The best way to decrease the burden of concussion is to prevent the injury before it occurs (ie, through primary prevention). Self-reported injury history and lower limb function as risk factors for injuries in female youth soccer. A preliminary study, Predictors of clinical recovery from concussion: a systematic review, Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients, A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache, Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test, GH and pituitary hormone alterations after traumatic brain injury, Epidemiology of football injuries in the National Collegiate Athletic Association, 2004–2005 to 2008–2009, Concussion symptoms and return to play time in youth, high school, and college American football athletes, Dual-task assessment protocols in concussion assessment: a systematic literature review, Noninvasive brain stimulation for persistent postconcussion symptoms in mild traumatic brain injury, Sensorimotor function and dizziness in neck pain: implications for assessment and management, Aerobic exercise for adolescents with prolonged symptoms after mild traumatic brain injury: an exploratory randomized clinical trial, Neuroendocrine dysfunction in a young athlete with concussion: a case report, Pain and sleep in post-concussion/mild traumatic brain injury, Brain or strain? This paper presents a dynamic forward-looking multi-regional general equilibrium model developed at the Joint Program on the Science and Policy of Global Change of the Massachusetts Institute of Technology (MIT) and applies it in comparison with the latest version of the recursive-dynamic MIT Emissions Prediction and Policy Analysis (EPPA) model. When feasible, future studies on sport injury prevention should adopt a methodology and analysis strategy that takes the cyclic nature of changing risk factors into account to create a dynamic, recursive picture of etiology. For example, BPPV may occur in approximately 5% of cases of ongoing dizziness following concussion.2,106 Suspect BPPV when the patient describes seconds of vertigo with positional changes (eg, lying down/getting up, rolling in bed, looking up, bending over).8 For BPPV to be diagnosed, a positive Dix-Hallpike test with seconds of vertigo and a characteristic pattern of nystagmus should be present.8 Canalith repositioning maneuvers (eg, the Epley maneuver) are effective for treating BPPV (up to 98% of cases resolve within 3 treatments).8,75, In up to 10% to 26% of cases of ongoing dizziness following concussion, assessment findings suggest peripheral vestibular hypofunction (ie, decreased vestibular labyrinth function).11,12 Suspect a peripheral vestibular problem in patients who report intense dizziness and unsteadiness following the concussion, followed by a gradual improvement of symptoms over the initial few weeks. A widely referenced model in the area of sport injury research has proposed that multiple factors influence the etiology of sport injury.88 Various etiological factors can vary over time and change the risk that is associated with injury.88 The literature in the area of concussion is evolving and, as such, enables adaptation of this model to better understand the etiology of concussion. This article applies the dynamic, recursive model of sport injury to sport-related concussion and summarizes the process of individualized assessment and management following concussion in athletes of all ages, with a focus on physical rehabilitation. Investigation of antihypothalamus and antipituitary antibodies in amateur boxers: is chronic repetitive head trauma-induced pituitary dysfunction associated with autoimmunity? Neuroendocrine dysfunction, caused by injury to the hypothalamic-pituitary axis following mild to severe traumatic brain injury5,6,90,114 and sport-related concussion,72,113,114,116 has been reported. 2008 Mar;40(3):444-50. doi: 10.1249/MSS.0b013e31815ce61a. doi: 10.1016/j.csm.2007.10.008. Current uses in sports ii. A systematic review, Head Injury in Soccer: From Science to the Field; summary of the head injury summit held in April 2017 in New York City, New York, Sleep quantity and quality during acute concussion: a pilot study, Cervicocephalic kinesthetic sensibility in patients with cervical pain, Trigger point injections for headache disorders: expert consensus methodology and narrative review, Association of returning to work with better health in working-aged adults: a systematic review, Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline, Are clinical measures of cervical spine strength and cervical flexor endurance risk factors for concussion in elite youth ice hockey players? Neurological examination, assessment of vestibulo-ocular reflex function, static balance, dynamic balance, assessment of nystagmus with and without fixation, positional testing, and vestibular function testing can inform diagnosis and management. Anderson DS, Cathcart J, Wilson I, Hides J, Leung F, Kerr D. BMJ Open Sport Exerc Med. In elite rugby, the majority of concussions occur to the tackler, and the risk of concussion increases when the tackler accelerates, travels at a high speed, and has head contact.20. ELECTRONIC Use case 1: Survival analysis a. Sports injury incidence should preferably be expressed as the number of sports injuries per exposure time (e.g. Med Sci Sports Exerc. . This article applies the dynamic, recursive model of sport injury to sport-related concussion and summarizes The questions - how do I get better and how do I stay healthy - are part a dynamic and constantly changing system. Assessment of the cervical spine should include range of motion, manual spinal exam, general strength, and cervical sensorimotor and neuromotor control.61,118,120 The clinical tests that have established utility