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CONTEXT: Sport concussion is currently the focus of much international attention. Innovative methods to assist athletic trainers in facilitating management after this injury need to be investigated. OBJECTIVE: To investigate the feasibility of using a Facebook concussion-management program termed iCon (interactive concussion management) to facilitate the safe return to play (RTP) of young persons after sport concussion. DESIGN: Observational study. SETTING: Facebook group containing interactive elements, with moderation and support from trained health care professionals. PATIENTS OR OTHER PARTICIPANTS: Eleven participants (n = 9 men, n = 2 women; range, 18 to 28 years old) completed the study. DATA COLLECTION AND ANALYSIS: The study was conducted over a 3-month period, with participant questionnaires administered preintervention and postintervention. The primary focus was on the qualitative experiences of the participants and the effect of iCon on their RTP. Usage data were also collected. RESULTS: At the completion of the study, all participants (100%) stated that they would recommend an intervention such as iCon to others. Their supporting quotes all indicated that iCon has the potential to improve the management of concussion among this cohort. Most participants (n = 9, 82%) stated they were better informed with regard to their RTP due to participating in iCon. CONCLUSIONS: This interactive adjunct to traditional concussion management was appreciated among this participant group, which indicates the feasibility of a future, larger study of iCon. Athletic trainers should consider the role that multimedia technologies may play in assisting with the management of sport concussion.

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BACKGROUND: YouTube is one of the largest social networking websites, allowing users to upload and view video content that provides entertainment and conveys many messages, including those related to health conditions, such as concussion. However, little is known about the content of videos relating to concussion. OBJECTIVE: To identify and classify the content of concussion-related videos available on YouTube. STUDY DESIGN: An observational study using content analysis. METHODS: YouTube's video database was systematically searched using 10 search terms selected from MeSH and Google Adwords. The 100 videos with the largest view counts were chosen from the identified videos. These videos and their accompanying text were analysed for purpose, source and description of content by a panel of assessors who classified them into data-driven thematic categories. RESULTS: 434 videos met the inclusion criteria and the 100 videos with the largest view counts were chosen. The most common categories of the videos were the depiction of a sporting injury (37%) and news reports (25%). News and media organisations were the predominant source (51%) of concussion-related videos on YouTube, with very few being uploaded by professional or academic organisations. The median number of views per video was 26 191. CONCLUSIONS: Although a wide range of concussion-related videos were identified, there is a need for healthcare and educational organisations to explore YouTube as a medium for the dissemination of quality-controlled information on sports concussion.

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Social networking sites (SNS) are now part of everyday life, and SNSs such as Facebook, YouTube, and Twitter are among the most accessed Web sites on the Internet. Although SNSs are primarily used for staying in touch with friends and family, they are increasingly being used for health-related purposes for a variety of conditions, including concussion awareness. As health interventions begin to be more commonly provided through SNSs (particularly Facebook), ethical issues have been raised with regard to confidentiality, privacy, and trust; these issues need to be addressed. This article outlines some of the key considerations when providing a concussion intervention through Facebook and discusses potential solutions to these issues.

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OBJECTIVES: To investigate physical therapy students' understanding of the concept of rest following a sport concussion and to ascertain if this understanding changes following a lecture based on current best practice concussion knowledge. DESIGN: Pre-post observational survey. SETTING: University classroom setting. PARTICIPANTS: A cohort of 118 (40 male, 78 female) physical therapy students participating in volunteer sports medic training. RESULTS: Participants provided 320 (pre) and 350 (post) responses depicting activities which should be restricted following a concussion. The responses were classified into three rest-related categories: 'Physical rest', 'Cognitive rest' and 'Mixed' (a combination of physical and cognitive rest). Pre-lecture, approximately 74% of the student's responses were categorized as Physical rest, and 25% under Mixed. There was a shift in the response pattern post-lecture, with 96% of the responses falling in the Mixed category. CONCLUSIONS: The results of the study highlight a lack of understanding of the concept of cognitive rest in concussion management among trainee sport medics. The need for wider dissemination of this concept as recommended by the recent consensus statement on sports concussion is indicated.

