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Context: Mindfulness interventions (yoga, meditation) in traumatic brain injury populations show promising improvements in injury outcomes. However, most studies include all injury severities and use in-person, general programming lacking accessibility and specificity to the nuance of concussion. Therefore, this study investigated the feasibility and preliminary effectiveness of an online, concussion-focused meditation intervention among young adults with a concussion history. Design: Unblinded, single-arm, pilot intervention. Methods: Fifteen young adults aged 18 to 30 with a concussion history within the past 5 years completed 10 to 20 minutes per day of online, guided meditations for 6 weeks. Feasibility was assessed using the Feasibility of Intervention Measure. Concussion symptoms were measured using the Rivermead Post-Concussion Symptom Questionnaire, perceived stress the Perceived Stress Scale-10, and mindfulness the Five Facet Mindfulness Questionnaire. Descriptive statistics described the study sample and determined intervention adherence and feasibility. Paired sample t tests were used to examine preintervention/postintervention changes in concussion symptoms, perceived stress, and mindfulness, with descriptive statistics further detailing significant t tests. Results: Fifteen participants were enrolled, and 12 completed the intervention. The majority completed 5+ days per week of the meditations, and Feasibility of Intervention Measure (17.4 [1.8]) scores indicated high feasibility. Concussion symptom severity significantly decreased after completing the meditation intervention (11.3 [10.3]) compared with before the intervention (24.5 [17.2]; t[11] = 3.0, P =.01). The number of concussion symptoms reported as worse than before their concussion significantly decreased after completing the meditation intervention (2.7 [3.9]) compared with before the intervention (8.0 [5.7]; t[11] = 3.7, P =.004). Postintervention, 83.33% (n = 10) reported lower concussion symptom severity, and 75.00% (n = 9) reported less concussion symptoms as a mild, moderate, or severe problem (ie, worse than before injury). Conclusions: Findings suggest positive adherence and feasibility of the meditation intervention, with the majority reporting concussion symptom improvement postintervention. Future research is necessary to expand these pilot findings into a large trial investigating concussion-specific meditation programming. [ABSTRACT FROM AUTHOR]

Ice hockey is a fast-paced sport with a high incidence of collisions between players. Shoulder checks are especially common, accounting for a large portion of injuries including concussions. The forces generated during these collisions depend on the inertial and viscoelastic characteristics of the impacting bodies. Furthermore, the effect of shoulder pads in reducing peak force depends on the baseline (unpadded) properties of the shoulder. We conducted experiments with nine men's ice hockey players (aged 19–26) to measure their effective shoulder stiffness, damping and mass during the impact stage of a shoulder check. Participants delivered a style of check commonly observed in men's university ice hockey, involving lateral impact to the deltoid region, with the shoulder brought stationary by the collision. The effective stiffness and damping coefficient of the shoulder averaged 12.8 kN/m and 377 N-s/m at 550 N, and the effective mass averaged 47% of total body mass. The damping coefficient and stiffness increased with increasing force, but there was no significant difference in the damping coefficient above 350 N. Our results provide new evidence on the dynamics of shoulder checks in ice hockey, as a starting point for designing test systems for evaluating and improving the protective value of shoulder pads. [ABSTRACT FROM AUTHOR]

Sports-related concussion (SRC) is an injury whereby impact to the face/head/neck impairs cognitive functioning. Parasport athletes have an increased risk for SRC. The Previous Concussion in Sport Group iterations lack guidance for parasport SRC assessment, management, and return-to-play. This article aims to investigate the research relating to parasport SRCs published since the 2021 Concussion in Para Sport (CIPS) position statement and highlights possible new recommendations. A literature review of parasport concussions was conducted. Articles citing the 2021 publication and/or published since then were reviewed. Relevant data were extracted and discussed in this article. Since 2021, twelve (n = 12) articles emerged investigating parasport SRC. Parasport athletes experience greater concussion symptoms and severity scores compared to able-bodied athletes. Visually impaired athletes account for >50% of parasport SRCs. Wheelchair basketball and rugby have the highest SRC incidence rates across parasports. Current SRC assessment methodologies are not designed with consideration of parasport athletes' unique experiences. Guidelines lack a return-to-learning protocol, making returning to education/work challenging for such athletes. Understanding these athletes' SRC experiences is paramount in supporting their recovery. Specific guidelines for SRC assessment, management, return-to-play, and return-to-learn for parasport athletes are necessary to enhance their rehabilitation and avoid the occurrence of long-term symptoms. [ABSTRACT FROM AUTHOR]

Few authors have investigated sport-related concussion (SRC) awareness and knowledge among athletes in Japan. Sport-related concussion research is scarce among Asian compared with North American and European cohorts. To examine previous SRC history, level of SRC knowledge, and previous exposure to SRC education among collegiate athletes in Japan by the level of contact and access to medical staff. Cross-sectional study. Single-university study in Japan. A total of 2103 athletes (48 varsity teams) were contacted to participate in an anonymous survey. Data from athletes with (1) SRC history in the past 3 months, (2) persistent SRC symptoms, (3) nontraditional sports, or (4) incomplete surveys were excluded. As a result, data from 593 athletes representing 43 varsity teams were included in this analysis. Outcome measures were level of contact (contact [CON], limited contact [LTD], noncontact [NC]), access to medical staff (MEDYES, MEDNO), SRC knowledge (maximum score of 49), previous SRC history (self-report; yes, no), and previous SRC education (self-report; yes, no). The average SRC knowledge total score was 33.4 ± 6.1 (range, 18–48). The knowledge score in CON was higher than in LTD and NC (P <.001) and in MEDYES than MEDNO (median, MEDYES = 34.0, MEDNO = 32.0; U = 27 841.5, P <.001). Sport-related concussion history was statistically different by the level of contact (= 27.95, P <.001) and by access to medical staff (= 4.5, P =.034). The presence of an SRC history and previous SRC education contributed to higher SRC knowledge, independent of the level of contact and access to medical staff (P <.001). Japanese athletes who participated in CON sports had a higher prevalence of SRC history, higher knowledge, and greater exposure to SRC education than those in LTD or NC sports. Access to medical staff was associated with higher SRC knowledge. [ABSTRACT FROM AUTHOR]

Many head acceleration events (HAEs) observed in youth football emanate from a practice environment. This study aimed to evaluate HAEs in youth football practice drills using a mouthpiece-based sensor, differentiating between inertial and direct HAEs. Head acceleration data were collected from athletes participating on 2 youth football teams (ages 11–13 y) using an instrumented mouthpiece-based sensor during all practice sessions in a single season. Video was recorded and analyzed to verify and assign HAEs to specific practice drill characteristics, including drill intensity, drill classification, and drill type. HAEs were quantified in terms of HAEs per athlete per minute and peak linear and rotational acceleration and rotational velocity. Mixed-effects models were used to evaluate the differences in kinematics, and generalized linear models were used to assess differences in HAE frequency between drill categories. A total of 3237 HAEs were verified and evaluated from 29 football athletes enrolled in this study. Head kinematics varied significantly between drill categorizations. HAEs collected at higher intensities resulted in significantly greater kinematics than lower-intensity drills. The results of this study add to the growing body of evidence informing evidence-based strategies to reduce head impact exposure and concussion risk in youth football practices. [ABSTRACT FROM AUTHOR]

Medical provider's ability to detect, diagnose, and treat sport-related concussion has greatly improved in recent years. Although more is known about the biomechanical forces involved in concussion, it is still uncertain whether there are preventative measures athletes can take to prevent a sport-related concussion from occurring. The objective of this review was to determine if either neck size or neck strength is related to a decreased risk of sustaining a sport-related concussion. A literature review was conducted on Google Scholar and Ovid MEDLINE for pertinent articles. Findings indicate that isometric neck strength, but not neck size, has been shown to be a predictor for sport-related concussion prevention. Formal neck strengthening programs are feasible and lead to decreased sport-related concussion risk. Additionally, there may be greater opportunity to increase neck strength in amateur athletes compared to professional. In conclusion, cervical strengthening programs have been shown to be feasible and beneficial for athletes to decrease their risk of sustaining a sport-related concussion, though the optimal duration, intensity, and frequency has yet to be determined. [ABSTRACT FROM AUTHOR]

