How completely are randomized controlled trials of non-pharmacological interventions following concussion reported? A systematic review

Purpose:The study aimed to examine the reporting completeness of randomized controlled trials(RCTs)of non-pharmacological interventions following concussion.Methods:We searched MEDLINE,Embase,PsycInfo,CINAHL,and Web of Science up to May 2022.Two reviewers independently screened studies and assessed reporting completeness using the Template for Intervention Description and Replication(TIDieR),Consensus on Exercise Reporting Template(CERT),and international Consensus on Therapeutic Exercise aNd Training(i-CONTENT)checklists.Additional information was sought my study authors where reporting was incomplete.Risk of bias(ROB)was assessed with the Cochrane ROB-2 Tool.RCTs examining non-pharmacological interventions following concussion.Results:We included 89 RCTs(n=53 high ROB)examining 11 different interventions for concussion:sub-symptom threshold aerobic exercise,cervicovestibular therapy,physical/cognitive rest,vision therapy,education,psychotherapy,hyperbaric oxygen therapy,transcranial magnetic stimulation,blue light therapy,osteopathic manipulation,and head/neck cooling.Median scores were:TIDieR 9/12(75%;interquartile range(IQR)=5;range:5-12),CERT 17/19(89%;IQR=2;range:10-19),and i-CONTENT 6/7(86%;IQR=1;range:5-7).Percentage of studies completely reporting all items was TIDieR 35%(31/89),CERT 24%(5/21),and i-CONTENT 10%(2/21).Studies were more completely reported after publication of TIDieR(t_(87)=2.08;p=0.04)and CERT(t_(19)=2.72;p=0.01).Reporting completeness was not strongly associated with journal impact factor(TIDieR:rs=0.27;p=0.01;CERT:r_(s)=-0.44;p=0.06;i-CONTENT:r_(s)=-0.17;p=0.48)or ROB(TIDieR:rs=0.11;p=0.31;CERT:rs=0.04;p=0.86;i-CONTENT:rs=0.12;p=0.60).Conclusion:RCTs of non-pharmacological interventions following concussion demonstrate moderate to good reporting completeness,but are often missing key components,particularly modifications,motivational strategies,and qualified supervisor.Reporting completeness improved after TIDieR and CERT publication,but publication in highly cited journals and low ROB do not guarantee reporting completeness.

Symptom presentation and evolution in the first 48 hours after injury are associated with return to play after concussion in elite Rugby Union

Background:Return to play(RTP)in elite rugby is managed using a 6-stage graduated RTP protocol,which can result in clearance to play within 1 week of injury.We aimed to explore how symptom,cognitive,and balance presentation and evolution during concussion screens 2 h(head injury assessment(HIA2)and 48 h(HIA3)after injury were associated with time to RTP)to identify whether a more conservative graduated RTP may be appropriate.Methods:A retrospective cohort study was conducted in 380 concussed rugby players from elite men’s rugby over 3 consecutive seasons.Players were classified as shorter or longer returns,depending on whether RTP occurred within 7 days(allowing them to be considered to play the match 1 week after injury)or longer than 8 days,respectively.Symptom,cognitive,and balance performance during screens was assessed relative to baseline(normal or abnormal)and to the preceding screen(improving or worsening).Associations between sub-test abnormalities and RTP time were explored using odds ratios(OR,longer vs.shorter).Median day absence was compared between players with abnormal or worsening results and those whose results were normal or improving.Results:Abnormal symptom results during screens 2 h and 48 h after concussion were associated with longer return time(HIA2:OR=2.21,95%confidence interval(95%CI):1.39-3.50;HIA3:OR=3.30,95%CI:1.89-5.75).Worsening symptom number or severity from the time of injury to 2 h and 48 h post-injury was associated with longer return(HIA2:OR=2.49,95%CI:1.36-4.58;HIA3:OR=3.34,95%CI:1.10-10.15).Median days absence was greater in players with abnormal symptom results at both HIA2 and HIA3.Cognitive and balance performance were not associated with longer return and did not affect median days absence.Conclusion:Symptom presentation and evolution within 48 h of concussion were associated with longer RTP times.This may guide a more conservative approach to RTP,while still adhering to individualized concussion management principles.