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BACKGROUND: Twitter is a rapidly growing social networking site (SNS) with approximately 124 million users worldwide. Twitter allows users to post brief messages ('tweets') online, on a range of everyday topics including those dealing with health and wellbeing. Currently, little is known about how tweets are used to convey information relating to specific injuries, such as concussion, that commonly occur in youth sports. OBJECTIVE: The purpose of this study was to analyse the online content of concussion-related tweets on the SNS Twitter, to determine the concept and context of mild traumatic brain injury as it relates to an online population. STUDY DESIGN: A prospective observational study using content analysis. METHODS: Twitter traffic was investigated over a 7-day period in July 2010, using eight concussion-related search terms. From the 3488 tweets identified, 1000 were randomly selected and independently analysed using a customised coding scheme to determine major content themes. RESULTS: The most frequent theme was 'news' (33%) followed by 'sharing personal information/situation' (27%) and 'inferred management' (13%). Demographic data were available for 60% of the sample, with the majority of tweets (82%) originating from the USA, followed by Asia (5%) and the UK (4.5%). CONCLUSION: This study highlights the capacity of Twitter to serve as a powerful broadcast medium for sports concussion information and education.

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BACKGROUND: The internet plays an important role in the dissemination of health information to the general public. Information on orthopaedic sports medicine websites has been shown to be of a varying standard, and to date there has been no evaluation of the overall quality of concussion-related websites. METHODS: A four-stage methodological sampling technique was used to identify concussion-related websites. Websites were assessed for the presence of a quality standard (the HONcode), their adherence to current expert concussion knowledge using a custom-developed concussion checklist ('CONcheck'), and their readability using the established Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL). RESULTS: 43 Websites were identified from the search strategy with the majority (70%) not HONcode certified. A wide distribution of scores was seen for the CONcheck (0-22), FRE (16.3-77.4) and FKGL (6-17.8). Statistical analysis using independent t tests between websites with the HONcode and websites without the HONcode showed no significant differences between the two groups for CONcheck (t(41)=0.571, p=0.571), FRE (t(41)=0.808, p=0.424) and FKGL(t(41)=-0.964, p=0.341) scores. CONCLUSIONS: The variability in the standard of concussion-related websites highlights the need for sports medicine website providers to consider the delivery, content and readability of information to the public.

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Gait training is a major focus of rehabilitation for many people with neurological disorders, yet systematic reviews have failed to identify the most effective form of gait training. The main objective of this study was to compare conditions for gait training for people with acquired brain injury (ABI). Seventeen people who had sustained an ABI and were unable to walk without assistance were recruited as a sample. Each participant was exposed to seven alternative gait training conditions in a randomized order. These were: (1) therapist manual facilitation; (2) the use of a gait-assistive device; (3) unsupported treadmill walking; and (4) four variations of body weight support treadmill training (BWSTT). Quantitative gait analysis was performed and Gait Profile Scores (GPS) were generated for each participant to determine which condition most closely resembled normal walking. BWSTT without additional therapist or self-support of the upper limbs was associated with more severe gait abnormality [Wilks' lambda = 0.20, F(6, 6) = 3.99, p = 0.047]. With the exception of therapist facilitation, the gait training conditions that achieved the closest approximation of normal walking required self-support of the upper limbs. When participants held on to a stable handrail, self-selected gait speeds were up to three times higher than the speeds obtained for over-ground walking [Wilks' lambda = 0.17, F(6, 7) = 5.85, p < 0.05]. The provision of stable upper-limb support was associated with high self-selected gait speeds that were not sustained when walking over ground. BWSTT protocols may need to prioritize reduction in self-support of the upper limbs, instead of increasing treadmill speed and reducing body weight support, in order to improve training outcomes.

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OBJECTIVE: The purpose of this study was to determine the effect of different levels of exercise intensity on the timed finger-to-nose (FTN) task, a measure of upper limb coordination included in the Sport Concussion Assessment Tool (SCAT2). METHODS: A three-group crossover randomised design was used to investigate changes in FTN times at three levels of exercise intensity; no exercise/rest (NE), moderate intensity exercise (ME) and high-intensity exercise (HE). Heart rates and a rating of perceived exertion (Borg Scale) were recorded to verify the level of exercise intensity. Participants performed three trials of the timed FTN task: pre-exercise, post-exercise and 15 min after the cessation of exercise. Linear mixed models were used to compare FTN change scores associated with exercise. RESULTS: Ninety asymptomatic participants (45♂:45♀) aged 18-32 years completed the study. Changes in FTN scores from pre-exercise showed that the HE condition was facilitated relative to NE at post-exercise (8% faster, 95% CI 5% to 10%, p<0.001) and at post-15 (3% faster, 95% CI 1% to 6%, p=0.005). ME did not show such a facilitation following exercise (2% faster, 95% CI 0% to 4%, p=0.081 and 1% faster, 95% CI 1% to 4%, p=0.225 respectively). CONCLUSIONS: Performance on the FTN task is enhanced by a short period of HE, and this effect persists for at least 15 min. There was no evidence of such an effect with ME.

