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1.
Curr Sports Med Rep ; 19(4): 151-156, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282461

RESUMO

The philosophy and practices concerning concussion management have evolved from passive to active strategies that incorporate immediate, guided rest followed by early integration of physical and cognitive activity as tolerated by symptoms. Recent research and clinical evidence support guidance that symptom tolerable and clinically guided activity is beneficial postconcussion both acutely and in the longer term. Furthermore, recent studies illustrate benefits of targeted deficit-based therapies (vestibular, cervicogenic, visual, psychological, etc.) postconcussion subacutely and in those with persistent symptoms. The dissemination of this new information occurs at a fast pace and is often difficult to rapidly integrate into clinical practice due to necessary policy and behavior changes. This review will outline recent evidence concerning both rest and exertion postconcussion through the lens of the socioecological model to more rapidly promote policy and practice changes.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Adolescente , Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Feminino , Humanos , Masculino , Esforço Físico , Síndrome Pós-Concussão/diagnóstico , Síndrome Pós-Concussão/terapia
3.
Lakartidningen ; 1172020 01 28.
Artigo em Sueco | MEDLINE | ID: mdl-31990363

RESUMO

In Sweden, there are currently no consensus guidelines aimed at the management of patients with mild traumatic brain injury (mTBI) in a primary care setting. The aim of this study was to assess the need for such guidelines by a web-based, multiple choice, case-based survey asking primary care physicians how they manage mTBI patients in the early (acute) and late (persistent symptoms) stage. The survey demonstrated a more uniform patient management pattern in the acute stage of mTBI, while it revealed a more heterogenous pattern in the later stage. This illustrates the need for consensus guidelines in the management of this patient category in the primary care setting, which was further substantiated by the request for such guidelines by 85% of the physicians participating in the survey.


Assuntos
Concussão Encefálica , Atenção Primária à Saúde , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Humanos , Guias de Prática Clínica como Assunto , Inquéritos e Questionários , Suécia
4.
J Sports Sci ; 38(1): 21-28, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31613188

RESUMO

Subjective evaluations of balance performance, like the modified Balance Error Scoring System (mBESS), are highly popular. Alternatively, quantitative measures may offer additional clarity in identifying balance dysfunction. A novel measure to define balance impairments is time to boundary (TTB), which represents the amount of time available to make corrective postural adjustments prior to the centre of pressure (CoP) reaching the edge of the base of support. The purpose of this investigation was to assess TTB and traditional measures of CoP displacement of young adults performing the mBESS on a BTrackS balance plate. Path length and TTB were calculated in anterior-posterior (AP) and medio-lateral (ML) directions, respectively. AP and ML path lengths were largest in Single stance (109.2 & 118.1 cm, respectively) and smallest in Dual stance (27.1 & 36.4 cm, respectively). The average AP and ML TTBs were higher in Dual (10.67 & 7.27 s, respectively) compared to Single (3.54 & 1.20 s, respectively) or Tandem (10.11 & 1.94 s, respectively) stances, and lower in Single stance compared to Tandem. Given the effect sizes for TTB were greater than those of path length in both directions, TTB more adequately differentiates these stance conditions than path length or subjective scores.


Assuntos
Ergometria/métodos , Equilíbrio Postural/fisiologia , Concussão Encefálica/diagnóstico , Feminino , Humanos , Masculino , Movimento/fisiologia , Fatores de Tempo , Adulto Jovem
5.
Br J Sports Med ; 54(2): 94-101, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31331944

