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261. A Pilot Randomised Double-Blind Study of the Tolerability and efficacy of repetitive Transcranial Magnetic Stimulation on Persistent Post-Concussion Syndrome. (Full text)

A Pilot Randomised Double-Blind Study of the Tolerability and efficacy of repetitive Transcranial Magnetic Stimulation on Persistent Post-Concussion Syndrome. This study investigates the effect of Repetitive Transcranial Magnetic Stimulation (rTMS) on persistent post-concussion syndrome (PCS). The study design was a randomized (coin toss), placebo controlled, and double-blind study. Thirty-seven participants with PCS were assessed for eligibility; 22 were randomised and 18 completed the study (...) requirements. Half the participants with PCS were given an Active rTMS intervention and the other half given Sham rTMS over 3 weeks. Follow ups were at the end of treatment and at 30 and 60 days. The primary outcome measure was the Rivermead Post-Concussion Symptoms Questionnaire (RPQ3 & RPQ13). The results indicate participants with more recent injuries (<12 month), who received Active rTMS, showed significant improvements compared to those of: 1) the same subgroup who received Sham, and 2) those

2019 Scientific reports Controlled trial quality: predicted high PubMed abstract

262. Imaging findings after acute sport-related concussion in American football players: A systematic review. (Abstract)

Imaging findings after acute sport-related concussion in American football players: A systematic review. Sport-related concussion (SRC) has emerged as a major public health problem. The results of brain imaging studies following SRC have raised questions about long-term neurologic health, but the clinical implications of these findings remain unknown. A systematic review of brain imaging findings after SRC was performed utilizing the following inclusion criteria: football players, brain imaging

2019 Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

263. Eye tracking technology in sports-related concussion: a systematic review and meta-analysis. (Abstract)

Eye tracking technology in sports-related concussion: a systematic review and meta-analysis. The development of objective quantitative tools for the assessment and monitoring of sports-related concussion is critical. Eye tracking is a novel tool that may provide suitable metrics. The aim of this review was to appraise current evidence for the use of eye tracking technology in sports-related concussion assessment and monitoring.A systematic literature review was conducted following the preferred (...) reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A search was run using Google Scholar, Microsoft Academic and PubMed for literature published between January 1980 and May 2018. Included were empirical research studies in English where at least 50% of the research participants were athletes, the participants were individuals with a diagnosis of concussion, and eye movements were measured using an eye tracking device.This systematic review integrates 21 publications on sports

2019 Physiological measurement

264. Longitudinal study of hyperbaric oxygen intervention on balance and affective symptoms in military service members with persistent post-concussive symptoms. (Abstract)

Longitudinal study of hyperbaric oxygen intervention on balance and affective symptoms in military service members with persistent post-concussive symptoms. Dizziness and imbalance are common after mild traumatic brain injury (mTBI). Hyperbaric oxygen (HBO2) has been proposed for persistent post-concussive symptoms after mTBI, but its effect on vestibular function is unknown.To describe balance function in military service-members before and after intervention, and to explore the influence

2019 Journal of vestibular research : equilibrium & orientation Controlled trial quality: uncertain

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

Comparison of Rest to Aerobic Exercise and Placebo-like Treatment of Acute Sport-Related Concussion in Male and Female Adolescents. To compare a sample of adolescents with sport-related concussion (SRC) who were prescribed rest with 2 arms of a randomized controlled trial comparing aerobic exercise with placebo-like stretching. We also compared sex differences across the 3 approaches to treatment.Quasi-experimental trial.University concussion management clinics.Adolescent athletes (aged 13-18

2019 Archives of physical medicine and rehabilitation Controlled trial quality: predicted high

266. Extended follow-up in a randomized trial of hyperbaric oxygen for persistent post-concussive symptoms. (Abstract)

Extended follow-up in a randomized trial of hyperbaric oxygen for persistent post-concussive symptoms. To date, several Department of Defense (DoD) and civilian studies have evaluated hyperbaric oxygen for mild forms of traumatic brain injury. Prior to the DoD-sponsored "Brain Injury and Mechanisms of Action of Hyperbaric Oxygen for Persistent Post-Concussive Symptoms after Mild Traumatic Brain Injury (mTBI) (BIMA)" trial, none included post-intervention follow-up beyond three to six months (...) . Post-hoc attempts at long-term follow-up were complicated by low participation and potential self-selection bias. BIMA planned for follow-up through 12 months but was amended to add post-concussive and post-traumatic stress disorder, quality of life, pain, depression, anxiety, and alcohol use assessments at 24 and 36 months. A total of 42 of 71 BIMA participants consented to extendedfollow-up, and 40 and 14 completed a 24- or 36-month visit, respectively, representing an overall response rate of 59