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BACKGROUND: Evidence-based clinical data are required for safe return to play after concussion in sport. PURPOSE: The objective of this study was to describe the natural history of concussion in sport and identify clinical features associated with more severe concussive injury, using return-to-sport decisions as a surrogate measure of injury severity. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 3. METHODS: Male elite senior, elite junior, and community-based Australian Rules football players had preseason baseline cognitive testing (Digit Symbol Substitution Test, Trail-Making Test-Part B, and CogSport computerized test battery). Players were recruited into the study after a concussive injury sustained while playing football. Concussed players were tested serially until all clinical features of their injury had resolved. RESULTS: Of 1015 players, 88 concussions were observed in 78 players. Concussion-associated symptoms lasted an average of 48.6 hours (95% confidence interval, 39.5-57.7 hours) with delayed return to sport correlated with > or = 4 symptoms, headache lasting > or = 60 hours, or self-reported "fatigue/fogginess." Cognitive deficits using the Digit Symbol Substitution Test and Trail-Making Test-part B recovered concomitantly with symptoms, but computerized test results recovered 2 to 3 days later and remained impaired in 35% of concussed players after symptom resolution. CONCLUSION: Delayed return to sport was associated with initially greater symptom load, prolonged headache, or subjective concentration deficits. Cognitive testing recovery varied, taking 2 to 3 days longer for computerized tests, suggesting greater sensitivity to impairment. Therefore, symptom assessment alone may be predictive of but may underestimate time to complete recovery, which may be better estimated with computerized cognitive testing.

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BACKGROUND: Reduced gait speed is common following traumatic brain injury (TBI). Several studies have found that people with TBI display increased lateral movement in their center of mass while walking. It has been hypothesized that reduced gait speed following TBI is a consequence of increased caution and postural instability, but reduced ankle power generation at push-off may also play a contributing role. OBJECTIVE: To determine whether postural instability or reduced muscle power were associated with reduced gait speed following TBI. METHODS: A convenience sample of 55 people with TBI receiving physiotherapy for gait disorders were assessed using 3D gait analysis at self-selected and fast walking speeds. A comparison group of 10 healthy controls performed walking trials at a speed matched to the mean TBI self-selected speed and at a fast walking speed. RESULTS: When matched for speed, people with TBI walked with similar cadence and step length but with reduced ankle power generation at push-off and increased hip power generation both in early stance and in preswing compared with healthy controls. Width of base of support and postural instability were also significantly increased for people with TBI. The differences between the 2 groups at the matched speed remained for the fast speed condition. Postural stability did not deteriorate with increasing gait speed in either group. CONCLUSION: Reduced gait speed following TBI appears to be attributable to biomechanical deficiencies such as reduced ankle power generation rather than reduced postural stability and increased caution.

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Postural control and motor coordination are essential components of normal athletic activity. Tasks involving balance and coordination are used to determine neurological function in sports-related concussion. Determining normative values for these tasks is therefore essential to provide sports medicine professionals with a frame of reference with which to interpret clinical measures obtained from players suspected of sustaining a concussion. One hundred and seventytwo healthy subjects (16-37 yrs) performed three timed tests: Tandem Gait (TG); Finger-to-Nose (FTN); Single-Leg-Stance (SLS) on firm and foam surfaces. Unadjusted geometric means (+/-SD) for each measure were averaged across three trials. Time to complete TG was 11.2+/-1.2s. FTN for the dominant and non-dominant arm were 2.9+/-1.1s and 3.0+/-1.2s, respectively. SLS values for dominant and non-dominant leg were 20.4+/-3.0s (firm), 3.4+/-1.6s (foam), and 21.0+/-2.9s (firm), 3.3+/-1.6s (foam), respectively. For TG, there was an order effect (P<.001) but no age, sex or BMI effects. FTN demonstrated a dominant arm preference (P<.001), sex (P=.006), BMI (P=.043) and order effects (P<.001). SLS demonstrated an order effect on the firm surface (P=.009) and an order (P<.001) and BMI (P=.001) effect on foam. Intra-rater reliability, as measured by ICC (3,3), demonstrated that TG and FTN had excellent reliability compared to SLS. FTN and TG should continue to be used in test batteries to determine neurological function in sports-related concussion.