Are EPB41 and alpha-synuclein diagnostic biomarkers of sport-related concussion?Findings from the NCAA and Department of Defense CARE Consortium

Background:Current protein biomarkers are only moderately predictive at identifying individuals with mild traumatic brain injury or concussion.Therefore,more accurate diagnostic markers are needed for sport-related concussion.Methods:This was a multicenter,prospective,case-control study of athletes who provided blood samples and were diagnosed with a concussion or were a matched non-concussed control within the National Collegiate Athletic Association-Department of Defense Concussion Assessment,Research,and Education Consortium conducted between 2015 and 2019.The blood was collected within 48 h of injury to identify protein abnormalities at the acute and subacute timepoints.Athletes with concussion were divided into 6 h post-injury(0-6 h post-injury)and after 6 h postinjury(7-48 h post-injury)groups.We applied a highly multiplexed proteomic technique that used a DNA aptamers assay to target 1305proteins in plasma samples from athletes with and without sport-related concussion.Results:A total of 140 athletes with concussion(79.3%males;aged 18.71±1.10 years,mean±SD)and 21 non-concussed athletes(76.2%males;19.14±1.10 years)were included in this study.We identified 338 plasma proteins that significantly differed in abundance(319 upregulated and 19 downregulated)in concussed athletes compared to non-concussed athletes.The top 20 most differentially abundant proteins discriminated concussed athletes from non-concussed athletes with an area under the curve(AUC)of 0.954(95%confidence interval:0.922-0.986).Specifically,after 6 h of injury,the individual AUC of plasma erythrocyte membrane protein band 4.1(EPB41)and alpha-synuclein(SNCA)were 0.956 and 0.875,respectively.The combination of EPB41 and SNCA provided the best AUC(1.000),which suggests this combination of candidate plasma biomarkers is the best for diagnosing concussion in athletes after 6 h of injury.Conclusion:Our data suggest that proteomic profiling may provide novel diagnostic protein markers and that a combination of EPB41 and SNCA is the most predictive biomarker of concussion after 6 h of injury.

English professional football players concussion knowledge and attitude

Background： Concussions are a common pathology in football and multiple misconceptions exist amongst the players and managers. To address these misconceptions, and potentially reduce concussion associated sequela, effective educational interventions need to be developed. However, the current knowledge and attitude status must be ascertained to appropriately develop these interventions. The purpose of this study was to assess the concussion knowledge and attitude of English professional footballers. Methods： Twenty-six participants from one English Football League Championship club completed the study. A mixed methods approach included the Rosenbaum Concussion Knowledge and Attitudes Survey （RoCKAS） and a semi-structured interview. The RoCKAS contains separate knowledge （055） and attitude （15-75） scores and was followed by a semi-structured interview consisting of concussion knowledge, attitude, and behavior related questions. Results： The mean score on the RoCK.AS knowledge was 16.4± 2.9 （range 11-22） and the attitude score was 59.6 ± 8.5 （range 41-71）. The interview responses identified inconsistencies between the RoCKAS and the intended behaviors, endorsing multiple concussion misconceptions, and revealed barriers to concussion reporting. Conclusion： The results of this study suggest that Championship Level English footballers have moderate concussion knowledge, safe attitudes, and good concussion symptom recognition when assessed with pen and paper questionnaires. However, within the semi-structured interview many respondents reported unsafe concussion behaviors despite accurately identifying the potential risks. Further, multiple barriers to concussion reporting were identified which included perceived severity of the injury, game situations, and the substitution rule. These findings can help form the foundation of educational interventions to potentially improve concussion reporting behaviors amongst professional footballers.

