• SCAT
• brain injury
• concussion
• pre-season
• rugby

• concussion
• pediatric sports medicine
• persistent postconcussion symptoms
• visio-vestibular examination

• Humans
• Child
• Adolescent
• Cohort Studies
• Prospective Studies
• Brain Concussion/etiology
• Post-Concussion Syndrome/diagnosis
• Post-Concussion Syndrome/etiology
• Risk Factors

• K23 NS128275 NINDS NIH HHS
• R01 NS097549 NINDS NIH HHS

• King-Devick test
• Postconcussion Symptom Inventory
• Sport Concussion Assessment Tool
• visio-vestibular examination

• Humans
• Adolescent
• Young Adult
• Adult
• Cross-Sectional Studies
• Neuropsychological Tests
• Brain Concussion/diagnosis
• Schools
• Sports
• Athletic Injuries/diagnosis

• R01 NS097549 NINDS NIH HHS

• Adolescent
• Humans
• Child
• Male
• Female
• Prospective Studies
• Ecological Momentary Assessment
• Brain Concussion/diagnosis
• Exercise
• Emergency Service, Hospital

• T2*
• concussion
• iron deposition
• migraine
• post-traumatic headache
• thalamus

• headache diary
• headache frequency
• mild traumatic brain injury
• post-traumatic headache
• predictive modeling

• Sport concussion assessment tool 5
• balance assessment
• neurocognitive testing
• sideline testing
• sport-related concussion
• standardized assessment of concussion

• Concussion
• Hormones
• Intimate partner violence
• Mild traumatic brain injury
• Persisting symptoms of concussion

• Brain Concussion/diagnosis
• Brain Concussion/epidemiology
• Brain Concussion/psychology
• Female
• Humans
• Incidence
• Male
• Risk Factors
• Sex Factors

• Concussion
• interprofessional Practice
• mild TBI
• return to Academics
• return to Learn
• return to School

• Athletes
• Athletic Injuries/therapy
• Brain Concussion/therapy
• Humans
• Interprofessional Relations
• Schools
• Sports Medicine

• Athletic Injuries/diagnosis
• Athletic Performance
• Brain Concussion/diagnosis
• Cross-Sectional Studies
• Female
• Football
• Humans
• Male
• Memory, Short-Term
• Neuropsychological Tests

Changes in speech can be detected objectively before and during migraine attacks. The goal of this study was to interrogate whether speech changes can be detected in subjects with post-traumatic headache (PTH) attributed to mild traumatic brain injury (mTBI) and whether there are within-subject changes in speech during headaches compared to the headache-free state.

Using a series of speech elicitation tasks uploaded via a mobile application, PTH subjects and healthy controls (HC) provided speech samples once every 3 days, over a period of 12 weeks. The following speech parameters were assessed: vowel space area, vowel articulation precision, consonant articulation precision, average pitch, pitch variance, speaking rate and pause rate. Speech samples of subjects with PTH were compared to HC. To assess speech changes associated with PTH, speech samples of subjects during headache were compared to speech samples when subjects were headache-free. All analyses were conducted using a mixed-effect model design.

Longitudinal speech samples were collected from nineteen subjects with PTH (mean age = 42.5, SD = 13.7) who were an average of 14 days (SD = 32.2) from their mTBI at the time of enrollment and thirty-one HC (mean age = 38.7, SD = 12.5). Regardless of headache presence or absence, PTH subjects had longer pause rates and reductions in vowel and consonant articulation precision relative to HC. On days when speech was collected during a headache, there were longer pause rates, slower sentence speaking rates and less precise consonant articulation compared to the speech production of HC. During headache, PTH subjects had slower speaking rates yet more precise vowel articulation compared to when they were headache-free.

Compared to HC, subjects with acute PTH demonstrate altered speech as measured by objective features of speech production. For individuals with PTH, speech production may have been more effortful resulting in slower speaking rates and more precise vowel articulation during headache vs. when they were headache-free, suggesting that speech alterations were related to PTH and not solely due to the underlying mTBI.

