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.

Orchard Sports Injury and Illness Classification System (OSIICS) Version 15

Background:Sports medicine(injury and illnesses)requires distinct coding systems because the International Classification of Diseases is insuf-ficient for sports medicine coding.The Orchard Sports Injury and Illness Classification System(OSIICS)is one of two sports medicine coding systems recommended by the International Olympic Committee.Regular updates of coding systems are required.Methods:For Version 15,updates for mental health conditions in athletes,sports cardiology,concussion sub-types,infectious diseases,and skin and eye conditions were considered particularly important.Results:Recommended codes were added from a recent International Olympic Committee consensus statement on mental health conditions in athletes.Two landmark sports cardiology papers were used to update a more comprehensive list of sports cardiology codes.Rugby union protocols on head injury assessment were used to create additional concussion codes.Conclusion:It is planned that OSIICS Version 15 will be translated into multiple new languages in a timely fashion to facilitate international accessibility.The large number of recently published sport-specific and discipline-specific consensus statements on athlete surveillance warrant regular updating of OSIICS.

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.

Tech to Protect Football Players' Heads--Technology Emerging to Detect and Prevent Concussions' in Football

头球是足球比赛中有力的得分手段,前德国国脚比埃尔霍夫就以头球著称。但医学研究发现,头球有可能导致颈部和头部损伤,并引发脑损伤,轻者引起人的轻微不适,重者则会危及生命。如果国际足联无法禁止头球,那么应该如何有效地保护、并且最大限度地降低头球给运动员的大脑带来的损伤程度呢?

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.

脑震荡及其法医学鉴定的讨论(附6分析)

作者在法医学尸体检验中曾遇到不同类型的脑震荡案例,现介绍6例,供读者分析参考。例1:王某,男,43岁。某年3月2日晚饭后,在通铺木板床上表演腾空翻跳,因失误头部着床跌倒在地,人事不省时隔20分钟左右死亡。

Depression following a traumatic brain injury:uncovering cytokine dysregulation as a pathogenic mechanism

A substantial number of individuals have long-lasting adverse effects from a traumatic brain injury（TBI）. Depression is one of these long-term complications that influences many aspects of life. Depression can limit the ability to return to work, and even worsen cognitive function and contribute to dementia. The mechanistic cause for the increased depression risk associated with a TBI remains to be defined. As TBI results in chronic neuroinflammation, and priming of glia to a secondary challenge, the inflammatory theory of depression provides a promising framework for investigating the cause of depression following a TBI. Increases in cytokines similar to those seen in depression in the general population are also increased following a TBI. Biomarker levels of cytokines peak within hours-to-days after the injury, yet pro-inflammatory cytokines may still be elevated above physiological levels months-to-years following TBI, which is the time frame in which post-TBI depression can persist. As tumor necrosis factor α and interleukin 1 can signal directly at the neuronal synapse, pathophysiological levels of these cytokines can detrimentally alter neuronal synaptic physiology. The purpose of this review is to outline the current evidence for the inflammatory hypothesis of depression specifically as it relates to depression following a TBI. Moreover, we will illustrate the potential synaptic mechanisms by which tumor necrosis factor α and interleukin 1 could contribute to depression. The association of inflammation with the development of depression is compelling; however, in the context of post-TBI depression, the role of inflammation is understudied. This review attempts to highlight the need to understand and treat the psychological complications of a TBI, potentially by neuroimmune modulation, as the neuropsychiatric disabilities can have a great impact on the rehabilitation from the injury, and overall quality of life.

Inflammation-related gene expression profiles of salivary extracellular vesicles in patients with head trauma

At present,there is no reliable biomarker for the diagnosis of traumatic brain injury(TBI).Studies have shown that extracellular vesicles released by damaged cells into biological fluids can be used as potential biomarkers for diagnosis of TBI and evaluation of TBI severity.We hypothesize that the genetic profile of salivary extracellular vesicles in patients with head trauma differs from that in uninjured subjects.Findings from this hypothesis would help investigate the severity of TBI.This study included 19 subjects,consisting of seven healthy controls who denied history of head trauma,six patients diagnosed with concussion injury from an outpatient concussion clinic,and six patients with TBI who received treatment in the emergency department within 24 hours after injury.Real-time PCR analysis of salivary extracellular vesicles in participants was performed using TaqMan Human Inflammation array.Gene expression analysis revealed nine upregulated genes in emergency department patients(LOX5,ANXA3,CASP1,IL2RG,ITGAM,ITGB2,LTA4H,MAPK14,and TNFRSF1A)and 13 upregulated genes in concussion clinic patients compared with healthy participants(ADRB1,ADRB2,BDKRB1,HRH1,HRH2,LTB4R2,LTB4R,PTAFR,CYSLTR1,CES1,KLK1,MC2R,and PTGER3).Each patient group had a unique profile.Comparison between groups showed that 15 inflammation-related genes had significant expression change.Our results indicate that inflammation biomarkers can be used for diagnosis of TBI and evaluation of disease severity.This study was approved by the Institutional Review Board on December 18,2015(approval No.0078-12)and on June 9,2016(approval No.4093-16).

