Diwakar, M; Harrington, D L; Maruta, J; Ghajar, J; El-Gabalawy, F; Muzzatti, L; Corbetta, M; Huang, M X; Lee, R R
Filling in the gaps: Anticipatory control of eye movements in chronic mild traumatic brain injury Journal Article
In: NeuroImage Clinical, vol. 8, pp. 210–223, 2015.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Diwakar2015,
title = {Filling in the gaps: Anticipatory control of eye movements in chronic mild traumatic brain injury},
author = {Diwakar, M and Harrington, D L and Maruta, J and Ghajar, J and El-Gabalawy, F and Muzzatti, L and Corbetta, M and Huang, M X and Lee, R R},
year = {2015},
date = {2015-01-01},
journal = {NeuroImage Clinical},
volume = {8},
pages = {210--223},
address = {Diwakar,Mithun. Department of Radiology, University of California, San Diego, San Diego, CA, USA. Harrington,Deborah L. Department of Radiology, University of California, San Diego, San Diego, CA, USA ; Radiology and Research Services, VA San Diego Health},
abstract = {A barrier in the diagnosis of mild traumatic brain injury (mTBI) stems from the lack of measures that are adequately sensitive in detecting mild head injuries. MRI and CT are typically negative in mTBI patients with persistent symptoms of post-concussive syndrome (PCS), and characteristic difficulties in sustaining attention often go undetected on neuropsychological testing, which can be insensitive to momentary lapses in concentration. Conversely, visual tracking strongly depends on sustained attention over time and is impaired in chronic mTBI patients, especially when tracking an occluded target. This finding suggests deficient internal anticipatory control in mTBI, the neural underpinnings of which are poorly understood. The present study investigated the neuronal bases for deficient anticipatory control during visual tracking in 25 chronic mTBI patients with persistent PCS symptoms and 25 healthy control subjects. The task was performed while undergoing magnetoencephalography (MEG), which allowed us to examine whether neural dysfunction associated with anticipatory control deficits was due to altered alpha, beta, and/or gamma activity. Neuropsychological examinations characterized cognition in both groups. During MEG recordings, subjects tracked a predictably moving target that was either continuously visible or randomly occluded (gap condition). MEG source-imaging analyses tested for group differences in alpha, beta, and gamma frequency bands. The results showed executive functioning, information processing speed, and verbal memory deficits in the mTBI group. Visual tracking was impaired in the mTBI group only in the gap condition. Patients showed greater error than controls before and during target occlusion, and were slower to resynchronize with the target when it reappeared. Impaired tracking concurred with abnormal beta activity, which was suppressed in the parietal cortex, especially the right hemisphere, and enhanced in left caudate and frontal-temporal areas. Regional beta-amplitude demonstrated high classification accuracy (92%) compared to eye-tracking (65%) and neuropsychological variables (80%). These findings show that deficient internal anticipatory control in mTBI is associated with altered beta activity, which is remarkably sensitive given the heterogeneity of injuries.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Fuller, G W; Kemp, S P; Decq, P
The International Rugby Board (IRB) Pitch Side Concussion Assessment trial: a pilot test accuracy study Journal Article
In: British Journal of Sports Medicine, vol. 49, pp. 529–535, 2015.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Fuller2015a,
title = {The International Rugby Board (IRB) Pitch Side Concussion Assessment trial: a pilot test accuracy study},
author = {Fuller, G W and Kemp, S P and Decq, P},
year = {2015},
date = {2015-01-01},
journal = {British Journal of Sports Medicine},
volume = {49},
pages = {529--535},
address = {Fuller,Gordon Ward. Emergency Medicine Research in Sheffield Group, School of Health and Related Research, University of Sheffield, Sheffield, UK. Kemp,Simon P T. Rugby Football Union, Middlesex, UK. Decq,Philippe. French Federation of Rugby, Neurosurgica},
abstract = {BACKGROUND: 'On the field and on the run' assessments of head impact events in professional rugby have resulted in a high proportion of players subsequently diagnosed with confirmed concussion not leaving the field of play at the time of injury. The International Rugby Board (IRB) consequently developed a process to support team doctors in the recognition and management of players at risk of concussion, including development of a multimodal assessment instrument-the Pitch Side Concussion Assessment (PSCA) tool. METHODS: This was a pilot cohort study designed to determine the feasibility of assessing the accuracy of the IRB PSCA tool in elite male rugby. The study population comprised consecutive players identified with a head impact event with the potential to result in concussion during eight international/national competitions. Players were assessed off field by match-day or team doctors, following a temporary substitution. The accuracy of the PSCA tool was measured against a reference standard of postmatch confirmed concussion, based on clinical judgement aided by an established concussion support instrument. RESULTS: A total of 165 head injury events with the potential to cause concussion were included in the study. The PSCA tool demonstrated a sensitivity of 84.6% (95% CI 73.5% to 92.4%) and a specificity of 74% (95% CI 64.3% to 82.3%) to identify players subsequently diagnosed with confirmed concussion. The negative predictive value was 88.1% (95% CI 79.2% to 94.1%); the positive predictive value was 67.9% (95% CI 56.6% to 77.8%). There were no major barriers identified that would prevent the evaluation of the PSCA process or tool in a future large-scale study. CONCLUSIONS: This pilot study has provided the first preliminary estimates for the performance of the PSCA tool, suggesting a potentially favourable balance between positive and negative predictive values. The study has also offered a strong basis to conduct a further larger trial, providing information for sample size calculations and highlighting areas for methodological development.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
King, D; Gissane, C; Hume, P A; Flaws, M
The King-Devick test was useful in management of concussion in amateur rugby union and rugby league in New Zealand Journal Article
In: Journal of the Neurological Sciences, vol. 351, pp. 58–64, 2015.
Abstract | BibTeX | Tags: Assessment/Testing
@article{King2015a,
title = {The King-Devick test was useful in management of concussion in amateur rugby union and rugby league in New Zealand},
author = {King, D and Gissane, C and Hume, P A and Flaws, M},
year = {2015},
date = {2015-01-01},
journal = {Journal of the Neurological Sciences},
volume = {351},
pages = {58--64},
address = {King,D. Sports Performance Research Institute New Zealand (SPRINZ) at AUT Millennium Campus, Faculty of Health and Environmental Science, Auckland University of Technology, New Zealand; Emergency Department, Hutt Valley District Health Board, Lower Hutt,},
abstract = {AIM: To use the King-Devick (K-D) test in senior amateur rugby union and rugby league players over a domestic competition season to see if it could identify witnessed and unwitnessed episodes of concussion that occurred from participation in competition matches over three years. METHODS: A prospective observational cohort study was conducted on a club level senior amateur rugby union team (n=36 players in 2012 and 35 players in 2013) and a rugby league team (n=33 players in 2014) during competition seasons in New Zealand. All 104 players completed two trials 10min apart of the K-D at the beginning of their competition season. Concussions (witnessed or unwitnessed) were only recorded if they were formally diagnosed by a health practitioner. RESULTS: A total of 52 (8 witnessed; 44 unwitnessed) concussive events were identified over the duration of the study resulting in a concussion injury incidence of 44 (95% CI: 32 to 56) per 1000 match participation hours. There was a six-fold difference between witnessed and unwitnessed concussions recorded. There were observable learning effects observed between the first and the second K-D test baseline testing (50 vs. 45s; z=-8.81; p\<0.001). For every 1 point reduction in each of the post-injury SAC components there was a corresponding increase (worsening) of K-D test times post-match for changes in orientation (2.9s), immediate memory (1.8s) concentration (2.8s), delayed recall (2.0s) and SAC total score (1.7s). DISCUSSION: The rate of undetected concussion was higher than detected concussions by using the K-D test routinely following matches. Worsening of the K-D test post-match was associated with reduction in components of the SAC. The appeal of the K-D test is in the rapid, easy manner of its administration and the reliable, objective results it provides to the administrator. The K-D test helped identify cognitive impairment in players without clinically observable symptoms.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Ventura, R E; Jancuska, J M; Balcer, L J; Galetta, S L
Diagnostic tests for concussion: is vision part of the puzzle? Journal Article
In: Journal of Neuro-Ophthalmology, vol. 35, pp. 73–81, 2015.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Ventura2015b,
title = {Diagnostic tests for concussion: is vision part of the puzzle?},
author = {Ventura, R E and Jancuska, J M and Balcer, L J and Galetta, S L},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neuro-Ophthalmology},
volume = {35},
pages = {73--81},
address = {Ventura,Rachel E. Departments of Neurology (REV, LJB, SLG), New York University School of Medicine (JMJ), New York, New York.},
abstract = {BACKGROUND: Concussion, particularly in relation to sports and combat activities, is increasingly recognized as a potential cause of both short- and long-term neurologic sequelae. This review will focus on the neuro-ophthalmologic findings associated with concussion, the current tests for concussion, and the potential for visual performance measures to improve our detection and assessment of concussions. EVIDENCE ACQUISITION: A PubMed search using the specific key words "concussion," "mild traumatic brain injury," "neuro-ophthalmological findings," and "diagnostic and management tests" was performed. An emphasis was placed on articles published during the past 5 years, but additional articles referenced within recent publications were obtained. RESULTS: Concussion is frequently associated with abnormalities of saccades, pursuit eye movements, convergence, accommodation, and the vestibular-ocular reflex. Current sideline testing for athletes includes the Sports Concussion Assessment Tool, Third Edition (SCAT3) incorporates cognitive and balance testing. The King-Devick (K-D) test is a rapid visual performance measures that can be used on sidelines by nonmedical personnel, including parents of youth athletes. The K-D test complements components of the SCAT3 and improves the detection of concussions. Other vision-based tools for diagnosing and for managing concussion include eye movement tracking devices, pupillary assessment, computerized testing, imaging modalities, and eletrophysiologic testing. Many of the imaging modalities and electrophysiological studies have been combined with vision-based tests. CONCLUSIONS: Concusssion is associated with many neuro-ophthalmologic signs and symptoms. Visual performance measures enhance the detection and management of concussion, and future studies are under way to further incorporate vision-based testing into sideline diagnosis and long-term clinical assessments.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Luoto, T M; Silverberg, N D; Kataja, A; Brander, A; Tenovuo, O; Ohman, J; Iverson, G L