• Language
• Migraine
• Post-traumatic headache
• Speech
• mTBI

• Head injuries
• brain concussion
• self-report
• sports psychology
• traumatic brain injury

• concussion
• female
• gender
• male
• sports analysis in different types of sports

Objective: There are growing concerns about the short- and long-term consequences of sports-related concussion, which account for about 5–9% of all sports injuries. We hypothesized there may be sex differences in concussion history and concussion-related symptoms, evaluated among elite soccer players in Sweden.

Design: Retrospective survey study.

Participants and Setting: Soccer players (n = 1,030) from 55 Swedish elite soccer teams. Questionnaires were completed prior to the start of the 2017 season.

Assessment of Risk Factors: Player history of soccer-related concussion (SoRC), symptoms and management following a SoRC were evaluated.

Main Outcome Measures: Before the start of the season the players completed a baseline questionnaire assessing previous concussions. The Sports Concussion Assessment Tool 3 was included with regard to symptom evaluation.

Results: Out of 993 responding players 334 (34.6%) reported a previous SoRC and 103 players (10.4%) reported a SoRC during the past year. After sustaining a SoRC, 114 players (34.2%) reported that they continued their ongoing activity without a period of rest, more commonly female (44.9%) than male players (27.7%; P = 0.002). Symptom resolution time was 1 week or less for 61.3% of the players that reported having persisting symptoms. A positive correlation was observed between number of previous concussions and prevalence of three persisting symptoms: fatigue (P < 0.001), concentration/memory issues (P = 0.002) and headache (P = 0.047).

Conclusion: About 35% of male and female elite soccer players in Sweden have experienced a previous SoRC, and about 10% experienced a SoRC during the last year. Female players continued to play after a SoRC, without a period of rest, more often than males. A higher risk of persisting symptoms was observed in players with a history of multiple concussions.

• concussion
• diagnosis
• evaluation
• hockey

Rugby Union requires annual baseline testing using the Sports Concussion Assessment Tool (SCAT5) as part of its head injury assessment protocols. Scores achieved during baseline testing are used to guide return-to-play decisions at the time of head impact events during matches, and concussion diagnosis during subsequent diagnostic screens. Baseline values must be valid, accurate representations of a player’s capability in the various SCAT5 sub-modes, including symptom report, cognitive function and balance. The extent to which prior exercise may affect performance is an important consideration, and the present cross-sectional study aimed to explore how SCAT5 performance differs when assessed at rest (RSCAT) compared to after 30 min of exercise (EXSCAT) in 698 male professional rugby players for whom paired exercise and rest SCAT5 data were available.

Symptom endorsement was greater when assessed after exercise than at rest. Fatigue/Low energy was 1.5 times more likely to be reported when assessed during EXSCAT. Orientation score was improved during SCAT5s performed after exercise, but only when rest and exercise SCAT5s were conducted on the same day, suggesting a learning effect. Concentration score was impaired during EXSCAT. No other cognitive sub-modes were affected by exercise. Total errors during Modified Balance Error Scoring System (MBESS) increased during EXSCAT, as a result of increased errors made during single leg balance, irrespective of testing sequence, with 42% of players making more errors in EXSCAT, compared to 28% making more errors in RSCAT.

Symptoms, cognitive sub-modes and balance sub-modes are all affected by exercise. These may be the result of learning effects that improve cognitive performance, and the direct effects of exercise on sub-mode performance. The clinical implications of these changes may be assessed in the future through a study of diagnostic screens in players after head impact events, to confirm whether an exercise baseline screen is required annually, or whether specific sub-modes of the SCAT5 should be obtained at rest and after exercise.

