Therefore, ex… Evaluating the dynamic model of psychological response to sport injury and rehabilitation Diane M. Wiese-Bjornstal , Courtney B. Albinson, Shaine E. Henert, Elizabeth A. Arendt , Susan J. Schwenz, Shelly S. Myers, Diane M. Gardetto-Heller 1. Blurred vision, double vision, and difficulty reading may be reported following a concussion. 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. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Add to My Bookmarks Export citation. Adapting the dynamic, recursive model of sport injury to concussion: an individualized approach to concussion prevention, detection, assessment, and treatment - Schneider KJ, Emery CA, Black A, Yeates KO, Debert CT, Lun V, Meeuwisse WH. [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. This integrated model … 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. 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. This model considers the implications of repeated exposure, whether such exposure produces adaptation, maladaptation, injury or complete/incomplete recovery from injury. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial, Sport-related concussion induces transient cardiovascular autonomic dysfunction, Pediatric post-traumatic headaches and peripheral nerve blocks of the scalp: a case series and patient satisfaction survey, What tests and measures should be added to the SCAT3 and related tests to improve their reliability, sensitivity and/or specificity in sideline concussion diagnosis? 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. When symptoms persist for longer than 7 to 10 days, a multifaceted interdisciplinary assessment to guide treatment is recommended. If symptoms recur, then the athlete should move back to the previous step. Get the latest public health information from CDC: https://www.coronavirus.gov. 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). In part 1 of this commentary, we address etiology, risk factors, and detection of concussion. Autonomic function may be disrupted following concussion.25 An increase in symptoms can occur for some individuals when they increase the intensity of physical activity. 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. The literature is inconsistent regarding sex as a risk factor for concussion. Introduction. The risk factors of concussion may be categorized as intrinsic (internal factors specific to the individual) or extrinsic (external factors related to the environment or sport). The purpose of this clinical commentary was to summarize prevention, detection, assessment, and treatment factors that affect individuals across the continuum of concussion care, using the dynamic, recursive model of sport injury 88 framework. Once the individual has completed 1 to 2 days of rest, a gradual return to sport and school/work is recommended. Epub 2019 Oct 14. 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. Other screening tools, such as the Vestibular/Ocular Motor Screening and a combination of optokinetic stimulation, gaze stabilization testing, and near point of convergence, may have clinical utility as screening tools for concussion in the subacute period (2–10 days) following concussion.85,89 The SCAT5 and Vestibular/Ocular Motor Screening tools can be used as part of the clinical assessment but should not replace other aspects of the clinical exam that may be warranted, based on the individual circumstances of the injury.21,29,84. In part 2, we address concussion assessment and management. Contents Acknowledgements xii Preface xiii Part I: Components of an economy 1. 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. J Orthop Sports Phys Ther 2019;49(11):799-810. Sports physiotherapists and other sports professionals recognise that the identification of the causes of injury is an important step in injury prevention as this can lead to the development of effective injury prevention programs. This item appears on. 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. A dynamic, recursive model of etiology in sport injury. 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. Adherence to sport injury rehabilitation means an injured athlete's compliance (or not) to a sports medicine/injury personnel's instructions of participating in a rehabilitation programme in a clinic, and/or doing rehabilitation exercises at home. 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. 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 this section, we outline 9 common persistent symptoms following concussion,7,58,106 describe differential diagnoses, and offer an overview of evidence-based rehabilitation approaches. Learn data science by working on real-world problems on sports injury prediction Learn how to use data and create predictive models to predict and reduce injury incidence. injury leading to either return to competition or a period of absence from competition. 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. cancer mortality). 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. 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. 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. Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment. Sports injuries are often recurrent in that some people experience more than one sports injury over time. Individual athletes have their own risk factors that predispose them to concussion (FIGURE 1). ERAIQ. Emotional Responses to Athletic Injury Questionnaire. When symptoms persist for longer than 7 to 10 days, a multifaceted interdisciplinary assessment to guide treatment is recommended. USA.gov. 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. This model considers the implications of repeated exposure, whether such exposure produces adaptation, maladaptation, injury or complete/incomplete recovery from injury. 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NIH 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. A Dynamic Model of Etiology in Sport Injury: The Recursive Nature of Risk and ... Issue 3 Page start 215 Page end 219 DOI 10.1097/JSM.0b013e3180592a48 Is part of Journal Title Clinical Journal of Sport Medicine ISSN 1050-642X Short title Clinical Journal of Sport Medicine. 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. 6, International Journal of Athletic Therapy and Training, 31 October 2019 | Journal of Orthopaedic & Sports Physical Therapy, Vol. It is important for sports professionals to know why certain athletes may be at risk of injury risk factors and how injuries occur (i… 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. 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