Some healthy athletes report high levels of baseline concussion symptoms, which may be attributable to several factors (eg, illness, personality, somaticizing). However, the role of baseline symptoms in outcomes after sport-related concussion (SRC) has not been empirically examined.Context: To determine if athletes with high symptom scores at baseline performed worse than athletes without baseline symptoms on neurocognitive testing after SRC.Objective: Cohort study.Design: High school and collegiate athletic programs.Setting: A total of 670 high school and collegiate athletes participated in the study. Participants were divided into groups with either no baseline symptoms (Postconcussion Symptom Scale [PCSS] score = 0, n = 247) or a high level of baseline symptoms (PCSS score > 18 [top 10% of sample], n = 68).Patients or Other Participants: Participants were evaluated at baseline and 2 to 7 days after SRC with the Immediate Post-concussion Assessment and Cognitive Test and PCSS. Outcome measures were Immediate Post-concussion Assessment and Cognitive Test composite scores (verbal memory, visual memory, visual motor processing speed, and reaction time) and total symptom score on the PCSS. The groups were compared using repeated-measures analyses of variance with Bonferroni correction to assess interactions between group and time for symptoms and neurocognitive impairment.Main Outcome Measure(s): The no-symptoms group represented 38% of the original sample, whereas the high-symptoms group represented 11% of the sample. The high-symptoms group experienced a larger decline from preinjury to postinjury than the no-symptoms group in verbal (P = .03) and visual memory (P = .05). However, total concussion-symptom scores increased from preinjury to postinjury for the no-symptoms group (P = .001) but remained stable for the high-symptoms group.Results: Reported baseline symptoms may help identify athletes at risk for worse outcomes after SRC. Clinicians should examine baseline symptom levels to better identify patients for earlier referral and treatment for their injury. Additional investigation of baseline symptoms is warranted to help delineate the type and severity of premorbid symptoms.Conclusions:
Purpose Limited research exists on treatment of sport concussion in visually impaired individuals. Adaptation to athlete’s needs is vital for individualized sport specific return to play (RTP). Methods Fifteen year-old, visually impaired, female, swimmer presented to an interdisciplinary Sport Concussion Program for protracted recovery with complaints of disequilibrium, headaches, cognitive fatigue, and exacerbation of premorbid resting nystagmus after being kicked in the head during practice. Patient is legally blind due to Peter’s Anomaly and right retinal detachment, with history of migraine, carsickness, and glaucoma. Patient completed two visits with clinical sports neuropsychologist and three vestibular therapy (VT) appointments, assessed via Post-Concussion Symptom Scale (PCSS), Montreal Cognitive Assessment (MoCA-BLIND), Modified Balance Error Scoring System (mBESS), Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence scale (ABC), Buffalo Concussion Treadmill Test (BCTT), and Children's Memory Scales (CMS). Differential Diagnosis: Concussion, Post-Concussion Syndrome, Post-Traumatic Headache, Vestibular Dysfunction. Results Initial consult revealed PCSS of 35 and normal MoCA-BLIND (18/22). Patient’s mBESS improved from 7 to 3 errors with VT, DHI mildly elevated (36%), ABC moderately elevated (43%). VT consisted of: neuromuscular re-education, balance training, positional changes, cognitive activity, sport specific RTP progressions (dry land modifications, transitions into water, communication to team athletic trainer). BCTT passed on third VT visit. Patient cleared for RTP with PCSS at 7 and (CMS) Stories, Word Lists, Numbers, and Sequences subtests within expectations (average to high average ranges). Conclusion This case study illustrates an interdisciplinary approach to concussion treatment with modification of established tools and proposal of sport specific RTP guidelines for visually impaired athletes.
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