Guardian Caps (GCs) are currently the most popular external helmet add-on designed to reduce the magnitude of head impacts experienced by American football players. Guardian Caps have been endorsed by influential professional organizations; however, few studies evaluating their efficiency are publicly available. To present preliminary on-field head kinematics data for National Collegiate Athletic Association (NCAA) Division I American football players using instrumented mouthguards through closely matched preseason workouts with and without GCs. Case series. The 2022 American football preseason. Twenty-five male NCAA Division I student-athletes participating in American football completed some portion of the 6 workouts included in this study. Of the 25 participants, 7 completed all 6 workouts using their instrumented mouthguards. Peak linear acceleration (PLA), peak angular acceleration (PAA), and total impacts were collected via instrumented mouthguards during 3 preseason workouts using traditional helmets (TRAD condition) and 3 using a TRAD and GCs (GC condition). The TRAD and GC values for PLA, PAA, and total impacts were evaluated using analyses of variance. No difference was present between the collapsed mean values for the entire sample between the TRAD and GC conditions for PLA (TRAD = 16.3g ± 2.0g, GC = 17.2g ± 3.3g, P =.20), PAA (TRAD = 992.1 ± 209.2 rad/s2, GC = 1029.4 ± 261.1 rad/s2, P =.51), or the total number of impacts (TRAD = 9.3 ± 4.7, GC = 9.7 ± 5.7, P =.72). Similarly, no difference was observed between the TRAD and GC conditions for PLA (TRAD = 16.1g ± 1.2g, GC = 17.2g ± 2.79g, P =.32), PAA (TRAD = 951.2 ± 95.4 rad/s2, GC = 1038.0 ± 166.8 rad/s2, P =.29), or total impacts (TRAD = 9.6 ± 4.2, GC = 9.7 ± 5.04, P =.32) between sessions for the 7 players who completed all 6 workouts. These data suggested no difference in head kinematics data (PLA, PAA, and total impacts) when GCs were worn. Therefore, GCs may not be effective in reducing the magnitude of head impacts experienced by NCAA Division I American football players. [ABSTRACT FROM AUTHOR]

Objective: To determine whether an investigational head–neck cooling device, Pro2cool, can better reduce symptom severity compared with standard postconcussion care in early adolescent athletes after a sports-related concussion. Design: Prospective, longitudinal, randomized trial design conducted over a 28-day period. Setting: Six pediatric medical centers in Ohio and Michigan. Participants: The study enrolled 167 male and female 12- to 19-year-old athletes who experienced a sports-related concussion within 8 days of study enrollment and registering a Sports Concussion Assessment Tool 5 (SCAT5) composite score.7. Interventions: Pro2cool, an investigational head–neck cooling therapy device, was applied at 2 postinjury time points compared with postconcussion standard of care only. Main Outcome Measures: Baseline SCAT5 composite symptom severity scores were determined for all subjects. Sports Concussion Assessment Tool 5 scores for concussed athletes receiving cooling treatment were analyzed across 6 independent postenrollment time points compared with subjects who did not receive cooling therapy and only standard care. Adverse reactions and participate demographics were also compared. Results: Athletes who received Pro2cool cooling therapy (n 5 79) experienced a 14.4% greater reduction in SCAT5 symptom severity scores at the initial visit posttreatment, a 25.5% greater reduction at the 72-hour visit posttreatment, and a 3.4% greater reduction at the 10-day visit compared with subjects receiving only standard care (n 5 88). Overall, 36 adverse events (increased blood pressure, decreased pulse, and dizziness) were reported, with 13 events associated with the device, of which 3 were classified as moderate in severity. Conclusions: This study demonstrates the efficacy and safety of head and neck cooling for the management of concussion symptoms in adolescent athletes of an age group for which little to no prior data are available. [ABSTRACT FROM AUTHOR]

Background: The rugby league tackle has been identified as the game event with the greatest propensity for a clinically diagnosed concussion. This study aims to replicate the work conducted in professional rugby league and rugby union by examining Head Injury Assessment (HIA) events to determine the associated tackle characteristics that increase concussion risk in sub-elite rugby league players. This comparison between competition levels is important due to the less developed physiological and tackle proficiency characteristics of sub-elite rugby league players and the fewer resources available for an on-field diagnosis, compared to the elite level of the sport. Results: Tackles resulting in Head Injury Assessments (HIAs, n = 131) and 2,088 tackles that did not result in a head injury were identified and coded from one season of the 2019 Queensland Cup. The body position of both ball carrier and tackler, tackle height, and body contact areas were evaluated. The propensity for tacklers to undergo a head injury assessment was 1.49 HIAs per 1,000 tackles, equating to a 2.5-fold higher risk than that of the ball carrier (0.59 HIAs per 1,000 tackles). The risk for an HIA was 2.75-fold greater when the tackler was upright (2.89 HIAs per 1,000 tackles) compared to a bent-at-the-waist tackler (1.05 HIAs per 1,000 tackles). The greatest risk for the tackler and ball carrier sustaining an HIA occurred when the tackle height was high, with head-to-head contact having the greatest propensity for an HIA (44.37 HIAs per 1,000 tackles). HIA risk was also greater for both players when the ball carrier did not employ an evasion strategy (3.73 HIAs per 1,000 tackles). Conclusions: The study replicates results from research in elite rugby league and rugby union. A combination of higher head contact/proximity and upright body position significantly increase an HIA risk. Tackler head position and ball carrier evasion behaviours also affect risk, suggesting that injury prevention strategies designed to reduce tackle height and improve tackle technique by focusing on head position, body position, and in a novel finding, ball carrier evasion, may reduce head injury risk in sub-elite rugby league players. Key Points: • An upright tackle results in the greatest risk for a Head Injury Assessment (HIA) for both the tackler and ball carrier. • The tackler is more likely to experience an HIA than the ball carrier. • When a ball carrier does not employ an evasion strategy, the risk for an HIA is greater for both the ball carrier and the tackler. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To (1) provide position-specific normative data for isometric cervical muscle strength and endurance in professional, male rugby players and (2) assess the relationship between age, height, weight, and playing position with cervical muscle strength and endurance. DESIGN: Cross-sectional study. METHODS: Professional rugby players completed peak isometric cervical strength testing followed by a test of cervical muscle endurance. Descriptive statistics for continuous variables with strength normalized to body weight were performed. Multiple linear regression was used to estimate associations between strength measurements. RESULTS: In total, 136 players participated including front-row forwards (27%), other forwards (28%), and backs (45%). Front-row forwards had significantly greater peak isometric cervical muscle strength than other position groups, with backs having the lowest strength. Extension produced the highest force for all 3 position groups (429 N ± 104 N), whereas flexion produced the least (275 N ± 65 N). Age was associated with increased isometric cervical muscle strength. There was a statistically significant relationship between peak flexion strength and flexion endurance (P = .003). The average time for the endurance tests were 55.7 (±17.1) seconds and 52.9 (±20.1) seconds for extension and flexion, respectively. Other forwards had lower cervical extension muscle endurance than backs and front-row forwards. CONCLUSIONS: Normative values for peak and endurance isometric strength in professional rugby players illustrate significant differences between playing position. Consider age, body weight, and intraindividual variability when interpreting cervical strength and endurance results. J Orthop Sports Phys [ABSTRACT FROM AUTHOR]

Concussion in para athletes with vision impairment (VI) is poorly understood. Recently published studies have suggested that athletes with VI may be more likely to sustain sport-related concussions compared to non-disabled athletes and athletes with other impairment types. There is a critical need for objective concussion incidence measures to determine concussion injury rates and risks more accurately. The aim of this review was to examine the limited available evidence of concussion incidence rates across six different para sports for athletes with VI and encourage the future collection of concussion incidence data and the adoption of injury prevention strategies in VI para sport. A literature search was conducted using four unique databases, which formed the basis of this narrative review. Injury prevention strategies such as modifying sport rules, introducing protective equipment, and incorporating additional safety measures into the field of play have been introduced sporadically, but the effectiveness of most strategies remains unknown. More prospective, sport-specific research examining mechanisms of injury and risk factors for concussion injuries in athletes with VI in both training and competition is needed. This research will help inform the development of targeted injury prevention strategies to reduce the likelihood of concussion for athletes with VI. [ABSTRACT FROM AUTHOR]

