Concussion Monthly Select- April 2020

Concussion Monthly Select- April 2020


Doug Van Pelt, PhD


The influence of fatiguing exercise on Sport Concussion Assessment Tool (SCAT) scoring in a female pediatric population.

Phys Sportsmed. 2020 Mar 30:1-5. doi: 10.1080/00913847.2020.1746979

Billeck J, Peeler J.

  • Summary: Concussion symptoms are non-specific and can also be caused by other activities. Researchers wanted to test whether aerobic exercise in female youth increased symptom reporting on the Child SCAT. The study evaluated female athletes who were 9-12 years old. The athletes completed a Child SCAT, rested 10 minutes, completed the Fitnessgram Pacer Aerobic Test, rested 10 minutes, and completed the Child SCAT. While most of the athletes reached 100% of their estimated maximum heart rate, there was no difference in SCAT symptoms or any other SCAT component pre- versus post-exercise. 

  • Takeaway: The Child SCAT is unaffected by aerobic exercise fatigue in female youth athletes. More research is needed to determine if the Child SCAT is also unaffected in male youth athletes, or if adult athlete SCAT performance is also unaffected by exercise. Luckily, the next article looks at adult SCAT performance after exercise. 

Comparison of Concussion Sideline Screening Measures Across Varying Exertion Levels Within Simulated Games

J Sport Rehabil. 2020 Mar 31:1-7. doi: 10.1123/jsr.2019-0307

Dubas RL, Teel EF, Kay MC, Ryan ED, Petschauer MA, Register-Mihalik JK.

  • Summary: Similar to the study above, researchers wanted to determine whether exercise changed SCAT-3 performance among adult basketball players. The athletes were male and female basketball players ranging in age from 18-28 years of age. The athletes played 6 on 6 scrimmages that had two 20 minute halves with a 15-minute halftime. The SCAT-3 was administered before the scrimmage, at halftime, and post-scrimmage. There were no significant differences in SAC or BESS performance at halftime or post-scrimmage compared to pre-scrimmage. While the changes in symptoms were also not significant, there was a moderate effect with 1-2 more symptoms reported after physical exertion. If an athletic trainer followed the conservative recommendation to remove an athlete with any concussion-like symptom, 31% of the athletes in the current study would have been removed from play, despite not sustaining a concussion. Low energy/fatigue and balance problems were more likely to occur after exercise induced fatigue.
  • Takeaway: In a study of adult basketball players, exercise does not change SAC or BESS performance on the SCAT-3. Since some symptoms can be induced by exercise it would be helpful to examine symptoms at rest and post-exercise to better delineate between symptoms that are caused by fatigue or concussive injury.

Architecture of Physical, Cognitive, and Emotional Symptoms at Preseason Baseline in Adolescent Student Athletes With a History of Mental Health Problems.

Front Neurol. 2020 Mar 20;11:175. doi: 10.3389/fneur.2020.00175

Iverson GL, Jones PJ, Karr JE, Maxwell B, Zafonte R, Berkner PD, McNally RJ

  • Summary: Similar to exercise, mental health problems may also cause changes in symptom reporting. Researchers designed a study to examine the association between symptom reporting and a history of mental health problems. Adolescent athletes who completed the ImPACT symptom scale at baseline and had a history of psychiatric treatment were included in the study. Researchers found strong relationships between the following symptoms:
  • sleeping less than usual and trouble falling asleep
  • sleeping less than usual and fatigue
  • feeling more emotional and sadness 
  • feeling more emotional and nervousness 
  • feeling more emotional and irritability
  • sensitivity to light and sensitivity to noise
  • dizziness and balance problems 
  • feeling mentally foggy and feeling slowed down 

Dizziness had greatest co-occurrence with other symptoms followed by feeling more emotional and feeling slowed down. 

  • Takeaway: This study identified interconnected symptoms among athletes with mental health histories. Understanding the association and relationships between these symptoms could inform a more precise approach to post-injury treatment and rehabilitation. For example, treating dizziness, there could be positive impact on other related symptoms.

Single-Legged Hop and Single-Legged Squat Balance Performance in Recreational Athletes With a History of Concussion

J Athl Train. 2020 Mar 27. doi: 10.4085/1062-6050-185-19

Lynall RC, Campbell KR, Mauntel TC, Blackburn JT, Mihalik JP

  • Summary: Athletes after a concussion may be at risk for a lower-body injury. Researchers measured athletes’ balance performance after a concussion to help identify a possible mechanism of increased lower-body injury risk. Researchers compared the balance performance of previously concussed athletes to athletes without a recent concussion using single-hop and single-leg squat tests. The concussion group demonstrated took longer to stabilize their dynamic balance during the single-legged hop on their nondominant leg. There were no differences in performance on their dominant leg or during the single-leg squat test.

  • Takeaway: Concussed athletes were on average, 126 days post-concussion (range 18 - 432 days). However, concussed athletes demonstrated persistent dynamic balance deficits that may indicate ongoing neuromuscular problems. Dynamic balance tests my provide clinicians with greater insight to identify deficits that linger well beyond static balance recovery.

Virtual Concussion Journal Club

Comparison of Rest to Aerobic Exercise and Placebo-like Treatment of Acute Sport-Related Concussion in Male and Female Adolescents.

Arch Phys Med Rehabil. 2019 Dec;100(12):2267-2275. doi: 10.1016/j.apmr.2019.07.003. Epub 2019 Aug 1.

Willer BS, Haider MN, Bezherano I, Wilber CG, Mannix R, Kozlowski K, Leddy JJ

During the journal club hosted by Dr. Seifert, there was a great discussion of Dr. Leddy’s study examining the effects of rest versus aerobic exercise versus stretching on concussion recovery. The exercise treatment was strictly prescribed based on initial performance on the Buffalo Concussion Treadmill Test. Athletes were told to complete 20 minutes of aerobic exercise (eg, walking, jogging, or biking) at the prescribed heart rate, with a 5-minute warm-up and a 5-minute cooldown. They were instructed to stop exercising if their symptoms got worse or at 20 minutes, whichever came first. The athletes who received the exercise intervention typically recovered within 13 days, while the rest group took 17 days and the stretching group took 16 days. Overall, prescribed exercise appears to improve concussion recovery and safety. It is also important to note that while the rest groups did not recover as fast as the exercise group, rest was not especially harmful. 

We then dug deeper into the article and looked at the symptom recoveries among male and female athletes. Interestingly, the females who received the exercise or stretching interventions had similar reductions in symptoms. However, males appeared to only respond to the exercise intervention. This observation, prompted a few theories from the group, hypothesizing the possible psychological and/or physical differences in males and females that may have caused a different response. 

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