Search Results (41)

Background: Sex-based variations in brain structure, hormonal balance, and neurochemistry may influence symptom presentation and recovery after mild traumatic brain injury (mTBI). This systematic review investigated sex-related differences in mTBI severity, symptoms, and recovery outcomes across different injury mechanisms. Methods: This review followed PRISMA 2020 guidelines and was registered with PROSPERO (CRD420251011379). Searches were conducted in PubMed, SPORTDiscus, Web of Science, and Scopus for articles published between 2000 and 2024. Eligible studies included adults (≥18 years) diagnosed with mTBI or concussion (Glasgow Coma Scale 13–15) with quantifiable outcome data for both sexes. Data extraction and quality assessment followed the JBI critical appraisal tools. Results: Forty-one studies involving 15,656 participants (8671 males; 6985 females) met the inclusion criteria. Female participants reported a greater symptom burden, higher pain intensity, and longer recovery times for gait abnormalities and return to activity compared with males. Neuroimaging studies showed more extensive white matter alterations in females, whereas males displayed greater reductions in cerebral blood flow. Cognitive and neurosensory outcomes revealed poorer cognitive performance, slower reaction times, and higher rates of vestibular–ocular and visual abnormalities in females. A limited number of studies explored electrophysiological measures, indicating sex-based differences in early brain responses to emotional stimuli. Conclusions: Sex plays an important role in symptom presentation and recovery after mTBI. Female patients demonstrate heightened vulnerability across several clinical domains, likely due to biological and neurochemical differences. Recognising these sex-specific patterns can support more targeted diagnostic and rehabilitation strategies. Future research should further explore the structural and biochemical mechanisms underlying these differences to improve precision in mTBI management. Full article

Background: Sport-related concussion (SRC) is a recognised public health concern, with combat sport athletes particularly vulnerable due to frequent head impacts. In Taekwondo, concussion incidence is comparable to other contact sports, yet underreporting and misconceptions may hinder safe management. Understanding knowledge, attitudes, and behaviours in this cohort is critical for athlete safety. Methods: This cross-sectional online survey was distributed to Australian Taekwondo athletes (AKA). Participants completed demographic, concussion history, and the Rosenbaum Concussion Knowledge and Attitudes Survey. Knowledge (CKI) and attitudes (CAI) indices were derived. Group differences were analysed using non-parametric tests, with associations between knowledge, attitudes, and reporting behaviours explored via correlation and logistic regression. Results: Athletes (n = 98) demonstrated good knowledge (mean CKI 19.8/25) and positive attitudes (mean CAI 61.6/75), though misconceptions remained. While 92% indicated they would seek medical attention, 21% reported returning to play the same day as a suspected concussion, and over 20% admitted to concealing symptoms. Higher CAI scores, but not CKI, were associated with safer reporting intentions. Conclusions: AKA showed strong knowledge and attitudes towards concussion; however, risky behaviours persisted. Attitudes, rather than knowledge, were more predictive of reporting behaviours, underscoring the need for interventions that strengthen positive attitudes and cultural support for symptom disclosure. Full article

Due to the highly individualised presentation of sport-related concussion (SRC), multi-domain assessments examining cognitive, migraine, vestibular, ocular, mood, sleep, and neck-related function have been suggested to assist clinicians with diagnosis, management, and rehabilitation. Normative data on such assessments for female, community players from countries outside the U.S. are needed. This study aimed to (i) describe normative data from community-level Ladies Gaelic Football players using a multi-domain assessment, and (ii) compare findings between adolescent and adult players. A total of 138 LGF players without SRC (101 adults, 37 adolescents) completed a multi-domain SRC assessment including Sport Concussion Assessment Tool 5th Edition, Concussion Clinical Profiles Screening, Vestibular/Ocular Motor Screening (VOMS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT^®), Patient Health Questionnaire-9, Generalised Anxiety Disorder-7, Pittsburgh Sleep Quality Index, Migraine Disability Assessment, and Neck Bournemouth Questionnaire, and neck dynamometry. Normative data were summarised using descriptive statistics, while differences in test scores between adolescents and adults were examined using parametric or non-parametric tests. While adolescents and adults scored similarly on most measures, adolescents scored worse on ImPACT^® visual–motor speed (d = 0.09) and reaction time (r = 0.52), SCAT5 concentration (V = 0.38), total modified Balance Error Scoring System (r = 0.42), and CP Screen vestibular profile (r = 0.38) (p < 0.05). This is the first study to describe and compare normative data for multidomain SRC assessments in adolescent and adult female, community athletes. Differences in some tests between adolescents and adults highlight the need for demographic-specific normative data when interpreting post-SRC assessment results. Full article

