Search

The incidence of paediatric fractures among winter sport athletes is not adequately studied. Our objective was to categorize fractures that occurred in paediatric skiers and snowboarders at a single ski resort. X-rays of 756 skiers/snowboarders aged 3–17 diagnosed with a fracture were categorized using the Salter-Harris (SH) classification. SH fractures were seen in 158 (21%) patients, with 123 (77%) being Type II. There were no significant differences between patients with a SH fracture and patients with a non-SH fracture for age, sex, snowboarding or skiing, mechanism of injury, terrain or the resort conditions on the day of injury. The most common mechanism of injury was falling onto snow while collisions resulted in more severe injuries. Compared to fractures without growth plate involvement, a higher proportion of SH fractures were seen in the humerus, radius, fibula and thumb; a lower proportion of SH fractures were observed at the tibia and clavicle. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: There is a well-established association between preexisting depression/anxiety and greater postconcussion symptom burden, but the potential impact of antidepressant medications has not been fully explored. The primary objective of this study was to compare preinjury/baseline and postinjury concussion symptomscores and neurocognitive performance of athletes on antidepressant medications, both with healthy controls and with those with depression/anxiety not on antidepressants. Methods: This is a cross-sectional study using data collected from 49,270 junior and high school athletes from computerized neurocognitive assessments (Immediate Post-Concussion Assessment and Cognitive Test [ImPACT]) administered between 2009 and 2018 held by the Massachusetts Concussion Management Coalition. The main outcome measures were symptom scores and neurocognitive performance measures, all of which were assessed both at baseline and postinjury. Statistical analysis included analysis of variance and Tukey pairwise comparisons for continuous variables and Fisher's exact test for categorical variables. Multivariate regression models were used to adjust for potential confounding variables. Results: Both at baseline and postinjury, athletes with depression/anxiety had mean total symptom scores that were more than double that of healthy controls regardless of antidepressant use. Although there were no significant differences in neurocognitive performance at baseline, depression/anxiety was associated with small but significant decreases in postinjury visual memory and visual motor scores. Conclusions: Both at baseline and after sustaining a concussion, young athletes with depression/anxiety experience significantly greater symptom burden compared with healthy controls regardless of antidepressant use. [ABSTRACT FROM AUTHOR]

While placebo effects are well recognized within clinical medicine, "nocebo effects" have received much less attention. Nocebo effects are problems caused by negative expectations derived from information or treatment provided during a clinical interaction. In this review, we examine how nocebo effects may arise following pediatric concussion and how they may worsen symptoms or prolong recovery. We offer several suggestions to prevent, lessen, or eliminate such effects. We provide recommendations for clinicians in the following areas: terminology selection, explicit and implicit messaging to patients, evidence-based recommendations, and awareness of potential biases during clinical interactions. Clinicians should consider the empirically grounded suggestions when approaching the care of pediatric patients with concussion. [ABSTRACT FROM AUTHOR]

We examined perceived risk of future sports injury and athlete burnout among uninjured adolescent athletes. Uninjured high school athlete participants completed the Athlete Burnout Questionnaire (ABQ) and a questionnaire assessing attitudes toward likelihood of sustaining a future sport-related injury. We compared ABQ responses between injury risk perception groups: those who expected injury versus those who did not. Half of the participants reported a somewhat/very high likelihood of future sport-related injury (n = 98; 52% female; age = 15.3 ± 1.9 years), while the other half reported it was unlikely/not possible (n = 98; 45% female; age = 15.3 ± 1.3 years). A significantly greater proportion of those in the expected injury group reported a history of bone/muscle/ligament/tendon injury (56% vs 24%; P <.001). Those in the expected injury group reported higher athlete burnout scores (median = 28 [interquartile range = 25-34] vs 25 [23-30]; P =.002). Adolescent athletes who reported they were likely to experience a future injury in their sport also reported greater levels of burnout. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Objectives: To compare gymnastics-related injuries between former collegiate gymnasts who did and did not report components of the female athlete triad (Triad) during college, including disordered eating or menstrual irregularity. We hypothesized that athletes reporting these 2 triad symptoms would have higher rates of time loss injury and injuries requiring surgery. Design: Retrospective case–control. Setting: Online survey. Patients: Four hundred seventy former collegiate gymnasts. Interventions: Athletes completed online survey distributed through social media. Main Outcome Measures: Participants were grouped based on self-reported menstrual irregularity and disordered eating during college. We compared time loss injuries, injuries resulting in surgery, and injury locations between the groups using χ2 analyses. Results: Seventy percent (n = 328) of participants in this study reported a time loss college injury without surgery, and 42% (n = 199) reported an injury during college that required surgical treatment. A significantly greater proportion of gymnasts with only disordered eating reported a time loss gymnastics injury (without surgery) compared with those who reported only menstrual irregularity during college (79% vs 64%; P =0.03). A significantly greater proportion of the disordered eating–only group reported a spine injury compared with the menstrual irregularity–only group (P = 0.007) and the group who reported neither menstrual irregularity nor disordered eating (P = 0.006). Conclusions: College gymnasts who experienced disordered eating were more likely to experience a nonsurgical time loss injury while in college, as well as spine injury compared with those with menstrual irregularity. Sports medicine providers should be aware of the association between injuries and individual components of Triad in gymnasts beyond bone stress injuries. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the clinical presentation (using PCSS), mechanism of injury, and recovery time of concussions sustained by gymnasts. A retrospective chart review was performed at Boston Children's Hospital: Sports Medicine Clinic. Patients were identified with the words 'gymnastics' and 'concussion.' Male and female gymnasts were included if they sustained a concussion during gymnastics training or competition and were between the ages of 6–22 years old. Sex, age, injury site, diagnosis, mechanism of injury, and time to presentation are described. Patients were compared during different types of gymnastics events for overall symptom burden, and individual symptom severities. A total of 201 charts were assessed over a 6-year period and 62 patients met inclusion criteria. Floor exercise was the most common event at the time of injury. Loss of consciousness occurred in 20% of injuries. There was no significant association between the type of event and PCSS upon initial clinical visit (p = 0.82). A total of 13 gymnasts returned to the clinic for a subsequent injury after their concussion (Table 3). Gymnasts are at risk for sport-related concussions. Most gymnasts reporting to a tertiary care center with the diagnosis of concussion sustain their injuries during floor exercise. [ABSTRACT FROM AUTHOR]

Background: Existing data suggest that after concussion, athletes experience an increased risk of subsequent injury. Exploring methods that may reduce injury risk after successful postconcussion return to play may lead to new treatment approaches. Purpose: To examine the efficacy of a neuromuscular training (NMT) intervention on acute sports-related time-loss injury over the subsequent year relative to standard of care. Study Design: Randomized clinical trial; Level of evidence, 1. Methods: A total of 27 youth athletes were assessed initially postconcussion (median, 7 days postconcussion; interquartile range [IQR], 5-10) and after return-to-play clearance (median, 40 days postconcussion; IQR, 15-52). After return-to-play clearance, they were randomly assigned to NMT intervention (n = 11; mean ± SD age, 14.7 ± 1.7 years; 36% female) or standard of care (n = 16; mean ± SD age, 15.3 ± 1.8 years; 44% female). The intervention (duration, 8 weeks; frequency, 2 times per week) included guided strength exercises with landing stabilization focus. Standard of care received no recommendations. For the subsequent year, athletes prospectively completed a monthly log of sports-related injuries and organized sports competitions. Results: During the first year after postconcussion return-to-play clearance, sports-related time-loss injuries were more common among standard of care relative to NMT intervention (75% [95% CI, 48%-93%] vs 36% [95% CI, 11%-69%]). After adjusting for age and sex, the hazard of subsequent injury in the standard-of-care group was 3.56 times (95% CI, 1.11-11.49; P =.0334) that of the NMT intervention group. Sports participation was similar between NMT intervention and standard of care during the year-long monitoring period (hours of organized sports per month; median, 12 [IQR, 2.6-32.1] vs 15.6 [IQR, 3.5-105.9]; P =.55). The age- and sex-adjusted incidence of injuries was 10.2 per 1000 competitive exposures (95% CI, 3.7-28.4) in the standard-of-care group as opposed to 3.4 per 1000 (95% CI, 0.9-13.4) in the NMT intervention group. After adjusting for age and sex, incidence of injuries was higher for standard of care vs NMT intervention (rate ratio, 2.96 [95% CI, 0.89-9.85]; P =.076). Conclusion: Although preliminary, our findings suggest that an NMT intervention initiated after return-to-play clearance may significantly reduce sports-related time-loss injuries over the subsequent year. Registration: NCT03917290 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Objectives: This study evaluates the correlation between the bone end and soft tissue end of the quadriceps tendon–patellar bone autograft (QPA) size and pre-operative MRI measurements of the quadriceps tendon along sections to be included in the graft harvest in adolescents. We also assessed association between graft diameter and anthropometric measures (height, weight, and BMI), age, and sex. Methods: Patients (10–18 years) who underwent QPA ACL reconstruction and had a pre-operative MRI were considered for inclusion. Age, height, and weight, tibial and femoral side graft diameter, and patellar bone block dimensions were collected. Using a pre-operative 2D sagittal plane MRI, we measured the quadriceps at 10-mm increments above the patella, up to 40 mm. We assessed correlation between the bone-end graft diameter and the AP measure at 10 mm above the patella, and correlation between the soft-tissue end graft diameter and the most proximal AP measure. Results: A total of 103 patients were included. A significant correlation between the soft-tissue side graft diameter and most proximal AP measurement was observed (rs = 0.51; p < 0.001). However, measurements significantly underestimated the soft-tissue end graft diameter (9.6 ± 0.8 vs. 7.4 ± 1.1; p < 0.001). There was no correlation between the bone-end graft diameter and AP measurement 10 mm above the patella. Anthropometric measures were not associated with graft size. Skeletal maturity was associated with smaller graft size (p = 0.08). Conclusion: Soft-tissue end graft diameter is associated with the AP measure of the quadriceps at 20–40 mm above the superior pole of the patella. [ABSTRACT FROM AUTHOR]

