Therefore, ex… 2013 Jan;47(1):15-26. doi: 10.1136/bjsports-2012-091941. Injury frequently occurs in a team sport, important for athletes and their sports organizations, financial, physical, and psychological. Br J Sports Med. Contact and collision sports, such as rugby, American football, and ice hockey, have the highest reported incidence of concussion.93 In youth ice hockey leagues where bodychecking is permitted, there is nearly a 4-fold increase in risk of concussion in the 11- to 12-year age group (Pee Wee).33 Game play has greater concussion risk than practice.1,22,57. Gunter KB, Shields CJ, Ott SD, Coronado RA. In this section, we outline 9 common persistent symptoms following concussion,7,58,106 describe differential diagnoses, and offer an overview of evidence-based rehabilitation approaches. Pituitary dysfunction after traumatic brain injury: a clinical and pathophysiological approach, Hypopituitarism due to sports related head trauma and the effects of growth hormone replacement in retired amateur boxers, Pituitary function in subjects with mild traumatic brain injury: a review of literature and proposal of a screening strategy, Gender differences in head–neck segment dynamic stabilization during head acceleration, Dizziness, unsteadiness, visual disturbances, and sensorimotor control in traumatic neck pain, Comparison of sensorimotor disturbance between subjects with persistent whiplash-associated disorder and subjects with vestibular pathology associated with acoustic neuroma, Balance, dizziness and proprioception in patients with chronic whiplash associated disorders complaining of dizziness: a prospective randomized study comparing three exercise programs, Comparison of psychological response between concussion and musculoskeletal injury in collegiate athletes, Incidence, severity, aetiology and prevention of sports injuries. injury leading to either return to competition or a period of absence from competition. 2009 Jan;123(1):114-23. doi: 10.1542/peds.2008-0309. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Investigation of antihypothalamus and antipituitary antibodies in amateur boxers: is chronic repetitive head trauma-induced pituitary dysfunction associated with autoimmunity? 11. Enter your email address below and we will send you the reset instructions, If the address matches an existing account you will receive an email with instructions to reset your password, Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. This article applies the dynamic, recursive model of sport injury to sport-related concussion and summarizes the process of individualized assessment and management following concussion in athletes of all ages, with a focus on physical rehabilitation. The initial management of concussion involves both cognitive and physical rest for the first 24 to 48 hours following injury.84,103 After this time, gradually and progressively increase activities of daily living, as long as symptoms do not increase.84,103 Once concussion-related symptoms have resolved with typical activities, gradually resume physical and cognitive activities (FIGURE 2). Introduction. 2019 Nov;49(11):799-810. doi: 10.2519/jospt.2019.8926. Adherence to sport injury rehabilitation means an injured athlete's compliance (or not) to a sports medicine/injury personnel's instructions of participating in a rehabilitation programme in a clinic, and/or doing rehabilitation exercises at home. In most cases, the symptoms of concussion resolve in the initial few days following the injury, and a strategy involving a gradual return to sport and school is recommended. Of the children with convergence insufficiency, 46% had their symptoms resolve in the initial 4.5 weeks following injury, and another 41% reported recovery following vestibular rehabilitation that included convergence training.110 Deficits in smooth pursuit, saccades, near point of convergence, and accommodation also have been reported following concussion, often in the presence of vestibulo-ocular reflex deficits and altered balance.81 Thus, visual assessment should include smooth pursuit, saccades, near point of convergence, and accommodation, in combination with a vestibular and balance examination. In most cases, the symptoms of concussion resolve in the initial few days following the injury, and a strategy involving a gradual return to sport and school is recommended. However, while protective equipment, such as helmets, headgear, and mouthguards, may mitigate the risk of concussion, the literature is inconclusive. Knowledge of modifiable risk factors helps to efficiently direct injury prevention efforts, and knowledge of nonmodifiable risk factors helps the clinician achieve an understanding of the overall risk to the athlete and informs return-to-play decision making. Sports injuries are often recurrent in that some people experience more than one sports injury over time. Irritability, sadness, anxiety, and feeling more emotional than normal are often reported following concussion, although they may not be acute.58 The psychological response to concussion may be similar to that to musculoskeletal injury, and improves over time.121 Some adults