Background: Considering the multifaceted consequences of improperly managed sport-related concussions (SRCs) in American football, identifying efficacious prevention measures for enhancing player safety is crucial. Purpose: To investigate the association of primary prevention measures (no-tackle practices and using a mobile tackling dummy in practice) with the frequency of SRCs within college football programs in the United States. Study Design: Descriptive epidemiology study. Methods: In this pilot study, we analyzed the frequency of new SRCs recorded during various settings (total, in preseason, in season, in practice, and game) across 14 seasons (2007-2019 and 2021) for Dartmouth College and across 7 seasons (2013-2019) for the 7 other teams in the Ivy League men's athletic football conference. Trends between seasons and the number of SRCs sustained were examined using correlations and basic descriptive statistics. We also examined SRC frequency in relation to primary prevention measures (no-tackle practices, use of mobile tackling dummies during practice) in the Dartmouth College football program, and we compared SRCs with regard to the no-tackle practice policy in the other Ivy League teams. Results: There was a statistically significant reduction in the number of SRCs over the seasons studied, with the strongest finding observed for Dartmouth College in-game SRCs (r = −0.52; P =.029). Relatedly, the strongest between-season effect was seen for the Dartmouth College practice policy on in-game SRCs (η2 = 0.510; P =.01). The use of mobile tackling dummies was found to be independently associated (adjusting for no-tackle practice) with a lower number total (β = −0.53; P =.049), in-season (β = −0.63; P =.023), and in-game (β = −0.79; P =.003) SRCs. While seasons with the no-tackle practice were not meaningfully associated with SRCs for Dartmouth College, stronger trends were observed in the other Ivy League teams, such that seasons with this policy were associated with lower SRC prevalence. Conclusion: Our data indicate that the use of the mobile tackling dummy in practice was related to the reduced number of SRCs sustained at multiple settings during the football season. To a lesser extent, the no-tackle practice policy was also associated with a reduced number of SRCs. [ABSTRACT FROM AUTHOR]

American football is associated with the largest number of emergency department visits for pediatric sport-related traumatic brain injury, including concussions. Tackling is responsible for almost two-thirds of football concussions. Some have recommended implementing age restrictions on tackling in youth football. To determine whether the public would support age restrictions and the factors that may drive such support. Cross-sectional study. Summer wave of Porter Novelli's 2020 US ConsumerStyles survey. A total of 4053 adults. Respondents answered questions about a good age for children to start playing tackle football, past football playing history, concerns about safety, and the benefits and risks of playing football. Most respondents believed that middle (32.8%) or high (27.8%) school was a good age to start playing tackle football. About 1 in 5 (19.8%) respondents reported that children should never play tackle football. Certain groups of individuals were more likely to support children starting to play tackle football at high school age or above or to say that they should never play tackle football, including those with a bachelor's degree or higher (rate ratio [RR]HS+ = 1.41, 95% CI = 1.14, 1.76; RRNEVER = 2.70, 95% CI = 1.93, 3.78), those who did not have children under 18 (RRHS+ = 1.54, 95% CI = 1.26, 1.90; RRNEVER = 1.54, 95% CI = 1.14, 2.07), those who were not football fans (RRNEVER = 3.07, 95% CI = 2.32, 4.06), and those who were very (RRHS+ = 3.94, 95% CI = 2.87, 5.42; RRNEVER = 11.52, 95% CI = 7.32, 18.15) or somewhat (RRHS+ = 1.88, 95% CI = 1.41, 2.52) concerned about the safety of children. Despite acknowledging the benefits of playing football, many adults expressed concern about safety and endorsed high school age and older or never as a good age to start playing tackle football, highlighting a disconnect with current football program practices regarding age. [ABSTRACT FROM AUTHOR]

Background: Numerous individual studies suggest that rest may have a negative effect on outcomes following concussion. Purpose: To perform a systematic meta-analysis of the effects of prescribed rest compared with active interventions after concussion. Study Design: Meta-analysis; Level of evidence, 4. Methods: A meta-analysis (using the Hedges g) of randomized controlled trials and cohort studies was conducted to evaluate the effects of prescribed rest on symptoms and recovery time after concussion. Subgroup analyses were performed for methodological, study, and sample characteristics. Data sources were obtained from systematic search of key terms using Ovid Medline, Embase, Cochrane Database of Systematic Reviews, APA PsycINFO, Web of Science, SPORTDiscus, and ProQuest dissertations and theses through May 28, 2021. Eligible studies were those that (1) assessed concussion or mild traumatic brain injury; (2) included symptoms or days to recovery for ≥2 time points; (3) included 2 groups with 1 group assigned to rest; and (4) were written in the English language. Results: In total, 19 studies involving 4239 participants met criteria. Prescribed rest had a significant negative effect on symptoms (k = 15; g = −0.27; SE = 0.11; 95% CI, −0.48 to −0.05; P =.04) but not on recovery time (k = 8; g = −0.16; SE = 0.21; 95% CI, −0.57 to 0.26; P =.03). Subgroup analyses suggested that studies with shorter duration (<28 days) (g = −0.46; k = 5), studies involving youth (g = −0.33; k = 12), and studies focused on sport-related concussion (g = −0.38; k = 8) reported higher effect sizes. Conclusion: The findings support a small negative effect for prescribed rest on symptoms after concussion. Younger age and sport-related mechanisms of injury were associated with a greater negative effect size. However, the lack of support for an effect for recovery time and the relatively small overall numbers of eligible studies highlight ongoing concerns regarding the quantity and rigor of clinical trials in concussion. Registration: CRD42021253060 (PROSPERO). [ABSTRACT FROM AUTHOR]

Return to learn (RTL) is the individualized process of coordinating cognitive care and reintegration for students into the academic setting after any sport and recreational-related concussion (SRRC). The guidelines for RTL are based on empirical evidence, however, implementation differs by institution. The purpose of the policy analysis is to evaluate RTL guidelines after SRRC of student-athletes in New England secondary school public school systems. A review of the six New England states' policies surrounding RTL was conducted. The Comprehensive Analysis of Physical Activity Framework was referenced to identify the analytic components of existing legislation and because of the relatively new implementation of RTL-specific policy, a novel policy analysis tool was utilized. States with RTL-specific language scored on average 7.9 to 11.1 points higher when compared to states without RTL-specific language. This difference was associated with disparities in access to RTL resources for residents according to their geographic location. Lobbying efforts should be targeted toward states without RTL-specific language to provide equal care and opportunities for student-athletes to receive RTL services. RTL policy provides a responsibility to assist students who have suffered from an SRRC and can serve to improve health outcomes and academic achievement. [ABSTRACT FROM AUTHOR]

Objective: Current evidence for concussions is mixed in water polo players. Surveys suggest rates as high as 36%, whereas surveillance studies at international competitions often fail to report them at all. The goal of this study was to examine the incidence of concussions in elite female water polo players from surveillance tools implemented longitudinally. Design: Retrospective chart analysis of 10 years spanning between 2012 and 2022. Setting: National teams or professional sports. Participants: Female players from the Canadian senior national water polo teams that participated in international competitions and trained more than 10 hours per week in a competitive environment. Assessment of Risk Factors: Included player position, recurrence, and time loss before full return to play. Main Outcome Measures: Prevalence of concussion diagnosis. Results: Forty-three concussions were identified over the 10 years observed at a median count of 3 concussions per year. Cumulative days lost spanned between 25 and 348 days per team*year. Altogether, this produced a median rate of 14.3 injuries per 100 player*years. Goalkeepers in the sample suffered the highest rates of concussion (25.8%), compared with players in other positions (22.8% of centers and 16.7% of drivers). Conclusions: This study found evidence for prevalence of concussions in elite female water polo players. Improved guidelines preceded a significant reduction in time loss after the year 2017. This adds to a body of knowledge suggesting that improved surveillance methods are needed to detect and care for concussions in this population. [ABSTRACT FROM AUTHOR]

Our purpose was to investigate the reliability and minimal detectable change characteristics of a smartphone-based assessment of single- and dual-task gait and cognitive performance. Uninjured adolescent athletes (n = 17; mean age = 16.6, SD = 1.3 y; 47% female) completed assessments initially and again 4 weeks later. The authors collected data via an automated smartphone-based application while participants completed a series of tasks under (1) single-task cognitive, (2) single-task gait, and (3) dual-task cognitive-gait conditions. The cognitive task was a series of continuous auditory Stroop cues. Average gait speed was consistent between testing sessions in single-task (0.98, SD = 0.21 vs 0.96, SD = 0.19 m/s; P =.60; r =.89) and dual-task (0.92, SD = 0.22 vs 0.89, SD = 0.22 m/s; P =.37; r =.88) conditions. Response accuracy was moderately consistent between assessments in single-task standing (82.3% accurate, SD = 17.9% vs 84.6% accurate, SD = 20.1%; P =.64; r =.52) and dual-task gait (89.4% accurate, SD = 15.9% vs 85.8% accurate, SD = 20.2%; P =.23; r =.81) conditions. Our results indicate automated motor-cognitive dual-task outcomes obtained within a smartphone-based assessment are consistent across a 1-month period. Further research is required to understand how this assessment performs in the setting of sport-related concussion. Given the relative reliability of values obtained, a smartphone-based evaluation may be considered for use to evaluate changes across time among adolescents, postconcussion. [ABSTRACT FROM AUTHOR]