Oculomotor dysfunction identified within the first 10 days of sport-related concussion (SRC) is a risk factor for Persisting Post-Concussion Symptoms (PPCS). Oculomotor rehabilitation is the recommended treatment for oculomotor dysfunction from the subacute period onwards. However, there are delays in initiating rehabilitation due to a limited number of specialized providers and associated healthcare costs. Delays in initiating treatment are associated with worse outcomes. We performed a retrospective, quasi-experimental trial to evaluate whether providing instructions for self-guided oculomotor rehabilitation in adolescents with 3 or more abnormal oculomotor findings after SRC (Experimental Arm, n = 27, mean age = 15.50 ± 1.53 years, 63.0% male, 5.74 ± 2.43 days since injury) reduced the number of persisting impairments at 4 weeks compared to a wait-and-see approach (Standard Care Arm, n = 106, mean age = 14.98 ± 1.87 years, 59.4% male, 5.69 ± 2.78 days since injury). A small difference was seen in the incidence of neck tenderness but there were no differences between groups in symptom severity or number of abnormal oculomotor findings at initial presentation. Overall, 50 out of 106 (47.2%) participants in the Standard Care Arm had PPCS compared to 7 out of 27 (25.9%) in the Experimental Arm, which was significantly different (Chi-squared = 3.966, p = 0.046). This corresponds to an absolute risk reduction of 21.3%. Results from our pilot study suggest these treatment guidelines are feasible to incorporate into a busy outpatient practice in a cost-effective manner. Prospectively designed randomized controlled trials are warranted to validate the effectiveness of this treatment. Full article

Objectives: Sports-related concussion (SRC) is mostly associated with contact and combat sports. However, emerging evidence suggest that cyclists are also at risk of repeated concussion injury. Moreover, long-term neurophysiological outcomes in cycling cohorts remain underexplored. This novel study investigated the long-term effect of repetitive concussions in cyclists. Road, mountain biking (MTB), and BMX riders with a history of concussions and self-reported persistent symptoms were assess for neurophysiology and cognitive–motor performance compared to previously concussed cyclists with no ongoing symptoms. Both groups were compared to age-matched with controls. Methods: Using a cross-sectional between-group design, 25 cyclists with a history of concussions (15 symptomatic, 10 asymptomatic) and 20 controls completed symptom reporting, cognitive and balance assessments (SCAT5), sensorimotor testing using vibrotactile stimulation, and neurophysiological assessments via transcranial magnetic stimulation (TMS). Results: Symptomatic cyclists reported a higher number of concussions compared to asymptomatic cyclists (p = 0.041). Cognitive testing revealed large effects (d > 1.0), with impaired concentration in symptomatic cyclists compared to controls (p = 0.005). Motor assessments demonstrated large effects (d > 1.0), with slower tandem gait times (p < 0.001) and greater errors (p = 0.02) in the symptomatic group. Sensorimotor testing indicated slowed simple reaction times (p = 0.001) and poorer temporal order judgement (p = 0.038). TMS showed large effects (d > 1.0) in increased cortical inhibition in the symptomatic group, with prolong cortical silent periods (p < 0.05) and large effects (d > 1.0), and reduced short interval intracortical inhibition (p = 0.001) compared to asymptomatic cyclists and controls. Conclusions: Cyclists reporting persistent symptoms showed greater cortical inhibition and impaired cognitive–motor performance, consistent with findings in contact sport athletes. These results suggest that repeated concussions in cycling carry risk of chronic neurophysiological alterations. Cycling disciplines should consider more rigorous concussion identification protocols and stricter management strategies to mitigate persistent and long-term consequences. Full article

