ImPACT Normative Data of Ethnically Diverse Adolescent Athletes.

OBJECTIVE: The aim of this research was to develop preliminary norms for the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) administered to a large sample of adolescent athletes from diverse ethnic backgrounds. DESIGN: A retrospective records review. SETTING: Middle and high school athletic departments. PARTICIPANTS: A total of 5741 male and female adolescent athletes in Hawaii, aged 13 to 18 years, in grades 9 to 12 were included in the study. INDEPENDENT VARIABLES: Age, sex, ethnicity, and sport. MAIN OUTCOME MEASURES: ImPACT Composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time, and Impulse Control) and Total Symptom score from baseline testing. RESULTS: The results indicated statistically significant differences between age and sex groups, as well as between ethnic and sport groups. CONCLUSIONS: The findings support the continued use of stratified norms for age and sex for ethnically diverse adolescent athletes. Comparisons of ethnic and sport groups deserve further investigation. When baseline scores are not available for postconcussion comparison, present observations tentatively support the cautious use of standard ImPACT norms with ethnically diverse athletes.

Effects of repetitive subconcussive head trauma on the neuropsychological functioning and symptom reporting of high school athletes in high and low contact sports: Age and sex.

OBJECTIVE: The present study was designed to assess the neuropsychological test performances of non-concussed female and male high school athletes of different ages in high and low contact sports. METHOD: Large samples of 2,510 high school athletes in High Contact sports (e.g., football) and 1,437 in Low Contact sports (e.g., basketball) were examined. The participants were administered a baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) prior to their respective seasons. RESULTS: Multivariate linear regression showed that the High Contact athletes had significantly poorer results than the Low Contact athletes in all four ImPACT Composite scores and the Total Symptom scores. No age differences were found, but in all three age groups, the High Contact athletes had lower Visual Motor Speed scores than the Low Contact athletes. No test score differences were noted between the females in the High and Low Contact groups, but the High Contact males had poorer Visual Motor Speed and Reaction Time than the Low Contact males. CONCLUSIONS: The present results were consistent with prior studies of subconcussive head trauma, with High Contact athletes obtaining overall poorer neuropsychological test results than Low Contact athletes. More investigations in this age group seems is warranted.

Sex comparisons in neuropsychological functioning and reported symptoms following a sports-related concussion among high school athletes.

The aim of this study was to compare the neuropsychological functioning and symptoms of female and male high school athletes following a single concussion during the school year. The baseline test scores of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) of 309 concussed athletes (169 females, 221 males) in varied sports were obtained. After a sport-related concussion, the athletes were re-administered the ImPACT, on the average, 7.25 days after the injury. MANCOVA compared the ImPACT baseline scores, post-concussion scores, and baseline-to-post-concussion changes of the female and male athletes, with p set at 0.01. The only significant sex comparison found females performing better on baseline visual motor speed (p < 0.001). Otherwise, no sex differences were found in baseline test scores, post-concussion scores, and baseline-to-post-concussion changes. The findings tentatively suggest that there are insignificant sex differences in the consequences of sport-related concussion after a week post-injury. Future studies on sex comparisons after a concussion are needed focusing on the acute and sub-acute phases of the recovery period.

Invalid Baseline Testing with ImPACT: Does Sandbagging Occur with High School Athletes?

The aim of this large-scale research was to determine the frequency of valid, invalid, and sandbagging results in ImPACT baseline testing of high school athletes. This retrospective study identified valid, invalid (identified by five embedded Invalidity Indicators), and sandbagging (identified by three "red flags") results in the ImPACT baseline test scores of 6,346 high school athletes. In addition, the ImPACT postconcussion scores of 266 athletes who sustained a concussion during the school year were evaluated to compare the baseline-to-postconcussion changes of valid versus a combined group of invalid and sandbagging scorers. There were 3,299 (51.99%) athletes who had valid baseline scores, 269 (4.24%) had invalid scores, and 3,009 (47.42%) had sandbagging scores. (There were 231 who obtained both invalidity and sandbagging scores.) The overall difference in baseline-to-postconcussion changes between the valid scorers and the combined group of invalid and sandbagging scorers was statistically significant. The high rate of athletes who had invalid and sandbagging scores raised concern that the underperformance of baseline testing occurs more commonly than is probably realized by those who utilize computerized neuropsychological testing with high school athletes. Accordingly, efforts are needed to improve test administration procedures so that maximal attention and effort can be maintained among the test takers. In the meantime, increased caution is called for in employing the baseline-to-postconcussion paradigm when return-to-play decisions are made.

Effects of preload 4 repetition maximum on 100-m sprint times in collegiate women.

