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Article ; Online: Considerations for Diagnosis and Management of Concussion.

Mucha, Anne / Trbovich, Alicia

The Journal of orthopaedic and sports physical therapy

2019 Volume 49, Issue 11, Page(s) 787–798

Abstract: Synopsis: Concussion is an ongoing concern for health care providers. The incidence rates continue to be high and the rate of recovery is variable due to potential risk factors. With no valid biomarkers, diagnosis and assessment of concussion remain a ... ...

Abstract	Synopsis: Concussion is an ongoing concern for health care providers. The incidence rates continue to be high and the rate of recovery is variable due to potential risk factors. With no valid biomarkers, diagnosis and assessment of concussion remain a clinical challenge. The heterogeneity in presentation following injury provides an additional level of complexity, requiring the screening and evaluation of diverse body systems, including oculomotor, vestibular, autonomic, psychiatric, cervical, and cognitive symptoms. While a few tools, such as the Vestibular/Ocular Motor Screening and Balance Error Scoring System, have been developed specifically for concussion, the vast majority of tests are adapted from other conditions. Further complicating the process is the overlapping and interactive nature of the multiple domains of postconcussion presentation. This commentary illustrates how clinicians can conceptualize the multiple profiles that present following concussion and describes tools that are available to assist with screening and evaluation of each area. The multifaceted nature of concussion warrants broad clinical screening skills and an interdisciplinary approach to management.
MeSH term(s)	Athletic Injuries/diagnosis ; Brain Concussion/diagnosis ; Diagnosis, Differential ; Disability Evaluation ; Exercise Test ; Humans ; Migraine Disorders ; Physical Examination ; Return to Sport ; Vestibular Function Tests
Language	English
Publishing date	2019-10-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	604640-x
ISSN	1938-1344 ; 0190-6011
ISSN (online)	1938-1344
ISSN	0190-6011
DOI	10.2519/jospt.2019.8855
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Article ; Online: Multidomain Predictors of Protracted Recovery following Concussion Among 5- to 9-Year-Old Patients: A Preliminary Study.

Trbovich, Alicia M / Mucha, Anne / Zynda, Aaron J / Farley, Taylor / Kegel, Nathan / Fazio, Vanessa / Collins, Michael W / Kontos, Anthony P

The Journal of pediatrics

2024 Volume 268, Page(s) 113927

Abstract: Objective: To determine which components from a multidomain assessment best predict protracted recovery in pediatric patients with a concussion.: Study design: A prospective cohort of patients aged 5-9 years who presented within 21 days of concussion ...

Abstract	Objective: To determine which components from a multidomain assessment best predict protracted recovery in pediatric patients with a concussion. Study design: A prospective cohort of patients aged 5-9 years who presented within 21 days of concussion to a specialty clinic were categorized into normal (≤30 days) and protracted (>30 days) recovery. Participants provided demographic and medical history information, and completed the Child Sport Concussion Assessment Tool-5 symptom report and balance assessment, the Vestibular/Ocular Motor Screen-Child (VOMS-C), and the Pediatric Immediate Post-concussion Assessment and Cognitive Testing. Univariate logistic regressions (LR) were used to inform a follow-up forward stepwise LR to identify the best predictors of protracted recovery. Receiver operating characteristic analysis of the area under the curve (AUC) was used to identify which predictors retained from the LR model best discriminated recovery. Results: The final sample included 68 patients (7.52 ± 2.3 years; 56% male), 36 (52.9%) with normal and 32 (47.1%) with protracted recovery. Results of the LR to identify protracted recovery were significant (P < .001) and accounted for 39% of the variance. The model accurately classified 78% of patients, with days to first clinic visit (OR, 1.2; 95% CI, 1.1-1.4; P = .003) and positive VOMS-C findings (OR, 8.32; 95% CI, 2.4-28.8; P < .001) as significant predictors. A receiver operating characteristic analysis of the AUC of this 2-factor model discriminated protracted from normal recovery (AUC, 0.82; 95% CI, 0.71-0.92; P < .001). Conclusions: Days to first clinic visit and positive findings on the VOMS-C were the most robust predictors of protracted recovery after concussion in young pediatric patients.
MeSH term(s)	Humans ; Male ; Female ; Brain Concussion/diagnosis ; Child ; Prospective Studies ; Child, Preschool ; Recovery of Function ; Neuropsychological Tests ; ROC Curve ; Logistic Models
Language	English
Publishing date	2024-02-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2024.113927
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Article ; Online: Comparison of Clinical Outcomes Between Athletes With Immediate and Delayed Onset of Symptoms Following Sport-Related Concussion.