Sport concussion assessment tool 2 in a civilian trauma sample with mild traumatic brain injury Journal Article
In: Journal of Neurotrauma, vol. 31, pp. 728–738, 2014.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Luoto2014,
title = {Sport concussion assessment tool 2 in a civilian trauma sample with mild traumatic brain injury},
author = {Luoto, T M and Silverberg, N D and Kataja, A and Brander, A and Tenovuo, O and Ohman, J and Iverson, G L},
year = {2014},
date = {2014-01-01},
journal = {Journal of Neurotrauma},
volume = {31},
pages = {728--738},
address = {1 Department of Neurosciences and Rehabilitation, Tampere University Hospital , Tampere, Finland .},
abstract = {The aim of the study was to evaluate the validity of the Sport Concussion Assessment Tool-Second Edition (SCAT2) in patients with acute mild traumatic brain injuries (mTBIs) in a civilian trauma setting. In addition, the SCAT2 was compared to the Military Acute Concussion Evaluation (MACE). All the participants of the study were prospectively recruited from the emergency department of Tampere University Hospital (Tampere, Finland). Patients (n=49) between the ages of 18 and 60 years, with no premorbid medical or psychiatric conditions, who met the World Health Organization criteria for mTBI, were enrolled. Trauma controls (n=33) were recruited using similar study criteria. The main measures of the study consisted of SCAT2, MACE, and mTBI severity markers, including neuroimaging (computed tomography and conventional magnetic resonance imaging [MRI]), and 1-month clinical outcomes (postconcussion syndrome diagnosis and return to work status). The scoreable components of the SCAT2 performed variably across five dimensions of validity (diagnostic, criterion, divergent, predictive, and responsiveness). The Standardized Assessment of Concussion component reasonably discriminated mTBI patients from controls, was associated with MRI lesions, improved over time, and predicted return to work. Symptom scores differentiated patients with mTBIs from controls, and elevated initial symptom scores in patients with mTBI were associated with a greater risk of persistent postconcussion symptoms. The SCAT2 was superior to the MACE. The SCAT2 appears useful for detecting acute mTBI-related symptoms and cognitive impairment, refining prognosis, and monitoring recovery.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Robbins, C A; Daneshvar, D H; Picano, J D; Gavett, B E; Baugh, C M; Riley, D O; Nowinski, C J; McKee, A C; Cantu, R C; Stern, R A
Self-reported concussion history: impact of providing a definition of concussion Journal Article
In: Open Access Journal of Sports Medicine, vol. 5, pp. 99–103, 2014.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Robbins2014,
title = {Self-reported concussion history: impact of providing a definition of concussion},
author = {Robbins, C A and Daneshvar, D H and Picano, J D and Gavett, B E and Baugh, C M and Riley, D O and Nowinski, C J and McKee, A C and Cantu, R C and Stern, R A},
year = {2014},
date = {2014-01-01},
journal = {Open Access Journal of Sports Medicine},
volume = {5},
pages = {99--103},
address = {Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, MA, USA. Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, MA, USA ; Department of Neurology, Boston University S},
abstract = {BACKGROUND: In recent years, the understanding of concussion has evolved in the research and medical communities to include more subtle and transient symptoms. The accepted definition of concussion in these communities has reflected this change. However, it is unclear whether this shift is also reflected in the understanding of the athletic community. WHAT IS KNOWN ABOUT THE SUBJECT: Self-reported concussion history is an inaccurate assessment of someone's lifetime exposure to concussive brain trauma. However, unfortunately, in many cases it is the only available tool. HYPOTHESIS/PURPOSE: We hypothesize that athletes' self-reported concussion histories will be significantly greater after reading them the current definition of concussion, relative to the reporting when no definition was provided. An increase from baseline to post-definition response will suggest that athletes are unaware of the currently accepted medical definition. STUDY DESIGN: Cross-sectional study of 472 current and former athletes. METHODS: Investigators conducted structured telephone interviews with current and former athletes between January 2010 and January 2013, asking participants to report how many concussions they had received in their lives. Interviewers then read participants a current definition of concussion, and asked them to re-estimate based on that definition. RESULTS: THE TWO ESTIMATES WERE SIGNIFICANTLY DIFFERENT (WILCOXON SIGNED RANK TEST: z=15.636, P\<0.001). Comparison of the baseline and post-definition medians (7 and 15, respectively) indicated that the post-definition estimate was approximately twice the baseline. Follow-up analyses indicated that this effect was consistent across all levels of competition examined and across type of sport (contact versus non-contact). CONCLUSION: Our results indicate that athletes' current understandings of concussions are not consistent with a currently accepted medical definition. We strongly recommend that clinicians and researchers preface requests for self-reported concussion history with a definition. In addition, it is extremely important that researchers report the definition they used in published manuscripts of their work. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE: Our study shows that unprompted reporting of concussion history produces results that are significantly different from those provided after a definition has been given, suggesting one possible mechanism to improve the reliability of self-reported concussion history across multiple individuals.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Murray, N; Salvatore, A; Powell, D; Reed-Jones, R
Reliability and validity evidence of multiple balance assessments in athletes with a concussion Journal Article
In: Journal of Athletic Training, vol. 49, pp. 540–549, 2014.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Murray2014b,
title = {Reliability and validity evidence of multiple balance assessments in athletes with a concussion},
author = {Murray, N and Salvatore, A and Powell, D and Reed-Jones, R},
year = {2014},
date = {2014-01-01},
journal = {Journal of Athletic Training},
volume = {49},
pages = {540--549},
address = {Murray,Nicholas. Department of Health and Kinesiology, Georgia Southern University, Statesboro.},
abstract = {CONTEXT: An estimated 300 000 sport-related concussion injuries occur in the United States annually. Approximately 30% of individuals with concussions experience balance disturbances. Common methods of balance assessment include the Clinical Test of Sensory Organization and Balance (CTSIB), the Sensory Organization Test (SOT), the Balance Error Scoring System (BESS), and the Romberg test; however, the National Collegiate Athletic Association recommended the Wii Fit as an alternative measure of balance in athletes with a concussion. A central concern regarding the implementation of the Wii Fit is whether it is reliable and valid for measuring balance disturbance in athletes with concussion. OBJECTIVE: To examine the reliability and validity evidence for the CTSIB, SOT, BESS, Romberg test, and Wii Fit for detecting balance disturbance in athletes with a concussion. DATA SOURCES: Literature considered for review included publications with reliability and validity data for the assessments of balance (CTSIB, SOT, BESS, Romberg test, and Wii Fit) from PubMed, PsycINFO, and CINAHL. DATA EXTRACTION: We identified 63 relevant articles for consideration in the review. Of the 63 articles, 28 were considered appropriate for inclusion and 35 were excluded. DATA SYNTHESIS: No current reliability or validity information supports the use of the CTSIB, SOT, Romberg test, or Wii Fit for balance assessment in athletes with a concussion. The BESS demonstrated moderate to high reliability (interclass correlation coefficient = 0.87) and low to moderate validity (sensitivity = 34%},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Iverson, G L; Koehle, M S
Normative data for the modified balance error scoring system in adults Journal Article
In: Brain Injury, vol. 27, pp. 596–599, 2013.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Iverson2013,
title = {Normative data for the modified balance error scoring system in adults},
author = {Iverson, G L and Koehle, M S},
year = {2013},
date = {2013-01-01},
journal = {Brain Injury},
volume = {27},
pages = {596--599},
abstract = {Primary objective: Head trauma, with or without injury to the brain, can impair balance and postural stability. The Modified Balance Error Scoring System (M-BESS) is a rapid, standardized, objective bedside test that can be helpful for monitoring recovery of balance and postural stability following head trauma. The purpose of this study is to develop preliminary normative data for this test for adults. Methods and procedures: Adults between the ages of 20-69 (n = 1234) were administered the M-BESS as part of a comprehensive preventive health screen. They did not have significant medical, neurological or lower extremity problems that might have an adverse effect on balance. Main outcomes and results: M-BESS performance significantly declined with age. Men and women performed similarly on the M-BESS. There was a small significant difference in M-BESS performance, with obese men performing more poorly than non-obese men and a larger significant difference between obese and non-obese women. Conclusions: The M-BESS normative data are presented for the total sample and by age, sex and age-by-sex. These normative data provide a frame of reference for interpreting M-BESS performance in adults who sustain traumatic brain injuries and adults with diverse neurological problems.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Purcell, Laura; Kissick, Jamie; Rizos, John
Concussion Journal Article
In: CMAJ: Canadian Medical Association Journal, vol. 185, no. 11, pp. 981, 2013, ISBN: 08203946.
