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Concussion management

Kelly Sarmiento, Zoe Donnell, Elizabeth Bell, Rosanne Hoffman
INTRODUCTION: Current research recommends that students returning to school after a concussion should receive a return to school plan that is tailored to their individual symptoms. School professionals play important roles in designing and implementing the supports outlined in return to school plans. METHODS: This qualitative study explored middle and high school professionals' experiences with concussion, particularly their knowledge and perceptions of the injury and their experience with supporting students with concussion...
February 2019: Journal of Safety Research
Daniel J Goble, Mitchell J Rauh, Harsimran S Baweja
CONTEXT: Balance tests are a recommended assessment of motor function in concussion protocols. The BTrackS Balance Test (BBT) is a tool for concussion balance testing that uses low-cost force-plate technology to objectively measure postural sway. OBJECTIVE: To provide normative data for the BBT in a large population of athletes. DESIGN: Cross-sectional study. SETTING: Concussion baseline testing at multiple facilities...
March 14, 2019: Journal of Athletic Training
Kelly Sarmiento, Karen E Thomas, Jill Daugherty, Dana Waltzman, Juliet K Haarbauer-Krupa, Alexis B Peterson, Tadesse Haileyesus, Matthew J Breiding
Traumatic brain injuries (TBIs), including concussions, are at the forefront of public concern about athletic injuries sustained by children. Caused by an impact to the head or body, a TBI can lead to emotional, physiologic, and cognitive sequelae in children (1). Physiologic factors (such as a child's developing nervous system and thinner cranial bones) might place children at increased risk for TBI (2,3). A previous study demonstrated that 70% of emergency department (ED) visits for sports- and recreation-related TBIs (SRR-TBIs) were among children (4)...
March 15, 2019: MMWR. Morbidity and Mortality Weekly Report
Pierre Frémont
No abstract text is available yet for this article.
March 2019: Canadian Family Physician Médecin de Famille Canadien
Kevin C Lee, Sung-Kiang Chuang, Sidney B Eisig
PURPOSE: The aims were to report the characteristics of Le Fort fractures and to quantify the associated hospital costs. MATERIALS AND METHODS: From October 2015 to December 2016, the National Inpatient Sample was searched for patients admitted with a primary diagnosis of a Le Fort fracture. Predictor variables were drawn from demographic, admission, and injury characteristics. The outcome variable was hospital cost. Summary statistics were calculated and compared among Le Fort patterns...
February 13, 2019: Journal of Oral and Maxillofacial Surgery
Michael Takagi, Franz E Babl, Nicholas Anderson, Silvia Bressan, Cathriona J Clarke, Ali Crichton, Kim Dalziel, Gavin A Davis, Melissa Doyle, Kevin Dunne, Celia Godfrey, Stephen J C Hearps, Vera Ignjatovic, Georgia Parkin, Vanessa Rausa, Marc Seal, Emma Jane Thompson, Katie Truss, Vicki Anderson
INTRODUCTION: The majority of children who sustain a concussion will recover quickly, but a significant minority will experience ongoing postconcussive symptoms, known as postconcussion syndrome (PCS). These symptoms include emotional, behavioural, cognitive and physical symptoms and can lead to considerable disability. The neurobiological underpinnings of PCS are poorly understood, limiting potential clinical interventions. As such, patients and families frequently re-present to clinical services, who are often ill equipped to address the multifactorial nature of PCS...
February 24, 2019: BMJ Open
Mitul Kapadia, Alison Scheid, Eric Fine, Rachel Zoffness
PURPOSE OF REVIEW: Post-concussion syndrome (PCS), when the patient's concussion symptoms last longer than 4-6 weeks, affects 10-30% of concussion patients. PCS presents a significant source of morbidity to patients and a management challenge to providers. In this review, we present the current evidence and best management approaches for pediatric PCS. RECENT FINDINGS: There is limited high-quality evidence in pediatric PCS. There is some evidence supporting pharmaceutical management of post-traumatic headaches, cognitive symptoms, and emotional symptoms...
