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Journal of Concussion
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This is an Open Access Journal

Open Access journal
ISSN (Print) 2059-7002 - ISSN (Online) 2059-7002
Published by Sage Publications

[1176 journals]

Cross-cultural adaptation and preliminary validation of the Arabic version
of the Rosenbaum Concussion Knowledge and Attitudes Survey - Student
Version (RoCKAS-ST-A)
- Authors: Anwar B. Almutairi, Jouzah Albous, Madhawi Almutairi, Nourah Alenezi, Shaikah Alfadhli, Shouq Aldhafeeri
  Abstract: Journal of Concussion, Volume 7, Issue , January-December 2023.
  Objectiveto cross-culturally adapt the Rosenbaum Concussion Knowledge and Attitudes Survey - Student Version (RoCKAS-ST) into Arabic (RoCKAS-ST-A), and to evaluate its psychometric properties (i.e., face validity, internal consistency and test-retest reliability) of the Arabic version 16 of the RoCKAS-ST (RoCKAS-ST-A).Designcross-cultural and preliminary validation of the of the Arabic version of the Rosenbaum Concussion Knowledge and Attitudes Survey - Student Version (RoCKAS-ST-A).Settingyouth clubs and after-school activities centers around Kuwait.ParticipantsAdolescent and young adults, aged 13–20 years old, both sexes.Independent Variablesage, sex, and type of sport (if any).Main Outcome measureRoCKAS-ST-A questionnaire answers and demographics of participants.ResultsTwo hundred and thirty-four adolescent and young adults (n = 234) participated in this study (mean age = 15.95, SD = 1.92). More than half of the participants were males (n = 163, 69.66%). The internal consistency for the concussion knowledge index (CKI) and concussion attitude index (CAI) ranged between fair and good (α = 0.31 & 0.97, respectively). The test-retest reliability of CKI score was 0.79 (95% CI = 0.42–0.92, P
  Citation: Journal of Concussion
  PubDate: 2023-11-09T07:34:38Z
  DOI: 10.1177/20597002231212035
  Issue No: Vol. 7 (2023)
Concussion disrupts brain synchrony: Evidence from interactive metronome
on young children with persisting symptoms and prolonged recovery
post-concussion
- Authors: Silvia Bonacina, Nina Kraus, Jennifer Krizman, Jacob Farley, Trent Nicol, Cynthia R LaBella
  Abstract: Journal of Concussion, Volume 7, Issue , January-December 2023.
  ObjectiveConcussions cause microstructural damage, which we hypothesize leads to a lack of synchrony in the brain. Interactive Metronome (IM) behaviorally assesses how well an individual can maintain a steady rhythm under both unsupervised (absence of feedback) and supervised (presence of visual feedback) conditions. If concussion causes dyssynchrony, then we predict that children with concussion do worse on IM than healthy children and that the difficulty should be greatest during the unsupervised condition, when the children must self-regulate their rhythm performance.Setting and ParticipantsSeventy-four children and adolescents (age range 8–17 years) were assessed on IM across two different tasks (unsupervised – “no feedback” and supervised – “visual feedback”) during a clinic visit after their concussion injury and diagnosis.Design and Main MeasuresWe compared the participants with concussion to a healthy control group (N = 73, age range 15–19 years) with respect to their ability to clap on time with a steady beat using IM, calculated as ms off the beat, separately for the unsupervised and supervised conditions.ResultsResults reveal participants with concussion struggled to maintain a steady rhythm compared to the control group, particularly during the unsupervised condition.ConclusionThese results support the hypothesis that concussion can give rise to brain dyssynchrony. IM captures this dysfunction and, we suggest rhythmic training has the potential to re-establish synchronization among neural networks that may be compromised after a concussion. Interventional studies are a necessary next step for testing the efficacy of IM training to accelerate concussion recovery.
  Citation: Journal of Concussion
  PubDate: 2023-11-08T07:57:44Z
  DOI: 10.1177/20597002231210751
  Issue No: Vol. 7 (2023)
Years of play alter MRI measures of brain health in former Canadian
Football League athletes: a pilot study
- Authors: Mitchell Doughty, Ethan Danielli, Rober Boshra, Kyle I. Ruiter, Luciano Minuzzi, John F. Connolly, Michael D. Noseworthy
  Abstract: Journal of Concussion, Volume 7, Issue , January-December 2023.