Abstract | Links | BibTeX | Tags: Assessment/Testing, BRAIN -- Concussion, BRAIN -- Diseases, BRAIN -- Imaging, BRAIN -- Wounds & injuries, BRAIN function localization, Children Under 13, Overviews
@article{Purcell2013,
title = {Concussion},
author = {Purcell, Laura and Kissick, Jamie and Rizos, John},
doi = {10.1503/cmaj.120039},
isbn = {08203946},
year = {2013},
date = {2013-01-01},
journal = {CMAJ: Canadian Medical Association Journal},
volume = {185},
number = {11},
pages = {981},
abstract = {The article offers information on several topics related to concussions which includes effects of brain trauma on brain functioning, Sport Concussion Assessment Tool 3 and ChildSCAT3 for evaluation of concussion and standard imaging. It also mentions that physical and mental rest is involved in management of acute concussion.},
keywords = {Assessment/Testing, BRAIN -- Concussion, BRAIN -- Diseases, BRAIN -- Imaging, BRAIN -- Wounds \& injuries, BRAIN function localization, Children Under 13, Overviews},
pubstate = {published},
tppubtype = {article}
}
Anonymous,
Pocket CRT Journal Article
In: British Journal of Sports Medicine, vol. 47, no. 5, pp. 267, 2013, ISBN: 1473-0480.
BibTeX | Tags: ambulatory care, Article, Assessment/Testing, brain concussion, human, injury scale, memory disorder, sport injury
@article{Anonymous2013a,
title = {Pocket CRT},
author = {Anonymous},
isbn = {1473-0480},
year = {2013},
date = {2013-01-01},
journal = {British Journal of Sports Medicine},
volume = {47},
number = {5},
pages = {267},
keywords = {ambulatory care, Article, Assessment/Testing, brain concussion, human, injury scale, memory disorder, sport injury},
pubstate = {published},
tppubtype = {article}
}
Temme, L; Bleiberg, J; Reeves, D; Still, D L; Levinson, D; Browning, R
Uncovering latent deficits due to mild traumatic brain injury by using normobaric hypoxia stress Journal Article
In: Frontiers in Neurology, vol. 4, pp. 41, 2013.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Temme2013,
title = {Uncovering latent deficits due to mild traumatic brain injury by using normobaric hypoxia stress},
author = {Temme, L and Bleiberg, J and Reeves, D and Still, D L and Levinson, D and Browning, R},
year = {2013},
date = {2013-01-01},
journal = {Frontiers in Neurology},
volume = {4},
pages = {41},
address = {Temme,Leonard. Vision Sciences Branch, Sensory Research Division, U.S. Army Aeromedical Research Laboratory Fort Rucker, AL, USA.},
abstract = {Memory deficits and other cognitive symptoms frequently associated with mTBI are commonly thought to resolve within 7-10days. This generalization is based principally on observations made in individuals who are in the unstressed environmental conditions typical of a clinic and so does not consider the impact of physiologic, environmental, or psychological stress. Normobaric hypoxic stress can be generated with normal mean sea level (MSL) air, which is about 21% oxygen (O2) and 78% nitrogen (N), by reducing the percentage of O2 and increasing the percentage of N so that the resultant mixed-gas has a partial pressure of O2 approximating that of specified altitudes. This technique was used to generate normobaric hypoxic equivalents of 8,000, 12,000, and 14,000feet above MSL in a group of 36 volunteers with a mTBI history and an equal number of controls matched on the basis of age, gender, tobacco smoking consumption, weight, height, and body mass index. Short-term visual memory was tested using the Matching to Sample (M2S) subtest of the BrainCheckers analog of the Automated Neuropsychological Assessment Metrics. Although there were no significant differences in M2S performance between the two groups of subjects at MSL, with increased altitude, the mTBI group performance was significantly worse than that of the control group. When the subjects were returned to MSL, the difference disappeared. This finding suggests that the "hypoxic challenge" paradigm developed here has potential clinical utility for assessing the effects of mTBI in individuals who appear asymptomatic under normal conditions.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Guskiewicz, K M; Register-Mihalik, J; McCrory, P; McCrea, M; Johnston, K; Makdissi, M; Dvořák, J; Davis, G; Meeuwisse, W
Evidence-based approach to revising the SCAT2: Introducing the SCAT3 Journal Article
In: British Journal of Sports Medicine, vol. 47, pp. 289–293, 2013.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Guskiewicz2013a,
title = {Evidence-based approach to revising the SCAT2: Introducing the SCAT3},
author = {Guskiewicz, K M and Register-Mihalik, J and McCrory, P and McCrea, M and Johnston, K and Makdissi, M and Dvo\v{r}\'{a}k, J and Davis, G and Meeuwisse, W},
year = {2013},
date = {2013-01-01},
journal = {British Journal of Sports Medicine},
volume = {47},
pages = {289--293},
abstract = {The Sport Concussion Assessment Tool 2 (SCAT2), which evolved from the 2008 Concussion in Sport Group (CISG) Consensus meeting, has been widely used internationally for the past 4 years. Although the instrument is considered very practical and moderately effective for use by clinicians who manage concussion, the utility and sensitivity of a 100-point scoring system for the SCAT2 has been questioned. The 2012 CISG Consensus Meeting provided an opportunity for several of the world's leading concussion researchers and clinicians to present data and to share experiences using the SCAT2. The purpose of this report is to consider recommendations by the CISG, and to review the current literature to identify the most sensitive and reliable concussion assessment components for inclusion in a revised version-the SCAT3. Through this process, it was determined that important clinical information can be ascertained in a streamlined manner through the use of a multimodal instrument such as the SCAT3. This test battery should include an initial assessment of injury severity using the Glasgow Coma Scale, immediately followed by observing and documenting concussion signs. Once this is complete, symptom endorsement and symptom severity, neurocognitive function and balance function should be assessed in any athlete suspected of sustaining a concussion. There is no evidence to support the use of a composite/total score; however, there is good evidence to support the use of each component (scored independently) in a revised assessment tool.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Diwakar, M; Harrington, D L; Maruta, J; Ghajar, J; El-Gabalawy, F; Muzzatti, L; Corbetta, M; Huang, M X; Lee, R R
Filling in the gaps: Anticipatory control of eye movements in chronic mild traumatic brain injury Journal Article
In: NeuroImage Clinical, vol. 8, pp. 210–223, 2015.
@article{Diwakar2015,
title = {Filling in the gaps: Anticipatory control of eye movements in chronic mild traumatic brain injury},
author = {Diwakar, M and Harrington, D L and Maruta, J and Ghajar, J and El-Gabalawy, F and Muzzatti, L and Corbetta, M and Huang, M X and Lee, R R},
year = {2015},
date = {2015-01-01},
journal = {NeuroImage Clinical},
volume = {8},
pages = {210--223},
address = {Diwakar,Mithun. Department of Radiology, University of California, San Diego, San Diego, CA, USA. Harrington,Deborah L. Department of Radiology, University of California, San Diego, San Diego, CA, USA ; Radiology and Research Services, VA San Diego Health},
abstract = {A barrier in the diagnosis of mild traumatic brain injury (mTBI) stems from the lack of measures that are adequately sensitive in detecting mild head injuries. MRI and CT are typically negative in mTBI patients with persistent symptoms of post-concussive syndrome (PCS), and characteristic difficulties in sustaining attention often go undetected on neuropsychological testing, which can be insensitive to momentary lapses in concentration. Conversely, visual tracking strongly depends on sustained attention over time and is impaired in chronic mTBI patients, especially when tracking an occluded target. This finding suggests deficient internal anticipatory control in mTBI, the neural underpinnings of which are poorly understood. The present study investigated the neuronal bases for deficient anticipatory control during visual tracking in 25 chronic mTBI patients with persistent PCS symptoms and 25 healthy control subjects. The task was performed while undergoing magnetoencephalography (MEG), which allowed us to examine whether neural dysfunction associated with anticipatory control deficits was due to altered alpha, beta, and/or gamma activity. Neuropsychological examinations characterized cognition in both groups. During MEG recordings, subjects tracked a predictably moving target that was either continuously visible or randomly occluded (gap condition). MEG source-imaging analyses tested for group differences in alpha, beta, and gamma frequency bands. The results showed executive functioning, information processing speed, and verbal memory deficits in the mTBI group. Visual tracking was impaired in the mTBI group only in the gap condition. Patients showed greater error than controls before and during target occlusion, and were slower to resynchronize with the target when it reappeared. Impaired tracking concurred with abnormal beta activity, which was suppressed in the parietal cortex, especially the right hemisphere, and enhanced in left caudate and frontal-temporal areas. Regional beta-amplitude demonstrated high classification accuracy (92%) compared to eye-tracking (65%) and neuropsychological variables (80%). These findings show that deficient internal anticipatory control in mTBI is associated with altered beta activity, which is remarkably sensitive given the heterogeneity of injuries.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Fuller, G W; Kemp, S P; Decq, P
The International Rugby Board (IRB) Pitch Side Concussion Assessment trial: a pilot test accuracy study Journal Article
In: British Journal of Sports Medicine, vol. 49, pp. 529–535, 2015.