Objective: To determine the length of time after concussion that impaired tandem gait performance is observed. Design: Clinical measurement, prospective longitudinal. Setting: NCAA collegiate athletic facility. Participants: Eighty-eight concussed NCAA Division I student-athletes and 30 healthy controls. Independent Variables: Group (concussion/control) and time (Baseline, Acute, Asymptomatic, and RTP). Main Outcome Measures: Participants completed 4 single-task and dual-task tandem gait trials. The concussion group completed tests at the following time points: preseason (Baseline), within 48 hours after concussion (Acute), on the day symptoms were no longer reported (Asymptomatic), and when cleared to return to sports (RTP). Controls completed the same protocol at similar intervals. The dual-task trials involved minimental style cognitive questions answered simultaneously during tandem gait. We analyzed the best time of the 4 trials, comparing groups with a linear mixed model. Results: Acutely after concussion, the concussion group performed single-task tandem gait slower (worse) than controls (concussion: 11.36 ± 2.43 seconds, controls: 9.07 ± 1.78 seconds, P < 0.001). The concussion group remained significantly slower than controls (9.95 ± 2.21 vs 8.89 ± 1.65 seconds, P = 0.03) at Asymptomatic day but not RTP. There were significant group (P < 0.001) and time (P < 0.001) effects for dual-task tandem gait. The groups were not significantly different at baseline for single-task (P = 0.95) or dual-task (P = 0.22) tandem gait. Conclusions: Our results indicate that tandem gait performance is significantly impaired acutely after concussion, compared with both preseason measures and controls. Postural control impairments were not present when the student-athletes were cleared for RTP. This information can assist clinicians when assessing postural control and determining recovery after a concussive injury. [ABSTRACT FROM AUTHOR]

Objectives: To examine the effect of sleep disturbances on concussion symptom recovery and to examine the effect of melatonin prescription on symptom improvement among concussed adolescents with sleep problems. Design: Longitudinal test–retest. Setting: Sports medicine clinic. Participants: Patients aged 8 to 18 years, diagnosed with a concussion, evaluated within 14 days after injury, and evaluated again 15 to 35 days after injury. Independent Variables: We grouped patients based on whether they reported sleep disturbances within 14 days of injury. Main Outcome Measures: Outcome measures included symptom severity, headache severity, melatonin prescription, and the change in symptom severity between visits. Results: Two hundred twenty-five patients were included: 36% who reported sleep problems (44% female; age = 14.4 ± 2.0 years; evaluated 7.3 ± 3.8 and 23.2 ± 5.4 days after injury) and 64% who did not (32% female; age = 14.6 ± 2.3 years; evaluated 7.2 ± 3.4 and 23.0 ± 5.3 days after injury). Those with sleep problems reported higher symptom severity than those without across the 2 visits (22.1 ± 14.3 vs 14.6 ± 12.5; P < 0.001). There was no significant difference in the change in symptom severity between visits among those who received [median = 9-point improvement; interquartile range (IQR) = 1-14] and did not (median = 9, IQR = 2-18) receive a melatonin prescription (P = 0.80). Conclusions: Sleep problems among pediatric patients within 2 weeks of concussion are associated with more severe symptoms. Melatonin prescription was not associated with faster symptom recovery. [ABSTRACT FROM AUTHOR]

Background: Aerobic exercise has emerged as a useful treatment to improve outcomes among individuals who experience a concussion. However, compliance with exercise recommendations and the effect of exercise volume on symptom recovery require further investigation. Purpose: To examine (1) if an 8-week aerobic exercise prescription, provided within 2 weeks of concussion, affects symptom severity or exercise volume; (2) whether prescription adherence, rather than randomized group assignment, reflects the actual effect of aerobic exercise in postconcussion recovery; and (3) the optimal volume of exercise associated with symptom resolution after 1 month of study. Study Design: Cohort study; Level of evidence, 2. Methods: Individuals randomized to an exercise intervention (n = 17; mean age, 17.2 ± 2.0 years; 41% female; initially tested a mean of 11.3 ± 2.8 days after injury) or standard of care (n = 20; mean age, 16.8 ± 2.2 years; 50% female; initially tested a mean of 10.7 ± 3.2 days after injury) completed an aerobic exercise test within 14 days of injury. They returned for assessments 1 month and 2 months after the initial visit. The aerobic exercise group was instructed to exercise 5 d/wk, 20 min/d (100 min/wk), at a target heart rate based on an exercise test at the initial visit. Participants reported their exercise volume each week over the 8-week study period and reported symptoms at each study visit (initial, 1 month, 2 months). Because of low compliance in both groups, there was no difference in the volume of exercise between the 2 groups. Results: There were no significant symptom severity differences between the intervention and standard-of-care groups at the initial (median Post-Concussion Symptom Inventory, 15 [interquartile range = 10, 42] vs 20 [11, 35.5]; P =.26), 1-month (4 [0, 28] vs 5.5 [0.5, 21.5]; P =.96), or 2-month (6.5 [0, 27.5] vs 0 [0, 4]; P =.11) study visits. Exercise volume was similar between groups (median, 115 [54, 225] vs 88 [28, 230] min/wk for exercise intervention vs standard of care; P =.52). Regardless of group, those who exercised <100 min/wk reported significantly higher symptom severity at the 1-month evaluation compared with those who exercised ≥100 min/wk (median, 1.5 [0, 7.5] vs 12 [4, 28]; P =.03). Exercising ≥160 min/wk successfully discriminated between those with and those without symptoms 1 month after study commencement (classification accuracy, 81%; sensitivity, 90%; specificity, 78%). Conclusion: Greater exercise volume was associated with lower symptom burden after 1 month of study, and an exercise volume >160 min/wk in the first month of the study was the threshold associated with symptom resolution after the first month of the study. Because our observation on the association between exercise volume and symptom level is a retrospective and secondary outcome, it is possible that participants who were feeling better were more likely to exercise more, rather than the exercise itself driving the reduction in symptom severity. [ABSTRACT FROM AUTHOR]

Objective: To evaluate recovery trajectories among youth athletes with a concussion and healthy controls across different domains using a quantitative and multifaceted protocol. Study design: Prospective repeated measures. Participants: Youth athletes diagnosed with a concussion between the ages of 8 and 18 years were evaluated (1) within 10 days after injury, (2) approximately 3 weeks after injury, and (3) after return-to-play clearance. Control participants completed the same protocol. Setting: Sport concussion clinic. Interventions: N/A. Main outcome measures: Participants underwent a multifaceted protocol that assessed symptoms (postconcussion symptom scale [PCSS]), dual-task gait, event-related potentials (ERPs), and eye tracking. Results: Sixty-seven athletes participated: 36 after concussion (age = 14.0 ± 2.6 years; 44% female) and 31 controls (age = 14.6 ± 2.2 years; 39% female). Concussion symptoms were higher for the concussion group compared with controls at the first (PCSS = 31.7 ± 18.8 vs 1.9 ± 2.9; P < 0.001) and second time points (PCSS = 10.8 ± 11.2 vs 1.8 ± 3.6; P = 0.001) but resolved by the final assessment (PCSS = 1.7 ± 3.6 vs 2.0 ± 3.8; P = 0.46). The concussion group walked slower during dual-task gait than controls at all 3 tests including after return-to-play clearance (0.83 ± 0.19 vs 0.95 ± 0.15 m/s; P = 0.049). There were no between-group differences for ERP connectivity or eye tracking. Those with concussions had a decrease in ERP connectivity recovery over the 3 time points, whereas control participants' scores increased (concussion Δ = -8.7 ± 28.0; control Δ = 13.9 ± 32.2; χ² = 14.1, P = 0.001). Conclusions: Concussion is associated with altered dual-task gait speeds after resolution of concussion symptoms, but ERP and eye tracking measures did not demonstrate between-group differences across time. Some objective approaches to concussion monitoring may support with identifying deficits after concussion, but further work is required to delineate the role of gait, electrophysiological, and eye tracking methods for clinical decision-making. [ABSTRACT FROM AUTHOR]