Trbovich, Alicia M / Kirschler, Abigail / Preszler, Jonathan / Collins, Michael W / Kontos, Anthony P

Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine

2022

Abstract: Objective: To compare characteristics and clinical outcomes of adolescent athletes with immediate and delayed onset of symptoms following sport-related concussion (SRC). A secondary objective was to describe the symptoms that are delayed and the timing ... ...

Abstract	Objective: To compare characteristics and clinical outcomes of adolescent athletes with immediate and delayed onset of symptoms following sport-related concussion (SRC). A secondary objective was to describe the symptoms that are delayed and the timing of symptom onset. Design: Prospective, repeated measures study. Setting: Concussion Specialty Clinic. Participants: One hundred fifty-two participants (63.3% men) aged 11 to 24 (15.78 ± 3.47) evaluated within 7 days (3.47 ± 1.66) of sustaining an SRC. Independent variable: Group classification of immediate (IMMEDIATE) or delayed onset of symptoms (DELAYED; >60 seconds following mechanism of injury) through structured clinical interview. Main outcome measures: Group comparisons on demographic and medical history factors, concussion and clinical profile symptom scores, computerized neurocognitive test scores, vestibular/oculomotor screening scores, and days to medical clearance. Results: 24.3% of athletes in the sample were DELAYED. The groups did not differ on demographics and medical history. The DELAYED group had increased likelihood of posttraumatic migraine (PTM) as a primary/secondary clinical profile (P = 0.03). Groups did not differ on any other clinical profiles (P > 0.05). Groups did not differ on recovery time (P = 0.47), the IMMEDIATE group higher dizziness on vestibular/ocular motor screening (P = 0.016) and increased likelihood of dizziness being the initial symptom experienced (P < 0 .001). Conclusions: The results indicated that delayed onset of symptoms in athletes were relatively common following SRC, supporting continued evaluation of athletes for several days following suspected injuries. Delayed onset of symptoms was associated with PTM, whereas immediate onset was associated with more pronounced vestibular dysfunction, suggesting that clinicians should consider the timing of symptom onset when assessing and treating athletes following SRC.
Language	English
Publishing date	2022-08-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	1062530-6
ISSN	1536-3724 ; 1050-642X
ISSN (online)	1536-3724
ISSN	1050-642X
DOI	10.1097/JSM.0000000000001059
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Article ; Online: Neck Symptoms and Associated Clinical Outcomes in Patients Following Concussion.

Oyekan, Anthony A / Eagle, Shawn / Trbovich, Alicia M / Shaw, Jeremy D / Schneider, Michael / Collins, Michael / Lee, Joon Y / Kontos, Anthony P

The Journal of head trauma rehabilitation

2023 Volume 38, Issue 6, Page(s) 417–424

Abstract: Objective: To examine the frequency and association of neck pain symptoms in patients with a concussion.: Study setting and participants: Three-hundred and thirty-one consecutively enrolled patients aged 9 to 68 years with a diagnosed concussion 1 to ...