Strategies to avoid a missed diagnosis of co-occurring concussion in post-acute patients having a spinal cord injury

Research scientists and clinicians should be aware that missed diagnoses of mild-moderate traumatic brain injuries in post-acute patients having spinal cord injuries may approach 60-74% with certain risk factors, potentially causing clinical consequences for patients, and confounding the results of clinical research studies. Factors leading to a missed diagnosis may include acute trauma-related life-threatening issues, sedation/intubation, subtle neuropathology on neuroimaging, failure to collect Glasgow Coma Scale scores or duration of posttraumatic amnesia, or lack of validity of this information, and overlap in neuro-cognitive symptoms with emotional responses to spinal cord injuries. Strategies for avoiding a missed diagnosis of mild-moderate traumatic brain injuries in patients having a spinal cord injuries are highlighted in this perspective.

Use of the stepwise progression return-to-play protocol following concussion among practicing athletic trainers

Purpose: The purpose of this study was to determine whether practicing athletic trainers(ATs) were using the stepwise progression to make return-to-play(RTP) decisions after concussion and to determine what factors influenced their decision to use the stepwise progression.Methods: A total of 166 ATs(response rate = 16.6%) completed a 21-item questionnaire that evaluated participant demographics, methods of concussion management, and RTP decision-making using the stepwise progression. Descriptive statistics and a logistic regression were completed to analyze data.Results: Factors such as education level(p = 0.05) and number of concussions treated(p = 0.05) predicted use of the stepwise progression,whereas sex(p = 0.17), employment setting(p = 0.17), state law(p = 0.86), and years practicing(p = 0.17) did not predict whether ATs were following the stepwise progression.Conclusion: The majority of the ATs from this study are employing the stepwise progression to safely return athletes to play after sustaining a concussion. This demonstrates that ATs are providing a standard of care for concussed athletes across various athletic training settings; however,having a graduate degree and treating more concussions per year are predictors of whether an AT follows all steps of the stepwise progression.

What do coaches want to know about sports-related concussion?A needs assessment study

Purpose: This study aims to identify the concussion-related training and education needs of Gaelic Athletic Association(GAA) coaches in Ireland,as well as the preferred method of concussion education delivery.Methods: We used a self-report questionnaire to collect data from a convenience sample of 108 GAA coaches in Ireland. Data were captured on(1) informational needs and desires,(2) preferred methods of delivery, and(3) concussion practices and procedures. Questionnaires were completed electronically from June 3 rd–September 29 th, 2015.Results: Coaches indicated that they were most interested in receiving information about the(1) signs and symptoms of concussion,(2) assessment of concussion, and(3) return-to-play guidelines. Over two-thirds of participants indicated that in-person training would be the most effective mode of delivery of concussion education for this population. Additionally, only 10% coaches reported that before the start of the season they talked to their athletes about concussion management and safety, and this was more common among coaches who reported being formally educated about concussion.Conclusion: Our findings reveal a disconnect between the concussion education needs and the education that is currently provided to GAA coaches, in terms of content and delivery modality. Our results suggest a need for a multifaceted approach to concussion education, tailored to the needs and learning preferences of the target population.

Diffusion tensor tractography characteristics of axonal injury in concussion/mild traumatic brain injury

The main advantage of diffusion tensor tractography is that it allows the entire neural tract to be evaluated.In addition,configurational analysis of reconstructed neural tracts can indicate abnormalities such as tearing,narrowing,or discontinuations,which have been used to identify axonal injury of neural tracts in concussion patients.This review focuses on the characteristic features of axonal injury in concussion or mild traumatic brain injury(m TBI)patients through the use of diffusion tensor tractography.Axonal injury in concussion(m TBI)patients is characterized by their occurrence in long neural tracts and multiple injuries,and these characteristics are common in patients with diffuse axonal injury and in concussion(m TBI)patients with axonal injury.However,the discontinuation of the corticospinal tract is mostly observed in diffuse axonal injury,and partial tearing and narrowing in the subcortical white matter are frequently observed in concussion(m TBI)patients with axonal injury.This difference appears to be attributed to the observation that axonal injury in concussion(m TBI)patients is the result of weaker forces than those producing diffuse axonal injuries.In addition,regarding the fornix,in diffuse axonal injury,discontinuation of the fornical crus has been frequently reported,but in concussion(m TBI)patients,many collateral branches form in the fornix in addition to these findings in many case studies.It is presumed that the impact on the brain in TBI is relatively weaker than that in diffuse axonal injury,and that the formation of collateral branches occurs during the fornix recovery process.Although the occurrence of axonal injury in multiple areas of the brain is an important feature of diffuse axonal injury,case studies in concussion(m TBI)have shown that axonal injury occurs in multiple neural tracts.Because axonal injury lesions in m TBI patients may persist for approximately 10 years after injury onset,the characteristics of axonal injury in concussion(m TBI)patients,which are reviewed and categorized in this review,are expected to serve as useful supplementary information in the diagnosis of axonal injury in concussion(m TBI)patients.