Context: Researchers investigating collision and contact sport participation during high school have found mixed results. Understanding the association between current contact and collision sport participation and quality-of-life outcomes can enhance our knowledge about the risks and benefits of sport participation. Objective: -To examine quality-of-life outcomes among high school athletes who reported participation in collision and limitedcontact sports in the year preceding assessment compared with no- or limited-contact sport athletes. Design: Cross - sectional study. Setting: Preparticipation physical examination. Patients or Other Participants: High school athletes 13 18 years of age. Main Outcome Measure(s): We obtained sport participation and Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric-25 outcomes, which assess self-reported, quality-of-life domains in the preceding 7 days (ie, state assessment). Our grouping variable was collision and contact versus no- or limited-contact sport participation during the year preceding assessment. We used multivariable linear regression models to identify the associations between PROMIS scores and associcollision and contact sport participation and adjusted for sex; age; history of bone, muscle, ligament, ortendon injury; history acute fracture or dislocation; and history of concussion. Results: A total of 143 (51 %) athletes reported collision and contact sport participation (24% female, mean age = 15.1 * 1.7 years) and 138 (49%) reported no- or limited-contact sport participation (66% female, mean age = 15.4 i 1.2 years). A higher proportion of collision and contact sport athletes reported history of time loss for bone, muscle, ligament, and tendon injuries (51 % versus 29 %, P < .001) and for acute fracture or dislocation (46% versus 26%, P < .001) than did no- or limitedcontact contact athletes. After adjusting for covariates, we found that collision and contact sport participation was significantly associated with lower state anxiety (B =- 1.072, 95% confidence interval =- 1.834, -0.310, P = . 006) and depressive (13 =-0. 807 % confidence interval =- 1.484, -0.130, P =. 020) symptom scores. Conclusions: Collision and contact sport athletes reported fewer anxiety and depressive symptoms in the week preceding evaluation than did no- or limited-contact sport athletes, but they had more extensive orthopaerlic injury histories. Potential benefjts and risks are associated with collision and contact sport participation. These data reinforce the need to examine the assumption that youth collision and contact sports are associcollision ated with negative quality of life. [ABSTRACT FROM AUTHOR]

Purpose: The purpose was to examine gait characteristics between collegiate athletes who did and did not sustain a lower-extremity musculoskeletal (LEMSK) injury in the year after concussion. Methods: Thirty-four NCAA collegiate athletes with diagnosed concussions were divided into two groups based on if they did (n = 16) or did not (n = 18) sustain a LEMSK in the year after concussion. Participants completed baseline testing before the start of the season and again at return to play postconcussion. Injuries were tracked using an electronic medical database. Participants were instrumented with three APDM Opal triaxial accelerometers and performed five single-task (ST) and five dual-task (DT) gait trials. Participants traversed a 10-meter walkway, turned around a specified endpoint, and returned to the original line. During DT, participants simultaneously walked and answered mini-mental style questions. A linear mixed-effects model assessed interactions and/or main effects between groups for gait speed, double support time, cadence, stride length, and cognitive accuracy. Results: The LEMSK group walked slower (ST, 1.15 ± 0.10 m·s−1; DT, 1.01 ± 0.10 m·s−1) than the uninjured group (ST, 1.23 ± 0.11 m·s−1; DT, 1.10 ± 0.11 m·s−1) during both ST (P = 0.04) and DT (P = 0.03). The injury group spent longer in double support (ST, 20.19% ± 2.34%; DT, 21.92% ± 2.13%) than the uninjured group (ST, 18.16% ± 2.60%; DT, 20.00% ± 2.32%) during both ST (P = 0.02) and DT (P = 0.02). The injury group had a significantly lower cognitive accuracy (89.56% ± 6.48%) than the uninjured group (95.40% ± 7.08%) across time points (P = 0.02). Conclusions: There were significant differences in gait characteristics and cognitive accuracy between those who did and did not sustain a LEMSK injury after concussion. The LEMSK group demonstrated a conservative gait strategy both before and after their concussive injury. [ABSTRACT FROM AUTHOR]

Context: Understanding how parents and their children perceive concussion symptoms may provide insights into optimal concussion-management strategies. Objective: To examine patient-parent correlations and agreement on concussion-symptom ratings, to identify differences in patient-parent symptom reporting between children (8-12 years of age) and adolescents (13-18 years of age), and to evaluate the correlation between patient and parent initial symptom-severity ratings with symptom duration and return-to-play time. Design: Cross-sectional study. Setting: Primary care sports medicine clinic. Patients or Other Participants: A total of 267 patients aged 8 to 18 years seen for care within 21 days of sustaining a concussion. Patients were classified as children (n = 65; age = 11.3 ± 1.4 years; age range, 8-12 years) or adolescents (n = 202; age = 15.5 ± 1.4 years; age range, 13-18 years). Main Outcome Measure(s): Each patient and his or her parent (or legal guardian) completed a concussion-symptomfrequency inventory, the Health and Behavior Inventory (HBI), at the initial postinjury examination. Patients were followed until they no longer reported concussion symptoms (symptomresolution time) and were allowed to return to unrestricted sport participation (return-to-play time). Results: At the initial examination (8.9 ± 5.2 days postinjury), the symptom-frequency correlation between children and their parents was high (rs = 0.88; 95% confidence interval [Cl] = 0.80, 0.95). Adolescents' symptom-frequency reports were also highly correlated with those of their parents (rs = 0.78; 95% Cl = 0.71, 0.85). However, the child-parent correlation was higher than the adolescent-parent agreement (z = 2.21, P = .03). Greater patient (consolidated child and adolescent) HBI ratings were associated with longer symptom-resolution times (coefficient = 0.019; 95% Cl = 0.007, 0.031; P= .002) and longer return-to-play times (coefficient = 0.012; 95% Cl = 0.002, 0.022; P = .02), whereas parent HBI ratings were not. Conclusions: Our findings may help to set expectations regarding concussion-symptom durations and return-to-play timing for pediatric patients and their families. Given the patient-parent correlations in our sample, substantial reporting discrepancies between patients and their parents may be a relevant factor for clinicians to investigate further during concussion evaluations. [ABSTRACT FROM AUTHOR]

Objective: To determine the test-retest correlation of an objective eye-tracking device among uninjured youth athletes. Design: Repeated-measures study. Setting: Sports-medicine clinic. Participants: Healthy youth athletes (mean age = 14.6 ± 2.2 years; 39% women) completed a brief, automated, and objective eye-tracking assessment. Independent variables: Participants completed the eye-tracking assessment at 2 different testing sessions. Main outcome measures: During the assessment, participants watched a 220-second video clip while it moved around a computer monitor in a clockwise direction as an eye tracker recorded eye movements. We obtained 13 eye movement outcome variables and assessed correlations between the assessments made at the 2 time points using Spearman's Rho (rs). Results: Thirty-one participants completed the eye-tracking evaluation at 2 time points [median = 7 (interquartile range = 6-9) days between tests]. No significant differences in outcomes were found between the 2 testing times. Several eye movement variables demonstrated moderate to moderately high test-retest reliability. Combined eye conjugacy metric (BOX score, rs = 0.529, P = 0.008), the variance of the ratio for both eye movements in the horizontal (rs = 0.497, P = 0.013) and vertical (rs = 0.446; P = 0.029) movement planes along the top/bottom of the computer screen, and the variance of the left and right eye movement along the bottom segment of the computer screen (rs = 0.565; P = 0.004) each demonstrated moderate between-test correlations. Conclusions: Automated and quantitative eye movement and conjugacy metrics provide relatively stable measurements among a group of healthy youth athletes. Thus, their inclusion as a visual tracking metric may be complementary to other visual examination techniques when monitoring concussion recovery across time. [ABSTRACT FROM AUTHOR]

Background: Reaction time (RT) deficits are reported following concussion, but it is unknown when these deficits normalize to pre-injury status. It is also unclear how factors such as RT measurement technique and participant characteristics influence post-concussion RT. Objective: The purpose of this systematic review and meta-analysis was to (1) characterize acute post-concussion (0–3 days) RT impairments, (2) examine RT recovery over time, and (3) explore moderating factors related to acute RT impairment following concussion. Methods: Database searches (PubMed, CINAHL, EBSCOhost) were conducted according to PRISMA guidelines for articles published in English from January 2002 to March 2019. Studies compared baseline-to-post-injury RT within individuals (within-subject) and/or RT in concussed individuals to non-concussed controls (between-subject). Sixty studies met inclusion criteria, reporting on a total of 9688 participants with 214 discrete RT effects (Hedges' d; between-subject: N = 29, k = 129; within-subject: N = 42, k = 85). Of the 214 effects, 93 occurred in the acute (0–3 days) post-injury timeframe (k = 47 between-subject). Numerous demographic [sex, age, concussion history, population type (athlete, military, and general population), athlete level (high school, college), and sport], and method-based (RT test and measure type, computerized neurocognitive testing platform, concussion definition, and time post-injury) moderators were examined for mean effect influence. Mixed-effects multi-level modeling with restricted-maximum-likelihood estimation was used to account for nested effects and high heterogeneity for the pooled effect size (D+). Results: Significant medium-magnitude RT deficits were observed acutely for between- (D+ = − 0.7279, 95% CI − 0.9919, − 0.4639, I2 = 88.66, p < 0.0001) and within-subject (D+ = − 0.7472, 95% CI − 0.9089, − 0.5855, I2 = 89.21, p < 0.0001) effect models. RT deficits were present at the sub-acute and intermediate-term timeframes for between-subject effects (sub-acute: D+ = − 0.5655, 95% CI − 0.6958, − 0.4352, p < 0.0001; intermediate-term: D+ = − 0.3219, 95% CI − 0.5988, − 0.0450, p = 0.0245). No significant RT mean effect was observed for the between-subject model at the long-term timeframe, indicating RT recovery among concussed participants relative to controls (D+ = 0.3505, 95% CI − 0.4787, 1.1797, p = 0.3639). Sex was a significant moderator for between-subject effects, with every 1% male sample size increase demonstrating − 0.0171 (95% CI − 0.0312, − 0.0029, p = 0.0193) larger RT deficits. Within-subject effect models resulted in RT measure type (simple: [D+ = − 0.9826] vs. mixed: [D+ = − 0.6557], p = 0.0438) and computerized neurocognitive testing platforms (ANAM: [D+ = − 0.3735] vs. HeadMinder CRI: [D+ = − 1.4799] vs. ImPACT: [D+ = − 0.6749], p = 0.0004) having significantly different RT-deficit magnitudes. No other moderators produced significantly different RT-deficit magnitudes (between-subject: [p ≥ 0.0763], within-subject: [p ≥ 0.1723]). Conclusions: Robust RT deficits were observed acutely following concussion. Minimal magnitude differences were noted when comparing between- and within-subject effects, suggesting that pre-injury baselines may not add clinical value in determining post-injury RT impairment. RT deficits persisted up till the intermediate-term (21–59 days post-injury) timeframe and indicate lingering deficits exist. Mean effect size differences were observed between RT measure types and computerized neurocognitive testing platforms; however, all categories displayed negative effects consistent with impaired RT following concussion. Clinical interpretation suggests that measuring RT post-concussion is more important than considering the RT method employed so long as reliable and valid tools are used. PROSPERO Registration #CRD42019119323. [ABSTRACT FROM AUTHOR]