• Concussion
• Concussion management
• Neurological screening
• Rugby union
• SCAT

• neurological injury
• physiology
• sports medicine

• Athletic Injuries/diagnosis
• Brain Concussion/diagnosis
• Football
• Gait
• Humans
• Neuropsychological Tests
• Retrospective Studies

• Concussion
• Concussion management
• Injury
• Neurological screening
• Rugby Union
• SCAT

• cervical spine
• mild traumatic brain injury
• pain
• sports
• youth

• head injury
• mild traumatic brain injury
• neurocognitive testing
• sideline testing

• cognition
• concussion
• headache
• outcome
• pediatric
• risk factor
• traumatic brain injury

• accumulative
• basal ganglia
• cumulative effects
• graded symptoms
• head injury
• sport injury

• SCAT
• concussion
• mild traumatic brain injury
• sideline
• sideline assessment
• sports-related concussion

• Mild traumatic brain injury
• gender differences
• head injury
• neuropsychological outcomes
• postconcussion symptoms

Baseline concussion assessments are advocated to provide an objective preinjury point of comparison for determining the extent of postconcussion neurological deficits and to assist with return-to-activity decision making. Many factors, including testing environment, proctor availability, and testing group size, can influence test accuracy and validity; however, it is unknown how self-reported fatigue affects test scores.

To investigate the influence of self-reported fatigue and patient sex on baseline concussion assessment scores.

Cross-sectional study; Level of evidence, 3.

Participants included 494 healthy Division I college student-athletes (221 women, 273 men; mean ± SD age, 20.0 ± 1.3 years). During preseason baseline testing, participants were asked to rate their fatigue on a scale from 0 to 100 based on how they normally feel and function each day (0, completely exhausted; 100, completely awake and alert). Each participant then completed a multimodal baseline concussion assessment, including a graded symptom checklist (number of symptoms endorsed and total symptom severity score), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and CNS Vital Signs computerized neurocognitive testing. Multiple linear regressions tested whether self-reported fatigue and sex predicted baseline concussion examination scores.

Athletes with higher self-reported fatigue levels (ß = –0.014, P < .01) and female athletes (ß = –0.216, P < .01) reported more total symptoms. Being male (ß = 0.856, P < .01) increased the likelihood of endorsing zero symptoms versus any symptoms by a factor of 2.40. Women also had significantly higher SAC scores (ß = 0.569, P < .001), BESS scores (ß = –2.747, P < .001), and CNS Vital Signs summary scores (ß = 4.506, P < .001). SAC, BESS, and CNS Vital Signs scores were not predicted by fatigue level (P > .05).

Female athletes and fatigued athletes endorsed more symptoms and higher symptom severity at baseline. Using total symptom endorsement and total symptom severity scores as part of the postinjury management is a common practice. The current data suggest that levels of reported exhaustion can influence concussion assessment scores meant to represent a healthy baseline and likely would interfere with postinjury assessment scores.

• college athlete
• mild traumatic brain injury
• neurocognition
• postinjury
• postural control

• Adolescent
• Adult
• Anisotropy
• Athletes
• Cross-Sectional Studies
• Diffusion Tensor Imaging
• Female
• Humans
• Longitudinal Studies
• Magnetic Resonance Imaging/methods
• Male
• Middle Aged
• Neuroimaging/methods
• Prospective Studies
• Sex Factors
• Soccer
• White Matter/diagnostic imaging
• White Matter/pathology
• Young Adult

• R01 NS082432 NINDS NIH HHS
• T32 GM007288 NIGMS NIH HHS

• SCAT5
• concussion
• sport concussion assessment tool

• SCAT3
• athletes
• concussion
• epidemiology
• sex differences

Injury risk in youth rugby has received much attention, highlighting the importance of establishing evidence-based injury reduction strategies.

To determine the efficacy of a movement control exercise programme in reducing injuries in youth rugby players and to investigate the effect of programme dose on injury measures.

In a cluster-randomised controlled trial, 40 independent schools (118 teams, 3188 players aged 14–18 years) were allocated to receive either the intervention or a reference programme, both of which were to be delivered by school coaches. The intervention comprised balance training, whole-body resistance training, plyometric training, and controlled rehearsal of landing and cutting manoeuvres. Time-loss (>24 hours) injuries arising from school rugby matches were recorded by coaches and medical staff.