Impaired motor control after sport-related concussion could increase risk for musculoskeletal injury:Implications for clinical management and rehabilitation

This review presents a conceptual framework and supporting evidence that links impaired motor control after sport-related concussion(SRC)to increased risk for musculoskeletal injury.Multiple studies have found that athletes who are post-SRC have higher risk for musculoskeletal injury compared to their counterparts.A small body of research suggests that impairments in motor control are associated with musculoskeletal injury risk.Motor control involves the perception and processing of sensory information and subsequent coordination of motor output within the central nervous system to perform a motor task.Motor control is inclusive of motor planning and motor learning.If sensory information is not accurately perceived or there is interference with sensory information processing and cognition,motor function will be altered,and an athlete may become vulnerable to injury during sport participation.Athletes with SRC show neuroanatomic and neurophysiological changes relevant to motor control even after meeting return to sport criteria,including a normal neurological examination,resolution of symptoms,and return to baseline function on traditional concussion testing.In conjunction,altered motor function is demonstrated after SRC in muscle activation and force production,movement patterns,balance/postural stability,and motor task performance,especially performance of a motor task paired with a cognitive task(i.e.,dual-task condition).The clinical implications of this conceptual framework include a need to intentionally address motor control impairments after SRC to mitigate musculoskeletal injury risk and to monitor motor control as the athlete progresses through the return to sport continuum.

Evaluation of diagnosis and curative criterion for concussion patients by color three-dimensional trascrani doppler

Objective In order to offer a noninvasive and objective examination method for assessing the clinical diagnosis and eurative criterion of concussion patients,the patients color three－dimensional transcranial doppler(3D－TCD)characteristic at deferent phases,parameter and clincal manifestation were studied.Method Parameter of Median Cerebral Artery(MCA),Base Artery(BA),the average peak forwand velocity of cerebral blood flow,train figure were tested by 3D－TCD within 24 hours,3－6 days and at the end of treatment,respectively.The results were compared with clinical diagnoses and curative criterion.Result Among 135 patients who had clinically diagnosed concussion,agreeable diagnoses 101 cases,basically agreeable diagnoses 12 cases,disagreeable diagnosis 22 cases(16.2％).At the end of treatment, according to clinical determination 96 cases(71.1％)were cured,39 cases(28.9％)were improved.Wave train character,figure and diagnoses parameter of cerebral spasm caused by concussion were suggested.Conclusion To be one of the diagnostic bases and curative criterion,3D－TCD technology is performable.Meanwhile,it is a new testing objective technique for assessing curative and determining prognosis.

Concussion management in soccer

Brain injuries in sports drew more and more public attentions in recent years. Brain injuries vary by name, type, and severity in the athletic setting. It should be noted, however, that these injuries are not isolated to only the athletic arena, as non-athletic mechanisms （e.g., motor vehicle accidents） are more common causes of traumatic brain injuries （TBI） among teenagers. Notwithstanding, as many as 1.6 to 3.8 million TBI result from sports and recreation each year in the United States alone. These injuries are extremely costly to the global health care system, and make TBI among the most expensive conditions to treat in children. This article serves to define common brain injuries in sport; describe their prevalence, what happens to the brain following injury, how to recognize and manage these injuries, and what you can expect as the athlete recovers. Some return-to-activity considerations for the brain-injured athlete will also be discussed.