Abstract	Objective: To examine the frequency and association of neck pain symptoms in patients with a concussion. Study setting and participants: Three-hundred and thirty-one consecutively enrolled patients aged 9 to 68 years with a diagnosed concussion 1 to 384 days post-injury were enrolled at a concussion clinic from a single integrated healthcare system in Western Pennsylvania between 2019 and 2021. Design: Retrospective cohort analysis of prospectively collected concussion screening tool intake survey responses and clinical outcomes data. The primary outcome was self-reported neck pain or difficulty with neck movement on the Concussion Clinical Profiles Screening (CP Screen) tool, recovery time, and incidence of treatment referral. Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) composite scores, Vestibular/Ocular Motor Screening (VOMS) item scores, type and severity of neck symptoms, mechanism of injury, time from injury to clinic presentation, medical history, and concussion symptom profile were secondary outcomes. Results: Of the 306 consecutively enrolled eligible patients in the registry, 145 (47%) reported neck pain, 68 (22.2%) reported difficulty moving their neck, and 146 (47.7%) reported either symptom. A total of 47 (15.4%) participants reported more severe neck symptoms, and this group took longer to recover (40 ± 27 days) than those not reporting neck symptoms (30 ± 28 days; U = 8316, P < .001). Stepwise logistic regression predicting more severe neck symptoms was significant (Nagelkerke R2 = 0.174, χ 2 = 9.315, P = .316) with older age ( P = .019) and mechanism of injury including motor vehicle collisions (MVCs) ( P = .047) and falls ( P = .044) as risk factors. MVCs and falls were associated with over 4 times and 2 times greater risk, respectively, for reporting more severe neck symptoms. Conclusion: Neck pain and stiffness symptoms are common in patients with a concussion following high-energy mechanisms of injury including MVCs or falls from height. These symptoms are associated with prolonged recovery. Providers should evaluate neck symptoms and consider targeted treatment strategies to limit their effects in patients with a concussion.
MeSH term(s)	Humans ; Athletic Injuries/diagnosis ; Athletic Injuries/epidemiology ; Athletic Injuries/complications ; Retrospective Studies ; Neck Pain/diagnosis ; Neck Pain/epidemiology ; Neck Pain/etiology ; Brain Concussion/diagnosis ; Brain Concussion/epidemiology ; Brain Concussion/complications ; Neuropsychological Tests ; Post-Concussion Syndrome/diagnosis ; Post-Concussion Syndrome/epidemiology ; Post-Concussion Syndrome/etiology
Language	English
Publishing date	2023-02-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	639221-0
ISSN	1550-509X ; 0885-9701
ISSN (online)	1550-509X
ISSN	0885-9701
DOI	10.1097/HTR.0000000000000866
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Article ; Online: Discriminating Young Children with Concussion in an Outpatient Specialty Clinic from Healthy Controls Using the Child Sports Concussion Assessment Tool-5.

Trbovich, Alicia M / Fazio-Sumrok, Vanessa / Preszler, Jonathan / Shaffer, Madelyn A / Kegel, Nathan / Kissinger-Knox, Alicia / Collins, Michael W / Kontos, Anthony P

The Journal of pediatrics

2023 Volume 257, Page(s) 113380

Abstract: Objective: To evaluate the clinical utility of the Sports Concussion Assessment Tool-5 Child (Child SCAT5) in an outpatient specialty clinic sample of children aged 5-9 years.: Study design: Ninety-six children within 30 days of a concussion (mean = ... ...

Abstract	Objective: To evaluate the clinical utility of the Sports Concussion Assessment Tool-5 Child (Child SCAT5) in an outpatient specialty clinic sample of children aged 5-9 years. Study design: Ninety-six children within 30 days of a concussion (mean = 8.90 ± 5.78 days) and 43 age- and sex-matched healthy controls completed the Child SCAT5, including balance items, cognitive screening, parent and child symptom severity reports, as well as each individual parent- and child-rated symptom severity (0-3). A series of receiver operating characteristic curves with area under the curve (AUC) analysis were performed to evaluate the clinical utility of the Child SCAT5 components to discriminate concussion. Results: The AUC values were nondiscriminate for cognitive screening (0.32) and poor for balance (0.61) items. The AUC values were acceptable for parent-reported symptoms worsening after physical activity (0.73) and mental activity (0.72). The AUCs for symptom severity items were excellent for parent (0.89) and child-reported (0.81) headaches, and were acceptable for parent-reported tired a lot (0.75) and both parent- (0.72) and child-reported (0.72) tired easily. Conclusion: With the exception of parent- and child-reported symptoms, the Child SCAT5 provides limited clinical utility for evaluating concussion in children aged 5-9 years seen at an outpatient concussion specialty clinic. The cognitive screening and balance testing items were not useful in discriminating concussion. Parent- and child-reported headache were the only Child SCAT5 items with excellent ability to differentiate concussion from controls in the age group.
MeSH term(s)	Humans ; Child, Preschool ; Athletic Injuries/diagnosis ; Outpatients ; Neuropsychological Tests ; Brain Concussion/diagnosis ; Sports ; Headache
Language	English
Publishing date	2023-03-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2023.02.024
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Article ; Online: Temporal Changes in Fixational Eye Movements After Concussion in Adolescents and Adults: Preliminary Findings.