  Introduction: Concussive and sub-concussive blows are commonly sustained during contact sports. Through a detailed neuroimaging analysis, this pilot study aimed to determine if a history of sport-related concussions exacerbated cognitive decline later in life. It was hypothesized that clinical health assessments and magnetic resonance imaging (MRI) techniques would provide insight into lasting health and well-being, structural, microstructural, and functional alterations caused by a history of concussive injuries. Materials and Methods: Twenty aging, retired Canadian Football League (rCFL) players (aged 56.9 ± 6.9) had clinical testing and MRI data acquired. Cortical thickness, voxel-wise diffusion tensor imaging (DTI), and Default Mode Network (DMN) connectivity data was collected for each subject and compared against healthy controls. Retired athlete age, playing position, and career length were also examined. Results: This study found widespread cortical thinning, significantly increased mean diffusivity, increased axial diffusivity, and both hyperactivity and hypoactivity within the DMN. Athlete age, position, and career length all influenced microstructural integrity. On average, retired athletes scored about 4 times greater depression-like and concussion-related symptoms and scored significantly lower in all health categories compared to healthy controls. Conclusions: These findings suggested that lasting signs of neurological injuries were present years after retiring from professional play.
  Citation: Journal of Concussion
  PubDate: 2023-09-06T07:46:54Z
  DOI: 10.1177/20597002231200372
  Issue No: Vol. 7 (2023)
Using eye-tracking technology to measure cognitive function in mild
traumatic brain injury: A scoping review
- Authors: Hilary C Pearson, Diane E MacKenzie, Darren T Oystreck, David A Westwood
  Abstract: Journal of Concussion, Volume 7, Issue , January-December 2023.
  Cognitive impairment is a common symptom of mild traumatic brain injury (mTBI) and can have long term cognitive and behavioral consequences. Despite this, there is no universally accepted protocol for assessment of cognition in this population. Conventional neuropsychological assessment tools rely on verbal or manual responses which lend themselves to confounding factors such as stress, intelligence, initiation, and motivation, suggesting the need for more objective tools. A scoping review was undertaken to explore the utility of eye-tracking methods for detecting cognitive impairment in mTBI patients, and to survey the kinds of tasks used in this context. Six academic databases were searched for studies related to brain injury, eye tracking, and cognition. Data from 17 articles were extracted and synthesized. In most cases, neuropsychological and eye-tracking methods were in accordance when detecting cognitive impairment. However, in many cases, eye-tracking measures detected impairments when neuropsychological tasks did not. This review suggests that eye tracking could provide an effective, objective method to measure cognitive impairment in mTBI.
  Citation: Journal of Concussion
  PubDate: 2023-09-04T05:46:26Z
  DOI: 10.1177/20597002231194151
  Issue No: Vol. 7 (2023)
A mixed methods investigation into athletic trainer and dietitian's
nutrition practices for sport-related concussion patients
- Authors: Michelle L Weber Rawlins, Tamara C Valovich McLeod
  Abstract: Journal of Concussion, Volume 7, Issue , January-December 2023.
  BackgroundNutrients may have implications following concussion, such as inflammation reduction or neuroprotection. The purpose of this study was to describe nutrition practices of athletic trainers (AT) and dietitians for patients regarding sport-related concussion, with respect to prevention, recommendations, and barriers to implementation.HypothesesDue to the descriptive nature of this study, hypotheses were not warranted.Study DesignMixed methods.Level of EvidenceLevel 3.MethodsA survey was distributed through professional memberships and included multiple-choice and open-ended items about nutritional practices regarding concussions. Participants included 1465 ATs and 51 dietitians accessing the survey (AT: age = 35.7 ± 11.4 years, females = 43.1%; dietitians: age = 31.8 ± 8.17 years, females = 45.1%). Open-ended survey responses regarding nutritional practices for concussion prevention, recommendations, and changes following concussion were analyzed by identifying key words or repeating phrases, theme development and categories into an initial codebook, using the codebook on responses, and coding all responses with the finalized codebook. Barriers to implementation was analyzed with descriptive statistics.ResultsThemes were identified for prevention strategies, and recommendations and changes following concussion. For concussion prevention, ATs noted overall health, specific target nutrients, barriers and limited research support, while dietitians identified overall health, specific target nutrients, recommendations/guidelines as themes. Post-injury themes for patient recommendations and changes were noted as overall health, specific target nutrients, resources, interprofessional collaboration by ATs, whereas dietitians identified overall health, specific target nutrients, interprofessional collaboration. ATs and dietitians noted numerous barriers including the lack of clinician knowledge and athlete compliance.Conclusions and Clinical RelevanceATs and dietitians are utilizing nutritional practices regarding concussion in numerous ways by focusing on use for whole body, brain health and specific targets such as omega fatty acids, hydration, micronutrients/supplements, and macronutrients. With these findings and the barriers listed by respondents, we can use this information to design focused research to influence evidence-based nutritional practices and concussion.