2019 Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc Controlled trial quality: uncertain

267. Characteristics and Costs of Pediatric Emergency Department Visits for Sports- and Recreation-Related Concussions, 2006-2014. (Abstract)

Characteristics and Costs of Pediatric Emergency Department Visits for Sports- and Recreation-Related Concussions, 2006-2014. Although concussion-related emergency department (ED) visits increased after the passage of concussion laws, little is known about how the laws may disproportionately impact ED utilization and associated health care costs among children in different demographic groups.Our aim was to examine the patient and clinical characteristics of pediatric ED visits and associated (...) health care costs for sports- and recreation-related concussions (SRRCs) before and after concussion law enactment.We retrospectively analyzed ED visits for SRRCs by children ages 5-18 years between 2006 and 2014 in the Pediatric Health Information System database (n = 123,220). ED visits were categorized as "pre-law," "immediate post-law," and "post-law" according to the respective state concussion law's effective date. Multinomial logistic regression models were used to assess the impact of the law

2019 Journal of Emergency Medicine

268. Posterior tibial bone bruising associated with posterior-medial meniscal tear in patients with acute anterior cruciate ligament injury. (Abstract)

Posterior tibial bone bruising associated with posterior-medial meniscal tear in patients with acute anterior cruciate ligament injury. To evaluate whether medial-sided bone bruising was associated with postero-medial meniscal tears in patients with an acute rupture of their anterior cruciate ligament (ACL).A retrospective analysis of 150 consecutive patients who had an MRI scan within 8 weeks of their ACL rupture that underwent an ACL reconstruction was performed. Based on the intra-operative (...) findings, two groups were identified: Group A (N = 75) had no postero-medial meniscal tear associated with the acute ACL rupture and Group B (N = 75) had a postero-medial meniscal tear found at time of reconstruction. All patients' pre-operative MRI scans were reviewed for bone bruising in the following anatomic sites: lateral femoral condyle (LFC), lateral tibial plateau (LTP), medial femoral condyle (MFC), and medial tibial plateau (MTP).MTP bone bruising was found to be more prevalent in cases

2019 Knee Surgery, Sports Traumatology, Arthroscopy

269. Antidepressants for depression after concussion and traumatic brain injury are still best practice. (Full text)

Antidepressants for depression after concussion and traumatic brain injury are still best practice. Depression is a common complication of traumatic brain injury (TBI). New evidence suggests that antidepressant medication may be no more effective than placebo in this population.Selective serotonin reuptake inhibitors are recommended as first-line treatment for depression in contemporary expert consensus clinical practice guidelines for management of TBI. This recommendation is based on multiple

2019 BMC Psychiatry PubMed abstract

270. A technology-enabled electronic incident report to document and facilitate management of sport concussion: A cohort study of youth and young adults. (Full text)

A technology-enabled electronic incident report to document and facilitate management of sport concussion: A cohort study of youth and young adults. Despite the widespread awareness of concussion across all levels of sport, the management of concussion from youth to college is inconsistent and fragmented. A fundamental gap contributing to inconsistent care is the lack of a scalable, systematic approach to document initial injury characteristics following concussion. The purpose of this study (...) was to determine differences in injury profiles and management of youth, high school, and college athletes using a mobile application for incident report documentation.A cohort study was conducted in which concussion electronic incident report data from 46 high schools and colleges, and Cleveland Clinic ambulatory concussion clinics were gathered and analyzed.In sum, 1421 (N = 88 youth, N = 1171 high school and N = 162 college) athletes with sport-related concussions were included.Despite the relative absence

2019 Medicine PubMed abstract

271. Pilot Randomized Controlled Trial of an Exercise Program Requiring Minimal In-person Visits for Youth With Persistent Sport-Related Concussion. (Full text)

