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321. Prevention of post-concussion-like symptoms in patients presenting at the emergency room, early single eye movement desensitization, and reprocessing intervention versus usual care: study protocol for a two-center randomized controlled trial Full Text available with Trip Pro

Prevention of post-concussion-like symptoms in patients presenting at the emergency room, early single eye movement desensitization, and reprocessing intervention versus usual care: study protocol for a two-center randomized controlled trial Recent data suggest that 10-20% of injury patients will suffer for several months after the event from diverse symptoms, generally referred to as post-concussion-like symptoms (PCLS), which will lead to a decline in quality of life. A preliminary randomized

2018 Trials Controlled trial quality: uncertain

322. Concussion with primary impact to the chest and the potential role of neck tension Full Text available with Trip Pro

Concussion with primary impact to the chest and the potential role of neck tension Most biomechanical research on brain injury focuses on direct blows to the head. There are a few older studies that indicate craniocervical stretch could be a factor in concussion by causing strain in the upper spinal cord and brainstem. The objectives of this study are to assess the biomechanical response and estimate the strain in the upper cervical spine and brainstem from primary impact to the chest (...) in American football.Impact testing was conducted to the chest of a stationary unhelmeted and helmeted anthropomorphic test device (ATD) as well as the laboratory reconstruction of two NFL game collisions resulting in concussion. A finite element (FE) study was also conducted to estimate the elongation of the cervical spine under tensile and flexion loading conditions.The helmeted ATD had a 40% (t=9.84, p<0.001) increase in neck tensile force and an 8% (t=7.267, p<0.001) increase in neck flexion angle

2018 BMJ Open Sport — Exercise Medicine

323. Pros and Cons of 19 Sport-Related Concussion Educational Resources in Canada: Avenues for Better Care and Prevention Full Text available with Trip Pro

Pros and Cons of 19 Sport-Related Concussion Educational Resources in Canada: Avenues for Better Care and Prevention Objective: The goal of this research was to assess the effectiveness of available concussion educational resources in Canada, the means used to disseminate this knowledge and the impact of these educational resources on players' concussion prevention knowledge. Methods: We assessed concussion knowledge before and after exposure to one or more of 19 resources introduced through (...) a national program aimed to increase awareness and knowledge of concussion. The effectiveness of the mode of delivery was measured by changes in concussion knowledge scores (CKS) between pre and pro scores. Measures: Concussion knowledge scores (CKS) were calculated for pre- and post- exposure to concussion educational resources and used as a measure of both, the effectiveness of each resource as well as the effectiveness of the delivery method. The effectiveness of each educational resource was also

2018 Frontiers in neurology

324. The effects of vision training, neck musculature strength, and reaction time on concussions in an athletic population Full Text available with Trip Pro

The effects of vision training, neck musculature strength, and reaction time on concussions in an athletic population A concussion is a major concern across the athletic population. Prevention of concussions can lead to a decrease of 3.8 million concussions that occur annually in the United States. Vision training, increasing neck musculature strength and quick reaction times are thought to be ways to prevent concussions. The purpose of this study is to review the literature on vision training (...) , neck musculature, and reaction time, and how these interventions can prevent concussions. Upon review of the literature, vision training is proven to prevent concussions in a collegiate football setting, but there is no literature on different levels or sports. There are inconclusive results on whether neck musculature strength prevents concussions. There are substantial results concluding reaction time does prevent concussions by allowing the athlete to protect and anticipate head impact lessening

2018 Journal of exercise rehabilitation

325. Protocol for the mixed-methods development of a concussion-specific health-related quality of life outcome measure based on the international classification of functioning, disability and health. Full Text available with Trip Pro

Protocol for the mixed-methods development of a concussion-specific health-related quality of life outcome measure based on the international classification of functioning, disability and health. Recovery from concussion has traditionally been evaluated by patient-reported symptoms, objective measures such as loss of consciousness, specific dimensions such as depression or fatigue, cognitive status, employment status, level of physical activity and the more complex construct of disability (...) . Increasingly, patient-reported outcome measures of health-related quality of life (HRQOL) are being emphasised as an important end point in patient care, clinical trial and health policy decisions. Currently, no standardised concussion-specific HRQOL outcome measure exists. The process for developing a concussion-specific HRQOL outcome measure based on the international classification of functioning, disability and health is outlined.A multistage, patient-centred approach to developing the outcome measure

2018 BMJ open

326. What can family medicine providers learn about concussion non-disclosure from former collegiate athletes? Full Text available with Trip Pro

