Sports-related concussions are a growing public health concern affecting numerous varsity football student-athletes. This study used the social ecological model to identify intrapersonal, interpersonal, and environmental factors. The purpose of this study is to identify constraints and facilitators in academic and athletic settings for varsity football student-athletes with a sport-related concussion. Twelve current varsity football student-athletes from one institution who suffered a sport-related concussion took part in semi-structured interviews. Data were thematically analyzed. Results indicate that varsity football student-athletes with a sport-related concussion perceived numerous constraining and facilitating social ecological factors in the academic and athletic settings. Intrapersonal constraints revolved around loss of motivation, loss of social identification, stress, anxiety and depression, injury-specific issues (i.e. difficulty thinking clearly, remembering, drowsiness), internal pressure to return, while intrapersonal facilitators included prior experiences of enjoyment in academic and athletic activities, seeing improvements in the recovery process, and not giving up. Interpersonal constraints related to insufficient social support, lack of awareness and guidance on concussion knowledge, external pressure to return, and lack of academic support post-concussion, while interpersonal facilitators included passionate therapy staff, and sport psychologist. Environmental constraints pertained to return-to-play and return-to-learn protocols, while environmental facilitators included having access to concussion-based resources. Findings suggest that there remains a need to address constraining and facilitating factors in the academic and athletic settings for varsity football student-athletes with a sport-related concussion

Hockey is a popular sport, and at its highest levels, it is a complex contact game characterized by physical strength, speed, and skill. The interaction of these characteristics contributes to the inherent risk of injury athletes must face while playing. Among hockey injuries, concussions are one of the most commonly sustained by athletes across all levels of play and age groups. Significant public attention, combined with poorly understood long-term effects, indicates the importance of tangible preventive strategies. The main goal of this thesis was to understand, through video analysis, how playing characteristics and mechanism of injury contribute to concussions in the National Hockey League (NHL). In the first study, the development and validation of an observational recording tool used to code and analyze NHL concussions observed via video analysis was described. The second study attempted to synthesize the description of players’ characteristics, antecedent events, and contextual variables associated with events leading to concussion at the NHL level. Several specific risk factors for concussion in NHL players were identified, including position, body size, specific locations on the ice, and particular situations based on a player's position. The final study systematically analyzed how concussions occur to identify potential pattern(s) of concussions. A common specific injury mechanism characterized by player-to-player contact and resulting in contact to the head by the shoulder, elbow, or gloves, was also identified. When the principal mechanism was refined further, several important characteristics were discernable: (i) contact was often to the lateral aspect of the head; (ii) the player who suffered a concussion was often not in possession of the puck; and (iii) no penalty was called on the play. Collectively, these studies served to address gaps in the literature; the implications for informing prevention and management strategies are also discussed.

Hockey is a popular sport, and at its highest levels, it is a complex contact game characterized by physical strength, speed, and skill. The interaction of these characteristics contributes to the inherent risk of injury athletes must face while playing. Among hockey injuries, concussions are one of the most commonly sustained by athletes across all levels of play and age groups. Significant public attention, combined with poorly understood long-term effects, indicates the importance of tangible preventive strategies. The main goal of this thesis was to understand, through video analysis, how playing characteristics and mechanism of injury contribute to concussions in the National Hockey League (NHL). In the first study, the development and validation of an observational recording tool used to code and analyze NHL concussions observed via video analysis was described. The second study attempted to synthesize the description of players’ characteristics, antecedent events, and contextual variables associated with events leading to concussion at the NHL level. Several specific risk factors for concussion in NHL players were identified, including position, body size, specific locations on the ice, and particular situations based on a player's position. The final study systematically analyzed how concussions occur to identify potential pattern(s) of concussions. A common specific injury mechanism characterized by player-to-player contact and resulting in contact to the head by the shoulder, elbow, or gloves, was also identified. When the principal mechanism was refined further, several important characteristics were discernable: (i) contact was often to the lateral aspect of the head; (ii) the player who suffered a concussion was often not in possession of the puck; and (iii) no penalty was called on the play. Collectively, these studies served to address gaps in the literature; the implications for informing prevention and management strategies are also discussed.

In recent years there has been considerable interest and research examining psychological distress resulting from athletic injuries, as well as coping strategies for an enhanced recovery. The purpose of this study was to examine the psychological effects of sport related concussions and to determine if participation in support groups can reduce these psychological side effects. Participants included concussed male and female varsity or comparable elite level athletes who were placed in either a control or an experimental group. All subjects completed the Profile of Mood States and the Post Concussion Rating Scale. Participants in the experimental group received three support group intervention sessions, while those in the control group received no intervention. Data was analyzed using descriptive statistics. It was revealed that participants in the experimental group improved their mood state. In addition to the impact of support groups on concussed athletes, factors influencing their moods were also identified including the concussion history of the athletes, the stage of rehabilitation, gender, and number of concussion symptoms.

