A Test Panel to Assess and Document an Absence of Concussive Signs for Sports Related Concussion
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Abstract
As sports-related concussions gain notoriety, legislation has also increased, placing greater liability on athletic trainers, who are typically the first to assess mild traumatic brain injury (mTBI). This has led to an increase in assessments for documenting an absence of or evidence of an mTBI. Although, their validation
and standardization have been called into scrutiny.
The purpose of this report is to develop and validate a neurologic test that provides objective evidence useful for documenting an absence of suspicious injury. In this retrospective cohort study, 26 athletes from the University of Cincinnati who incurred a suspicious concussive impact were evaluated using this assessment battery.
Of the 26 athletes, 7 were found to have a suspicious injury and referred to a specialist for further work-up. All 7 were eventually diagnosed with a concussion. Nineteen were found to have an absence of suspicious injury, none of which developed delayed concussive symptoms.
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References
1. Harmon KG, Clugston JG, Roberts WO, et al. American Medical Society for Sports Medicine Position Statement on Concussion in Sport. Clin J Sport Med 2019;29(2):87–100.
2. McCrory P, Reddermann-Demont N, Tarnutzer AA, et al. What is the definition of sports-related concussion: a systematic review. Br J Sports Med 2017;51(11): 877–87.
3. McCrory P, Meeuwisse W, Vox PE, et al. Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017;51(11):838–47.
4. Bramley H, Hong J, Silvis M, et al. Mild traumatic brain injury and post-concussive syndrome: treatment and related sequela for persistent symptomatic disease. Sports Med Arthrosc Rev 2016;24(3):123–9.
5. Centers for Disease Control and Prevention. Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. Atlanta, GA; 2015.
6. McKee AC, Stein TC, Alvarez VE, et al. The neuropathology of chronic traumatic encephalopathy. Brain Pathol 2015;25(3):350–64.
7. Vanltallie TB. Traumatic brain injury (TBI) in collision sports: Possible mechanisms of transformation into chronic traumatic encephalopathy (CTE). Metabolism. 2019;100S:153943.
8. Mahar I, Alosco ML, McKee AC. Psychiatric phenotypes in chronic traumatic encephalopathy. Neurosci Biobehac Rev 2017;(83):622–30.
9. Dart T. Future of NFL at risk from lawsuits over head injuries. The Times. October 22, 2012. Available at http:// www.thetimes.co.uk/tto/sport/us-sport/article3575212. ece. Accessed January 11, 2020.
10. Kaplan E. NHL reaches settlement in concussion lawsuit. ESPN. November 12, 2018. Available at https://www. espn.com/nhl/story/_/id/25256208/nhl-reaches-settle-ment-concussion-lawsuit. Accessed January 11, 2020.
11. Russo R. Wave of concussion lawsuits to test NCAA’s liability. AP News. February 7, 2019. Available at https:// apnews.com/4a4ed68e4c3a426abc4e34606ae4a399. Accessed January 11, 2020.
12. Albano AW Jr, Senter C, Asif IM, et al. The Legal Land-cape of Concussion: Implications for Sports Medicine Providers. Sports Health 2016 Sep; 8(5):465–68.
13. Gibson TB, Herring SA, Broglio SP, et al. Analyzing the effect of state legislation on health care utilization for children with concussion. JAMA Pediatr 2015;169(2):163–8.
14. Casson I. Legal and ethical implications in the evaluation and management of sports-related concussion. Neurology. 2015;84(8):861.
15. Broglio S, Guskiewicz K, Norwig J. If you’re not measuring, you’re guessing: the advent of objective concussion assessments. J Athl Train 2017;52(3):160–6.
16. Scheiman M, Gallaway M, Mitchell GL, et al. Nearpoint of convergence: test procedure, target selection, and normative data. Optom Vis Sci 2003;83(3):214–25.
17. Clark JF, Mangine R, Divine J, et al. Vision training methods for sports concussion mitigation and management. J Visual Exper 2015;(99):e52648.
18. Clark J, Graman P, Ellis J, et al. An exploratory study of the potential effects of vision training on concussion incidence in football. Optom Vis Perf 2015;3(2):116–25.
19. Schwab S, Memmert D. The impact of a sports vision training program in youth field hockey players. J Sports Sci Med 2012;11:624–31.
20. Rucker JC, Tomsak RL. Binocular diplopia. A practical approach. Neurologist 2005;11(2):98–110.
21. Khasnis A, Gokula R M. Romberg’s test. J Postgrad Med 2003;49:169.
22. Hernandes Rocha TA, Elahi C, Vissoci JR, et al. A traumatic brain injury prognostic model to support in-hospital triage in a low-income country: a machine learning-based approach. J Neurosurg 2019:1–9.
23. Farnsworth JL 2nd, Dargo L, Kang M, et al. Reliability of computerized neurocognitive tests for concussion assessment: a meta-analysis. J Athl Train 2017;52(9):826–33.
24. Register-Mihalik JK, Sarmiento K, GuskiewiczKM, et al. Considerations for Athletic Trainers: A Review of Guidance on Mild Traumatic Brain Injury Among Children from the Centers for Disease Control and Prevention and the National Athletic Trainers’ Association. 2019;54(1):12–20.
25. Silverberg ND, Iaccarino MA, Panenka WJ, et al. Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Arch Phys Med Rehabil 2019;S0003–9993(19)31305-X.