RESUMO

OBJECTIVES: To determine whether individuals who sustained a sports concussion would exhibit persistent impairments in gait and quiet standing compared to non-injured controls during a dual-task assessment . DESIGN: Systematic review and meta-analysis using individual participant data (IPD). DATA SOURCES: The search strategy was applied across seven electronic bibliographic and grey literature databases: MEDLINE, EMBASE, CINAHL, SportDISCUS, PsycINFO, PsycARTICLES and Web of Science, from database inception until June 2017. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Studies were included if; individuals with a sports concussion and non-injured controls were included as participants; a steady-state walking or static postural balance task was used as the primary motor task; dual-task performance was assessed with the addition of a secondary cognitive task; spatiotemporal, kinematic or kinetic outcome variables were reported, and; included studies comprised an observational study design with case-control matching. DATA EXTRACTION AND SYNTHESIS: Our review is reported in line with the Preferred Reporting Items for Systematic review and Meta-Analyses-IPD Statement. We implemented the Risk of Bias Assessment tool for Non-randomised Studies to undertake an outcome-level risk of bias assessment using a domain-based tool. Study-level data were synthesised in one of three tiers depending on the availability and quality of data: (1) homogeneous IPD; (2) heterogeneous IPD and (3) aggregate data for inclusion in a descriptive synthesis. IPD were aggregated using a 'one-stage', random-effects model. RESULTS: 26 studies were included. IPD were available for 20 included studies. Consistently high and unclear risk of bias was identified for selection, detection, attrition, and reporting biases across studies. Individuals with a recent sports concussion walked with slower average walking speed (χ2=51.7; df=4; p<0.001; mean difference=0.06 m/s; 95% CI: 0.004 to 0.11) and greater frontal plane centre of mass displacement (χ2=10.3; df=4; p=0.036; mean difference -0.0039 m; 95% CI: -0.0075 to -0.0004) than controls when evaluated using a dual-task assessment up to 2 months following concussion. SUMMARY/CONCLUSIONS: Our IPD evidence synthesis identifies that, when evaluated using a dual-task assessment, individuals who had incurred a sports concussion exhibited impairments in gait that persisted beyond reported standard clinical recovery timelines of 7-10 days. Dual-task assessment (with motion capture) may be a useful clinical assessment to evaluate recovery after sports concussion. PROTOCOL PRE-REGISTRATION: This systematic review was prospectively registered in PROSPERO CRD42017064861.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Exame Neurológico/métodos , Velocidade de Caminhada , Fenômenos Biomecânicos , Humanos , Equilíbrio Postural , Análise e Desempenho de Tarefas
6.
Br J Sports Med ; 54(2): 102-109, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31036562

RESUMO

OBJECTIVE: We compared data from the National Collegiate Athletic Association (NCAA) Concussion Study (1999-2001) and the NCAA-Department of Defense Concussion Assessment, Research and Education (CARE) Consortium (2014-2017) to examine how clinical management, return to play (RTP) and risk of repeat concussion in collegiate football players have changed over the past 15 years. METHODS: We analysed data on reported duration of symptoms, symptom-free waiting period (SFWP), RTP and occurrence of within-season repeat concussion in collegiate football players with diagnosed concussion from the NCAA Study (n=184) and CARE (n=701). RESULTS: CARE athletes had significantly longer symptom duration (CARE median=5.92 days, IQR=3.02-9.98 days; NCAA median=2.00 days, IQR=1.00-4.00 days), SFWP (CARE median=6.00 days, IQR=3.49-9.00 days; NCAA median=0.98 days, IQR=0.00-4.00 days) and RTP (CARE median=12.23 days, IQR=8.04-18.92 days; NCAA median=3.00 days, IQR=1.00-8.00 days) than NCAA Study athletes (all p<0.0001). In CARE, there was only one case of repeat concussion within 10 days of initial injury (3.7% of within-season repeat concussions), whereas 92% of repeat concussions occurred within 10 days in the NCAA Study (p<0.001). The average interval between first and repeat concussion in CARE was 56.41 days, compared with 5.59 days in the NCAA Study (M difference=50.82 days; 95% CI 38.37 to 63.27; p<0.0001). CONCLUSION: Our findings indicate that concussion in collegiate football is managed more conservatively than 15 years ago. These changes in clinical management appear to have reduced the risk of repetitive concussion during the critical period of cerebral vulnerability after sport-related concussion (SRC). These data support international guidelines recommending additional time for brain recovery before athletes RTP after SRC.