Background: The UK Department for Digital, Culture, Media, and Sport (DCMS) grassroots concussion guidance, May 2023, advised that all community-based sport-related concussions (SRCs) be diagnosed by a healthcare practitioner. This may require that general practitioners (GPs) diagnose and manage SRCs. Diagnosing SRCs in primary care settings in the United Kingdom (UK) presents significant challenges, primarily due to the lack of validated tools specifically designed for general practitioners (GPs). This scoping review aims to identify diagnostic and management tools for SRCs in grassroots sports and primary care settings. Aims: To identify tools that can be used by GPs to diagnose and manage concussions in primary care, both adult and paediatric populations. Design and Methods: A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScRs). Five databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, Google Scholar) were searched from 1946 to April 2025. Search terms included “concussion”, “primary care”, and “diagnosis”. Studies that discussed SRCs in community or primary care settings were included. Those that exclusively discussed secondary care and elite sports were excluded, as well as non-English studies. Two reviewers independently screened titles, abstracts, and full texts, with a third resolving any disagreements. Data were extracted into Microsoft Excel. Studies were assessed for quality using the Joanna Briggs critical appraisal tools and AGREE II checklist. Results: Of 727 studies, 12 met the inclusion criteria. Identified tools included Sport Concussion Assessment Tool 6 (SCAT6, 10–15 min, adolescent/adults), Sport Concussion Office Assessment Tool 6 (SCOAT6, 45–60 min, multidisciplinary), the Buffalo Concussion Physical Examination (BCPE, 5–6 min, adolescent-focused), and the Brain Injury Screening Tool (BIST, 6 min, ages 8+). As part of BCPE, a separate Telehealth version was developed for remote consultations. SCAT6 and SCOAT6 are designed for healthcare professionals, including GPs, but require additional training and time beyond typical UK consultation lengths (9.2 min). BIST and BCPE show promise but require UK validation. Conclusions: SCAT6, SCOAT6, BIST, and BCPE could enhance SRC care, but their feasibility in UK primary care requires adaptation (e.g., integration with GP IT systems and alignment with NICE guidelines). Further research is required to validate these tools and assess additional training needs. Full article

Background/Objectives: Functional near-infrared spectroscopy (fNIRS) may help quantify changes in brain haemodynamics during sport-related concussions (SRCs). This study compared post-match prefrontal cortex (PFC) brain haemodynamics measured by fNIRS during the King–-Devick test (K-DT) with players suspected of having sustained an SRC. It was hypothesized that changes in the K-DT would correspond with brain haemodynamic processes. Methods: Twenty-two male and female collegiate rugby players (six males and twenty-two females; age range: 18–22) completed a baseline K-DT+fNIRS assessment. Over the course of two to three matches, all participants were invited to complete at least one post-match K-DT+fNIRS assessment. If a player was suspected of having sustained an SRC, they were re-assessed with the K-DT+fNIRS. If a participant who was not suspected of having sustained an SRC performed worse on the K-DT post-match, they were included in the participant category of ‘concussion’ for the analysis. A repeated measures ANOVA was performed. Test–retest reliability was calculated using the intra-class correlation coefficient (ICC). A Pearson correlation coefficient (r) assessed the linear relationship between the changes in the K-DT and the measurements of the left and right PFC. Results: Differences were identified in the K-DT for the players with a suspected concussive injury post-match (χ2(1) =5.0; p = 0.0253; z = −2.0; p = 0.0431; d = 0.16). There were also significant differences between the baseline and post-match results for all concussed players in the right PFC (t(8) = 250; p = 0.0371; d = 0.92) and for the concussed females in the right PFC (t(6) = 2.78; p = 0.0319; d = 0.52). There were no correlations between the K-DT and PFC values in the suspected concussed group. Conclusions: The SRC group had decreased cognitive performance and a notable change in PFC activation, while the non-concussed group showed an increase in the activation in the PFC and no change in cognitive performance scores. This represents a possible acute adjustment in brain haemodynamics and provides insight into how SRCs can negatively impact cognitive performance. Full article

Background and Objectives: Collision-sport athletes, such as rugby players, are at risk of sport-related concussion (SRC). Women are known to be at higher risk of SRC and may experience more severe and chronic symptomology than men. Knowledge of the factors that affect a player’s disclosure of their concussive symptoms could help to inform strategies to improve compliance with reporting and management of head injuries. The aim of this study was to investigate the factors that may impact women rugby players’ disclosure of a concussion. Methods: Twenty-eight adult (≥18 years of age) elite and semi-elite women rugby players from the UK and Ireland (n = 17) and the United States (n = 11) were interviewed on their playing background and SRC experience in women’s rugby via one-on-one interviews (UK and Ireland) or an online questionnaire (US). Results: SRC data were analysed inductively using a thematic analysis approach to determine the potential reasons for SRC non-disclosure in women’s rugby. Four main themes were identified which may influence a player’s SRC non-disclosure: 1. women rugby players are self-managing SRC; 2. work-related concerns impact on SRC disclosure; 3. players and support staff lack knowledge on SRC management; and 4. poor internal and external communication affect the support players receive when injured. Conclusions: The findings were consistent across players from different countries. This research highlighted several factors that may impact on women rugby players’ disclosure of SRC regardless of country of origin (UK, Ireland, or US) and access to concussion care. Coaches and management teams should be aware of these reasons, which may enhance how they discuss and manage concussion. There is a clear need for further education on concussion for players and support staff and for strategies to create environments where women can openly discuss their concussion concerns. Full article