The purpose of this study is to analyze the relationship between the occurrence of the National Brain Injury Awareness Week and public interest in the concussion topic in Australia through an analysis of Internet search activity data from Google Trends. Online retrospective observational study. For the keyword "concussion", the search interest rate over a period of 10 years between August 2012 and August 2022 within Australia has been analyzed using the Google Trends tool. The rising related topics that contributed to the months with the highest search interest were extracted for each year and a trendline analysis was performed to capture temporal patterns. There was a significant difference in the average search interest between the month of August, when the Brain Injury Awareness Week is annually held, and the rest of the year (d = 0.09, p = 0.017). Also, May and August were the two months with the overall highest search interests (mean ± SD: 73.3 ± 5.16 and mean ± SD: 70.1 ± 5.49, respectively). Trendline analysis showed a positive slope of 0.3081 with R2 = 0.4462 for search interests of concussion over the 10-year period. The data suggest that there is a growing interest and potential awareness of concussion in Australia that seems highly limited to the context of sports such as football, rugby, and soccer. Major sports events, news coverage, and media exposure appear to be associated with this trend. The study highlights the importance of more investment in producing engaging media content to educate the public on concussion of different causes and improving strategies for National Brain Injury Awareness Week. [ABSTRACT FROM AUTHOR]

Objective: To help address the high concussion burden in Canadian youth ice hockey, our primary objective was to examine the concurrent validity of youth ice hockey referees' ability to assess head contacts (HCs) and associated penalties using video analysis methods after implementation of the "zero tolerance for HC" policy by Hockey Canada. Study Design: Cross-sectional study. Participants: Certified Level II-III referees in Alberta, Canada. Intervention: A secured online survey with 60 videos (10 to 15 seconds) containing a player-to-player physical contact with or without a HC from elite U15 (ages 13 to 14) youth ice hockey games. OutcomeMeasures: Survey questions were completed by all referees for each video, including (1). 'Did you see a player-toplayer contact?', (2). 'Should a penalty be assessed?', and if yes, (3). 'Which player, penalty type, and penalty intensity?' Referee assessments were compared with a consensus agreement from 2 national and member (top level) gold standard referees for concurrent validity through percent agreement and sensitivity/specificity measures. Results: Complete-case analysis of 100 referees (131 recruited) showed an overall median agreement of 83.5% (sensitivity 5 0.74; specificity 5 0.69) with the gold standard. Agreement with the gold standard was highest for HC infractions [85.1% (sensitivity 50.80; specificity50.69)], followed by HC penalty type (81.5%) and penalty intensity (53.7%). Conclusions: Concurrent validity through percent agreement was high (.80%) compared with the gold standard for identifying both HC and other infractions; however, it was moderate for penalty intensity. Although knowledge of identifying HCs and penalties in this survey was acceptable, this study suggests in-game factors (eg, game management and positioning) may be a primary limitation for HC enforcement. [ABSTRACT FROM AUTHOR]

Background: Kickoff plays in American football are associated with an increased risk of concussion compared with other play types. In 2018, the National Collegiate Athletic Association (NCAA) Football Rules Committee altered the kickoff rules so a fair catch inside the 25-yard line results in a touchback, with the ensuing drive starting on the 25-yard line. The intention was to decrease the number of kickoff returns with a corresponding decrease in the rate of concussions on kickoff plays. Purpose: To determine whether the 2018 rule changes had the intended effects in an NCAA Division 1 Conference. Study Design: Cohort study; Level of evidence, 3. Methods: The study population included football athletes in the NCAA Pacific-12 (Pac-12) Conference. Data on the total number of plays, punts, kickoffs, touchbacks, and fair catches were obtained for all in-conference games from the 2016 to 2021 seasons. The number of game concussions and the play type were provided by each conference institution. Incidence of concussions occurring during kickoff plays before (2016-2017) and after (2018-2021) the rule change were compared with a difference-in-difference analysis using Poisson general linear models. Results: There were 242 concussions in 108,774 total plays in the study period, with an overall concussion rate of 2.2 per 1000 plays. The percentage of touchbacks increased significantly from 45% to 51% (P <.001) and the percentage of fair catches increased from 1% to 7% (P <.001) from before to after the rule change. Kickoffs accounted for 6% of plays both before and after the rule change and 11% of concussions before and 14% after the change. The mean annual concussion rate (per 1000 plays) on kickoffs was 3.42 before and 5.31 after the rule change (rate difference: 1.89; 95% confidence interval, -1.22 to 5.01). Conclusion: Touchbacks and fair catches increased after the kickoff rule change, but there was not a corresponding decrease in concussions during kickoff plays as anticipated. Concussions occurring during other football plays remained stable. [ABSTRACT FROM AUTHOR]

Ice hockey has one of the highest concussion rates among youth sports. Sensor technology has been implemented in contact and collision sports to inform the frequency and severity of head impacts experienced on-ice. However, existing studies have utilized helmet-mounted sensors with limited accuracy. The objective of this study was to characterize head kinematics of contact events in a sample of youth boys' hockey players using a validated instrumented mouthpiece with improved accuracy. Head kinematics from 892 video-verified events were recorded from 18 athletes across 127 sessions. Median peak resultant linear acceleration, rotational velocity, and rotational acceleration of video-verified events were 7.4 g, 7.7 rad/s, and 576 rad/s2, respectively. Contact events occurred at a higher rate in games (2.48 per game) than practices (1.30 per practice). Scenarios involving head contact had higher peak kinematics than those without head contact. This study improves our understanding of head kinematics in boys' youth hockey. [ABSTRACT FROM AUTHOR]

Background: Rugby Union is a collision team sport played globally. Despite this, significant concerns have been raised regarding the sport's safety, particularly in youth players. Given this, a review of injury rates, risk factors and prevention strategies is required across different youth age groups as well as in males and females. Objective: The objective of this systematic review (SR) and meta-analysis was to investigate injury and concussion rates, risk factors and primary prevention strategies in youth rugby. Methods: To be included, studies were required to report either rates, risk factors or prevention strategies in youth rugby and to have a randomised controlled trial, quasi-experimental, cohort, case control, or ecological study design. Exclusion criteria included non-peer-reviewed grey literature, conference abstracts, case studies, previous systematic reviews and studies not written in English. Nine databases were searched. The full search strategy and list of sources are available and pre-registered on PROSPERO (Ref: CRD42020208343). Each study was assessed for risk of bias using the Downs and Black quality assessment tool. Meta-analyses were conducted using a DerSimonian Laird random effect model for each age group and sex. Results: Sixty-nine studies were included in this SR. The match injury rates (using a 24-h time-loss definition) were 40.2/1000 match hours (95% CI 13.9–66.5) in males and 69.0/1000 match hours (95% CI 46.8–91.2) in females. Concussion rates were 6.2/1000 player-hours (95% CI 5.0–7.4) for males and 33.9/1000 player-hours (95% CI: 24.1–43.7) for females. The most common injury site was lower extremity (males) and the head/neck (females). The most common injury type was ligament sprain (males) and concussion (females). The tackle was the most common event associated with injury in matches (55% male, 71% females). Median time loss was 21 days for males and 17 days for females. Twenty-three risk factors were reported. The risk factors with the strongest evidence were higher levels of play and increasing age. Primary injury prevention strategies were the focus of only eight studies and included law changes (n = 2), equipment (n = 4), education (n = 1) and training (n = 1). The prevention strategy with the most promising evidence was neuromuscular training. The primary limitations included a broad range of injury definitions (n = 9) and rate denominators (n = 11) used, as well as a limited number of studies which could be included in the meta-analysis for females (n = 2). Conclusion: A focus on high-quality risk factor and primary prevention evaluation should be considered in future studies. Targeting primary prevention and stakeholder education remain key strategies in the prevention, recognition and management of injuries and concussions in youth rugby. [ABSTRACT FROM AUTHOR]

