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Context The abrupt cessation of school and sport participation during the COVID-19 pandemic may have negative implications for adolescent mental health. Objective (1) To compare mental, physical, and social health and behaviors during pandemic-related stay-at-home mandates with the same measures collected 1–2 years prior. (2) To assess the relationship of physical activity and sleep during the pandemic with anxiety, fatigue, and peer relationship changes between assessment timepoints. Design Prospective cohort study, repeated-measures Setting Pediatric sports medicine center Participants High school athletes (n=39; 16.2±0.9 years of age; 64% female) Main Outcome Measures Patient Reported Outcome Measurement System (PROMIS) anxiety, fatigue, and peer relationships short forms and the Pittsburgh Sleep Quality Index (PSQI) were completed at two timepoints (initial assessment: May 2018 or 2019; follow-up assessment: May/June 2020). Physical activity frequency and duration, and frequency of interaction with other individuals (family, peers, sport coaches, etc.), were self-reported at follow-up assessment for the two weeks prior to school/sport closure and the two weeks prior to questionnaire completion. Results Higher levels of anxiety (5.5±4.0 vs. 3.6±3.4; p=0.003) and fatigue (5.4±3.7 vs. 2.3±2.5; p Conclusions Mental and physical health declined during stay-at-home mandates, compared to assessments 1–2 years earlier. Physical activity behaviors and sources of social interaction underwent significant changes following school and sport cessation. Quality sleep may provide some protection against declining adolescent mental health during the pandemic, although this relationship requires further investigation.

Context Reaction time (RT) is a critical element of return to participation (RTP), and impairments have been linked to subsequent injury following a concussion. Current RT assessments have limitations in clinical feasibility, and identification of subtle deficits after concussion symptom resolution. Objective To examine the utility of RT measurements (clinical drop stick, simple stimulus-response, single-task Stroop, and dual-task Stroop) to differentiate between adolescents with concussion and uninjured control at initial assessment and RTP. Design Prospective Cohort Study Setting Pediatric sports medicine center associated with a regional tertiary care hospital. Patients or Other Participants Twenty-seven adolescents with a concussion (mean age=14.8±2.1 years; 52% female; tested 7.0±3.3 days post-concussion) and twenty-one uninjured controls (mean age=15.5±1.6 years; 48% female). Main Outcome Measure(s) Participants completed the Post-Concussion Symptoms Inventory (PCSI) and battery of RT tests: clinical drop stick, simple stimulus-response, single-task Stroop, and dual-task Stroop. Results The concussion group demonstrated significantly slower clinical drop stick (β=58.8; 95% CI= 29.2, 88.3, p Conclusion Adolescents recovering from concussion may have initial RT deficits which persist despite symptom recovery. Clinical drop stick and dual-task Stroop RT demonstrate high clinical utility given high classification accuracy, sensitivity, and specificity to detect post-concussion RT deficits, and may be considered for initial and RTP assessment.

Context Dizziness, poor sleep quality, and postural instability are all commonly reported postconcussion and individually relate to poor outcomes. Objective To examine sleep quality and postural stability among adolescents who did and those who did not report dizziness within 2 weeks of concussion. Design Cross-sectional study. Setting Research laboratory. Patients or Other Participants Participants were individuals 12 to 18 years old and either within 14 days of concussion (n = 58; girls = 29, boys = 29, age = 15.2 ± 1.8 years, time postinjury = 7.1 ± 3.1 days) or uninjured control recruits (n = 73, girls = 31, boys = 42, age = 15.8 ± 1.3 years). Main Outcome Measure(s) Participants rated preinjury and current dizziness using the Post-Concussion Symptom Inventory (PCSI) and current sleep quality using the Pittsburgh Sleep Quality Index. They also completed postural stability assessments (single-task and dual-task tandem gait and modified Balance Error Scoring System[mBESS]). Results We divided patients with concussion into dizzy (n = 21) or not-dizzy (n = 37) groups based on PCSI dizziness ratings (difference between current and preinjury dizziness rating: dizzy = >3, not dizzy = Conclusions Individuals with postconcussion dizziness demonstrated impaired tandem-gait performance, whereas poor sleep quality was associated with total symptom severity. Identifying and treating the underlying dysfunction contributing to dizziness and postural instability may guide customized rehabilitation strategies and facilitate recovery.