@article{Fuller2015a,
title = {The International Rugby Board (IRB) Pitch Side Concussion Assessment trial: a pilot test accuracy study},
author = {Fuller, G W and Kemp, S P and Decq, P},
year = {2015},
date = {2015-01-01},
journal = {British Journal of Sports Medicine},
volume = {49},
pages = {529--535},
address = {Fuller,Gordon Ward. Emergency Medicine Research in Sheffield Group, School of Health and Related Research, University of Sheffield, Sheffield, UK. Kemp,Simon P T. Rugby Football Union, Middlesex, UK. Decq,Philippe. French Federation of Rugby, Neurosurgica},
abstract = {BACKGROUND: 'On the field and on the run' assessments of head impact events in professional rugby have resulted in a high proportion of players subsequently diagnosed with confirmed concussion not leaving the field of play at the time of injury. The International Rugby Board (IRB) consequently developed a process to support team doctors in the recognition and management of players at risk of concussion, including development of a multimodal assessment instrument-the Pitch Side Concussion Assessment (PSCA) tool. METHODS: This was a pilot cohort study designed to determine the feasibility of assessing the accuracy of the IRB PSCA tool in elite male rugby. The study population comprised consecutive players identified with a head impact event with the potential to result in concussion during eight international/national competitions. Players were assessed off field by match-day or team doctors, following a temporary substitution. The accuracy of the PSCA tool was measured against a reference standard of postmatch confirmed concussion, based on clinical judgement aided by an established concussion support instrument. RESULTS: A total of 165 head injury events with the potential to cause concussion were included in the study. The PSCA tool demonstrated a sensitivity of 84.6% (95% CI 73.5% to 92.4%) and a specificity of 74% (95% CI 64.3% to 82.3%) to identify players subsequently diagnosed with confirmed concussion. The negative predictive value was 88.1% (95% CI 79.2% to 94.1%); the positive predictive value was 67.9% (95% CI 56.6% to 77.8%). There were no major barriers identified that would prevent the evaluation of the PSCA process or tool in a future large-scale study. CONCLUSIONS: This pilot study has provided the first preliminary estimates for the performance of the PSCA tool, suggesting a potentially favourable balance between positive and negative predictive values. The study has also offered a strong basis to conduct a further larger trial, providing information for sample size calculations and highlighting areas for methodological development.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
King, D; Gissane, C; Hume, P A; Flaws, M
The King-Devick test was useful in management of concussion in amateur rugby union and rugby league in New Zealand Journal Article
In: Journal of the Neurological Sciences, vol. 351, pp. 58–64, 2015.
@article{King2015a,
title = {The King-Devick test was useful in management of concussion in amateur rugby union and rugby league in New Zealand},
author = {King, D and Gissane, C and Hume, P A and Flaws, M},
year = {2015},
date = {2015-01-01},
journal = {Journal of the Neurological Sciences},
volume = {351},
pages = {58--64},
address = {King,D. Sports Performance Research Institute New Zealand (SPRINZ) at AUT Millennium Campus, Faculty of Health and Environmental Science, Auckland University of Technology, New Zealand; Emergency Department, Hutt Valley District Health Board, Lower Hutt,},
abstract = {AIM: To use the King-Devick (K-D) test in senior amateur rugby union and rugby league players over a domestic competition season to see if it could identify witnessed and unwitnessed episodes of concussion that occurred from participation in competition matches over three years. METHODS: A prospective observational cohort study was conducted on a club level senior amateur rugby union team (n=36 players in 2012 and 35 players in 2013) and a rugby league team (n=33 players in 2014) during competition seasons in New Zealand. All 104 players completed two trials 10min apart of the K-D at the beginning of their competition season. Concussions (witnessed or unwitnessed) were only recorded if they were formally diagnosed by a health practitioner. RESULTS: A total of 52 (8 witnessed; 44 unwitnessed) concussive events were identified over the duration of the study resulting in a concussion injury incidence of 44 (95% CI: 32 to 56) per 1000 match participation hours. There was a six-fold difference between witnessed and unwitnessed concussions recorded. There were observable learning effects observed between the first and the second K-D test baseline testing (50 vs. 45s; z=-8.81; p\<0.001). For every 1 point reduction in each of the post-injury SAC components there was a corresponding increase (worsening) of K-D test times post-match for changes in orientation (2.9s), immediate memory (1.8s) concentration (2.8s), delayed recall (2.0s) and SAC total score (1.7s). DISCUSSION: The rate of undetected concussion was higher than detected concussions by using the K-D test routinely following matches. Worsening of the K-D test post-match was associated with reduction in components of the SAC. The appeal of the K-D test is in the rapid, easy manner of its administration and the reliable, objective results it provides to the administrator. The K-D test helped identify cognitive impairment in players without clinically observable symptoms.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Ventura, R E; Jancuska, J M; Balcer, L J; Galetta, S L
Diagnostic tests for concussion: is vision part of the puzzle? Journal Article
In: Journal of Neuro-Ophthalmology, vol. 35, pp. 73–81, 2015.
@article{Ventura2015b,
title = {Diagnostic tests for concussion: is vision part of the puzzle?},
author = {Ventura, R E and Jancuska, J M and Balcer, L J and Galetta, S L},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neuro-Ophthalmology},
volume = {35},
pages = {73--81},
address = {Ventura,Rachel E. Departments of Neurology (REV, LJB, SLG), New York University School of Medicine (JMJ), New York, New York.},
abstract = {BACKGROUND: Concussion, particularly in relation to sports and combat activities, is increasingly recognized as a potential cause of both short- and long-term neurologic sequelae. This review will focus on the neuro-ophthalmologic findings associated with concussion, the current tests for concussion, and the potential for visual performance measures to improve our detection and assessment of concussions. EVIDENCE ACQUISITION: A PubMed search using the specific key words "concussion," "mild traumatic brain injury," "neuro-ophthalmological findings," and "diagnostic and management tests" was performed. An emphasis was placed on articles published during the past 5 years, but additional articles referenced within recent publications were obtained. RESULTS: Concussion is frequently associated with abnormalities of saccades, pursuit eye movements, convergence, accommodation, and the vestibular-ocular reflex. Current sideline testing for athletes includes the Sports Concussion Assessment Tool, Third Edition (SCAT3) incorporates cognitive and balance testing. The King-Devick (K-D) test is a rapid visual performance measures that can be used on sidelines by nonmedical personnel, including parents of youth athletes. The K-D test complements components of the SCAT3 and improves the detection of concussions. Other vision-based tools for diagnosing and for managing concussion include eye movement tracking devices, pupillary assessment, computerized testing, imaging modalities, and eletrophysiologic testing. Many of the imaging modalities and electrophysiological studies have been combined with vision-based tests. CONCLUSIONS: Concusssion is associated with many neuro-ophthalmologic signs and symptoms. Visual performance measures enhance the detection and management of concussion, and future studies are under way to further incorporate vision-based testing into sideline diagnosis and long-term clinical assessments.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Luoto, T M; Silverberg, N D; Kataja, A; Brander, A; Tenovuo, O; Ohman, J; Iverson, G L
Sport concussion assessment tool 2 in a civilian trauma sample with mild traumatic brain injury Journal Article
In: Journal of Neurotrauma, vol. 31, pp. 728–738, 2014.
@article{Luoto2014,
title = {Sport concussion assessment tool 2 in a civilian trauma sample with mild traumatic brain injury},
author = {Luoto, T M and Silverberg, N D and Kataja, A and Brander, A and Tenovuo, O and Ohman, J and Iverson, G L},
year = {2014},
date = {2014-01-01},
journal = {Journal of Neurotrauma},
volume = {31},
pages = {728--738},
address = {1 Department of Neurosciences and Rehabilitation, Tampere University Hospital , Tampere, Finland .},
abstract = {The aim of the study was to evaluate the validity of the Sport Concussion Assessment Tool-Second Edition (SCAT2) in patients with acute mild traumatic brain injuries (mTBIs) in a civilian trauma setting. In addition, the SCAT2 was compared to the Military Acute Concussion Evaluation (MACE). All the participants of the study were prospectively recruited from the emergency department of Tampere University Hospital (Tampere, Finland). Patients (n=49) between the ages of 18 and 60 years, with no premorbid medical or psychiatric conditions, who met the World Health Organization criteria for mTBI, were enrolled. Trauma controls (n=33) were recruited using similar study criteria. The main measures of the study consisted of SCAT2, MACE, and mTBI severity markers, including neuroimaging (computed tomography and conventional magnetic resonance imaging [MRI]), and 1-month clinical outcomes (postconcussion syndrome diagnosis and return to work status). The scoreable components of the SCAT2 performed variably across five dimensions of validity (diagnostic, criterion, divergent, predictive, and responsiveness). The Standardized Assessment of Concussion component reasonably discriminated mTBI patients from controls, was associated with MRI lesions, improved over time, and predicted return to work. Symptom scores differentiated patients with mTBIs from controls, and elevated initial symptom scores in patients with mTBI were associated with a greater risk of persistent postconcussion symptoms. The SCAT2 was superior to the MACE. The SCAT2 appears useful for detecting acute mTBI-related symptoms and cognitive impairment, refining prognosis, and monitoring recovery.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Robbins, C A; Daneshvar, D H; Picano, J D; Gavett, B E; Baugh, C M; Riley, D O; Nowinski, C J; McKee, A C; Cantu, R C; Stern, R A
Self-reported concussion history: impact of providing a definition of concussion Journal Article
In: Open Access Journal of Sports Medicine, vol. 5, pp. 99–103, 2014.
