Cara Camiolo Reddy

Concussion in Sports: Postconcussive Activity Levels, Symptoms, and Neurocognitive Performance

CONTEXT Evidence suggests that athletes engaging in high-intensity activities after concussion have more difficulties with cognitive recovery. OBJECTIVE To examine the role postinjury activity level plays in postconcussive symptoms and performance on neurocognitive tests in a population of student-athletes. DESIGN Retrospective cohort study with repeated measures of neurocognitive performance and symptom reporting. SETTING University-based sports concussion clinic. PATIENTS OR OTHER PARTICIPANTS Ninety-five student-athletes (80 males, 15 females: age = 15.88 +/- 1.35 years) were retrospectively assigned to 1 of 5 groups based on a postinjury activity intensity scale. MAIN OUTCOME MEASURE(S) We employed a regression analysis for repeated measures to evaluate the relationship of activity intensity to symptoms and neurocognitive outcome up to 33 days after concussion. Postconcussion symptom scores and neurocognitive (verbal memory, visual memory, visual motor speed, and reaction time) scores served as the primary outcome measures. RESULTS Level of exertion was significantly related to all outcome variables (P < .02 for all comparisons). With multivariate analysis, activity intensity remained significant with respect to visual memory (P = .003) and reaction time (P < .001). CONCLUSIONS Activity level after concussion affected symptoms and neurocognitive recovery. Athletes engaging in high levels of activity after concussion demonstrated worse neurocognitive performance. For these tasks, those engaging in moderate levels of activity demonstrated the best performance.

Adolescent sports concussion

Approximately 2 million sports and recreation concussive injuries occur per year in the United States, which may be an underestimate because of inconsistent data reporting. The field of concussion management has evolved rapidly over the last 10 years, and with these advances comes new understanding of the significant symptomatic and cognitive impairments of concussion. These sequelae are more fully realized and may last longer than previously thought. Data have emerged regarding pathophysiology of concussion, risk factors, outcome, effects of repetitive injury, subtypes of concussive injury, and treatment protocols. This evidence calls for more conservative management of concussion, particularly in younger athletes, and demonstrates the shortcomings of concussion guidelines.

Efficacy of amantadine treatment on symptoms and neurocognitive performance among adolescents following sports-related concussion.

Objective:To evaluate the efficacy of amantadine in the treatment of symptoms and neurocognitive performance in adolescents following sports-related concussion. Participants:A clinical sample of 25 male (n = 11) and female (n = 14) adolescent subjects with an age-, sex-, and concussion history–matched group of 25 male (n = 11) and female (n = 14) control subjects. Setting:Outpatient concussion clinic. Intervention:Retrospective, case-control design. Treatment group consisted of patients treated with 100 mg of amantadine twice daily (200 mg total per day) following a period of rest. Matched controls were evaluated and treated conservatively without medication at the same concussion program prior to the start of the current amantadine protocol. Main Outcome Measures:Immediate Postconcussion Assessment and Cognitive Test computerized neurocognitive test battery and symptom report. Results:Results support significantly greater improvements from pre- to posttest in reported symptoms, verbal memory, and reaction time performance for the amantadine group than the matched controls. There were no significant differences for visual memory or visual motor processing speed. Conclusion:This study provides empirical support for amantadine as an effective pharmacologic treatment of certain concussion-related cognitive deficits and symptoms in athletes with protracted recovery of more than 3 weeks.

Sports concussion: management and predictors of outcome.

Interest in sports concussion has grown widely in the last two decades among laypersons and medical professionals. Significant contributions of evidence-based research have led to a better understanding of this multifaceted, but still often elusive, injury. This information has transformed all aspects of concussion management, from on-field evaluation through return-to-play guidelines. The aim of this article is to highlight important research regarding predictors of outcome and treatment protocols. This research has been the basis of the paradigm shift from traditional concussion grading scales to individualized care. Today, concussion management requires a patient-centered approach with individualized assessment, including risk factor analysis, neurocognitive testing, and a thorough symptom evaluation.