26. Kutcher JS, Giza CC. Sports concussion diagnosis and management. Continuum (Minneap Minn) 2014;(6 Sports Neurology):1552–69
27. Putukian M. Clinical Evaluation of the Concussed athlete: a view from the sideline. J Athl Train 2017;52(3):236–44. 28. Agrawal Y, Carey J, Schubert M, et al. The modified Romberg balance test: normative data in US adults.
Otol Neurotol 2011;32(8):1309–11.
29. Bates WH. Better Eye Sight Without Glasses. Hind Pocket Books; 2003.
2. McCrory P, Reddermann-Demont N, Tarnutzer AA, et al. What is the definition of sports-related concussion: a systematic review. Br J Sports Med 2017;51(11): 877–87.
3. McCrory P, Meeuwisse W, Vox PE, et al. Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017;51(11):838–47.
4. Bramley H, Hong J, Silvis M, et al. Mild traumatic brain injury and post-concussive syndrome: treatment and related sequela for persistent symptomatic disease. Sports Med Arthrosc Rev 2016;24(3):123–9.
5. Centers for Disease Control and Prevention. Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. Atlanta, GA; 2015.
6. McKee AC, Stein TC, Alvarez VE, et al. The neuropathology of chronic traumatic encephalopathy. Brain Pathol 2015;25(3):350–64.
7. Vanltallie TB. Traumatic brain injury (TBI) in collision sports: Possible mechanisms of transformation into chronic traumatic encephalopathy (CTE). Metabolism. 2019;100S:153943.
8. Mahar I, Alosco ML, McKee AC. Psychiatric phenotypes in chronic traumatic encephalopathy. Neurosci Biobehac Rev 2017;(83):622–30.
9. Dart T. Future of NFL at risk from lawsuits over head injuries. The Times. October 22, 2012. Available at http:// www.thetimes.co.uk/tto/sport/us-sport/article3575212. ece. Accessed January 11, 2020.
10. Kaplan E. NHL reaches settlement in concussion lawsuit. ESPN. November 12, 2018. Available at https://www. espn.com/nhl/story/_/id/25256208/nhl-reaches-settle-ment-concussion-lawsuit. Accessed January 11, 2020.
11. Russo R. Wave of concussion lawsuits to test NCAA’s liability. AP News. February 7, 2019. Available at https:// apnews.com/4a4ed68e4c3a426abc4e34606ae4a399. Accessed January 11, 2020.
12. Albano AW Jr, Senter C, Asif IM, et al. The Legal Land-cape of Concussion: Implications for Sports Medicine Providers. Sports Health 2016 Sep; 8(5):465–68.
13. Gibson TB, Herring SA, Broglio SP, et al. Analyzing the effect of state legislation on health care utilization for children with concussion. JAMA Pediatr 2015;169(2):163–8.
14. Casson I. Legal and ethical implications in the evaluation and management of sports-related concussion. Neurology. 2015;84(8):861.
15. Broglio S, Guskiewicz K, Norwig J. If you’re not measuring, you’re guessing: the advent of objective concussion assessments. J Athl Train 2017;52(3):160–6.
16. Scheiman M, Gallaway M, Mitchell GL, et al. Nearpoint of convergence: test procedure, target selection, and normative data. Optom Vis Sci 2003;83(3):214–25.
17. Clark JF, Mangine R, Divine J, et al. Vision training methods for sports concussion mitigation and management. J Visual Exper 2015;(99):e52648.
18. Clark J, Graman P, Ellis J, et al. An exploratory study of the potential effects of vision training on concussion incidence in football. Optom Vis Perf 2015;3(2):116–25.
19. Schwab S, Memmert D. The impact of a sports vision training program in youth field hockey players. J Sports Sci Med 2012;11:624–31.
20. Rucker JC, Tomsak RL. Binocular diplopia. A practical approach. Neurologist 2005;11(2):98–110.
21. Khasnis A, Gokula R M. Romberg’s test. J Postgrad Med 2003;49:169.
22. Hernandes Rocha TA, Elahi C, Vissoci JR, et al. A traumatic brain injury prognostic model to support in-hospital triage in a low-income country: a machine learning-based approach. J Neurosurg 2019:1–9.
23. Farnsworth JL 2nd, Dargo L, Kang M, et al. Reliability of computerized neurocognitive tests for concussion assessment: a meta-analysis. J Athl Train 2017;52(9):826–33.
24. Register-Mihalik JK, Sarmiento K, GuskiewiczKM, et al. Considerations for Athletic Trainers: A Review of Guidance on Mild Traumatic Brain Injury Among Children from the Centers for Disease Control and Prevention and the National Athletic Trainers’ Association. 2019;54(1):12–20.
25. Silverberg ND, Iaccarino MA, Panenka WJ, et al. Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Arch Phys Med Rehabil 2019;S0003–9993(19)31305-X.
26. Kutcher JS, Giza CC. Sports concussion diagnosis and management. Continuum (Minneap Minn) 2014;(6 Sports Neurology):1552–69
27. Putukian M. Clinical Evaluation of the Concussed athlete: a view from the sideline. J Athl Train 2017;52(3):236–44. 28. Agrawal Y, Carey J, Schubert M, et al. The modified Romberg balance test: normative data in US adults.
Otol Neurotol 2011;32(8):1309–11.
29. Bates WH. Better Eye Sight Without Glasses. Hind Pocket Books; 2003.