in the cervical spine literature, including joint position sense, cervical movement control, the craniocervical flexion test, cervical flexor and extensor endurance, the cervical flexion-rotation test, and manual spinal exam, may be useful in identifying potential areas of dysfunction in concussion.53,55,61,97,106,107,119. doi: 10.1136/bmjsem-2020-000806. Return to participation in sport should occur along a continuum, with respect to the individual's risk of concussion and the characteristics of the environment to which the person is returning. doi:10.2519/jospt.2019.8926, Sport-related concussion is among the most frequently reported injuries in sport and recreation.80 A sport-related concussion is “a traumatic brain injury induced by biomechanical forces.”84 Symptoms and signs that occur following a concussion are believed to represent a functional rather than structural injury, as structural neuroimaging studies do not detect abnormalities.84 Recovery can occur in the initial days to weeks for most adults, but up to one third of children and youth may take longer than 4 weeks to recover.108,127. Evidence for cognitive remediation following concussion is very limited. Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment Journal of Orthopaedic & Sports Physical Therapy, Vol. Dizziness symptoms can be vertigo (ie, sensation of spinning of the environment or the person), light-headedness, presyncope, or a sense of disorientation. Consider occupation-specific activities (eg, cognitive and physical demands, safety requirements) in any return-to-work recommendations.15,91 Positive health outcomes have been reported with return to work or staying at work.99 However, reintroduction of risk and timing in the early recovery period must be carefully monitored.91. In addition, decisions regarding return to sport may be affected by the intrinsic and extrinsic factors that characterize the individual athlete. A Dynamic Model of Etiology in Sport Injury: The Recursive Nature of Risk and Causation: Clinical Journal of Sport Medicine 17, 215–219 (2007). When the 2 injuries occur concurrently, they must be treated appropriately. The purpose of this manuscript is to outline a new model representing a dynamic approach that incorporates the consequences of repeated participation in sport, both with and without injury. In these cases, the athlete continues to play, and ongoing adaptation and changes in the set of risk factors to which the athlete is exposed may occur, resulting in higher or lower concussion risk. A special edition from JOSPT, focusing on concussion, has published Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment (Schneider et al) Every step, competition or practice is an exposure that impacts the body. Sometimes, cognitive symptoms persist and may be associated with ongoing difficulties with school and with occupational, sport, and social activities.86 Cognitive symptoms often occur in the presence of other symptoms, such as pain, headaches, difficulties with vision, and sleep problems.87 Referral to a neuropsychologist may be warranted for a thorough assessment to clarify the etiology of the cognitive complaints and to assist in developing an individualized management plan. The initial management of concussion involves both cognitive and physical rest for the first 24 to 48 hours following injury.84,103 After this time, gradually and progressively increase activities of daily living, as long as symptoms do not increase.84,103 Once concussion-related symptoms have resolved with typical activities, gradually resume physical and cognitive activities (FIGURE 2). Get the latest public health information from CDC: https://www.coronavirus.gov. Cognitive behavioral therapy may be beneficial for insomnia.36 Melatonin may have benefits for sleep following concussion, but is not currently recommended for sleep onset or maintenance problems.100 In the presence of ongoing sleep difficulties, refer to a sleep specialist to further investigate potential underlying causes. In this section, we summarize the key intrinsic and extrinsic risk factors for concussion. Stage of the return to sport models In order to explain the psychological stages of the rehabilitation, stage models provide a succession of emotions and attitudes occurring following sport injury. Farley JB, Barrett LM, Keogh JWL, Woods CT, Milne N. Sports Med Open. A systematic review, Risk of injury associated with body checking among youth ice hockey players, Injury rates, risk factors, and mechanisms of injury in minor hockey, Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice, What domains of clinical function should be assessed after sport-related concussion? National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Epidemiology of injury in child and adolescent sports: injury rates, risk factors, and prevention. The return-to-sport strategy includes 6 steps: (1) symptom-limited activity, (2) light aerobic exercise, (3) sport-specific exercise, (4) noncontact training drills, (5) full-contact practice, and (6) return to sport (FIGURE 3).29,84 Medical clearance to return to sport occurs once the individual is able to complete the return-to-sport protocol with no symptom exacerbation and when no other clinical assessment findings suggest ongoing problems that would preclude returning to sport.84, Return-to-work recommendations are based on similar principles as those of return to school and return to sport.91 Gradually and progressively increase activities, provided there is no increase in symptoms. The office (off-field) assessment portion of the SCAT5 includes history, symptoms, cognitive screening (from the Standardized Assessment of Concussion, which includes orientation, immediate and delayed memory questions, and digits and months of the year in reverse order), a neurological screen (including reading, cervical spine range of motion, ocular motor function, coordination, and balance), and a modified version of the Balance Error Scoring System.29 The Child Sport Concussion Assessment Tool Fifth Edition should be used with children aged 5 to 12 years.21, The clinical utility of the SCAT5 diminishes after the initial 3 to 5 days following injury.84 However, the symptom scale on the SCAT5 can be used to evaluate change in symptoms over time. If symptoms persist following the initial days to weeks following injury, a multifaceted assessment to identify areas that may require rehabilitation is warranted.37,65,78,103 Refer the patient for additional assessment and rehabilitation if the individual has not recovered in the 10 to 14 days following injury. 