Browsing by Subject "Athletic Injuries"
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Item A Comparison of Post-Injury Symptomatology and Recovery Following Concussion Versus Orthopedic Injury(August 2021) Allen, Tahnae Tarkenton; Cullum, C. Munro; Didehbani, Nyaz; Hynan, Linda S.; Silver, Cheryl H.; Miller, ShaneOBJECTIVE: Concussion research has utilized orthopedic injury (OI) comparison groups to examine outcomes specific to concussion versus physical injury in general, due to the suggestion that preexisting, comorbid, and other injury-related factors influence post-concussion symptom reporting and recovery. The first aim of this dissertation (Study 1) was to conduct a review of the literature on post-injury symptoms and outcomes following concussion versus OI in children and adolescents, focusing on study design and synthesizing conclusions about concussion versus OI in youth populations. Incorporating findings from the review, the second objective of this dissertation (Study 2) was to collect original data from concussed youth and a carefully selected OI control group to compare symptomatology and recovery at initial presentation and 3-months post-injury to examine whether concussion outcomes are unique to a brain injury or more related to response to injury in general. METHODS: A scoping review using MEDLINE and PubMed to query databases from 2000 to 2020 was performed. Studies were included if they reported children, adolescents, or young adults with mild traumatic brain injury (mTBI)/concussion, used an orthopedic control group, and compared post-injury outcomes, which resulted in a total of 52 articles out of the 526 initially identified. For the second study, participants age 12-18 who sustained a concussion (n = 50) were matched by sex, age, and days since injury to an OI group (n = 50). Repeated measure analyses of covariance (ANCOVAs) were used to compare post-concussion symptoms, emotional symptoms, and recovery outcomes between injury groups at initial and 3 months post-injury. Binary logistic regression analyses were used to determine predictors of prolonged recovery separately in concussion and OI groups. RESULTS: Study 1: sixty-nine percent of the studies included in the scoping review reported differences between concussion and OI outcomes during at least one assessment time point during the recovery period, with higher and more persistent symptomatology in the concussion group. Study 2: the repeated measure ANCOVAs indicated that concussion participants reported significantly higher post-injury symptomatology and psychological sequelae within the first week of injury compared to OI subjects, but by 3 months, the groups showed no differences. Within the concussion group, females reported significantly higher symptoms compared to males, but this pattern was not observed in the OI group. Significant predictors for prolonged recovery also differed between injury groups. For the concussion group, previous concussion was the only significant predictor in our model for prolonged recovery. In the OI group, time since injury and functional impairment rating scores predicted prolonged recovery. CONCLUSIONS: Overall, findings suggest concussion results in a unique expression of symptoms, and recovery following concussion is influenced by a specific set of concussion-related factors that are not commonly seen in OI. Clinically, a unique presentation and recovery course following concussion versus OI supports the utility of specialized concussion treatment and clinical protocols, and may help identify individuals at greater risk of prolonged recovery.Item ImPACT™ Performance of High School Student Athletes with ADHD(2015-08-31) Gomez, Brooke Marie; Silver, Cheryl H.; Resch, Jacob; Cullum, C. MunroBACKGROUND: To date, two studies demonstrate that adolescents with ADHD tend to perform poorer on the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT; Lovell, 2013) at baseline than do adolescents without ADHD at baseline (Elbin et al., 2013; Zuckerman, Lee, Odom, Solomon, & Sills, 2013). In an effort to replicate and extend these studies, the baseline and immediate post-concussion performance of high school athletes with and without ADHD were evaluated to identify potential differences between groups on the ImPACT’s domains. SUBJECTS: Student athletes were recruited from a private high school. Baseline testing was conducted biannually to establish pre-injury/baseline levels of individual participants. Thirty-eight students with ADHD and a matched control group of thirty-eight students without ADHD were used to test the first hypothesis. Twenty-three students with ADHD and a matched control group of twenty-three students without ADHD who sustained a concussion were used to test the second and