Acute Clinical Recovery from Sport-Related Concussion

Concussion is a highly prevalent injury in contact and collision sports that has historically been poorly understood. An influx of sport-concussion research in recent years has led to a dramatic improvement in our understanding of the injury’s defining characteristics and natural history of recovery. In this review, we discuss the current state of knowledge regarding the characteristic features of concussion and typical acute course of recovery, with an emphasis on the aspects of functioning most commonly assessed by clinicians and researchers (e.g., symptoms, cognitive deficits, postural stability). While prototypical clinical recovery is becoming better understood, questions remain regarding what factors (e.g., injury severity, demographic variables, history of prior concussions, psychological factors) may explain individual variability in recovery. Although research concerning individual differences in response to concussion is relatively new, and in many cases limited methodologically, we discuss the evidence about several potential moderators of concussion recovery and point out areas for future research. Finally, we describe how increased knowledge about the negative effects of and recovery following concussion has been translated into clinical guidelines for managing concussed athletes.     

Computerized Neurocognitive Testing in the Management of Sport-Related Concussion: An Update

Since the late nineties, computerized neurocognitive testing has become a central component of sport-related concussion (SRC) management at all levels of sport. In 2005, a review of the available evidence on the psychometric properties of four computerized neuropsychological test batteries concluded that the tests did not possess the necessary criteria to warrant clinical application. Since the publication of that review, several more computerized neurocognitive tests have entered the market place. The purpose of this review is to summarize the body of published studies on psychometric properties and clinical utility of computerized neurocognitive tests available for use in the assessment of SRC. A review of the literature from 2005 to 2013 was conducted to gather evidence of test-retest reliability and clinical validity of these instruments. Reviewed articles included both prospective and retrospective studies of primarily sport-based adult and pediatric samples. Summaries are provided regarding the available evidence of reliability and validity for the most commonly used computerized neurocognitive tests in sports settings.     

An Introduction to Sports Concussion for the Sport Psychology Consultant

This paper was designed to introduce the sport psychology consultant (SPC) to the relevant practical and theoretical information pertaining to sports concussion. The paper discusses four key areas related to sports concussion: 1) recognition, 2) management, 3) psychological issues following a concussion, and 4) prevention and education. Throughout the paper, the authors emphasize the role of the SPC in each of these four areas. An integrated review of the sport concussion literature and current research and guidelines regarding the definition, pathophysiology, symptoms, neuropsychological testing, and risk factors for concussion is presented. The SPC's roles in educating and helping athletes deal with post-concussion issues such as the pressure to return to play and fear of reinjury are examined. The authors highlight the need for baseline neuropsychological testing of athletes; and advocate a multidimensional team approach to sport concussion, involving the SPC as a key member of that team.     

Is extracurricular participation associated with beneficial outcomes? Concurrent and longitudinal relations

The authors examined the relations between participation in a range of high school extracurricular contexts and developmental outcomes in adolescence and young adulthood among an economically diverse sample of African American and European American youths. In general, when some prior self-selection factors were controlled, 11th graders' participation in school clubs and organized sports was associated with concurrent indicators of academic and psychological adjustment and with drug and alcohol use. In addition, participation in 11th grade school clubs and prosocial activities was associated with educational status and civic engagement at 1 year after high school. A few of the concurrent and longitudinal relations between activity participation and development were moderated by race and gender. Finally, breadth of participation, or number of activity contexts, was associated with positive academic, psychological, and behavioral outcomes.     

Ethics,Brain Injuries,and Sports: Prohibition,Reform, and Prudence

Abstract

In this paper, we explore the issue of the elimination of sports, or elements of sports, that present a high risk of brain injury. In particular, we critically examine two elements of Angelo Corlett’s and Pam Sailors’ arguments for the prohibition of football and Nicholas Dixon’s claim for the reformation of boxing to eliminate blows to the head based on (a) the empirical assumption of an essential or causal connection between brain injuries incurred in football and the development of a degenerative brain disease known as chronic traumatic encephalopathy (CTE); and (b) John Stuart Mill’s rejection of consensual domination (ie voluntary enslavement). We present four arguments to contest the validity of Corlett, Dixon’s and Sailor’s positions. Specifically, we argue that (i) certain autonomy-based arguments undermine paternalist arguments for reform; (ii) the nature of the goods people pursue in their lives might justify their foregoing (degrees of) future autonomy; (iii) Mill’s argument against consensual domination draws on ambiguous and arbitrary distinctions; (iv) the lack of consensus and empirical evidence regarding CTE arising from brain injuries in sport underdetermines calls for reform. We conclude that these proposals for reforming or eliminating sports with high risks of brain injuries are not well founded.     

