American Medical Society for Sports Medicine position statement: concussion in sport

A concussion is considered a subset of a mild traumatic brain injury. Research has found that a second hit to the brain before it has had adequate time to heal may result in worsening of metabolic changes within the cells of the brain. Research has also found that an early return to increased cognitive or physical load may cause the brain to be vulnerable to prolonged dysfunctions. Short-term risks for premature return to play include decreased reaction time and an increased risk of a repeat concussion or injury. Long-term effects include secondary neurological conditions. There is currently no validated return to play guidelines for concussions. It is found that athlete diagnosed with a concussion should never return the same day or should return to sport if they are still symptomatic. It is concluded that treating concussions requires a multifaceted approach. It is important for the athlete to be honest with their symptoms and for all parties involved to be able to recognize signs and symptoms of the injury.  It is then recommended that a healthcare provider that is familiar with the athlete and knowledgeable in recognition and evaluation of concussions be used to properly diagnose a concussion. To see full article and a list of signs and symptoms of a concussion

Impacts post concussion with dual-task gait balance control

As there is a continuation of recognition of concussions in the adolescent populations there is still not current agreed upon regulations for return to activity post concussion. It has previously been hypothesized that gait stability during dual-task walking may be particularly sensitive to long-term disruptions after concussions. This study looked at a cohort of adolescents who returned to activity within 2 months of their injury. The participant’s cognition, symptom severity, and balance control during single-task and dual-task walking was observed before and after returning to pre-injury activities. In regards to balance, this study found the participants to have an increased medial/lateral center of mass displacement and velocity during dual-task walking after they returned to their pre-injury activities. See full study

Diagnostic Tests for Concussions: Is Vision Part of the Puzzle?

The Centers for Disease Control and Prevention have estimated that 1.4- 3.8 million sports-related mild traumatic brain injures (mTBI) annually in the United States. Not including mTBI not reported or ones seen in the out-patient setting. Sustaining one concussion during a sports season gives an athlete a 3 times greater risk for a second concussion. This article seeks to look at the visual impairments associated with concussions. This can help both with screening and monitoring the recovery of mTBI. In summary concussions and mTBI can have multiple of effects on the visual system. The authors of this article suggest adding a visual component to the current sideline tests in identifying sports-related concussions. See full article 

Exercise Prescription Patterns in Patients Treated with Vestibular Rehabilitation After Concussion

In individuals post-concussion, 23-81% report of dizziness. It has been estimated that persistent dizziness after mild traumatic brain injury varies from 16-18% three-months post concussion.  Previous studies have shown that vestibular rehabilitation reduces dizziness and improves overall balance for individuals with a head injury. The purpose of this study was to describe exercise prescription patterns in patients treated with vestibular rehabilitation. A total of 104 participants (mean age of 24) received a computer-generated home exercise program of vestibular rehabilitation exercises after being diagnosed with a concussion. The range of interventions were from 7-181 days post-concussion with a median of  33 days. A range of 2-13 visits from a physical therapists with at least 3 years experience in vestibular physical therapy (mean of 4 visits).  The computer-generated exercise handout program (Visual Health Information, WA, USA)  was reviewed by one of the authors and modified and progressed by a physical therapist.

The 5 main exercise categories are: eye-head coordination, sitting balance, standing static balance, standing dynamic balance, and ambulation. Based on the exercises that were prescribed, it was found that most of the impairments in this cohort of patients were in the domains of eye-head coordination, standing static balance, and ambulation. Possible implications for findings suggest that impairments in the eye-head coordination could be caused by a disruption in the Vestibulo-ocular reflex (VOR) or reflect increased symptoms with head and eye movement. In this current study 95% of patients were found to have impairments in eye-head coordination. In this current study, they found 88% of participants to have impairments in standing static balance at least 6 days after concussion. This could cause implications of slower gait velocity, shorter stride length, and wider step width. In the current sample 76% of participants had impairments in ambulation. Other important findings in regards to clinical decision making found that physical therapists did not address the ambulation impairments in the first visit, instead their initial focus was the eye-head coordination category. Clinical reasoning is further discussed in the article. In summary, this article has found that expert clinicians prescribe comparable exercises for patients post-concussion with the aforementioned impairments to an individual with unilateral vestibular hypo-function. This further highlights the importance of the vestibular system in post-concussion individuals and an idea of a preferred prescription patterns. See full study.

Multiple Prior Concussion in High School Athletes

Currently it is suggested that the rate of concussions in high school athletes is 0.51 concussions per 1000 athlete exposures. There is current research pertaining to the effects of multiple concussions and their long lasting effects in Division I collegiate athletes and professional athletes but there has not been any studies of the long-term effects in high school athletes. A study was done looking at the relationship between prior concussions on baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in student athletes from 49 Maine High Schools in 2010. 85.3% of the athletes reported to having no prior history of concussions. There was not a significant difference in cognitive composite scores in baseline testing between the athletes with a previous history and without a previous history. The study did show that those athletes with a previous history had an increase in subjective symptoms scores, the researchers hypothesized that this could be associated with long-term development of depression, anxiety, or other mental health problems. The study did reveal gender-associated differences in their ImPACT cognitive composite scores and symptoms. It was found that high school girls had higher scores on verbal memory and processing speed, while boys had higher scores on the visual memory portion. Girls also reported more baseline symptoms that boys. For both girls and boys it was found that athletes who reported having a history of learning problems such as ADHA had overall lower scores as well. To see full study.