Yes / Sport-related concussion (SRC) and physical pain are both associated with poor mental health, impaired cognition, and reduced quality of life. Despite SRC and physical pain often co-occurring, there is little research that investigates these two factors together, and therefore it is difficult to conclude which of these contributes to the negative outcomes asso ciated with them. Therefore, the present study aimed to investigate the effect of SRC and physical pain on mental health, cognitive ability, and quality of life. Depression was measured using the Center for Epidemiological Studies Depression Scale, anxiety was assessed using the State-Trait Anxiety Inventory while the SF-12 recorded health-related quality of life. A trail making task (TMT) assessed cognitive flexibility of participants. Analysis of 83 participants (43 concussed) revealed that SRC led to reduced accuracy on TMT(A) and (B), whereas physical pain was responsible for poorer mental health and reduced quality of life. This study highlights the influence that SRC has on cognitive ability and the impact that physical pain has on mental health and quality of life. With this information, we are better placed to predict the negative consequences of SRC and physical pain and therefore tailor support accordingly.

Objective: To determine the extent to which aspects of the Sport Concussion Assessment Tool 3 (SCAT3) or Child SCAT3 (C-SCAT3), and the King-Devick Test (KDT) predict Three-Dimensional Multiple Object Tracking (3D-MOT) speed. Participants: A sample of 304 healthy, non-concussed participants with a sporting history (101 females, 203 males) ranging in age from 7-29 years (mean age = 16.05 +/- 4.36) were included in the analysis. Methods: Participants completed the SCAT3, KDT and 3D-MOT in a single visit. Data Analysis: A regression analysis was performed to determine the extent to which aspects of the SCAT3 (immediate memory (IM), coordination (COOR), delayed recall (DR)), and the KDT predicted 3D-MOT speed. Results: Using the stepwise method, it was found that KDT, DR and COOR explain a significant amount of the variance in the speed of the 3D-MOT (F(3, 256)) = 11.82, p < .000 with an R2 = .12. The analysis shows that KDT (Beta = -0.01, p < .000), DR (Beta = 0.07, p < .02), and COOR (Beta = .23, p < .03), were significant predictors of 3D-MOT speed. Conclusions: This study suggests that the KDT, DR, and COOR significantly account for 12% of the 3D-MOT scores, however, there is a large portion of variability unaccounted for by the SCAT3 or C-SCAT3 and KDT. This shows that 3D-MOT likely accounts for central cognitive functions above and beyond the SCAT3 or C-SCAT3 and KDT. Future studies should examine this relationship at baseline, post-injury, and through concussion recovery. This could provide valuable information to better inform clinicians responsible for making return to play determinations. Keywords: Concussion, Mild Traumatic Brain Injury, 3D-MOT, King-Devick Test, Sport Concussion Assessment Tool 3, Child Sport Concussion Assessment Tool 3. / Graduate / 0769 / 0633 / 0566 / oslundk@uvic.ca

Objective: The long-term cognitive effects of mild traumatic brain injury (MTBI) and sport-related concussion (SRC) are not always clear. Higher-level longer-term cognitive difficulties can indicate enduring neurological damage, as part of a post-concussion syndrome (PCS). This study aimed to investigate whether cognitive performance and self-reported PCS symptoms of athletes (rugby players) relate to SRC and whether gender moderates these effects. Method: Eighty-six participants completed a questionnaire detailing SRC history (frequency and severity) and rated long-term symptoms using the Sport Concussion Assessment Tool 3 (SCAT3) symptom evaluation scales, before completing the CogState Brief Battery and STOP-IT (stop-signal response inhibition task). Results: No significant relationships between SRC dosage (frequency/severity), self-reported PCS symptoms, and cognitive test performance were identified. A greater proportion of males reported SRC compared to females, but no effect of gender was found on any of the cognitive outcome measures or self-reports of PCS symptoms. Conclusions: The results show that SRC has no observable long-term effects on cognitive test performance or PCS symptom self-reports. The analysis may have lacked power to detect effects. Analysis of individual performance over time against baseline scores may be more relevant for accurate diagnosis than relying on normative test scores. Recommendations for future research were made.

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While substantial literature exists regarding the neurocognitive sequelae of concussion and return to play determinations for student-athletes who have suffered a concussion, there is a paucity of research that has conceptualized the impact of concussion on common academic outcomes. This study examined these topics in an attempt to evaluate the impact of concussion on GPA and school attendance, the association of preinjury neurocognitive performance to changes in academic achievement following a concussion, as well as the relationship between baseline neurocognitive performance and academic outcomes. The change in monthly assignment GPA and attendance were analyzed for three comparison groups (concussion, other sport-related injuries, control) regarding their differences pre and post injury. Second, whether a student-athlete's performance on a computerized baseline neuropsychological assessment (ImPACT) moderated the change in monthly assignment GPA for a group of concussed student-athletes identified as either short recovery or long recovery was investigated. Lastly, the association between baseline ImPACT scores and cumulative GPA/standardized achievement measures was examined for the entire group of student- athletes. Results of this study indicated no systematic differences between comparison groups (concussion, control, and injury) with the change in pre and post injury monthly assignment GPA and daily attendance rates, although academic declines were evident among all student-athletes. Further analysis revealed that more athletes who experienced concussions evidenced a significant drop in GPA (> .5) than would be expected by chance. Contrary to expectations, baseline ImPACT assessment scores did not moderate the degree of academic decline for concussed student-athletes within the short or long recovery groups. Finally, baseline ImPACT composite scores were significantly related to general academic achievement outcomes. Specifically, the ImPACT Visual Memory, Visual Motor and Reaction Time Composite scores significantly predicted GPA. Standardized academic achievement scores as measured by the Arizona Instrument to Measure Standards (math, reading, writing and science) were all significantly predicted by the baseline ImPACT Visual Motor Composite score. This study highlights the risk factors that may lead to diminished academic performance for student-athletes and the pre-injury neurocognitive variables measured by ImPACT that predict academic performance for student-athletes.

