3 months from randomization. Primary outcome measure was the Rivermead Post-Concussion Symptoms Questionnaire at 3 months. Secondary outcomes were correct recall, Hospital Anxiety and Depression Scale score, health-related quality of life (12-Item Short Form Health Survey), return visits, and patient satisfaction. RESULTS: A total of 2,883 patients were assessed for eligibility, of whom 381 were included in the control group and 390 in the video intervention group. Difference in mean total Rivermead Post-Concussion Symptoms Questionnaire score between the 2 groups was 0.2 at 1 week and 0.3 at 3 months after traumatic brain injury (estimated effect -0.7; 95% confidence interval -2.1 to 0.7). There was also no difference in Hospital Anxiety and Depression Scale score, recall, 12-Item Short Form Health Survey score, return visits, and patient satisfaction between the control and intervention group. CONCLUSION: Severity of postconcussion symptoms in patients with mild traumatic brain injury did not improve by adding video information to standard care. Also, there was no difference in recall, health-related quality of life, return visits, and patient satisfaction between the control and intervention groups.


Assuntos
Concussão Encefálica/terapia , Serviço Hospitalar de Emergência , Alta do Paciente , Educação de Pacientes como Assunto/métodos , Gravação em Vídeo , Adulto , Idoso , Concussão Encefálica/diagnóstico , Concussão Encefálica/fisiopatologia , Concussão Encefálica/psicologia , Feminino , Seguimentos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Síndrome Pós-Concussão/diagnóstico , Síndrome Pós-Concussão/fisiopatologia , Síndrome Pós-Concussão/prevenção & controle , Síndrome Pós-Concussão/psicologia , Qualidade de Vida , Índice de Gravidade de Doença , Resultado do Tratamento
2.
J Athl Train ; 56(2): 157-163, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33596598

RESUMO

CONTEXT: Mandated concussion education has aimed to improve student-athlete knowledge; however, some collegiate student-athletes continue to not disclose concussion. Concussion knowledge may not be the only factor influencing reporting, as student-athlete sex, sport, and pressure from external stakeholders (eg, coaches, teammates, fans, parents or family) have all been documented as influencing collegiate concussion-reporting behavior. OBJECTIVE: To examine factors associated with concussion nondisclosure in collegiate student-athletes. DESIGN: Cross-sectional study. SETTING: Four National Collegiate Athletic Association Division I and two Division II universities. PATIENTS OR OTHER PARTICIPANTS: A total of 1125 collegiate student-athletes completed the survey, and 741 provided viable responses and were included for data analysis. MAIN OUTCOME MEASURE(S): We used a 10- to 15-minute electronic or paper-and-pencil survey that asked about personal and sport demographics, diagnosed concussions and nondisclosed concussion history, concussion knowledge, and level of agreement regarding pressure to play after a head impact experienced during collegiate sport participation. Significant univariable factors were entered into a multivariable logistic regression analysis. RESULTS: Sex (P = .005), sport-risk type (P < .001), diagnosed concussion history (P < .001), concussion knowledge (P = .017), and pressure from coaches (P < .001), teammates (P < .001), fans (P = .024), and parents or family (P = .003) were factors associated with concussion nondisclosure in individual univariable logistic regressions. After we conducted multivariable analyses, male sex (P = .001), high concussion-risk sport participation (P = .048), diagnosed concussion history (P < .001), increased concussion knowledge (P = .013), and experiencing pressure from coaches to continue playing after sustaining a hit to the head (P = .002) were factors associated with concussion nondisclosure in collegiate student-athletes. CONCLUSIONS: Our results suggest that concussion-education programs should go beyond the identification of signs and symptoms to include the dangers of continuing to play, long-term consequences, and transparency about concussion protocols. Comprehensive concussion-education programs should involve coaches and athletes to improve the reporting culture.


