Concussion – The Sport Journal

Return to Play and Learn: Findings from a Countywide High School Sports-Related Concussion Program

Authors: Gillian Hotz PhD¹, Jacob R. Griffin², Hengyi Ke³, Raymond Crittenden IV², Abraham Chileuitt MD⁴

¹Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA

²KiDZ Neuroscience Center, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA

³Department of Public Health, Division of Biostatistics, University of Miami Miller School of Medicine, Miami, FL, USA

⁴Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA

Corresponding Author:

Gillian Hotz, Ph.D.
1095 NW 14th Ter
Miami, FL 33136
ghotz@med.miami.edu
305-243-2074

Gillian A. Hotz, PhD is a research professor at the University of Miami Miller School of Medicine and a nationally recognized behavioral neuroscientist and expert in pediatric and adult neurotrauma, concussion management, and neurorehabilitation. Dr. Hotz is the director of the KiDZ Neuroscience Center, WalkSafe, and BikeSafe programs.

Return to Play and Learn: Findings from a Countywide High School Sports-Related Concussion Program

ABSTRACT

Purpose
To report return to play (RTP) and learn (RTL) findings of high school athletes with a sports-related concussion (SRC) from a 10-year injury surveillance system. The goal was also to explore differences between athletes who received and did not receive academic accommodations.

Methods

SRC data was entered into a REDCap database by certified athletic trainers (ATs) at 35 public high schools in Miami-Dade County (MDC). A required 6 Steps to Safe Play concussion protocol was implemented between 2012 to 2022. Concussion Clinic data was also reported for as well as symptom scores of post-injury ImPACT retesting.

Results

From review and analysis of the ImPACT retesting scores, the most common symptoms reported included; headache (54.0%), difficulty concentrating (35.0%), sensitivity to light (34.6%), and dizziness (30.5%). Overall, female athletes reported a higher symptom count and severity on post-injury ImPACT assessments than males (7 vs. 4 total symptoms score; p < 0.001), and all but 4 of the 22 reportable symptoms listed on the symptom inventory (vomiting, fatigue, numbness/tingling, and difficulty remembering) were significant (p < 0.05) between males and females. Despite experiencing a greater number of overall SRCs, athletes playing football had a smaller average (p < 0.001) ImPACT total symptom score than athletes playing other sports (10.9 vs. 14.2). Those seen in clinic and receiving academic accommodations were less likely to RTP, have a greater (p < 0.05) ImPACT total symptom score, more days between injury date and post-ImPACT testing, and a greater number of days until returning to play than athletes not academically accommodated.

Conclusions

It is important for concussion providers to identify and monitor symptoms post-SRC. Study findings report that high school female athletes report more symptoms following an SRC and that appropriate academic accommodations should be included when necessary to ensure athletes recover in a safe and timely manner. Understanding how SRC symptoms vary based on an athlete’s circumstances can help in managing SRC and making better RTL and RTL decisions.

Application In Sports

Academic accommodations, when appropriate, should be incorporated and implemented in an athlete’s recovery plan to help them safely return to the field and classroom after an SRC.

Key Words: Concussion, Adolescent, Accommodations, Symptoms

(more…)

Vandy Pacetti-Donelson2023-08-25T14:38:06-05:00August 25th, 2023|Research, Sports Management|Comments Off

Increased Identification of Concussions in High School Wrestlers after Rule Change

Authors: Luis Gude, MD, Gillian Hotz, PHD

Corresponding Author:
Gillian Hotz Ph.D
Lois Pope LIFE Center – 1-40, (R-48)
1095 NW 14^th Terrace
Miami, Florida 33136.
ghotz@med.miami.edu
305-243-4004

Gillian A. Hotz, PhD is a research professor at the University Of Miami Miller School Of Medicine and a nationally recognized behavioral neuroscientist and expert in pediatric and adult neurotrauma, concussion management, and neurorehabilitation.

Dr. Hotz is the director of the KiDZ Neuroscience Center, WalkSafe, BikeSafe, and SkateSafe programs, and has been co-director of the Miller School of Medicine’s Concussion Program since 1995. She continues to assess and treat many athletes from Miami-Dade County public and private high schools, the University of Miami, and from other colleges and the community.

Increased Identification of Concussions in High School Wrestlers after Rule Change

ABSTRACT

Purpose: The purpose of this study is to report on concussions identified in high school wrestlers, and to compare the number of injuries before and after the National Federation of State High School Associations (NFHS) enacted a rule change prior to the start of the 2019-20 season that increased the amount of time that an appropriate health-care professional may use to evaluate for a suspected sport related concussion (SRC) from 30 seconds to 5 minutes during competition.

