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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

[1174 journals]

Applying knowledge translation frameworks, approaches and principles to
co-create a dissemination plan: Optimizing the spread of a pediatric
concussion guideline
- Authors: Christine Provvidenza, Shauna Kingsnorth, Jennifer Dawson, Andree-Anne Ledoux, Roger Zemek, Nick Reed
  Abstract: Journal of Concussion, Volume 6, Issue , January-December 2022.
  BackgroundClinical practice guidelines are evidence-based statements that assist healthcare professionals with improving patient care. Achieving guideline aims depends on successful knowledge translation (KT) and includes dissemination and implementation efforts. Dissemination efforts are important precursors to implementation, help to maximize awareness and reach of best practices, and prepare for evidence adoption. This article shares the application of KT frameworks, approaches and principles in the creation of a dissemination plan and KT products for the Living Guideline for Pediatric Concussion Care. The target audience for dissemination are healthcare professionals delivering clinical care to patients between 5–18 years.MethodsGuided by the Framework for Knowledge Transfer and an integrated KT (iKT) approach, 46 concussion experts participated in an iKT workshop and knowledge board activity to: 1) establish a Living Guideline dissemination plan; 2) identify products to share the Living Guideline; and, 3) prepare for Living Guideline implementation planning. Post-workshop, a snowball approach invited knowledge users including educators and youth/young adults with lived experience in concussion via interviews and focus groups, to expand upon the dissemination plan and recommended products.ResultsThe dissemination plan yielded a reach of nearly 42,000 Living Guideline page views from September, 2019-January, 2022. Dissemination efforts included 13 multi-media interviews, over 40 activities (e.g. webinars), and 28 engagement emails to help raise awareness. Eight KT products were developed to foster sharing and use of the Living Guideline, with over 3000 downloads across all KT products.ConclusionsApplying an iKT approach alongside appropriate frameworks and principles allowed for interaction and partnership building, resulting in the development of a robust dissemination plan and essential KT products. By showing the breadth and impact of the KT activities undertaken, it is hoped that the concussion community will explore how KT practices can bolster efforts to drive evidence into practice and optimize concussion care.
  Citation: Journal of Concussion
  PubDate: 2022-08-04T07:17:26Z
  DOI: 10.1177/20597002221116239
  Issue No: Vol. 6 (2022)
Post-traumatic headache: Pathophysiology and management - A review
- Authors: Andrew Blumenfeld, Jennifer McVige, Kerry Knievel
  Abstract: Journal of Concussion, Volume 6, Issue , January-December 2022.
  BackgroundPost-traumatic headache (PTH) is a common secondary headache due to traumatic brain injury. In the past, significant research has been conducted to understand the pathophysiology and treatment options for PTH. However, PTH still lacks evidence-based treatment, and most of the management depends on the primary phenotype observed in the patient.ObjectiveThe main objective of this review is to provide a single reference that covers the current understanding of the pathophysiology and the treatment options available for PTH.MethodsA detailed literature search on PubMed was performed, and a narrative review was prepared.ResultsThe pathophysiology of PTH is multifactorial. Acute PTH may be attributed to increased peripheral pain sensitization with impaired pain inhibiting pathways. Chronic or persistent PTH may be due to a chronic inflammatory response and peripheral as well as central sensitization. The mechanism responsible for the transition of acute to persistent PTH is unknown. The migraine-like phenotype is reported to be the most prevalent headache type seen in PTH. New targets for preventive treatment have been identified in recent years, such as neuropeptides like calcitonin-gene-related peptide (CGRP), nitric oxide, and glutamate. The preventive pharmacological and non-pharmacological strategies employed for migraine (e.g. anti-CGRP monoclonal antibodies, onabotulinumtoxinA, physical therapy, cognitive and behavioral treatment, and neurostimulation techniques) have shown in preliminary studies that they are potentially efficacious, but large, randomized, double blind, placebo controlled trials are needed to further establish these as treatment options for PTH.ConclusionsThe lack of evidence-based treatment for PTH has created a need for future large trials to confirm the safety and efficacy of the currently employed treatments.
  Citation: Journal of Concussion
  PubDate: 2022-05-10T06:43:39Z
  DOI: 10.1177/20597002221093478
  Issue No: Vol. 6 (2022)
Top cited articles in concussion: A bibliometric analysis of the state of
the science
- Authors: Bhanu Sharma, David Wyndham Lawrence
  Abstract: Journal of Concussion, Volume 6, Issue , January-December 2022.