@article{Robbins2014,
title = {Self-reported concussion history: impact of providing a definition of concussion},
author = {Robbins, C A and Daneshvar, D H and Picano, J D and Gavett, B E and Baugh, C M and Riley, D O and Nowinski, C J and McKee, A C and Cantu, R C and Stern, R A},
year = {2014},
date = {2014-01-01},
journal = {Open Access Journal of Sports Medicine},
volume = {5},
pages = {99--103},
address = {Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, MA, USA. Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, MA, USA ; Department of Neurology, Boston University S},
abstract = {BACKGROUND: In recent years, the understanding of concussion has evolved in the research and medical communities to include more subtle and transient symptoms. The accepted definition of concussion in these communities has reflected this change. However, it is unclear whether this shift is also reflected in the understanding of the athletic community. WHAT IS KNOWN ABOUT THE SUBJECT: Self-reported concussion history is an inaccurate assessment of someone's lifetime exposure to concussive brain trauma. However, unfortunately, in many cases it is the only available tool. HYPOTHESIS/PURPOSE: We hypothesize that athletes' self-reported concussion histories will be significantly greater after reading them the current definition of concussion, relative to the reporting when no definition was provided. An increase from baseline to post-definition response will suggest that athletes are unaware of the currently accepted medical definition. STUDY DESIGN: Cross-sectional study of 472 current and former athletes. METHODS: Investigators conducted structured telephone interviews with current and former athletes between January 2010 and January 2013, asking participants to report how many concussions they had received in their lives. Interviewers then read participants a current definition of concussion, and asked them to re-estimate based on that definition. RESULTS: THE TWO ESTIMATES WERE SIGNIFICANTLY DIFFERENT (WILCOXON SIGNED RANK TEST: z=15.636, P\<0.001). Comparison of the baseline and post-definition medians (7 and 15, respectively) indicated that the post-definition estimate was approximately twice the baseline. Follow-up analyses indicated that this effect was consistent across all levels of competition examined and across type of sport (contact versus non-contact). CONCLUSION: Our results indicate that athletes' current understandings of concussions are not consistent with a currently accepted medical definition. We strongly recommend that clinicians and researchers preface requests for self-reported concussion history with a definition. In addition, it is extremely important that researchers report the definition they used in published manuscripts of their work. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE: Our study shows that unprompted reporting of concussion history produces results that are significantly different from those provided after a definition has been given, suggesting one possible mechanism to improve the reliability of self-reported concussion history across multiple individuals.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Murray, N; Salvatore, A; Powell, D; Reed-Jones, R
Reliability and validity evidence of multiple balance assessments in athletes with a concussion Journal Article
In: Journal of Athletic Training, vol. 49, pp. 540–549, 2014.
@article{Murray2014b,
title = {Reliability and validity evidence of multiple balance assessments in athletes with a concussion},
author = {Murray, N and Salvatore, A and Powell, D and Reed-Jones, R},
year = {2014},
date = {2014-01-01},
journal = {Journal of Athletic Training},
volume = {49},
pages = {540--549},
address = {Murray,Nicholas. Department of Health and Kinesiology, Georgia Southern University, Statesboro.},
abstract = {CONTEXT: An estimated 300 000 sport-related concussion injuries occur in the United States annually. Approximately 30% of individuals with concussions experience balance disturbances. Common methods of balance assessment include the Clinical Test of Sensory Organization and Balance (CTSIB), the Sensory Organization Test (SOT), the Balance Error Scoring System (BESS), and the Romberg test; however, the National Collegiate Athletic Association recommended the Wii Fit as an alternative measure of balance in athletes with a concussion. A central concern regarding the implementation of the Wii Fit is whether it is reliable and valid for measuring balance disturbance in athletes with concussion. OBJECTIVE: To examine the reliability and validity evidence for the CTSIB, SOT, BESS, Romberg test, and Wii Fit for detecting balance disturbance in athletes with a concussion. DATA SOURCES: Literature considered for review included publications with reliability and validity data for the assessments of balance (CTSIB, SOT, BESS, Romberg test, and Wii Fit) from PubMed, PsycINFO, and CINAHL. DATA EXTRACTION: We identified 63 relevant articles for consideration in the review. Of the 63 articles, 28 were considered appropriate for inclusion and 35 were excluded. DATA SYNTHESIS: No current reliability or validity information supports the use of the CTSIB, SOT, Romberg test, or Wii Fit for balance assessment in athletes with a concussion. The BESS demonstrated moderate to high reliability (interclass correlation coefficient = 0.87) and low to moderate validity (sensitivity = 34%},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Iverson, G L; Koehle, M S
Normative data for the modified balance error scoring system in adults Journal Article
In: Brain Injury, vol. 27, pp. 596–599, 2013.
@article{Iverson2013,
title = {Normative data for the modified balance error scoring system in adults},
author = {Iverson, G L and Koehle, M S},
year = {2013},
date = {2013-01-01},
journal = {Brain Injury},
volume = {27},
pages = {596--599},
abstract = {Primary objective: Head trauma, with or without injury to the brain, can impair balance and postural stability. The Modified Balance Error Scoring System (M-BESS) is a rapid, standardized, objective bedside test that can be helpful for monitoring recovery of balance and postural stability following head trauma. The purpose of this study is to develop preliminary normative data for this test for adults. Methods and procedures: Adults between the ages of 20-69 (n = 1234) were administered the M-BESS as part of a comprehensive preventive health screen. They did not have significant medical, neurological or lower extremity problems that might have an adverse effect on balance. Main outcomes and results: M-BESS performance significantly declined with age. Men and women performed similarly on the M-BESS. There was a small significant difference in M-BESS performance, with obese men performing more poorly than non-obese men and a larger significant difference between obese and non-obese women. Conclusions: The M-BESS normative data are presented for the total sample and by age, sex and age-by-sex. These normative data provide a frame of reference for interpreting M-BESS performance in adults who sustain traumatic brain injuries and adults with diverse neurological problems.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Purcell, Laura; Kissick, Jamie; Rizos, John
Concussion Journal Article
In: CMAJ: Canadian Medical Association Journal, vol. 185, no. 11, pp. 981, 2013, ISBN: 08203946.
@article{Purcell2013,
title = {Concussion},
author = {Purcell, Laura and Kissick, Jamie and Rizos, John},
doi = {10.1503/cmaj.120039},
isbn = {08203946},
year = {2013},
date = {2013-01-01},
journal = {CMAJ: Canadian Medical Association Journal},
volume = {185},
number = {11},
pages = {981},
abstract = {The article offers information on several topics related to concussions which includes effects of brain trauma on brain functioning, Sport Concussion Assessment Tool 3 and ChildSCAT3 for evaluation of concussion and standard imaging. It also mentions that physical and mental rest is involved in management of acute concussion.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Anonymous,
Pocket CRT Journal Article
In: British Journal of Sports Medicine, vol. 47, no. 5, pp. 267, 2013, ISBN: 1473-0480.
@article{Anonymous2013a,
title = {Pocket CRT},
author = {Anonymous},
isbn = {1473-0480},
year = {2013},
date = {2013-01-01},
journal = {British Journal of Sports Medicine},
volume = {47},
number = {5},
pages = {267},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Temme, L; Bleiberg, J; Reeves, D; Still, D L; Levinson, D; Browning, R
Uncovering latent deficits due to mild traumatic brain injury by using normobaric hypoxia stress Journal Article
In: Frontiers in Neurology, vol. 4, pp. 41, 2013.
@article{Temme2013,
title = {Uncovering latent deficits due to mild traumatic brain injury by using normobaric hypoxia stress},
author = {Temme, L and Bleiberg, J and Reeves, D and Still, D L and Levinson, D and Browning, R},
year = {2013},
date = {2013-01-01},
journal = {Frontiers in Neurology},
volume = {4},
pages = {41},
address = {Temme,Leonard. Vision Sciences Branch, Sensory Research Division, U.S. Army Aeromedical Research Laboratory Fort Rucker, AL, USA.},
abstract = {Memory deficits and other cognitive symptoms frequently associated with mTBI are commonly thought to resolve within 7-10days. This generalization is based principally on observations made in individuals who are in the unstressed environmental conditions typical of a clinic and so does not consider the impact of physiologic, environmental, or psychological stress. Normobaric hypoxic stress can be generated with normal mean sea level (MSL) air, which is about 21% oxygen (O2) and 78% nitrogen (N), by reducing the percentage of O2 and increasing the percentage of N so that the resultant mixed-gas has a partial pressure of O2 approximating that of specified altitudes. This technique was used to generate normobaric hypoxic equivalents of 8,000, 12,000, and 14,000feet above MSL in a group of 36 volunteers with a mTBI history and an equal number of controls matched on the basis of age, gender, tobacco smoking consumption, weight, height, and body mass index. Short-term visual memory was tested using the Matching to Sample (M2S) subtest of the BrainCheckers analog of the Automated Neuropsychological Assessment Metrics. Although there were no significant differences in M2S performance between the two groups of subjects at MSL, with increased altitude, the mTBI group performance was significantly worse than that of the control group. When the subjects were returned to MSL, the difference disappeared. This finding suggests that the "hypoxic challenge" paradigm developed here has potential clinical utility for assessing the effects of mTBI in individuals who appear asymptomatic under normal conditions.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Guskiewicz, K M; Register-Mihalik, J; McCrory, P; McCrea, M; Johnston, K; Makdissi, M; Dvořák, J; Davis, G; Meeuwisse, W
Evidence-based approach to revising the SCAT2: Introducing the SCAT3 Journal Article
In: British Journal of Sports Medicine, vol. 47, pp. 289–293, 2013.