Introduction-Physical activity can reduce the risk of contracting many of the 'diseases of the sedentary', such as coronary heart disease and cancer (Blair et al., 1996). Recognition of this protective effect has led to the development of many programmes designed to promote the benefit of participation in sport and physical exercise (Hillary Commission, 1993; Nicholl et aI., 1995). With participation in sport, especially contact sport, the risk for injuries increases, including injuries to the head and neck (Wilberger, 1993; Wekesa et al., 1996; Pettersen, 2002). Mild traumatic brain injuries (MTBI) or concussion as used interchangeably in the literature (Maroon et al., 2000; Wills & Leathem, 2001) are an important public health concern, due to the high incidence and frequently persisting symptomatology (Evans, 1992). Mild traumatic brain injury is defined as a complex patho-physiological process affecting the brain induced by traumatic biomechanical forces (Aubry et al., 2002; McCrory et al., 2004). A sub-concussive injury or very mild traumatic brain injury (vMTBI) may be defined as an apparent brain insult with insufficient force to cause hallmark symptoms of concussion (Jordan, 2000; Webbe & Bath, 2003). The high incidence of sport related head injuries in South Africa is alarming, although the prevalence thereof is unknown and difficult to assess, as the seemingly trivial injuries frequently remain unreported (Roux et al., 1987). This is especially applicable in sport where a milder form of head injury is common. This is cause for concern as cumulative head injuries traditionally regarded as trivial or 'minor' may result in players running the risk of increasingly negative consequences following repetitive 'minor' head injuries. In contact sport such as rugby, players are at great risk of sustaining repetitive mild traumatic brain injuries. The negative outcome following these repetitive minor head injuries has been demonstrated by numerous studies on boxers and other athletes exposed to repeated MTBI and vMTBI (McLatchie et aI., 1987). The incidence of vMTBI has not yet been researched in school rugby and this study is the first to report the incidence of vMTBI in a secondary school rugby team. Obiectives - The objectives of this study were to determine the incidence, the neuropsychological consequences and the effect on the academic performance of repeated mild (MTBI) and very mild traumatic brain injuries (vMTBI) in a secondary school rugby team during one playing season. Methods - A cohort of 35 secondary school male rugby players divided into a vMTBI (group 1) (n=26) and a MTBI (group 2) (n=9) from a local secondary school's first and second team, was followed for a full competitive season by a trained Biokineticist, who was present at all the games and contact sessions played. All vMTBI and MTBI and the severity of these injuries were documented. A control (group 3) that consisted of 10 secondary school non-rugby players were compared with the vMTBI and MTBI groups. The incidence of repeated MTBI and vMTBI in a secondary school rugby team were gathered by questionnaires and observation next to the field by a trained Biokineticist. Pre-season and post-season neuropsychological tests were conducted on the research groups and the control group. The neuropsychological tests that were conducted on the three groups were the Colour Trial Test 1 and 2 (CTT 1 + 2), the Symbol Digit Modalities Test (SDMT), the Wechsler Memory Scale-Revised (WMS-R) and the Standardised Assessment of Concussion (SAC). After each match played throughout the season the research group also completed a SAC test. The academic results of the final examination (year 1) of the year of the specific rugby season were obtained, as well as the academic results of the final examination of the preceding two years (year 2 and 3). The programme STATISTICA (version 7.0, Stat soft, Tulsa, OK) was used to analyse the data. Descriptive statistics, one-way ANOVA's, two-way repeated measures ANOVA's, Post-hoc Tuckey HSD analysis and Pearson's product moment correlation were used for all the statistical analyses. Results - This study of a secondary school rugby team has shown 726 vMTBI's and 18 MTBI's throughout one rugby season. This relates to 1951 vMTBI's per 1000 player hours and 48 MTBI's per 1000 player hours. Reductions in delayed memory (p=O.O1)from preseason to post-season in a group of players with repetitive vMTBI's during a single rugby season were found. This was the first evidence of possible neurocognitive deficits towards delayed memory in very mild traumatic brain injuries at secondary school level. Statistically significant (p<=0.05)results of the SAC test totals between both the vMTBI and MTBI groups were documented in the different games throughout the rugby season and compared with the baseline test. No statistically significant differences (p<=0.05) between the pre-season and post-season's scores of the SAC test totals were documented. A decrease in academic performance in the subject Afrikaans (year 1 compared with year 2) with a p-value of p=O.O17(group 1) and p=O.O16(group 2) respectively was found. Conclusion - The findings of this study indicate a high incidence of vMTBI in a cohort of secondary school rugby players in one season, a statistically significant reduction (p=O.O1 )in delayed memory of the vMTBI rugby players and a statistically significant decrease in academic performance p=O.O17 (group 1) and p=O.O16 (group 2) in the subject Afrikaans from year 1 to year 2 final examinations. / Thesis (Ph.D. (Human Movement Science))--North-West University, Potchefstroom Campus, 2006.