Objective: To examine injury and concussion rates, mechanisms, locations, and types of injury in Canadian high school male rugby. Design: Prospective cohort study. Setting: High school male rugby. Participants: A total of 429 high school players (2018: n = 225, 2019: n = 256) were recruited from 12 teams in 7 schools in Calgary, Canada. Interventions: None. Main Outcome Measures: Injury surveillance included baseline questionnaires, weekly exposure, and injury reports. Injuries included those requiring medical attention, resulted in time loss and/or inability to complete a session. Concussion was defined as per the fifth Consensus on Concussion in Sport, and all players with a suspected concussion were referred to a study sport medicine physician. Results: A total of 134 injuries were captured, leading to an injury incidence rate (IR) of 57.9/1000 hours [95% confidence intervals (CIs): 45.4-73.8]. Median time loss was 6 days (range: 0-90). Injuries to the head were the most common (40%), followed by shoulder (12%) and ankle (10%). The concussion IR was 22.0/1000 hours (95% CIs: 15.9-30.4), which was the most common injury type (38%), followed by sprain (20%) and strain (15%). Sixty-five percent of injuries occurred in the tackle (ball carrier 35%, tackler 30%) and 76% of concussions (ball carrier 41%, tackler 35%). Conclusions: The rate of injury and concussion in Canadian youth high school male rugby is high, with tackle-related injuries and concussions the most common. Given this, there is a critical need for implementation of prevention strategies, in particular targeting concussion and the tackle event (eg, neuromuscular, tackle training, and law changes). [ABSTRACT FROM AUTHOR]

The nuances of swimming make the application of traditional return-to-play progressions following concussion challenging. Our purpose was to describe athletic training services and concussion management protocols among National Collegiate Athletic Association swim programs and compare them between the National Collegiate Athletic Association divisions. We surveyed 228 athletic trainers assigned to or with knowledge of their institution's swim programs from a convenience sample of 539 (response rate = 42.3%) athletic trainers. Athletic training services were provided to 98.6% (214/217) of the programs. Nearly 80% (164/207) of the programs administered baseline concussion testing to swimmers, with differences observed between divisions (p <.001). No differences (p =.108) in the number of concussions sustained by swimmers in the past academic year were noted between divisions. Specific return-to-swim protocols were reported by 51.8% (115/222) of respondents with no differences in the presence of a specific return-to-swim protocol between divisions (p =.790). While concussions are reported less frequently in swimming than other sports, appropriate medical care, including a specific return-to-swim protocol, is warranted and provided for future use. [ABSTRACT FROM AUTHOR]

Attention to concussion prevention and management has grown in recent years due to the potentially long-term, debilitating effects a head injury can have on an individual. Although multiple campaigns have been designed to target this issue, there remains a need to evaluate the persuasive principles used to advocate for safety measures and protocols, specifically within youth sports. With this in mind, we applied the health belief model (HBM) in our content analysis of the Centers for Disease Control and Prevention's (CDC) Heads Up concussion awareness campaign. Campaign videos (N = 35) were coded for threat severity, threat susceptibility, benefits, barriers, self-efficacy, and cues to action. The majority of videos communicated the seriousness of concussions and attempts to communicate concussion susceptibility were driven by personal stories, rather than facts and statistics demonstrating concussion prevalence. Less than half of the videos communicated the benefits of following concussion protocols and only a third of the messages described barriers to following recommended protocols. The majority of videos aimed to elevate self-efficacy among athletes and parents, but not coaches, by focusing on identifying symptoms and concussion avoidance. The implications for concussion prevention and management among athletes, parents, and coaches are discussed. [ABSTRACT FROM AUTHOR]

Clinical management of sport-related concussion requires the assessment of various factors, including motor performance. The tandem gait test, a measure of postinjury motor performance, has demonstrated clinical utility but is limited by time availability and test uniformity. To assess intrasession reliability between tandem gait test trials and determine the number of trials necessary for optimal utility and feasibility in clinical decision-making after concussion. Cross-sectional study. Pediatric sport medicine clinic. Adolescent athletes who recently sustained a concussion (n = 44; age = 15.4 ± 1.8 years; 39% females) and were seen for care within 14 days (7.3 ± 3.2 days) of their injury as well as uninjured control participants (n = 73; age = 15.8 ± 1.3 years; 41% females). All individuals completed 3 single-task and 3 dual-task tandem gait trials. We collected test completion time and cognitive performance for each trial and calculated Pearson correlation coefficients between trials and intraclass correlation coefficients (ICCs) to determine intrasession reliability. We also compared performance between groups and calculated area under the curve (AUC) values to identify the ability of each trial to distinguish between groups. Both the concussion and control groups demonstrated high intrasession reliability between tandem gait trials under single- (R ≥ 0.82, ICC ≥ 0.93) and dual- (R ≥ 0.79, ICC ≥ 0.92) task conditions. The greatest group classification values were obtained from the second single-task trial (AUC = 0.89) and first dual-task trial (AUC = 0.83). Test completion time provided excellent between-groups discrimination in single- and dual-task conditions. However, cognitive performance during dual-task trials demonstrated only marginally significant clinical utility (AUC ≤ 0.67). Tandem gait assessments may only require 2 trials under single-task and 1 trial under dual-task conditions to effectively discriminate between concussion and control groups. This approach may improve the feasibility (ie, time requirement) of the test while maintaining excellent discriminatory ability. [ABSTRACT FROM AUTHOR]

Concussion is a type of mild traumatic brain injury which results in symptoms within the physical, cognitive, emotional, and sleep domains. Historically, guidelines established by expert opinion have recommended rest during the initial stages of recovery following a concussion until symptom resolution. However, recent recommendations have shifted to advise an initial period of 24–48 h of rest immediately following concussion with the gradual introduction of light-to-moderate intensity aerobic exercise thereafter. Given the relatively recent transition in recommendations, the aim of this review is to provide an overview of the current literature on the efficacy of aerobic exercise following concussion. The current literature is limited to studies assessing the impact of standardized aerobic exercise following concussion. Upon review, literature suggests participating in aerobic exercise below the point of symptom exacerbation is safe in both the acute and chronic post-concussion symptom stages of recovery and does not delay time to medical clearance. Future large-scale randomized controlled trials assessing the impact of aerobic exercise and differences between males and females would help support the current evidence suggesting aerobic exercise could improve time to recovery following concussion and identify any sex differences in response. As well, future studies with the purpose of identifying optimal aerobic exercise volume and intensity in the treatment of concussion could improve the specificity of the current guidelines. [ABSTRACT FROM AUTHOR]

Background: Concussion public policies have been developed to address the burden of concussions. The aim of the present study was to examine implementation compliance, barriers, and facilitators of Canada's first concussion public policy, Ontario's Policy/Program Memorandum 158: School Board Policies on Concussion (PPM158). Methods: An electronic survey was sent to 515 randomly selected elementary and high school principals across specific geographic, language, and publicly funded school types in Ontario. Data were analyzed using both qualitative and quantitative methods. Results: One hundred and thirty‐five principals responded to the survey (26%). Concussion education was provided to teachers in 81% of schools, to students in 83%, and coaches in 79%. Additionally, 89% reported having a return‐to‐learn protocol in place and 90% reported having a return‐to‐play protocol. Implementation barriers included difficulties in providing concussion education to parents (42%), obtaining notes from physicians, and maintaining the volume of documentation. Eighty‐seven percent of respondents believed that PPM158 improves student well‐being. Conclusions: Identified implementation barriers and facilitators can inform concussion policy practices to improve student well‐being. We recommend: (1) an appointed concussion policy lead at each school, (2) electronic documentation, (3) determining the optimal education format to improve parent/guardian education, (4) fostering relationships between schools and health care professionals, and (5) student concussion education in every grade in Ontario schools. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Objective: To determine whether slow processing speed is associated with risk of sport-related concussion. Design: We conducted a retrospective cohort study using computerized neurocognitive assessments (Immediate Post-concussion Assessment and Cognitive Testing [ImPACT]) from the Massachusetts Concussion Management Coalition. Slow processing speed was defined as 2 SD below the sample mean (n = 131) and fast processing speed as 2 SD above the sample mean (n = 259). We used a binary logistic regression model to determine the odds of sustaining a concussion with our main predictor being processing speed (high or low) adjusted for the effects of age, sex, and prior number of concussions. Setting: Massachusetts Concussion Management Coalition, Institutional care. Participants: Three hundred ninety junior high soccer players ages 10 to 15 with a baseline score for ImPACT. Independent Variables: Processing Speed. Main Outcome Measures: Risk of sustaining a concussion. Results: Those with slow processing speed had a visual motor composite score of ≤19.92, those with fast-processing speed had a score of ≥46.20. Athletes with slow processing speed were younger (13 vs 14 years; P < 0.001) and more likely to be male (57% vs 49%; P = 0.014). After adjusting for the effects of age, sex, and prior concussions, there was no significant difference in the odds of sustaining a concussion between groups (aOR 1.01; 95% CI, 0.99-1.04). Conclusions: Despite previous research showing that slow processing speed is a risk factor for musculoskeletal injuries during sports, our study suggests that processing speed is not associated with the risk of sustaining a concussion among junior high school soccer players. [ABSTRACT FROM AUTHOR]