February 13, 2019: Current Reviews in Musculoskeletal Medicine
Phillip R Worts, Scott O Burkhart, Jeong-Su Kim
Clinical management of concussion has evolved over the last 20 years, and complete cognitive and physical rest remains a common clinical recommendation. The duration of rest may vary widely, from 24-48 h to several weeks or until the patient's symptoms have resolved or returned to near baseline levels. Following a period of rest, a stepwise progression of exercise is used for gradual return to play or to work. Previous research in healthy people suggested that prolonged periods of physical inactivity consistently induced deleterious physiological and psychological effects...
February 11, 2019: Sports Medicine
Jay L Alberts, Michael T Modic, Belinda Udeh, Tanujit Dey, Kay Cherian, Xiaoyang Lu, Richard Figler, Andrew Russman, Susan M Linder
The evidence-informed standardization of care along disease lines is recommended to improve outcomes and reduce healthcare costs. The aim of this project is to 1) describe the development and implementation of the Concussion Carepath, 2) demonstrate the process of integrating technology in the form of a mobile application to enable the carepath and guide clinical decision-making, and 3) present data on the utility of the C3 app in facilitating decision-making throughout the injury recovery process. A multi-disciplinary team of experts in concussion care was formed to develop an evidence-informed algorithm, outlining best practices for the clinical management of concussion along three phases of recovery - acute, subacute, and post-concussive...
January 20, 2019: Journal of Visualized Experiments: JoVE
Michael J Ellis, Susan Boles, Vickie Derksen, Brenda Dawyduk, Adam Amadu, Karen Stelmack, Matthew Kowalchuk, Kelly Russell
Pediatric concussion patients living in northern communities in Canada can face unique challenges accessing primary and specialized healthcare. In this study we report the clinical characteristics, healthcare utilization, outcomes and estimated cost avoidance associated with a pilot pediatric concussion telemedicine program established between a multi-disciplinary pediatric concussion program in Winnipeg, Manitoba and a hospital in Thompson, Manitoba. From October 1st - July 1st , 2018, 20 patients were evaluated; mean age 13...
December 2019: International Journal of Circumpolar Health
Erik B Smith, Jennifer K Lee, Monica S Vavilala, Sarah A Lee
Pediatric traumatic brain injury (TBI) uniquely affects the pediatric population. Abusive head trauma (AHT) is a subset of severe pediatric TBI usually affecting children in the first year of life. AHT is a form of nonaccidental trauma. Sports-related TBI resulting in concussion is a milder form of TBI affecting older children. Current recommended perioperative management of AHT and sports concussions relies on general pediatric TBI guidelines. Research into more specific pediatric TBI screening and management goals is ongoing...
March 2019: Anesthesiology Clinics
Kimberly G Harmon, James R Clugston, Katherine Dec, Brian Hainline, Stanley Herring, Shawn F Kane, Anthony P Kontos, John J Leddy, Michael McCrea, Sourav K Poddar, Margot Putukian, Julie C Wilson, William O Roberts
Sport-related concussion (SRC) is a common injury in recreational and organised sport. Over the past 30 years, there has been significant progress in our scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment and management of SRC. In addition to a growing need for knowledgeable healthcare professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC...
February 2019: British Journal of Sports Medicine
William T Jackson, Amaal J Starling
Concussion is a public health crisis affecting vulnerable populations including youth athletes. As awareness increases, more patients with acute concussion are seeking medical evaluations. Internists are frontline medical providers and thus should be able to identify, diagnose, manage, and know when to refer patients with concussion. Management of concussion includes rapid removal from play, symptomatic treatment, and return to learn/play recommendations. Inappropriate management may lead to recurrent concussions, prolonged recovery, and potential long-term consequences...