Arrests, recent life circumstances, and recurrent job loss for at-risk young men: An event-history analysis

This study used longitudinal data from 202 at-risk young men to examine effects of arrests, prior risk factors, and recent life circumstances on job loss across a 7-year period in early adulthood. Repeated failure-time continuous event-history analysis indicated that occurrence of job loss was primarily related to prior mental health problems, recent arrests, recent drug use, and recent being married/cohabitation. It is argued that long-term effects of criminal justice contact on employment outcomes should be understood in the context of (shared) prior risk factors and recent life circumstances.     

A concussion by any other name: Differences in willingness to risk brain injury by label and level of participation in high‐school and college sports

One factor in reducing the likelihood of sports‐related brain injuries is the recognition of risks. However, using colloquial terms may deemphasize the severity of these risks. We hypothesized that using colloquial language to describe sports‐related brain injuries will lead to greater willingness to take on the risk. We conducted two experiments, varying the label describing an injury (getting your bell rung, concussion, or brain injury) and assessing willingness of current athletes, former athletes, and nonathletes to accept this risk as part of sports participation. High‐school and college athletes were willing to expose themselves to a high probability of risk, compared with nonathletes, when described colloquially. However, risk thresholds were low and indistinguishable across groups when using the term “brain injury.” Findings remained significant when controlling for knowledge, age, and sensation seeking. These differences indicate that the term “getting your bell rung” should not be used to describe a brain injury.     

Assessment of risk for substance use disorder consequent to consumption of illegal drugs: psychometric validation of the neurobehavior disinhibition trait.

Previous research has shown that the trait neurobehavior disinhibition (ND), which consists of affect, behavior, and cognitive indicators of self-regulation, is a significant predictor of substance use disorder (SUD) between childhood and young adulthood. The authors evaluated the psychometric properties of the ND trait in 278 boys evaluated at ages 10-12 and 16 years. ND score significantly predicted SUD and outcomes that commonly manifest in tandem with SUD by age 19, such as violence, arrests, committing crime while intoxicated, and concussion injury. In addition to predictive validity, the ND trait was found to have good construct, discriminative, and concurrent validity, as well as good test-retest and internal reliability. The ND trait may be useful for detecting youths at high risk for developing SUD and related outcomes.     

Ethical considerations in the management of military related concussion

Since the year 2000 over 300,000 military service members have been diagnosed with mild traumatic brain injury/concussion. Consequently, this injury has become the subject of increased awareness and study within the military healthcare environment. Although single and/or isolated concussions typically heal in a relatively rapid fashion with limited to no long-term sequelae, there is debate in the field about the impact of repeat concussion. To this end, various ethical challenges arise when managing patients with such injuries. Several papers outlining these issues with regard to athletes have been published in the sports medicine literature. However, because providers caring for military service members must make return-to-duty-decisions, practice within the military setting results in a number of unique ethical considerations. More specifically, management of service members with a history of repeat concussion and increasingly complicated recoveries, as well as the potential for premature return-to-duty are topics of concern for military health care providers. Using the American Psychological Association ethical principles and standards, the current article outlines various ethical challenges to concussion management in the military setting. The ethical principles of Beneficence and Nonmaleficence and Respect for People’s Rights and Dignity, as well as the 3 related ethical standards of Competence, Avoiding Harm, and Conflict of Interest are discussed. Policy changes are highlighted as a proximal solution to these ethical challenges.     

Crime and violence in Brazil: Systematic review of time trends,prevalence rates and risk factors

Between 1980 and 2010 there were 1 million homicides in Brazil. Dramatic increases in homicide rates followed rises in inequality, more young men in the population, greater availability of firearms, and increased drug use. Nevertheless, disarmament legislation may have helped reduce homicide rates in recent years. Despite its very high rate of lethal violence, Brazil appears to have similar levels of general criminal victimization as several other Latin American and North American countries. Brazil has lower rates of drug use compared to other countries such as the United States, but the prevalence of youth drug use in Brazil has increased substantially in recent years. Since 1990, the growth of the Brazilian prison population has been enormous, resulting in the fourth largest prison population in the world. Through a systematic review of the literature, we identified 10 studies assessing the prevalence of self-reported offending in Brazil and 9 studies examining risk factors. Levels of self-reported offending seem quite high among school students in Brazil. Individual and family-level risk factors identified in Brazil are very similar to those found in high-income countries.     

