No description available.

Traumatic brain injury (TBI) is the most common injury in childhood, and it is the leading cause of disability. Early childhood is an area of specific interest because it is a period of rather significant vulnerability to longer-standing problems. Better health and behavior-related outcomes generally improve when diagnosis occurs early enough to inform evidence-based interventions adequately. However, there continues to be relatively weak identification of concussions in early childhood, and misdiagnoses often lead children to receive the incorrect intervention if they receive intervention at all. Clinicians need to identify symptoms of a concussion immediately following injury. To this end, the present study examines the literature to determine domains, and any narrow abilities impacted following a concussion. Assessments items were generated based on a review of published norm references tests and task demands analyses (n = 18). Testing items were cross-referenced using developmental literature to ensure they were appropriate for assessment for children age 3 years. Via the Delphi survey method, a heterogeneous panel of experts (Round 1 n = 17; Round 2 n = 13), including physicians, psychologists, school nurses, speech and language pathologists, and athletic trainers, offered their opinion regarding what areas are impacted following a concussion. The panel provided clarification on the operational definitions and agreed that the testing items, indeed, were developmentally appropriate. The group also decided that a paraprofessional could administer the items with minimal training, which is an essential consideration because children in early childhood are often cared for by professionals untrained in assessment, working in daycare or preschool settings. The present study concludes that, indeed, an evaluation of concussions symptoms that are like traditional sideline assessments is possible. However, the results of this assessment are only preliminary, and there was no evidence for validity based on response processes or relations to other variables; likewise, reliability data are unavailable at this time. Recommendations for future research are included, and ideas to move toward standardization are presented. Recommendations for the training of paraprofessionals in these assessment procedures, too, are outlined. / School Psychology

Concussion affects the adolescent population in large numbers, primarily because of the popularity of team sports that are played in middle and high school. This adolescent age group is more susceptible to the adverse effects of concussion due to physiological immaturity, and recovery for this population takes longer than in adults. Speech-language pathologists, who are trained to treat cognitive-communication deficits, are present in the majority of school systems throughout the United States, and could be a useful resource to manage and treat students who incur concussion. However, speech-language pathologists historically have not treated students with concussion, and may not be receiving adequate education regarding concussion in graduate programs. This study sought to ascertain the education, training, and experience regarding concussion of speech-language pathologists in Texas secondary schools. Anonymous survey responses were collected via an Internet survey platform, yielding 49 respondents for the final data pool. The answers provided by these respondents indicate Texas speech-language pathologists are not yet receiving adequate concussion education and training. Respondents reported low confidence levels in several key areas of concussion knowledge, and doubt regarding the speech-language pathologist's role in managing concussion. Recommendations include concussion-targeted graduate school curriculum as an extension of traumatic brain injury curriculum, increased continuing education efforts by ASHA regarding concussion and the speech-language pathologist's role in treating concussion, and further advocacy by ASHA for speech-language pathologists to be part of concussion management teams based in schools. / text

Objectives: After mild traumatic brain injury (mTBI), psychological factors can contribute to persisting post-concussion symptoms (PCS). Consistent with constructive theories of memory, negative expectations for increased symptoms after mTBI may contribute to misattributing symptoms to the mTBI and underestimating pre-injury symptoms, called the “good old days’ bias” (Gunstad & Suhr, 2001). The good old days’ bias is not thought to be a general retrospective recall bias but studies to date have largely not controlled for normative memory processes including those that lead to a biased, more positive recall of the past. Therefore, the current study examines whether there is a good old days’ bias after mTBI above and beyond normal memory biases. This study also examines how soon after mTBI the good old days’ bias affects recall of pre-injury symptoms in the first month after mTBI in adolescents as well as whether the good old days’ bias causes pre-injury symptom severity to be underestimated or if symptoms are entirely forgotten. Finally, the clinical significance of symptom recall biases is investigated. Method: The sample is 42 adolescents who sustained an mTBI (ages 13-18 years; 24 males) and 42 uninjured adolescents (ages 13-18 years; 24 males, ). The mTBI group rated current and retrospective post-concussion symptom ratings within one week and again, at one month, post-injury. The control group rated current and retrospective post-concussion symptoms at baseline and one month later. Cross-sectional and longitudinal comparisons using non-parametric statistical tests were used. Results: Wilcoxon signed-rank tests showed that, by one month post-mTBI, adolescents report fewer total, physical, and emotional pre-injury symptoms than they had reported within one week of their concussion. The control group did not demonstrate this good old days’ bias. There were no between-group differences in retrospective PCS ratings at either time point. Chi-square analyses found that the mTBI group was as likely as the control group to recall “no” pre-injury/past symptoms one month post-injury after having initially reported some pre-injury symptoms. Only four more adolescents were classified as “recovered” if their one-month PCS ratings were compared with pre-injury PCS ratings made within 1-week post-concussion rather than pre-injury ratings from 1-month post-injury. Discussion: There was mixed evidence for a good old days’ bias by one month post-concussion. This bias was not demonstrated in healthy adolescents, suggesting that the good old days’ bias is found specifically after concussion. During the acute post-injury period, the good old days’ bias may only be apparent by studying changes in concussed individuals’ own PCS ratings. The good old days’ bias leads to underestimating the severity of pre-injury symptoms rather than forgetting them entirely. The good old days’ bias does not greatly affect symptom recovery tracking by one month post-concussion. Future studies should directly examine expectations about concussion and their effect on current and retrospective symptom reporting. / Graduate / 2019-07-10