Albrecht, Ted J / Makwana Mehmel, Bindal / Rossi, Ethan A / Trbovich, Alicia M / Eagle, Shawn R / Kontos, Anthony P

Journal of neurotrauma

2023 Volume 41, Issue 1-2, Page(s) 199–208

Abstract: Concussions often involve ocular impairment and symptoms such as convergence insufficiency, accommodative insufficiency, blurred vision, diplopia, eye strain, and pain. Current clinical assessments of ocular function and symptoms rely on subjective ... ...

Abstract	Concussions often involve ocular impairment and symptoms such as convergence insufficiency, accommodative insufficiency, blurred vision, diplopia, eye strain, and pain. Current clinical assessments of ocular function and symptoms rely on subjective symptom reporting and/or involve lengthy administration time. More objective, brief assessments of ocular function following concussion are warranted. The purpose of this study was to evaluate changes in fixational eye movements (FEMs) and their association with clinical outcomes including recovery time, symptoms, cognitive and vestibular/ocular motor impairment. Thirty-three athletes (13-27 years of age; 54.5% female) within 21 days of a diagnosed concussion participated in the study. A tracking scanning laser ophthalmoscope (TSLO) evaluated FEMs metrics during fixation on a center and corner target. Participants completed symptom (Post-Concussion Symptom Scale [PCSS]), cognitive (Immediate Post-concussion Assessment and Cognitive Testing [ImPACT], and Vestibular/Ocular Motor Screening (VOMS) evaluations. All measures were administered at the initial visit and following medical clearance, which was defined as clinical recovery. Changes in FEMs were calculated using paired-samples
MeSH term(s)	Humans ; Female ; Adolescent ; Male ; Eye Movements ; Athletic Injuries/diagnosis ; Brain Concussion/complications ; Brain Concussion/diagnosis ; Post-Concussion Syndrome/diagnosis ; Post-Concussion Syndrome/etiology ; Nausea
Language	English
Publishing date	2023-10-17
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	645092-1
ISSN	1557-9042 ; 0897-7151
ISSN (online)	1557-9042
ISSN	0897-7151
DOI	10.1089/neu.2023.0080
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Article ; Online: Impact of Sex and Pubertal Development on Anxiety in Adolescents After Concussion.

Gomes, Dean / Eagle, Shawn / Mehmel, Bindal / Albrecht, Ted / Versace, Amelia / Lima Santos, João Paulo / Trbovich, Alicia / Stiffler, Richelle / Martinez, Laramie / Holland, Cyndi L / Zynda, Aaron J / Collins, Michael W / Kontos, Anthony P

Journal of neurotrauma

2024

Abstract: Concussion often results in psychological symptoms, including anxiety. Post-concussion anxiety has been well documented, although much of this research has focused on collegiate athletes. The purpose of this study was to compare (1) anxiety symptoms in ... ...

Abstract	Concussion often results in psychological symptoms, including anxiety. Post-concussion anxiety has been well documented, although much of this research has focused on collegiate athletes. The purpose of this study was to compare (1) anxiety symptoms in concussed and healthy controls over time and (2) to explore sex differences in post-concussion anxiety within the context of pubertal development. Participants (N = 126, mean age = 15.1 years old), including concussed (
Language	English
Publishing date	2024-03-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	645092-1
ISSN	1557-9042 ; 0897-7151
ISSN (online)	1557-9042
ISSN	0897-7151
DOI	10.1089/neu.2023.0132
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Article ; Online: Evaluating Recovery After Two and Three Repeated Concussions Using Growth Curves.