  Citation: Journal of Concussion
  PubDate: 2023-08-30T06:52:43Z
  DOI: 10.1177/20597002231198616
  Issue No: Vol. 7 (2023)
Inversion position testing in concussed athletes
- Authors: Masaaki Tsuruike, Norikazu Hirose, Robert S. Nishime
  Abstract: Journal of Concussion, Volume 7, Issue , January-December 2023.
  ContextNo prior study has examined inversion position testing in individuals who have experienced sports related concussions.ObjectiveTo investigate whether the inversion position testing (IPT) would un-mask symptoms in asymptomatic concussed collegiate athletes during the return to play progression assessment.DesignCase-Control Study.SettingAthletic Training Room.ParticipantsOne hundred and thirty-nine collegiate student athletes were randomly recruited from 12 different sports belonging to National Collegiate Athletic Association Division I Conference.Main outcome measure(s)A baseline concussion symptom questionnaire was administered. Of the 139, 122 participants without any of the suspicious symptoms related to concussions were examined using the Concussion Symptom Inventory (CSI) in connection with IPT. Also, the 18 concussed athletes underwent the IPT when any symptom subsided.ResultsEighteen of the 122 (16.2%) non-concussed athletes showed some post-IPT symptoms, while 5 of 12 (41.7%) concussed athletes showed some post-IPT symptoms in the baseline test. For the latter, neither the interaction (P = 0.08) nor difference in the total CSI score was observed either from pre- to post-IPT (P = 0.14) or between the baseline and post-concussion (P = 0.96).ConclusionThis study demonstrated that symptoms could be exacerbated by the IPT in concussed athletes even when their original symptoms had subsided prior to the testing. The IPT exacerbated post-concussive symptoms may depend on a number of days required for post-concussive symptoms to subside. The innovative instrument of IPT may prove effective in clarifying the degree to which post-concussive symptoms have subsided.Key wordsConcussion, College athletes, Inversion position, Symptoms.
  Citation: Journal of Concussion
  PubDate: 2023-08-03T06:17:22Z
  DOI: 10.1177/20597002231192763
  Issue No: Vol. 7 (2023)
Diagnostic tools for return-to-play decisions in sports-related concussion
- Authors: Dennis Wellm, Karen Zentgraf
  Abstract: Journal of Concussion, Volume 7, Issue , January-December 2023.
  Research has improved the understanding of sports related concussion (SRC), and several classification systems and guidelines are available in the literature. The exact timing and clearing of athletes for return-to-play (RTP) is still based primarily on subjective reports of concussion symptoms, however symptoms link poorly to objective recovery. Current literature suggest that symptoms alone cannot accurately identify either all concussed athletes or their recovery. The difficult task of interpreting which symptoms are directly related to concussion, and which are related to other conditions, speaks for an increased focus on the RTP process itself. This study examines the literature on neurocognitive assessments and their importance as indicators of accurate timing of when athletes can return to either ball training with duels or the playing field. Entries in three electronic databases (PubMed, Web of Science, and SURF) were searched from January 2000 to June 2022. Search terms were concussion, mild traumatic brain injury (mTBI), sport, athlete, expert, elite, professional, diagnostic, testing, return to play, management, neurocognitive, and cognitive. Inclusion criteria comprised performance-based participation in a team sport and being in the age range of possible peak performance (18–40 years). In addition, only studies with pre-post designs were considered. The PEDro scale was used to assess methodological quality. The methodological quality of the fifteen included studies ranged from 5 (one study) to 6 (fourteen studies) from a maximum of 10. Despite being symptom-free, athletes in all fifteen studies showed lower performance compared to controls on tests of visual and verbal memory (approx. 3–5% deficit) and on processing speed (approx. 6% deficit) after mTBI. All studies report specific neurocognitive deficits after mTBI, although the athletes were declared clinically symptom-free. Therefore, the systematic consideration of neurocognitive parameters in RTP decision making is recommended, especially in light of subsequent muscular injuries of the lower musculoskeletal system, recurrence of mTBI, and residual neurodegenerative disorders.