Background: There is currently no standard method of diagnosing the presence or severity of concussion in acute primary care settings. This pilot project is part of a larger study to develop a Computerized Concussion Assessment Tool (CCAT). Methods: A prospective observational clinical study was conducted to explore the validity of the CCAT among patients presenting to the Emergency Department at Kingston General Hospital and at Hotel Dieu Hospital (Kingston, Ontario) with minor head injury. Twenty-two patients with concussion and eighteen patients with head injury (but not diagnosed with concussion) were recruited to the study. All participants completed a background questionnaire, several neurocognitive tests and the CCAT assessment. Performance on the CCAT was compared between these two groups. Data collected during the development phase of the CCAT from a Normal Volunteers group (n=68) were used in an additional comparison. CCAT Scores for Selective Attention, Divided Attention and Memory were compared with standard neurocognitive tests through correlational analyses. In addition, the validity and clinical yield of the CCAT were investigated relative to gold standard measures. Results: After adjustment for covariates, no statistically significant differences were found between the three participant groups for any of the three primary CCAT Scores (Selective Attention, Divided Attention and Memory). Correlational analyses showed that the CCAT Selective Attention Score and the CCAT Memory Score are moderately correlated with standard neurocognitive tests. There was no correlation observed for the CCAT Divided Attention Score and its associated neurocognitive test. Conclusion: The CCAT was unable to discriminate between concussed patients and non-concussed individuals. However, moderate correlations observed between the CCAT Scores for Memory and Selective Attention and their respective neurocognitive tests support a view that there should be optimism for the future development of the CCAT. Issues related to the feasibility of the study and its administration in the emergency department setting are discussed. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2008-09-23 10:40:20.199

No description available.

No description available.

Mild head injury or concussion accounts for as many as 90% of all traumatic brain injuries and can sometime result in long-lasting and disabling post-concussion symptoms (PCS), even in the absence of detectable structural damage to the brain by morphological imaging. To date, the nature of persistent PCS following mild head injury remains poorly understood as objective and scientifically valid diagnostic tools are practically absent. This, in turn, likely accounts for missed diagnoses, prevents accurate assessment of the severity of the injury and creates difficulties for achieving proper patient management. / This dissertation describes 4 functional magnetic resonance imaging (fMRI) studies designed to establish whether there is a pathological basis to persistent PCS following cerebral concussion in male athletes. Study 1 was intended to evaluate the feasibility of using fMRI to detect changes in brain activation following concussion. The results showed that concussed athletes displayed reduced prefrontal activities compared to a healthy control group when performing a working memory task. In Study 2, we examined the relationship between self-reported PCS and the pattern of brain activity measured by fMRI. The severity of self-reported PCS was found to be associated with blood oxygen level dependent (BOLD) activation patterns in the region of interest: the higher the PCS score the lower the BOLD signal. In Study 3, we used serial fMRI approach to investigate brain activation pattern in the course of injury recovery. The results showed that symptom resolution was accompanied by a return to normal BOLD response patterns. Study 4 was designed to investigate the nature of depression, a common PCS, following concussion. Concussed athletes with depression showed less activation in the dorsolateral prefrontal cortex, and attenuated deactivation in the medial prefrontal region, consistent with functional neuroimaging findings in major depression. Again, depression severity correlated with the strength of the fMRI signal in the region of interests. / Taken together, these results demonstrate the value of functional MRI in the evaluation of cerebral concussion, and provide evidence of an underlying pathology in persistent PCS following concussion.

L’âge, le génotype et les traumatismes crâniens (TCC) sont trois facteurs de risque majeurs du développement de la maladie d’Alzheimer (MA). Avec une accumulation d’évidences démontrant la persistance d’anomalies cérébrales suite aux plus légers des TCC, qui affichent d’ailleurs la plus haute incidence, il devient impératif de tester l’hypothèse selon laquelle même les commotions cérébrales puissent interagir avec l’âge et les gènes afin de précipiter la neurodégénération. Trente ex-athlètes de haut niveau (âge M = 60 ans), dont la moitié a subi des commotions cérébrales il y a plus de 30 ans, ont été évalués en neuropsychologie, en neuroimagerie multimodale ainsi qu’en génétique. De nombreuses mesures neuroanatomiques, dont l’expansion du volume des ventricules latéraux, se trouvent à corréler avec divers déficits cognitifs (mémoire différée et de reconnaissance) détectés chez les participants commotionnés. D’un intérêt particulier, certains de ces résultats sont modulés par le polymorphisme nucléotidique simple du gène Apolipoprotéine E. Ces résultats appuient l’hypothèse selon laquelle la commotion cérébrale chez de jeunes athlètes serait un facteur de risque de neurodégénération dans le vieillissement normal. / Age, genotype and traumatic brain injury (TBI) are three of the most important risk factors of Alzheimer’s Disease. With a growing body of evidence showing the persistent deleterious effects of the mildest form of TBI, it becomes imperative to test the hypothesis that sports concussion could interact with aging to precipitate neurodegeneration. Thirty former high-level athletes (mean age = 60 yrs), half of them having sustained sports concussion during their young adulthood, underwent neuropsychological, neuroanatomical and APOE genotype examination. Data analysis revealed numerous neurobiological anomalies, such as ventricular enlargement, correlating with cognitive deficits (delayed and recognition memory) in concussed participants. Of particular interest, some neuroanatomical measures were found to be modulated by APOE single-nucleotide polymorphisms. These findings support the idea that sports concussions sustained in early adulthood are a risk factor of neurodegeneration in late adulthood.