Many collegiate athletes use scooters and mopeds for transportation, and they are at greater risk for head injury without helmets. Objective: Investigate college athletes' reasons for wearing/not wearing helmets while riding a scooter or moped. Participants, Methods: 125 Division I athletes across five teams (two with helmet mandates) completed a cross sectional survey on rates and attitudes about helmet use on scooters or mopeds. Results: Helmet use on mandated vs non-mandated teams was 100% vs 3.6% (OR 1141; 95% CI 56.97, 22,850). For the question, "if you do not wear a helmet, what might make you change your mind and wear one?", players most commonly wrote in a law or coaches' rule (57%). Conclusions: A coach's rule is associated with a higher rate of helmet use in collegiate athletes, and athletes primarily report a rule or law as the reason they would wear a helmet on a scooter or moped. [ABSTRACT FROM AUTHOR]

All states have youth sports concussion laws that have helped shape school concussion policy. However, state laws do not specify how schools distribute policy. The present study examined parent, youth, and school personnel's knowledge of school concussion policy in Colorado and ease of access to policy via school website. Youth (n = 1,987), parents (n = 520), and school personnel (n = 130) completed an online survey about knowledge of their schools' concussion policy. Less than half of parents (48.9%) and students (43.0%) knew their school had a policy. School personnel were aware of the policy (96%). Among youth, rates of knowledge differed across gender, school level, and sport participation. Forty-nine percent of school district websites contained information on concussion. There are gaps in knowledge of concussion policy for youth and their parents. Teachers, administrators, coaches, and school nurses, who are educated on policy, could help facilitate communication. School websites are not being fully utilized to disseminate concussion policy. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate how four types of successfully executed, legal front-on, one-on-one torso tackles influence the tacklers' and ball carriers' inertial head kinematics. Methods: A total of 455 successful front-on, one-on-one torso tackle trials completed by 15 rugby code players using three-dimensional motion capture were recorded. Tackles differed with respects to the height of the contact point on the ball carrier's torso. A series of mixed general linear models were conducted. Results: The tackler sustained the highest peak resultant linear (P < 0.001) and angular (P < 0.01) head accelerations when contacting the lower torso to execute a "dominant" tackle compared with mid or upper torso, although these latter tackle types had the lowest ball carrier inertial head kinematics. When executing a "smother" tackle technique, a significant decrease in peak resultant linear head acceleration was observed with a vertical "pop" then lock action used, compared with the traditional upper torso tackling technique (P < 0.001). Conclusions: Modifying the tackler's engagement with a ball carrier's torso, with respect to height and technical execution, alters the inertial head kinematics of the tackler and the ball carrier. The traditional thinking about optimal tackle technique, as instructed, may need to be reevaluated, with the midtorso being a potential alternative target contact height, whereas changes in tackle execution may be relatively protective for tacklers when executing either a dominant or smother tackle. This study provides critical scientific evidence to underpin revised coaching tackling technique interventions that might enhance player safety. Tackles in which the tackler contacts the ball carrier around the midtorso region, rather than lower torso, produce the lowest acceleration and thus may contribute to reducing head injury risk for the tackler. [ABSTRACT FROM AUTHOR]

Objectives: To describe injury and concussion rates and mechanisms in female high school rugby players. Design: Two-year prospective cohort study. Setting: High school rugby. Participants: Participants included 214 female High school rugby players (year 1) and 207 female High school players (year 2) from the Calgary Senior High School Athletics Association 2018 and 2019 rugby competition. Intervention: None. Main Outcome Measures: Match and training injury and concussion. Injury definition included any injury resulting in time loss, inability to complete a session, and/or requiring medical attention. Details of reported injuries were collected on injury report forms and validated by a certified athletic therapist on a validated online injury surveillance platform. Exposure hours for players were tracked using paper or virtual weekly exposure forms by team designates. Results: A match incidence rate (IR) = 93.7 injuries/1000 match hours (95% confidence intervals (CI): 78.6-11.7) and training IR = 5.3 injuries/1000 training hours (95% CI: 4.0-6.9) were estimated. The tackle accounted for 109 (70%) match and 37 (44%) training injuries. Tackling was the most frequent mechanism of injury (IR = 37.5 injuries/1000 match hours, 95% CI: 27.5-51.8 and 1.2 injuries/1000 training hours, 95% CI: 0.7-2.4). Sixty-two match concussions (IR = 37.5 concussions/1000 match hours, 95% CI: 26.8-52.3) and 16 training concussions (IR = 1.0 concussions/1000 training hours, 95% CI: 0.7-1.4) occurred. Of 78 reported concussions, 78% for match and 56% for training were physician diagnosed. Tackling was the most frequent mechanism of concussion in matches (IR = 18.1 concussions/1000 match hours, 95% CI:11.4-28.6). Conclusions: Injury and concussion rates in female high school rugby are high. The tackle accounted for the highest proportion of injuries. Prevention strategies (eg, tackle policy change, tackle-training programs, and neuromuscular training) should be explored to increase sport safety. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Objective: Studies investigating the associations between personality and sports-related concussion are limited. The current study aimed to address this gap by examining whether specific personality dimensions predicted self-reported sports-related concussion outcomes. Design: This study included 1141 undergraduate students (M age = 19.47, SD = 2.14, female = 64.5%) who completed a battery of online personality measures and self-reported sports-related concussion items. The self-reported sports-related concussion outcomes included a single diagnosed sports-related concussion incident (i.e., "diagnosed sports-related concussion incidence") and incidents of multiple diagnosed sports-related concussions (i.e., "multiple diagnosed sports-related concussion incidents"). Analyses included splitting data randomly into training and validation data sets. Multivariate logistic regression models were then fit to each data set to determine predictors of sports-related concussion. Results: In both training and validation data sets, extraversion and experience seeking were found to be positively and most strongly associated with both sports-related concussion outcomes, whereas motor inhibition was found to be negatively associated with both outcomes. Additional personality dimensions showed differential relations with each sports-related concussion outcome. Conclusions: The current study highlights the importance of considering personality dimensions in the context of self-reported sports-related concussion outcomes, as there are differential relations between personality dimensions and these outcomes. Thus, prevention efforts for sports-related concussion may benefit from evaluating additional athlete factors, like personality traits. [ABSTRACT FROM AUTHOR]

Physicians play a key role in ensuring athletes with concussion safely return to sport. Research has shown deficiencies in concussion education amongst physicians and medical students. However, studies have not previously been conducted in UK medical schools. To assess students' concussion knowledge and learning in Scottish Medical Schools. A survey with 23 questions was distributed to Year 3–6 medical students studying in Scotland in October 2020. The survey included the following: (1) demographics, (2) concussion knowledge, e.g. 'What is the role of headgear in preventing concussion?' (3) concussion learning, 'In which part of the curriculum should concussion be taught?.' Frequencies of responses were calculated for each question. 200 students responded (response rate 8%). The average symptoms and management score were 87.3% and 31% respectively. 15% of participants knew that headgear has no role in preventing concussions and one participant identified the minimum "return to sport" timeframes for adults and children. 15% had learnt about concussion at medical school with 92.5% interested in receiving concussion teaching at medical school. Knowledge gaps exist in managing and preventing sports-related concussion. There is a discrepancy between levels of concussion teaching and the desire and importance placed on concussion education. [ABSTRACT FROM AUTHOR]