Postconcussion Syndrome: A Physiatrist's Approach

Concussion and its subsequent postconcussive symptoms were first described by p more than a century ago. Since then and through the early 2000s, concus characterized by a myriad of definitions and anecdotally based grading scales an to-play guidelines, miring this injury in controversy. During the past decade, the cation and management of concussive injury has undergone a dramatic “paradigm s Although many of the earlier issues that affect concussion practice and research co persist, including the adoption of consistent definitions and return-to-play guide field has evolved toward a more evidence-based approach. Postconcussion syndrome (PCS), the term most commonly used to refe collection of symptoms that occur after a concussion, remains an area of grea For many years, persons in the fields of neurology and psychiatry professed that co did not result in persistent somatic or behavioral effects [2]. Because treatment predicated on self-report of symptoms, many medical professionals continue t delayed recovery with psychological factors (eg, anxiety or depression) or financi (eg, medicolegal compensation) [3]. Fueling this argument is the fact that the sym PCS are not unique to the injury. Similar symptoms have been reported in uninjure control subjects, personal injury claimants, patients with depression, and patie chronic pain [4,5]. A syndrome is a collection of symptoms that, when taken together, charac underlying condition. Researchers have argued that the collection of symptoms ide PCS are so nonspecific that they do not fulfill requirements of this definition [6]. T recognized and cited definitions of PCS, which are from the Diagnostic and Statistica of Mental Diseases, 4th edition (DSM-IV) [7] and the International Classification of 10th revision (ICD-10) [http://www.ihs-classification.org/en/02_klassifikation/ 05.00.00_necktrauma.html, 8], differ in their language and diagnostic criteria (Ta a prospective study of patients with concussion 3 months after injury, Boake reported that when the DSM-IV criteria were used, the diagnosis rate of postcon disorder was 11%, compared with a diagnosis rate of 64% when the ICD-10 criteri were used. Neither the DSM-IV nor the ICD-10 criteria are specific in differentiating with PCS and/or postconcussional disorder from those with extracranial trauma DSM-IV criteria suggest that symptoms that persist for 3 months are required for the d whereas the ICD-10 criteria do not assert such a time frame. In summary, the inc criteria applied to PCS result in considerable inconsistencies in diagnosis and su treatment for patients with PCS. The debate regarding the diagnostic criteria of PCS revolves around the no nature of its symptoms; however, the underlying factors that may influence the inc PCS also have come under scrutiny. For example, researchers have argued that th incidence of PCS in countries such as the United States and the United Kingdom m medicolegal compensation systems in those countries, because the incidence of been lower in countries without such systems [10]. Mittenberg et al [11] also sug patients may have an “expectation” of symptoms after concussion and there attribute pre-existing symptoms to their concussion. Moreover, researchers have that, within military populations, comorbid post-traumatic stress disorder (PT depression confound the diagnostic criteria for PCS [12]. In the absence of unique biologic markers of concussion and PCS, the aforem issues will continue to invite controversy [13]. However, the emergence of valid and rel

Concussion management and treatment considerations in the adolescent population.

Abstract Over the past decade, significant advances have been made in understanding concussions. Information regarding proper identification, pathophysiology, risks, outcomes, and management protocols has shifted the treatment paradigm from a generalized grading system to an individualized approach. Early identification and timely management of a concussion is necessary to ensure that patients minimize persistent post-concussive symptoms affecting the physical, behavioral, emotional, and cognitive domains. Adolescents are particularly vulnerable to concussions, having greater susceptibility and more prolonged recovery after sustaining an injury. This article aims to inform clinicians on how to improve symptom relief and functional outcomes for adolescent patients with concussion via immediate intervention, neuropsychological management, and pharmacological treatment.

Managing Patients with Prolonged Recovery Following Concussion

Persistent symptoms following concussion can be debilitating for patients and challenging for clinicians; however, evidence-based approaches to symptom management are emerging. The presentation of postconcussion syndrome can be variable among patients. Given this variability, a thorough history and physical examination are necessary to tailor an individualized treatment approach. Pharmacologic interventions can be considered when prolonged symptoms are negatively affecting quality of life. This article reviews evidence available to guide such treatment decisions.

Rehabilitation Interventions in Parkinson Disease

This self‐directed learning module provides an evidence‐based update of exercise‐based rehabilitation interventions to treat Parkinson disease (PD). It is part of the study guide on stroke and neurodegenerative disorders in the Self‐Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This focused review emphasizes treatment of locomotion deficits, upper limb motor control deficits, and hypokinetic dysarthria. New dopaminergic agents and deep brain stimulation are facilitating longer periods of functional stability for patients with PD. Adjunctive exercise‐based treatments can therefore be applied over longer periods of time to optimize function before inevitable decline from this neurodegenerative disease. As function deteriorates in patients with PD, the role of caregivers becomes more critical, thus training caregivers is of paramount importance to help maintain a safe environment and limit caregiver anxiety and depression. The overall goal of this article is to enhance the learners existing practice techniques used to treat PD through exercise‐based intervention methods.

Stroke and Neurodegenerative Disorders: 3. Poststroke Rehabilitation

This self‐directed learning module highlights rehabilitation strategies in poststroke rehabilitation. It is part of the study guide on stroke and neurodegenerative disorders in the Self‐Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Using a case vignette format, this article specifically focuses on typical clinical presentations, recovery patterns, and traditional and innovative therapeutic interventions in poststroke rehabilitation such as constraint‐induced movement therapy, treadmill training, functional electrical stimulation, robot‐aided therapy, virtual reality treatment, cortical stimulation, speech therapy for aphasia, and orthotic management. The goal of this article is to influence the learners knowledge on the delivery of poststroke rehabilitation treatment.

Is There a Need for Early Seizure Prophylaxis After Traumatic Brain Injury

You are the consulting physiatrist of a busy surgical intensive care unit (ICU) at a large, urban academic medical center. You are part of a Pharmacy and Therapeutics Ad Hoc Subcommittee charged with exploring all “routineeper protocol” use of medications in the ICU. Your charge is to critically assess these types of medications from the perspective of both safety and expense. One of the categories the Subcommittee is charged with reviewing is the routine use of seizure prophylaxis in the first week after traumatic brain injury (TBI). Data provided by the finance department have indicated that there has been a steady trend during the past 3 years to use levetiracetam rather than phenytoin as the prophylactic agent of choice in the first days to weeks after TBI. The financial ramification of this trend has been significant, to the magnitude of