Posttraumatic stress disorder following the September 11, 2001, terrorist attacks: a review of the literature among highly exposed populations

The September 11, 2001 (9/11), terrorist attacks were unprecedented in their magnitude and aftermath. In the wake of the attacks, researchers reported a wide range of mental and physical health outcomes, with posttraumatic stress disorder (PTSD) the one most commonly studied. In this review, we aim to assess the evidence about PTSD among highly exposed populations in the first 10 years after the 9/11 attacks. We performed a systematic review. Eligible studies included original reports based on the full Diagnostic and Statistical Manual of Mental Disorders (4th ed., rev.; American Psychiatric Association, 2000) criteria of PTSD among highly exposed populations such as those living or working within close proximity to the World Trade Center (WTC) and the Pentagon in New York City and Washington, DC, respectively, and first responders, including rescue, cleaning, and recovery workers. The large body of research conducted after the 9/11 attacks in the past decade suggests that the burden of PTSD among persons with high exposure to 9/11 was substantial. PTSD that was 9/11-related was associated with a wide range of correlates, including sociodemographic and background factors, event exposure characteristics, loss of life of significant others, and social support factors. Few studies used longitudinal study design or clinical assessments, and no studies reported findings beyond six years post-9/11, thus hindering documentation of the long-term course of confirmed PTSD. Future directions for research are discussed.     

A systematic review of the effectiveness of machine learning for predicting psychosocial outcomes in acquired brain injury: Which algorithms are used and why?

Clinicians working in the field of acquired brain injury (ABI, an injury to the brain sustained after birth) are challenged to develop suitable care pathways for an individual client’s needs. Being able to predict psychosocial outcomes after ABI would enable clinicians and service providers to make advance decisions and better tailor care plans. Machine learning (ML, a predictive method from the field of artificial intelligence) is increasingly used for predicting ABI outcomes. This review aimed to examine the efficacy of using ML to make psychosocial predictions in ABI, evaluate the methodological quality of studies, and understand researchers’ rationale for their choice of ML algorithms. Nine studies were reviewed from five databases, predicting a range of psychosocial outcomes from stroke, traumatic brain injury, and concussion. Eleven types of ML were employed with a total of 75 ML models. Every model was evaluated as having high risk of bias, unable to provide adequate evidence for predictive performance due to poor methodological quality. Overall, there was limited rationale for the choice of ML algorithms and poor evaluation of the methodological limitations by study authors. Considerations for overcoming methodological shortcomings are discussed, along with suggestions for assessing the suitability of data and suitability of ML algorithms for different ABI research questions.     

Review of a Parent’s Influence on Pediatric Procedural Distress and Recovery

Understanding how parents influence their child’s medical procedures can inform future work to reduce pediatric procedural distress and improve recovery outcomes. Following a pediatric injury or illness diagnosis, the associated medical procedures can be potentially traumatic events that are often painful and distressing and can lead to the child experiencing long-term physical and psychological problems. Children under 6 years old are particularly at risk of illness or injury, yet their pain-related distress during medical procedures is often difficult to manage because of their young developmental level. Parents can also experience ongoing psychological distress following a child’s injury or illness diagnosis. The parent and parenting behavior is one of many risk factors for increased pediatric procedural distress. The impact of parents on pediatric procedural distress is an important yet not well-understood phenomenon. There is some evidence to indicate parents influence their child through their own psychological distress and through parenting behavior. This paper has three purposes: (1) review current empirical research on parent-related risk factors for distressing pediatric medical procedures, and longer-term recovery outcomes; (2) consider and develop existing theories to present a new model for understanding the parent–child distress relationship during medical procedures; and (3) review and make recommendations regarding current assessment tools and developing parenting behavior interventions for reducing pediatric procedural distress.     

Resilience and Other Possible Outcomes After Mild Traumatic Brain Injury: a Systematic Review

The relation between resilience and mild traumatic brain injury (TBI) outcome has been theorized but empirical studies have been scarce. This systematic review aimed to describe the research in this area. Electronic databases (Medline, CINAHL, PsychINFO, SPORTdiscus, and PILOTS) were searched from inception to August 2015 for studies in which resilience was measured following TBI. The search terms included ‘TBI’ ‘concussion’ ‘postconcussion’ ‘resilience’ and ‘hardiness’. Inclusion criteria were peer reviewed original research reports published in English, human participants aged 18 years and over with brain injury, and an accepted definition of mild TBI. Hand searching of identified articles was also undertaken. Of the 71 studies identified, five studies were accepted for review. These studies were formally assessed for risk of bias by two independent reviewers. Each study carried a risk of bias, most commonly a detection bias, but none were excluded on this basis. A narrative interpretation of the findings was used because the studies reflected fundamental differences in the conceptualization of resilience. No studies employed a trajectory based approach to measure a resilient outcome. In most cases, the eligible studies assessed trait resilience with a scale and used it as a predictor of outcome (postconcussion symptoms). Three of these studies showed that greater trait resilience was associated with better mild TBI outcomes (fewer symptoms). Future research of the adult mild TBI response that predicts a resilient outcome is encouraged. These studies could yield empirical evidence for a resilient, and other possible mild TBI outcomes.     