Detailed description of Division I ice hockey concussions:Findings from the NCAA and Department of Defense CARE Consortium

Objective:Since concussion is the most common injury in ice hockey,the objective of the current study was to elucidate risk factors,specific mechanisms,and clinical presentations of concussion in men’s and women’s ice hockey.Methods:Ice hockey players from 5 institutions participating in the Concussion Assessment,Research,and Education Consortium were eligible for the current study.Participants who sustained a concussion outside of this sport were excluded.There were 332(250 males,82 females)athletes who participated in ice hockey,and 47(36 males,11 females)who sustained a concussion.Results:Previous concussion(odds ratio(OR)=2.00;95%confidence interval(95%CI):1.02‒3.91)was associated with increased incident concussion odds,while wearing a mouthguard was protective against incident concussion(OR=0.43;95%CI:0.22‒0.85).Overall,concussion mechanisms did not significantly differ between sexes.There were specific differences in how concussions presented clinically across male and female ice hockey players,however.Females(9.09%)were less likely than males(41.67%)to have a delayed symptom onset(p=0.045).Additionally,females took significantly longer to reach asymptomatic(p=0.015)and return-to-play clearance(p=0.005).Within the first 2 weeks post-concussion,86.11%of males reached asymptomatic,while only 45.50%of females reached the same phase of recovery.Most males(91.67%)were cleared for return to play within 3 weeks of their concussion,compared to less than half(45.50%)of females.Conclusion:The current study proposes possible risk factors,mechanisms,and clinical profiles to be validated in future concussions studies with larger female sample sizes.Understanding specific risk factors,concussion mechanisms,and clinical profiles of concussion in collegiate ice hockey may generate ideas for future concussion prevention or intervention studies.

Postural control deficits identify lingering post-concussion neurological deficits

Concussion,or mild traumatic brain injury,incidence rates have reached epidemic levels and impaired postural control is a cardinal symptom.The purpose of this review is to provide an overview of the linear and non-linear assessments of post-concussion postural control.The current acute evaluation for concussion utilizes the subjective balance error scoring system(BESS) to assess postural control.While the sensitivity of the overall test battery is high,the sensitivity of the BESS is unacceptably low and,with repeat administration,is unable to accurately identify recovery.Sophisticated measures of postural control,utilizing traditional linear assessments,have identified impairments in postural control well beyond BESS recovery.Both assessments of quiet stance and gait have identified lingering impairments for at least 1 month post-concussion.Recently,the application of non-linear metrics to concussion recovery have begun to receive limited attention with the most commonly utilized metric being approximate entropy(Ap En).Ap En,most commonly in the medial-lateral plane,has successfully identified impaired postural control in the acute post-concussion timeframe even when linear assessments of instrumented measures are equivalent to healthy pre-injury values;unfortunately these studies have not gone beyond the acute phase of recovery.One study has identified lingering deficits in postural control,utilizing Shannon and Renyi entropy metrics,which persist at least through clinical recovery and return to participation.Finally,limited evidence from two studies suggest that individuals with a previous history of a single concussion,even months or years prior,may display altered Ap En metrics.Overall,non-linear metrics provide a fertile area for future study to further the understanding of postural control impairments acutely post-concussion and address the current challenge of sensitive identification of recovery.

