Erin Reynolds

A comprehensive, targeted approach to the clinical care of athletes following sport-related concussion

AbstractPurpose The purpose of this paper is to discuss risk and prognostic factors for concussion outcomes, review comprehensive approaches to assessment, and describe a new method for conceptualizing treatment for sport-related concussion using clinical experience.MethodsBased on the current literature of sport-related concussion and clinical experience, an approach for conceptualizing concussion care using clinical trajectories and targeted treatments was developed.ResultsA comprehensive approach to assessment and targeted treatments for sport-related concussion was developed using specific clinical trajectories.ConclusionSport-related concussions are heterogeneous and require an individualized clinical approach. The use of a comprehensive approach for assessing specific clinical trajectories following a sport-related concussion will help clinicians better conceptualize this injury. Clinicians can then match targeted treatment pathways to specific clinical trajectories to accelerate safe return to play for athletes following a sport-related concussion.Level of evidenceV.

Establishing a clinical service for the management of sports-related concussions.

The clinical management of sports-related concussions is a specialized area of interest with a lack of empirical findings regarding best practice approaches. The University of Pittsburgh Medical Center Sports Concussion Program was the first of its kind; 13 years after its inception, it remains a leader in the clinical management and research of sports-related concussions. This article outlines the essential components of a successful clinical service for the management of sports-related concussions, using the University of Pittsburgh Medical Center Sports Concussion Program as a case example. Drawing on both empirical evidence and anecdotal conclusions from this high-volume clinical practice, this article provides a detailed account of the inner workings of a multidisciplinary concussion clinic with a comprehensive approach to the management of sports-related concussions. A detailed description of the evaluation process and an in-depth analysis of targeted clinical pathways and subtypes of sports-related concussions effectively set the stage for a comprehensive understanding of the assessment, treatment, and rehabilitation model used in Pittsburgh today. ABBREVIATIONS:: ImPACT, Immediate Post-Concussion Assessment and Cognitive TestingmTBI, mild traumatic brain injuryUPMC, University of Pittsburgh Medical Center. Language: enThe clinical management of sports-related concussions is a specialized area of interest with a lack of empirical findings regarding best practice approaches. The University of Pittsburgh Medical Center Sports Concussion Program was the first of its kind; 13 years after its inception, it remains a leader in the clinical management and research of sports-related concussions. This article outlines the essential components of a successful clinical service for the management of sports-related concussions, using the University of Pittsburgh Medical Center Sports Concussion Program as a case example. Drawing on both empirical evidence and anecdotal conclusions from this high-volume clinical practice, this article provides a detailed account of the inner workings of a multidisciplinary concussion clinic with a comprehensive approach to the management of sports-related concussions. A detailed description of the evaluation process and an in-depth analysis of targeted clinical pathways and subtypes of sports-related concussions effectively set the stage for a comprehensive understanding of the assessment, treatment, and rehabilitation model used in Pittsburgh today.

Mental health implications and consequences following sport-related concussion

Concussion is a heterogeneous injury involving a myriad of physical (eg, dizziness, headache), cognitive (eg, memory problems, difficulty concentrating), sleep-related and affective (eg, depression, anxiety) symptoms, and impairment (eg, cognitive, vestibular, oculomotor). Consequently, clinical researchers have advocated for a more comprehensive and targeted approach to assessing and treating sport-related concussion (SRC).1 Some athletes experience mood-related consequences including anxiety and depression following SRC.2 In the extreme, these consequences if ignored or improperly managed can lead to clinical depression, anxiety, and even suicidal ideation and intent. As such, it is important to assess mood-related changes following SRC in all athletes and to properly treat those athletes who may be experiencing more pervasive affective symptoms. In this paper, we aim to highlight the current research on the mental health consequences of SRC and explore their implications for assessment and treatment of SRC. We also discuss potential directions for future research on mental health-related outcomes following SRC. Affective symptoms (eg, depression, anxiety) following traumatic brain injuries including concussion are common.2 However, it is estimated that only 6% of patients experience some form of depression following the concussion.3 Recent consensus statements on SRC have called for more research exploring the emotional sequelae that may accompany SRC as well as appropriate assessment and treatment approaches.2 ,4 Researchers have indicated that affective responses, particularly depression, are common following concussion.5–9 However, it is important to note that most affective responses occur at a subclinical level that does not meet diagnostic criteria for a clinical disorder. Additionally, it is important for the clinician to be aware of any pre-existing psychological conditions that may affect the emotional responses following SRC. Both psychosocial and neurobiological factors may help to explain affective responses following SRC. For example, individuals with clinical depression have been found …

Cognitive Development and the Immediate Postconcussion Assessment and Cognitive Testing: A Case for Separate Norms in Preadolescents

With youth sports participation and concern about sports-related concussions both on the rise, it is important to properly measure cognitive function to ensure the clinical utility of baseline testing. Computerized testing batteries are often employed as baseline and postinjury measures of cognitive function, with the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) being the most used of all the current testing platforms. The current study compared 10- to 12-year-old children across the composite scores yielded by the ImPACT and provided normative data on each of the subtests used to calculate the composite scores. Normative data are separated by gender for athletes aged 10 to 12 years old, as this is the current age bracket used by the ImPACT. These norms may be helpful in the interpretation of the ImPACT clinical report and further delineation of areas of neurocognitive dysfunction.

Anxiety and mood clinical profile following sport-related concussion: From risk factors to treatment.

Conceptual models for assessing and treating sport-related concussion (SRC) have evolved from a homogenous approach to include different clinical profiles that reflect the heterogeneous nature of this injury and its effects. There are six identified clinical profiles, or subtypes, from SRC, and one such clinical profile is the anxiety and mood profile. Athletes with this profile experience predominant emotional disturbance and anxiety following SRC. The purpose of this targeted review was to present an overview of the empirical evidence to support factors contributing to the anxiety and mood profile, along with methods of evaluation and treatment of this clinical profile following SRC. We discuss the potential underlying mechanisms and risk factors for this clinical profile, describe comprehensive assessments to evaluate concussed athletes with an anxiety and mood clinical profile, and explore behavioral and other interventions for treating these athletes. Although there is limited, but growing, empirical evidence for the anxiety and mood clinical profile following SRC, understanding this clinical profile is germane for clinicians who are treating athletes with emotional sequelae after SRC.

In-Office Management of Sport-Related Concussion

The field of sport-related concussion has grown exponentially over the past decade, with more concussion-specific clinics being identified in major hospital systems as well as independent practitioners offices. To date, there is no standardized in-office protocol for managing ongoing symptoms. The University of Pittsburgh Medical Center (UPMC) Sports Concussion Program, established in 2000, is one of the largest programs in the USA, pioneering the way in clinical management, research, and education of sport-related concussion. This report will outline the essential components of a successful concussion clinic, using the UPMC Sports Concussion Program as a case example of best practice. We will share several case studies illustrating the individualized and complex nature of this injury, as well as review important rehabilitation components.