  Citation: Journal of Concussion
  PubDate: 2023-07-17T03:02:10Z
  DOI: 10.1177/20597002231183234
  Issue No: Vol. 7 (2023)
Do concussed and non-concussed head trauma individuals have similar
symptoms' A retrospective chart review of chronic post-concussive
symptomatology
- Authors: Shazia Malik, Rahim Ahmed, Teresa Gambale, Michel P Rathbone
  Abstract: Journal of Concussion, Volume 7, Issue , January-December 2023.
  Many head trauma patients who present with prolonged post-concussion symptoms do not meet the American Congress of Rehabilitation Medicine (ACRM) diagnostic criteria for mild traumatic brain injuries (mTBI). This population has not been extensively studied and its clinical characteristics are currently uncertain. A retrospective chart review was conducted to explore the symptomatic differences between mTBI and non-mTBI head trauma patients presenting at a concussion clinic with chronic post-concussion symptoms (PCSx). Patient information was extracted from 161 charts, of which 128 subjects met the ACRM criteria for mTBI (ACRM + PCSx), while 33 did not (non-ACRM + PCSx). These two groups were compared for demographic variables and symptomology. This study found that 20.5% of subjects presenting with chronic post-concussion symptoms do not meet ACRM criteria. No symptom-specific differences were found between the two populations in any of the categories tested. These results show that chronic post-concussion symptoms are similar in both mTBI and non-mTBI head trauma patients in the general population, suggesting a need for further research focusing on this group.
  Citation: Journal of Concussion
  PubDate: 2023-05-17T07:22:06Z
  DOI: 10.1177/20597002231173772
  Issue No: Vol. 7 (2023)
Providing a clearer insight into how sport-related concussion and physical
pain impact mental health, cognition, and quality of life
- Authors: Daniel Walker, Adam W. Qureshi, David Marchant, Ben Ford, Alex Bahrami Balani
  Abstract: Journal of Concussion, Volume 7, Issue , January-December 2023.
  Sport-related concussion (SRC) and physical pain are both associated with poor mental health, impaired cognition, and reduced quality of life. Despite SRC and physical pain often co-occurring, there is little research that investigates these two factors together, and therefore it is difficult to conclude which of these contributes to the negative outcomes associated with them. Therefore, the present study aimed to investigate the effect of SRC and physical pain on mental health, cognitive ability, and quality of life. Depression was measured using the Center for Epidemiological Studies Depression Scale, anxiety was assessed using the State-Trait Anxiety Inventory while the SF-12 recorded health-related quality of life. A trail making task (TMT) assessed cognitive flexibility of participants. Analysis of 83 participants (43 concussed) revealed that SRC led to reduced accuracy on TMT(A) and (B), whereas physical pain was responsible for poorer mental health and reduced quality of life. This study highlights the influence that SRC has on cognitive ability and the impact that physical pain has on mental health and quality of life. With this information, we are better placed to predict the negative consequences of SRC and physical pain and therefore tailor support accordingly.
  Citation: Journal of Concussion
  PubDate: 2023-03-08T03:38:14Z
  DOI: 10.1177/20597002221142379
  Issue No: Vol. 7 (2023)
Vestibular/ocular motor screening (VOMS) score for identification of
concussion in cases of non-severe head injury: A systematic review
- Authors: Caroline E. Thomas, Stephen H. Thomas, Ben Bloom
  Abstract: Journal of Concussion, Volume 7, Issue , January-December 2023.
