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Concussion Research

Head Impact Exposure and Neurologic Function of Youth Football Players

Medicine & Science in Sports & Exercise, 2014

Thayne A. Munce, Jason C. Dorman, Paul A. Thompson, Verle D. Valentine,
Michael F. Bergeron.

Football players are subjected to repetitive impacts that may lead to brain injury and neurologic dysfunction. Knowledge about head impact exposure (HIE) and consequent neurologic function among youth football players is limited.

Purpose: To measure and profile HIE of youth football players throughout one season and explore associations between HIE and changes in selected clinical measures of neurologic function.

Methods: Twenty-two middle school football players (11-13 yr) wore helmets outfitted with a Head Impact Telemetry (HIT) System to quantify head impact number, severity and location. Impact data were collected for each practice (27) and game (9) in a single season. Selected clinical measures of balance, visual reading speed, reaction time and self-reported symptoms were assessed before and after the season.

Conclusion: Head impact forces of middle school football players are remarkably similar to those of high school players, but there are only about half as many of them over the course of a full season in middle school vs. high school football. Moreover, the players in this study did not do any worse on tests of balance, reaction time and reading speed after the season (compared to before the season), and their performance on these tests was not related to the number or force of their head impacts. Therefore, the study provided no evidence that normal football participation causes short term impairments in brain function in middle school football players.

Effects of youth football on selected clinical measures of neurologic function: a pilot study

Journal of Child Neurology, 2013

Thayne A. Munce, Jason C. Dorman, Tryg O. Odney, Paul A. Thompson, Verle D. Valentine, Michael F. Bergeron.

Football players are subjected to repetitive impacts that may lead to brain injury and neurologic dysfunction. Knowledge about head impact exposure (HIE) and consequent neurologic function among youth football players is limited.

Purpose: To measure and characterize HIE of youth football players throughout one season and explore associations between HIE and changes in selected clinical measures of neurologic function.

Methods: Twenty-two youth football players (11-13 yr) wore helmets outfitted with a Head Impact Telemetry (HIT) System to quantify head impact frequency, magnitude, duration and location. Impact data were collected for each practice (27) and game (9) in a single season. Selected clinical measures of balance, oculomotor performance, reaction time and self-reported symptoms were assessed before and after the season.

Conclusions: This study provides a novel examination of HIE and associations with short-term neurologic function in youth football and notably contributes to the limited HIE data currently available for this population. While youth football players can experience remarkably similar head impact forces as high school players, cumulative sub-concussive HIE throughout one youth football season may not be detrimental to short-term clinical measures of neurologic function.

Tracking postural stability of young concussion patients using dual-task interference

Journal of Science and Medicine in Sport, 2013

Jason C. Dorman, Verle D. Valentine, Thayne A. Munce, B. Joel Tjarks, Paul A. Thompson, Michael F. Bergeron.

Because balance testing with an added cognitive task is a relatively new assessment in concussion care, optimal protocols and reference standards have not yet been established. Accordingly, this research helps to establish the validity of this method, while offering clinicians another objective tool to assist in the evaluation and management of this increasingly prevalent condition.

Purpose: To examine the diagnostic benefit of using dual-task interference balance testing in young concussion patients and the longitudinal changes in postural stability that occur relative to other standard clinical assessments of concussion injury.

Methods: Eighteen patients (16.6 (1.6) y) diagnosed with a concussion provided 22 separate ratings to characterize the severity of their current concussion-related symptoms and were evaluated for postural stability at each of four clinical visits. Twenty-six injury-free adolescents (17 (2.8) y) performed balance testing on two occasions, separated by ∼1 week.

Conclusions: Improvements in postural stability coincide with reductions in reported symptoms, though apparent recovery of these selected measures of postural stability seemingly occurs sooner. Because of the distinguishing time course of recovery indicated by dual-task interference balance testing, this type of balance testing assessment may be particularly valuable in evaluating integrated functional impairment and recovery in young concussion patients.

Comparison and utility of King-Devick and ImPACT® composite scores in adolescent concussion patients

Journal of the Neurological Sciences, 2013

B. Joel Tjarks, Jason C. Dorman, Verle D. Valentine, Thayne A. Munce, Paul A. Thompson, Shanna L. Kindt, Michael F. Bergeron.

The King-Devick (KD) oculomotor test has recently been advocated for sideline diagnosis of concussion. Although visual processing and performance are often impaired in concussion patients, the utility of KD as a concussion diagnostic tool is not validated.

Purpose: To examine the diagnostic value of KD, by comparing KD with post-concussion symptom scale (PCSS) and ImPACT® composite scores. We hypothesized that KD would be correlated with visual motor speed/memory and reaction time, because all require cognitive visual processing. We also expected parallel changes in KD and PCSS across recovery.

Methods: Thirty-five concussed individuals (12–19 y; 18 females, 17 males) were evaluated with PCSS, ImPACT® composite and KD scores over four clinical visits.

Conclusions: Cognitive visual performance testing using KD has utility in concussion evaluation. Validation would further establish KD as an effective ancillary tool in longitudinal concussion management and research.

Sport concussion knowledge base, clinical practices and needs for continuing medical education: a survey of family physicians and cross-border comparison

British Journal of Sports Medicine, 2013

Constance M. Lebrun, Martin Mrazik, Abhaya S. Prasad, B. Joel Tjarks, Jason C. Dorman, Michael F. Bergeron, Thayne A. Munce, Verle D. Valentine.

Concussions are the most common form of head injury in recreational and competitive sports and have recently been identified as a major public health concern worldwide. With greater clinical and scientific appreciation of effects and recovery time, new research and discoveries, newly adopted legislation and revised management guidelines, sport-related concussion has received considerable attention recently from the media and healthcare organizations. Concomitantly, it is challenging for healthcare professionals to remain informed of the latest evidence-based concussion information.

Purpose: To identify current knowledge and practice patterns of family physicians in Alberta, Canada and North & South Dakota regarding their clinical management of patients with sport-related concussion; and to examine their preferred delivery methods of knowledge transfer and exchange on this subject.

Methods: A brief, internet-based survey was distributed to family physicians in selected regions (Alberta, CAN; North & South Dakota, USA).

Conclusions: Existing published recommendations regarding diagnosis/management of concussion are not always translated into practice, particularly the recommendation for cognitive rest; predicating enhanced, innovative CME initiatives.