Assuntos
Concussão Encefálica/diagnóstico , Futebol Americano/lesões , Volta ao Esporte , Adolescente , Feminino , Humanos , Masculino , Recidiva , Fatores de Risco , Fatores de Tempo , Adulto Jovem
8.
Emerg Med Clin North Am ; 38(1): 207-222, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757251

RESUMO

A systematic approach is required for patients with a suspected concussion. Although standardized tools can aid in assessment, the diagnosis of concussion remains a clinical one. At the time of diagnosis, patients should be given both verbal and written review of the common symptoms of concussion, expected course of recovery, as well as strategies to manage symptoms. Most patients benefit from a brief period of rest, followed by a gradual reintroduction of activities, and a graduated return-to-sport protocol. Patients with prolonged recovery from a concussion may benefit from exercise, vestibular, and cognitive rehabilitation programs.


Assuntos
Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Diagnóstico por Imagem/métodos , Gerenciamento Clínico , Emergências , Medicina Esportiva/métodos , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Concussão Encefálica/etiologia , Humanos , Índices de Gravidade do Trauma
9.
Artigo em Russo | MEDLINE | ID: mdl-31793550

RESUMO

Article is devoted to topical issues of complex diagnosis and treatment of the consequences of traumatic brain injury (TBI) in children, adolescents and adults. Craniocerebral trauma is one of the most important problems of modern neurology, due to the high frequency and severity of disability. In recent years, there has been a steady increase in effects of TBI, a significant part of which are asthenic, autonomic, cognitive, emotional and motor disorders. Factors affecting the severity of the consequences of TBI are: the severity of the injury, the age, at which the injury occurred, the time elapsed since the injury, the localization of the lesion. After mild TBI, the structure of cognitive impairment is dominated by memory and attention disorders (75%), visual-motor coordination, as well as asthenic disorders (88%), chronic headaches (95%). After moderate and severe TBI, there are more pronounced impairment of cognitive and motor functions accompanied by pathological neurological symptoms in 94-100% of children, which leads to difficulties in learning, self-service and has a negative impact on social adaptation. The article describes in detail the modern methods of complex diagnosis, as well as pathogenetically justified methods of drug therapy of cognitive disorders in patients with the consequences of TBI. The high efficacy of the modern cytoprotective drug Cytoflavin in the treatment of the effects of TBI is shown.


Assuntos
Concussão Encefálica , Lesões Encefálicas Traumáticas , Disfunção Cognitiva , Transtornos da Memória , Adolescente , Adulto , Concussão Encefálica/complicações , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/terapia , Criança , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/terapia , Humanos , Memória , Transtornos da Memória/diagnóstico , Transtornos da Memória/etiologia , Transtornos da Memória/terapia
10.
Int J Sports Med ; 40(13): 825-830, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31574545

RESUMO

Concussion is a frequently occurring injury in rugby which is not usually reported to coaches or medical staff. Recognition and treatment of concussion should be a priority; however, education surrounding concussion knowledge and attitudes of the players have been lacking. The aim of this study was to investigate the knowledge and attitudes toward concussion in Western Province Rugby Union (WPRU) Super League senior club rugby players. This study focused on gathering quantitative information from WPRU club rugby players, using the Rosenbaum Concussion Knowledge and Attitudes Survey-Student Version (RoCKAS-ST). The correlation between the Concussion Attitude Index (CAI) and Concussion Knowledge Index (CKI) was (r=0.14). The CKI average for the players was (16.72±2.96). The participants answered 67% (16.72±2.96) of the CKI questions and 62% (46.54±5.75) of the CAI questions correctly. The participants demonstrated sufficient knowledge of concussion, as well as safe attitudes toward concussion. A small number of players lacked knowledge of symptoms and attitudes toward concussion, which may have been influenced by the importance of games. Overall, the participants in this study demonstrated superior knowledge and safe attitudes compared to other studies. The current study found that the players had good knowledge and safe attitudes regarding the severity of concussion.