Gender differences in nonlinear motor performance following concussion

Purpose:To quantify differences in nonlinear aspects of performance on a seated visual-motor tracking task between clinically asymptomatic males and females with and without a self-reported mild traumatic brain injury history.Methods:Seventy-three individuals with a self-reported concussion history(age:21.40±2.25 years,mean±SD)and 75 without completed the visual-motor tracking task(age:21.50±2.00 years).Participants pressed an index finger against a force sensor,tracing a line across a computer screen(visual-motor tracking).The produced signal's root-mean-square error(RMSE),sample entropy(SampEn,a measure of regularity),and average power(AvP)between 0 and 12 Hz were calculated.Results:Males with a history of 0 or 1 concussion had greater RMSE(worse performance)than females with 0(p<0.0001)and 1 concussion(p=0.052).Additionally,females with 2+concussions exhibited lower SampEn than females with no history(p=0.001)or a history of 1 concussion(p=0.026).Finally,females with 2+concussions had lower 8-12 Hz AvP than males with 2+concussions(p=0.031).Few differences were observed in the male participants.Conclusion:Females with a self-reported history of multiple concussions exhibited lower SampEn in the visual-motor tracking-task force output structure as compared to those with no reported history of concussion and their male counterparts.Lower SampEn and lower power between 8 and12 Hz indicated persistent impairment in visual processing and feed-forward or predictive motor control systems.

Quiet rest ameliorates biochemical metabolism in the brain in a simple concussion rabbit model Evaluation of hydrogen proton magnetic resonance spectroscopy

The present study analyzed changes in the biochemical metabolites N-acetyl aspartate, choline, and creatine in a simple concussion rabbit model following quiet rest, hyperbaric oxygen therapy, or interference stimulation through the use of hydrogen proton magnetic resonance spectroscopy detection. Experimental findings showed that brain N-acetyl aspartate and choline peak values significantly decreased, while creatine peak values significantly increased following simple concussion. Following treatments, N-acetyl aspartate and choline peaks returned to normal levels in the quiet rest and hyperbaric oxygen therapy groups, but no changes were observed in the interference stimulation group. Results demonstrated abnormal changes in the brain biochemical metabolism environment following simple concussion. Quiet rest was shown to play an important role in restoration of biochemical metabolism following simple concussion.

Microstructural changes in memory and reticular formation neural pathway after simple concussion

Patients with concussion often present with temporary disturbance of consciousness. The microstructural and functional changes in the brain associated with concussion, as well as the relationship with transient cognitive disorders, are currently unclear. In the present study, a rabbit model of simple concussion was established. Magnetic resonance-diffusion tensor imaging results revealed that the corona radiata and midbrain exhibited significantly decreased fractional anisotropy values in the neural pathways associated with memory and the reticular formation. In addition, the apparent diffusion coefficient values were significantly increased following injury compared with those before injury. Following a 1-hour period of quiet rest, the fractional anisotropy values significantly increased, and apparent diffusion coefficient values significantly decreased, returning to normal pre-injury levels. In contrast, the fractional anisotropy values and apparent diffusion coefficient values in the corpus callosum, thalamus and hippocampus showed no statistical significant alterations following injury. These findings indicate that the neural pathways associated with memory and the reticular formation pathway exhibit reversible microstructural white matter changes when concussion occurs, and these changes are exhibited to a different extent in different regions.

Which psychosocial factors are associated with return to sport following concussion? A systematic review

Background:Psycho social factors predict recurrent inj ury and return to preinjury level of performance following orthopedic injury but are poorly understood following concussion.Current management protocols prioritize physical measures of recovery.Therefore,the objective of this study was to describe the psychosocial factors associated with return to sport(RTS) and how they are measured in athletes who sustained a concussion.Methods:MEDLINE,Embase,APA PsycINFO,CINAHL,and SPORTDiscus were searched through February 2,2021.Eligible studies included original peer-reviewed publications describing psychosocial factors associated with RTS following a diagnosed concussion.The primary outcome was scales or measures employed and/or key thematic concepts.Results:Of the 3615 studies identified,10 quantitative cohort studies(Oxford Centre for Evidence-Based Medicine Level-3) representing 2032 athletes(85% male;high-school and collegiate collision/contact athletes) and 4 qualitative studies representing 66 athletes(74% male;70% American football;aged 9-28 years) were included.We identified 3 overarching themes and 10 outcome measures related to psychosocial factors associated with RTS following concussion:(a) fear(e.g,of recurrent concussion,of RTS,of losing playing status);(b) emotional factors(e.g,depression,anxiety,perceived stress,mental health,disturbance mood);and(c) contextual factors(e.g,social support,pressure,sense of identity).Conclusion:Although current medical clearance decisions prioritize physical measures of recovery,evidence suggests diverse psychosocial factors influence RTS following concussion.It remains unclear which psychosocial factors contribute to a successful RTS,including the influence of sex/gender and age.Future studies should evaluate the association of psychological readiness with physical measures of recovery at medical clearance,preinjury level of performance,and risk of recurrent concussion to support RTS clinical decision-making.