The purpose of this study was to determine the effects of postactivation potentiation (PAP) on track-sprint performance after a preload set of 4 repetition maximum (4RM) parallel back half-squat exercises in collegiate women. All subjects (n = 12) participated in 2 testing sessions over a 3-week period. During the first testing session, subjects performed the Controlled protocol consisting of a 4-minute standardized warm-up, followed by a 4-minute active rest, a 100-m track sprint, a second 4-minute active rest, finalized with a second 100-m sprint. The second testing session, the Treatment protocol, consisted of a 4-minute standardized warm-up, followed by 4-minute active rest, sprint, a second 4-minute active rest, a warm-up of 4RM parallel back half-squat, a third 9-minute active rest, finalized with a second sprint. The results indicated that there was a significant improvement of 0.19 seconds (p < 0.05), when the second sprint was preceded by a 4RM back-squat protocol during Treatment. The standardized effect size, d, was 0.82, indicating a large effect size. Additionally, the results indicated that it would be expected that mean sprint times would increase 0.04-0.34 seconds (p < 0.05), when using a preload 4RM squat protocol. There were no significant differences between Control pre and posttests (p > 0.05). The findings suggest that performing a 4RM parallel back half-squat warm-up before a track sprint will have a positive PAP affect on decreased track-sprint times. Track coaches, looking for the "competitive edge" (PAP effect) may re-warm up their sprinters during meets.

Effects of a Single Concussion During the School Year on the Academic Performance and Neuropsychological Functioning of High School Athletes.

There are very few studies examining the effects of sports-related concussion (SRC) on objective measures of school performance, such as grades or test scores. In this research, the grade point averages (GPAs) and scores of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) of athletes who sustained an SRC during the school year were compared with those of athletes who did not have an SRC. Multivariate analysis of variance (MANOVA) revealed a significant linear decline in GPA of both groups across the school year, but indicated no difference in the GPA decline between the concussion and no concussion groups. The GPAs of the concussion and no concussion groups were not significantly different across the school year. Finally, no differences were found between the pre- and post-concussion ImPACT scores of the concussed athletes. This study found that an SRC during the school year did not affect the academic performance or neurocognitive test scores of high school athletes.

Maximizing Recovery From Concussions for Youth Participating in Sports and Recreational Activities.

Concussions have become a public health issue. This public health concern has drawn the attention of many states in which laws were created to address concussions safety, recognition of signs and symptoms, immediate removal, medical clearance, and return-to-play protocols. Most state legislation focused on student athletes participating in organized sports. However, the rise in concussion can be directly attributed to children, youth, and adolescents participating in nonsports-related events. Maximizing recovery from a concussion involves implementing education programs that focus on recognition of symptoms, treatment, and return-to-learn options. Treatment strategies used to address concussed youth include physical and cognitive rest and minimizing external stimuli that can increase symptoms. Because learning is a direct outcome for all youth, a return-to-learn protocol based on a collaborative school-based team approach is suggested.

Incidence and Risk of Concussions in Youth Athletes: Comparisons of Age, Sex, Concussion History, Sport, and Football Position.

OBJECTIVE: This study was designed to determine concussion incidence, risk, and relative risk among middle and high school athletes participating in various sports. METHOD: Data were retrospectively obtained from 10,334 athletes of 12 different sports in Hawaii. In addition to determining the overall concussion incidence, comparisons of incidence, risk, and relative risk were made according to age, sex, concussion history, sport, and football position. RESULTS: The overall incidence of concussion among youth athletes was 1,250 (12.1%). The relative risk for a concussion was almost two times greater in 18-year olds than in 13-year-old athletes. In comparable sports, girls had a 1.5 times higher concussion risk than boys. Athletes with a prior concussion had 3-5 times greater risk to sustain a concussion than those with no history of a concussion. Among varied sports, wrestling and martial arts had the highest relative risk of a concussion, followed by cheerleading, football, and track and field. No differences in concussion risks were found among the football players in different positions. CONCLUSIONS: Older youths, females, those with a history of concussion, and those participating in high contact sports were found to have higher risks of sustaining a concussion. The findings increase awareness of concussion patterns in young athletes and raise concerns regarding protective strategies and concussion management in youth sports.

Effects of repetitive subconcussive head trauma on the neuropsychological test performance of high school athletes: A comparison of high, moderate, and low contact sports.

The aim of this study was to examine the neuropsychological test results of non-concussed high school athletes playing at three different levels of contact sports. Based on the concussion risk data of 12 different sports, a High Contact group (n=2819; wrestling/martial arts, cheerleading, track and field, football), a Moderate Contact group (n=2323; softball, basketball, soccer), and a Low Contact group (n=1580; baseball, volleyball, water polo, tennis, cross-country) were formed and compared in terms of their scores on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). The results revealed that the High Contact group obtained small but statistically poorer performances in ImPACT Visual Memory, Visual Motor Speed, Impulse Control, and Total Symptom scores compared to the Moderate and Low Contact groups. The High Contact group also had poorer Reaction Time scores compared to the Low Contact group. No differences between the Moderate and Low Contact groups were noted. The findings, along with prior similar results, tentatively raise concerns that participant in high contact sports, exposed to repetitive subconcussive head trauma, may be at greater risk for lowered neuropsychological functioning and increased symptoms, compared to other high school athletes. In view of the preliminary nature of this investigation, more research into the effects of frequent head impacts in high school sports is strongly recommended.