  Backgroundand importance Each year, 1.4 million patients attend a UK ED with a head injury. Mild traumatic brain injury affects up to 300/100 000 admitted patients/year and a greater number of non-admitted patients. Identifying those patients with a head injury that have concussion, and of those, which will have a prolonged recovery, is critical for discharge planning. The Vestibular/Ocular Motor Screening test (VOMS) has been reported as a useful “sideline tool” to evaluate for sports-related concussion (SRC). VOMS has been assessed for utility primarily for predicting in head-injured, which cases will have concussion, and secondarily in predicting in concussed patients, which will have prolonged recovery. Originally described in 2014, VOMS has not been subject to systematic review or meta-analysis, with regard to its predictive performance for concussion.ObjectiveTo assess the state of VOMS evidence for dichotomously classifying concussion status in patients with non-severe head injuryDesignSystematic review.Setting and participantsStudies comprising the review enrolled ambulatory head-injured adults and children, usually from sports-related settings, in Europe or the USA.ExposureVOMS.Outcome measuresPresence of concussion, presence of prolonged recovery in concussed patientsMain resultsThe review identified 17 studies, characterized by a wide variety of specific approaches to administering and scoring VOMS. While VOMS showed promise as a screening tool for concussion, marked study heterogeneity precluded generation of a pooled effect estimate for VOMS performance.ConclusionVOMS is potentially useful as a concussion screening tool. Available evidence from the SRC arena suggests sensitivity ranging from 58–96%, with specificity 46−92%. Directions for future VOMS research should include evaluation of standardized administration and scoring, potentially of a simpler VOMS (with fewer components), in a general head-injured population. Further analysis of precisely defined VOMS application may be useful to determine the proper place of VOMS screening for the head-injured.
  Citation: Journal of Concussion
  PubDate: 2023-03-07T06:00:58Z
  DOI: 10.1177/20597002231160941
  Issue No: Vol. 7 (2023)
Parents’/guardians’ experiences with their adolescents’ prolonged
recovery from a sport-related concussion
- Authors: Shelley Lucas, Nicole D. Bolter, Laura J. Petranek, Kurt Nilsson, Kristi Pardue, Hilary Flint
  Abstract: Journal of Concussion, Volume 7, Issue , January-December 2023.
  Sport-related concussions (SRCs) occur at alarming rates among adolescents and evidence suggests that adolescents experience more severe and longer-lasting symptoms compared to other age groups. Developmentally, adolescence is a time when youth become less reliant on their parents, establish their personal identity, and rely more on other social support networks (e.g., peers, teammates). However, previous studies show that parents play a prominent role in the recovery process from an SRC, especially in situations where recovery is prolonged. The purpose of this study was to examine the lived experiences of parents/guardians of teens who were recovering from a concussion and whose symptoms were persistent. Participants (N = 12) were individually interviewed to better understand how they navigated and advocated for their teen during their prolonged recovery. An inductive content analysis revealed eight thematic categories that were interpreted with a developmental lens: (a) difficulties enforcing cognitive and physical rest, (b) concerns about depression and isolation, (c) observing struggles with athletic identity, (d) feelings of frustration, helplessness, and stress, (e) challenges of a hidden injury, (f) decisions about returning to sport, (g) being lied to about symptoms, and (h) offering strategies and practical advice. The themes illustrate how challenging and complicated the recovery process can be for parents of teenagers in particular, which is supported in previous concussion studies and the broader developmental literature. These results reinforce the idea that taking a biopsychosocial approach to care is best in order to adequately support parents/guardians and adolescents during the SRC recovery process.
  Citation: Journal of Concussion
  PubDate: 2023-03-03T08:28:25Z
  DOI: 10.1177/20597002231160946
  Issue No: Vol. 7 (2023)
The incidence and severity of symptoms similiar to peristing concussion
symptoms in neurologically healthy individuals in aotearoa New Zealand
- Authors: Josh W Faulkner
  Abstract: Journal of Concussion, Volume 7, Issue , January-December 2023.
  The non-specificity of persisting concussion symptoms (PCS) following concussion can make treatment and rehabilitation a complex and challenging endeavour for clinicians. International studies have demonstrated that in neurologically healthy individuals similar symptoms also exist. This study aimed to examine the presence and frequency of symptoms similar to PCS in neurologically healthy adults in Aotearoa New Zealand and compare these to PCS following concussion. 252 neurologically healthy adults (34.22 years); completed the Rivermead Post-Concussion Questionnaire (RPQ). Scores on this measure were evaluated and compared with 146 individuals who were at least three months post-injury (34.62 years). 25.79% (n = 65) of the neurologically healthy individuals had scores on the RPQ of ≥16. Fatigue was the most commonly endorsed symptom (67.9%), followed by sleep disturbances (59.9%). Certain demographic factors (age, education history and gender) were associated with higher endorsement but only on specific symptoms. The concussion group had significantly higher scores on the RPQ and significantly more individuals with PCS. However, at the individual item level, just over half of PCS symptoms were significantly higher in the concussion group. These symptoms were predominately neurological, with only forgetfulness and irritability significantly different between the concussion and neurologically healthy groups. Symptoms similar to PCS are prevalent in neurologically healthy individuals in Aotearoa New Zealand. The implications of these findings on the rehabilitation and management of PCS are discussed.
