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Concussion

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1. Standards for post-concussion care from diagnosis to the interdisciplinary concussion clinic

Standards for post-concussion care from diagnosis to the interdisciplinary concussion clinic 1 June 8, 2017 STANDARDS FOR POST- CONCUSSION CARE from diagnosis to the interdisciplinary concussion clinic ONF Standards for Post- Concussion Care 2 This report is submitted by the following: The Concussion Advisory Subcommittee of the Ontario Neurotrauma Foundation: Diana Velikonja, PhD, CPsych (Chair) - Hamilton Health Sciences & McMaster University Tara Baldisera, MD, CCFP - Sudbury Family Health (...) Organization, Health Sciences North, Northern Ontario School of Medicine Shannon Bauman, MD, CCFP, Dip. Sports Med - Concussion North, Royal Victoria Regional Health Centre Sheree Davis, MSW, CDR, CPF - Consultant, Health Systems Advisor Carol Di Salle, MSc(S), Reg CASLPO, S-LP (C) - Health Sciences North Melissa Freedman, MSW, RSW, Patient/Family Expert - Ontario Brain Injury Association Donna Ouchterlony, MD, CCFP - St. Michael's Hospital Deanna Quon, MD, FRCPC - Ottawa Hospital Rehabilitation Centre

2017 CPG Infobase

2. Guidelines for diagnosing and managing pediatric concussion

Guidelines for diagnosing and managing pediatric concussion Guidelines for Diagnosing and Managing Pediatric Concussion First edition, June 2014, v1.1 Recommendations for Health Care Professionals This document is intended to guide health care professionals in diagnosing and managing pediatric—not adult—concussion. It is not for self-diagnosis or treatment. Parents and/or caregivers may bring it to the attention of their child/adolescent’s health care professionals. The best knowledge available (...) or damage arising from any claims made by a third party. Also, as the sponsor of this document, the Ontario Neurotrauma Foundation assumes no responsibility or liability whatsoever for changes made to the guidelines without its consent. Any changes must be accompanied by the statement: “Adapted from Guidelines for Diagnosing and Managing Pediatric Concussion with/without permission,” according to whether or not permission was sought and/or given. About the Ontario Neurotrauma Foundation The Ontario

2019 CPG Infobase

3. Artificial intelligence for understanding concussion: Retrospective cluster analysis on the balance and vestibular diagnostic data of concussion patients. (PubMed)

Artificial intelligence for understanding concussion: Retrospective cluster analysis on the balance and vestibular diagnostic data of concussion patients. We propose a bottom-up, machine-learning approach, for the objective vestibular and balance diagnostic data of concussion patients, to provide insight into the differences in patients' phenotypes, independent of existing diagnoses (unsupervised learning).Diagnostic data from a battery of validated balance and vestibular assessments were (...) extracted from the database of the Swiss Concussion Center. The desired number of clusters within the patient database was estimated using Calinski-Harabasz criteria. Complex (self-organizing map, SOM) and standard (k-means) clustering tools were used, and the formed clusters were compared.A total of 96 patients (81.3% male, age (median [IQR]): 25.0[10.8]) who were expected to suffer from sports-related concussion or post-concussive syndrome (52[140] days between diagnostic testing and the concussive

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2019 PLoS ONE

6. Concussion

Concussion Concussion - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Concussion Last reviewed: February 2019 Last updated: March 2018 Summary A closed head injury due to a direct blow to the head or deceleration of the head from an impulsive force, resulting in a transient change in mental status. Most common causes are motor vehicle accidents, sports, assaults, and falls. Diagnosing concussion (mild traumatic brain (...) injury) is difficult based on acute injury characteristics and presenting signs and symptoms. Headache, mental slowing and fogginess, and memory difficulties are typical symptoms. Symptoms may fluctuate, but typically subside after 1 week to 1 month. Loss of consciousness is not necessary for a positive diagnosis. CT scan and MRI are typically normal in concussive injury. For uncomplicated cases, physical and cognitive rest is usually sufficient. Definition Concussion (mild traumatic brain injury

2018 BMJ Best Practice

7. Systematic review and image-based meta-analysis of diffusion MRI scalars in concussed sportspeople compared to non-concussed people