Assuntos
Atletas/estatística & dados numéricos , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Revelação , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Michigan , Ohio , Pennsylvania , South Carolina , Esportes , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Universidades , Adulto Jovem
3.
JAMA Netw Open ; 4(2): e2037349, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33587137

RESUMO

Importance: An objective, reliable indicator of the presence and severity of concussive brain injury and of the readiness for the return to activity has the potential to reduce concussion-related disability. Objective: To validate the classification accuracy of a previously derived, machine learning, multimodal, brain electrical activity-based Concussion Index in an independent cohort of athletes with concussion. Design, Setting, and Participants: This prospective diagnostic cohort study was conducted at 10 clinical sites (ie, US universities and high schools) between February 4, 2017, and March 20, 2019. A cohort comprising a consecutive sample of 207 athletes aged 13 to 25 years with concussion and 373 matched athlete controls without concussion were assessed with electroencephalography, cognitive testing, and symptom inventories within 72 hours of injury, at return to play, and 45 days after return to play. Variables from the multimodal assessment were used to generate a Concussion Index at each time point. Athletes with concussion had experienced a witnessed head impact, were removed from play for 5 days or more, and had an initial Glasgow Coma Scale score of 13 to 15. Participants were excluded for known neurologic disease or history within the last year of traumatic brain injury. Athlete controls were matched to athletes with concussion for age, sex, and type of sport played. Main Outcomes and Measures: Classification accuracy of the Concussion Index at time of injury using a prespecified cutoff of 70 or less (total range, 0-100, where ≤70 indicates it is likely the individual has a concussion and >70 indicates it is likely the individual does not have a concussion). Results: Of 580 eligible participants with analyzable data, 207 had concussion (124 male participants [59.9%]; mean [SD] age, 19.4 [2.5] years), and 373 were athlete controls (187 male participants [50.1%]; mean [SD] age, 19.6 [2.2] years). The Concussion Index had a sensitivity of 86.0% (95% CI, 80.5%-90.4%), specificity of 70.8% (95% CI, 65.9%-75.4%), negative predictive value of 90.1% (95% CI, 86.1%-93.3%), positive predictive value of 62.0% (95% CI, 56.1%-67.7%), and area under receiver operator characteristic curve of 0.89. At day 0, the mean (SD) Concussion Index among athletes with concussion was significantly lower than among athletes without concussion (75.0 [14.0] vs 32.7 [27.2]; P < .001). Among athletes with concussion, there was a significant increase in the Concussion Index between day 0 and return to play, with a mean (SD) paired difference between these time points of -41.2 (27.0) (P < .001). Conclusions and Relevance: These results suggest that the multimodal brain activity-based Concussion Index has high classification accuracy for identification of the likelihood of concussion at time of injury and may be associated with the return to control values at the time of recovery. The Concussion Index has the potential to aid in the clinical diagnosis of concussion and in the assessment of athletes' readiness to return to play.


Assuntos
Atletas , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Encéfalo/fisiopatologia , Eletroencefalografia , Aprendizado de Máquina , Adolescente , Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/fisiopatologia , Estudos de Casos e Controles , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Testes de Estado Mental e Demência , Estudos Prospectivos , Reprodutibilidade dos Testes , Volta ao Esporte , Instituições Acadêmicas , Universidades , Adulto Jovem
4.
J Athl Train ; 56(1): 92-100, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33534900

RESUMO

CONTEXT: Many survey-based methods have been used to explore concussion-reporting behavior. However, because the decision to report or conceal a concussion is likely multifactorial, this may narrow the findings, as the surveys were largely designed by the researchers. OBJECTIVE: To explore student-athletes' perspectives regarding factors that may influence the reporting of sport-related concussion. DESIGN: Qualitative study. SETTING: National Collegiate Athletic Association Division I athletics. PATIENTS OR OTHER PARTICIPANTS: We conducted 17 semistructured interviews with student-athletes who had sustained 1 or more concussions while attending a large university (men = 4, women = 13, age = 20.9 ± 1.3 years). DATA COLLECTION AND ANALYSIS: After data saturation and member checks, a 5-cycle analytic process was completed: topical review, literature review, data collection and summarizing using a codebook developed by a 3-person research team, linking of findings to current research, and final interpretations. RESULTS: We discovered 3 themes. Participants discussed concussion perceptions by describing their understanding of a concussion, their own injury experiences, and their perceptions of symptom severity and duration. Regarding reporting behavior, participants described an order of individuals with whom they would speak, symptoms present in order to report (eg, feeling different from normal), immediate reactions, and influential factors for mitigating short- and long-term consequences. Lastly, participants discussed the value of support systems, such as how coaches can both positively and negatively influence reporting and athletic trainer involvement. CONCLUSIONS: Participants often drew from their own concussion experiences in naming common concussion signs and symptoms. Additionally, they indicated that both short- and long-term health consequences influenced and deterred their seeking care and that their support systems, including coaches and athletic trainers, played a role in their concussion experience. Research is needed to determine if using student-athletes' own words to describe a concussion and incorporating student-athletes' support systems, especially coaches and athletic trainers, is effective in increasing concussion reporting.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Revelação , Autorrelato , Atletas/estatística & dados numéricos , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Esportes , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Universidades , Adulto Jovem
5.
J Athl Train ; 56(1): 85-91, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33534901

