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The article discusses the recognition and treatment of post-concussion syndrome in athletes. A discussion of an increase which has been seen in the number of athletes that are seeking treatment for the syndrome is presented. Post-concussion syndrome symptoms that may resemble symptoms of other disorders are discussed. The use of neuropsychological testing to identify syndrome symptoms is examined. Accommodations which should be made for post-concussion syndrome patients are discussed.

Interest and participation in organized sports for children, preadolescents, and adolescents continue to grow. Because of increased participation, and younger entry age, in organized sports, appropriate practice, game schedules, and content become more important, taking into account athlete developmental stage and skills. Parental support for organized sports in general, with focus on development and fun instead of winning, has emerged as a key factor in the athlete's enjoyment of sports. Schools and community sports organizations who support multiple levels of sport (eg, recreational, competitive, elite) can include more youth who want to play sports and combat sport dropout. This report reviews the benefits and risks of organized sports as well as the roles of schools, community organizations, parents, and coaches in organized sports. It is designed to complement the American Academy of Pediatrics clinical reports "Physical Activity Assessment and Counseling in Pediatric Clinical Settings" and "Sports Specialization and Intensive Training in Young Athletes" by reviewing relevant literature on healthy organized sports for youth and providing guidance on organized sport readiness and entry. The report also provides guidance for pediatricians on counseling parents and advocating for healthy organized sports participation. [ABSTRACT FROM AUTHOR]

The article presents case studies for students, based on the football career of Anthony "Tony Tonka Truck" Williams. Topics include the objectives of the case studies which include helping students develop the knowledge of Chronic Traumatic Encephalopathy (CTE), concussions and Second Impact Syndrome (SIS), cases on Anthony Williams's childhood and High School football stint.

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]

Athletes of all ages may be affected by medical and mental health issues. Sports medicine physicians should be familiar with common conditions that may affect the well-being of athletes, such as attention-deficit/hyperactivity disorder (ADHD). ADHD behaviors have the potential to affect a person's ability to concentrate. It is likely that social and cognitive therapies combined with pharmacotherapy will be the most effective way to treat ADHD in athletes. Medications used for ADHD, especially stimulant types, are known to improve alertness, reaction time, anaerobic performance, and endurance, which would potentially improve athletic performance. Furthermore, stimulant medications may enable student athletes with ADHD to focus on academic studies for longer periods of time, beyond usual levels of fatigue, important for those who may be exhausted after practices and games. The purported performance enhancement effects and potential adverse effects of stimulant medications have prompted many sports governing bodies to ban prescription stimulants or establish strict rules for their use. Athletes taking physician-prescribed stimulants to treat ADHD need to provide the appropriate documentation for approval before competition or risk punitive measures. Physicians should strive to provide a high quality of care to athletes with ADHD through early diagnosis, appropriate and careful multidisciplinary treatment, and complete and timely documentation to facilitate continued sports participation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether a mobile health application that employs elements of social game design could compliment medical care for unresolved concussion symptoms. Design: Phase I and Phase II (open-label, non-randomized, ecological momentary assessment methodology). Setting: Outpatient concussion clinic. Participants: Youth, aged 13–18 years, with concussion symptoms 3+ weeks after injury;Phase I: n = 20;Phase II: n = 19. Interventions: Participants received standard of care for concussion. The experimental group also used a mobile health application as a gamified symptoms journal. Outcome measures: Phase I: feasibility and satisfaction with intervention (7-point Likert scale, 1 high).Phase II: change in SCAT-3 concussion symptoms (primary), depression and optimism. Results: Phase 1: A plurality of participants completed the intervention (14 of 20) with high use (110 +/− 18% play) and satisfaction (median +/− interquartile range (IQR) = 2.0+/− 0.0).Phase II: Groups were equivalent on baseline symptoms, intervention duration, gender distribution, days since injury and medication prescription. Symptoms and optimism improved more for the experimental than for the active control cohort (U =18.5,p= 0.028, effect sizer= 0.50 andU =18.5,p= 0.028, effect sizer= 0.51, respectively). Conclusions: Mobile apps incorporating social game mechanics and a heroic narrative may promote health management among teenagers with unresolved concussion symptoms. [ABSTRACT FROM PUBLISHER]

An introduction is presented which discusses various reports within the issue on topics including the prevalence of urinary incontinence in active women, burnout in youth sport and the 2014 annual meeting of the American Medical Society for Sports Medicine (AMSSM).