  ObjectiveCitation analyses identify the most-cited publications in a given field, which aids in understanding areas of the literature that are well-developed and those where additional research is required. Our objective was to perform a citation analysis in concussion to understand the state of the science from a bibliometric perspective.DesignWe performed a keyword search for articles related to concussion in Harzing's Publish or Perish, which scrapes Google Scholar for citation metrics. This approach was used to identify the 50 articles with the most lifetime citations as well as the 50 articles with the highest citation rate.Main outcome measuresCitations and citation rates.ResultsPer our citation analysis, we found that concussion guidelines are among the most cited publications (comprising ≥20% of each citation cohort), yet there is a dearth of widely cited clinical trials to inform them; only one randomized trial (studying the effects of rest following concussion) was included in our citation analysis. The majority of study designs (≥40% of each citation cohort) were cross-sectional. Concussion recovery and secondary complications of concussion were common study topics, with ≥20% of publications in each citation cohort focused on these issues. The publications included in our analysis were authored by 596 authors from only 12 countries, suggesting a lack of global representation in concussion research.ConclusionsExisting reviews and consensus statements have called for additional, high-quality research in concussion; our citation analysis quantifies this need. Further, although concussion is a global problem with its incidence and burden increasing in the developing world, our citation analysis demonstrates that the most-cited and discussed articles in concussion are published by authors from only 12 countries. Going forward, to address the global problem that is concussion, a more global research perspective is called for.
  Citation: Journal of Concussion
  PubDate: 2022-03-21T07:53:52Z
  DOI: 10.1177/20597002221086095
  Issue No: Vol. 6 (2022)
An investigation into the measurement properties of the King-Devick Eye
Tracking system
- Authors: M. Hecimovich, D. King, M. Murphy, K. Koyama
  Abstract: Journal of Concussion, Volume 6, Issue , January-December 2022.
  ObjectivesEye tracking has been gaining increasing attention as a possible assessment and monitoring tool for concussion. The King-Devick test (K-DT) was expanded to include an infrared video-oculography-based eye tracker (K-D ET). Therefore, the aim was to provide evidence on the reliability of the K-D ET system under an exercise condition.MethodsParticipants (N = 61; 26 male, 35 female; age range 19-25) were allocated to an exercise or sedentary group. Both groups completed a baseline K-D ET measurement and then either two 10-min exercise or sedentary interventions with repeated K-D ET measurements between interventions.ResultsThe test-retest reliability of the K-D ET ranged from good to excellent for the different variables measured. The mean ± SD of the differences for the total number of saccades was 1.04 ± 4.01 and there was an observable difference (p = 0.005) in the trial number. There were no observable differences for the intervention (p = 0.768), gender (p = 0.121) and trial (p = 0.777) for average saccade’s velocity. The mean ± SD of the difference of the total fixations before and after intervention across both trials was 1.04 ± 3.63 and there was an observable difference in the trial number (p = 0.025). The mean ± SD of the differences for the Inter-Saccadic Interval and the fixation polyarea before and after intervention across both trials were 1.86 ± 22.99 msec and 0.51 ± 59.11 mm2 and no observable differences for the intervention, gender and trial.ConclusionThe results provide evidence on the reliability of the K-D ET, and the eye-tracking components and demonstrate the relationship between completion time and other variables of the K-D ET system. This is vital as the use of the K-DT may be increasing and the combination of the K-DT and eye tracking as one single package highlights the need to specifically measure the reliability of this combined unit.
  Citation: Journal of Concussion
  PubDate: 2022-02-25T03:52:18Z
  DOI: 10.1177/20597002221082865
  Issue No: Vol. 6 (2022)
Youth sport parents’ familiarity and perceptions of concussion
legislation
- Authors: Sungwon Kim, Daniel P. Connaughton, John O. Spengler
  Abstract: Journal of Concussion, Volume 6, Issue , January-December 2022.
  ObjectivesIn an effort to reduce the negative health consequences often associated with concussions among young athletes, all U.S. states and the District of Columbia enacted youth concussion legislation between 2009 and 2014. This study explored youth sport parents’ (1) familiarity with their state's concussion legislation, and (2) perceptions about the need for additional legislative provisions not currently found in such laws.MethodsCross-sectional online survey data were obtained from parents (n = 430) of youth sport athletes from 22 U.S states.ResultsPrimary findings suggest that 67% of parents were moderately to extremely familiar with the removal from play requirement; 69.9% were moderately to extremely familiar with mandatory concussion training for coaches; and 75.1% were moderately to extremely familiar with the medical clearance requirement for athletes to return to play. In regard to perceptions, approximately half (50.2%) believed it is essential to mandate parent/guardian notification when a child suffers a potential concussion; and 42.8% believed it is essential to include a penalty/sanction for violating the statute. Based on the results of a multivariable logistic regression model, a significantly greater familiarity of concussion legislation was found among parents who were White/Caucasian, had advanced degrees, had higher household incomes, or were urban residents.ConclusionsOur findings suggest that most youth sport parents have a sound understanding of concussion legislation and believe that the laws should be revised to improve best practices in preventing and managing concussions. Parents who face socio-cultural and economic barriers can benefit most from having access to credible information about their state's concussion law.