RESUMO

CONTEXT: Collegiate student-athletes continue competing after experiencing symptoms of a concussion. Self-report of concussion symptoms is a critical element of the recovery process. Identifying factors related to concussion disclosure can aid in encouraging self-reporting. OBJECTIVE: To use latent profile analysis to categorize and describe athletes based on factors related to concussion disclosure. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 2 881 (52.4% female; 65.3% in-season; 40% collision sport) student-athletes from 16 National Collegiate Athletic Association member institutions. MAIN OUTCOME MEASURE(S): Student-athlete concussion expectations, attitudes, and norms were the profile variables and reporting intentions served as the distal outcome variable. We conducted latent profile analysis using select profile variables to determine the optimal number of classes. Differences in concussion-reporting intentions by profile assignment were then examined. Lastly, the extent to which a student-athlete's sex, season status, and level of contact predicted his or her intentions to report a concussion within each profile was investigated. RESULTS: Five unique student-athlete profiles emerged, including 1 profile that was most risky and another that was least risky. Females had significantly higher odds of being in the least risky profile. Those participating in collision sports had significantly higher odds of being in the top 2 most risky profiles. Contact-sport and in-season athletes were less likely to be in the least risky profile. CONCLUSIONS: With a better understanding of student-athlete profiles, athletic trainers have an opportunity to encourage concussion disclosure. Prompt disclosure would allow student-athletes to begin the return-to-play protocol in a more timely manner.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Revelação , Autorrelato , Atletas/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Intenção , Masculino , Esportes , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Universidades
6.
Neurology ; 96(15): 705-715, 2021 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-33637627

RESUMO

OBJECTIVE: To evaluate whether participating in physical contact sports is associated with a release of neurofilaments and whether such release is related to future clinical neurologic and/or psychiatric impairment. METHODS: We performed a systematic review of the PubMed, MEDLINE, and Cochrane Library databases using a combination of the search terms neurofilament(s)/intermediate filament and sport(s)/athletes. Original studies, written in English, reporting on neurofilaments in CSF and/or serum/plasma of contact sport athletes were included. This review was conducted following the Preferred Reporting Items for Systematic Review and Analyses guidelines. RESULTS: Eighteen studies in 8 different contact sports (i.e., boxing, American football, ice hockey, soccer, mixed martial arts, lacrosse, rugby, and wrestling) matched our criteria. Elevated light chain neurofilament (NfL) levels were described in 13/18 cohorts. Most compelling evidence was present in boxing and American football, where exposure-related increases were appreciable at the intraindividual level (up to 4.1- and 2.0-fold, respectively) in well-defined groups. Differences in exposure severity (including previous cumulative effects), sampling/measurement time points (with regard to expected peak values), and definitions of the baseline setting are considered as main contributors to the variability in findings. No studies were encountered that have investigated the relationship with the targeted clinical end points; therefore no NfL cutoffs exist that are associated with a poor outcome. CONCLUSION: NfL release can be seen, as a potential marker of neuronal brain damage, in participants of physical contact sports, particularly boxing and American football. The exact significance regarding the risk for future clinical impairment remains to be elucidated.