may have generalized anxiety disorder, panic attacks, and posttraumatic stress disorder following injury, which may reflect a new diagnosis or an exacerbation of a previous condition.128 Anxiety and depression are more common in women than in men, and may predict a longer recovery.52,109 Ongoing psychological or psychiatric problems are rare in children and youth without preinjury problems.31 Management of mental health problems will depend on the specific diagnosis (eg, pharmacological or psychological treatment). A model originally described by Meeuwisse (1994) and adapted and expanded upon by Barr and Krosshaug (2005)may guide sports professionals. Neurological examination, assessment of vestibulo-ocular reflex function, static balance, dynamic balance, assessment of nystagmus with and without fixation, positional testing, and vestibular function testing can inform diagnosis and management. Growth hormone is the most commonly affected hormone following concussion.56,63,114,115 Individuals with symptoms consistent with alteration in sex hormones, hypothyroidism, adrenal dysfunction, diabetes insipidus, syndrome of inappropriate antidiuretic hormone secretion, or growth hormone deficiency (fatigue, disrupted sleep patterns, and cognitive difficulties) should be investigated for hypothalamic-pituitary axis dysfunction.114, People with more, and more severe, acute and subacute symptoms take longer to recover following concussion.52 Adolescent age, female sex, the presence of a migraine history, and pre-existing mental health problems are predictors of slower recovery.52 Many other factors (eg, previous history of concussion, preschool age, race, genetics) have been evaluated as potential predictors of longer recovery, with mixed results.52 Attention deficit hyperactivity disorder and learning disabilities are unlikely to be risk factors for prolonged recovery.52 Among youths 5 to 18 years of age who presented to an emergency department, female sex, older than 13 years of age, migraine history, previous concussion with symptoms for greater than 1 week, sensitivity to noise, fatigue, headache, parent reporting that the child answers questions slowly, and more than 3 errors on the Balance Error Scoring System-tandem stance were predictors of longer recovery.127 Children with visual, vestibular, and cervical spine findings also recover more slowly.30,81, After an initial 24 to 48 hours of cognitive and physical rest,84,103 initiate a strategy of gradual return to school and sport.84 If symptoms persist beyond 7 to 10 days following injury, targeted treatment may be warranted.84,103 Rehabilitation following concussion should be informed by a multifaceted, interdisciplinary assessment aimed at identifying underlying sources of ongoing symptoms.78,103, In the presence of headache, differential diagnosis of headache type is imperative to inform management. Introduction. Epub 2019 Oct 14. One frequently referenced models of injury prevention is the van Mechelen model.122 In this model, understanding the overall burden of injury in the population and identifying risk factors inform interventions aimed at injury prevention. | Exercise may facilitate recovery following concussion.40,66,67 Two different paradigms of exercise have demonstrated benefit for symptoms and function: (1) subsymptom aerobic exercise training at 80% of the maximal heart rate that was achieved on the Buffalo Concussion Treadmill Test, 5 days per week67; and (2) exercising at 60% of maximal heart rate (calculated as 220 − age × 60%) for up to 15 minutes, combined with guided imagery and sport-specific coordination exercises.39,40 However, some studies have reported an increase in symptoms with exercise in children and youth, and others have reported no change.77,103 Given the known general positive benefits of exercise, consideration of aerobic exercise training following the initial return to activity after concussion is warranted in the absence of contraindications to exercise.103. Clinicians should use a multifaceted assessment that includes symptoms, a neurological screen, and assessment of multiple clinical domains.27,37 The Sport Concussion Assessment Tool Fifth Edition (SCAT5)29 includes an immediate/on-field assessment that incorporates red flags, observable signs, memory assessment (ie, the Maddocks questions), the Glasgow Coma Scale, and a cervical spine assessment. assessment; clinical care; concussion; prevention; rehabilitation. Understanding the impact that these factors may have on assessment, management, and return to activity/sport helps to ensure a well-balanced and evidence-informed approach to care. Ericsson, K. A. Ericsson, K. A. Previous history of concussion is a risk factor for future concussion.1 The exact mechanism by which this occurs is not yet well understood and may be related to genetics, epigenetics, sensorimotor or neuromuscular control, and other factors. When the 2 injuries occur concurrently, they must be treated appropriately. Treatment of sleep disorders often includes pharmacological and nonpharmacological management.123,124 Education regarding sleep hygiene may improve sleep quality. Consider occupation-specific