Introduction and Rationale: Concussions account for the majority of traumatic brain injuries in children. Currently there more than 500,000 pediatric concussions per year and that number is likely low due to under-reporting (Rose, Weber, Collen,& Heyer, 2015). Most symptoms of concussion are easily recognized to the trained pediatric primary care provider. Yet, symptom management and recommendations for rest, exercise, specialty care referral, and return to normal activities can be challenging for many providers, due to the lack of evidence and lack of formal recommendations by any organization (Rose et al., 2015; Silverberg & Iverson, 2013). Purpose and Objective: The main purpose of this Doctor of Nursing Practice (DNP) project is to develop evidence-based clinical practice guidelines (CPG) for pediatric primary care providers. The objective is to provide a CPG that offers clinical guidance when managing pediatric concussion patients in the primary care setting. This CPG will also provide clarity for pediatric primary care providers (PCP) when determining what options are available in treatment for pediatric concussions. Methods: The working framework of this project was The Appraisal of Guidelines for Research & Evaluation II (AGREE II). The American Academy of Pediatrics (AAP) procedure for reporting clinical guidelines, in the form of key action statements, was used as the model for development of the CPG. Results: The CPG was appraised using the AGREE II instrument, which provides valid and reliable scores and data used in the evaluation of CPG's. Six domains were evaluated, and the CPG yielded scores above 80% for all categories. The overall standard deviation was 0, which indicts a very low level of discrepancy between users of the instrument. Conclusion: This DNP project addresses an evidence and primary care practice gap. With a large number of pediatric concussions, a consistent management approach will ensure a safe and therapeutic recovery. A CPG was developed and evaluated using the AGREE II instrument. The CPG was found to meet the standards for general recommended use in pediatric primary care.

Ice hockey helmets effectively mitigate the risk of skull fractures and focal traumatic brain injuries in professional ice hockey (PIH), but do not manage diffuse brain injuries such as concussion. This is due to current standard tests, which only represent one head impact event (a fall to the ice) and do not measure rotational head kinematics. It is important that helmets are evaluated using impact conditions that represent how players sustain concussions in ice hockey. The objective of this study was to describe the relationship between three ice hockey helmet tests and reconstructions of three concussive injury events in PIH. A flat anvil drop test (representing head-to-ice impacts), angled anvil drop test (representing head-to-boards impacts at 30o and 45o) and pneumatic ram test (representing medium and high compliance shoulder-to-head impacts) were performed using parameters reflecting concussive injuries in PIH. Stepwise regressions identified the dynamic response variables producing the strongest relationships with MPS. For the flat anvil drop test, dominant linear acceleration had the strongest relationship with MPS (R2 = 0.960), while there were no significant predictors of MPS from the PIH head-to-ice reconstructions. Rotational velocity had the strongest relationship for the 30o (R2 = 0.978) and 45o Anvil Drop Tests (R2 = 0.977), while rotational acceleration had the strongest relationship for the PIH head-to-boards reconstructions (R2 = 0.649). Resultant rotational acceleration had the strongest relationship for the medium compliance ram test (R2 = 0.671), the high compliance ram test (R2 = 0.850) and the PIH shoulder-to-head reconstructions (R2 = 0.763). The flat anvil drop test results indicate that falls on a flat, rigid surface induce primarily linear acceleration of the head. Standards should continue using this type of test to ensure helmets prevent skull fracture and focal TBI. Ice hockey helmets should also be evaluated using an angled anvil drop test and a collision ram test, representing two unique head impact events known to cause concussive injuries. The 45o Anvil Drop Test provided a closer representation of concussive head-to-boards impacts in PIH, with rotational velocity producing the strongest relationship with MPS. For collision impacts, the Medium Compliance Ram Test yielded repeatable impact conditions while the High Compliance Ram Test provided a closer representation of real-world concussive shoulder-to-head impacts. For these pneumatic ram tests, rotational acceleration produced the strongest relationship with MPS. The information in this thesis may be used by standards organizations when designing future ice hockey helmet tests.