third hypotheses. Additional analyses were performed on data from four student athletes with ADHD who sustained a concussion. METHOD: Data were used from a larger study conducted by a large public metropolitan university. Variables included demographic information and the ImPACT. All data were stored on an encrypted computer or in a locked file cabinet. RESULTS: Independent samples t-tests revealed significant differences between athletes with ADHD and non-ADHD athletes at baseline on the Impulse Control (t (74) = 2.73, p < .01) and the Total Symptoms (t(74)= 2.63, p < .05) scores of the ImPACT. A multivariate analysis of variance (MANOVA) was conducted on data from two time periods. A statistically significant difference (F(6, 39) = 2.86, p = .02; Wilks’ ? = 0.694; ?2 = .31) in ImPACT performance was found between non-concussed athletes with ADHD tested at baseline and concussed athletes without ADHD tested within 72 hours of injury (M = 1.83 days). Further analysis using independent samples t-tests found that athletes with ADHD at baseline performed significantly better than concussed athletes without ADHD tested within 72 hours of injury, on the following composites: Verbal Memory (t(44)= 2.25, p < .05), Visual Motor Speed (t(44)= 2.33, p < .05), Reaction Time (t(44)= -3.42, p < .01), and Total Symptoms (t(44)= -3.52, p < .01). No significant between-group differences were found on the Visual Memory or Impulse Control composites of the ImPACT. DISCUSSION: These findings indicate that administration of the ImPACT to individuals with ADHD is appropriate. At baseline, both groups performed similarly on Verbal Memory, Visual Memory, Visual Motor Speed and Reaction Time. However, the overlap in ADHD and concussion profiles on Impulse Control and Visual Memory warrant caution in the clinical interpretation of the ImPACT profiles of individuals with ADHD. Nevertheless, these findings suggest that the overall use of normative data within an ADHD population is appropriate, and baseline testing has values for athletes with ADHD.Item Neuropsychological Functioning in Aging National Football League Retirees(2020-08-01T05:00:00.000Z) Schaffert, Jeffrey Michael; Cullum, C. Munro; Didehbani, Nyaz; LoBue, Christian; Motes, Michael A.; Hart, John, Jr.Concussive and sub-concussive head impacts sustained over a National Football League (NFL) career have been proposed to increase risk for later cognitive impairment. However, research is generally limited on the neuropsychological functioning among NFL retirees, and no studies to date have investigated the cognitive performance of NFL retirees over time. Study One was a critical review of research on neuropsychological functioning among NFL retirees. Findings were mixed, but studies suggested some NFL retirees have lower verbal memory, confrontation naming, and executive functioning abilities compared to control groups. Investigations of dose-response relationships between cognition and head-injury exposure also generated mixed findings which may be related to small samples, sampling bias, small effect sizes, and the measurement of different head-injury exposure variables. Study Two was a prospective cohort design investigating neuropsychological functioning and head-injury exposure in NFL retirees aged 50 and up. Retirees underwent baseline (N = 53) and follow-up (N = 29) comprehensive neuropsychological evaluations. Cognitively normal retirees (n = 26) were age, education, and IQ-matched to healthy controls (n = 26). Retirees diagnosed with MCI or dementia (n = 27) were matched as closely as possible to a clinical sample of patients with MCI and dementia by age, education, and diagnosis (n = 22). Independent samples t-tests and repeated measures ANCOVAs were used to evaluate neuropsychological scores between groups. Pearson correlations, partial correlations, and quadratic regressions were used to examine relationships between head-injury exposure and neuropsychological scores. Head-injury exposure variables included concussions, number of concussions with loss of consciousness, years playing professionally, games played, games started, and age beginning tackle football. Overall, NFL retirees did not significantly differ on the majority of measures at baseline or on any measures over time compared to their respective control groups. Furthermore, the vast majority of neuropsychological scores were not significantly related to head-injury exposure, regardless of cognitive diagnosis. In totality, findings suggest that NFL retirees do not have lower cognitive functioning compare to non-athlete controls later in life, and that head-injury exposure obtained over an NFL career is not related to cognitive functioning later-in-life.Item [News](1980-02-26) Williams, AnnItem [News](1981-11-04) Rutherford, SusanItem Outcomes Following Sports-Related Concussion in School-Aged Children and Adolescents: The Influence of Psychological Factors(2018-07-30) Wilmoth, Kristin Michelle; Cullum, C. Munro; Bell, Kathleen R.; Hynan, Linda S.; Didehbani, Nyaz; Rossetti, HeidiAlthough neurocognitive performance has been a popular topic of investigation in sports-related concussion, biopsychosocial sequelae have received considerably less attention. We reviewed the literature on emotional and psychosocial functioning in school-aged children and adolescents following concussion. MEDLINE and PsycINFO database queries identified 604 studies examining psychological and/or social outcomes of mild traumatic brain injury in children, 11 of those specific to athletes. This small body of literature and extrapolation from the general pediatric concussion literature indicated behavioral disturbances present at least temporarily following injury. Postconcussive anxiety and depressive symptoms are common, though levels may be subclinical. Social and academic disruption was less clearly documented. To aid clinicians in anticipating the psychosocial needs of concussed student athletes, well-controlled and adequately powered research on emotional and psychosocial outcomes are needed. The impact of post-injury psychological functioning on concussion recovery is poorly understood, particularly in youth. To this end, we explored initial mood and sleep symptoms as predictors of prolonged symptom clearance in a sample of adolescents, controlling for previously established injury-related and demographic risk factors. Student athletes (aged 12-18, N=393, 55% male) evaluated in outpatient concussion clinics completed brief self-report anxiety, depression, sleep, and postconcussive symptom scales 0-2 weeks post-injury. Medical record review at three-month follow-up provided date of symptom clearance. Survival analysis for time to recovery was conducted based on 1) self-reported injury/medical factors: sex, psychiatric history, prior concussion history, loss of consciousness, amnesia, initial symptom severity, and 2) psychological factors: anxiety, depression, and sleep screeners. Having amnesia, greater postconcussive symptoms, and worse sleep quality decreased the odds of recovery across time points (HRs = 0.64-0.99, ps < .05) in the total sample. When separated by sex, only postconcussive symptoms were associated with recovery in females, while amnesia and depressive symptoms were the only significant predictors of recovery for males (HRs = 0.54-0.98, ps < .05). Our findings linked brief psychological screeners to prolonged recovery, even considering injury and medical factors. Assessment of mood and sleep may aid in identification of individuals at risk for worse outcomes, though further exploration of postconcussive psychological issues is warranted before drawing firm conclusions.Item Rodeo Thumb: To Replant or Not(2020-05-01T05:00:00.000Z) Davis, Justin Joe; Zhang, Andrew; Sammer, Douglas; Koehler, DanielOBJECTIVE: To investigate patient reported outcomes after surgical treatment of Rodeo Thumb to help guide clinical decision making at the time of injury. METHODS: A retrospective review was performed for all rodeo thumb amputations from 2009-2019. Outcomes measured included daily functionality determined by QuickDASH scores, roping ability, and overall satisfaction. These were then compared between different levels of injury and definitive treatment. Outcomes between older and younger patients were also compared. Two-sided t-tests were used for QuickDASH scores and Pearson's Chi square test for categorical data. RESULTS: Thirty-seven patients underwent replantation or amputation as definitive treatment. IP level injury patients treated with replantation had a lower average QuickDASH than those treated with amputation (1.36 vs. 8.11; p=0.07), but fewer were roping at the same level or better (40% vs 78.6%; p=0.262). Patients with MCP level injury treated with replantation also had an average QuickDASH less than those treated with amputation (7.32 vs 10.4; p=0.52) and were roping at same level or better (66.6% vs 55.6%; p=1.00). Younger patients had lower QuickDASH scores than older patients (5.53 vs. 8.19; p=0.42), more who were roping at the same level or better (100% vs. 53%; p=0.02), and more who were satisfied with their treatment decision (88.9% vs. 60.7%; p=0.22.). CONCLUSIONS: For IP level injury, amputation seems to result in the same or better roping abilities as replantation. Replantation is the preferred treatment for MCP level injury. Younger patients tend to have better outcomes, possibly due to increased adaptation to injury. LEVEL OF EVIDENCE: IVItem [Southwestern News](2000-03-17) Stieglitz, Heather