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.

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.

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.

Electroencephalogram and evoked potential parameters examined in Chinese mild head injury patients for forensic medicine

Objective To evaluate the usefulness of quantitative electroencephalogram （QEEG）, flash visual evoked potential （F-VEP） and auditory brainstem responses （ABR） as indicators of general neurological status. Methods Comparison was conducted on healthy controls （N=30） and patients with brain concussion （N=60） within 24 h after traumatic brain injury. Follow-up study of patient group was completed with the same standard paradigm 3 months later. All participants were recorded in multi-modality related potential testing in both early and late concussion at the same clinical setting. Glasgow coma scale, CT scanning, and physical examinations of neuro-psychological function, optic and auditory nervous system were performed before electroencephalogram （EEG） and evoked potential （EEG-EP） testing. Any participants showed abnormal changes of clinical examinations were excluded from the study. Average power of frequency spectrum and power ratios were selected for QEEG testing, and latency and amplitude of F-VEP and ABR were recorded. Results Between patients and normal controls, the results indicated： （1） Highly significance （P 〈 0.01） in average power of α1 and power ratios of θ/α1, 0/α2, α1/α2 of EEG recording; （2） N70-P 100 amplitude of F-VEP in significant difference at early brain concussion; and （3） apparent prolongation of Ⅰ～Ⅲ inter-peak latency of ABR appeared in some individuals at early stage after concussion. The follow-up study showed that some patients with concussion were also afflicted with characteristic changes of EEG components for both increments of α1 average power and θ/α2 power ratio after 3 months recording. Conclusion EEG testing has been shown to be more effective and sensitive than evoked potential tests alone on detecting functional state of patients with mild traumatic brain injury （MTBI）. Increments of α1 average power and θ/α2 power ratio are the sensitive EEG parameters to determining early concussion and evaluating outcome of postconcussion symptoms （PCS）. Follow-up study associated with persistent PCS may be consistent with the postulate of substantial biological, rather than psychological origin. The study suggests that combination of EEG and EP parameters can contribute to the evaluation of brain function as a whole for clinical and forensic applications.

Effects of purposeful soccer heading on circulating small extracellular vesicle concentration and cargo

Background:Considering the potential cumulative effects of repetitive head impact(HI)exposure,we need sensitive biomarkers to track shortand long-term effects.Circulating small extracellular vesicles(sEVs)(<200 nm)traffic biological molecules throughout the body and may have diagnostic value as biomarkers for disease.The purpose of this study was to identify the microRNA(miRNA)profile in circulating sEVs derived from human plasma following repetitive HI exposure.Methods:Healthy adult(aged 18-35 years)soccer players were randomly assigned to one of 3 groups:the HI group performed 10 standing headers,the leg impact group performed 10 soccer ball trapping maneuvers over 10 min,and the control group did not participate in any soccer drills.Plasma was collected before testing and 24 h afterward,and sEVs were isolated and characterized via nanoparticle tracking analysis.Next-generation sequencing was utilized to identify candidate miRNAs isolated from sEVs,and candidate microRNAs were analyzed via quantitative polymerase chain reaction.In silico target prediction was performed using TargetScan(Version 7.0;targetscan.org)and miRWalk(http://mirwalk.umm.uni-heidelberg.de/)programs,and target validation was performed using luciferase reporter vectors with a miR-7844-5p mimic in human embryonic kidney(HEK)293T/17 cells.Results:Plasma sEV concentration and size were not affected across time and group following repetitive HI exposure.After 24 h,the HI read count from next-generation sequencing showed a 4-fold or greater increase in miR-92b-5p,miR-423-5p,and miR-24-3p and a 3-fold or greater decrease in miR-7844-5p,miR-144-5p,miR-221-5p,and miR-22-3p.Analysis of quantitative polymerase chain reaction revealed that leg impact did not alter the candidate miRNA levels.To our knowledge,miR-7844-5p is a previously unknown miRNA.We identified 8 miR-7844-5p mRNA targets:protein phosphatase 1 regulatory inhibitor subunit 1B(PPP1R1B),LIM and senescent cell antigen-like domains 1(LIMS1),autophagy-related 12(ATG12),microtubule-associated protein 1 light chain 3 beta(MAP1LC3B),integrin subunit alpha-1(ITGA1),mitogenactivated protein kinase 1(MAPK1),glycogen synthase kinase 3b(GSK3b),and mitogen-activated protein kinase 8(MAPK8).Conclusion:Collectively,these data indicate repetitive HI exposure alters plasma sEV miRNA content,but not sEV size or number.Furthermore,for the first time we demonstrate that previously unknown miR-7844-5p targets mRNAs known to be involved in mitochondrial apoptosis,autophagy regulation,mood disorders,and neurodegenerative disease.

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.

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.

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.

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.