Background: Concussion prognosis is a challenging clinical task. Identification of measures useful for persistent symptom risk can help optimize treatment pathways and allow clinicians to offer appropriate anticipatory guidance.Research Question: Can a multifaceted single/dual-task postural control assessment within one week of a diagnosed concussion identify the odds of developing persistent post-concussion symptoms (PPCS; symptoms that persist for more than 28 days post-concussion)?Methods: We conducted a prospective cohort study of youth and young adult athletes who were evaluated within 7 days of injury, and followed until they no longer reported concussion symptoms. Participants were grouped into those who developed PPCS and those who did not. During the initial evaluation, participants completed a postural control evaluation in single/dual-task conditions. We calculated six gait performance variables (in single/dual-task conditions), nine quiet stance performance variables, and three cognitive task performance (standing and walking) variables. We conducted between-group comparisons to identify candidate PPCS prognostic variables, and multivariable models to adjust for covariates (age, post-injury evaluation time, history of concussion, and BMI).Results: Sixty-six participants completed the study: 24% reported PPCS (mean age = 16.9 ± 3.5 years; 50% female; evaluated 4.2 ± 1.9 days post-injury) and 74% (mean age = 18.3 ± 3.0 years; 52% female; evaluated 3.5 ± 1.6 days post-injury) did not. Between-group comparisons indicated greater dual-task transverse plane center-of-mass (COM) range of motion (ROM) (13.1 ± 4.3 vs. 9.9 ± 2.5 degrees; p = 0.013) and lateral step variability (5.1 ± 1.4 vs. 4.0 ± 1.2 cm; p = 0.003) for the PPCS group relative to the no PPCS group. After multivariable modeling, dual-task transverse plane COM ROM (adjusted odds ratio = 1.34, 95% CI = 1.07, 1.68) and lateral step variability (adjusted odds ratio = 1.85, 95% CI = 1.13, 3.05) were significantly associated with PPCS.Significance: Dual-task transverse plane movement and lateral step variability demonstrate viable prognostic ability for PPCS among youth and young adult athletes and, along with other established factors, may add incremental value to PPCS prognosis models. [ABSTRACT FROM AUTHOR]

Our objective was to examine the effect of current neck or shoulder pain on concussion outcomes. Variables included symptom resolution and return-to-sport time, symptom severity, amount of school missed, and sleep disturbances. Three hundred twelve patients (37% female; median age = 15.0 years; evaluated median = 9 days postinjury) reported experiencing current neck or shoulder pain at initial evaluation, and 268 did not (31% female; median age = 14.7 years; evaluated median = 8 days postinjury). Neck or shoulder pain was associated with longer symptom resolution time (β = 6.38, 95% confidence interval [CI] = 2.44, 10.31; P =.002), more severe symptoms (β = 7.06, 95% CI = 4.91, 9.21; P <.001), and greater odds of missing >5 days of school (adjusted odds ratio [aOR] = 1.89, 95% CI = 1.23, 2.93; P =.004), and postinjury sleep problems (aOR = 2.20, 95% CI = 1.51, 3.21; P <.001). Experiencing neck or shoulder pain during the initial postinjury clinical evaluation was associated with worsened clinical outcomes. Clinicians may consider referral to early rehabilitation following concussion among those who report neck or shoulder pain. [ABSTRACT FROM AUTHOR]

Purpose: Few studies have investigated recovery between sexes using objective outcome measures. Our purpose was to examine the independent association between biological sex and recovery of postconcussion gait among collegiate athletes. Methods: We evaluated participants with a diagnosed concussion <7 d postinjury, and approximately 1.5 months and 3.5 months postinjury. Participants completed a single/dual-task gait evaluation and symptom inventory. During dual-task trials, they completed a mental task (backward subtraction, spelling, or month recitation). The primary outcome measure was height-adjusted gait velocity recovery, defined as achieving normal gait velocity using established values: >0.56 and >0.50 gait velocity (m·s−1)/height (m) under single and dual-task conditions, respectively. We used a multivariable Cox proportional hazard model to identify associations between sex and dual-task recovery, controlling for age, concussion history, symptom severity, and loss of consciousness at the time of injury. Results: Ninety-four individuals participated in the study: 47 (50%) were female athletes (mean age = 20.1, SD = 1.3 yr) and 47 (50%) were male athletes (mean age = 20.3, SD = 1.3 yr). Sex was not independently associated with height-adjusted single-task gait velocity recovery after controlling for potential confounders (hazard ratio = 1.62, 95% confidence interval = 0.87–3.01). However, male sex was independently associated with longer dual-task gait recovery time after controlling for potential confounders (hazard ratio = 2.43, 95% confidence interval = 1.11–5.35). Conclusion: Male athletes required a longer duration of time after concussion to achieve dual-task gait recovery than female athletes. Thus, functional dual-task abilities after concussion may be affected differentially by sex and should be accounted for within individualized concussion management strategies. [ABSTRACT FROM AUTHOR]

Objective: To determine whether continuing to play after a concussion is associated with higher symptom burden or prolonged symptom duration. Design: Patients who presented for care at a sport concussion clinic within the first 3 weeks of injury were asked whether they continued to play immediately after their injury. Setting: Sport concussion clinic within a regional tertiary care hospital. Main Outcome Measures: Clinical outcomes including symptom severity, symptom duration, age, time from injury-clinical presentation, sex, sport type, previous concussion history, and whether or not they experienced loss of consciousness or amnesia at the time of injury were recorded. Univariable comparisons between those who did and did not report continuing play were conducted. Multivariate linear regression models were constructed to identify the independent association of continuing to play postinjury with symptom burden and symptom recovery time, while controlling for the effect of potential confounding variables. Results: A total of 516 patients were included in the study, assessed a mean of 12.1 ± 5.2 days postinjury (35% female, mean age = 14.5 ± 2.3 years). A total of 227 (44%) continued play after sustaining a concussion. Continuing to play postconcussion was independently associated with higher symptom severity during the initial clinical evaluation [p-coefficient - 6.144,95% confidence interval (CI), 1.357-10.93], but not with symptom duration evaluation (^-coefficient = 1.794, 95% CI, -15.66 to 19.25). Conclusion: Those who continued to play postconcussion presented with more severe symptoms after injury. Recognition of suspected concussion and removal from play on diagnosis confirmation may lead to better initial clinical outcomes after concussion among child and adolescent athletes. [ABSTRACT FROM AUTHOR]

We examined the association between sleep quality and quality of life (QOL) among uninjured high school athletes. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Profile 25 questionnaire. One hundred ten athletes reported poor sleep quality (mean PSQI: 6.6 ± 2.0; mean age: 15.3 ± 1.1; 62% female); 162 athletes reported good sleep quality (mean PSQI: 2.3 ± 1.3; mean age: 15.1 ± 1.7; 33% female). After adjusting for sex and age, worse sleep quality was associated with higher physical function/mobility (β = 0.034; 95% confidence interval [CI] = 0.007-0.060; P =.01), anxiety (β= 0.391; 95% CI = 0.263-0.520; P <.001), depressive symptom (β = 0.456; 95% CI = 0.346-0.565; P <.001), fatigue (β = 0.537; 95% CI = 0.438-0.636; P <.001), pain interference (β = 0.247; 95% CI = 0.119-0.375; P <.001), and pain intensity (β = 0.103; 95% CI = 0.029-0.177; P =.006) ratings. Poor self-reported sleep quality among adolescent athletes was associated with worse QOL ratings. Clinicians should consider assessing sleep hygiene to provide guidance on issues pertaining to reduced QOL. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of prior concussion history on cognitive test performance and concussion symptom reporting among adolescent youth rugby league athletes.Participants: Participants were male elite level youth rugby league players (N = 73; Mean Age = 15.8; SD = 0.9; range = 14–18 years).Main Outcome Measure: CogSport performance based on participants group; those who reported no previous concussions (n = 30),1–2 previous concussions (n = 19), and ≥3 previous concussions (n = 29).Results: 73 participants with valid CogSport scores were included in the cognitive analyses. All participants were included in the symptom analyses. There were no differences between the groups with 0,1–2, or ≥3 previous concussions for processing speed, attention, learning, or working memory. There was atrend for those with multiple prior concussions to report more baseline preseason symptoms.Conclusions: There were no differences in scores on the CogSport test among those with ahistory of 0,1–2, or ≥3 prior concussions. Consistent with prior studies, youth with ahistory of multiple past concussions are more likely to endorse baseline preseason symptoms. [ABSTRACT FROM AUTHOR]