Assuntos
Traumatismos em Atletas/diagnóstico , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Concussão Encefálica/etiologia , Filamentos Intermediários/metabolismo , Traumatismos em Atletas/sangue , Traumatismos em Atletas/líquido cefalorraquidiano , Boxe/lesões , Concussão Encefálica/diagnóstico , Futebol Americano/lesões , Hóquei/lesões , Humanos , Artes Marciais/lesões , Esportes com Raquete/lesões , Futebol/lesões , Luta Romana/lesões
7.
Am J Sports Med ; 49(4): 1040-1048, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33600216

RESUMO

BACKGROUND: Vestibular and ocular symptoms in sport-related concussions are common. The Vestibular/Ocular-Motor Screening (VOMS) tool is a rapid, free, pen-and-paper tool that directly assesses these symptoms and shows consistent utility in concussion identification, prognosis, and management. However, a VOMS validation study in the acute concussion period of a large sample is lacking. PURPOSE: To examine VOMS validity among collegiate student-athletes, concussed and nonconcussed, from the multisite National Collegiate Athletic Association-Department of Defense Concussion Assessment, Research and Education (CARE) Consortium. A secondary aim was to utilize multidimensional machine learning pattern classifiers to deduce the additive power of the VOMS in relation to components of the Sport Concussion Assessment Tool 3 (SCAT3). STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Preseason and acute concussion assessments were analyzed for 419 student-athletes. Variables in the analysis included the VOMS, Balance Error Scoring System, Standardized Assessment of Concussion, and SCAT3 symptom evaluation score. Descriptive statistics were calculated for all tools, including Kolmogorov-Smirnov significance and Cohen d effect size. Correlations between tools were analyzed with Spearman r, and predictive accuracy was evaluated through an Ada Boosted Tree machine learning model's generated receiver operating characteristic curves. RESULTS: Total VOMS scores and SCAT3 symptom scores demonstrated significant increases in the acute concussion time frame (Cohen d = 1.23 and 1.06; P < .0001), whereas the Balance Error Scoring System lacked clinical significance (Cohen d = 0.17). Incorporation of VOMS into the full SCAT3 significantly boosted overall diagnostic ability by 4.4% to an area under the curve of 0.848 (P < .0001) and produced a 9% improvement in test sensitivity over the existing SCAT3 battery. CONCLUSION: The results from this study highlight the relevance of the vestibular and oculomotor systems to concussion and the utility of the VOMS tool. Given the 3.8 million sports-related and 45,121 military-related concussions per year, the addition of VOMS to the SCAT3 is poised to identify up to an additional 304,000 athletes and 3610 servicemembers annually who are concussed, thereby improving concussion assessment and diagnostic rates. Health care providers should consider the addition of VOMS to their concussion assessment toolkits, as its use can positively affect assessment and management of concussions, which may ultimately improve outcomes for this complex and common injury.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Esportes , Atletas , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Estudos de Coortes , Humanos , Testes Neuropsicológicos , Universidades
8.
Clin EEG Neurosci ; 52(2): 114-118, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33601899

RESUMO

Concussion is a common brain injury. The American Academy of Neurology provides a definition of concussion: "Concussion is a traumatically, or biomechanically, induced alteration of brain function. Emphasis is placed on a pathophysiological process, or functional disruption, as opposed to anatomic, structural, or tissue injury.". The incidence of mild traumatic brain injury (mTBI) is estimated at 200 per 100 000. The Centers for Disease Control and Prevention (CDC) estimates 3.8 million sport and recreational mTBIs occurring in the United States each year. A more recent CDC assessment estimates 2.5 million concussion injuries in high school sports alone. The controlled environment and opportunity for direct surveillance and observation has made the sports arena the scientific "wet lab" for the study of mTBI natural history, short- and long-term consequences and opportunities to intervene. Quantitative EEG methods have been utilized in the assessment and management of mTBI and lends to provide a cost-effective procedure that has the sensitivities needed to identify pathology where routine visual inspection of the EEG has failed.


Assuntos
Concussão Encefálica , Lesões Encefálicas , Concussão Encefálica/diagnóstico , Eletroencefalografia , Humanos , Incidência , Estados Unidos
9.
Mil Med ; 186(Suppl 1): 552-558, 2021 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-33499481