Methods: The subjects of this study were wrestlers from Miami Dade County public high schools who sustained a sports related concussion from August 2017 to March 2020, identified from the Miami Concussion Model Concussion Injury Surveillance System. The database is compiled from reports submitted by certified athletic trainers after a suspected concussion, post-injury ImPACT tests, and from patients who presented to the University of Miami Sports Concussion Clinic for evaluation.

Results: A total of 37 wrestlers were identified. The 2019-20 academic year accounted for the greatest number of injuries (17, 46%), including the highest number of injuries identified that occurred during competition and practice compared to previous years.

Conclusions: The increase in identified concussions in wrestlers in the 2019-20 season is likely multifactorial given increased knowledge, education, and training on SRC that is targeted to athletes, parents, coaches, and athletic trainers. The increase in the number of injuries identified during competition is also likely attributable to the rule change instituted by the NFHS prior to the start of the 2019-20 season.

Applications in Sport: It is important to identify sport related concussions when they occur so that these athletes may seek treatment and obtain proper clearance prior to return to play, which may decrease the risk of subsequent SRC and long-term sequelae of mild traumatic brain injuries. Our findings support the rule change instituted by the NFHS prior to the start of the 2019-20 season as this increased the amount of time that an appropriate health-care professional may use to evaluate for a suspected SRC and likely contributed to an increase in the number of SRC identified in wrestlers during competition.

(more…)

U.S. Sports Academy2021-03-09T08:23:13-06:00March 5th, 2021|Sports Medicine|Comments Off

Concussion in the Collegiate Equestrian Athlete

Authors: Tasneem Zahira PhD, Timothy Henry PhD ATC, Michael L. Pilato MS ATC

Corresponding Author:
Michael L. Pilato MS ATC
1000 East Henrietta Road, Rochester, NY 14623
mikep316@yahoo.com
585-329-6463

Michael L. Pilato is an athletic trainer with Monroe Community College in Rochester, N.Y. He has been researching sports medicine for the equestrian athlete since 2003 and has been published in peer and non-peer reviewed journals.

Tasneem Zaihra PhD.
Department of Mathematics State University New York College at Brockport
350 New Campus Dr, Brockport, NY 14420
tzahira@brockport.edu
585-3952075

Tasneem Zaihra is an assistant professor of statistics in the department of mathematics, SUNY Brockport. She has many presentations and publications in peer-reviewed journals, to her credit.

Timothy Henry PhD. ATC
Department of HPERD State University New York College at Brockport
350 New Campus Dr, Brockport, NY 14420
thenry@borckport.edu
585-395-5357

Timothy Henry is director of the athletic training program at SUNY Brockport. He is also a reviewer for The Journal of Sport Rehabilitation and The Journal of Athletic Training.

Concussion in the Collegiate Equestrian Athlete

ABSTRACT

Equestrian sports, in general, pose a significant risk of concussion. Minimizing the risk of concussion has been a focal point in recent years. The purpose of this paper is to describe concussion and explore potential association(s) between groups of musculoskeletal injuries and Body Mass Index (BMI) on the risk and odds of concussion in the collegiate equestrian athlete. Forty-three schools, ranging from DI to DIII, from the Eastern United States were selected from the NCAA and Intercollegiate Horse Show Association’s websites. Self-reported injury and demographic data was collected through an online survey created in Mach Forms. Seventy-three participants completed the online survey (women n=71, men=2). Aggregate descriptive data is reported on all subjects. After removing data on 2 men, and a single female with incomplete data, the data from 70 females with complete data was analyzed using chi-squared and Fisher’s exact tests and ordinal logistic regression. Pearson’s chi-squared as well as Fisher’s exact test (p-value =.0288 and.0297 respectively) indicates the risk of having concussion with 0 UE injury is not the same as with 1 or 2+ injuries. The average number of injuries per athlete increased from 0 to 2(+) concussions. Concussion is a commonly reported injury. Upper extremity injury is identified as having the strongest association with concussion risk in the equestrian athlete. Knowing UE injury status could be useful in gaging the risk and odds of concussion in equestrian athletes.

