Our understanding of the diverse physiological manifestations of concussion is changing rapidly. This has an influence on the clinical assessment of patients who have sustained a concussion. The 2017 Consensus Statement on Concussion in Sport states that numerous post-injury clinical findings, such as cognitive deficits, post-traumatic headaches, dizziness, difficulties with oculomotor function, and depression have all been associated with a poorer prognosis in concussed patients. This demonstrates that there are several potential clinical manifestations after head injury warranting clinical evaluation. We have developed an acronym to guide the office-based assessment of concussed patients to consider each of the potential clinical phenotypes. “COACH CV” prompts the clinician to evaluate for cognitive problems, oculomotor dysfunction, affective disturbances, cervical spine disorders, headaches, and cardiovascular and vestibular anomalies.

The Concussion Office Based Rehabilitation Assessment (COBRA) is a novel tool constructed to ensure a comprehensive assessment of patients who may have sustained a concussion. The SCAT-5 (Sport Concussion Assessment Tool) has long been the gold standard for concussion assessment, however, it was designed as a sideline tool and its utility can be seen to decrease after a few days post-concussion. It also does not prompt evaluation of all the phenotypes of concussion. As such, the COBRA was created to assess the majority of potential manifestations of concussion in the office setting a day or two after an injury has been sustained. The COBRA utilizes the eight phenotypes of concussion as a guide to assess each of the potential biopsychosocial features that can be associated with these injuries and can be used to guide evidence-based treatments. Through early identification of concussion phenotypes, the clinician may start optimal treatment and hopefully prevent prolonged recovery and persisting symptoms.

In adult muscle, activation of satellite cells (SCs) is required for muscle maintenance, growth and repair. SCs are activated in response to exercise, stretch, trauma, denervation and nitric oxide (NO). The muscle response to exercise is age‐dependant and muscle‐specific and may be a factor in age‐related muscle atrophy. The purpose of this experiment was to determine the effects of treatment with an NO‐donor isosorbide dinitrate (ISDN) and exercise on muscle mass, SC activation (DNA synthesis), NOS‐I and β‐dystroglycan and fiber cross‐sectional area (CSA) on muscle in 18‐month‐old mice. Mice between 18–19 mo of age were divided into 6 groups to study effects of ISDN (0, 3 and 6 weeks) with and without exercise for the first 3 weeks of the experiment. Groups had 4–8 mice. Results in quadriceps muscle showed that ISDN treatment combined with exercise increased muscle mass, fiber CSA, and the protein‐expression ratio of NOS‐I/β‐dystroglycan. ISDN for 6 wks also produced the greatest increase in SC activation. These findings show that combining NO treatment and exercise has the potential to combat age‐related muscle atrophy. Supported by the Canadian Space Agency: Life Sciences