Systematic review and image-based meta-analysis of diffusion MRI scalars in concussed sportspeople compared to non-concussed people Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record

2019 PROSPERO

8. Systematic review of multiple prior concussions as a vulnerability factor for worse outcome following sport-related concussion

Systematic review of multiple prior concussions as a vulnerability factor for worse outcome following sport-related concussion Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any

2019 PROSPERO

9. Rest Evaluation for Active Concussion Treatment (ReAct) Protocol: a prospective cohort study of levels of physical and cognitive rest after youth sports-related concussion. (PubMed)

Rest Evaluation for Active Concussion Treatment (ReAct) Protocol: a prospective cohort study of levels of physical and cognitive rest after youth sports-related concussion. Although current guidelines for the early clinical management of sports-related concussion (SRC) call for a gradual return-to-activity, the optimal level of rest needed to promote recovery remains unknown. This paper describes the protocol of the Rest Evaluation for Active Concussion Treatment (ReAct) study which objectively (...) measures physical and cognitive rest following SRC and its relation to recovery among youth athletes.Youth athletes aged 11-17 years are recruited preinjury and enrolled within 72 hours following a physician-diagnosed concussion. Injury information and acute clinical presentation are assessed at the time of injury. Youth participants are prospectively followed to objectively monitor daily physical and cognitive rest using two electronic devices: ActiGraph (to measure physical rest and sleep

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2019 BMJ open

10. Multidisciplinary Concussion Management: A Model for Outpatient Concussion Management in the Acute and Post-Acute Settings. (PubMed)

Multidisciplinary Concussion Management: A Model for Outpatient Concussion Management in the Acute and Post-Acute Settings. To describe a model of multidisciplinary concussion management and explore management methods in the acute and post-acute settings.A multidisciplinary concussion management program within a large health system.Patients with sports and non-sports-related concussions aged 14 to 18 years with persisting concussion symptoms at 4 weeks postinjury or beyond.Pilot randomized (...) controlled trial comparing a subsymptom threshold exercise program with standard-of-care treatment in the post-acute setting.Beck Depression Inventory-II and the Post-Concussion Scale-Revised.Across groups, 60% improvement in concussion symptoms was noted. After removing the influence of depression, the intervention showed a large effect on symptom reduction, with participants in the intervention group improving more than those in the control group. There was no difference in response to the intervention

2019 The Journal of head trauma rehabilitation Controlled trial quality: uncertain

11. Australian Institute of Sport and Australian Medical Association position statement on concussion in sport

Australian Institute of Sport and Australian Medical Association position statement on concussion in sport Australian Institute of Sport and Australian Medical Association position statement on concussion in sport | The Medical Journal of Australia mja-search search Use the for more specific terms. Title contains Body contains Date range from Date range to Article type Author's surname Volume First page doi: 10.5694/mja__.______ Search Reset  close Individual Login Purchase options Connect (...) person_outline Login keyboard_arrow_down Individual Login Purchase options menu search Advertisement close Australian Institute of Sport and Australian Medical Association position statement on concussion in sport Lisa J Elkington and David C Hughes Med J Aust 2017; 206 (1): . || doi: 10.5694/mja16.00741 Published online: 16 January 2017 Topics Summary Sport-related concussion is a growing health concern in Australia. Public concern is focused on the incidence and potential long term consequences

2017 MJA Clinical Guidelines

12. Contact Sports-related Concussion in Amateur Athletes, Primary Prevention of

Contact Sports-related Concussion in Amateur Athletes, Primary Prevention of Contact Sports-related Concussion in Amateur Athletes, Primary Prevention of - Practice Management Guideline Search » Contact Sports-related Concussion in Amateur Athletes, Primary Prevention of Published 2018 Citation: Authors Toby M Enniss, Khaled Basiouny, Brian Brewer, Nikolay Bugaev, Julius Cheng, Omar K Danner, Thomas Duncan, Shannon Foster, Gregory Hawryluk, Hee Soo Jung, Felix Lui, Rishi Rattan, Pina Violano (...) , 2018 Correspondence to: Dr Toby M Enniss, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA; Abstract Background Awareness of the magnitude of contact sports-related concussions has risen exponentially in recent years. Our objective is to conduct a prospectively registered systematic review of the scientific evidence regarding interventions to prevent contact sports-related concussions. Methods Using the Grading of Recommendations Assessment, Development