  Citation: Journal of Concussion
  PubDate: 2023-03-02T05:57:13Z
  DOI: 10.1177/20597002231160959
  Issue No: Vol. 7 (2023)
Validation of an accelerometer-based gait assessment: Establishing
test-retest reliability, convergent validity, and predictive validity for
concussion symptom endorsement
- Authors: Len Lecci, Kelly Dugan, Ken Zeiger, Julian Keith, Sasidharan Taravath, Wayland Tseh, Mark Williams
  Abstract: Journal of Concussion, Volume 7, Issue , January-December 2023.
  BackgroundGait accelerometer (sensor) technology has proven effective in predicting several medical outcomes, but less is known regarding its prediction of concussion symptoms relative to conventional measures of gait and balance.ObjectiveTo establish the reliability and validity of gait accelerometer data. We first examine test-retest reliability and the impact of footwear and walking surfaces on gait. We then examine the convergent validity between gait accelerometer data and the NIH 4-meter gait test. Finally, we compare gait accelerometer data to gait speed and balance measures for predicting concussion symptoms.MethodsStudy 1 used a crossover study design with 60 participants to evaluate retest reliability and examine the effects of footwear (shoes/no-shoes) and walking surface (tile floor/grass) on gait accelerometer data. Study 2 employed a cross-sectional design with 1008 participants to assess gait accelerometer correlations with NIH 4-meter gait and the prediction of Centers for Disease Control and Prevention (CDC) concussion symptoms relative to previously validated gait and balance measures.ResultsRetest reliability (4-day average retest interval) for the no shoes/tile surface condition ranged from .72-.91 (mean = .80). Significant effects of footwear and especially walking surface revealed by Analysis of Variances (ANOVAs) on gait accelerometer data for the power, stride, balance, and symmetry domains indicate the need to standardize these variables. Gait accelerometer data correlates significantly with NIH 4-meter gait scores. Regression analyses found that gait accelerometer data predicts CDC concussion symptom endorsement, outperforming the BESS and NIH 4-meter gait at least three-fold.ConclusionsWhen standardized on footwear and walking surface, gait accelerometers achieve strong test-retest reliability, converge with established measures of gait speed, and are superior to established measures of gait speed and balance when predicting concussion symptoms. Gait accelerometers represent a rapid tool for collecting additional gait information to quantify the behavioral sequelae of concussion and potentially inform return-to-play decision-making.
  Citation: Journal of Concussion
  PubDate: 2023-02-20T08:36:36Z
  DOI: 10.1177/20597002231157947
  Issue No: Vol. 7 (2023)
The impact of riboflavin on the duration of sport-related concussion: A
randomized placebo-controlled trial
- Authors: Jeremy B. Kent, B. Kent Diduch, Siobhan M. Statuta, Kelli Pugh, John M. MacKnight
  Abstract: Journal of Concussion, Volume 7, Issue , January-December 2023.
  ObjectivesThe objective of this study was to investigate the time to recovery after an SRC comparing riboflavin 400mg daily to placebo in a group of elite level athletes from multiple sports.MethodsThe study was a double-blind randomized placebo-controlled trial with intention to treat conducted from 2016–2020 at two different academic institutions. The study enrolled varsity student-athletes (SA) at each institution. The investigators and participants were blinded to treatment allocation. The treatment group received 14 capsules of either riboflavin 400mg or placebo to take daily until completed. The team physician made the diagnosis of an SRC within 24 h of the injury.ResultsA total of sixty participants enrolled in the study. Fifty-two participants completed the study. Subjects in the riboflavin group had a statistically significant lower number of average days to recovery of 9.92 days (CI ± 2.8) compared to placebo of 22.2 days (CI ± 11.5) (P
  Citation: Journal of Concussion
  PubDate: 2023-02-02T07:35:51Z
  DOI: 10.1177/20597002231153707
  Issue No: Vol. 7 (2023)

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