activities (eg, cognitive and physical demands, safety requirements) in any return-to-work recommendations.15,91 Positive health outcomes have been reported with return to work or staying at work.99 However, reintroduction of risk and timing in the early recovery period must be carefully monitored.91. Clipboard, Search History, and several other advanced features are temporarily unavailable. In part 1 of this commentary, we address etiology, risk factors, and detection of concussion. | 10, No. This article applies the dynamic, recursive model of sport injury to sport-related concussion and summarizes the process of individualized assessment and management following concussion in athletes of all ages, with a focus on physical rehabilitation. The purpose of this clinical commentary was to summarize prevention, detection, assessment, and treatment factors that affect individuals across the continuum of concussion care, using the dynamic, recursive model of sport injury88 framework. J Orthop Sports Phys Ther 2019;49(11):799-810. doi:10.2519/jospt.2019.8926. Injury prediction is one of the most challenging issues in sports and a key component for injury prevention. Other screening tools, such as the Vestibular/Ocular Motor Screening and a combination of optokinetic stimulation, gaze stabilization testing, and near point of convergence, may have clinical utility as screening tools for concussion in the subacute period (2–10 days) following concussion.85,89 The SCAT5 and Vestibular/Ocular Motor Screening tools can be used as part of the clinical assessment but should not replace other aspects of the clinical exam that may be warranted, based on the individual circumstances of the injury.21,29,84. Interventions aimed at primary prevention have shown promise in decreasing the risk of concussion. Get the latest research from NIH: https://www.nih.gov/coronavirus. J Orthop Sports Phys Ther. Each individual who participates in an activity brings a specific set of intrinsic and extrinsic factors (FIGURE 1). In other cases, findings suggest that central vestibular involvement may be present. 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Pediatrics. ELECTRONIC Each individual can present with a unique set of symptoms and aggravating or relieving factors following concussion.84 Individualized assessments are imperative to best understand the etiology of symptoms.37,78,102,106 A multifaceted, interdisciplinary approach to assessment and management is vital. If symptoms recur or are exacerbated, reduce the demands of the task to a level that does not provoke symptoms. In part 1 of this commentary, we address etiology, risk factors, and detection of concussion. Limit naps to less than 1 hour, and prior to mid afternoon. Thus, consideration of sport-specific skills should be an integral part of a rehabilitation program. J Orthop Sports Phys Ther. Evaluating the dynamic model of psychological response to sport injury and rehabilitation @inproceedings{WieseBjornstal2012EvaluatingTD, title={Evaluating the dynamic model of psychological response to sport injury and rehabilitation}, author={D. Wiese-Bjornstal and Courtney B. Albinson and S. Henert and E. Arendt and Susan J. Schwenz and S. S. Myers and Diane M. … a dynamic, recursive model for risk and causes of sports injuries, considering that the injury has a non-linear behavior. Once the individual has completed 1 to 2 days of rest, a gradual return to sport and school/work is recommended. 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When feasible, future studies on sport injury prevention should adopt a methodology and analysis strategy that takes the cyclic nature of changing risk factors into account to create a dynamic, recursive picture of etiology. An integrated model is illustrated which provides a synthesis of existing conceptual models depicting the dynamic process of psychological response to sport injury. Once a concussion is suspected, the player should be removed from play and further assessed by a qualified health care professional (FIGURE 2). It is important for sports professionals to know why certain athletes may be at risk of injury risk factors and how injuries occur (i… Combining specific exercises with manual therapy is effective for treating cervical spine pain.54 After concussion, include neuromotor control, sensorimotor control, manual therapy, and soft tissue techniques, in combination with vestibular rehabilitation.106 A sequential approach to addressing headaches and cervical spine findings (including neuromotor control) as an initial step of rehabilitation is appropriate, given the connections between the upper cervical spine and the vestibular and visual systems. Cognitive symptoms can include difficulties remembering and concentrating, slowed processing, decreased attention, and difficulty with learning.58,86 Cognitive symptoms often resolve over the initial days to weeks following injury. Cognitive behavioral therapy may be beneficial for insomnia.36 Melatonin may have benefits for sleep following concussion, but is not currently recommended for sleep onset or maintenance problems.100 In the presence of ongoing sleep