Nature-Based Therapy for People Suffering from Post-Concussion Syndrome—A Pilot Study

Background: Approximately 10% - 15% of people diagnosed with a concussion develop post-concussion syndrome (PCS), in which mental fatigue is a dominating symptom. PCS has major consequences for the individuals diagnosed, and society as a whole. Objective: The objective of the pilot study was to investigate whether a nature-based therapeutic (NBT) intervention would be suitable for ameliorating the symptoms experienced by people with PCS, especially mental fatigue. Method: Eight participants diagnosed with PCS took part in a NBT programme, which consisted of weekly two-hour sessions over the course of eight weeks. The participants’ level of mental fatigue was measured on the Mental Fatigue Scale (MFS) before and after the intervention. An analogue scale inspired by the EuroQol-visual analogue scales (EQ-VAS) was used to measure immediate self-perceived feeling of health/ well-being before and after individual sessions. A semi-structured interview was held with each participant after the intervention. The interviews and logbooks were analysed through content analysis, which entails several steps in a spiral-like process, from reading and re-reading the transcripts to forming units of meaning, which were then grouped into sub-categories and categories for further analysis. Result: The MFS showed a significant decrease in mental fatigue and large effect size. The participants’ self-assessed health/ well-being on the analogue scale showed an increase from the beginning to the end of each session. The analysis of the interviews revealed that the participants experienced the sensory stimuli and exercises in the natural environment as motivating and meaningful, even when they were challenging. Further, they found the psycho-educational aspects transferable to everyday life. Conclusion: The results support that NBT can have potential in the rehabilitation of PCS, by lowering mental fatigue and improving health and well-being. The NBT was further found to be experienced as enjoyable and motivating with good transferability to everyday life.

The explosive-concussion jet:a new type fire distinguisher

Based on the fluid transient theory and explosive dynamics, a new type explosive driven jet is put forward. The generator of the proposed jet system comprises an explosive power source, a dynamic cavity, a spacing block, a water storage chamber, and a rubber membrane. The dynamic explosive source of power for the jet is composed of a cartridge and a bullet. The pressure in the dynamic cavity goes up to a range from 300 MPa to 350 MPa very quickly when the bullet is emitted. Driven by such a high pressure, the speed of the jet reaches 120 m/s. The effective distance to distinguish a fire is within 40 m. The jet has the following advantages over a conventional high-pressure water jet system: 1)strong power and strong transient force produced by dynamic source; 2) the energy of the dynamical source concentrated in a small scope with very little loss; 3) extensive applicability; and 4) safe usage without sparkling and smoke.

Concussion Practice Patterns among Speech-Language Pathologists

OBJECTIVE: To identify current SLP practice patterns in concussion care, clarify definitions of common cognitive retraining terminology, and establish areas of growth in clinical practice and research. METHOD: An online 10 question survey to collect data on assessment and practice components. Total 79 respondents from ASHA Special Interest Group 2 Neurogenic Communication Disorders website participated. Data were analyzed using descriptive statistics. RESULTS: Patient education and symptom management were regular components of cognitive retraining with concussion. Smaller percentage included cognitive endurance building. Further analysis identified variation in how clinicians defined terms: patient education, symptom management, and cognitive endurance building. Discrepancies noted with diagnostic tools, with one quarter using screening tools as primary assessment. CONCLUSION: Strong knowledge base to support differential diagnosis and therapeutic plan is critical to optimize outcomes in concussion care. Consistency with terminology use can reduce the risk of confusion but also support the value of what SLPs contribute to an interdisciplinary concussion team.