Pilot Randomized Controlled Trial of an Exercise Program Requiring Minimal In-person Visits for Youth With Persistent Sport-Related Concussion. Objective: To evaluate feasibility and acceptability of a sub-threshold exercise program with minimal in-person visits to treat youth with persistent sport-related concussion, and explore efficacy for improving concussive symptoms, health-related quality of life, and fear-avoidance. Study design: We conducted a pilot randomized controlled trial (...) comparing a 6 week sub-threshold exercise program requiring only two in-person visits to active control (stretching) for 12-18 year old youth with persistent sport-related concussion. We measured moderate-to-vigorous physical activity pre- and post-intervention using accelerometry, and increased goals weekly via phone contact. We examined feasibility and acceptability using qualitative interviews. We used exponential regression to model differences in trajectory of concussive symptoms by experimental

2019 Frontiers in neurology Controlled trial quality: uncertain PubMed abstract

272. Self-efficacy predicts response to cognitive rehabilitation in military service members with post-concussive symptoms. (Abstract)

Self-efficacy predicts response to cognitive rehabilitation in military service members with post-concussive symptoms. This study examined whether self-efficacy differentiated treatment responders from non-responders in a trial of cognitive rehabilitation (CR) for postconcussive symptoms. 126 service members with mild TBI seen on average 9.5 months since injury completed one of four cognitive rehabilitation treatments for 6 weeks. The four treatment arms were: (1) Psychoeducation control, (2 (...) patients' level of self-efficacy may be important for successful treatment of psychological distress in those with remote concussion.

2019 Neuropsychological rehabilitation Controlled trial quality: uncertain

273. Concussion and Academic Impairment Among U.S. High School Students. (Abstract)

Concussion and Academic Impairment Among U.S. High School Students. Sports and physical activities are a frequent cause of traumatic brain injury, primarily concussions, among adolescents. These concussions may adversely affect students' ability to learn and impair academic achievement in educational settings.The 2017 Youth Risk Behavior Survey, conducted among a nationally representative sample of 14,765 U.S. high school students, was analyzed in 2018 to examine associations between self (...) -reported sports- and physical activity-related concussions and symptoms of cognitive impairment (difficulty concentrating, remembering, or making decisions) and self-reported academic grades (mostly A's=4.0, mostly B's=3.0, mostly C's=2.0, mostly D's=1.0, mostly F's=0.0). Adjusted prevalence ratio and the difference in self-reported estimated grade point average were adjusted for sex, race/ethnicity, grade, and athlete status (participation on sports teams) and considered statistically significant if p

2019 American journal of preventive medicine

274. Consensus Statement on Sports-Related Concussions in Youth Sports Using a Modified Delphi Approach. (Abstract)

Consensus Statement on Sports-Related Concussions in Youth Sports Using a Modified Delphi Approach. Given the importance of sports-related concussions among youth athletes, the rapid progress of research on this topic over the last decade, and the need to provide further guidance to youth athletes, their families, medical professionals, and athletic personnel and organizations, a panel of experts undertook a modified Delphi consensus process to summarize the current literature and provide (...) recommendations regarding the prevention, assessment, and management of sports-related concussions for young athletes.A consensus panel of 11 experts was created to represent a broad spectrum of expertise in youth sports and concussions. The specific questions to be addressed were developed through an iterative process consisting of 3 rounds, and a review of the literature was conducted to identify research studies related to each question. The consensus panel used a modified Delphi process to reach consensus

2019 JAMA pediatrics

275. Recent Preoperative Concussion and Postoperative Complications: A Retrospective Matched-cohort Study. (Abstract)

Recent Preoperative Concussion and Postoperative Complications: A Retrospective Matched-cohort Study. Physiological alterations during the perianesthetic period may contribute to secondary neurocognitive injury after a concussion.Patients exposed to concussion and who received an anesthetic within 90 days were matched to unexposed patients without concussion. Intraoperative and postoperative events were compared. Subgroup analyses assessed relationships among patients with a concussion (...) in the prior 30, 31 to 60, and 61 to 90 days and their respective unexposed matches. To facilitate identification of potential targets for further investigation, statistical comparisons are reported before, as well as after, correction for multiple comparisons.Sixty concussion patients were matched to 176 unexposed patients. Before correction, 28.3% postconcussion versus 14.8% unexposed patients reported postanesthesia care unit pain score≥7 (P=0.02); 16.7% concussion versus 6.5% unexposed patients

2019 Journal of neurosurgical anesthesiology

276. The Influence of Psychological Factors on the Incidence and Severity of Sports-Related Concussions: A Systematic Review. (Abstract)