RESUMO

INTRODUCTION: Tactile-based quantitative sensory assessments have proven successful in differentiating concussed vs. non-concussed individuals. One potential advantage of this methodology is that an experimental animal model can be used to obtain neurophysiological recordings of the neural activity in the somatosensory cortex evoked in response to the same tactile stimuli that are used in human sensory assessments and establish parallels between various metrics of stimulus-evoked cortical activity and perception of the stimulus attributes. MATERIALS AND METHODS: Stimulus-evoked neural activity was recorded via extracellular microelectrodes in rat primary somatosensory cortex (S1) in response to vibrotactile stimuli that are used in two particular human sensory assessments (reaction time (RT) and amplitude discrimination). Experiments were conducted on healthy control and brain-injured (BI) rats. RESULTS: Similar to the effects of mild traumatic brain injuries (mTBI) on human neurosensory assessments, comparable experimentally induced brain injuries in rats resulted in the following: (1) elevation of S1 responsivity to vibrotactile stimulation that depended nonlinearly on stimulus amplitude, significantly reducing its capacity to discriminate between stimuli of different amplitudes; (2) 50% reduction in S1 signal-to-noise ratios, which can be expected to contribute to elevation of RT in BI rats; and (3) 60% increase in intertrial variability of S1 responses to vibrotactile stimulation, which can be expected to contribute to elevation of RT variability in BI rats. CONCLUSIONS: The results demonstrate suggestive similarities between neurophysiological observations made in the experimental rat mTBI model and observations made in post-concussion individuals with regard to three sensory assessment metrics (amplitude discrimination, RT, and RT variability). This is the first successful model that demonstrates that perceptual metrics obtained from human individuals are impacted by mTBI in a manner consistent with neurophysiological observations obtained from rat S1.


Assuntos
Concussão Encefálica , Animais , Concussão Encefálica/diagnóstico , Modelos Animais , Ratos , Córtex Somatossensorial , Tato , Percepção do Tato
10.
Am J Nurs ; 121(2): 28-38, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33470615

RESUMO

BACKGROUND: School nurses' knowledge about and confidence in managing concussions are important to ensure continuity of care between a student's school and home environments. This mixed-methods study explored concussion-related knowledge, confidence, and management experiences among urban and rural school nurses in Washington State. METHODS: Public school nurses, identified via state educational service district websites and recruited by e-mail, completed an online survey assessing their concussion knowledge and confidence levels. Following the survey, a subset of respondents participated in semistructured interviews aimed at exploring their confidence in managing concussions. RESULTS: Of the 945 school nurses to whom the survey was sent, 315 responded (33% response rate). Most survey respondents held an RN license (89.6%) and were from urban areas (90.8%). Overall, the respondents exhibited accurate concussion knowledge; only one significant difference was noted based on rural-urban status. Correct responses were given for most questions (67.4% to 98.7% correct responses). In interviews with a subset of six school nurses, emergent themes pertained to communication, assessment, and monitoring, and the nurse's role in postconcussion management. Barriers can include a lack of relevant school policies, low concussion awareness among teachers and parents, and limited resources. CONCLUSIONS: The study findings suggest that school nurses possess high levels of concussion knowledge and confidence in managing concussions. Continuing education remains important to ensure that current research and evidence inform practice regarding ongoing concussion management among school-age children.


Assuntos
Concussão Encefálica/enfermagem , Competência Clínica/normas , Serviços de Enfermagem Escolar/métodos , Concussão Encefálica/diagnóstico , Competência Clínica/estatística & dados numéricos , Estudos Transversais , Humanos , Incidência , Washington
11.
Phys Ther Sport ; 48: 101-108, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33406456

RESUMO

OBJECTIVE: The purpose of this study was to describe the concussion-related symptoms reported among combat sport athletes with and without a history of concussion, and a history of neck injury. DESIGN: Cross-sectional survey. SETTING: Data were collected using an online survey instrument. PARTICIPANTS: Three hundred and nine adult combat sport athletes. MAIN OUTCOME MEASURES: Self-reported 12-month concussion history and neck injury history and a 22-item symptom checklist. RESULTS: A history of concussion was reported by 19.1% of athletes, a history of neck injury was reported by 23.0%, and 13.6% reported both injuries. Neck pain was the most frequently reported symptom. Athletes with a history of injury had significantly greater proportions of 'high' total symptoms and symptom severity scores compared with athletes with no history of injury. Athletes with a history of concussion had 2.35 times higher odds of reporting 'high' total symptoms and symptoms severity scores. CONCLUSION: Athletes with a history of concussion or neck injury have greater odds of presenting with higher symptom scores. The presence of high total symptom scores and high symptom severity scores may indicate a need for further investigation into domains commonly associated with concussion.