What can family medicine providers learn about concussion non-disclosure from former collegiate athletes? Despite the risks, concussion symptoms often go underreported by athletes, leading to delayed or forgone treatment and increased potential for concussion recurrence. One of the most serious long-term consequences of sports-related concussions is Chronic Traumatic Encephelopathy (CTE), a disorder associated with progressive neurological deterioration. The purpose of this study was to explore (...) former collegiate athletes' understanding of concussions and motivations behind concussion non-disclosure in order to better assist family medicine providers in screening for and managing a history of concussions.Informed by the theoretical framework Social Cognitive Theory, we conducted focus groups with former collegiate athletes using a field-tested discussion guide. Discussions were transcribed, coded, and analyzed via content and thematic analyses using NVivo 10 software.Thirty-two former

2018 BMC Family Practice

327. Sports-Related Concussions in Children: Differences in Care and Expectations When Seen in an Emergency Department Versus a Sports Medicine Clinic. (Abstract)

Sports-Related Concussions in Children: Differences in Care and Expectations When Seen in an Emergency Department Versus a Sports Medicine Clinic. Patient and parent expectations can potentially influence management of care. We compared expectations in the diagnosis of concussion between patients who presented to a pediatric emergency department (ED) and those who presented to a sports medicine clinic, and if there was a difference in computed tomography (CT) scans performed.Head-injured (...) athletes aged 8 to 18 years presenting to a pediatric ED and a sports medicine clinic were enrolled. Both groups completed questionnaires on their understanding of concussion and expectations of care. Charts were then reviewed.Forty patients were enrolled in the study: 23 from a pediatric ED and 17 from a sports medicine clinic. Forty-one percent of athletes received a head CT in the pediatric ED versus 12% of those in the clinic population with no abnormal findings (P = 0.04). Forty-one percent

2018 Pediatric Emergency Care

328. Vertebral Artery Dissection Masquerading as Concussion in an Adolescent. (Abstract)

Vertebral Artery Dissection Masquerading as Concussion in an Adolescent. Educate providers about the clinical presentation and consequences of delaying diagnosis of traumatic vertebral artery dissection with thromboembolic ischemic strokes in the pediatric population. Vertebral artery dissection is often difficult to diagnose and can be a potentially devastating cause of ischemic stroke.Review of the chart, peer review/discussion, and imaging interpretation.A 16-year-old boy was admitted (...) with confusion after a head and neck trauma was sustained while wrestling. (Glasgow Coma Scale=15, NIHSS = 0). Investigations including computed tomography (CT) head and cervical spine were normal. He then developed severe nausea, vomiting, dizziness, and headaches and was admitted for symptoms of concussion. Ten hours later, patient declined (hypertensive and unresponsive) and was noted to have decerebrate posturing. After emergent intubation, he was transferred to the pediatric intensive care unit. Repeat

2018 Pediatric Emergency Care

329. The Diagnosis of Concussion in Pediatric Emergency Departments: A Prospective Multicenter Study. (Abstract)

The Diagnosis of Concussion in Pediatric Emergency Departments: A Prospective Multicenter Study. The accurate identification of children with a concussion by emergency physicians is important to initiate appropriate anticipatory guidance and management.We compared the frequency of persistent concussion symptoms in children who were provided the diagnosis of concussion by an emergency physician versus those who met Berlin/Zurich international criteria for this diagnosis. We also determined (...) the clinical variables independently associated with a physician-diagnosed concussion.This was a planned secondary analysis of a prospective, multicenter cohort study. Participants were 5-17 years of age and met the Zurich/Berlin International Consensus Statement criteria for concussion.There were 2946 enrolled children. In those with physician-diagnosed concussion vs. no concussion, the frequency of persistent symptoms was 62.5% vs. 38.8% (p < 0.0001) at 1 week, 46.3% vs. 25.8% (p < 0.0001) at 2 weeks

2018 Journal of Emergency Medicine

330. A Prospective Evaluation of the Influence of an Electronic Clinical Practice Guidelines on Concussion Patients' Future Activities and Outcomes. (Abstract)

A Prospective Evaluation of the Influence of an Electronic Clinical Practice Guidelines on Concussion Patients' Future Activities and Outcomes. Patients with mild traumatic brain injury or concussion commonly present to the emergency department for assessment; providing patients with information on usual symptoms and their progression may encourage faster recovery.This study aimed to document the role of an electronic clinical practice guideline (eCPG) patient handout on concussion recovery (...) in adult patients discharged from the hospital.A prospective cohort study was carried out in 3 Canadian urban emergency departments. Adults (≥17 years of age) with a Glasgow Coma Scale score of 13 to 15 who sustained a concussion were recruited by on-site research assistants. Physician use of a concussion-specific eCPG was documented from physician and patient reports. Patient follow-up calls at 30 and 90 days documented return to work/school activities and patient symptoms. Multivariate analyses were