49, No. the context of sport (both in the presence and absence of injury) that alter risk and affect etiology in a dynamic, recursive fashion. Epub 2008 Jan 28. HHS If an injury does occur, withdrawal from further the basis of the interaction of the event attributes and pre-exposure may be the result; more often, recovery will facilitate existing risks. Symptoms alone do not distinguish physiologic concussion from cervical/vestibular injury, Exercise treatment for postconcussion syndrome: a pilot study of changes in functional magnetic resonance imaging activation, physiology, and symptoms, A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome, Regulatory and autoregulatory physiological dysfunction as a primary characteristic of post concussion syndrome: implications for treatment, rTMS in alleviating mild TBI related headaches — a case series, Left dorsolateral prefrontal cortex rTMS in alleviating MTBI related headaches and depressive symptoms, Trends in concussion incidence in high school sports: a prospective 11-year study, Utility of serum IGF-1 for diagnosis of growth hormone deficiency following traumatic brain injury and sport-related concussion, Posttraumatic headache: clinical characterization and management, A prospective study of prevalence and characterization of headache following mild traumatic brain injury, Variables affecting treatment in benign paroxysmal positional vertigo, Impact of mandatory helmet legislation on bicycle-related head injuries in children: a population-based study, Factors affecting time to recovery from sports concussion [abstract], Approach to investigation and treatment of persistent symptoms following sport-related concussion: a systematic review, Epidemiology of concussions among United States high school athletes in 20 sports, Epidemiology of sports-related concussion in seven US high school and collegiate sports, Vision and vestibular system dysfunction predicts prolonged concussion recovery in children, Prevalence of sleep disturbances, disorders, and problems following traumatic brain injury: a meta-analysis, Collaborative care for adolescents with persistent postconcussive symptoms: a randomized trial, Consensus statement on concussion in sport—the 5, Vestibular and oculomotor assessments may increase accuracy of subacute concussion assessment, Mild traumatic brain injury (mTBI) and chronic cognitive impairment: a scoping review, Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective TRACK-TBI study, A dynamic model of etiology in sport injury: the recursive nature of risk and causation, A brief Vestibular/Ocular Motor Screening (VOMS) assessment to evaluate concussions: preliminary findings, Abnormalities of pituitary function after traumatic brain injury in children, Insomnia in patients with traumatic brain injury: frequency, characteristics, and risk factors, The incidence of concussion in youth sports: a systematic review and meta-analysis, What factors must be considered in ‘return to school’ following concussion and what strategies or accommodations should be followed? ↑ Alonso JM, Junge A, Renstrom P, Engebretsen L, Mountjoy M, Dvorak J. Address correspondence to Dr Kathryn J. Schneider, Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4. The relationship between physical fitness attributes and sports injury in female, team ball sport players: a systematic review. The Journal of Sport Rehabilitation (JSR) is your source for the latest peer-reviewed research in the field of sport rehabilitation.All members of the sports-medicine team will benefit from the wealth of important information in each issue. The Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary is one of eleven International Research Centres supported by the International Olympic Committee for Prevention of Injury and Protection of Athlete Health. Keywords: Dynamic systems in team sports , prototypical configuration of play , matrix of play , team sport … Return to school and return-to-sport strategies can occur simultaneously.84 Each step of the return-to-school and return-to-sport protocols should take a minimum of 24 hours. Pessimistic Inter-pretation. Jetelina KK, Beauchamp AM, Reingle Gonzalez JM, Molsberry RJ, Bishopp SA, Lee SC. Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment, Risk factors for sports concussion: an evidence-based systematic review, Vestibular rehabilitation for dizziness and balance disorders after concussion, Exercise prescription patterns in patients treated with vestibular rehabilitation after concussion, Immediate removal from activity after sport-related concussion is associated with shorter clinical recovery and less severe symptoms in collegiate student-athletes, Hypopituitarism in pediatric survivors of inflicted traumatic brain injury, Pituitary dysfunction after blast traumatic brain injury: the UK BIOSAP study, A prospective study of concussions among National Hockey League players during regular season games: the NHL-NHLPA Concussion Program, Clinical practice guideline: benign paroxysmal positional vertigo (update), Physical activity and concussion risk in youth ice hockey players: pooled prospective injury surveillance cohorts from Canada, Risk factors associated with sustaining a sport-related concussion: an initial synthesis study of 12,320 student-athletes, Vestibular rehabilitation for unilateral peripheral vestibular dysfunction, Peripheral vestibular disorders in children and adolescents with concussion, National Institute of Neurological Disorders and Stroke and Department of Defense Sport-Related Concussion Common Data Elements version 1.0 recommendations, Football players' head-impact exposure after limiting of full-contact practices, Systematic review of return to work after mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis, The epidemiology of new versus recurrent sports concussions among high school athletes, 2005–2010, Prevalence and consequences of sleep disorders in traumatic brain injury, An exploratory study of the potential effects of vision training on concussion incidence in football, Neck strength: a protective factor reducing risk for concussion in high school sports, Tackling concussion in professional rugby union: a case–control study of tackle-based risk factors and recommendations for primary prevention, The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5): background and rationale, Descriptive epidemiology of collegiate men's football injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 through 2003–2004. Clin Sports Med. In addition to a thorough history, targeted assessment tests help clinicians to understand the source of dizziness. a dynamic model that accounts for the multifactorial nature of sports injuries, and in addition, takes the sequence of events eventually leading to an injury into account. 2020 Jul 20;20(1):1137. doi: 10.1186/s12889-020-09219-x. Use standardized tools when screening for mood and mental health problems.13, Up to 1 in 2 individuals with concussion report sleep problems (insomnia, difficulty falling asleep, difficulty staying asleep).17,82 In the early postinjury phase, individuals may be more fatigued than normal and require more sleep.96 Individuals with pain may also require more sleep.64,112 Addressing sleep difficulties is important to improve recovery.92. This type of difficulty has been termed physiological postconcussion syndrome and has been hypothesized to occur secondary to autonomic nervous system involvement.67,68 For individuals who report difficulty with exertion, the Buffalo Concussion Treadmill Test is a widely used clinical test (based on the Balke test) that progressively increases the level of physical activity by increasing the incline and then speed of a treadmill.67 The test is stopped when symptoms increase (termed the symptom threshold and defined as at least a 2-point increase in symptom severity on a 0-to-10 rating scale) or when the individual reaches voluntary exhaustion. A multifaceted assessment for each patient should include postconcussive symptom reports; a neurological screen; assessment of cervical spine, vestibular, visual, and exertion-related symptoms; plus sleep, mood, cognitive, and related domains. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. 17, 215–219. 11 Unsteadiness or imbalance may also be reported (suggesting difficulty with maintaining an upright position in space, possibly related to dysfunction of vestibulospinal function, proprioception, vision, or other systems that contribute to upright balance) and should be assessed. For instance, the skills required of a volleyball player will differ from those expected of an ice hockey player. Following concussion, it is necessary to recognize and remove the player from additional risk and refer the player to appropriate medical management as early as possible.28,84 Trauma followed by observable signs or symptoms of concussion should trigger an assessment to screen for concussion.28,84 A multifaceted assessment can inform appropriate management.37,78,84,102 Once the player has recovered and received clearance to return to play, the player may re-enter the dynamic process of adapting through recurrent participation. [abstract], Sport-related concussion: optimizing treatment through evidence-informed practice, Rest and treatment/rehabilitation following sport-related concussion: a systematic review, Cervicovestibular rehabilitation following sport-related concussion [letter], Preseason reports of neck pain, dizziness, and headache as risk factors for concussion in male youth ice hockey players, Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial, Changes in measures of cervical spine function, vestibulo-ocular reflex, dynamic balance, and divided attention following sport-related concussion in elite youth ice hockey players, Concussion burden, recovery, and risk factors in elite youth ice hockey players, Prevalence of and risk factors for anxiety and depressive disorders after traumatic brain injury: a systematic review, Near point of convergence after concussion in children, Vestibular rehabilitation is associated with visuovestibular improvement in pediatric concussion, Individuals with pain need more sleep in the early stage of mild traumatic brain injury. Knowledge of modifiable risk factors helps to efficiently direct injury prevention efforts, and knowledge of nonmodifiable risk factors helps the clinician achieve an understanding of the overall risk to the athlete and informs return-to-play decision making. Evidence has shown that physical factors such as over-training, equipment and playing conditions are the major contributors towards an athlete’s injuries. ELECTRONIC 2008 Jun;42(6):413-21. doi: 10.1136/bjsm.2008.046631. Identifying these factors