Kevin D. Walter

Sport-Related Concussion in Children and Adolescents

Sport-related concussion is a “hot topic” in the media and in medicine. It is a common injury that is likely underreported by pediatric and adolescent athletes. Football has the highest incidence of concussion, but girls have higher concussion rates than boys do in similar sports. A clear understanding of the definition, signs, and symptoms of concussion is necessary to recognize it and rule out more severe intracranial injury. Concussion can cause symptoms that interfere with school, social and family relationships, and participation in sports. Recognition and education are paramount, because although proper equipment, sport technique, and adherence to rules of the sport may decrease the incidence or severity of concussions, nothing has been shown to prevent them. Appropriate management is essential for reducing the risk of long-term symptoms and complications. Cognitive and physical rest is the mainstay of management after diagnosis, and neuropsychological testing is a helpful tool in the management of concussion. Return to sport should be accomplished by using a progressive exercise program while evaluating for any return of signs or symptoms. This report serves as a basis for understanding the diagnosis and management of concussion in children and adolescent athletes.

American Academy of Pediatrics. Clinical report--sport-related concussion in children and adolescents.

Sport-related concussion is a “hot topic” in the media and in medicine. It is a common injury that is likely underreported by pediatric and adolescent athletes. Football has the highest incidence of concussion, but girls have higher concussion rates than boys do in similar sports. A clear understanding of the definition, signs, and symptoms of concussion is necessary to recognize it and rule out more severe intracranial injury. Concussion can cause symptoms that interfere with school, social and family relationships, and participation in sports. Recognition and education are paramount, because although proper equipment, sport technique, and adherence to rules of the sport may decrease the incidence or severity of concussions, nothing has been shown to prevent them. Appropriate management is essential for reducing the risk of long-term symptoms and complications. Cognitive and physical rest is the mainstay of management after diagnosis, and neuropsychological testing is a helpful tool in the management of concussion. Return to sport should be accomplished by using a progressive exercise program while evaluating for any return of signs or symptoms. This report serves as a basis for understanding the diagnosis and management of concussion in children and adolescent athletes.

Clinical report - Sport-related concussion in children and adolescents

Sport-related concussion is a “hot topic” in the media and in medicine. It is a common injury that is likely underreported by pediatric and adolescent athletes. Football has the highest incidence of concussion, but girls have higher concussion rates than boys do in similar sports. A clear understanding of the definition, signs, and symptoms of concussion is necessary to recognize it and rule out more severe intracranial injury. Concussion can cause symptoms that interfere with school, social and family relationships, and participation in sports. Recognition and education are paramount, because although proper equipment, sport technique, and adherence to rules of the sport may decrease the incidence or severity of concussions, nothing has been shown to prevent them. Appropriate management is essential for reducing the risk of long-term symptoms and complications. Cognitive and physical rest is the mainstay of management after diagnosis, and neuropsychological testing is a helpful tool in the management of concussion. Return to sport should be accomplished by using a progressive exercise program while evaluating for any return of signs or symptoms. This report serves as a basis for understanding the diagnosis and management of concussion in children and adolescent athletes.

Anterior Cruciate Ligament Injuries: Diagnosis, Treatment, and Prevention

The number of anterior cruciate ligament (ACL) injuries reported in athletes younger than 18 years has increased over the past 2 decades. Reasons for the increasing ACL injury rate include the growing number of children and adolescents participating in organized sports, intensive sports training at an earlier age, and greater rate of diagnosis because of increased awareness and greater use of advanced medical imaging. ACL injury rates are low in young children and increase sharply during puberty, especially for girls, who have higher rates of noncontact ACL injuries than boys do in similar sports. Intrinsic risk factors for ACL injury include higher BMI, subtalar joint overpronation, generalized ligamentous laxity, and decreased neuromuscular control of knee motion. ACL injuries often require surgery and/or many months of rehabilitation and substantial time lost from school and sports participation. Unfortunately, regardless of treatment, athletes with ACL injuries are up to 10 times more likely to develop degenerative arthritis of the knee. Safe and effective surgical techniques for children and adolescents continue to evolve. Neuromuscular training can reduce risk of ACL injury in adolescent girls. This report outlines the current state of knowledge on epidemiology, diagnosis, treatment, and prevention of ACL injuries in children and adolescents.

Sport-Related Concussion Reporting and State Legislative Effects.