Although there have been many studies examining the factors involved in children’s risk of injury, there has been a dearth of research that examines specific individual parental factors in children’s risk of injury. This thesis examined how the attitudes, values, and beliefs of 119 Canadian minor hockey parents of children (aged 9 to 12 years) with respect to their decision-making regarding their children’s safe participation in hockey. Two studies are reported. The first study describes: (a) the development of a questionnaire that quantifies the constructs of perceived control, probabilities, values, risk propensity, competitiveness, and assertiveness expectancies; and (b) a sample of hockey parents in terms of their demographic characteristics and their attitudes, values, and beliefs regarding their children’s participation in minor hockey. The second study examined the relationships between these attitudes, values, and beliefs and a measure of their risk decision-making. Overall, results showed that (a) this sample of hockey parents tended to be well educated, and did not see themselves as being generally over-competitive or aggressive; (b) hockey parents’ attitudes, values, and beliefs regarding their children’s risk of concussion had very little predictive value or reliable connection with respect to their risk decision-making on behalf of their children; and (c) the most significant factors in parents’ risk decision-making were the opinions of their children, and the opinions of the doctors. The implications of these findings for future research and practice are discussed. / Thesis (Master, Education) -- Queen's University, 2012-12-21 16:12:00.221

PROBLEM: Expanding knowledge of how the brain responds to various exercise types may allow for investigation and development of individualized methods of concussion management. PURPOSE: Identify differences in cerebral oxygenation recovery following bouts of maximal anaerobic, resistance and aerobic exercise. METHODS: Twenty-eight active adults were recruited, each partaking in two sessions. At the first, anthropometric measures and leg press 1-RM were determined. During the second session, cerebral oxygenation and ventilatory gas exchange variables were recorded while participants completed maximal anaerobic, resistance, and aerobic tests, and for 15-minutes of recovery. RESULTS: Anaerobic (637.41s ± 330.42s) and aerobic (689.29s ± 311.05s) exercise resulted in longer durations of time to return to baseline compared to resistance (363.07s ± 366.34s). CONCLUSION: Anaerobic and aerobic exercise taking longer than resistance to return to baseline indicates prolonged activity. Expecting equivalent outcomes as concussion management tools from differing exercise methods may be misguided and requires additional research. / February 2017

Background: Concussion assessments rely on a multifaceted approach where evaluation of balance and postural control plays an important role. Following a concussion, 67% of individuals report dizziness as a persistent symptom and 30% experience balance impairments. Studies incorporating the common Balance Error Scoring System (BESS) tool suggest that these impairments return to pre-injury baselines within ten days of incident. In contrast, however, studies incorporating more advanced posturography methods observe significant differences in balance up to one year following injury. While the BESS is consistently associated with low sensitivity and poor reliability scores, advanced posturography systems using force plates are not practical or accessible in most recreational sports environments. Recently, the Wii Balance Board (WBB) has been identified as a potential force plate proxy. Research confirms that the WBB is both valid and reliable in collecting center of pressure data. Thus, the WBB may be useful for investigating post-concussion balance deficits. Objective: The purpose of this study was to investigate the potential utility of a customized WBB program to assess postural balance in an athletic population. The study aimed to assess change in postural balance using the clinical BESS and WBB assessment tools to evaluate balance at fixed intervals during a regular athletic season and following concussion. Design: Prospective partial cohort. Methods: Balance was assessed at baseline, mid-, and post-season. Individuals who sustained a concussion during the study period were further assessed weekly for four weeks post-injury. Results: No significant differences were observed in raw BESS scores across regular season or post-concussion time points. In contrast, significant differences in several WBB outcome measures were observed. In the single stance condition, COPML worsened by 24% and COPT worsened by 9% between baseline and post-season time points (p=.002 and p=.007). In contrast, participants improved by 14% on a timed dynamic task (p=.003) between baseline and post-season time points. Following concussion, only the WBB dynamic outcome measures were found to be statistically significant. A positive trend was observed post-concussion, suggesting that a learning effect exists with the dynamic WBB program. Conclusion: Study results emphasize the importance of considering the progression of athletic season when interpreting baseline and post-concussion balance measurements. Study results support the use of a quantitative balance assessment, such as with a WBB, to improve measurement of static and dynamic postural balance. / Graduate / 0566 / hilarymcullen@gmail.com

The purpose of this study was to examine the effects of aerobic fitness level on concussion risk, severity and recovery in high school football players. Participants (N=158) completed aerobic fitness (i.e., estimated VO2 max) and baseline neurocognitive tests (i.e., ImPACT). Concussed athletes completed ImPACT every 24-72 hours until they were asymptomatic or returned to baseline levels. A post-season questionnaire assessed unreported concussions and symptoms. Twenty players incurred concussions. Previously concussed athletes were 3.71 times more likely to be concussed than those with no concussion history. Severely concussed participants reported lingering symptoms. Previously concussed athletes high in aerobic fitness reported fewer symptoms than those low in aerobic fitness. Non-significant trends suggested that aerobic fitness might be related to faster recovery times and fewer symptoms. Twenty-eight percent (n= 38) of non-concussed participants reported a potential concussion and symptoms that were not recorded by medical staff during the season.