2018 Eastern Association for the Surgery of Trauma

13. Mouthguards for the Prevention of Dental Injuries and Concussions: Clinical Effectiveness

Mouthguards for the Prevention of Dental Injuries and Concussions: Clinical Effectiveness Mouthguards for the Prevention of Dental Injuries and Concussions: Clinical Effectiveness | CADTH.ca Find the information you need Mouthguards for the Prevention of Dental Injuries and Concussions: Clinical Effectiveness Mouthguards for the Prevention of Dental Injuries and Concussions: Clinical Effectiveness Published on: February 12, 2016 Project Number: RB0961-000 Product Line: Research Type: Devices (...) and Systems Report Type: Summary of Abstracts Result type: Report Question What is the clinical effectiveness of the use of mouthguards for the reduction in the number and severity of dental injuries resulting from contact sports? What is the clinical effectiveness of the use of mouthguards for the reduction in the number and severity of concussions resulting from contact sports? Key Message Three systematic reviews, one randomized controlled trial, and five non-randomized studies were identified

2016 Canadian Agency for Drugs and Technologies in Health - Rapid Review

14. Concussed athletes walk slower than non-concussed athletes during cognitive-motor dual-task assessments but not during single-task assessments 2 months after sports concussion: a systematic review and meta-analysis using individual participant data. (PubMed)

Concussed athletes walk slower than non-concussed athletes during cognitive-motor dual-task assessments but not during single-task assessments 2 months after sports concussion: a systematic review and meta-analysis using individual participant data. To determine whether individuals who sustained a sports concussion would exhibit persistent impairments in gait and quiet standing compared to non-injured controls during a dual-task assessment .Systematic review and meta-analysis using individual (...) participant data (IPD).The search strategy was applied across seven electronic bibliographic and grey literature databases: MEDLINE, EMBASE, CINAHL, SportDISCUS, PsycINFO, PsycARTICLES and Web of Science, from database inception until June 2017.Studies were included if; individuals with a sports concussion and non-injured controls were included as participants; a steady-state walking or static postural balance task was used as the primary motor task; dual-task performance was assessed with the addition

2019 British Journal of Sports Medicine

15. Concussion, microvascular injury, and early tauopathy in young athletes after impact head injury and an impact concussion mouse model. (PubMed)

Concussion, microvascular injury, and early tauopathy in young athletes after impact head injury and an impact concussion mouse model. The mechanisms underpinning concussion, traumatic brain injury, and chronic traumatic encephalopathy, and the relationships between these disorders, are poorly understood. We examined post-mortem brains from teenage athletes in the acute-subacute period after mild closed-head impact injury and found astrocytosis, myelinated axonopathy, microvascular injury (...) , perivascular neuroinflammation, and phosphorylated tau protein pathology. To investigate causal mechanisms, we developed a mouse model of lateral closed-head impact injury that uses momentum transfer to induce traumatic head acceleration. Unanaesthetized mice subjected to unilateral impact exhibited abrupt onset, transient course, and rapid resolution of a concussion-like syndrome characterized by altered arousal, contralateral hemiparesis, truncal ataxia, locomotor and balance impairments

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2018 Brain

16. Influence of Concussion History and Genetics on Event-Related Potentials in Athletes: Potential Use in Concussion Management (PubMed)

Influence of Concussion History and Genetics on Event-Related Potentials in Athletes: Potential Use in Concussion Management Sports-related concussions are an increasing public health issue with much concern about the possible long-term decrements in cognitive function and quality of life that may occur in athletes. The measurement of cognitive function is a common component of concussion management protocols due to cognitive impairments that occur after sustaining a concussion; however (...) , the tools that are often used may not be sensitive enough to expose long term problems with cognitive function. The current paper is a brief review, which suggests that measuring cognitive processing through the use of event related potentials (ERPs) may provide a more sensitive assessment of cognitive function, as shown through recent research showing concussion history to influence ERPs components. The potential influence of genetics on cognitive function and ERPs components will also be discussed

