Concussion Monthly Select- January 2020

Concussion Monthly Select- January 2020


Doug Van Pelt, PhD


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

Relationships Between Post-Concussion Sleep and Symptom Recovery: A Preliminary Study.

Hoffman NL, O'Connor PJ, Schmidt MD, Lynall RC, Schmidt JD

J Neurotrauma. 2019 Nov 27

  • Summary: While up to 50% of concussed individuals experience sleep difficulties after their concussion, it is unknown whether these difficulties are associated with recovery. The study by Hoffman and colleagues used an actigraph to objectively quantify sleep along with subjective self-reports among college students. Researchers found that individuals who spent more time awake and/or had less efficient sleep took longer to recover. Individuals who reported having poorer sleep also took longer to recover. There was no association between the amount of time to transition from awake to sleep or total sleep time with recovery.
  • Takeaway: Sleep is related to recovery after a concussion, however, it remains unknown whether sleep causes a longer recovery. This study found that individuals with a concussion spend less time sleeping in bed, but do not take longer to fall asleep. Finding ways to help an individual’s sleep quality after a concussion may speed recovery.

A Systematic Review of Barriers and Facilitators for Concussion Reporting Behavior Among Student Athletes

Clark R, Stanfill AG

J Trauma Nurs. 2019 Nov/Dec;26(6):297-311

  • Summary: Many researchers have been focused on improving concussion diagnosis. Removing injured players in a timely manner is critical for their well-being and recovery. However, many clinicians and researchers have struggled with 30-50% of athletes not reporting their concussion. This systematic review examined 24 studies to identify factors that facilitate or create barriers for concussion reporting. The authors found that female sex and younger athletes were more likely to report a concussion. Barriers to concussion reporting were mostly fear-based. In particular, athletes were afraid of losing current, decreased playing time, or letting the team down. Also, the researchers identified educational opportunities since athletes did not report their concussion since they did not think the injury was serious or they did not know the signs and symptoms of concussion.
  • Takeaway: Barriers to concussion reporting appear to either be fear or knowledge-based. These findings demonstrate the importance of creating a safe environment for injury reporting and developing strong athlete education. 

Institutionally Based ImPACT Test® Normative Values May Differ from Manufacturer-Provided Normative Values.

Walton SR, Broshek DK, Freeman JR, Hertel J, Meyer JP, Erdman NK, Resch JE

Arch Clin Neuropsychol. 2019 Nov 11. pii: acz068

  • Summary: Computer neurocognitive tests like ImPACT provide normative data with their test platform. This normative data is compared to post-injury tests when a baseline is not available on an individual. However, it is unknown how well the ImPACT normative data matches athletes at specific schools. Therefore, researchers compared ImPACT normative data to athletes at a D1 university. A total of 952 athletes (aged 19.2 ± 1.4 years, 42.5% female) completed baseline ImPACT tests. Researchers found that athletes at their institution performed better on the verbal memory, visual memory, and visual-motor speed portions of ImPACT compared to the normative data. Conversely, athletes performed worse on the reaction time portion.
  • Takeaway: Since computerized neurocognitive tests like ImPACT are used to guide diagnosis and recovery it is critical to understand how well the normative data represents athletes at your institution. This study demonstrates that normative data provided by ImPACT may not be an ideal representation of athletes at your institution. The researchers recommend using an individual baseline. However, if an individual baseline is not available, consider using institutionally derived normative data rather than manufacturer-provided normative data. By using individual baseline or institutionally derived normative data, we can hopefully reduce misclassifying impairment after a concussion.

Influence of Test Environment, Age, Sex, and Sport on Baseline Computerized Neurocognitive Test Performance.

French J, Huber P, McShane J, Holland CL, Elbin RJ, Kontos AP

Am J Sports Med. 2019 Nov;47(13):3263-3269

  • Summary: There is concern that when neurocognitive tests are done in a group setting test scores may not reflect an athlete’s best performance or the athlete might be more prone to distraction. The researchers of this study wanted to compare the validity of computerized neurocognitive testing across testing environments (group, individual), age groups (10-12, 13-15, 16-18 years), sexes (male, female), and sport types (collision/combat, contact, noncontact). Researchers found that there was no difference in ImPACT scores whether the test was administered individually or in a group environment. There were significant effects of age and sex on ImPACT performance. The 10-12 year olds performed significantly worse on each component of ImPACT. Females performed better on verbal memory while males performed better on visual-motor speed. Validity was only associated with sport type. Non-contact sport athletes had greater invalid tests than contact or collision/combat sport athletes.
  • Takeaway: Given the logistic difficulties with administering computerized tests individually, it is reassuring that there was no difference in performance on ImPACT verbal memory, visual memory, visual-motor speed, or reaction time. However, clinicians should consider sex, age, and sport type when interpreting ImPACT scores.

Athletic Trainers' Concussion-Assessment and -Management Practices: An Update.

Lempke LB, Schmidt JD, Lynall RC

J Athl Train. 2019 Dec 19

  • Summary: Athletic trainers typically are the first medical provider to assess an athlete for a concussion. The authors of the current study surveyed 1307 athletic trainers to learn more about their concussion assessment and management practices. Of the athletic trainers surveyed, 35% reported working in a high school and 27% reported working in a collegiate setting. On average, athletic trainers each observed 16 concussions per year with most concussions observed in football, women’s soccer, and men’s soccer. The clinical evaluation was used by 95% of athletic trainers to assess for a concussion. The symptom evaluation (87%) and balance assessment (85%) were the next most commonly used tools. The multi-domain assessment of symptoms, balance, and neurocognitive function was used by 53% of athletic trainers. For return-to-participation, 61% of athletic trainers followed the 2014 NATA position statement and 37% followed the 2017 International Conference on Concussion in Sport recommendations. The final decision for returning an athlete to participation was made by the physician (41%) or athletic trainer (37%).
  • Takeaway: Athletic trainers observe and treat a significant number of concussions per year. Overall, concussion assessment practices are improving with 53% of athletic trainers using symptoms, balance, and neurocognitive evaluations to assess for a concussion compared to 21% in 2013 and 3% in 2005. While this study highlights the improvement in adopting best-practices, there is still a significant proportion of athletic trainers who have not or are unable to implement best-practice recommendations in their clinical setting.

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