Background/Objective: Assessing Orthostatic Intolerance (OI, symptoms upon standing from supine) is recommended in athletes with sport-related concussions (SRCs), as this is caused by impairments in the cardiovascular autonomic nervous system (cANS). Early Exercise Intolerance (Early EI, symptoms on light physical exertion) is also due to impairments in the cANS but is difficult to incorporate into outpatient clinical practice (cost of personnel, time, equipment). The purpose of this study was to determine if we could use OI to screen for Early EI, as well as understand differences between adolescents who do and do not report OI. Methods: Retrospective chart review. Adolescents with physician-diagnosed SRC performed the 2 min supine to 1 min standing OI test and the Buffalo Concussion Treadmill Test (BCTT) during their first post-SRC visit. Early EI was defined as more-than-mild symptom exacerbation at a heart rate (HR) below 135 bpm on the BCTT; OI was defined as new or increased symptoms of dizziness or lightheadedness on postural change. The sensitivity, specificity and diagnostic accuracy were calculated. Participants with and without OI were compared. Results: In total, 166 adolescents (mean 15.4 years, 58.8% male) were seen a mean of 5.5 days after injury; 48.2% had OI and 52.4% had Early EI, but there was no association between the two measures (Phi = 0.122, p = 0.115). The sensitivity and specificity (with 95% confidence intervals) for OI to screen for Early EI were 54.0% (43.5, 64.3) and 58.2% (47.2, 68.7), respectively. Adolescents with OI had a higher incidence of delayed recovery (24% vs. 9%, p = 0.012). Conclusions: Although both measures seem to be related to impaired autonomic function after SRC, OI has limited accuracy in screening for Early EI, which suggests that their etiologies may be different. Nevertheless, the assessment of OI has clinical utility in the management of SRC. Full article

Background: Quantitative pupillometry has been proposed as an objective means to diagnose acute sports-related concussion (SRC). Objective: To assess the diagnostic accuracy of a smartphone-based quantitative pupillometer in the acute diagnosis of SRC. Methods: Division I college football players had baseline pupillometry including pupillary light reflex (PLR) parameters of maximum resting diameter, minimum diameter after light stimulus, percent change in pupil diameter, latency of pupil constriction onset, mean constriction velocity, maximum constriction velocity, and mean dilation velocity using a smartphone-based app. When an SRC occurred, athletes had the smartphone pupillometry repeated as part of their concussion testing. All combinations of the seven PLR parameters were tested in machine learning binary classification models to determine the optimal combination for differentiating between non-concussed and concussed athletes. Results: 93 football athletes underwent baseline pupillometry testing. Among these athletes, 11 suffered future SRC and had pupillometry recordings repeated at the time of diagnosis. In the machine learning pupillometry analysis that used the synthetic minority oversampling technique to account for the significant class imbalance in our dataset, the best-performing model was a random forest algorithm with the combination of latency, maximum diameter, minimum diameter, mean constriction velocity, and maximum constriction velocity PLR parameters as feature inputs. This model produced 91% overall accuracy, 98% sensitivity, 84.2% specificity, area under the curve (AUC) of 0.91, and an F1 score of 91.6% in differentiating between baseline and SRC recordings. In the machine learning analysis prior to oversampling of our imbalanced dataset, the best-performing model was k-nearest neighbors using latency, maximum diameter, maximum constriction velocity, and mean dilation velocity to produce 82% accuracy, 40% sensitivity, 87% specificity, AUC of 0.64, and F1 score of 24%. Conclusions: Smartphone pupillometry in combination with machine learning may provide fast and objective SRC diagnosis in football athletes. Full article

Background/objectives: Ocular tools and technologies may be used in the diagnosis of sport-related concussions (SRCs), but their clinical utility can vary. The following study aimed to review the literature pertaining to the reliability and diagnostic accuracy of such assessments. Methods: The preferred reporting items for systematic reviews and meta-analysis (PRISMA) extension for scoping reviews was adhered to. Reference standard reliability (RSR ≥ 0.75) and diagnostic accuracy (RSDA ≥ 0.80) were implemented to aid interpretation. Results: In total, 5223 articles were screened using the PCC acronym (Population, Concept, Context) with 74 included in the final analysis. Assessments included the King-Devick (KD) (n = 34), vestibular-ocular motor screening (VOMs) and/or near point of convergence (NPC) (n = 25), and various alternative tools and technologies (n = 20). The KD met RSR, but RSDA beyond amateur sport was limited. NPC met RSR but did not have RSDA to identify SRCs. The VOMs had conflicting RSR for total score and did not meet RSR in its individual tests. The VOMs total score did perform well in RSDA for SRCs. No alternative tool or technology met both RSR and RSDA. Conclusion: Ocular tools are useful, rapid screening tools but should remain within a multi-modal assessment for SRCs at this time. Full article