Context: The tandem gait test is a method for assessing dynamic postural control and part of the Sport Concussion Assessment Tool, versions 3 and 5. However, its reliability among child and adolescent athletes has yet to be established. Objective: To examine the test-retest reliability of the single-task and dual-task tandem gait test among healthy child and adolescent athletes. Design: Descriptive laboratory study. Setting: Sports injury-prevention center. Patients or Other Participants: Uninjured and healthy athletes between the ages of 9 and 18 years. Intervention(s): Tandem gait measures repeated 3 times across the period of approximately 1 month. Main Outcome Measure(s): Participants completed the tandem gait test under single-task and dual-task (ie, while simultaneously executing a cognitive task) conditions. Our primary outcome measure was completion time during the single-task and dual-task conditions. We also assessed cognitive accuracy and response rate while participants completed the dual-task tandem gait test. Results: Thirty-two child and adolescent athletes completed the study (mean age = 14.3 ± 2.4 years; females = 16). Single- task tandem gait times were similar across the 3 testing sessions (14.4 ± 4.8, 13.5 ± 4.2, and 13.8 ± 4.8 seconds; P = .45). Dual-task tandem gait times steadily improved across the test timeline (18.6 ± 6.9, 16.6 ± 4.5, and 15.8 ± 4.7 seconds; P = .02). Bivariate correlations indicated moderately high to high agreement from test 1 to test 2 (single-task r= .627; dual-task r= 0.655) and from test 2 to test 3 (single-task r = 0.852; dual-task r = 0.775). Both the single-task (intraclass correlation coefficient; ICC [3,1] = 0.86; 95% confidence interval [CI] = 0.73, 0.93) and dual-task (ICC [3,1] = 0.84; 95% CI = 0.69, 0.92) conditions demonstrated high reliability across testing sessions. Conclusions: Tandem gait outcome measures demonstrat¬ed high test-retest reliability in both the single- and dual-task conditions. The overall reliability was within the acceptable range for clinical practice, but improvements across tests suggested a moderate practice effect. Tandem gait represents a reliable, dynamic, postural-control test that requires minimal space, cost, and time. [ABSTRACT FROM AUTHOR]

Objectives: (1) To examine how age influences initial symptom presentation following concussion; and (2) to determine whether specific symptom profiles are associated with duration of postconcussion symptoms, and whether they vary by age group. Design: A total of 689 patients (20% children 7-12 years of age, 69% adolescents 13-18 years of age, and 11% young adults 19-30 years of age) were seen and diagnosed with a concussion within 21 days after injury. Patients completed the Post-Concussion Symptom Scale (PCSS) and were followed until they no longer required care. Setting: Two specialty care sport concussion clinical practices. Main outcome measures: Overall PCSS score was obtained, as well as severity ratings from somatic, vestibular-ocular, cognitive, sleep, and emotional symptom domains. We also calculated total symptom duration time. Results: No significant main effect of age, or age by sex associations were identified among the symptom domains. Females endorsed a higher somatic symptom severity rating than males (9.8 +/- 6.7 vs 8.1 +/- 6.7; P = 0.03). For patients between 7 and 12 years of age, higher somatic [[beta]-coefficient = 1.57, 95% confidence interval (CI), 1.47-1.67] and cognitive ([beta]-coefficient = 2.50, 95% CI, 2.32-2.68) symptom severities were associated with longer duration of concussion symptoms. Among adolescents, longer total symptom duration was associated with more severe somatic ([beta]-coefficient = 1.25, 95% CI, 0.34-2.15) and vestibular-ocular ([beta]-coefficient = 2.36, 95% CI, 1.49-3.23) symptoms. Conclusions: Within 21 days after concussion, symptom-reporting behavior seems to be similar across the age spectrum, but the relationship between symptom profiles and time to symptom resolution varies by age. Although overall symptom ratings are beneficial in determining clinical pathways, symptom domain use may provide a beneficial method to determine individualized patient care that differs between children and adolescents after concussion. [ABSTRACT FROM AUTHOR]

Objectives: To (1) examine the association between a commonly used concussion test, tandem gait, in single/dual-task conditions with single-task and dual-task average walking speed, (2) characterize the prevalence of tandem gait false positives, and (3) develop a normative reference range of dual-task tandem gait times. Design: Cross-sectional study. Setting: Two NCAA collegiate athletic facilities. Independent Variables: Athletes completed the tandem gait test and a gait evaluation in single/dual-task conditions during a preseason examination. Main Outcome Measures: Associations between tandem gait times and average walking speeds were evaluated using multiple linear regression models. Various tandem gait test time pass/fail cutoffs were calculated to examine false-positive rates. Results: Among the 171 participants (103 men, 19.8 ± 1.2 years of age), dual-task tandem gait completion times were independently associated with dual-task average walking speed [β = −4.018; 95% confidence interval (CI), −7.153 to −0.883], but single-task associations were not found. Male gender was associated with faster tandem gait times in both single-task (β = −0.880, 95% CI, −1.731 to −0.029) and dual-task conditions (β = −2.225, 95% CI, −3.691 to −0.759). A pass/fail cutoff threshold of 14 seconds resulted in a 2% false-positive rate for single-task tandem gait, while it resulted in a 29% false-positive rate during dual-task tandem gait. Conclusions: Average walking speed and dual-task tandem gait represent objective measures that are useful in concussion management. While a single-task tandem gait cutoff of 14 seconds seems appropriate for males, adjustments may be necessary based on sex and alternate pass/fail criteria may be appropriate for dual-task tandem gait. [ABSTRACT FROM AUTHOR]

Our objective was to identify factors associated with trouble falling asleep postconcussion. Patients seen for care after sport-related concussion were assessed ≤10 days postinjury and were between 6 and 19 years of age. Outcomes included symptoms (Post-Concussion Symptom Scale), postural steadiness, missed school, and medical history. There were 261 patients (49% female; mean age=14.8±2.5 years): 45% reported trouble falling asleep. A greater proportion of patients who reported trouble falling asleep missed ≥2 days of school (64% vs 49%; P = .02). Patients who reported trouble falling asleep endorsed more severe symptom severity than those who did not (median=38 vs 18; P < .001). After covariate adjustment, confusion (aOR = 1.95, 95% CI = 1.131-3.375), missing ≥2 days of school (aOR = 4.52, 95% CI = 1.553-13.16), and noise sensitivity (aOR = 1.48, 95% CI = 1.1.042-2.010) were independently associated with trouble falling asleep. Sleep disturbances are associated with poorer clinical outcomes after concussion. Inclusion of sleep assessments may help to provide early therapeutic pathways for pediatric concussion patients. [ABSTRACT FROM AUTHOR]

Aerobic exercise has received increasing attention in the scientific literature as a component of management for individuals who sustain a concussion. Because exercise training has been reported to reduce symptoms and improve function for those experiencing persistent postconcussion symptoms, it represents a potentially useful and clinically pragmatic rehabilitation technique. However, the specific exercise parameters that best facilitate recovery from concussion remain poorly defined and unclear. This review will provide a summary of the current understanding of the role of subsymptom exercise to improve outcomes after a concussion and will describe the exercise parameters that appear to be important. The latter will take into account the three pillars of exercise dose—frequency, duration, and intensity—to examine what is currently known. In addition, we identify important gaps in our knowledge of exercise as a treatment for those who develop persistent symptoms of concussion. [ABSTRACT FROM AUTHOR]

We conducted a prospective study of children and adolescents (n = 176; mean age = 13.0 ±2.7 years; 38% female) assessed acutely post-concussion and again 30 days later. We investigated the association between symptom burden and quality of life (QOL) outcomes, as well as the effect of age on QOL. We assessed QOL using patient-reported Pediatric Quality of Life Inventory 4.0, and symptoms using the Health and Behavior Inventory (HBI). Acute (<2 days post-injury) HBI ratings demonstrated a low correlation (R2 = 0.08) with physical health QOL and a moderate correlation with psychosocial health QOL (R2 = 0.21) 30 days post-concussion. HBI ratings 30 days post-concussion demonstrated a moderately high correlation with physical health QOL (R2 = 0.35) and psychosocial health QOL (R2 = 0.57). Age was not significantly associated with physical or psychosocial QOL ratings. Impairments in QOL following concussion may identify children and adolescents who need additional referral to address persistent symptoms at this time. [ABSTRACT FROM AUTHOR]