Assuntos
Atletas/psicologia , Concussão Encefálica , Futebol Americano/lesões , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Concussão Encefálica/diagnóstico , Concussão Encefálica/etiologia , Humanos , Masculino , África do Sul , Inquéritos e Questionários , Adulto Jovem
11.
South Med J ; 112(10): 547-550, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31583417

RESUMO

Sports-related encephalopathies are a growing concern among athletes who have experienced head trauma. Anxiety is heightened for the public and especially among parents of children playing contact sports. The most common neuropsychological conditions are concussions and traumatic encephalopathies. Concussions result from brain traumas that can be asymptomatic, but more serious concussions can include loss of consciousness, neurological abnormalities, and/or posttraumatic amnesias. Repetitive concussions lead to persistent brain pathology, known as chronic traumatic encephalopathies. This gradually progressive neurodegenerative disease frequently presents with cognitive and neurological deficits, which can result in significant parkinsonian features and dementia. Imaging studies may be noncontributory; however, diffusion tensor imaging, magnetic resonance spectroscopy, and functional magnetic resonance imaging can detect changes indicative of these encephalopathies. Progressive neuronal degeneration with tau proteins are documented on pathological examination. Prevention, early diagnosis, and proper treatment are the recommended approach to these conditions.


Assuntos
Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/prevenção & controle , Encefalopatia Traumática Crônica/prevenção & controle , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/patologia , Traumatismos em Atletas/terapia , Concussão Encefálica/diagnóstico , Concussão Encefálica/patologia , Concussão Encefálica/terapia , Encefalopatia Traumática Crônica/diagnóstico , Encefalopatia Traumática Crônica/patologia , Encefalopatia Traumática Crônica/terapia , Dispositivos de Proteção da Cabeça , Educação em Saúde , Humanos , Equipamento de Proteção Individual , Volta ao Esporte/normas
13.
Clin Sports Med ; 38(4): 497-511, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31472762

RESUMO

Concussion is a challenging and controversial medical diagnosis that can test even the most seasoned practitioner. Knowledge on this topic is ever evolving. It was not so long ago that grading guidelines were based on loss of consciousness and amnesia. Medicine has seen a renaissance of discovery over the past 20 years in concussion evaluation and management. A PubMed search for "concussion" between 1990 and 2000 produced just over 1000 articles and that same search including the last 18 years expands to over 10,000 publications. The most recent knowledge and recommendations are discussed based on the published evidence.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Humanos , Exame Físico , Medicina Esportiva/métodos , Avaliação de Sintomas
14.
Sports Health ; 11(6): 492-497, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31486715

RESUMO

BACKGROUND: The Buffalo Concussion Treadmill Test (BCTT) is a graded exertion test for assessing exercise tolerance after concussion, but its utility is limited for certain populations. HYPOTHESIS: We developed the Buffalo Concussion Bike Test (BCBT) and tested its comparability with the BCTT. We hypothesize that heart rate (HR) at symptom exacerbation on the BCBT will be equivalent to the BCTT. STUDY DESIGN: Case-control study. LEVEL OF EVIDENCE: Level 3. METHODS: Adolescents with acute concussion (AC) (n = 20; mean age, 15.9 ± 1.1 years; 60% male) presenting to a concussion clinic within 10 days of injury and age- and sex-matched healthy controls (n = 20; mean age, 15.9 ± 1.1 years; 60% male) performed the BCTT at first visit and returned within 3 days to perform the BCBT. Test duration, HR, symptom severity (measured using a visual analog scale), and exertion (measured using the Borg Rating of Perceived Exertion) were collected during each test. RESULTS: Adolescents with AC who were exercise intolerant on the BCTT were also intolerant on the BCBT, with symptom exacerbation occurring at a mean 8.1 ± 2.8 minutes on the BCTT versus 14.6 ± 6.0 minutes on the BCBT (P < 0.01). Two 1-sided t tests showed that the HR at symptom exacerbation in AC patients (137 ± 28 bpm on BCTT vs 135 ± 25 bpm on BCBT; 95% CI, <0.01-0.03) and at voluntary exhaustion for controls (175 ± 13 bpm on BCTT vs 175 ± 13 bpm on BCBT; 95% CI, 0.03-0.03) on each test were statistically equivalent. CONCLUSION: The HR at symptom exacerbation on BCBT is equivalent to the BCTT for the assessment of exercise tolerance after concussion in adolescents. CLINICAL RELEVANCE: The BCBT can be used in patients with limited mobility or for research interventions that require limited participant motion.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Teste de Esforço/métodos , Adolescente , Estudos de Casos e Controles , Tolerância ao Exercício/fisiologia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino
15.
Dev Neuropsychol ; 44(6): 443-451, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31537099