This study aimed to clarify the differences between the previously reported mechanisms of sports-related concussion (SRC) injuries without a loss of consciousness in contact and collision sports and the mechanisms of SRC injuries in our cases. Based on two videos of SRC injuries occurring during a men’s rhythmic gymnastics competition (three people were injured), the risk of SRC occurrence was estimated from various parameters using a multibody analysis and eight brain injury evaluation criteria. In the present study, the three SRC impacts that occurred in men’s rhythmic gymnastics showed significant characteristics in duration compared to previously reported cases in the contact sports. This suggests that the occurrence of SRC may have been caused by a different type of impact from that which causes SRC in contact sports (e.g., tackling). In addition, calculation of the strain indicating the rate of brain deformation suggested a risk of nerve swelling in all cases involving type 2 axonal injuries. Therefore, when reexamining sports-related head injuries, it is important to recognize the characteristics and mechanisms of SRC that occur in each different sport, as well as the symptoms and course of SRC after injury. Full article

In recent years, sports-related concussion (SRC) in soccer has been extensively researched worldwide. However, there have been no reports of large-scale SRC studies among soccer players in Japan. The purpose of this study is to investigate the epidemiology of SRC among university soccer players in Japan. This descriptive epidemiological study collected data on the history of SRC and details of SRC injuries during soccer. The participants were university male soccer players belonging to the Japan University Football Association. SRC rates were calculated per 1000 athlete-exposures (AEs). A total of 5953 students participated in this study. The SRC rate was 0.10/1000 AE during total activities. The SRC rate during competition (0.42/1000 AE) was higher than in practice (0.04/1000 AE). The most frequent mechanism of SRC was “head-to-head” (26.9%), followed by “head-to-ball” (24.2%). During competition, the most frequent mechanism was “head-to-head” (30.8%), followed by “head-to-ground” (23.8%), and “head-to-ball” (19.3%) followed, while in practice, it was “head-to-ball” (34.8%), followed by “head-to-ground” (23.8%), and “head-to-head” (17.2%). Thus, there was a difference in the mechanism of injury between competition and practice. In this study, among Japanese university soccer players, the SRC rate was to be approximately ten times higher in competition than in practice. Full article

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

This study aimed to investigate the significance of baseline measurements for amateur team athletes playing contact and collision team sports with a specific focus on the Sports Concussion Assessment Tool (SCAT) to improve concussion management. Symptoms of sports-related concussions (SRCs) can be diverse and long-lasting and include cognitive impairment, sleep disturbances, and vestibular dysfunction. Therefore, comprehensive baseline data are essential to preventing recurrent concussions and secondary injuries. This study was conducted during the 2023 off-season and evaluated the baseline condition of 65 male university rugby players using the SCAT5, which includes self-reported symptoms, and the modified Balance Error Scoring System (mBESS). The athletes were assessed for the presence or absence of SRC, and the mean values were compared using the Mann–Whitney U test. Among the participants, 35.38% (23/65) reported symptoms, with an average of 1.5 ± 2.8 symptoms per player and an average symptom score of 2.66 ± 5.93. In the mBESS, no errors were observed in the tandem stance test; however, 72.31% (47/65) made errors in the single-leg stance test on the non-dominant foot, with an average of 1.7 ± 1.5 errors. Many athletes self-reported symptoms and balance errors, even during asymptomatic periods before experiencing concussion, indicating unresolved issues. In the injury history survey, the baseline evaluations and injury histories of the participants classified into the SRC and non-SRC groups were compared. In the mBESS single-leg stance test (non-dominant foot), 84.21% (32/38) of the SRC group participants made errors, with an average score of 2.13 ± 1.52, whereas 55.55% (15/27) of the non-SRC group participants made errors, with an average score of 1.15 ± 1.35, showing a significant difference (p = 0.007). Additionally, significant differences were observed in the average number of ankle sprains (p = 0.027) and fractures (p = 0.048) between patients with and without a history of SRC. These findings indicate that athletes may have underlying issues even during normal periods before concussion. Moreover, the results highlighted the impact of previous concussions on motor control and injury risk. This underscores the importance of preseason baseline measurements using the SCAT to identify at-risk athletes and implement preventive measures. These findings align with the recommendations of the 6th International Conference on Concussion in Sport and suggest further refinement of concussion assessment tools. Full article