March 2019: Medical Clinics of North America
Michael F Bergeron, Sara Landset, Todd A Maugans, Vernon B Williams, Christy L Collins, Erin B Wasserman, Taghi M Khoshgoftaar
INTRODUCTION: Concussion prevalence in Sport is well-recognized; so too is the challenge of clinical and return-to-play management for an injury with an inherent indeterminant time course of resolve. Clear, valid insight to the anticipated resolution time could assist in planning treatment intervention. PURPOSE: This study implemented a supervised machine learning-based approach in modeling estimated symptom resolve time in high school athletes who incurred a concussion during sport activity...
January 25, 2019: Medicine and Science in Sports and Exercise
Justine B Lawrence, Mohammad N Haider, John J Leddy, Andrea Hinds, Jeffery C Miecznikowski, Barry S Willer
OBJECTIVE: This study investigated the diagnostic and prognostic value of the King-Devick (K-D) test in conjunction with treadmill testing in adolescents after sport-related concussion (SRC) in an outpatient concussion management clinic without baseline measures. DESIGN: Prospective cohort. METHODS: The K-D test was administered pre- and post-exercise on a graded treadmill test to acutely concussed (AC, <10 days from injury, n = 46, 15...
December 22, 2018: Journal of the Neurological Sciences
Vanessa Hubertus, Niklas Marklund, Peter Vajkoczy
BACKGROUND: When participating in contact sports, (mild) head trauma is a common incident-observed in both professional and amateur sports. When head trauma results in transient neurological impairment, a sports-related concussion has occurred. Acute concussion, repetitive concussions, as well as cumulative "sub-concussive" head impacts may increase the risk of developing cognitive and behavioral deficits for athletes, as well as accelerated cerebral degeneration. While this concept has been well established for classic contact sports like American Football, Rugby, or Boxing, there is still an awareness gap for the role of sports-related concussion in the context of the world's most popular sport-Soccer...
January 28, 2019: Acta Neurochirurgica
Theresa L Miyashita, Paul A Ullucci
CONTEXT: Managing a concussion injury should involve the incorporation of a multi-faceted approach, including a vision assessment. The fronto-parietal circuits and subcortical nuclei are susceptible to trauma from a concussion injury, leading to dysfunction of the vestibular-ocular system. Research investigating the effect of cumulative subconcussive impacts on neurological function is still in its infancy, but repetitive head impacts may result in vestibular system dysfunction. This dysfunction could create visual deficits, pre-disposing the individual to further head trauma...
January 24, 2019: Journal of Sport Rehabilitation
Praveen Satarasinghe, D Kojo Hamilton, Robert J Buchanan, Michael T Koltz
Objective: There is a plethora of theories about the pathophysiology behind a sport-related concussion. In this review of the literature, the authors evaluated studies on the pathophysiology of sport-related concussion and professional athlete return-to-play guidelines. The goal of this article is to summarize the most common hypotheses for sport-related concussion, evaluate if there are common underlying mechanisms, and determine if correlations are seen between published mechanisms and the most current return-to-play recommendations...
2019: Journal of Experimental Neuroscience
Jeremy M Root, Jeanette Fong, Gia Badolato, Ponda Jamil Madati
OBJECTIVES: This study aimed to survey pediatric emergency medicine (PEM) providers on their management of 2 hypothetical acute concussion scenarios. We hypothesized that most providers would recommend a management strategy based on cognitive and physical rest. METHODS: Fifty-nine percent (46/78) of PEM providers that were surveyed completed the study. The survey consisted of 2 clinical scenarios-a female patient with a mild concussion and a male patient with a moderate concussion...
January 21, 2019: Pediatric Emergency Care
Abby L Blake, Casey L McVicar, Mckenzie Retino, Eric E Hall, Caroline J Ketcham
OBJECTIVES: Immediately after experiencing a concussion, many will report the presence of a variety of symptoms, which may include disturbances in sleep. It is possible that these symptoms and other resulting quality of life (QOL) disturbances may persist for some time following a concussion. The purpose of this study was to determine if a history of concussions was related to ongoing sleep disturbances, symptoms, and changes in QOL. METHODS: Eighty-two student-athletes (club and varsity) completed an online survey to determine concussion history, sleep disturbances, concussion symptoms, and QOL dysfunctions...
February 2019: Sleep Health
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