The Influence of Psychological Factors on the Incidence and Severity of Sports-Related Concussions: A Systematic Review. An athlete's preexisting psychological factors may influence the incidence and/or severity of sports-related concussions (SRCs).To determine if emotional states, personality traits, temperament, life stressors, and explanatory styles (optimism vs pessimism) influence the incidence and severity of SRCs in athletes.Systematic review.A systematic literature search of multiple

2019 The American Journal of Sports Medicine

277. Sex-Based Differences in the Incidence of Sports-Related Concussion: Systematic Review and Meta-analysis. (Full text)

Sex-Based Differences in the Incidence of Sports-Related Concussion: Systematic Review and Meta-analysis. The incidence of sports-related concussion in females has been increasing in recent years.To conduct a meta-analysis on sex-based differences in concussion incidence in various sports and to determine the effects of study design (retrospective vs prospective), setting (competition vs practice), and population (university and above vs high school and below) via a meta-regression.PubMed (...) (Medline), EMBASE, and Cochrane Library databases were searched from January 2000 to January 2018.Studies reporting sports-related concussion incidence data for both males and females (age ≥10 years) were included.Systematic review with meta-analysis and meta-regression.Level 4.The rate ratio was calculated as the concussion rate in females/males. Data were pooled using the DerSimonian-Laird random-effects model.Thirty-eight studies met the eligibility criteria and were included in the meta-analysis

2019 Sports health PubMed abstract

278. Prevalence of Concussion Among US Adolescents and Correlated Factors (Full text)

Prevalence of Concussion Among US Adolescents and Correlated Factors 28973604 2017 10 19 2018 11 13 1538-3598 318 12 2017 09 26 JAMA JAMA Prevalence of Concussion Among US Adolescents and Correlated Factors. 1180-1182 10.1001/jama.2017.9087 Veliz Phil P Institute for Research on Women and Gender, University of Michigan, Ann Arbor. McCabe Sean E SE Institute for Research on Women and Gender, University of Michigan, Ann Arbor. Eckner James T JT Department of Physical Medicine and Rehabilitation (...) , University of Michigan, Ann Arbor. Schulenberg John E JE Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor. eng R01 DA001411 DA NIDA NIH HHS United States R01 CA203809 CA NCI NIH HHS United States K23 HD078502 HD NICHD NIH HHS United States R01 DA031160 DA NIDA NIH HHS United States L40 DA042452 DA NIDA NIH HHS United States Journal Article United States JAMA 7501160 0098-7484 AIM IM Adolescent Brain Concussion epidemiology Child Cross-Sectional Studies Female

2017 JAMA PubMed abstract

279. Patterned Bruises From Abusive Squeezing. (Abstract)

Patterned Bruises From Abusive Squeezing. Bruising is the most common presentation of child physical abuse. Many patterns of abusive bruising result in positive or negative imprints of the implement used (eg, fingertips in "grab mark" contusions or hand in slap injury). However, bruising may also form along the lines of greatest anatomical stress (eg, gluteal cleft or pinna bruising). Bruising due to abusive squeezing also forms along lines of greatest anatomical stress, resulting in a negative (...) imprint of the flexural folds of the hand. Four cases of children with this unique pattern of bruising due to abusive squeezing are presented. Recognition of these bruises as inflicted represents an opportunity for early identification and intervention in cases of child physical abuse.

2019 Pediatric Emergency Care

280. Rest-Based Concussion Management of Pediatric Emergency Medicine Providers. (Abstract)

Rest-Based Concussion Management of Pediatric Emergency Medicine Providers. This study aimed to survey pediatric emergency medicine (PEM) providers on their management of 2 hypothetical acute concussion scenarios. We hypothesized that most providers would recommend a management strategy based on cognitive and physical rest.Fifty-nine percent (46/78) of PEM providers that were surveyed completed the study. The survey consisted of 2 clinical scenarios-a female patient with a mild concussion (...) and a male patient with a moderate concussion. Practitioners were asked questions regarding how they would hypothetically manage these patients in terms of recommendations for returning to school and returning to sports.Eighty-six percent of providers recommended moderate time off from school for the moderate concussion scenario compared with 67% of providers in the mild concussion scenario (P = 0.008). In regard to return to sports, all providers recommended moderate time off in both scenarios

2019 Pediatric Emergency Care

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