Patellofemoral pain (PFP) is defined as retro‐ or peri‐patellar knee pain without a clear structural abnormality. Unfortunately, many current treatment approaches fail to provide long‐term pain relief, potentially due to an incomplete understanding of pain‐disrupted sensorimotor dysfunction within the central nervous system. The purposes of this study were to evaluate brain functional connectivity in participants with and without PFP, and to determine the relationship between altered brain functional connectivity in association with patient‐reported outcomes. Young female patients with PFP (n = 15; 14.3 ± 3.2 years) completed resting‐state functional magnetic resonance imaging (rs‐fMRI) and patient‐reported outcome measures. Each patient with PFP was matched with two controls (n = 30, 15.5 ± 1.4 years) who also completed identical rs‐fMRI testing. Six bilateral seeds important for pain and sensorimotor control were created, and seed‐to‐voxel analyses were conducted to compare functional connectivity between the two groups, as well as to determine the relationship between connectivity alterations and patient‐reported outcomes. Relative to controls, patients with PFP exhibited altered functional connectivity between regions important for pain, psychological functioning, and sensorimotor control, and the connectivity alterations were related to perceived disability, dysfunction, and kinesiophobia. The present results support emergent evidence that PFP is not localized to structural knee dysfunction, but may actually be resultant to altered central neural processes. Clinical significance: These data provide potential neuro‐therapeutic targets for novel therapies aimed to reorganize neural processes, improve neuromuscular function, and restore an active pain‐free lifestyle in young females with PFP. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of pediatric mild traumatic brain injury (mTBI), using a broad parent-reported measure, and to determine whether parent-ratings of mTBI symptoms are higher among those with premorbid attention-deficit/hyperactivity disorder (ADHD) and females. Design: Retrospective case–control. Setting: Hospital-based sports medicine clinic. Participants: The retrospective chart review included 1346 (age: M = 13.11 years, SD = 2.6; 61.7% male) pediatric patients with (n = 209) and without (n = 1137) ADHD. Independent Variables: Group membership (ADHD vs non-ADHD) and sex (male vs female). Main Outcome Measures: Baseline and current Post-Concussion Symptom Inventory–Parent Report Form (PCSI-P) Physical, Emotional, Cognitive, and Fatigue subscale scores. This study used a retrospective chart review; therefore, the hypotheses reported for the current study were formed after data were collected. Results: Controlling for patient age and days from mTBI, patients with ADHD had significantly higher retrospective parent-reported pre-mTBI ratings of physical, emotional, and cognitive symptoms (d s = 0.17-0.62) and higher post-mTBI ratings across all 4 symptom domains (d s = 0.18-0.57) than those without ADHD. There was no group × time interaction for any of the PCSI-P subscales. Females overall had higher retrospective parent-reported pre-injury Fatigue and Emotional symptoms (d s = 0.13-0.19) and higher post-mTBI symptoms in all 4 PCSI-P symptom domains (d s = 0.23-0.35), relative to males. Conclusions: Attention-deficit/hyperactivity disorder-related postinjury exacerbations in parent-reported symptoms can be explained, in part, by elevated retrospective parent-reported ADHD-related pre-mTBI ratings. These results highlight the importance of assessing a patient's baseline symptoms post-mTBI. These data also indicate that ADHD status and sex should be considered when interpreting mTBI symptom severity during clinical evaluation of concussion. [ABSTRACT FROM AUTHOR]

Sports-related concussion (SRC) can exert serious acute and long-term consequences on brain microstructure, function, and behavioral outcomes. We aimed to quantify the alterations in white matter (WM) microstructure and global network organization, and the decrements in behavioral and cognitive outcomes from pre-season to post-concussion in youth athletes who experienced SRC. We also aimed to evaluate whether wearing a jugular compression neck collar, a device designed to mitigate brain "slosh" injury, would mitigate the pre-season to post-concussion alterations in neuroimaging, behavioral, and cognitive outcomes. A total of 488 high school football and soccer athletes (14-18 years old) were prospectively enrolled and assigned to the non-collar group (n = 237) or the collar group (n = 251). The outcomes of the study were the pre-season to post-concussion neuroimaging, behavioral, and cognitive alterations. Forty-six participants (non-collar: n = 24; collar: n = 22) were diagnosed with a SRC during the season. Forty of these 46 athletes (non-collar: n = 20; collar: n = 20) completed neuroimaging assessment. Significant pre-season to post-concussion alterations in WM microstructural integrity and brain network organization were found in these athletes (corrected p < 0.05). The alterations were significantly reduced in collar-wearing athletes compared to non-collar-wearing athletes (corrected p < 0.05). Concussion and collar main effects were identified for some of the behavioral and cognitive outcomes, but no collar by SRC interaction effects were observed in any outcomes. In summary, young athletes exhibited significant WM microstructural and network organizational, and cognitive alterations following SRC. The use of the jugular vein compression collar showed promising evidence to reduce these alterations in high school contact sport athletes. [ABSTRACT FROM AUTHOR]

