Underreporting of concussions and concussion-like symptoms in athletes continues to be a serious medical concern and research focus. Despite mounting worry, little evidence exists examining incidence of underreporting and documenting characteristics of head injury in female athletes participating in high school sports. This study examined the self-reporting behaviors of female high school athletes. Seventy-seven athletes participated, representing 14 high school sports. Nearly half of the athletes (31 participants) reported a suspected concussion, with 10 of the 31 athletes refraining from reporting symptoms to training staff after injury. Only 66% reported receiving concussion education. Concussion education appeared to have no relationship with diagnosed concussion rates in athletes, removing athletes from play, or follow-up medical care after injury. In conclusion, female high school athletes underreport signs and symptoms of concussions. Concussion education should occur at higher rates among female athletes to influence reporting behaviors.

Background Balance assessment is necessary when evaluating athletes after a concussion. We investigated a mobile device application (app) for providing valid, reliable, and objective measures of static balance. Objectives The mobile device app would demonstrate similar test–retest reliability to force platform center of pressure (COP) sway variables and that SWAY scores and force platform COP sway variables would demonstrate good correlation coefficients. Methods Twenty-six healthy adults performed balance stances on a force platform while holding a mobile device equipped with SWAY (Sway Medical LLC) to measure postural sway based on acceleration changes detected by the mobile device's accelerometer. Participants completed four series of three 10-second stances (feet together, tandem, and single leg), twice with eyes open and twice with eyes closed. Test–retest reliability was assessed using intraclass correlation coefficients (ICC). Concurrent validity of SWAY scores and COP sway variables were determined with Pearson correlation coefficients. Results Reliability of SWAY scores was comparable to force platform results for the same test condition (ICC = 0.21–0.57). Validity showed moderate associations between SWAY scores and COP sway variables during tandem stance (r = –0.430 to –0.493). Lower SWAY scores, indicating instability, were associated with greater COP sway. Discussion The SWAY app is a valid and reliable tool when measuring balance of healthy individuals in tandem stance. Further study of clinical populations is needed prior to assessment use. Conclusion The SWAY app has potential for objective clinical and sideline evaluations of concussed athletes, although continued evaluation is needed.

Information processing speed is often altered following a concussion. Few portable assessments exist to evaluate simple reaction time (SRT) in hospitals and clinics. We evaluated the use of a SRT application for mobile device measurement. 27 healthy adults (age = 30.7 ± 11.5 years) completed SRT tests using a mobile device with Sway, an application for SRT testing. Participants completed computerized SRT tests using the Computerized Test of Information Processing (CTIP). Test-retest reliability was assessed using intraclass correlation coefficients (ICC) between Sway trials. Pearson correlations and Bland-Altman analyses were used to assess criterion validity between Sway and CTIP means. ICC comparisons between Sway tests were all statistically significant. ICCs ranged from 0.84-0.90, with p-values <.001. A one-way analysis of variance (ANOVA) revealed no significant differences between trials (F =  1.35, p = .26. Pearson correlation between Sway and CTIP outcomes yielded a significant correlation (r = 0.59, p = .001). The mean difference between measurement methods was 43.7 ms, with limits of agreement between -140.8-53.4 ms. High ICC indicates Sway is a reliable method to assess SRT. A strong correlation and clinically acceptable agreement between Sway and the computer-based test indicates that Sway is suited for rapid administration of SRT testing in healthy individuals. Future research using Sway to assess altered information processing in a population of individuals after concussion is warranted.