RESUMO

The influence of fear of re-injury that this variable has on recovery outcomes following sports-related concussion remains unknown. We examined changes in fear of re-injury throughout concussion recovery, and compared changes in neurocognitive, symptom, vestibular/ocular motor, and recovery time outcomes between concussed adolescent athletes who endorsed high and low fear of re-injury. Individuals with high fear of re-injury were more symptomatic and more likely to exhibit vestibular/ocular motor symptoms over clinical cutoffs than those with low fear of re-injury. Recovery time was not significantly different between the groups. These findings may help explain performance on more subjective concussion assessments.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/psicologia , Concussão Encefálica/diagnóstico , Concussão Encefálica/psicologia , Transtornos Cognitivos/diagnóstico , Medo , Adolescente , Atletas , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Estudos Prospectivos , Instituições Acadêmicas , Esportes
16.
J Sci Med Sport ; 22(12): 1292-1297, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31521485

RESUMO

OBJECTIVES: The current study investigated the role of persistent vestibular-ocular symptoms and impairment following sport-related concussion on recovery time and clinical outcomes among adolescents. DESIGN: Prospective cohort. METHODS: 50 (F-22/M-28) adolescents aged 12-20 years completed a vestibular-ocular motor screening, neurocognitive assessment, and the Post-Concussion Symptom Scale (PCSS) at clinical assessments conducted at 0-10 and 11-21 days after concussion. Participants were assigned to: 1) persistent vestibular-ocular (PERSIST), 2) vestibular-ocular improvement (IMPROVE), or 3) no vestibular-ocular impairment (NONE) groups based on vestibular-ocular motor screening conducted during each assessment. A 3 (GROUP) X 2 (TIME) ANOVA was performed on neurocognitive and symptom scores, and a between-subjects ANOVA was performed for recovery time. RESULTS: 49 subjects were identified among the PERSIST (n=17), IMPROVE (n=12) and NONE (n=20) groups. There were no neurocognitive performance differences between groups at 0-10 days post-concussion, but groups differed on PCSS at 11-21 days (p=.001), with the PERSIST (29.0±24.9) group reporting higher symptoms than the NONE (5.45±10.0; p=.005) group. The PERSIST group took significantly longer to recover (34.9±11.6 days) than the NONE (22.9±14.9 days) group (p=.03). All groups improved on verbal (p<.001) and visual memory (p=.028), visual motor speed (p=.005), and reaction time (p=.004) from 0-10 to 11-20 days following SRC and no significant group by time interactions for cognitive scores identified. CONCLUSIONS: Persistent post-concussion vestibular-ocular symptoms and impairment may influence neurocognitive performance and clinical recovery following sport-related concussion.


Assuntos
Traumatismos em Atletas/complicações , Concussão Encefálica/complicações , Transtornos da Motilidade Ocular/etiologia , Síndrome Pós-Concussão/diagnóstico , Doenças Vestibulares/etiologia , Adolescente , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Criança , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Transtornos da Motilidade Ocular/diagnóstico , Estudos Prospectivos , Tempo de Reação , Doenças Vestibulares/diagnóstico , Adulto Jovem
18.
Ergonomics ; 62(11): 1485-1494, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31390942

RESUMO

The effective management of sports-related concussion is an on-going problem in amateur sport due to a number of systemic issues. These factors have often been studied in isolation with minimal consideration for the interactions between them, or the overall system in which they occur. The aim of this research was to model the actors, controls, and feedback mechanisms influencing the management of concussion in community rugby union using the Systems-Theoretic Accident Model and Processes (STAMP) method. Findings show that there are currently many inadequate controls, that are directly and indirectly impacting effective concussion management. The practical implications of these findings are discussed (e.g. improved guideline education, mandatory medical presence, rule amendments). Additionally, the model provides a sound framework similar team sports can use to inform research into injury management and prevention (e.g. rugby league, hockey, AFL). Practitioner Summary: Research shows that concussion management in regional sport is inconsistent due to contextual limitations. Systems-Theoretic Accident Model and Processes was applied to identify the systemic factors currently influencing concussion management practices in community sport. Findings show inadequate controls precipitate concussion management gaps. Practical implications of the findings are discussed.