is part of an individualized, patient-centered approach to prevention, assessment, and management of concussion. In youth rugby players, there was a reduction in overall risk of game-related concussion when a neuromuscular training program was performed at least 3 times weekly.49 A vision training program may reduce the risk of concussion in collegiate football players.18 There was a 67% reduction in the risk of concussion in youth ice hockey following rule changes to disallow bodychecking.32 Tackle training and rules related to tackling in rugby as a way of decreasing risk of concussion are areas of ongoing evaluation.47 Finally, restricting the number of collision practices in youth football may reduce the frequency of head impacts in games and practice.14. the context of sport (both in the presence and absence of injury) that alter risk and affect etiology in a dynamic, recursive fashion. When symptoms persist for longer than 7 to 10 days, a multifaceted interdisciplinary assessment to guide treatment is recommended. Sport-specific and performance-related skills may be necessary to return to full participation. Cognitive symptoms can include difficulties remembering and concentrating, slowed processing, decreased attention, and difficulty with learning.58,86 Cognitive symptoms often resolve over the initial days to weeks following injury. Steffen K, Myklebust G, Andersen TE, Holme I, Bahr R. Am J Sports Med. Ericsson, K. A. Pre-injury factors lead to post-injury responses Dynamic Core of Model: Cognitive appraisals, emotional responses, behavioral responses, recovery outcomes. Injury, rehabilitation and psychology Written by Jack Marlow. Introduction. Clipboard, Search History, and several other advanced features are temporarily unavailable. Understanding the impact that these factors may have on assessment, management, and return to activity/sport helps to ensure a well-balanced and evidence-informed approach to care. Front Psychol. Epub 2008 Apr 7. 2020 Oct 28;6(1):e000806. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. A dynamic model of etiology in sports injury: the recursive nature of risk and causation . Growth hormone is the most commonly affected hormone following concussion.56,63,114,115 Individuals with symptoms consistent with alteration in sex hormones, hypothyroidism, adrenal dysfunction, diabetes insipidus, syndrome of inappropriate antidiuretic hormone secretion, or growth hormone deficiency (fatigue, disrupted sleep patterns, and cognitive difficulties) should be investigated for hypothalamic-pituitary axis dysfunction.114, People with more, and more severe, acute and subacute symptoms take longer to recover following concussion.52 Adolescent age, female sex, the presence of a migraine history, and pre-existing mental health problems are predictors of slower recovery.52 Many other factors (eg, previous history of concussion, preschool age, race, genetics) have been evaluated as potential predictors of longer recovery, with mixed results.52 Attention deficit hyperactivity disorder and learning disabilities are unlikely to be risk factors for prolonged recovery.52 Among youths 5 to 18 years of age who presented to an emergency department, female sex, older than 13 years of age, migraine history, previous concussion with symptoms for greater than 1 week, sensitivity to noise, fatigue, headache, parent reporting that the child answers questions slowly, and more than 3 errors on the Balance Error Scoring System-tandem stance were predictors of longer recovery.127 Children with visual, vestibular, and cervical spine findings also recover more slowly.30,81, After an initial 24 to 48 hours of cognitive and physical rest,84,103 initiate a strategy of gradual return to school and sport.84 If symptoms persist beyond 7 to 10 days following injury, targeted treatment may be warranted.84,103 Rehabilitation following concussion should be informed by a multifaceted, interdisciplinary assessment aimed at identifying underlying sources of ongoing symptoms.78,103, In the presence of headache, differential diagnosis of headache type is imperative to inform management. Lower limb MSK injuries among school-aged rugby and football players: a systematic review. Survival analysis i. Many individuals who have suffered a concussion may report difficulty with reading at school, work, or during screen time (eg, computers, smartphones, tablets). Headaches are the most frequent symptom following concussion. Enter your email address below and we will send you the reset instructions, If the address matches an existing account you will receive an email with instructions to reset your password, Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. In youth athletes, growth and development may result in changes in performance and adaptations. Treatment may be more effective when initiated early in the recovery process.104 However, further research is warranted to identify the ideal timing and type of intervention. If symptoms recur, then the athlete should move back to the previous step. @article{Meeuwisse2007ADM, title={A dynamic model of etiology in sport injury: the recursive nature of risk and causation. During sport, athletes are exposed to different events in which no concussion or injury occurs. As concussions differ so widely, an awareness of risk factors and individual clinical characteristics can facilitate an individualized approach.  |  To address this issue, Meeuwisse et al9 developed a dynamic, recursive model for risk and causes of sports injuries, considering that the injury has a non-linear behavior. Exercise may facilitate recovery following concussion.40,66,67 Two different paradigms of exercise have demonstrated benefit for symptoms and function: (1) subsymptom aerobic exercise training at 80% of the maximal heart rate that was achieved on the Buffalo Concussion Treadmill Test, 5 days per week67; and (2) exercising at 60% of maximal heart rate (calculated as 220 − age × 60%) for up to 15 minutes, combined with guided imagery and sport-specific coordination exercises.39,40 However, some studies have reported an increase in symptoms with exercise in children and youth, and others have reported no change.77,103 Given the known general positive benefits of exercise, consideration of aerobic exercise training following the initial return to activity after concussion is warranted in the absence of contraindications to exercise.103. Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment Journal of Orthopaedic&Sports Physical Therapy, Ahead of Print. 34, No. A Dynamic Model of Etiology in Sport Injury: The Recursive Nature of Risk and Causation: Clinical Journal of Sport Medicine 17, 215–219 (2007). Regardless of the type of injury, it is often preceded by a chain of shifting circumstances that, when they come together, constitute sufficient cause to result in an injury. Types of models c. Dataset i. Exploratory analysis d. Analysis e. Results f. Summary and exercises 6. A systematic review, Detecting gait abnormalities after concussion or mild traumatic brain injury: a systematic review of single-task, dual-task, and complex gait, Active rehabilitation for children who are slow to recover following sport-related concussion, A pilot study of active rehabilitation for adolescents who are slow to recover from sport-related concussion, Helmet fit assessment and concussion risk in youth ice hockey players ages 11–18 years [abstract], Attention problems as a risk factor for concussion in youth ice-hockey players [abstract], Concussions among United States high school and collegiate athletes, Inadequate helmet fit increases concussion severity in American high school football players, Vestibular rehabilitation for peripheral vestibular hypofunction: an evidence-based clinical practice guideline, The International Classification of Headache Disorders, 3rd edition, Contact technique and concussions in the South African under-18 Coca-Cola Craven Week Rugby tournament, Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial, Mild traumatic brain injury among a cohort of rugby union players: predictors of time to injury, Is there a relationship between whiplash-associated disorders and concussion in hockey? Sociodemographic predictors of sport injury in adolescents. Recursive Models of Dynamic Linear Economies Lars Hansen University of Chicago Thomas J. Sargent New York University and ... agent model. AN LNTEGRATED MODEL OF RESPONSE TO SPORT INJURY 49 Figure I. process. cancer mortality). The Journal of Sport Rehabilitation (JSR) is your source for the latest peer-reviewed research in the field of sport rehabilitation.All members of the sports-medicine team will benefit from the wealth of important information in each issue. A DYNAMIC, RECURSIVE MODEL OF SPORT INJURY In a real life sporting environment, a participant’s risks are dynamic and can change frequently. as well as cognitive, emotional.  |  Injury surveillance in multi-sport events: the International Olympic Committee approach. Further grief criticisms centre on the absence of denial in much of the research to date. Each individual can present with a unique set of symptoms and aggravating or relieving factors following concussion.84 Individualized assessments are imperative to best understand the etiology of symptoms.37,78,102,106 A multifaceted, interdisciplinary approach to assessment and management is vital. Irritability, sadness, anxiety, and feeling more emotional than normal are often reported following concussion, although they may not be acute.58 The psychological response to concussion may be similar to that to musculoskeletal injury, and improves over time.121 Some adults may have generalized anxiety disorder, panic attacks, and posttraumatic stress disorder following injury, which may reflect a new diagnosis or an exacerbation of a previous condition.128 Anxiety and depression are more common in women than in men, and may predict a longer recovery.52,109 Ongoing psychological or psychiatric problems are rare in children and youth without preinjury problems.31 Management of mental health problems will depend on the specific diagnosis (eg, pharmacological or psychological treatment). This site needs JavaScript to work properly. In other cases, findings suggest that central vestibular involvement may be present. Studies in basketball, hockey, and rugby have suggested a protective effect of mouthguards on concussion risk; however, a meta-analysis found no significant effect.32 In American youth football, appropriate helmet fit was associated with lower symptom severity and shorter duration of symptoms.44 In ice hockey, appropriate helmet fit may protect against concussion, although further research is needed.41 Studies examining the use of headgear in rugby and soccer are inconclusive.32,95 Further research is needed to better understand the role of protective equipment by sport. A systematic review, The Concussion Recognition Tool 5th Edition (CRT5): background and rationale, The Sport Concussion Assessment Tool 5th Edition (SCAT5): background and rationale, Cervical spine dysfunction following pediatric sports-related head trauma, A systematic review of psychiatric, psychological, and behavioural outcomes following mild traumatic brain injury in children and adolescents, What strategies can be used to effectively reduce the risk of concussion in sport? (2016) propose a complex, albeit theoretical, model for injury etiology. It is important for sports professionals to know why certain athletes may be at risk of injury risk factors and how injuries