Hawai'i Concussion Awareness & Management Program (HCAMP): Impact.

Concussion, also referred to as mild traumatic brain injury (mTBI), is caused by a direct or indirect blow to the head or body causing the brain to move rapidly within the skull, resulting in immediate, but temporary, brain dysfunction. Developing awareness and promoting concussion education can reduce the number of short and long-term injuries associated with sports and non-sports related concussions in Hawai'i. The purpose of this study was two-fold: (1) to describe the number of concussions in 67 Hawai'i high school athletic programs using the ImPACT database; and (2) to describe which contact and collision sports had the highest rate of concussions in 67 Hawai'i high schools. This was a retrospective study that described the number of concussions generated across school years 2010-2016, concussion data across 14 contact sports, and athletic exposure rating for the 14 contact sports. Data were analyzed and aggregated from a data-bank associated with the Hawai'i Concussion Awareness and Management program. Findings suggest that for Hawai'i high school student athletes' concussions increased from 2010-2013 with a gradual decrease from 2014-2016, specific sports had higher number of concussions (eg, football), and when evaluating concussion rate per 1000 exposures, girls' judo was the highest. These findings stress the need for continued data collection, monitoring, education/awareness and research that will reduce the number of concussions among student athletes.

Comparison of neuropsychological test scores of high school athletes in high and low contact sports: A replication study.

This replication study re-examined the neuropsychological effects of participation in high and low contact youth sports. Modeled after a recently published investigation, two contact sport groups of participants ages 12 to 18 were formed based on the rate of concussion in their respective sport, with the assumption that more head impacts and neuropsychological effects occur in high contact sports that have a greater number of reported concussions as compared with low contact sports. The preseason baseline ImPACT neuropsychological test scores and symptom scores of non-concussed youth athletes in a High Contact Sport (football, n = 139) and a Low Contact Sport (basketball, baseball, soccer, wrestling, volleyball, paddling, and cheerleading, n = 57) were compared. The results revealed significantly poorer ImPACT test performances in visual motor speed and reaction time among high contact sport athletes compared to low contact sport athletes. No differences were found between the two groups in Verbal Memory, Visual Memory, and Total Symptom. These findings were identical to a recent study in which nonconcussed youth athletes in a high contact sport, that is, football, exhibited poorer neuropsychological test performance than their peers in low contact sports, that is, basketball, baseball, soccer, wrestling, and judo. This research replication verified the results of the prior study, and raises concerns that youth athletes exposed to repetitive head trauma may be at risk for lowered neuropsychological functioning, even without a reported concussive event.

Computerized neuropsychological test performance of youth football players at different positions: A comparison of high and low contact players.

The aim of this study was to examine the effects of head impact frequency on the neuropsychological test results of football players who participate in different positions on the team. Based on the biomechanical measures of head impact frequency reported in high school football, a High Contact group (n = 480) consisting of offensive and defensive linemen was compared with a Low Contact group (n = 640) comprised of receivers and defensive backs. The results revealed that the High Contact group obtained poorer performances on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) on three Composite scores (Verbal Memory, Visual Motor Speed, Impulse Control) and the Total Symptom score compared to the Low Contact group. The present study is the first, to date, to report differences in the neuropsychological test performances of athletes who participate in high and low contact football positions. The findings raise tentative concerns that youth football players exposed to repetitive head trauma, including subconcussive impacts, may be at risk for lowered neuropsychological functioning and increased symptoms.

Role of Native Language in Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) of Youth Athletes.

OBJECTIVE: The aim of this research was to examine the role of native language in the performance of youth athletes on a computerized neuropsychological test battery, the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). METHOD: The study compared the baseline test scores of 5545 participants whose native language was English versus 195 whose native language was not English. The mean age of the participants was 15.06 years. RESULTS: A multivariate analysis of variance revealed no differences in the five ImPACT Composite scores of the two language groups. CONCLUSION: Contrary to prior research, one cannot simply expect that non-native English speakers will do more poorly on ImPACT than native English speakers. Further research on the use of ImPACT with other non-native English-speaking youth athletes is recommended.

Physical Educators' Judgments About Inclusion: A New Instrument for Preservice Teachers.

The purpose was to develop an instrument for use in physical education teacher education (PETE) programs that would yield valid evidence of the judgments of PETE preservice teachers toward the inclusion of students with disabilities into general physical education classes. Both the conceptualization that judgments represent the cognitive expressions of attitudes (Ajzen, 2001; Sherif & Hovland, 1961) and focus group discussions were used to create the Physical Educators' Judgments About Inclusion (PEJI) instrument. Following content validation procedures, we administered PEJI to 272 PETE preservice teachers. Subsequent principal component analysis to generate construct validity evidence indicated 15 items should be retained; they collectively explained 53% of the variance using a three-component model. Dimensions of the PEJI pertained to judgments about inclusion, acceptance, and perceived training needs. Alpha coefficients for the three subscales ranged from .64 to .88.