The varied impact parameters that characterize an impact to the head have shown to influence the resulting type and severity of outcome injury, both in terms of the dynamic response, and the corresponding deformation of neural tissue. Therefore, when determining head injury risks through event reconstruction, it is important to understand how individual impact characteristics influence these responses. The effect of inbound mass had not yet been documented in the literature. The purpose of this study was to determine the effects of inbound mass on the dynamic impact response and brain tissue deformation. A 50th percentile Hybrid III adult male head form was impacted using a simple pendulum system. Impacts to a centric and a non-centric impact location were performed with six varied inbound masses at a velocity of 4.0 m/s. The peak linear and peak angular accelerations were measured. A finite element model, (UCDBTM) was used to determine brain deformation, namely peak maximum principal strain and peak von Mises stress. Inbound mass produced significant differences for peak linear acceleration for centric (F(5, 24) = 217.55, p=.0005) and non-centric (F(5, 24) = 161.98, p=.0005), and for peak angular acceleration for centric (F(5, 24) = 52.51, p=.0005) and non-centric (F(5, 24) = 4.18, p=.007) impact locations. A change in inbound mass also had a significant effect on peak maximum principal strain for centric (F(5, 24) = 11.04, p=.0005) and non-centric (F(5, 24) = 5.87, p =.001), and for peak von Mises stress for centric (F(5, 24) = 24.01, p=.0005) and non-centric (F(5, 24) = 4.62, p=.004) impact locations. These results indicate the inbound mass of an impact should be of consideration when determining risks and prevention to head and brain injury.

Recently, researchers have found evidence that after a concussion, residual visuomotor control deficits may linger longer than working memory or psychomotor speed deficits. All of the major computer administered test batteries currently in use for concussion management rely on examination of the latter tasks, and lack any measure of visuomotor control. The present research set out to develop a task to measure visuomotor performance. Using a touch-screen computer, the task required participants to point towards or away from (i.e., antipointing) a target in a design simmilar to an anti-saccade task. The task required participants to use visual information to execute controlled movements, and is designed to measure movement planning, execution performance and accuracy. The task was delivered to a large sample of healthy individuals to develop a normative performance data set. A self-report questionnaire was used to identify a small group of individuals from the normative population who were identified with a prior history of concussion. These individuals were directly contrasted with the healthy individuals. While only a few reported moderate or severe concussions, and information about recency and number of occurrences was unavailable, performance differences were observed --providing evidence of residual deficits. In particular, while concussed individuals were not slower, or less accurate overall than the healthy population on the task, they demonstrated unusual hand and spatial asymmetries. Future research will compare recently concussed individuals with the normative set developed here, and will make direct comparisons with existing computer administered test batteries to determine the efficacy of visuomotor tasks for detecting the long-term effects of concussion.

Recently, researchers have found evidence that after a concussion, residual visuomotor control deficits may linger longer than working memory or psychomotor speed deficits. All of the major computer administered test batteries currently in use for concussion management rely on examination of the latter tasks, and lack any measure of visuomotor control. The present research set out to develop a task to measure visuomotor performance. Using a touch-screen computer, the task required participants to point towards or away from (i.e., antipointing) a target in a design simmilar to an anti-saccade task. The task required participants to use visual information to execute controlled movements, and is designed to measure movement planning, execution performance and accuracy. The task was delivered to a large sample of healthy individuals to develop a normative performance data set. A self-report questionnaire was used to identify a small group of individuals from the normative population who were identified with a prior history of concussion. These individuals were directly contrasted with the healthy individuals. While only a few reported moderate or severe concussions, and information about recency and number of occurrences was unavailable, performance differences were observed --providing evidence of residual deficits. In particular, while concussed individuals were not slower, or less accurate overall than the healthy population on the task, they demonstrated unusual hand and spatial asymmetries. Future research will compare recently concussed individuals with the normative set developed here, and will make direct comparisons with existing computer administered test batteries to determine the efficacy of visuomotor tasks for detecting the long-term effects of concussion.

Two anthropometric measurements were evaluated as possible risk factors for concussions among university contact-sport athletes: head and neck circumference ratio (HNCR) and body mass index (BMI). Athletes (N=575) competing in intercollegiate football, hockey, and soccer were followed prospectively for concussions over a 4-year period. A total of 86 concussions occurred, with a higher incidence among the female athletes. For HNCR, there was no consistent association observed with the exception of female hockey players. For BMI, there was no consistent association observed with the exception of male soccer players. Linear regression analysis revealed a statistically significant inverse association between HNCR and BMI among concussed athletes for both genders (p<0.001). In conclusion, the novel HNCR was found to be a valid and reliable measurement ratio that may have potential clinical applications in predicting the risk of sustaining a concussion among contact-sport athletes.