Football continues to demonstrate the highest rate of sport-related concussion (SRC) in high school athletics. To mitigate the SRC risk, the Michigan High School Athletic Association (MHSAA) implemented rules aimed at reducing the number of collisions occurring in practices. To estimate the rates of SRC in MHSAA football programs and evaluate progressive limitations to collision practices over 5 consecutive seasons. Retrospective cohort study. Michigan high school football. High school (9th–12th grade) football athletes (>99% male) participating in MHSAA-sanctioned events. Designated administrators at each school recorded the total number of participating athletes and SRCs (defined as head injuries resulting from athletic participation that required the student-athletes to be withheld from activity after exhibiting signs, symptoms, or behaviors consistent with an SRC) in the MHSAA injury-surveillance system each season (2015–2016 through 2019–2020). Progressive limitations to collision practices occurred across the study period. We estimated athlete-exposures (AEs) as the total number of players multiplied by the total number of possible practices (11 weeks, 4 days each) or competitions (9 weeks, 1 day each) during each season. Incidence rates and rate ratios (RRs) with 95% CIs were used to compare practice and competition SRCs and each season with the most recent season. A total of 7755 football SRCs were diagnosed across the 5-year period. The overall SRC rate was 8.03 per 10 000 AEs (95% CI = 7.85, 8.21). The competition SRC rate (30.13/10 000 AEs) was higher than the practice rate (3.51/10 000 AEs; RR = 8.58; 95% CI = 8.19, 9.00). The practice SRC rate was lower in 2017–2018 (RR = 0.86; 95% CI = 0.77, 0.97), 2018–2019 (RR = 0.89; 95% CI = 0.79, 1.0), and 2019–2020 (RR = 0.83; 95% CI = 0.74, 0.94) relative to 2015–2016. We found that the progressive limitations to collision practices were protective against SRCs, as the rate of SRC was lower in the 3 most recent seasons relative to 2015–2016. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate sport-related injury rates, types, locations, and mechanisms in female youth team sports. This was a secondary analysis of a cross-sectional study. An anonymous online survey was administered to high school students (ages 14-19) in Alberta, Canada. The survey included questions regarding demographic information, sport participation and self-reported injuries sustained in the past year. Results were analyzed for girls who reported playing a top ten team sports for female participation. For girls participating in team sports, the overall injury rate was 55.5 injuries/100 participants/year. The rate of at least one concussion was 9.4 concussions/100 participants/year. Injury and concussion rates were highest in ringette (Injury rate=42.9 injuries/100 participants/year, Concussion rate=19.0 concussions/100 participants/year) and rugby (Injury rate=40.0, Concussion rate=15.3). The top three most serious injury locations were the knee (24.7%), ankle (21.6%) and head (16.1%). The most common injury types were joint/ligament sprain (26.71%), fracture (13.0%) and concussion (11.8%). Contact mechanisms accounted for 73.4% of all serious injuries reported in girls team sports. Team sport injury rates are high in female youth team sports. Specific consideration of sport-specific injury rates, types and mechanisms in girls' team sports will inform development and evaluation of targeted sport-specific prevention strategies. [ABSTRACT FROM AUTHOR]

Objectives: The aims were to (1) examine the rates and mechanisms of concussion and head impact in youth football (high school level or younger); (2) identify modifiable risk factors for concussion and head impact; and (3) evaluate the effectiveness of prevention strategies in tackle football at any level. Methods: Nine databases (CINAHL Plus with Full Text; Cochrane Central Register of Controlled Trials; EMBASE; ERIC; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; ProQuest Dissertations & Theses Global Database; PsycINFO; Scopus; and SPORTDiscus with Full Text) were searched using the search strategy focusing on four main concepts: concussion/head impact, tackle football, modifiable risk factors, and primary prevention. Two reviewers completed title, abstract, and full-text screening as well as risk of bias assessment (using the Downs and Black checklist), with a third author available to resolve any disagreements. Main Results: After removing duplicates, 1911 articles were returned. Fifty-eight articles were included in the review and 20 in the meta-analysis. The overall combined rates of concussion (including game and practice-related concussion) based on the meta-analysis were 0.78 concussions/1000 athlete exposures [95% confidence interval (CI) 0.67–0.89] for high school football (ages 13–19) and 1.15 concussions/1000 athlete exposures (95% CI 0.89–1.41) for minor football players (ages 5–15). There is evidence that contact training and practice contact restrictions have reduced the rate of head impacts and concussion. Heads Up Football (an intervention focused on coach education and contact training) has been shown to reduce the rate of concussion by 32% and head impacts by 38% amongst high school football players. Limiting contact practices in high schools to 2 days per week reduced practice head impacts per player-season by 42%, and limiting full contact in practice to 75 min per week in the second week of the season and 60 min in week 3 and beyond resulted in a 54% decrease in the practice-related concussion rate (p = 0.003). Conclusions: This review identified a critical need for interventions to address the high rates of concussion and head impact in youth football. To date, contact training and contact restrictions have the strongest evidence supporting their effectiveness at reducing these rates. Future research should use consistent concussion definitions and validated injury surveillance systems, and ensure complete reporting of participant characteristics and sampling details. Prospero ID CRD42020193775. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Objective: The aim of this review is to provide a summary of the epidemiology, clinical presentation, pathophysiology, and treatment of traumatic brain injury in collision athletes, particularly those participating in American football. Data Sources: A literature search was conducted using the PubMed/MEDLINE and Google Scholar databases for publications between 1990 and 2019. The following search phrases were used: " concussion," "professional athletes," "collision athletes," "mild traumatic brain injury," "severe traumatic brain injury," "management of concussion," "management of severe traumatic brain injury," and " chronic traumatic encephalopathy." Publications that did not present epidemiology, clinical presentation, pathophysiology, radiological evaluation, or management were omitted. Classic articles as per senior author recommendations were retrieved through reference review. Results: The results of the literature review yielded 147 references: 21 articles discussing epidemiology, 16 discussing clinical presentation, 34 discussing etiology and pathophysiology, 10 discussing radiological evaluation, 34 articles for on-field management, and 32 articles for medical and surgical management. Conclusion: Traumatic brain injuries are frequent in professional collision athletes, and more severe injuries can have devastating and lasting consequences. Although sport-related concussions are well studied in professional American football, there is limited literature on the epidemiology and management of severe traumatic brain injuries. This article reviews the epidemiology, as well as the current practices in sideline evaluation, acute management, and surgical treatment of concussions and severe traumatic brain injury in professional collision athletes. Return-to-play decisions should be based on individual patient symptoms and recovery. [ABSTRACT FROM AUTHOR]

BACKGROUND: To inform prevention strategies, this study provides incidence, factors, and actions taken when a suspected concussion occurred in K‐12 schools in Utah. METHODS: Data were collected using Utah's Student Injury Reporting System (SIRS) from the academic years 2011‐2012 to 2018‐2019. SIRS is a unique online system that tracks injuries that occur in the school setting among K‐12 students in Utah. Descriptive statistics were computed to characterize students with a suspected concussion. Chi‐square (χ2) analysis looking at characteristics by school level was also conducted. RESULTS: Over 63,000 K‐12 students in Utah sustained an injury at school during the study period. Suspected concussions comprised 10% of all injuries. The prevalence of concussions was highest among males (60.6%) and elementary school students (42.6%) and most often occurred outdoors (57.6%) or on a playground/playfield (33.9%), and in sports‐ and recreation‐related activities (75.1%) (specifically contact sports, 24.0%). Most students with a suspected concussion were absent 1 day or less from school (71.4%) but about 68% were seen by a medical professional. Further, there were differences by school level. Females and students playing contact sports had a higher percentage of suspected concussions as school level increased, whereas males and concussions sustained during school hours had a lower percentage of suspected concussions as school level increased. CONCLUSIONS: SIRS enables schools in Utah to identify groups at risk for concussion, as well as activities most commonly associated with these injuries, within the school environment. Using this information, schools may implement targeted prevention strategies to protect students. [ABSTRACT FROM AUTHOR]