Background: Although most children report symptom resolution within a month of a concussion, some patients experience persistent postconcussion symptoms (PPCS) that continues for more than 1 month. Identifying patients at risk for PPCS soon after an injury can provide useful clinical information. Purpose: To determine if the Predicting Persistent Post-concussive Problems in Pediatrics (5P) clinical risk score, an emergency department (ED)--derived and validated tool, is associated with developing PPCS when obtained in a primary care sports concussion setting. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a study of patients seen at a pediatric sports medicine concussion clinic between May 1, 2013, and October 1, 2017, who were <19 years of age and evaluated within 10 days of a concussion. The main outcome was PPCS, defined as symptoms lasting >28 days. Nine variables were used to calculate the 5P clinical risk score, and we assessed the association between the 5P clinical risk score and PPCS occurrence. The secondary outcome was total symptom duration. Results: We examined data from 230 children (mean age, 14.8 6 2.5 years; 50% female; mean time from injury to clinical assessment, 5.6 6 2.7 days). In univariable analyses, a greater proportion of those who developed PPCS reported feeling slowed down (72% vs 44%, respectively; P< .001), headache (94% vs 72%, respectively; P < .001), sensitivity to noise (71% vs 43%, respectively; P< .001), and fatigue (82% vs 51%, respectively; P <.001) and committed ≥4 errors in tandem stance (33%vs 7%, respectively; P< .001) than those who did not. Higher 5P clinical risk scores were associated with increased odds of developing PPCS (adjusted odds ratio [OR], 1.62 [95%CI, 1.30-2.02]) and longer symptom resolution times (β = 8.40 [95%CI, 3.25-13.50]). Among the individual participants who received a high 5P clinical risk score (9-12), the majority (82%) went on to experience PPCS. The area under the curve for the 5P clinical risk score was 0.75 (95% CI, 0.66-0.84). After adjusting for the effect of covariates, fatigue (adjusted OR, 2.93) and ≥4 errors in tandem stance (adjusted OR, 7.40) were independently associated with PPCS. Conclusion: Our findings extend the potential use for an ED-derived clinical risk score for predicting the PPCS risk into the sports concussion clinic setting. While not all 9 predictor variables of the 5P clinical risk score were independently associated with the PPCS risk in univariable or multivariable analyses, the combination of factors used to calculate the 5P clinical risk score was significantly associated with the odds of developing PPCS. Thus, obtaining clinically pragmatic risk scores soon after a concussion may be useful for early treatments or interventions to mitigate the PPCS risk. [ABSTRACT FROM AUTHOR]

Quantification of visual deficits may help to identify dysfunction following concussion. We evaluated eye-tracking measurements among adolescents within 10 days of concussion and healthy control participants. Patients who reported to 2 tertiary care sport concussion clinics within 10 days of concussion completed an objective eye tracking assessment. Seventy-nine participants completed the study, 44 with concussion (mean age = 14.1 ± 2.2 years, 39% female) and 35 controls (mean age = 14.3 ± 2.4 years, 57% female). Right eye skew along the bottom of the screen was significantly higher for the concussion group compared to controls (median = 0.022 [interquartile range = –0.263, 0.482] vs 0.377 [interquartile range = –0.574, –0.031]; P = .002), but not the left eye. Among the variables investigated, right eye skew was altered for adolescents with a concussion. Visual function is an important component in the postconcussion evaluation, and identifying deficits soon after injury may allow for earlier specialist referral and intervention. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between dual-task gait performance and brain network activation (BNA) using an electroencephalography (EEG)-based Go/No-Go paradigm among children and adolescents with concussion. Methods: Participants with a concussion completed a visual Go/No-Go task with collection of electroencephalogram brain activity. Data were treated with BNA analysis, which involves an algorithmic approach to EEG-ERP activation quantification. Participants also completed a dual-task gait assessment. The relationship between dual-task gait speed and BNA was assessed using multiple linear regression models. Results: Participants (n = 20, 13.9 ± 2.3 years of age, 50% female) were tested at a mean of 7.0 ± 2.5 days post-concussion and were symptomatic at the time of testing (post-concussion symptom scale = 40.4 ± 21.9). Slower dual-task average gait speed (mean = 82.2 ± 21.0 cm/s) was significantly associated with lower relative time BNA scores (mean = 39.6 ± 25.8) during the No-Go task (β = 0.599, 95% CI = 0.214, 0.985, p = 0.005, R2 = 0.405), while controlling for the effect of age and gender. Conclusion: Among children and adolescents with a concussion, slower dual-task gait speed was independently associated with lower BNA relative time scores during a visual Go/No-Go task. The relationship between abnormal gait behaviour and brain activation deficits may be reflective of disruption to multiple functional abilities after concussion. [ABSTRACT FROM AUTHOR]

Prior studies suggest that concussion may lead to an increased risk of a subsequent time-loss sport-related injury, but the mechanisms responsible are unknown. We measured the symptom and dual-task gait outcomes for athletes initially post-concussion and after clinical recovery. Participants then self-reported any additional injuries incurred in the year after their concussion. Forty-two athletes (52% female, mean age = 16.8 ± 3.2 years) completed the study. They underwent a dual-task gait evaluation and symptom inventory within 21 days post-concussion, and again after they were deemed clinically recovered. Approximately one year later, participants documented if they had sustained any subsequent sport-related injuries. The repeated measures analysis of variance (ANOVA) was used to evaluate changes in dual-task gait and symptoms across time and between groups. A significant group*time interaction (p = 0.02) indicated that the group that went on to sustain a subsequent time-loss injury after returning to sports (n = 15) demonstrated significant average walking speed dual-task cost worsening across time (−17.9 ± 9.1% vs. −25.1 ± 12.5%; p = 0.007). In contrast, the group that did not sustain an additional injury walked with consistent dual-task cost values across time (−25.2 ± 9.2% vs. −24.6 ± 8.4%; p = 0.76). Symptoms improved for all participants (main effect of time, p < 0.001; Post-Concussion Symptom Scale [PCSS] = 25.0 ± 16.9 vs. 2.8 ± 7.5; p < 0.001), but did not differ between groups (p = 0.77). Significant dual-task gait cost worsening throughout concussion recovery was associated with time-loss injuries during sports in the year after a concussion. These findings indicate that worsening ability to execute a concurrent gait and cognitive task may relate to the risk of incurring an injury during sports after clinical concussion recovery. [ABSTRACT FROM AUTHOR]

An emerging area of research has identified that an increased risk of musculoskeletal injury may exist upon returning to sports after a sport-related concussion. The mechanisms underlying this recently discovered phenomenon, however, remain unknown. One theorized reason for this increased injury risk includes residual neuromuscular control deficits that remain impaired despite clinical recovery. Thus, the objectives of this review were: (1) to summarize the literature examining the relationship between concussion and risk of subsequent injury and (2) to summarize the literature for one mechanism with a theorized association with this increased injury risk, i.e., neuromuscular control deficits observed during gait after concussion under dual-task conditions. Two separate reviews were conducted consistent with both specified objectives. Studies published before 9 December, 2016 were identified using PubMed, Web of Science, and Academic Search Premier (EBSCOhost). Inclusion for the objective 1 search included dependent variables of quantitative measurements of musculoskeletal injury after concussion. Inclusion criteria for the objective 2 search included dependent variables pertaining to gait, dynamic balance control, and dual-task function. A total of 32 studies were included in the two reviews (objective 1 n = 10, objective 2 n = 22). According to a variety of study designs, athletes appear to have an increased risk of sustaining a musculoskeletal injury following a concussion. Furthermore, dual-task neuromuscular control deficits may continue to exist after patients report resolution of concussion symptoms, or perform normally on other clinical concussion tests. Therefore, musculoskeletal injury risk appears to increase following a concussion and persistent motor system and attentional deficits also seem to exist after a concussion. While not yet experimentally tested, these motor system and attentional deficits may contribute to the risk of sustaining a musculoskeletal injury upon returning to full athletic participation. [ABSTRACT FROM AUTHOR]

Objective: To prospectively examine gait characteristics of participants acutely after concussion with and without receded near point of convergence (NPC), compared with healthy controls. Design: Cross-sectional study. Setting: Sports-medicine clinic. Participants: Patients examined after concussion (n = 33; mean ± SD = 7.2 ± 3.1 days) and a group of uninjured athletes (n = 31) completed a Postconcussion Symptom Scale, underwent NPC testing, and single/dual-task gait assessments. Independent Variables: Near point of convergence was defined as the patient-reported diplopia distance when a fixation target moved toward the nose. Receded NPC was defined as a distance >5 cm from the tip of the nose. Main Outcome Measures: Spatiotemporal gait characteristics in single-task and dual-task conditions were evaluated with analysis of variance; correlations were calculated between NPC and gait measures. Results: Eighteen of 33 (55%) patients with concussion presented with receded NPC. Those with receded NPC exhibited slower gait speed (single-task = 1.06 ± 0.14 m/s vs 1.19 ± 0.15 m/s; dual-task = 0.80 ± 0.13 m/s vs 0.94 ± 0.13 m/s; P = 0.003) and shorter stride lengths (single-task = 1.11 ± 0.10 m vs 1.24 ± 0.11 m; dual-task = 0.97 ± 0.11 m vs 1.09 ± 0.11 m; P = 0.001) than healthy controls. Near point of convergence was moderately correlated with dual-task average walking speed for the normal NPC group (ρ = -0.56; P = 0.05). Postconcussion Symptom Scale scores did not significantly differ between groups (27 ± 18 vs 28 ± 16). Conclusions: After concussion, adolescents with receded NPC exhibited significant gait-related deficits compared with healthy controls, whereas those with normal NPC did not. Vergence and gross motor system dysfunction may be associated after concussion. Gait and vergence measures may contribute useful information to postconcussion evaluations. [ABSTRACT FROM AUTHOR]