Objective:To investigate concussion rates and reporting frequencies in high school and collegiate athletes in 2013, compare results to those obtained from 1999 to 2002, and examine to what extent the 2012 Wisconsin state concussion law affected reporting in 2013. Design:Retrospective 2013 survey compared with prior survey. Setting:High schools and colleges in the Milwaukee, Wisconsin, area. Participants:Athletes (N = 784) from multiple sports were surveyed in 2013. Football players (N = 1532) from 1999 to 2002 completed the same measure. Main Outcome Measures:Both surveys assessed concussion history, concussion incidence during the current season, whether incident concussions were reported, who concussions were reported to, and reasons for not reporting. The 2013 survey also assessed awareness of the Wisconsin state law and its effect on reporting. Results:Rates of concussion in the surveyed season were comparable to previous findings from 1999 to 2002 (16.6% vs 15.3%, P = 0.558). Notably, athletes were significantly more likely to report their concussions in 2013 (70.6% vs 47.3% previously, P = 0.011). Among high school athletes surveyed, 59.5% were aware of the Wisconsin state law, with 55.1% stating it would make them more likely to report a concussion. Conclusions:Rates of concussion for 1 sport season have not changed significantly over the past 14 years. The percentage of concussions that are reported to someone has increased significantly. Awareness of the Wisconsin state law does not fully account for the increase in concussion reporting. Clinical Relevance:Given the finite amount of knowledge regarding the influence of concussion-related cultural and legal changes, these findings will help to inform clinicians of the current concussion milieu from the perspective of athletes. It will inform practitioners involved in concussion management to what extent athletes are aware of and report concussions.

Effect of education and language on baseline concussion screening tests in professional baseball players.

Objective:The purpose of the present study was to investigate the possible effects of sociocultural influences, specifically pertaining to language and education, on baseline neuropsychological concussion testing as obtained via immediate postconcussion assessment and cognitive testing (ImPACT) of players from a professional baseball team. Design:A retrospective chart review. Setting:Baseline testing of a professional baseball organization. Participants:Four hundred five professional baseball players. Independent Variables:Age, languages spoken, hometown country location (United States/Canada vs overseas), and years of education. Main Outcome Measures:The 5 ImPACT composite scores (verbal memory, visual memory, visual motor speed, reaction time, impulse control) and ImPACT total symptom score from the initial baseline testing. Results:The result of t tests revealed significant differences (P < 0.05) when comparing native English to native Spanish speakers in many scores. Even when corrected for education, the significant differences (P < 0.05) remained in some scores. Conclusions:Sociocultural differences may result in differences in computer-based neuropsychological testing scores.

Radiographic evaluation of the patient with sport-related abdominal trauma.

Abdominal injuries are rare in sports, but they can be very serious, even life threatening when they occur. With the increasing popularity of snowboarding and extreme skiing, the rate of abdominal injuries is beginning to rise slightly. It is imperative that physicians be able to recognize signs of injury to the liver, spleen, kidney, and hollow abdominal viscera and order appropriate diagnostic tests to investigate these injuries. This article focuses on the imaging modalities physicians can use to assist in diagnosis of sport-related abdominal trauma. Although the sports medicine physician will likely not provide definitive care and treatment of these injuries, because a team approach works best, it is important to know how to diagnose them through the proper studies.

Frequency and Outcomes of a Symptom-Free Waiting Period After Sport-Related Concussion

Background: Guidelines and practices for the management of sport-related concussion (SRC) have evolved swiftly over the past 2 decades. Despite common recommendations for a symptom-free waiting period (SFWP) before returning to sport, past reports have suggested poor utilization rates for this intervention. Purpose: To obtain current estimates of the utilization and characterization of SFWPs with high school and collegiate athletes. Study Design: Descriptive epidemiology study. Methods: Data were extracted from a larger prospective study that followed athletes with SRC across 13 institutions in southeastern Wisconsin from 2012 to 2014. Participants included 143 contact and collision sport athletes who were followed serially through their recoveries after SRCs. Results: In the current study sample, 99.3% of athletes used an SFWP. The mean self-reported symptom duration was 6.35 days (median, 5 days), with 72.7% reporting symptom recovery within 1 week of injury, 93.7% within 2 weeks, and 99.3% within 30 days. Rate of same-season repeat concussion was low (3.8%) and was similar to or lower than the overall rate of concussion (4.3%). Five same-season repeat concussions occurred at a range of 8 to 42 days after initial injuries. Conclusion: In comparison with prior published data collected from 1999 to 2004, utilization and duration of SFWPs were higher in the current study samples (99.3% vs 60.3% of athletes reported an SFWP; mean duration, 6.1 vs 3.2 days), and athletes were withheld from sports for more days than previously reported (12.3 vs 7.4 days). Rate of same-season repeat concussion was equivalent to that of prior published data. The findings support improved adherence to clinical management guidelines through increased utilization of SFWPs after SRC.

Pediatric and adolescent concussion

Pediatric and adolescent concussion : , Pediatric and adolescent concussion : , کتابخانه دیجیتال جندی شاپور اهواز

Addressing concussion in youth sports

Though new concussion laws protecting young athletes are a step in the right direction, more must be done.