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2018 Sports

17. Heart Rate Variability in Healthy Non-Concussed Youth Athletes: Exploring the Effect of Age, Sex, and Concussion-Like Symptoms (PubMed)

Heart Rate Variability in Healthy Non-Concussed Youth Athletes: Exploring the Effect of Age, Sex, and Concussion-Like Symptoms Heart rate variability (HRV) is a non-invasive neurophysiological measure of autonomic nervous system regulation emerging in concussion research. To date, most concussion studies have focused on the university-aged athlete with no research examining healthy active youths. Corroborating changes in HRV alongside traditional subjective self-report measures (concussion (...) symptoms) in the non-concussed state provides a foundation for interpreting change following concussion. The objectives were to (1) explore the influence of age and sex on HRV and (2) examine the relationship between HRV and baseline/pre-injury concussion symptom domains (physical, cognitive, emotional, and fatigue) in healthy youth athletes.Healthy, youth athletes 13-18 years of age [N = 294, female = 166 (56.5%), male = 128 (43.5%)] participated in this cross-sectional study. Age, sex, and concussion

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2018 Frontiers in neurology

18. Distinguishing between enduring and dynamic concussion symptoms: applying Generalisability Theory to the Rivermead Post Concussion Symptoms Questionnaire (RPQ) (PubMed)

Distinguishing between enduring and dynamic concussion symptoms: applying Generalisability Theory to the Rivermead Post Concussion Symptoms Questionnaire (RPQ) The Rivermead Post Concussion Symptoms Questionnaire (RPQ) is a widely-used, 16-item measure of concussion symptoms yet its ability to assess change in the symptom experience over time has come under criticism. We applied Generalisability theory to differentiate between dynamic and enduring aspects of post-concussion symptoms (...) by interaction between person and occasion. Items measuring concentration, fatigue, restlessness and irritability reflected more dynamic patterns compared to more enduring patterns of sensitivity to noise, impatience, nausea and sleep disturbance.The RPQ demonstrated strong reliability in assessing enduring post-concussion symptoms but its ability to assess dynamic symptoms is limited. Clinicians should exercise caution in use of the RPQ to track dynamic symptom change over time. Further investigation

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2018 PeerJ

19. Heart rate variability following youth concussion: how do autonomic regulation and concussion symptoms differ over time postinjury? (PubMed)

Heart rate variability following youth concussion: how do autonomic regulation and concussion symptoms differ over time postinjury? Following youth concussion, objective physiological indicators are needed to corroborate changes in subjective clinical measures. The objectives of the current study were to: (1) explore the effect of concussion on heart rate variability (HRV) across days postinjury in youth athletes aged 13-18 years old, compared with healthy age-matched and sex-matched controls (...) and (2) examine the relationship between postconcussion symptom domains (physical, cognitive, fatigue and emotional) and HRV.Prospective, longitudinal, case-control study (N=44). This study comprised 29 concussed athletes between the ages of 13 and 18 years old (21 females, 8 males) and 15 age-matched and sex-matched controls). All participants completed baseline testing, which included demographic information (age, sex, concussion history), self-reported concussion symptoms (Post-Concussion Symptom

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2018 BMJ Open Sport — Exercise Medicine

20. Concussion BASICS III: Serum biomarker changes following sport-related concussion. (PubMed)

Concussion BASICS III: Serum biomarker changes following sport-related concussion. To evaluate changes in serum biomarker concentrations (β-amyloid peptide 42 [Aβ42], total tau, ubiquitin carboxy-terminal hydrolyzing enzyme L1, S100 calcium binding protein B [S100B], glial fibrillary acidic protein [GFAP], microtubule associated protein 2 [MAP2], and 2',3'-cyclic-nucleotide 3'-phosphodiesterase [CNPase]) after sport-related concussion (SRC) in a sample of collegiate athletes. Associations (...) is collected within a few hours. Accurate blood marker identification of SRC appears somewhat dependent on the "healthy" comparison. Additional research must evaluate whether physiologic changes in the absence of clinical changes, or vice versa, are relevant for concurrent or future neurologic health.This study provides Class III evidence that certain serum biomarkers are elevated from baseline and higher than demographically matched controls after sport-related concussion.© 2018 American Academy

2018 Neurology

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