  Citation: Journal of Concussion
  PubDate: 2022-01-28T12:46:24Z
  DOI: 10.1177/20597002221075007
  Issue No: Vol. 6 (2022)
Longitudinal assessment of hemodynamic alterations after mild traumatic
brain injury in adolescents: Selected case study review
- Authors: Corey M. Thibeault, Amber Y. Dorn, Shankar Radhakrishnan, Robert B. Hamilton
  Abstract: Journal of Concussion, Volume 6, Issue , January-December 2022.
  Alterations in the neurovasculature after traumatic brain injury (TBI) represents a significant sequelae. However, despite theoretical and empirical evidence supporting the near-ubiquity of vascular injury, its pathophysiology remains elusive. Although this has been shown for all grades of TBI, the vascular changes after injuries with the broad mild traumatic brain injuries (mTBI) classification, remain particularly difficult to describe. Our group has previously demonstrated hemodynamic alterations in mTBI by utilizing transcranial Doppler ultrasound and cerebrovascular reactivity in a cross-sectional study. That work identified a phasic progression of deviations over varying days post-injury. These phases were then characterized by a set of inverse models that provided a hypothetical process of hemodynamic dysfunction after mTBI. This model set provides a framework with the potential for guiding clinical treatment over the course of recovery. However, it is still unclear if individual patients will progress through the phases of dysfunction similar to that found at the population level. The work presented here explores six individual patients with high-density data collected during their post-injury recovery. Breath-hold index (BHI) was found to be the most robust feature related to mTBI longitudinally. All six subjects exhibited BHI recovery curves that followed the population model's progression. The changes in pulsatile features lacked the universality of BHI, but were present in subjects with higher self-reported symptom scores and longer periods of recovery. This work suggests neurovascular dysfunction after an mTBI may be a robust phenomenon. Additionally, the capabilities of TCD in capturing these changes highlights its potential for aiding clinicians in monitoring patient's recovery post mTBI.
  Citation: Journal of Concussion
  PubDate: 2022-01-06T11:31:37Z
  DOI: 10.1177/20597002211065855
  Issue No: Vol. 6 (2022)
Biomarkers to aid the return to play decision following sports-related
concussion: a systematic review
- Authors: Nipuna Senaratne, Alexandra Hunt, Eleanor Sotsman, Michael J. Grey
  Abstract: Journal of Concussion, Volume 6, Issue , January-December 2022.
  Premature return to play (RTP) following sports-related concussion (SRC) is associated with significant morbidity including risk of neurological and non-neurological injury, persistent post-concussion symptoms and chronic neurological deficits. Assessing athletes for RTP is critical but these decisions are currently based on clinical assessments that are subject to bias and symptomatic reporting that rely on compliance. An objective and easily obtained biomarker that can indicate recovery following SRC would aid clinicians to make safer RTP decisions. We performed a systematic review to identify potential biomarkers from saliva, urine and blood sources that could inform the clinical RTP decision. The MEDLINE database was searched. Inclusion criteria were studies focusing on adults diagnosed with SRC, fluid biomarkers from blood, saliva or urine and clinical recovery from SRC or at RTP. We assessed each biomarker for their time course post SRC and relationship to clinical recovery. Secondary outcomes included correlation with symptom scores and predictive value for prolonged RTP. We identified 8 studies all investigating blood-based markers of diffuse axonal injury (tau, NFL, SNTF), neuroglial injury (NSE, VLP-1, UCH-L1, S100B, GFAP), inflammation and hormonal disturbances. Tau, SNTF, UCH-1, GFAP, S100B and the inflammatory cytokine MCP-4 are raised post SRC and return to baseline by RTP. Changes in tau, NFL, SNTF, GFAP and MCP-4 post SRC correlate with severity of concussion as measured by symptom severity or RTP duration. There is only preliminary case-reporting for hormonal biomarkers. The evidence is limited by a lack of highly powered studies, variation in use of athletic and Contact sport controls (CSC) and a lack of consistent sampling and assessment protocols. There is promise for biomarkers to aid RTP decisions following SRC, most notably in use alongside clinical assessment in RTP criteria to allow greater precision in identifying mild and severe concussion.
  Citation: Journal of Concussion
  PubDate: 2022-01-04T03:44:30Z
  DOI: 10.1177/20597002211070735
  Issue No: Vol. 6 (2022)