Assuntos
Boxe/lesões , Concussão Encefálica/diagnóstico , Artes Marciais/lesões , Adulto , Concussão Encefálica/complicações , Estudos Transversais , Feminino , Humanos , Masculino , Lesões do Pescoço/complicações , Lesões do Pescoço/diagnóstico , Cervicalgia/etiologia , Autorrelato , Inquéritos e Questionários
12.
Clin Sports Med ; 40(1): 123-131, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33187603

RESUMO

The medications used in postconcussion syndrome are typically used to help manage or minimize disruptive symptoms while recovery proceeds. These medications are not routinely used in most concussions that recover within days to weeks. However, it is beneficial to be aware of medication options that may be used in athletes with prolonged concussion symptoms or for those that have symptom burdens that preclude entry into basic concussion protocols. Medications and supplements remain a small part of the concussion treatment plan, which may include temporary academic adjustments, physical therapy, vestibular and ocular therapy, psychological support, and graded noncontact exercise.


Assuntos
Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Síndrome Pós-Concussão/terapia , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/tratamento farmacológico , Concussão Encefálica/diagnóstico , Concussão Encefálica/tratamento farmacológico , Suplementos Nutricionais , Ácidos Docosa-Hexaenoicos/uso terapêutico , Humanos , Modalidades de Fisioterapia , Síndrome Pós-Concussão/diagnóstico , Síndrome Pós-Concussão/tratamento farmacológico , Psicoterapia
13.
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
14.
Clin Sports Med ; 40(1): 187-197, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33187608

RESUMO

The recommendation to retire from sport after concussion has evolved with the understanding of concussion. Age, sport, position, level of play, relevant medical and concussion history, severity and duration of symptoms, neuroimaging and neuropsychological testing should all be considered. Susceptibility to injury, persistence of symptoms, psychological distress, and personal values and support may also play a role. Pediatric athletes may require a more conservative approach, given ongoing growth and development. For professional and/or elite athletes, financial or career implications may be considerations. When possible, retirement should be a shared decision among the athlete, the family, and the health care team.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/psicologia , Concussão Encefálica/diagnóstico , Concussão Encefálica/psicologia , Tomada de Decisão Compartilhada , Aposentadoria , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/terapia , Concussão Encefálica/diagnóstico por imagem , Concussão Encefálica/terapia , Família , Humanos , Neuroimagem , Testes Neuropsicológicos , Equipe de Assistência ao Paciente , Volta ao Esporte
15.
Clin Sports Med ; 40(1): 199-211, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33187610

RESUMO

This article focuses on 3 concepts that continue to be investigated in the search for the holy grail of concussion-a valid diagnostic test. Imaging advances are discussed with optimism that functional MRI and diffusion tensor imaging may be available clinically. Biomarkers and the use of genetic tests are covered. Sideline accelerometer use may help steer discussions of head trauma risk once technology exists to accurately estimate acceleration of the brain. In the meantime, strategies including allowing athletes to be substituted out of games for an evaluation and video review in elite sports can improve recognition of sports-related concussion.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Medicina Esportiva/tendências , Acelerometria , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/terapia , Biomarcadores , Concussão Encefálica/diagnóstico por imagem , Concussão Encefálica/terapia , Imagem de Tensor de Difusão , Testes Genéticos , Humanos , Imagem por Ressonância Magnética
16.
Clin Sports Med ; 40(1): 53-63, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33187613

RESUMO

The diagnosis of sport-related concussion is still based primarily on history and physical examination. Use of a standardized history and examination form is recommended. There have been many tests investigated, but none have been proven to be sensitive and specific for the diagnosis of concussion. Sideline management is based on recognition, diagnosis, and initial treatment. It is clear that symptoms of a concussion can worsen with continued play, and so, if a concussion is suspected based on observation, history, and physical examination, then the athlete should be removed from play.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Primeiros Socorros , Humanos , Anamnese , Exame Físico
17.
Clin Sports Med ; 40(1): 65-79, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33187614

RESUMO

Outpatient sports-related concussion (SRC) management continues to evolve as evidence emerges supporting a multidisciplinary approach to the clinical assessment of SRC. Early active rehabilitation has replaced strict cognitive and physical rest. With this paradigm shift in management, pragmatic approaches are highly sought by busy clinicians that provide direction to individualized treatment, which can potentially expedite symptom resolution. Treatment strategies that address domain-based symptom constellations continue to be developed by clinician researchers. Although the optimal timing and dose of these domain-specific therapies has yet to be determined, future directions of SRC treatment will answer these and other questions regarding SRC management.