Associations between depression, distress tolerance, delay discounting, and alcohol-related problems in European American and African American college students

Although levels of heavy drinking and alcohol-related problems are high in college students, there is significant variability in the number and type of problems experienced, even among students who drink heavily. African American students drink less and experience fewer alcohol-related problems than European American students, but are still at risk, and little research has investigated the potentially unique patterns and predictors of problems among these students. Depression, distress tolerance, and delay discounting have been implicated in adult substance abuse and may be important predictors of alcohol problem severity among college students. We examined the relationship between these variables and alcohol-related problems among African American and European American students (N = 206; 53% female; 68% European American; 28% African American) who reported recent heavy drinking. In regression models that controlled for drinking level, depression, distress tolerance, and delay discounting were associated with alcohol problems among African American students, but only depression was associated with alcohol problems among European American students. These results suggest that negative affect is a key risk factor for alcohol problems among college student drinkers. For African American students, the inability to tolerate negative emotions and to organize their behavior around future outcomes may also be especially relevant risk factors.     

Evaluating behavioral skills training to teach safe tackling skills to youth football players

With concussion rates on the rise for football players, there is a need for further research to increase skills and decrease injuries. Behavioral skills training is effective in teaching a wide variety of skills but has yet to be studied in the sports setting. We evaluated behavioral skills training to teach safer tackling techniques to six participants from a Pop Warner football team. Safer tackling techniques increased during practice and generalized to games for the two participants who had opportunities to tackle in games.     

The influence of psychological variables on sports performance: assessment with the Questionnaire of Sports Performance-related Psychological Characteristics

The purpose of this research was to observe the relationship among psychological variables and three important issues in sports competition: achieving success, long-term continuance and sustaining injuries. Three studies were carried out with three groups of athletes from the areas of judo, football and swimming, using the Questionnaire of Sports Performance-related Psychological Characteristics as the measuring instrument. The analyses carried out revealed significantly statistical associations between the perception of stress control and of self-confidence, and between achieving success, long-term continuance in competition sports and sustaining injuries. These results indicate the importance of psychological skills training to aid sports performance and prevent injuries, as well as the use of the above-mentioned questionnaire, which, with a limited number of items, measures a wide range of psychological variables in the specific context of sports.     

Mental health in retired professional football players: 12-month incidence,adverse life events and support

ObjectivesThe primary aim was to explore the incidence of symptoms of common mental disorders (CMD; distress, sleep disturbance, anxiety/depression, adverse alcohol use) in retired professional football players and to explore the association between adverse life events and the onset of symptoms of CMD. The secondary aim was to get an insight into the views and needs of retired professional football players on medical support related to symptoms of CMD.DesignAn observational prospective cohort study with three measurements over a follow-up period of twelve months was conducted among retired professional football players.MethodThe data for symptoms of CMD and adverse life events was collected by using validated questionnaires. The views and needs were explored by means of five questions.ResultsThe 12-month incidence of symptoms of CMD (self-reported and not clinically diagnosed) ranged from 11 to 29%. Retired professional football players with one or two life events were 1.7 times more likely to report distress than retired football players with no life events. The risk with three or more recent life events on sleep disturbance was more than 4.5 times higher than with no recent life events.ConclusionsThe 12-months incidence of symptoms of CMD in retired professional football players seems high compared to the general population. More life events showed a higher risk of experiencing distress and sleep disturbance in retired professional football players. The views and needs showed that there is a need for support for current and former professional football players.     

Athletic experience influences shoulder rotations when running through apertures

In order to pass through apertures safely and efficiently, individuals must perceive the width of the aperture relative to (1) the width of the person-plus-object system and to (2) their (anticipated) movement speed. The present study investigated whether athletes who have extensive experience playing sports that require running through narrow spaces while wearing shoulder pads control their shoulder rotations differently while performing this behavior than athletes who lack such experience. Groups of athletes with experience competing in different sports (American football, rugby, and control athletes) performed a behavioral task in which they ran or walked between two tucking dummies with or without wearing shoulder pads. They also performed a psychophysical task in which they reported perceived width of the body and shoulder pads. When running through the apertures, the athletes who played American football exhibited smaller magnitudes and later onset of shoulder rotations than control athletes. No such difference was found when walking through the apertures. There was no difference in perception of the width of the shoulder pads among three groups. These findings suggest that performance of this behavior is action-scaled and task-specific.