Assuntos
Concussão Encefálica/diagnóstico , Encefalopatia Traumática Crônica/prevenção & controle , Futebol Americano/lesões , Análise de Sistemas , Adulto , Austrália , Concussão Encefálica/terapia , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Política Organizacional , Equipamento de Proteção Individual , Valores Sociais
19.
J Athl Train ; 54(8): 852-857, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415183

RESUMO

OBJECTIVE: To assist sideline medical staff and to augment detection of concussion in National Football League (NFL) players during preseason and regular season games via the use of certified athletic trainer (ATC) spotters. BACKGROUND: Detecting concussive injuries in contact-sport athletes can be a challenging task for health care providers on the sideline. Over the past 8 years, professional sport leagues have begun to use additional sets of eyes (medical spotters along with video review) to help identify athletes with possible concussive injuries. DESCRIPTION: The NFL first began a program using spotters in 2011, and the ATC Spotter Program has undergone systematic enhancements each year. This article describes the evolution of the ATC Spotter Program, the requirements and training of its participants, and the program data available to date. Directions for future improvement and research are addressed. CLINICAL ADVANTAGES: The use of ATC spotters stationed in the broadcast booth has enhanced the real-time detection of concussed players in the NFL.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Futebol Americano/lesões , Gestão da Segurança , Traumatismos em Atletas/etiologia , Concussão Encefálica/etiologia , Humanos , Desenvolvimento de Programas , Melhoria de Qualidade , Segurança , Gestão da Segurança/métodos , Gestão da Segurança/organização & administração , Estados Unidos
20.
Sports Health ; 11(6): 479-485, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31411942

RESUMO

BACKGROUND: Oculomotor impairments, dizziness, and imbalance are common after sports-related concussion (SRC) in adolescents and suggest a relationship between SRC and vestibular system dysfunction. However, it is not clear whether the source of these problems is attributable to the peripheral or central vestibular system. HYPOTHESIS: The video Head Impulse Test (vHIT), which assesses peripheral vestibular function, will show differences in gain between adolescents with and without SRC. Furthermore, there will be an association between vHIT and clinical balance and vestibular/oculomotor testing. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 2. METHODS: Twenty-five symptomatic adolescents aged between 12 and 19 years with a recent (within 10 days) SRC and 22 healthy controls aged 13 to 20 years were assessed using the vHIT, Balance Error Scoring System (BESS), and Vestibular Ocular Motor Screening (VOMS) tools. The vestibulo-ocular reflex (VOR) gain was calculated independently for right and left head impulses. Independent-samples t tests or Mann-Whitney U tests for nonnormal distributions were used to compare concussed patients and controls on the measures. Spearman rank-order correlations were used to assess the association of vHIT with BESS and VOMS. RESULTS: VOR gain in all adolescents with SRC was greater than 0.8, which is considered within normal limits. VOR gain and BESS scores were not significantly different between groups. Adolescents with SRC had significantly worse VOMS item scores than adolescents without SRC (P < 0.001). There were no significant correlations among vHIT gain and VOMS or BESS. CONCLUSION: There was no evidence for dysfunction in the peripheral horizontal semicircular canal function at high rotation speeds (ie, vHIT) after SRC, and vHIT was unrelated to balance and vestibular/oculomotor symptoms and dysfunction. However, adolescents with SRC scored worse on vestibular and oculomotor testing than those without SRC. Vestibular dysfunction and symptoms after SRC may be centrally derived. CLINICAL RELEVANCE: We do not recommend the assessment of head impulse function in adolescents with SRC unless more definitive signs of peripheral vestibular injury are present. We recommend using the VOMS to assess symptoms of suspected SRC injury in adolescents.


Assuntos
Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/fisiopatologia , Reflexo Vestíbulo-Ocular/fisiologia , Adolescente , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Criança , Estudos Transversais , Feminino , Teste do Impulso da Cabeça , Humanos , Masculino , Equilíbrio Postural/fisiologia , Canais Semicirculares/fisiopatologia , Adulto Jovem
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