Objective: To identify factors associated with entry into primary care sports medicine (PCSM) fellowship programs. Design: Primary care sports medicine fellowship directors (FDs) and fellowship faculty were surveyed regarding preferences for accepting applicants into their programs. Setting: Survey study. Participants: Primary care sports medicine FDs and fellowship faculty. Assessment of risk factors: Questions were designed to delineate factors [clinical experience, letters of recommendation (LOR), scholarship, service commitment, interview performance, etc] perceived to be associated with entry into PCSM fellowship (1-10 scale; 10 = highest value). Weighted mean ± SD were calculated for each question. Main outcome measures: Determination of most valued factors for entry into PCSM fellowship. Results: Responses were provided by 242/2332 (10.4%) of the American Medical Society for Sports Medicine members, including 77 of 175 (44%) FDs. The top 3 factors for entry into PCSM fellowships for all respondents were as follows: interview performance (9.17 ± 1.13), LOR from SM fellowship faculty (8.20 ± 1.67), and high school game/event coverage (7.83 ± 1.70). Musculoskeletal ultrasound experience (4.50 ± 2.23) and residency training in pediatrics (4.58 ± 2.54), internal medicine (4.48 ± 2.44), emergency medicine (4.44 ± 2.59), and physical medicine and rehabilitation (4.40 ± 2.83) received the lowest scores. Conclusions: Applicants seeking entry into SM fellowships should prioritize performance during interviews, LOR from SM fellowship faculty, and team game/event coverage experiences. [ABSTRACT FROM AUTHOR]

Objective: To establish the King-Devick test (KD) performance values for children and adolescents. Design: Prospective cohort. Setting: Pediatric sports medicine clinics. Participants: Five hundred seven athletes presenting to a pediatric sports medicine clinic for non-concussion-related evaluations. Independent Variables: Age, sex, and risk factors for abnormal concussion recovery. Main Outcome Measures: The King-Devick test time. Results: Four hundred eighty-three participants were included in the final analysis, which included 60.5% girls (n = 292) and 39.5% boys (n = 191). The KD test performance varied by age with a steady decrease in test time yearly from 8 years through 14 years of age, where some plateauing occurred. Baseline scores changed approximately 31 seconds over ages 8 to 18. Analysis of variance results revealed a strong effect of age on overall mean KD time (P < 0.001). The KD test performance was not associated with sex or other studied concussion risk factors or comorbid conditions. Conclusions: The KD test performance was reported in a cohort of youth aged 8 to 18 years, allowing for comparison of performance in individuals who may not have a baseline assessment. If baseline testing is desired, at least yearly intervals seems to be appropriate through childhood and early adolescence. Clinical Relevance [ABSTRACT FROM AUTHOR]

Recent neuroimaging studies have suggested that repetitive subconcussive head impacts, even after only one sport season, may lead to pre- to post-season structural and functional alterations in male high school football athletes. However, data on female athletes are limited. In the current investigation, we aimed to (1) assess the longitudinal pre- to post-season changes in functional MRI (fMRI) of working memory and working memory performance, (2) quantify the association between the pre- to post-season change in fMRI of working memory and the exposure to head impact and working memory performance, and (3) assess whether wearing a neck collar designed to reduce intracranial slosh via mild compression of the jugular veins can ameliorate the changes in fMRI brain activation observed in the female high school athletes who did not wear collars after a full soccer season. A total of 48 female high school soccer athletes (age range: 14.00–17.97 years) were included in the study. These athletes were assigned to the non-collar group (n = 21) or to the collar group (n = 27). All athletes undewent MRI at both pre-season and post-season. In each session, a fMRI verbal N-Back task was used to engage working memory. A significant pre- to post-season increase in fMRI blood oxygen level dependent (BOLD) signal was demonstrated when performing the N-back working memory task in the non-collar group but not in the collar group, despite the comparable exposure to head impacts during the season between the two groups. The collar group demonstrated significantly smaller pre- to post-season change in fMRI BOLD signal than the non-collar group, suggesting a potential protective effect from the collar device. Significant correlations were also found between the pre- to post-season increase in fMRI brain activation and the decrease in task accuracy in the non-collar group, indicating an association between the compensatory mechanism in underlying neurophysiology and the alteration in the behavioral outcomes. [ABSTRACT FROM AUTHOR]

Following a concussion, it is common for children and adolescents to experience difficulties in the school setting. Cognitive difficulties, such as learning new tasks or remembering previously learned material, may pose challenges in the classroom. The school environment may also increase symptoms with exposure to bright lights and screens or noisy cafeterias and hallways. Unfortunately, because most children and adolescents look physically normal after a concussion, school officials often fail to recognize the need for academic or environmental adjustments. Appropriate guidance and recommendations from the pediatrician may ease the transition back to the school environment and facilitate the recovery of the child or adolescent. This report serves to provide a better understanding of possible factors that may contribute to difficulties in a school environment after a concussion and serves as a framework for the medical home, the educational home, and the family home to guide the student to a successful and safe return to learning. [ABSTRACT FROM AUTHOR]