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OBJECTIVE: To identify the most common gait abnormalities presenting after traumatic brain injury (TBI) and quantify their incidence rate. DESIGN: Case series. SETTING: Biomechanics laboratory. PARTICIPANTS: A convenience sample of 41 people with TBI receiving therapy for gait abnormalities, and a sample of 25 healthy controls. INTERVENTION: Three-dimensional gait analysis. MAIN OUTCOME MEASURES: Spatiotemporal, kinematic, and kinetic data at a self-selected walking speed. RESULTS: People with TBI walked with a significantly slower speed than matched healthy controls. There was a significant difference between groups for cadence, step length, stance time on the affected leg, double support phase, and width of base of support. The most frequently observed biomechanical abnormality was excessive knee flexion at initial foot contact. Other significant gait abnormalities were increased trunk anterior/posterior amplitude of movement, increased anterior pelvic tilt, increased peak pelvic obliquity, reduced peak knee flexion at toe-off, and increased lateral center of mass displacement. Ankle equinovarus at foot-contact occurred infrequently. CONCLUSIONS: People with TBI were found to have multijoint gait abnormalities. Many of these abnormalities have not been previously reported in this population.

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OBJECTIVE: To determine injury rates and risk factors for injury in a cohort of professional boxers. DESIGN: Retrospective cohort design reporting on data collected for a fight statistics database maintained by the Professional Boxing and Combat Sports Board of Victoria, Australia. Data were extracted for the years January 1997 through June 2005. SETTING: Victoria, Australia. PARTICIPANTS: 545 professional boxers (age, 18 to 43 years) who participated in a total of 907 fights over the study period. ASSESSMENT OF RISK FACTORS: Independent variables under investigation included age, gender, weight, bout exposure, and location of the bout (within or outside of the State of Victoria). MAIN OUTCOME MEASURES: Physician-reported acute boxing injuries occurring during bouts of any region or nature. RESULTS: 214 injuries were sustained over the 8.5 years, corresponding to an injury rate of 23.6 per 100 professional fights. The majority of these injuries were lacerations to the head and face. An increasing age and an increasing number of fights were both significant predictors of injury. CONCLUSIONS: Injury reduction strategies for professional boxing might include restrictions of eligibility to fight based on age and boxing bout exposure. Future research using prospective cohort designs and standardized injury definitions are needed to confirm these results. Greater mechanistic detail and more complete data entry are necessary to ensure that optimal injury prevention strategies can be developed and implemented. Upon confirmation of the results of this study, the Professional Boxing and Combat Sports Board of Victoria may consider different criteria upon which to sanction a fight.

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Many sports have neurologic injury from incidental head contact; however, combat sports allow head contact, and a potential exists for acute and chronic neurologic injuries. Although each combat sport differs in which regions of the body can be used for contact, they are similar in competitor exposure time. Their acute injury rates are similar; thus their injuries can appropriately be considered together. Injuries of all types occur in combat sports, with injuries in between one fifth to one half of all fights in boxing, karate, and tae kwon do. Most boxing injuries are to the head and neck region. In other combat sports, the head and neck region are the second (after the lower limbs) or the first most common injury site.

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Many sports have neurologic injury from incidental head contact; however, combat sports allow head contact, and a potential exists for acute and chronic neurologic injuries. Although each combat sport differs in which regions of the body can be used for contact, they are similar in competitor exposure time. Their acute injury rates are similar; thus their injuries can appropriately be considered together. Injuries of all types occur in combat sports, with injuries in between one fifth to one half of all fights in boxing, karate, and tae kwon do. Most boxing injuries are to the head and neck region. In other combat sports, the head and neck region are the second (after the lower limbs) or the first most common injury site.

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The acute symptoms of concussion provide the basis for assessment, classification, and ultimately, management of this common problem in sport. The only concussive symptoms that have been scientifically validated are loss of consciousness, headache, dizziness, nausea, blurred vision, attentional deficit, and memory loss. Although many symptoms have been anecdotally attributed to concussive injury, their clinical significance is unknown. An evidence-based analysis of concussive symptoms and their prognostic significance can aid physicians who must make management and return-to-play decisions.