Preszler, Jonathan / Manderino, Lisa / Eagle, Shawn R / Trbovich, Alicia / Kissinger-Knox, Alicia / Feder, Abigail / Mehmel, Bindal / Collins, Michael W / Kontos, Anthony P

Journal of neurotrauma

2024

Abstract: The results of prior research concerning the effects of repeated concussions have been mixed. The aim of this study was to evaluate how concussion outcomes and presentation changed within patients who were evaluated at a concussion specialty clinic ... ...

Abstract	The results of prior research concerning the effects of repeated concussions have been mixed. The aim of this study was to evaluate how concussion outcomes and presentation changed within patients who were evaluated at a concussion specialty clinic multiple times with a concussion. Subjects included 202 patients (54% male) aged 10-21 years (M = 13.17) who presented to a specialty concussion clinic for two and three concussions (77% sport-related) and were followed through formal clearance. First, growth curve models were estimated to determine recovery time and initial symptom burden across the multiple injuries. Second, covariates were added to these models to evaluate which demographic, risk factor, or injury variables predicted any change that did occur in evaluation or outcome variables. Models indicated that each subsequent concussion linearly resulted in significantly fewer days to recovery (-4.62 days,
Language	English
Publishing date	2024-04-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	645092-1
ISSN	1557-9042 ; 0897-7151
ISSN (online)	1557-9042
ISSN	0897-7151
DOI	10.1089/neu.2023.0148
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Article ; Online: Lower post-injury psychological resilience is associated with increased recovery time and symptom burden following sport-related concussion.

Ernst, Nathan / Eagle, Shawn / Trbovich, Alicia / Kissinger-Knox, Alicia / Bitzer, Hannah / Kontos, Anthony P

Applied neuropsychology. Child

2021 Volume 11, Issue 4, Page(s) 781–788

Abstract: The purpose of this study was to compare athletes with high and low resilience scores on concussion outcomes, and identify significant predictors associated with protracted recovery (>30 days). Forty-five adolescent and young adult athletes (28 males; ... ...

Abstract	The purpose of this study was to compare athletes with high and low resilience scores on concussion outcomes, and identify significant predictors associated with protracted recovery (>30 days). Forty-five adolescent and young adult athletes (28 males; aged 15.13 ± 2.74; range of 11-22) were diagnosed with an SRC within 14 days of injury (M = 4.9 days) and grouped as high or low resilience based on score on the Connor-Davidson Resilience Scale-10 (CD-RISC-10). Primary dependent measures included days to full clearance, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Depression Anxiety and Stress Scale-21 (DASS-21), and Vestibular/Ocular Motor Screening (VOMS). The low resilience group (
MeSH term(s)	Adolescent ; Athletes ; Athletic Injuries/diagnosis ; Brain Concussion/diagnosis ; Humans ; Male ; Neuropsychological Tests ; Post-Concussion Syndrome/complications ; Post-Concussion Syndrome/diagnosis ; Resilience, Psychological ; Sports ; Young Adult
Language	English
Publishing date	2021-08-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2673759-0
ISSN	2162-2973 ; 2162-2965
ISSN (online)	2162-2973
ISSN	2162-2965
DOI	10.1080/21622965.2021.1964966
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Article ; Online: Predictors of poor reading performance in student-athletes following sport-related concussion.

Sherry, Natalie / Trbovich, Alicia / Holland, Cyndi / Eagle, Shawn / Bitzer, Hannah / Kontos, Anthony P

Applied neuropsychology. Child

2021 Volume 11, Issue 3, Page(s) 364–372

Abstract: The goal of the current study was to determine which sport/recreation-related concussion (SRC) assessments predict academic reading performance following SRC. The study included 70 concussed students aged 14-22 years ( ...

Abstract	The goal of the current study was to determine which sport/recreation-related concussion (SRC) assessments predict academic reading performance following SRC. The study included 70 concussed students aged 14-22 years (
MeSH term(s)	Athletes ; Athletic Injuries/complications ; Athletic Injuries/diagnosis ; Brain Concussion/complications ; Brain Concussion/diagnosis ; Humans ; Reading ; Students
Language	English
Publishing date	2021-01-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	2673759-0
ISSN	2162-2973 ; 2162-2965
ISSN (online)	2162-2973
ISSN	2162-2965
DOI	10.1080/21622965.2020.1850449
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