2018 Journal of Emergency Medicine

331. Characterizing Hospitalizations for Pediatric Concussion and Trends in Care. Full Text available with Trip Pro

Characterizing Hospitalizations for Pediatric Concussion and Trends in Care. Children hospitalized for concussion may be at a higher risk for persistent symptoms, but little is known about this subset of children.Delineate a cohort of children admitted for concussion, describe care practices received, examine factors associated with prolonged length of stay (LOS) or emergency department (ED) readmission, and investigate changes in care over time.Retrospective analysis of data submitted by 40 (...) pediatric hospitals to the Pediatric Health Information System.Children 0 to 17 years old admitted with a primary diagnosis of concussion from 2007 to 2014.Descriptive statistics characterized this cohort and care practices delivered, logistic regression identified factors associated with a LOS of =2 days and ED readmission, and trend analyses assessed changes in care over time.Of the 10,729 children admitted for concussion, 68.7% received intravenous pain or antiemetic medications. Female sex

2018 Journal of Hospital Medicine

332. Pilot single-centre cross-sectional study to determine emergency physicians’ knowledge and management of sports concussion: an experience from Singapore Full Text available with Trip Pro

Pilot single-centre cross-sectional study to determine emergency physicians’ knowledge and management of sports concussion: an experience from Singapore Sports concussion remains challenging to manage despite changes to policy and practice since the 2012 International Consensus Conference on Concussion in Sport. Emergency physicians (EPs) are usually the first line of medical care for athletes in amateur and youth collision sports. This single-centre cross-sectional study aimed to establish (...) EPs' understanding and management of concussion in Singapore.An anonymised, 17-item online questionnaire was sent to EPs requesting for information on their clinical experience, training, exposure to concussion cases in the emergency department (ED) and assessed knowledge of the condition.Out of 65 EPs, 52 (80%) responded, 25 (48.1%) of whom were medical officers. Over 90% had not received formal training in concussion management, and 73.1% regularly assessed concussion. 40 (76.9%) EPs recognised

2018 Singapore medical journal

333. Activity and Exercise Intolerance After Concussion: Identification and Management of Postural Orthostatic Tachycardia Syndrome Full Text available with Trip Pro

Activity and Exercise Intolerance After Concussion: Identification and Management of Postural Orthostatic Tachycardia Syndrome Postural orthostatic tachycardia syndrome (POTS) is increasingly recognized as a complication affecting recovery from concussion. Individuals with POTS demonstrate refractory dizziness, lightheadedness, cognitive dysfunction, fatigue, headache, chronic pain, nausea and gastrointestinal dysmotility, activity and exercise intolerance, syncope, and tachycardia. Subtypes (...) of POTS may include hypovolemia, hyperadrenergic states, autonomic neuropathy, and underlying autoimmunity, which may variably impact response to rehabilitation in varying ways. The subtle presentation of POTS postconcussion is often mistaken for underlying anxiety, conversion disorder, or lack of motivation for recovery. This article will present clinical features of POTS that may arise after concussion, and propose a role for physical therapists in the diagnosis and management of POTS during

2018 Journal of Neurologic Physical Therapy

334. Reduced Functional Connectivity in Adults with Persistent Post-Concussion Symptoms: A Functional Near-Infrared Spectroscopy Study Full Text available with Trip Pro

Reduced Functional Connectivity in Adults with Persistent Post-Concussion Symptoms: A Functional Near-Infrared Spectroscopy Study Concussion, or mild traumatic brain injury (mTBI), accounts for ∼80% of all TBIs across North America. The majority of mTBI patients recover within days to weeks; however, 14-36% of the time, acute mTBI symptoms persist for months or even years and develop into persistent post-concussion symptoms (PPCS). There is a need to find biomarkers in patients with PPCS

2018 Journal of neurotrauma

335. Quantitative Susceptibility Mapping after Sport-related Concussion Full Text available with Trip Pro

Quantitative Susceptibility Mapping after Sport-related Concussion Quantitative susceptibility mapping using MR imaging can assess changes in brain tissue structure and composition. This report presents preliminary results demonstrating changes in tissue magnetic susceptibility after sports-related concussion.Longitudinal quantitative susceptibility mapping metrics were produced from imaging data acquired from cohorts of concussed and control football athletes. One hundred thirty-six (...) quantitative susceptibility mapping datasets were analyzed across 3 separate visits (24 hours after injury, 8 days postinjury, and 6 months postinjury). Longitudinal quantitative susceptibility mapping group analyses were performed on stability-thresholded brain tissue compartments and selected subregions. Clinical concussion metrics were also measured longitudinally in both cohorts and compared with the measured quantitative susceptibility mapping.Statistically significant increases in white matter