Background: Sleep deficits are associated with motor and cognitive function deficits, even in the absence of a recent concussion.Research Question: Does the amount of self-reported sleep prior to pre-season concussion testing affect single-task and dual-task instrumented steady-state gait and timed tandem gait test performance?Methods: One hundred and fourteen healthy collegiate athletes (mean age 18.8 ± 0.7 years; 60% female) reported the amount of sleep they received during the prior night and completed a timed tandem gait test and an instrumented assessment of steady-state gait in both single-task and dual-task conditions. Outcome variables included spatio-temporal gait parameters during steady-state gait, best and mean tandem gait times, and cognitive test accuracy.Results: Participants who reported sleeping <7 h of sleep during the night prior to testing (n = 62) had significantly longer tandem gait times in single-task and dual-task conditions (11.1 ± 2.2 vs. 10.1 ± 2.0 s and 14.5 ± 4.3 vs. 12.3 ± 2.6 s, respectively; p = .009) compared to those who reported sleeping ≥7 h (n = 52). No significant differences between groups were observed for spatio-temporal steady-state gait variables or for cognitive test accuracy.Significance: Self-reported sleep duration may be associated with baseline testing tandem gait performance. Thus, as sleep can play a role in motor abilities, clinicians may consider interpreting tandem gait performance in light of sleep duration during the night prior to testing. [ABSTRACT FROM AUTHOR]

Quantitative gait measurements can identify persistent postconcussion impairments. However, their prognostic utility after injury to identify the likelihood of prolonged concussion symptoms remains unknown. Our objective was to examine if dual-task gait performance measures are independently associated with persistent (> 28 days) concussion symptoms among a sample of athletes. Sixty individuals diagnosed with a sport-related concussion were assessed within 10 days of their injury. Each participant completed a postconcussion symptom scale, an injury history questionnaire, and a single/dual-task gait examination. They were followed until they no longer reported symptoms, and the duration of time required for symptom resolution was calculated. A binary multivariable logistic regression model determined the independent association between dual-task gait and symptom duration (≤ 28 days vs. >28 days) while controlling for the effect of gender, age, symptom severity, injury-to-examination time, and history of concussion. Seventeen (28%) participants reported a symptom duration >28 days. The dual-task cost for average gait speed (−25.9 ± 9.5% vs. −19.8 ± 8.9%; p = 0.027) and cadence (−18.0 ± 2.9% vs. −12.0 ± 7.7%; p = 0.029) was significantly greater among participants who experienced symptoms for >28 days. After adjusting for potential confounding variables, greater dual-task average gait speed costs were independently associated with prolonged symptom duration (aOR = 0.908; 95% CI = 0.835-0.987). Examinations of dual-task gait may provide useful information during multifaceted concussion examinations. Quantitative assessments that simultaneously test multiple domains, such as dual tasks, may be clinically valuable after a concussion to identify those more likely to experience symptoms for >28 days after injury. [ABSTRACT FROM AUTHOR]

Objective: Postural stability is often affected by sport-related injuries and subsequently evaluated during postinjury examinations. Intrinsic factors, however, may also affect postural control. We sought to compare the postural control of female and male athletes as measured simultaneously by (1) the modified balance error scoring system (mBESS) and (2) a video-force plate system. Design: Cross-sectional study. Setting: Sports injury prevention center. Participants: Pediatric, adolescent, and young adult athletes who performed mBESS during an injury prevention evaluation. Independent Variables: We compared the postural control of female and male athletes. We also accounted for independent variables associated with postural stability, including age, body mass index, and history of ankle injury, concussion, and migraine headache. Main Outcome Measures: Total errors committed during the mBESS and measurements derived from integrated kinematic and kinetic data obtained by a video-force plate system. Differences between males and females were tested using analysis of covariance. Results: Participants (n = 409) ranged in age from 10 to 29 years (mean = 14.6 ± 2.8); 60% were female. No significant differences on mBESS were detected between females and males; however, female athletes demonstrated significantly better postural stability on the video-force plate analysis during double-leg (P = 0.03, d = 0.28), single-leg (P < 0.001, d = 0.62), and tandem stances (P < 0.001, d = 0.53) when compared with males. Conclusions: Uninjured female athletes demonstrate better postural stability on video-force plate analysis than their uninjured male counterparts. These findings provide an important information assistive to clinicians during interpretation of postinjury balance tests. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to prospectively examine the association between intracortical inhibition and functional recovery after mild traumatic brain injury (mTBI). Methods: Twenty individuals with mTBI and 20 matched control participants were assessed using transcranial magnetic stimulation, the Attentional Network Test, and gait analysis. Hierarchical linear modeling was used to longitudinally examine potential differences between groups and relationships in the pattern of recovery in cortical silent period (CSP) duration, cognitive reaction time, and single- and dual-task walking speeds across five testing time points. Individuals with mTBI were assessed within 72 h of injury, and again at 1 wk, 2 wk, 1 month, and 2 months postinjury. After initial testing, control participants followed a similar timeline. Results: At the 72-h time point, the group with mTBI had longer reaction time (b = -91.76, P = 0.01), similar single-task walking speed (b = 0.055, P = 0.10), and slower dual-task walking speed (b = 0.10, P = 0.012) compared with control participants. The CSP duration also tended to be longer in individuals with mTBI than controls at the 72-h time point (b = -16.34, P = 0.062). The change is CSP duration over time was not significantly associated with the change in reaction time (b = -0.19, P = 0.47), single-task walking speed (b = 0.0001, P = 0.53), or dual-task walking speed (b < 0.001, P = 0.68). Conclusion: Although cognitive and motor functions were significantly impaired in the mTBI group acutely after injury, levels of intracortical inhibition were not associated with recovery in either functional domain. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to determine whether high levels of strenuous physical activity outside of organised sports are associated with better functional test performance.Methods: Youth athletes (n = 445, mean = 14.2 ± 2.5 years) reported their frequency of strenuous physical activity outside of organised sports. The functional performance tests: vertical jump height, pro agility test time, estimated maximal oxygen uptake (VO2 max), front plank time and postural stability were measured and compared between groups.Results: Athletes in the five or more times a week group demonstrated faster pro agility times (5.37 ± 0.43 seconds) than the never group (5.59 ± 0.56 seconds; p = 0.002) and the 1-4 times a week group (5.52 ± 0.47 seconds; p = 0.005). The five or more times a week group demonstrated higher mean vertical jump height (42.9 ± 13.3 vs. 40.3 ± 10.8 cm; p = 0.009) and higher estimated VO2 max (48.1 vs. 45.6 mL/kg/minute; p = 0.001) than the 1-4 times a week group.Conclusion: Youth athletes who engaged in strenuous physical activity outside of organised sports five or more times a week performed best on functional performance tests. [ABSTRACT FROM AUTHOR]

Concussion may affect females and males differentially. Identification of gender-related differences after concussion, therefore, may help clinicians with individualized evaluations. We examined potential differences in dual-task gait between females and males after concussion. Thirty-five participants diagnosed with a concussion (49% female, mean age=15.0±2.1 years, 7.5±3.0 days post-injury) and 51 controls (51% female, mean age=14.4±2.1 years) completed a symptom inventory and single/dual-task gait assessment. The primary outcome variable, the dual-task cost, was calculated as the percent change between single-task and dual-task conditions to account for individual differences in spatio-temporal gait variables. No significant differences in symptom severity measured by the post-concussion symptom scale were observed between females (32.0±18.0) and males (27.8±18.2). Compared with males, adolescent females walked with significantly decreased cadence dual-task costs after concussion (-19.7%±10.0% vs. -11.3%±9.2%, p=0.007) when adjusted for age, height, and prior concussion history. No significant differences were found between female and male control groups on other dual-task cost gait measures. Females and males with concussion also walked with significantly shorter stride lengths than controls during single-task (females: 1.13±0.11m vs. 1.26±0.11m, p=0.001; males: 1.14±0.14m vs. 1.22±0.15m, p=0.04) and dual-task gait (females: 0.99±0.10m vs. 1.10±0.11m, p=0.001; males: 1.00±0.13m vs. 1.08±0.14m, p=0.04). Females demonstrated a significantly greater amount of cadence change between single-task and dual-task gait than males after a sport-related concussion. Thus, differential alterations may exist during gait among those with a concussion; gender may be one prominent factor affecting dual-task gait. [ABSTRACT FROM AUTHOR]

Sustaining repeated concussions has been associated with worse outcomes after additional injuries. This effect has been identified using symptom inventories and neurocognitive tests; however, few investigations have examined how a prior concussion history affects gait soon after a subsequent concussion. We examined the gait characteristics of athletes with no documented concussion history ( n = 31), athletes recovering from their first lifetime concussion ( n = 15), and athletes recovering from their second or greater lifetime concussion ( n = 22). All participants completed a single-task and dual-task gait examination, a medical history questionnaire, and a postconcussion symptom scale. Multivariate analyses of covariance (MANCOVA) models were used to evaluate mean gait differences among groups, and Spearman's ρ analyses were used to assess correlations between the number of lifetime concussions and gait characteristics. Patients reporting to the clinic with their second or greater lifetime concussion demonstrated smaller stride lengths than healthy control participants during dual-task walking ( p = 0.01; d = 0.70). A moderate but insignificant correlation was detected between dual-task gait speed and the number of prior concussions (ρ = 0.41, p = 0.07). These results indicate that a cumulative effect of concussions across the lifetime may contribute to worsening dual-task dynamic motor function after concussion. [ABSTRACT FROM AUTHOR]