441 time-loss match injuries (intervention, 233; control, 208) were reported across 15 938 match exposure-hours (intervention, 9083; control, 6855). Intention-to-treat results indicated unclear effects of trial arm on overall match injury incidence (rate ratio (RR)=0.85, 90% confidence limits 0.61 to 1.17), although clear reductions were evident in the intervention arm for concussion incidence (RR=0.71, 0.48 to 1.05). When trial arm comparisons were limited to teams who had completed three or more weekly programme sessions on average, clear reductions in overall match injury incidence (RR=0.28, 0.14 to 0.51) and concussion incidence (RR=0.41, 0.17 to 0.99) were noted in the intervention group.

A preventive movement control exercise programme can reduce match injury outcomes, including concussion, in schoolboy rugby players when compared with a standardised control exercise programme, although to realise the greatest effects players should complete the programme at least three times per week.

• Concussion
• Injury prevention
• Intervention
• Rugby

• assessment
• return to play
• traumatic brain injuries

• Athletes
• Athletic Injuries/diagnosis
• Athletic Injuries/prevention & control
• Brain Concussion/diagnosis
• Brain Concussion/prevention & control
• Cognition Disorders/diagnosis
• Emergency Service, Hospital
• Female
• Head Protective Devices
• Humans
• Male
• Neurologic Examination/methods
• Postural Balance
• Psychological Tests
• Psychomotor Performance/physiology
• Referral and Consultation
• Sensitivity and Specificity
• Sports
• Sports Medicine/methods

Identify all Sport Concussion Assessment Tool (SCAT2/3) studies, compare baseline and postconcussion results.

Systematic review (qualitative synthesis, weighted means).

18 databases, 9 grey literature resources searched for SCAT2/3 data; 9150 articles identified, titles/abstracts assessed/data-entry independently by two reviewers.

Any studies reporting partial/complete SCAT2/3 data.

21 studies with data (partial/complete data 16 SCAT2 (4087 athletes); 5 SCAT3 (891). Newcastle-Ottawa risk-of-bias scale: studies with maximum possible score of 4, 85% scored 3 or 4; studies with maximum possible score of 6, 75% scored 5 or 6. SCAT2 high schoolers: weighted mean score for symptoms 18.46 (22=no symptoms), Balance Error Scoring System (BESS) 26.14, Standardised Assessment of Concussion (SAC) 26.00 and SCAT2 total 88.63. Collegiate/adults weighted means: symptoms 20.09, BESS 25.54, SAC 27.51 and total SCAT2 91.20. Between-study and within-study variability similar to those of the high schoolers. Limited variability between genders. Only 2 studies report baseline and postconcussion scores and 9 partial scores, but data are too limited to provide weighted average scores.

Group mean baseline SCAT scores for high school and collegiate athletes are similar, with minimal gender differences; baseline symptoms show more variability than other components. There are minimal data for elementary students and professionals, no data for adult non-collegiate athletes. Two studies provide preconcussion and postconcussion scores. No data on minimal significant clinical differences to guide players/coaches in withdrawing from a game in progress and deciding when recovery is complete and play can be resumed. The SCAT needs supplementing with clinical and neuropsychological return-to-play assessments.

