Concussion Monthly Select- August 2019

Concussion Monthly Select- August 2019


Doug Van Pelt, PhD


Below are 5 highlighted recently published concussion research articles with a brief summary and takeaway points.

1. Repetitive Head Impact Exposure in College Football Following an NCAA Rule Change to Eliminate Two-A-Day Preseason Practices: A Study from the NCAA-DoD CARE Consortium. Stemper BD, Shah AS, Harezlak J, Rowson S, Duma S, Mihalik JP, Riggen LD, Brooks A, Cameron KL, Giza CC, Houston MN, Jackson J, Posner MA, McGinty G, DiFiori J, Broglio SP, McAllister TW, McCrea M4 And the CARE Consortium Investigators. Ann Biomed Eng. 2019 Aug 6. doi: 10.1007/s10439-019-02335-9.

  • Summary: This study evaluated head impacts among NCAA football players using the Head Impact Telemetry System (HITS). The HITS system is set of accelerometers placed into the football helmet that can quantify the number of head impacts and their associated magnitudes. The goal of the study was to determine the effectiveness of the 2017 NCAA policy eliminating two-a-day practices for Division I Football Bowl Subdivision programs. The idea for eliminating two-a-day practices was that concussion risk might be reduced by reducing the number of head impacts during preseason. Contrary to the hypothesis, eliminating two-a-day practices actually increased the contact intensity (average impact exposure per hour) resulting 26% more head impacts in the 2017 season.
  • Takeaway: Eliminating two-a-day practices resulted in more impacts per pre-season practice. Future policies might be more effective if they focus on limiting the number of daily head impacts rather than number of sessions. The study also found that athletes sustained 40% more head impacts during the fall preseason compared to the regular season. Thus, clinicians should be aware of the potential concussion risk during football preseason.

2. Acute Sport Concussion Assessment Optimization: A Prospective Assessment from the CARE Consortium. Broglio SP, Harezlak J, Katz B, Zhao S, McAllister T, McCrea M; CARE Consortium Investigators. Sports Med. 2019 Jul 26. doi: 10.1007/s40279-019-01155-0. [Epub ahead of print]

  • Summary: This study evaluated which concussion assessments provided the best utility for concussion evaluation and determining how often baseline assessments completed. A total of 1640 concussions occurred among 1458 NCAA athletes. The SCAT3 was completed as baseline and up to three times within 72 hours of a concussion. The SCAT symptoms, BESS completed on firm surface, and SAC total score provided the optimal assessment battery and comparing these scores to a baseline completed the same season provided the best sensitivity. Additionally, computerized neurocognitive testing did not add any value to concussion assessment sensitivity within 72 hours of injury.
  • Takeaway: Baseline assessments should be completed annually to provide the best sensitivity to detect a concussion. The SCAT symptoms, firm BESS score, and total SAC score are the most useful assessments for concussion evaluation within 72 hours of injury. {NOTE: These findings are not yet standard practice so clinicians should continue their current standard of care practices}

3. Estimated Age of First Exposure to Contact Sports is Not Associated with Greater Symptoms or Worse Cognitive Functioning in U.S. Service Academy Athletes. Caccese J, Iverson GL, Cameron K, Houston MN, McGinty J, Jackson JC, O'Donnell PG, Pasquina PF, Broglio SP, McCrea M, McAllister T, Buckley T. J Neurotrauma. 2019 Aug 2. doi: 10.1089/neu.2019.6571.

  • Summary: This study wanted to determine whether athletes who played contact sports for more time had more symptoms and/or worse cognitive impairment compared to athletes who played contact sports for fewer years. The study included 891 male cadets at the United States Service Academies who were participating in various contact sports (lacrosse, wrestling, ice hockey, soccer, rugby) or non-contact sports. Cadets completed the ImPACT computerized neurocognitve test before the season. The study found no association between years of contact sport exposure or current contact sport participation on symptoms or neurocognitive function.
  • Takeaway: Years of contact sport exposure and current contact sport participation do not appear to be associated with greater symptoms or worse neurocogntive performance.

4. Comparison of Rest to Aerobic Exercise and Placebo-Like Treatment of Acute Sport-Related Concussion in Male and Female Adolescents. Willer BS, Haider MN, Bezherano I, Wilber CG, Mannix R, Kozlowski K, Leddy JJ. Arch Phys Med Rehabil. 2019 Aug 1. pii: S0003-9993(19)30505-2. doi: 10.1016/j.apmr.2019.07.003.

  • Summary: There is growing evidence that aerobic exercise post-concussion facilitates recovery. The current study compared aerobic exercise to placebo-like stretching or rest to determine whether adolescent athletes with a concussion recovered faster when prescribed aerobic exercise. The aerobic exercise group typically recovered within 13 days, the stretching group typically recovered within 17 days and the rest group typically recovered within 16 days.
  • Takeaway: Sub-symptom threshold aerobic exercise appears to provide an effective recovery program.  

5. Effect of Concussions on the Performance of Running Backs and Wide Receivers in the National Football League. Jildeh TR, Okoroha KR, Taylor KA, Buckley P, Mehta S, Mehran N, Moutzouros V. Am J Sports Med. 2019 Aug 6:363546519864581. doi: 10.1177/0363546519864581.

  • Summary: Concussions are a common injury for American football players. There is growing interest whether a concussion had a meaningful impact on a professional athletes performance post-concussion. The current study evaluated whether a concussion sustained by running backs or wide receivers participating in the National Football League had any decreases in performance after sustaining a concussion. The 38 players who sustained a concussion were compared to non-injured players. The players who sustained a concussion did not have any significant decreases in performance within the same season of their injury, in the following season, or within 3 years of their injury.
  • Takeaway: NFL running backs and wide receivers do not appear to suffer decreases in performance after a concussion. This finding may reflect improved care, ensuring athletes return to sport only once recovered.

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