(more…)

U.S. Sports Academy2020-01-31T09:20:28-06:00February 7th, 2020|Research, Sports Medicine|Comments Off

St. Luke’s Virtual Concussion Clinic: A Unique Structure to Provide Comprehensive Care for Patients

Authors:
Kurt J. Nilsson, MD, MS
St. Luke’s Health System
St. Luke’s Concussion Clinic

Hilary Flint, PhD, MPH
St. Luke’s Health System
St. Luke’s Research

Janet Reis, PhD
Boise State University
College of Health Sciences
Office of Research

Krisi Pardue, CCC-SLP, CBIS
St. Luke’s Health System
St. Luke’s Concussion Clinic

Corresponding Author:
Kurt J. Nilsson, MD, MS
St. Luke’s Health System
St. Luke’s Concussion Clinic
600 N. Robbins Rd, Boise, ID 83702
208-383-2665
knilsson@slhs.org

St. Luke’s Virtual Concussion Clinic: A Unique Structure to Provide Comprehensive Care for Patients

ABSTRACT
Purpose: Failure to provide timely assessment and management of patients with concussions creates prolonged challenges for patients and primary care providers by disrupting work and school, interpersonal and family relationships, and placing patients at risk of injury. Thus, it is essential to provide timely and appropriate care to minimize post-concussion symptoms. The development of a virtual concussion clinic with a central referral and care coordination system is described. Additionally, key identifiers of virtual clinic patients are presented.

Methods: Intake and referral processes were implemented within 18 specialty clinics and 3 emergency departments. All patients (n= 623) completed a modified version of the Centers for Disease Control (CDC) Acute Concussion Evaluation (ACE) Form prior to their referred appointment with a clinician. Data was collected over a year and a half period.

General linear models compared the ACE domains and overall ACE scores with fixed variables of gender and cause of concussion.

Results: For our sample, most referrals came from emergency departments and primary care physicians. The sample was majority male (57%), with mean age 21.8 years. Females playing soccer, basketball, and cheerleading were most likely to have a concussion, whereas football represented 65% of concussions in male patients.

Significant effects for gender (p <0.02) were observed for all ACE domains except for Cognitive, and cause of concussion (p <.001) was significant for all ACE domains. The interaction between gender and cause of concussion (p=0.02) on the Physical ACE domain was significant. Conclusions: A virtual concussion clinic can successfully match the patient and his/her individual health care needs to an appropriate provider. Results demonstrate gender and cause of concussion impact evaluation, and warrants further research to discern optimal care for patients with concussion.
(more…)

U.S. Sports Academy2017-09-13T11:51:32-05:00October 26th, 2017|Sports Medicine|Comments Off

Taking Concussion Vital Signs Neurocognitive Test Under Varied Conditions

Authors: Scott L. Bruce, EdD, AT, ATC
Sarah Stauffer, AT, ATC
Andrew Chaney, AT, ATC
Kelsey Garrison, AT, ATC
Wright State University

Corresponding Author:
Scott L. Bruce, EdD, AT, ATC
Assistant Professor/Director of Research
Wright State University
3680 Colonel Glenn Hwy
Dayton, OH 45435
937-245-7622
scott.bruce@wright.edu

Scott Bruce is an Assistant Professor and the Director of Research for the Athletic Training Program at Wright State University.

Taking Concussion Vital Signs Neurocognitive Test Under Varied Conditions

ABSTRACT
Neurocognitive test batteries are commonly used tools for concussion assessments in the medical professions. Administered at baseline and post-injury these tests provide information on a patient’s neurocognitive ability during the recovery and return-to-activity phases. In athletics, student-athletes usually take the baseline exam as a group in a computer lab prior to the season beginning. If a medical professional believes an individual has sustained a possible concussion, they will retest them and compare their post-injury and baseline results. A deficit in one of more areas of the neurocognitive test may be indicative of a possible concussion. The purpose of this study was to examine whether or not there was a difference in neurocognitive test scores from Concussion Vital Signs when tested under two different conditions: “lights out” and with distractions. Our study was a randomized control trial performed at a Midwestern NCAA, “mid-major” Division I Institution. The subjects were 15 college-aged students with an overall mean age of 19 years (1.2). There were seven females (mean age was 19 ± 0.77) and eight males (mean age was 20 ± 1.2). A paired t-test was used to determine if a difference in the neurocognitive test section scores between the conditions existed. On three of the ten test sections, there was a statistically significant difference between the baseline and distraction condition. On four of the ten test sections between baseline and the lights out condition for males, but not for females. Testing should be done in a quiet room, with distractions minimized, as distraction hinders focus and performance. The results of this study indicate males may have a more difficult time concentrating while taking neurocognitive tests than females. Administering neurocognitive testing in a quiet, well-lit room is the best condition for the patient to take these concussion-related tests.

(more…)

U.S. Sports Academy2016-10-31T10:36:51-05:00November 17th, 2016|Sports Medicine|Comments Off