State laws provide general guidelines for sport-related concussion (SRC) management but do not comprehensively address the multiple layers of management for this complex injury. Although high schools are encouraged to develop SRC protocols that include both state law tenets and additional management practices, the execution of these protocols warrants examination. To investigate state law compliance and practice components included in high school SRC protocols and determine whether the degree of sports medicine coverage influenced protocol quality. Qualitative document analysis. High school athletics. In total, 184 Pennsylvania high schools (24.3% of schools statewide; full-time athletic trainers [ATs] = 149, part-time ATs = 13, missing = 22) voluntarily provided copies of their protocols from the 2018–2019 academic year. Four ATs conducted document analyses using a 67-item component analysis guide. Frequencies were computed for included protocol components related to the state law, preparticipation and prevention, recognition and assessment, and management. The difference in the total number of included components (maximum = 60) by sports medicine coverage was assessed using a Mann-Whitney U test. Heterogeneity existed in the components included in the submitted protocols. Only 23.4% included all mandatory state law tenets. Immediate removal from play was noted in 67.4% of protocols, whereas only 1.6% contained prevention strategies. Return to play was addressed more frequently than return to learn (74.5% versus 32.6%). The sample had a mean of 15.5 ± 9.7 total components per protocol. Schools with full-time sports medicine coverage had more protocol components than those with part-time ATs (15 [interquartile range = 8.5–22.5] versus 6 [3–10.5] median components; U = 377.5, P <.001). School-level written SRC protocols were often missing components of the state law and additional best-practice recommendations. Full-time sports medicine coverage in high schools is recommended to increase SRC protocol and health care quality. [ABSTRACT FROM AUTHOR]

Focused Clinical Question: Does cognitive behavioral therapy (CBT) reduce concussion symptoms among children and adolescents following mild traumatic brain injury? Clinical Bottom Line: Based on the results of this critically appraised topic, there is moderate evidence to support the use of CBT as a treatment intervention to reduce complaints of persistent concussion symptoms in children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Previously studied risk factors for sports-related concussion in soccer players include sex, age, and player position. However, prior studies were limited in number, they reported conflicting results, and most did not assess initial concussion severity. Purpose/Hypothesis: The purpose of this study was to conduct an in-depth analysis of soccer players across key demographic groups (sex, age, position) for both concussion incidence and severity. It was hypothesized that concussion incidence and severity would be higher among male players, players aged ≥17 years, and goalkeepers. Study Design: Cohort study; Level of evidence, 3. Methods: The authors analyzed baseline and postinjury ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) scores for athletes aged 12 to 22 years between July 2009 and June 2019. Players were assigned to an age group based on when they had their most recent baseline test. Concussion incidence and concussion severity index were compared using t tests and multivariate logistic regression. Results: For 1189 individuals who reported soccer as their primary sport, 1032 contributed 1754 baseline ImPACT tests (some individuals had multiple baseline tests), whereas 445 individuals were suspected of sustaining a concussion and then referred for a postinjury 1 test. Of these players, 254 (24.6%) had both a baseline and a postinjury test and were analyzed for concussion severity. Linear regression showed that forwards had a lower incidence of ImPACT-proxied concussions than goalkeepers had (P =.008). Female players had a significantly higher incidence of ImPACT concussions compared with male players (mean, 0.07 [female] vs 0.04 [male] concussions per person-year; P =.05). Players in the ≥17-year age group had a higher incidence of ImPACT concussions than players in the 15- to 16-year age group (P =.04), although the 15- to 16-year age group had more severe concussions than the ≥17-year age group (mean severity index, 2.91 [age 15-16 years] vs 1.73 [age ≥17 years]; P =.001). Conclusion: Female soccer players experienced a higher incidence of concussion than did male players, and goalkeepers experienced a greater incidence of ImPACT concussions than did forwards. Players of both sexes and all positions in the 15- to 16-year age group showed increased initial concussion severity compared with the ≥17-year age group, despite a lower comparative incidence of ImPACT concussions. Further study is needed to understand whether sex and player position affect concussion severity. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study is to evaluate the effect of policy change disallowing body checking in adolescent ice hockey leagues (ages 15-17) on reducing rates of injury and concussion.Methods: This is a prospective cohort study. Players 15-17 years-old were recruited from teams in non-elite divisions of play (lower 40%-70% by division of play depending on year and city of play in leagues where policy permits or prohibit body checking in Alberta and British Columbia, Canada (2015-18). A validated injury surveillance methodology supported baseline, exposure-hours and injury data collection. Any player with a suspected concussion was referred to a study physician. Primary outcomes include game-related injuries, game-related injuries (>7 days time loss), game-related concussions and game-related concussions (>10 days time loss).Results: 44 teams (453 player-seasons) from non-body checking and 52 teams (674 player-seasons) from body checking leagues participated. In body checking leagues there were 213 injuries (69 concussions) and in non-body checking leagues 40 injuries (18 concussions) during games. Based on multiple multilevel mixed-effects Poisson regression analyses, policy prohibiting body checking was associated with a lower rate of injury (incidence rate ratio (IRR): 0.38 (95% CI 0.24 to 0.6)) and concussion (IRR: 0.49; 95% CI 0.26 to 0.89). This translates to an absolute rate reduction of 7.82 injuries/1000 game-hours (95% CI 2.74 to 12.9) and the prevention of 7326 injuries (95% CI 2570 to 12083) in Canada annually.Conclusions: The rate of injury was 62% lower (concussion 51% lower) in leagues not permitting body checking in non-elite 15-17 years old leagues highlighting the potential public health impact of policy prohibiting body checking in older adolescent ice hockey players. [ABSTRACT FROM AUTHOR]

Background: Sport-related head and neck injuries, including concussion, are a growing global public health concern with a need to explore injury risk reduction strategies such as neck exercises. Objectives: To systematically review the literature to investigate: (1) the relationship between neck strength and sport-related head and neck injuries (including sport-related concussion (SRC); and (2) whether neck exercise programs can reduce the incidence of (a) sport-related head and neck injuries; and (b) SRC. Methods: Five databases (Ovid MEDLINE, CINAHL, EMBASE, SPORTDiscus, and Web of Science) and research lists of included studies were searched using a combination of medical subject headings and keywords to locate original studies which reported the association between incidence of head and/or neck injury and neck strength data, or included a neck exercise intervention either in isolation or as part of a more comprehensive exercise program. Results: From an initial search of 593 studies, six were included in this review. A narrative synthesis was performed due to the heterogeneity of the included studies. The results of two observational studies reported that higher neck strength, but not deep neck flexor endurance, is associated with a lower risk of sustaining a SRC. Four intervention studies demonstrated that injury reduction programs that included neck exercises can reduce the incidence of sport-related head and neck injuries including SRC. Conclusion: Consideration should be given towards incorporating neck exercises into injury reduction exercise programs to reduce the incidence of sport-related head and neck injuries, including SRC. Systematic Review Registration: PROSPERO (registration number: 194217). [ABSTRACT FROM AUTHOR]

Current evidence regarding the protective effect of mouthguard use on symptom severity in children and adolescents who sustain sport-related concussions is insufficient to make clinical recommendations. To compare the association between mouthguard use and symptoms stratified by sex in the first 4 weeks after pediatric sport-related concussion. We hypothesized that mouthguard use would be associated with less severe symptoms. Prospective cohort study. Nine Canadian pediatric emergency departments (EDs). Children aged 5 to 18 years who were assessed within 48 hours of concussions sustained during a collision or contact sport. Injury characteristics were collected using the Acute Concussion Evaluation. The primary outcome measure was symptom score (range = 0–6), measured using age-appropriate versions (5–7, 8–12, or 13–18 years) of the Post-Concussion Symptom Inventory. The independent variable was time postconcussion (initial assessment and 1, 2, and 4 weeks). Of 1019 children (73% male; median [interquartile range] age = 13.43 years [11.01–15.27 years]), 42% wore a mouthguard at the time of injury. 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Male mouthguard users reported similar symptom scores in the ED (difference in Post-Concussion Symptom Inventory Δ scores [diff] = −0.07; 95% CI = −0.23, 0.09) and at weeks 1 (diff = −0.02; 95% CI = −0.18, 0.14), 2 (diff = −0.03; 95% CI = −0.19, 0.13), and 4 (diff = −0.13; 95% CI = −0.29, 0.04) compared with males who did not wear a mouthguard. Female mouthguard users described minimally higher symptom scores at week 1 compared with non-mouthguard users (diff = 0.29; 95% CI = 0.01, 0.56). In the ED, symptom scores were not different for females who wore a mouthguard and those who did not (diff = 0.22; 95% CI = −0.04, 0.48) or at weeks 2 (diff = 0.22; 95% CI = −0.06, 0.51) or 4 (diff = 0.08; 95% CI = −0.20, 0.36). Wearing a mouthguard at the time of injury was not associated with reduced acute or subacute symptoms after sport-related concussion in either males or females who were treated in the ED compared with those who did not wear a mouthguard. Athletes are still encouraged to wear mouthguards during sports because overwhelming evidence supports their use in preventing dental injuries. [ABSTRACT FROM AUTHOR]