2018 AJNR. American journal of neuroradiology

336. Self-Reported Concussions from Playing a Sport or Being Physically Active Among High School Students — United States, 2017 Full Text available with Trip Pro

Self-Reported Concussions from Playing a Sport or Being Physically Active Among High School Students — United States, 2017 Increased susceptibility to concussions and longer recovery times among high school athletes compared with older athletes (1) make concussions among youths playing a sport or being physically active an area of concern. Short-term and long-term sequelae of concussions can include cognitive, affective, and behavioral changes (1). Surveillance methods used to monitor (...) concussions among youths likely underestimate the prevalence. Estimates assessed from emergency departments miss concussions treated outside hospitals, those generated using high school athletic trainer reports miss concussions sustained outside of school-based sports (2), and both sources miss medically untreated concussions. To estimate the prevalence of concussions among U.S. high school students related to playing a sport or being physically active, CDC analyzed data from the 2017 national Youth Risk

2018 Morbidity and Mortality Weekly Report

337. Survey of chiropractic clinicians on self-reported knowledge and recognition of concussion injuries Full Text available with Trip Pro

Survey of chiropractic clinicians on self-reported knowledge and recognition of concussion injuries There has been little study of the recognition of mild traumatic brain injury (MTBI) by the chiropractic practitioner, or of the inquiry by the clinician to assess those patients who may be suffering from the condition, but fail to report the symptoms. Although severe cases of TBI are more often recognized and treated by attendance to hospital or emergency room, MTBI is less recognizable (...) to the chiropractic clinician office was an average of less than one per month. Sixty nine percent (69%) of the clinicians relied upon their history and clinical exam for diagnosis. There was no knowledge of the Balance Error Scoring system and only 20% utilized the Standardized Concussion Assessment Tool (SCAT). The primary action of the chiropractic clinician who suspected MTBI was to refer to a neurological specialist (76%). A small minority of practitioners would provide treatment.There is an overconfidence

2018 Chiropractic & manual therapies

338. Head CT Guidelines Following Concussion among the Youngest Trauma Patients: Can We Limit Radiation Exposure Following Traumatic Brain Injury? Full Text available with Trip Pro

Head CT Guidelines Following Concussion among the Youngest Trauma Patients: Can We Limit Radiation Exposure Following Traumatic Brain Injury? Recent studies have provided guidelines on the use of head computed tomography (CT) scans in pediatric trauma patients. The purpose of this study was to identify the prevalence of these guidelines among concussed pediatric patients.A retrospective review was conducted of patients four years or younger with a concussion from blunt trauma. Demographics

2018 Kansas Journal of Medicine

339. The Effects of Altitude on Concussion Incidence in the 2013-2017 National Hockey League Seasons Full Text available with Trip Pro

The Effects of Altitude on Concussion Incidence in the 2013-2017 National Hockey League Seasons Background and objective The high incidence of traumatic brain injuries during contact sports has necessitated the need for further research pertaining to their implications and possible mitigation. Despite increasing attention to sports-related concussions, there is still a striking lack of detail pertaining to the environmental factors that contribute to their occurrence. One environmental (...) condition that has yet to be considered is altitude. Altitude cannot be readily adjusted, yet can still impact quality of play and concussion incidence. The current body of published evidence evaluating environmental effects on concussion is divided on the degree to which altitude mitigates concussion incidence. We aim to systematically compare the prevalence of concussions that occur at high and low altitude utilizing 1000 feet (304.8 meters) as a cut-off marker for high altitude. Our research also

2018 Cureus

340. Comments on “Bilateral medial rectus palsy due to midbrain infarction following concussion head injury” Full Text available with Trip Pro

Comments on “Bilateral medial rectus palsy due to midbrain infarction following concussion head injury” 29941773 2018 07 04 2018 12 02 1998-3689 66 7 2018 07 Indian journal of ophthalmology Indian J Ophthalmol Comments on "Bilateral medial rectus palsy due to midbrain infarction following concussion head injury". 1049-1050 10.4103/ijo.IJO_184_18 Pandey Pramod Kumar PK Department of Ophthalmology, Guru Nanak Eye Center and Maulana Azad Medical College, New Delhi, India. Joon Annu

2018 Indian journal of ophthalmology

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