Aim: To determine which initial postinjury symptom domains are independently associated with symptoms lasting >28 days in youth athletes who sustained sport-related concussions.Methods: Patients who presented for care at a sport concussion clinic completed the postconcussion symptom scale. They were classified into two groups: those who reported symptom resolution within 28 days of injury and those who did not. Logistic regression models were constructed for children and adolescents to determine the independent association between symptom recovery and potential predictor variables: initial symptom scores in 5 postconcussion symptom scale domains (somatic, vestibular-ocular, cognitive, sleep and emotional), sex, loss of consciousness or amnesia at the time of injury, history of prior concussion, prior treatment for headaches or migraines, or family history of concussion.Results: Sixty-eight child (8-12 years of age) and 250 adolescent (13-18 years of age) athletes were included. For adolescents, initial somatic symptom severity was independently associated with prolonged symptom duration (adjusted odds ratio = 1.162; 95% CI: 1.060, 1.275) and no other predictor variables were. No potential predictor variables were independently associated with prolonged symptom duration for children.Conclusion: Among adolescent athletes, a high initial somatic symptom burden (e.g. headache, nausea, vomiting, etc.) is associated with increased odds of symptoms beyond 28 days postinjury. [ABSTRACT FROM AUTHOR]

Matched control data are commonly used to examine recovery from concussion. Limited data exist, however, examining dual-task gait data consistency collected over time in healthy individuals. The study purposes were to: 1) assess the consistency of single-task and dual-task gait balance control measures, 2) determine the minimal detectable change (MDC) of gait balance control measures, and 3) examine the extent to which age and task complexity affect dual-task walking costs in healthy adolescents and young adults. Twenty-four adolescent (mean age=15.5±1.1years) and 21 young adult (mean age=21.2±4.5years) healthy participants completed 5 testing sessions across a two-month period, which involved analyses of gait balance control and temporal-distance variables during single-task and dual-task walking conditions in a motion analysis laboratory. Cronbach's α and MDCs were used to determine the consistency of the gait balance control variables and the smallest amount of change required to distinguish true performance from change due to the performance/measurement variability, respectively. Dual-task costs were evaluated to determine the effect of task complexity and age across time using 3-way ANOVAs. Good to excellent test-retest consistency was found for all single-task and dual-task walking (Cronbach's α range: 0.764-0.970), with a center-of-mass medial-lateral displacement MDC range of 0.835-0.948cm. Greater frontal plane dual-task costs were observed during more complex secondary tasks (p<0.001). The results revealed good-excellent consistency across testing sessions for all variables and indicated dual-task costs are affected by task complexity. Thus, healthy controls can be effective comparators when assessing injured subjects. [ABSTRACT FROM AUTHOR]

Context: Single- and dual-task walking gait assessments have been used to identify persistent movement and cognitive dysfunction among athletes with concussions. However, it is unclear whether previous ankle sprain injuries confound these outcomes during baseline testing. The purpose of this study was to determine the effects of (1) ankle sprain history and (2) time since prior ankle sprain injury on single- and dual-task spatiotemporal gait outcomes and cognitive measures. Design: Cross- sectional study. Methods: We assessed 60 college Division-I athletes (31 with ankle sprain history; 13 females and 18 males, 19.3 [0.8] y; 29 with no ankle sprain history, 14 females and 15 males, 19.7 [0.9] y) who completed injury history forms and underwent concussion baseline testing. Athletes completed single- and dual-task gait assessments by walking back and forth along an 8-m walkway for 40 seconds. Athletes wore a smartphone with an associated mobile application on their lumbar spine to record spatiotemporal gait parameters and dual-task cognitive performance. Separate multivariate analyses of variance were used to assess the effects of ankle sprain injury history on spatiotemporal measures, gait variability, and cognitive performance. We performed a multivariate regression subanalysis on athletes who reported time since injury (n = 23) to assess temporal effects on gait and cognitive performance. Results: Athletes with and without a histoiy of ankle sprains had comparable spatiotemporal and gait variability outcomes during single- (P = .42; P = .13) and dual-task (P = .75; P = .55) conditions. Additionally, ankle sprain injury history did not significantly influence cognitive performance (P = .35). Finally, time since ankle sprain did not significantly affect single- (P = .75) and dual-task gait (P = .69), nor cognitive performance (P = 19). Conclusions: Ankle sprain injury history did not significantly alter spatiotemporal gait outcomes nor cognitive performance during this common clinical assessment. Future studies may consider including athletes with ankle sprain injury history during concussion assessments. [ABSTRACT FROM AUTHOR]

Background: Physical rest after a concussion has been described as a key component in the management of the injury. Evidence supporting this recommendation, however, is limited. Purpose: To examine the association between physical activity and symptom duration in a cohort of patients after a concussion. Study Design: Cohort study; Level of evidence, 2. Methods: This study included 364 patients who were diagnosed with a concussion, were seen by a physician within 3 weeks of injury, and completed a questionnaire at the initial clinic visit. The questionnaire assessed the postconcussion symptom scale (PCSS) score, previous number of concussions, presence of the loss of consciousness or amnesia at the time of injury, and prior treatment for headaches. During each follow-up clinic visit, physical activity level was self-reported. A Cox proportional hazard model was constructed to determine the association between symptom duration, initial clinic visit responses, and self-reported physical activity level after the injury. Results: Study participants ranged in age from 8 to 27 years (mean age, 15.0 years) and had sustained a mean of 0.8 prior concussions; 222 patients (61%) were male. On initial examination, the mean PCSS score was 34.7. The mean symptom duration was 48.9 days after the injury. Among the variables included in the model, initial PCSS score and female sex were independently associated with symptom duration, while physical activity level after the injury was not. For participants aged between 13 and 18 years, however, higher levels of physical activity after the injury were associated with a shorter symptom duration. Conclusion: Results from this study indicate that physical activity after the injury may not be universally detrimental to the recovery of concussion symptoms. [ABSTRACT FROM AUTHOR]

Museums have long served as a source of inspiration for horror and fiction writers. The cultural institutions maintain an aura of mystery, making them the ideal setting for stories of the macabre. Graphic novel authors have also made liberal use of these buildings as setting, and make frequent use of museum employees as key figures in narrative development. What though, is the role of the museum as depicted in graphic novels? What function do they play, and how are museum employees represented? Does the graphic novel offer a way in which museums can reach out to and develop new audiences, or will the medium serve only to confuse and mislead potential visitors about the reality of museums? [ABSTRACT FROM PUBLISHER]

Recent work has identified deficits in dual-task gait balance control for up to 2 months after adolescent concussion; however, how resumption of preinjury physical activities affects recovery is unknown. Purpose: The objective of this study is to examine how return to activity (RTA) affects recovery from concussion on measures of symptom severity, cognition, and balance control during single-task and dual-task walking. Methods: Nineteen adolescents with concussion who returned to preinjury activity within 2 months after injury and 19 uninjured, matched controls completed symptom inventories, computerized cognitive testing, and single-task and dual-task gait analyses. Concussion participants were assessed at five time points: within 72 h, 1 wk, 2 wk, 1 month, and 2 months postinjury. Control participants were assessed at the same time points as their matched concussion counterparts. RTA day was documented as the postinjury day in which physical activity participation was allowed. The effect of returning to physical activity was assessed by examining the percent change on each dependent variable across time before and directly after the RTA. Data were analyzed by two-way mixed effects ANOVAs. Results: After the RTA day, concussion participants significantly increased their total center-of-mass medial/lateral displacement (P = 0.009, ƞp2 = .175) and peak velocity (P = 0.048, ƞp2 = 0.104) during dual-task walking when compared with pre-RTA data, whereas no changes for the concussion group or between groups were detected on measures of single-task walking, forward movement, or cognition. Conclusions: Adolescents with concussion displayed increased center-of-mass medial/lateral displacement and velocity during dual-task walking after RTA, suggesting a regression of recovery in gait balance control. This study reinforces the need for a multifaceted approach to concussion management and continued monitoring beyond the point of clinical recovery. [ABSTRACT FROM AUTHOR]

Background: Age has been described as a factor that affects recovery after concussion. The recommended management protocol is to treat adolescents in a more cautious manner than adults. However, few studies have prospectively and longitudinally assessed the way these age groups perform on motor tasks after concussion. Purpose: To examine dual-task gait balance control deficits after concussion in a group of adolescents and young adults in reference to matched control subjects within 72 hours of injury and throughout 2 months after injury. Study Design: Cohort study; Level of evidence, 2. Methods: Adolescents and young adults who sustained a concussion and individually matched controls completed a whole-body motion gait analysis while simultaneously performing a cognitive task. Subjects with concussion reported to the laboratory within 72 hours after injury and at the following time points: 1 week, 2 weeks, 1 month, and 2 months after injury. Control subjects completed the same protocol at similar time points. Gait balance control measurements included whole-body center-of-mass (COM) medial-lateral displacement/velocity and anterior velocity. Results: A total of 38 subjects with concussion, 19 young adults (mean ± SD age, 20.3 ± 2.4 years) and 19 adolescents (mean ± SD age, 15.1 ± 1.1 years), and 38 individually matched control subjects were tested. Within 72 hours of injury, adolescents displayed significantly greater COM medial-lateral displacement (P = .001) and peak velocity (P = .001) relative to their control group, and the young adult concussion group displayed significantly less peak COM anterior velocity than their control group (P = .01). Across the 2 months of testing, adolescents with concussion displayed significantly greater total COM medial-lateral displacement than did adolescent controls (P = .001), while young adults with concussion did not significantly differ from their matched controls (P = .07). Conclusion: An examination of gait balance control during dual-task walking revealed that after concussion, in reference to matched controls, adolescents demonstrated greater gait balance control deficits than did young adults initially and throughout the 2-month postinjury period, supporting the recommendation of conservative management for adolescents after concussion. [ABSTRACT FROM AUTHOR]