@article{Guskiewicz2013a,
title = {Evidence-based approach to revising the SCAT2: Introducing the SCAT3},
author = {Guskiewicz, K M and Register-Mihalik, J and McCrory, P and McCrea, M and Johnston, K and Makdissi, M and Dvo\v{r}\'{a}k, J and Davis, G and Meeuwisse, W},
year = {2013},
date = {2013-01-01},
journal = {British Journal of Sports Medicine},
volume = {47},
pages = {289--293},
abstract = {The Sport Concussion Assessment Tool 2 (SCAT2), which evolved from the 2008 Concussion in Sport Group (CISG) Consensus meeting, has been widely used internationally for the past 4 years. Although the instrument is considered very practical and moderately effective for use by clinicians who manage concussion, the utility and sensitivity of a 100-point scoring system for the SCAT2 has been questioned. The 2012 CISG Consensus Meeting provided an opportunity for several of the world's leading concussion researchers and clinicians to present data and to share experiences using the SCAT2. The purpose of this report is to consider recommendations by the CISG, and to review the current literature to identify the most sensitive and reliable concussion assessment components for inclusion in a revised version-the SCAT3. Through this process, it was determined that important clinical information can be ascertained in a streamlined manner through the use of a multimodal instrument such as the SCAT3. This test battery should include an initial assessment of injury severity using the Glasgow Coma Scale, immediately followed by observing and documenting concussion signs. Once this is complete, symptom endorsement and symptom severity, neurocognitive function and balance function should be assessed in any athlete suspected of sustaining a concussion. There is no evidence to support the use of a composite/total score; however, there is good evidence to support the use of each component (scored independently) in a revised assessment tool.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Diwakar, M; Harrington, D L; Maruta, J; Ghajar, J; El-Gabalawy, F; Muzzatti, L; Corbetta, M; Huang, M X; Lee, R R
Filling in the gaps: Anticipatory control of eye movements in chronic mild traumatic brain injury Journal Article
In: NeuroImage Clinical, vol. 8, pp. 210–223, 2015.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Diwakar2015,
title = {Filling in the gaps: Anticipatory control of eye movements in chronic mild traumatic brain injury},
author = {Diwakar, M and Harrington, D L and Maruta, J and Ghajar, J and El-Gabalawy, F and Muzzatti, L and Corbetta, M and Huang, M X and Lee, R R},
year = {2015},
date = {2015-01-01},
journal = {NeuroImage Clinical},
volume = {8},
pages = {210--223},
address = {Diwakar,Mithun. Department of Radiology, University of California, San Diego, San Diego, CA, USA. Harrington,Deborah L. Department of Radiology, University of California, San Diego, San Diego, CA, USA ; Radiology and Research Services, VA San Diego Health},
abstract = {A barrier in the diagnosis of mild traumatic brain injury (mTBI) stems from the lack of measures that are adequately sensitive in detecting mild head injuries. MRI and CT are typically negative in mTBI patients with persistent symptoms of post-concussive syndrome (PCS), and characteristic difficulties in sustaining attention often go undetected on neuropsychological testing, which can be insensitive to momentary lapses in concentration. Conversely, visual tracking strongly depends on sustained attention over time and is impaired in chronic mTBI patients, especially when tracking an occluded target. This finding suggests deficient internal anticipatory control in mTBI, the neural underpinnings of which are poorly understood. The present study investigated the neuronal bases for deficient anticipatory control during visual tracking in 25 chronic mTBI patients with persistent PCS symptoms and 25 healthy control subjects. The task was performed while undergoing magnetoencephalography (MEG), which allowed us to examine whether neural dysfunction associated with anticipatory control deficits was due to altered alpha, beta, and/or gamma activity. Neuropsychological examinations characterized cognition in both groups. During MEG recordings, subjects tracked a predictably moving target that was either continuously visible or randomly occluded (gap condition). MEG source-imaging analyses tested for group differences in alpha, beta, and gamma frequency bands. The results showed executive functioning, information processing speed, and verbal memory deficits in the mTBI group. Visual tracking was impaired in the mTBI group only in the gap condition. Patients showed greater error than controls before and during target occlusion, and were slower to resynchronize with the target when it reappeared. Impaired tracking concurred with abnormal beta activity, which was suppressed in the parietal cortex, especially the right hemisphere, and enhanced in left caudate and frontal-temporal areas. Regional beta-amplitude demonstrated high classification accuracy (92%) compared to eye-tracking (65%) and neuropsychological variables (80%). These findings show that deficient internal anticipatory control in mTBI is associated with altered beta activity, which is remarkably sensitive given the heterogeneity of injuries.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Fuller, G W; Kemp, S P; Decq, P
The International Rugby Board (IRB) Pitch Side Concussion Assessment trial: a pilot test accuracy study Journal Article
In: British Journal of Sports Medicine, vol. 49, pp. 529–535, 2015.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Fuller2015a,
title = {The International Rugby Board (IRB) Pitch Side Concussion Assessment trial: a pilot test accuracy study},
author = {Fuller, G W and Kemp, S P and Decq, P},
year = {2015},
date = {2015-01-01},
journal = {British Journal of Sports Medicine},
volume = {49},
pages = {529--535},
address = {Fuller,Gordon Ward. Emergency Medicine Research in Sheffield Group, School of Health and Related Research, University of Sheffield, Sheffield, UK. Kemp,Simon P T. Rugby Football Union, Middlesex, UK. Decq,Philippe. French Federation of Rugby, Neurosurgica},
abstract = {BACKGROUND: 'On the field and on the run' assessments of head impact events in professional rugby have resulted in a high proportion of players subsequently diagnosed with confirmed concussion not leaving the field of play at the time of injury. The International Rugby Board (IRB) consequently developed a process to support team doctors in the recognition and management of players at risk of concussion, including development of a multimodal assessment instrument-the Pitch Side Concussion Assessment (PSCA) tool. METHODS: This was a pilot cohort study designed to determine the feasibility of assessing the accuracy of the IRB PSCA tool in elite male rugby. The study population comprised consecutive players identified with a head impact event with the potential to result in concussion during eight international/national competitions. Players were assessed off field by match-day or team doctors, following a temporary substitution. The accuracy of the PSCA tool was measured against a reference standard of postmatch confirmed concussion, based on clinical judgement aided by an established concussion support instrument. RESULTS: A total of 165 head injury events with the potential to cause concussion were included in the study. The PSCA tool demonstrated a sensitivity of 84.6% (95% CI 73.5% to 92.4%) and a specificity of 74% (95% CI 64.3% to 82.3%) to identify players subsequently diagnosed with confirmed concussion. The negative predictive value was 88.1% (95% CI 79.2% to 94.1%); the positive predictive value was 67.9% (95% CI 56.6% to 77.8%). There were no major barriers identified that would prevent the evaluation of the PSCA process or tool in a future large-scale study. CONCLUSIONS: This pilot study has provided the first preliminary estimates for the performance of the PSCA tool, suggesting a potentially favourable balance between positive and negative predictive values. The study has also offered a strong basis to conduct a further larger trial, providing information for sample size calculations and highlighting areas for methodological development.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
King, D; Gissane, C; Hume, P A; Flaws, M
The King-Devick test was useful in management of concussion in amateur rugby union and rugby league in New Zealand Journal Article
In: Journal of the Neurological Sciences, vol. 351, pp. 58–64, 2015.