Assuntos
Assistência Ambulatorial , Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Aprendizagem , Volta ao Esporte , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/psicologia , Concussão Encefálica/diagnóstico , Concussão Encefálica/fisiopatologia , Concussão Encefálica/psicologia , Humanos , Descanso
18.
Clin Sports Med ; 40(1): 81-91, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33187615

RESUMO

Neuropsychological assessment is a key component in a comprehensive, multidisciplinary approach to assessment of sport-related concussion (SRC). Currently computerized tests are the most commonly used modality of neurocognitive testing and involve both baseline and postinjury assessments. A comprehensive neuropsychological assessment should not only include neurocognitive testing but also incorporate symptom inventories, vestibular-ocular screening, and a psychological evaluation. Neuropsychological assessments are most effective when completed by a Clinical Neuropsychologist, given their specialized training in test interpretation and conceptualization of the psychological, cognitive, behavioral, physiologic, as well as neurologic principals when treating and managing SRC.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Testes Neuropsicológicos , Adolescente , Traumatismos em Atletas/psicologia , Traumatismos em Atletas/terapia , Concussão Encefálica/psicologia , Concussão Encefálica/terapia , Disfunção Cognitiva/diagnóstico , Humanos , Masculino
19.
Clin Sports Med ; 40(1): 93-109, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33187616

RESUMO

This article provides a summary of clinical assessment methods and nonpharmacologic rehabilitation techniques used for concussed patients. It describes concussion-relevant physical examination methods to identify underlying symptom generators. This approach allows practitioners to prescribe targeted rehabilitation therapies to treat postconcussion symptoms. Evidence-based rehabilitation approaches include cervical rehabilitation, vestibulo-ocular rehabilitation, and sub-symptom threshold aerobic exercise.


Assuntos
Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Terapia por Exercício , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/diagnóstico , Concussão Encefálica/fisiopatologia , Terapia por Exercício/métodos , Tolerância ao Exercício , Humanos , Equipe de Assistência ao Paciente , Exame Físico , Síndrome Pós-Concussão/terapia
20.
J Safety Res ; 75: 166-172, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33334474

RESUMO

INTRODUCTION: Concussion is a type of traumatic brain injury that can be sustained through participation in different sports. It is important that a parent be able to identify common and uncommon symptoms of a concussion to ensure the safety and good health of their child. The purpose of this study was to compare knowledge of concussion scores among White and African American parents and guardians. METHODOLOGY: This cross-sectional study consisted of a single survey of 53 questions that was given to parents/guardians of high school athletes at a preseason parent meeting. Parent and guardian knowledge of concussion was assessed through a series of 45 questions. Participants were asked to correctly identify signs and symptoms of concussion, answer questions regarding the anatomy of a concussion (i.e. a concussion is an injury to the brain), answer true/false questions about general concussion knowledge, select from a list the consequences of multiple concussions and select from a list the consequences of returning to play too soon from a concussion. Knowledge of concussion was calculated by summing correct responses for the 45 knowledge questions. Racial differences were calculated using an ANCOVA, controlling for socioeconomic school type. The statistical significance level was set a priori p ≤ 0.05 for all analyses. RESULTS: Participants of this study consisted of 176 [115 (65.3%) White, 61 (34.7%) African American] parents/guardians of high school athletes. Significant differences in knowledge of concussion scores between White parents/guardians [38.50 ±â€¯4.55 (85.6% correct)], and African American parents/guardians [35.15 ±â€¯4.97, 78.1% correct)] were identified (F(1,172) = 4.82, p = 0.03). CONCLUSION: Knowledge of concussion disparities exist between African American and White parents/guardians. This disparity could cause complications from concussion to surface among children and adolescents participating in sport as their parents/guardians may not be able to correctly identify the signs and symptoms in order to seek proper medical care. Practical Application: Findings from this study highlight quantitative differences in concussion knowledge of parents from different demographics. These findings underline disparities and inequities in access to concussion-health resources that need to be addressed.


Assuntos
Afro-Americanos/psicologia , Traumatismos em Atletas/psicologia , Concussão Encefálica/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pais/psicologia , Adulto , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ohio
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