difficulties, refer to a sleep specialist to further investigate potential underlying causes. This site needs JavaScript to work properly. These factors may change over time. If symptoms persist following the initial days to weeks following injury, a multifaceted assessment to identify areas that may require rehabilitation is warranted.37,65,78,103 Refer the patient for additional assessment and rehabilitation if the individual has not recovered in the 10 to 14 days following injury. In addition to a thorough history, targeted assessment tests help clinicians to understand the source of dizziness. A dynamic, recursive model of etiology in sport injury. Dizziness symptoms can be vertigo (ie, sensation of spinning of the environment or the person), light-headedness, presyncope, or a sense of disorientation. Many individuals who have suffered a concussion may report difficulty with reading at school, work, or during screen time (eg, computers, smartphones, tablets). Symptom onset can be delayed, with the duration of the delay predicting a longer time to recovery following injury. Return to participation in sport should occur along a continuum, with respect to the individual's risk of concussion and the characteristics of the environment to which the person is returning. The risk factors of concussion may be categorized as intrinsic (internal factors specific to the individual) or extrinsic (external factors related to the environment or sport). USA.gov. This model considers the implications of repeated exposure, whether such exposure produces adaptation, maladaptation, injury or complete/incomplete recovery from injury. 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National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Extrinsic Risk Factors for Concussion The environment in which an athlete plays includes factors that can influence the risk of concussion, many of which may be modifiable. Sports physiotherapists and other sports professionals recognise that the identification of the causes of injury is an important step in injury prevention as this can lead to the development of effective injury prevention programs. . This model considers the implications of repeated exposure, whether such exposure produces adaptation, maladaptation, injury or complete/incomplete recovery from injury. The office (off-field) assessment portion of the SCAT5 includes history, symptoms, cognitive screening (from the Standardized Assessment of Concussion, which includes orientation, immediate and delayed memory questions, and digits and months of the year in reverse order), a neurological screen (including reading, cervical spine range of motion, ocular motor function, coordination, and balance), and a modified version of the Balance Error Scoring System.29 The Child Sport Concussion Assessment Tool Fifth Edition should be used with children aged 5 to 12 years.21, The clinical utility of the SCAT5 diminishes after the initial 3 to 5 days following injury.84 However, the symptom scale on the SCAT5 can be used to evaluate change in symptoms over time. An integrated model of response to sport injury: Psychological and sociological dynamics. Assessment of the cervical spine should include range of motion, manual spinal exam, general strength, and cervical sensorimotor and neuromotor control.61,118,120 The clinical tests that have established utility in the cervical spine literature, including joint position sense, cervical movement control, the craniocervical flexion test, cervical flexor and extensor endurance, the cervical flexion-rotation test, and manual spinal exam, may be useful in identifying potential areas of dysfunction in concussion.53,55,61,97,106,107,119. Recursive Models of Dynamic Linear Economies Lars Hansen University of Chicago Thomas J. Sargent New York University and Hoover Institution c Lars Peter Hansen and Thomas J. Sargent 6 September 2005. Such a rehabilitation strategy, tailored to the individual, can facilitate high-quality, evidence-informed care and injury prevention. Sport-specific and performance-related skills may be necessary to return to full participation. There may be alterations in gait, reduced gait velocity, and increased sway when dividing attention following concussion.38,59 Further research to better understand changes in the ability to divide attention while accounting for growth and development is warranted. Dupré D., Bland B., Bolster A., Morrison G., McKeown G. (2018) Dynamic Model of Athletes’ Emotions Based on Wearable Devices. Sport-Related Concussion: Optimizing Treatment Through Evidence-Informed Practice. Symptoms are often provoked with rapid head motions, and blurred vision may be reported in association with head movement (suggesting altered vestibulo-ocular reflex dysfunction). Decreasing the risk of concussion, and several other advanced features are temporarily unavailable injury before it occurs ie... Strategies can occur simultaneously.84 each step of the complete set of intrinsic and extrinsic factors that characterize the individual.. Minimum of 24 hours: Review and critique of the stress and prevention... 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