Abstract | BibTeX | Tags: Assessment/Testing
@article{King2015a,
title = {The King-Devick test was useful in management of concussion in amateur rugby union and rugby league in New Zealand},
author = {King, D and Gissane, C and Hume, P A and Flaws, M},
year = {2015},
date = {2015-01-01},
journal = {Journal of the Neurological Sciences},
volume = {351},
pages = {58--64},
address = {King,D. Sports Performance Research Institute New Zealand (SPRINZ) at AUT Millennium Campus, Faculty of Health and Environmental Science, Auckland University of Technology, New Zealand; Emergency Department, Hutt Valley District Health Board, Lower Hutt,},
abstract = {AIM: To use the King-Devick (K-D) test in senior amateur rugby union and rugby league players over a domestic competition season to see if it could identify witnessed and unwitnessed episodes of concussion that occurred from participation in competition matches over three years. METHODS: A prospective observational cohort study was conducted on a club level senior amateur rugby union team (n=36 players in 2012 and 35 players in 2013) and a rugby league team (n=33 players in 2014) during competition seasons in New Zealand. All 104 players completed two trials 10min apart of the K-D at the beginning of their competition season. Concussions (witnessed or unwitnessed) were only recorded if they were formally diagnosed by a health practitioner. RESULTS: A total of 52 (8 witnessed; 44 unwitnessed) concussive events were identified over the duration of the study resulting in a concussion injury incidence of 44 (95% CI: 32 to 56) per 1000 match participation hours. There was a six-fold difference between witnessed and unwitnessed concussions recorded. There were observable learning effects observed between the first and the second K-D test baseline testing (50 vs. 45s; z=-8.81; p\<0.001). For every 1 point reduction in each of the post-injury SAC components there was a corresponding increase (worsening) of K-D test times post-match for changes in orientation (2.9s), immediate memory (1.8s) concentration (2.8s), delayed recall (2.0s) and SAC total score (1.7s). DISCUSSION: The rate of undetected concussion was higher than detected concussions by using the K-D test routinely following matches. Worsening of the K-D test post-match was associated with reduction in components of the SAC. The appeal of the K-D test is in the rapid, easy manner of its administration and the reliable, objective results it provides to the administrator. The K-D test helped identify cognitive impairment in players without clinically observable symptoms.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Ventura, R E; Jancuska, J M; Balcer, L J; Galetta, S L
Diagnostic tests for concussion: is vision part of the puzzle? Journal Article
In: Journal of Neuro-Ophthalmology, vol. 35, pp. 73–81, 2015.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Ventura2015b,
title = {Diagnostic tests for concussion: is vision part of the puzzle?},
author = {Ventura, R E and Jancuska, J M and Balcer, L J and Galetta, S L},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neuro-Ophthalmology},
volume = {35},
pages = {73--81},
address = {Ventura,Rachel E. Departments of Neurology (REV, LJB, SLG), New York University School of Medicine (JMJ), New York, New York.},
abstract = {BACKGROUND: Concussion, particularly in relation to sports and combat activities, is increasingly recognized as a potential cause of both short- and long-term neurologic sequelae. This review will focus on the neuro-ophthalmologic findings associated with concussion, the current tests for concussion, and the potential for visual performance measures to improve our detection and assessment of concussions. EVIDENCE ACQUISITION: A PubMed search using the specific key words "concussion," "mild traumatic brain injury," "neuro-ophthalmological findings," and "diagnostic and management tests" was performed. An emphasis was placed on articles published during the past 5 years, but additional articles referenced within recent publications were obtained. RESULTS: Concussion is frequently associated with abnormalities of saccades, pursuit eye movements, convergence, accommodation, and the vestibular-ocular reflex. Current sideline testing for athletes includes the Sports Concussion Assessment Tool, Third Edition (SCAT3) incorporates cognitive and balance testing. The King-Devick (K-D) test is a rapid visual performance measures that can be used on sidelines by nonmedical personnel, including parents of youth athletes. The K-D test complements components of the SCAT3 and improves the detection of concussions. Other vision-based tools for diagnosing and for managing concussion include eye movement tracking devices, pupillary assessment, computerized testing, imaging modalities, and eletrophysiologic testing. Many of the imaging modalities and electrophysiological studies have been combined with vision-based tests. CONCLUSIONS: Concusssion is associated with many neuro-ophthalmologic signs and symptoms. Visual performance measures enhance the detection and management of concussion, and future studies are under way to further incorporate vision-based testing into sideline diagnosis and long-term clinical assessments.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Luoto, T M; Silverberg, N D; Kataja, A; Brander, A; Tenovuo, O; Ohman, J; Iverson, G L
Sport concussion assessment tool 2 in a civilian trauma sample with mild traumatic brain injury Journal Article
In: Journal of Neurotrauma, vol. 31, pp. 728–738, 2014.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Luoto2014,
title = {Sport concussion assessment tool 2 in a civilian trauma sample with mild traumatic brain injury},
author = {Luoto, T M and Silverberg, N D and Kataja, A and Brander, A and Tenovuo, O and Ohman, J and Iverson, G L},
year = {2014},
date = {2014-01-01},
journal = {Journal of Neurotrauma},
volume = {31},
pages = {728--738},
address = {1 Department of Neurosciences and Rehabilitation, Tampere University Hospital , Tampere, Finland .},
abstract = {The aim of the study was to evaluate the validity of the Sport Concussion Assessment Tool-Second Edition (SCAT2) in patients with acute mild traumatic brain injuries (mTBIs) in a civilian trauma setting. In addition, the SCAT2 was compared to the Military Acute Concussion Evaluation (MACE). All the participants of the study were prospectively recruited from the emergency department of Tampere University Hospital (Tampere, Finland). Patients (n=49) between the ages of 18 and 60 years, with no premorbid medical or psychiatric conditions, who met the World Health Organization criteria for mTBI, were enrolled. Trauma controls (n=33) were recruited using similar study criteria. The main measures of the study consisted of SCAT2, MACE, and mTBI severity markers, including neuroimaging (computed tomography and conventional magnetic resonance imaging [MRI]), and 1-month clinical outcomes (postconcussion syndrome diagnosis and return to work status). The scoreable components of the SCAT2 performed variably across five dimensions of validity (diagnostic, criterion, divergent, predictive, and responsiveness). The Standardized Assessment of Concussion component reasonably discriminated mTBI patients from controls, was associated with MRI lesions, improved over time, and predicted return to work. Symptom scores differentiated patients with mTBIs from controls, and elevated initial symptom scores in patients with mTBI were associated with a greater risk of persistent postconcussion symptoms. The SCAT2 was superior to the MACE. The SCAT2 appears useful for detecting acute mTBI-related symptoms and cognitive impairment, refining prognosis, and monitoring recovery.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Robbins, C A; Daneshvar, D H; Picano, J D; Gavett, B E; Baugh, C M; Riley, D O; Nowinski, C J; McKee, A C; Cantu, R C; Stern, R A
Self-reported concussion history: impact of providing a definition of concussion Journal Article
In: Open Access Journal of Sports Medicine, vol. 5, pp. 99–103, 2014.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Robbins2014,
title = {Self-reported concussion history: impact of providing a definition of concussion},
author = {Robbins, C A and Daneshvar, D H and Picano, J D and Gavett, B E and Baugh, C M and Riley, D O and Nowinski, C J and McKee, A C and Cantu, R C and Stern, R A},
year = {2014},
date = {2014-01-01},
journal = {Open Access Journal of Sports Medicine},
volume = {5},
pages = {99--103},
address = {Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, MA, USA. Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, MA, USA ; Department of Neurology, Boston University S},
abstract = {BACKGROUND: In recent years, the understanding of concussion has evolved in the research and medical communities to include more subtle and transient symptoms. The accepted definition of concussion in these communities has reflected this change. However, it is unclear whether this shift is also reflected in the understanding of the athletic community. WHAT IS KNOWN ABOUT THE SUBJECT: Self-reported concussion history is an inaccurate assessment of someone's lifetime exposure to concussive brain trauma. However, unfortunately, in many cases it is the only available tool. HYPOTHESIS/PURPOSE: We hypothesize that athletes' self-reported concussion histories will be significantly greater after reading them the current definition of concussion, relative to the reporting when no definition was provided. An increase from baseline to post-definition response will suggest that athletes are unaware of the currently accepted medical definition. STUDY DESIGN: Cross-sectional study of 472 current and former athletes. METHODS: Investigators conducted structured telephone interviews with current and former athletes between January 2010 and January 2013, asking participants to report how many concussions they had received in their lives. Interviewers then read participants a current definition of concussion, and asked them to re-estimate based on that definition. RESULTS: THE TWO ESTIMATES WERE SIGNIFICANTLY DIFFERENT (WILCOXON SIGNED RANK TEST: z=15.636, P\<0.001). Comparison of the baseline and post-definition medians (7 and 15, respectively) indicated that the post-definition estimate was approximately twice the baseline. Follow-up analyses indicated that this effect was consistent across all levels of competition examined and across type of sport (contact versus non-contact). CONCLUSION: Our results indicate that athletes' current understandings of concussions are not consistent with a currently accepted medical definition. We strongly recommend that clinicians and researchers preface requests for self-reported concussion history with a definition. In addition, it is extremely important that researchers report the definition they used in published manuscripts of their work. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE: Our study shows that unprompted reporting of concussion history produces results that are significantly different from those provided after a definition has been given, suggesting one possible mechanism to improve the reliability of self-reported concussion history across multiple individuals.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Murray, N; Salvatore, A; Powell, D; Reed-Jones, R
