Relapse of concussion symptoms in the context of premature return to learn and return to play

Carson, James D.; Diep, Dion; Baker, Carmen; Kraft, Sari A; Kuwahara, Nariko; Garel, Alisha; Frémont, Pierre

doi:10.46747/cfp.6803e87

Cited by 14 publications

(37 citation statements)

References 11 publications

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“…3 This can result in exposure to another head injury before recovery is complete, resulting in prolonged recovery. 4,5 An objective diagnostic aid has the potential to improve concussion recognition and reduce or prevent disability associated with premature RTP.…”

Section: Introductionmentioning

confidence: 99%

“…However, the current symptom-based method of concussion diagnosis has been criticized for being subjective, allowing injured athletes to downplay symptoms to avoid being removed from play . This can result in exposure to another head injury before recovery is complete, resulting in prolonged recovery . An objective diagnostic aid has the potential to improve concussion recognition and reduce or prevent disability associated with premature RTP.…”

Section: Introductionmentioning

confidence: 99%

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Classification of Comprehensive Neuro-Ophthalmologic Measures of Postacute Concussion

et al. 2021

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IMPORTANCE Symptom-based methods of concussion diagnosis in contact sports result in underdiagnosis and repeated head injury exposure, increasing the risk of long-term disability. Measures of neuro-ophthalmologic (NO) function have the potential to serve as objective aids, but their diagnostic utility is unknown. OBJECTIVE To identify NO measures that accurately differentiate athletes with and without concussion. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted among athletes with and without concussion who were aged 17 to 22 years between 2016 and 2017. Eye movements and cognitive function were measured a median of 19 days after injury among patients who had an injury meeting the study definition of concussion while playing a sport (retrospectively selected from a concussion clinic), then compared with a control group of participants without concussion (enrolled from 104 noncontact collegiate athlete volunteers without prior head injury). Data analysis was conducted from November 2019 through May 2020. EXPOSURE Concussion. MAIN OUTCOMES AND MEASURES Classification accuracy of clinically important discriminator eye-tracking (ET) metrics. Participants' eye movements were evaluated with a 12-minute ET procedure, yielding 42 metrics related to smooth pursuit eye movement (SPEM), saccades, dynamic visual acuity, and reaction time. Clinically important discriminator metrics were defined as those with significantly different group differences and area under the receiver operator characteristic curves (AUROCs) of at least 0.70. RESULTS A total of 34 participants with concussions (mean [SD] age, 19.7 [2.4] years; 20 [63%] men) and 54 participants without concussions (mean [SD] age, 20.8 [2.2] years; 31 [57%] men) completed the study. Six ET metrics (ie, simple reaction time, discriminate reaction time, discriminate visual reaction speed, choice visual reaction speed, and reaction time on 2 measures of dynamic visual acuity 2) were found to be clinically important; all were measures of reaction time, and none were related to SPEM. Combined, these 6 metrics had an AUROC of 0.90 (95% CI, 0.80-0.99), a sensitivity of 77.8%, and a specificity of 92.6%. The 6 metrics remained significant on sensitivity testing. CONCLUSIONS AND RELEVANCE In this study, ET measures of slowed visual reaction time had high classification accuracy for concussion. Accurate, objective measures of NO function have the potential to improve concussion recognition and reduce the disability associated with underdiagnosis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Classification of Comprehensive Neuro-Ophthalmologic Measures of Postacute Concussion

et al. 2021

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“…A retrospective study examines relapse and explores why rates are higher with return to learning than return to play (page e87). 2 Qualitative research focuses on challenges teenage girls face in returning to school after concussion, revealing important findings about the unique social pressures they endure (page 203). 3 Psychiatrist Dr Julia Gibson has created thought-provoking artwork to complement the article.…”

Section: What If This Happens Again? What If This Never Ends?mentioning

confidence: 99%

Concussions: understanding the invisible injury

Fraser¹

2022

Can Fam Physician

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“…6 Furthermore, a five-year, retrospective study by Carson et al found that 43.5% of SRCs returned to play too soon. 7 SRCs are challenging to manage due to the underlying pathophysiology. A rapid change in intracranial velocity results in axonal shearing and cerebral edema creating metabolic changes and reduced cerebral blood flow.…”

Section: Background and Introductionmentioning

confidence: 99%

“…Although prolonged and complete cognitive rest has been shown to delay recovery, 17 Carson et al found that 44.7% of athletes with SRCs returned to full academic participation too soon, and findings from the Ivy League-Big Ten Epidemiology Study show that athletes who return to full academics too soon take longer to recover from SRC and that improved clarity in the timing of RTL is warranted. 7,18 Authors have suggested that impairments in working memory and attentional control can also lead to impairments in lower extremity motor control. 19 However, these domains can be improved with targeted interventions, including physical therapy.…”

Section: Background and Introductionmentioning

confidence: 99%

The Implementation of a Return-to-Play Protocol with Standardized Physical Therapy Referrals in a Collegiate Football Program: PT’s Role in Return-to-Play, A Clinical Commentary

Teare-Ketter

Ebert

Todd

2023

International Journal of Sports Physical Therapy

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Sport-related concussions (SRCs) are multi-faceted injuries requiring coordinated care for return-to-play (RTP). Although the number of concussions in collegiate football is increasing annually, there is poor standardization among RTP protocols. Recent evidence suggests there is an increased risk of lower extremity injury, neuropsychiatric consequences, and re-injury after SRC, and risk factors for a prolonged recovery from SRC have also been identified. Evidence demonstrates a faster RTP and improved outcomes with early physical therapy intervention; however, this is not yet common practice in the treatment of acute SRC. There is little guidance available on the development and implementation of a multidisciplinary RTP rehabilitation protocol for SRC that incorporates standardized physical therapy. By describing an evidence-based RTP protocol with standardized physical therapy management, and measures taken to implement this protocol, this clinical commentary aims to identify steps in treating SRC that can be used to improve recovery. The purpose of this commentary is to: a) survey the current state of standardization of RTP protocols in collegiate football; b) highlight the development and implementation of a RTP protocol with standardized physical therapy referral and management in an NCAA Division II collegiate football program; and c) describe results of a full-season pilot study, including time to evaluation, time to RTP, rate of re-injury or lower extremity injury, and the clinical significance of protocol implementation. Level of Evidence Level V

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Relapse of concussion symptoms in the context of premature return to learn and return to play

Cited by 14 publications

References 11 publications

Classification of Comprehensive Neuro-Ophthalmologic Measures of Postacute Concussion

Classification of Comprehensive Neuro-Ophthalmologic Measures of Postacute Concussion

Concussions: understanding the invisible injury

The Implementation of a Return-to-Play Protocol with Standardized Physical Therapy Referrals in a Collegiate Football Program: PT’s Role in Return-to-Play, A Clinical Commentary

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