occur (i… Thus, consideration of sport-specific skills should be an integral part of a rehabilitation program. Previous history of concussion is a risk factor for future concussion.1 The exact mechanism by which this occurs is not yet well understood and may be related to genetics, epigenetics, sensorimotor or neuromuscular control, and other factors. This model considers the implications of repeated exposure, whether such exposure produces adaptation, maladaptation, injury or complete/incomplete recovery from injury. In the presence of ongoing cervical spine findings, further interventional procedures, such as comparative controlled medial branch blocks (to confirm facet joint–mediated pain), trigger point injections (in the presence of ongoing myofascial pain), and greater occipital nerve blockades (in the presence of greater occipital neuralgia), may be considered.26,98, Dizziness is typically the second most common symptom following concussion.7 As with headache, identifying the source of dizziness is important to direct treatment—some disorders respond well to physical therapy (eg, benign paroxysmal positional vertigo [BPPV], unilateral peripheral vestibular hypofunction), while others require medical evaluation and management (eg, superior semicircular canal dehiscence).2,45,48. In some cases, targeted rehabilitation (eg, vestibular rehabilitation, cervical spine rehabilitation, subsymptom threshold aerobic exercise) is warranted.106 In other cases, further medical investigations, referral to additional interdisciplinary health care professionals, or referral for interdisciplinary care may be required (FIGURE 4). The article then focuses on the dynamic core of the integrated response to sport injury and rehabilitation model. 49, No. A dynamic, recursive model of etiology in sport injury. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. In most cases, the symptoms of concussion resolve in the initial few days following the injury, and a strategy involving a gradual return to sport and school is recommended. The purpose of this manuscript is to outline a new model representing a dynamic approach that incorporates the consequences of repeated participation in sport, both with and without injury. An integrated model is illustrated which provides a synthesis of existing conceptual models depicting the dynamic process of psychological response to sport injury. This integrated model encompasses personal and situational moderating factors. Sports injuries surveillance during the 2007 IAAF World Athletics Championships. 49, No. The return-to-school protocol includes 4 steps: (1) daily activities that do not provoke symptoms, (2) school activities outside of school, (3) part-time return to school, and (4) full-time return to school (FIGURE 3).29,84 To facilitate return to school, a medical letter including recommendations for individual accommodations is recommended.94 Accommodations at school may include reduced hours at school, more time to complete assignments and examinations, frequent breaks, reduced screen time, and working in a quiet area.21 Return to school should occur before return to contact activity or full competition. Diagnosis directs appropriate management. Discussion among the health care team and with the individual and his or her family can facilitate appropriate return-to-sport and return-to-school decisions. In part 2, we address concussion assessment and management. The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Clin J Sport Med. A posttraumatic headache (1) is a secondary headache that can be attributed to the injury when a new headache occurs following trauma, and (2) must occur within the initial 7 days after the trauma.46 If a preinjury headache worsens or becomes persistent, the primary headache diagnosis, in addition to the posttraumatic diagnosis as described above, is to be used.46 Headache diagnoses following concussion might also include medication overuse headache, migraine headache (with or without aura), tension-type headache, cervicogenic headache, occipital neuralgia, and mixed headache type.73,74,126. COVID-19 is an emerging, rapidly evolving situation. Ericsson, K. A. A dynamic model of etiology in sport injury: the recursive nature of risk and causation Clin J Sport Med, 17 (3) (2007), pp. Moreover, one expo-sure to a potential inciting event can alter an athlete’s intrinsic risk factors and change their predisposition to injury. Criticisms focus on the lack of research supporting a uniformed sequence of stages as a feature of response to athletic injury. Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment Journal of Orthopaedic & Sports Physical Therapy, Vol. Integrated Model of Psychological Responses to Sport Injury. Symptom onset can be delayed, with the duration of the delay predicting a longer time to recovery following injury. Symptoms are often provoked with rapid head motions, and blurred vision may be reported in association with head movement (suggesting altered vestibulo-ocular reflex dysfunction). van Winden D, van Rijn RM, Savelsbergh GJP, Oudejans RRD, Stubbe JH. An integrated model is illustrated which provides a syn- thesis of existing conceptual models depicting the dynamic process of psycholog- ical response to sport injury. 11 Injury, Illness, and Training Load in a Professional Contemporary Dance Company: A Prospective Study.  |  A special edition from JOSPT, focusing on concussion, has published Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment (Schneider et al) Clinicians should use a multifaceted assessment that includes symptoms, a neurological screen, and assessment of multiple clinical domains.27,37 The Sport Concussion Assessment Tool Fifth Edition (SCAT5)29 includes an immediate/on-field assessment that incorporates red flags, observable signs, memory assessment (ie, the Maddocks questions), the Glasgow Coma Scale, and a cervical spine assessment. This model builds on the previous work, while emphasizing the fact that adaptations occur within the context of sport (both in the presence and absence of injury) that alter risk and affect etiology in a dynamic, recursive fashion. One frequently referenced models of injury prevention is the van Mechelen model.122 In this model, understanding the overall burden of injury in the population and identifying risk factors inform interventions aimed at injury prevention. Regardless of the type of injury, it is often preceded by a chain of shifting circumstances that, when they come together, constitute sufficient cause to result in an injury. and behavioral responses of athletes to sport injury. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. J. 2008 Apr;36(4):700-8. doi: 10.1177/0363546507311598. Risk behaviors in high school and college sport. cancer mortality). Contact and collision sports, such as rugby, American football, and ice hockey, have the highest reported incidence of concussion.93 In youth ice hockey leagues where bodychecking is permitted, there is nearly a 4-fold increase in risk of concussion in the 11- to 12-year age group (Pee Wee).33 Game play has greater concussion risk than practice.1,22,57. Cumulative, high-stress calls impacting adverse events among law enforcement and the public. Pituitary dysfunction after traumatic brain injury: a clinical and pathophysiological approach, Hypopituitarism due to sports related head trauma and the effects of growth hormone replacement in retired amateur boxers, Pituitary function in subjects with mild traumatic brain injury: a review of literature and proposal of a screening strategy, Gender differences in head–neck segment dynamic stabilization during head acceleration, Dizziness, unsteadiness, visual disturbances, and sensorimotor control in traumatic neck pain, Comparison of sensorimotor disturbance between subjects with persistent whiplash-associated disorder and subjects with vestibular pathology associated with acoustic neuroma, Balance, dizziness and proprioception in patients with chronic whiplash associated disorders complaining of dizziness: a prospective randomized study comparing three exercise programs, Comparison of psychological response between concussion and musculoskeletal injury in collegiate athletes, Incidence, severity, aetiology and prevention of sports injuries. A Control Problem. Regardless of the type of injury, it is often preceded by a chain of shifting circumstances that, when they come together, constitute sufficient cause to result in an injury. Statistical metrics c. Machine learning model validation 5. Limit naps to less than 1 hour, and prior to mid afternoon. If an injury does occur, withdrawal from further the basis of the interaction of the event attributes and pre-exposure may be the result; more often, recovery will facilitate existing risks. Individual athletes have their own risk factors that predispose them to concussion (FIGURE 1). In many cases, medical management is required; for some headache types, such as cervicogenic headaches, physical therapy may be of benefit.54,125 Botulinum toxin injection can be considered for posttraumatic chronic migraine headaches.24 Repetitive transcranial magnetic stimulation may be effective in the treatment of posttraumatic headache.60,69,70 Often, a multimodal approach to headache management includes both acute and prophylactic medication. Clin. Avoid caffeine and alcohol for several hours before bedtime. Whether its recreational or professional, injury is a common occurrence at all levels of sport and exercise. Limited Coping Skills, Young Age, and High BMI Are Risk Factors for Injuries in Contemporary Dance: A 1-Year Prospective Study. response to sport injury. per 1000 hours of sports participation) in order to facilitate the comparability of research results. Increasing knowledge regarding concussion burden and identifying factors contributing to multifaceted and recursive risk for concussion will inform the development and evaluation of effective concussion prevention strategies. This article applies the dynamic, recursive model of sport injury to sport-related concussion and summarizes the process of individualized assessment and management following concussion in athletes of all ages, with a focus on physical rehabilitation. A Dynamic Model of Etiology in Sport Injury: The Recursive Nature of Risk and Causation: Clinical Journal of Sport Medicine 17, 215–219 (2007). The Such a rehabilitation strategy, tailored to the individual, can facilitate high-quality, evidence-informed care and injury prevention. ERAIQ. The Concussion Recognition Tool Fifth Edition (CRT5) is a sideline tool that can be used by parents, coaches, officials, and players to recognize when a concussion may have occurred.28 In some sports, a “spotter” watches for potential signs of concussion and identifies individuals who may require screening for concussion. 215-219 View Record in Scopus Google Scholar These factors may change over time. Curr Sports Med Rep. 2008 Nov-Dec;7(6):359-66. doi: 10.1249/JSR.0b013e31818f0bed. 16.3. 2020 Jul 10;11:1452. doi: 10.3389/fpsyg.2020.01452. Symptoms may be reported by the player, such as headaches, dizziness, nausea, sensitivity to light or noise, fatigue, and feeling as though in a fog. eCollection 2020. Extrinsic Risk Factors for Concussion The environment in which an athlete plays includes factors that can influence the risk of concussion, many of which may be modifiable. : 10.1186/s40798-020-00264-9 at primary prevention have shown promise in decreasing the risk concussion... 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