Reliability and validity evidence of multiple balance assessments in athletes with a concussion Journal Article
In: Journal of Athletic Training, vol. 49, pp. 540–549, 2014.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Murray2014b,
title = {Reliability and validity evidence of multiple balance assessments in athletes with a concussion},
author = {Murray, N and Salvatore, A and Powell, D and Reed-Jones, R},
year = {2014},
date = {2014-01-01},
journal = {Journal of Athletic Training},
volume = {49},
pages = {540--549},
address = {Murray,Nicholas. Department of Health and Kinesiology, Georgia Southern University, Statesboro.},
abstract = {CONTEXT: An estimated 300 000 sport-related concussion injuries occur in the United States annually. Approximately 30% of individuals with concussions experience balance disturbances. Common methods of balance assessment include the Clinical Test of Sensory Organization and Balance (CTSIB), the Sensory Organization Test (SOT), the Balance Error Scoring System (BESS), and the Romberg test; however, the National Collegiate Athletic Association recommended the Wii Fit as an alternative measure of balance in athletes with a concussion. A central concern regarding the implementation of the Wii Fit is whether it is reliable and valid for measuring balance disturbance in athletes with concussion. OBJECTIVE: To examine the reliability and validity evidence for the CTSIB, SOT, BESS, Romberg test, and Wii Fit for detecting balance disturbance in athletes with a concussion. DATA SOURCES: Literature considered for review included publications with reliability and validity data for the assessments of balance (CTSIB, SOT, BESS, Romberg test, and Wii Fit) from PubMed, PsycINFO, and CINAHL. DATA EXTRACTION: We identified 63 relevant articles for consideration in the review. Of the 63 articles, 28 were considered appropriate for inclusion and 35 were excluded. DATA SYNTHESIS: No current reliability or validity information supports the use of the CTSIB, SOT, Romberg test, or Wii Fit for balance assessment in athletes with a concussion. The BESS demonstrated moderate to high reliability (interclass correlation coefficient = 0.87) and low to moderate validity (sensitivity = 34%},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Iverson, G L; Koehle, M S
Normative data for the modified balance error scoring system in adults Journal Article
In: Brain Injury, vol. 27, pp. 596–599, 2013.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Iverson2013,
title = {Normative data for the modified balance error scoring system in adults},
author = {Iverson, G L and Koehle, M S},
year = {2013},
date = {2013-01-01},
journal = {Brain Injury},
volume = {27},
pages = {596--599},
abstract = {Primary objective: Head trauma, with or without injury to the brain, can impair balance and postural stability. The Modified Balance Error Scoring System (M-BESS) is a rapid, standardized, objective bedside test that can be helpful for monitoring recovery of balance and postural stability following head trauma. The purpose of this study is to develop preliminary normative data for this test for adults. Methods and procedures: Adults between the ages of 20-69 (n = 1234) were administered the M-BESS as part of a comprehensive preventive health screen. They did not have significant medical, neurological or lower extremity problems that might have an adverse effect on balance. Main outcomes and results: M-BESS performance significantly declined with age. Men and women performed similarly on the M-BESS. There was a small significant difference in M-BESS performance, with obese men performing more poorly than non-obese men and a larger significant difference between obese and non-obese women. Conclusions: The M-BESS normative data are presented for the total sample and by age, sex and age-by-sex. These normative data provide a frame of reference for interpreting M-BESS performance in adults who sustain traumatic brain injuries and adults with diverse neurological problems.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Purcell, Laura; Kissick, Jamie; Rizos, John
Concussion Journal Article
In: CMAJ: Canadian Medical Association Journal, vol. 185, no. 11, pp. 981, 2013, ISBN: 08203946.
Abstract | Links | BibTeX | Tags: Assessment/Testing, BRAIN -- Concussion, BRAIN -- Diseases, BRAIN -- Imaging, BRAIN -- Wounds & injuries, BRAIN function localization, Children Under 13, Overviews
@article{Purcell2013,
title = {Concussion},
author = {Purcell, Laura and Kissick, Jamie and Rizos, John},
doi = {10.1503/cmaj.120039},
isbn = {08203946},
year = {2013},
date = {2013-01-01},
journal = {CMAJ: Canadian Medical Association Journal},
volume = {185},
number = {11},
pages = {981},
abstract = {The article offers information on several topics related to concussions which includes effects of brain trauma on brain functioning, Sport Concussion Assessment Tool 3 and ChildSCAT3 for evaluation of concussion and standard imaging. It also mentions that physical and mental rest is involved in management of acute concussion.},
keywords = {Assessment/Testing, BRAIN -- Concussion, BRAIN -- Diseases, BRAIN -- Imaging, BRAIN -- Wounds \& injuries, BRAIN function localization, Children Under 13, Overviews},
pubstate = {published},
tppubtype = {article}
}
Anonymous,
Pocket CRT Journal Article
In: British Journal of Sports Medicine, vol. 47, no. 5, pp. 267, 2013, ISBN: 1473-0480.
BibTeX | Tags: ambulatory care, Article, Assessment/Testing, brain concussion, human, injury scale, memory disorder, sport injury
@article{Anonymous2013a,
title = {Pocket CRT},
author = {Anonymous},
isbn = {1473-0480},
year = {2013},
date = {2013-01-01},
journal = {British Journal of Sports Medicine},
volume = {47},
number = {5},
pages = {267},
keywords = {ambulatory care, Article, Assessment/Testing, brain concussion, human, injury scale, memory disorder, sport injury},
pubstate = {published},
tppubtype = {article}
}
Temme, L; Bleiberg, J; Reeves, D; Still, D L; Levinson, D; Browning, R
Uncovering latent deficits due to mild traumatic brain injury by using normobaric hypoxia stress Journal Article
In: Frontiers in Neurology, vol. 4, pp. 41, 2013.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Temme2013,
title = {Uncovering latent deficits due to mild traumatic brain injury by using normobaric hypoxia stress},
author = {Temme, L and Bleiberg, J and Reeves, D and Still, D L and Levinson, D and Browning, R},
year = {2013},
date = {2013-01-01},
journal = {Frontiers in Neurology},
volume = {4},
pages = {41},
address = {Temme,Leonard. Vision Sciences Branch, Sensory Research Division, U.S. Army Aeromedical Research Laboratory Fort Rucker, AL, USA.},
abstract = {Memory deficits and other cognitive symptoms frequently associated with mTBI are commonly thought to resolve within 7-10days. This generalization is based principally on observations made in individuals who are in the unstressed environmental conditions typical of a clinic and so does not consider the impact of physiologic, environmental, or psychological stress. Normobaric hypoxic stress can be generated with normal mean sea level (MSL) air, which is about 21% oxygen (O2) and 78% nitrogen (N), by reducing the percentage of O2 and increasing the percentage of N so that the resultant mixed-gas has a partial pressure of O2 approximating that of specified altitudes. This technique was used to generate normobaric hypoxic equivalents of 8,000, 12,000, and 14,000feet above MSL in a group of 36 volunteers with a mTBI history and an equal number of controls matched on the basis of age, gender, tobacco smoking consumption, weight, height, and body mass index. Short-term visual memory was tested using the Matching to Sample (M2S) subtest of the BrainCheckers analog of the Automated Neuropsychological Assessment Metrics. Although there were no significant differences in M2S performance between the two groups of subjects at MSL, with increased altitude, the mTBI group performance was significantly worse than that of the control group. When the subjects were returned to MSL, the difference disappeared. This finding suggests that the "hypoxic challenge" paradigm developed here has potential clinical utility for assessing the effects of mTBI in individuals who appear asymptomatic under normal conditions.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}
Guskiewicz, K M; Register-Mihalik, J; McCrory, P; McCrea, M; Johnston, K; Makdissi, M; Dvořák, J; Davis, G; Meeuwisse, W
Evidence-based approach to revising the SCAT2: Introducing the SCAT3 Journal Article
In: British Journal of Sports Medicine, vol. 47, pp. 289–293, 2013.
Abstract | BibTeX | Tags: Assessment/Testing
@article{Guskiewicz2013a,
title = {Evidence-based approach to revising the SCAT2: Introducing the SCAT3},
author = {Guskiewicz, K M and Register-Mihalik, J and McCrory, P and McCrea, M and Johnston, K and Makdissi, M and Dvo\v{r}\'{a}k, J and Davis, G and Meeuwisse, W},
year = {2013},
date = {2013-01-01},
journal = {British Journal of Sports Medicine},
volume = {47},
pages = {289--293},
abstract = {The Sport Concussion Assessment Tool 2 (SCAT2), which evolved from the 2008 Concussion in Sport Group (CISG) Consensus meeting, has been widely used internationally for the past 4 years. Although the instrument is considered very practical and moderately effective for use by clinicians who manage concussion, the utility and sensitivity of a 100-point scoring system for the SCAT2 has been questioned. The 2012 CISG Consensus Meeting provided an opportunity for several of the world's leading concussion researchers and clinicians to present data and to share experiences using the SCAT2. The purpose of this report is to consider recommendations by the CISG, and to review the current literature to identify the most sensitive and reliable concussion assessment components for inclusion in a revised version-the SCAT3. Through this process, it was determined that important clinical information can be ascertained in a streamlined manner through the use of a multimodal instrument such as the SCAT3. This test battery should include an initial assessment of injury severity using the Glasgow Coma Scale, immediately followed by observing and documenting concussion signs. Once this is complete, symptom endorsement and symptom severity, neurocognitive function and balance function should be assessed in any athlete suspected of sustaining a concussion. There is no evidence to support the use of a composite/total score; however, there is good evidence to support the use of each component (scored independently) in a revised assessment tool.},
keywords = {Assessment/Testing},
pubstate = {published},
tppubtype = {article}
}