• Concussion
• Evidence based review
• Measurement
• Sports

• Sport Concussion Assessment Tool–3 (SCAT3)
• athletic training
• clinical assessments/grading scales
• head injuries/concussions

Mild Traumatic Brain Injury (mTBI) is a prominent public health issue. To date, subjective symptom complaints primarily dictate diagnostic and treatment approaches. As such, the description and qualification of these symptoms in the mTBI patient population is of great value. This manuscript describes the symptoms of mTBI patients as compared to controls in a larger study designed to examine the use of vestibular testing to diagnose mTBI. Five symptom clusters were identified: Post-Traumatic Headache/Migraine, Nausea, Emotional/Affective, Fatigue/Malaise, and Dizziness/Mild Cognitive Impairment. Our analysis indicates that individuals with mTBI have headache, dizziness, and cognitive dysfunction far out of proportion to those without mTBI. In addition, sleep disorders and emotional issues were significantly more common amongst mTBI patients than non-injured individuals. A simple set of questions inquiring about dizziness, headache, and cognitive issues may provide diagnostic accuracy. The consideration of other symptoms may be critical for providing prognostic value and treatment for best short-term outcomes or prevention of long-term complications.

• Acute Disease
• Adolescent
• Adult
• Affective Symptoms/etiology
• Brain Injuries/complications
• Brain Injuries/diagnosis
• Cluster Analysis
• Cognitive Dysfunction/etiology
• Dizziness/etiology
• Emergency Service, Hospital
• Fatigue/etiology
• Female
• Gait Disorders, Neurologic/etiology
• Headache/etiology
• Hospitals, Military
• Hospitals, University
• Humans
• Male
• Middle Aged
• Nausea/etiology
• Neuropsychological Tests
• Principal Component Analysis
• Prognosis
• Sex Factors
• Surveys and Questionnaires
• Symptom Assessment
• Trauma Severity Indices
• Vestibular Function Tests
• Young Adult

AIM: To review the use of the Months Backwards Test (MBT) in clinical and research contexts.

METHODS: We conducted a systematic review of reports relating to the MBT based upon a search of PsychINFO and MEDLINE between January 1980 and December 2014. Only reports that specifically described findings pertaining to the MBT were included. Findings were considered in terms of rating procedures, testing performance, psychometric properties, neuropsychological studies and use in clinical populations.

RESULTS: We identified 22 data reports. The MBT is administered and rated in a variety of ways with very little consistency across studies. It has been used to assess various cognitive functions including focused and sustained attention as well as central processing speed. Performance can be assessed in terms of the ability to accurately complete the test without errors (“MB accuracy”), and time taken to complete the test (“MB duration”). Completion time in cognitively intact subjects is usually < 20 s with upper limits of 60-90 s typically applied in studies. The majority of cognitively intact adults can complete the test without error such that any errors of omission are strongly suggestive of cognitive dysfunction. Coverage of clinical populations, including those with significant cognitive difficulties is high with the majority of subjects able to engage with MBT procedures. Performance correlates highly with other cognitive tests, especially of attention, including the digit span backwards, trailmaking test B, serial threes and sevens, tests of simple and complex choice reaction time, delayed story recall and standardized list learning measures. Test-retest and inter-rater reliability are high (both > 0.90). Functional magnetic resonance imaging studies comparing the months forward test and MBT indicate greater involvement of more complex networks (bilateral middle and inferior frontal gyri, the posterior parietal cortex and the left anterior cingulate gyrus) for backwards cognitive processing. The MBT has been usefully applied to the study of a variety of clinical presentations, for both cognitive and functional assessment. In addition to the assessment of major neuropsychiatric conditions such as delirium, dementia and Mild Cognitive Impairment, the MBT has been used in the assessment of concussion, profiling of neurocognitive impairments in organic brain disorders and Parkinson’s disease, prediction of delirium risk in surgical patients and medication compliance in diabetes. The reported sensitivity for acute neurocognitive disturbance/delirium in hospitalised patients is estimated at 83%-93%. Repeated testing can be used to identify deteriorating cognitive function over time.

CONCLUSION: The MBT is a simple, versatile tool that is sensitive to significant cognitive impairment. Performance can be assessed according to accuracy and speed of performance. However, greater consistency in administration and rating is needed. We suggest two approaches to assessing performance - a simple (pass/fail) method as well as a ten point scale for rating test performance (467).

• Cognition
• Assessment
• Months backward test
• Delirium
• Dementia