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BACKGROUND: The Gaze Stabilization Test (GST) assesses vestibulo-ocular reflex (VOR) function by determining the maximum head velocity at which an individual can accurately perceive a fixed-size visual target. There is limited information about gaze stability performance in youth athletes. OBJECTIVE: The purpose of this study is to describe baseline performance of athletes ages 17 years and under on a computerized GST and explore the influence of demographic characteristics on performance. METHODS: Baseline GST and demographic data were acquired via retrospective chart review. RESULTS: The sample included 106 athletes aged 8 to 17 years (mean 13.9 years±1.79; 78% male). The median values for baseline GST function were 180 (IQR: 150-210) degrees per second (d/sec) in the leftward direction, and 190 d/sec (IQR: 160-220) in the rightward direction. There were no significant effects of sex/gender or concussion history on GST performance. CONCLUSIONS: The GST is one of many tools available for clinicians to use in a multi-modal approach to concussion management. Understanding how healthy young athletes perform can assist clinicians in determining vestibular impairment, formulating the exercise prescription, and estimating physiologic recovery.

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BACKGROUND: The ability to clearly perceive an object while the head is in motion is important in athletics, as it relates to performance and potentially to injury prevention. Normative data for healthy adults on measures of gaze stability have been established. However, data for elite athletes is scarce. OBJECTIVE: To describe performance of elite athletes on computerized gaze stability testing and establish normative data for reference. METHODS: Data were acquired via retrospective chart review. 134 male professional baseball players completed computerized Visual Acuity, Visual Perception Time and Gaze Stability Tests as part of a multi-modal baseline testing session. RESULTS: Performance of all athletes was superior to general population norms reported in the literature. There were no significant differences between the optimal and suboptimal consistency groups or between English-speaking and non- or limited-English speaking players. CONCLUSIONS: Similar to prior studies with smaller samples that have examined GST in athletes, we found high levels of GST performance in professional baseball players relative to normative data for the general population. Normative data for elite athletes was established using this healthy sample. This study underscores the importance of understanding the unique abilities of elite athletes when providing therapy after injury.

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Over the past decade, research has increased scientific and public knowledge about the importance of identification and proper management of concussion. These concerns have prompted many state, regional, and private organizations to mandate the creation of, and strict adherence to, concussion management protocols, particularly with regard to sport-related concussion and subsequent return to play. Because of the individualized nature of the concussive injury and its recovery, a multidisciplinary approach provides comprehensive patient care that best addresses treatment and management of changing symptoms and their impact on multiple aspects of a patient's life and overall function. The current report will explore a model of multidisciplinary concussion management from program establishment and baseline testing to recovery from chronic postconcussion symptoms.

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OBJECTIVE: Researchers evaluated the effect of manualized treatments for depression on comorbid symptoms of insomnia. METHOD: Hierarchical linear modeling was used to analyze archival data collected from 14 studies (N = 910) examining the efficacy of psychological treatments for depression in adults. RESULTS: Participants receiving a psychological treatment for depression experienced significantly more relief from symptoms of insomnia with overall, early-, middle-, and late-night sleep than those not receiving such treatment. CONCLUSION: Symptoms of insomnia in those with an average (or lower) level of depression can be reduced through psychological treatment for depression. However, more severe depressive symptoms do not receive great relief from sleep disturbance and may require an additional treatment component targeting symptoms of insomnia.

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BACKGROUND: The severity of sports-related concussion is often characterized by the number and severity of postconcussive symptoms (eg, headache, dizziness, difficulty concentrating). Although the level of postconcussive symptoms after injury is believed to index the severity of the neurological insult sustained, studies examining the relationship between symptom severity and neural functioning in concussed athletes remain rare. OBJECTIVE: This exploratory study examined the association between self-reported symptom severity and functional activation on a working memory task in a group of 16 recently concussed student athletes. METHODS: Functional magnetic resonance imaging was used to examine the relationship of symptom severity to brain activation during a working memory task in 16 concussed subjects. RESULTS: Findings indicated that symptom severity was associated with regionally specific hyperactivation during a working memory task, even though symptom severity was not significantly related to task accuracy. CONCLUSION: The results add to a growing body of literature that demonstrates that functional neuroimaging may have the potential to serve as a sensitive biomarker of the severity of concussion and mild traumatic brain injury.

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The objective of this study was to examine differences in neurocognitive performance between symptomatic concussed athletes, a group of concussed athletes with no subjective symptoms, and a non-concussed control group of athletes. All concussed athletes were evaluated within one week of injury using the ImPACT computerized test battery. Results indicate that concussed athletes who denied subjective symptoms demonstrated poorer performance than control subjects on all four composite scores of the ImPACT test batters (Verbal Memory, Visual Memory, Reaction Time and Processing Speed However, the concussed but asymptomatic group demonstrated significantly better performance than did the concussed and symptomatic group. Thus, concussed athletes who did not report subjective symptoms were not fully recovered based on neurocognitive testing. This study underscores the importance of neurocognitive testing in the assessment of concussion sequelae and recovery.

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OBJECTIVE: The relationship between athlete reports of symptoms, neurophysiological activation, and neuropsychological functioning is investigated in a sample of high school athletes. METHODS: All athletes were evaluated using functional magnetic resonance imaging (fMRI), a computer-based battery of neurocognitive tests, and a subjective symptom scale. Athletes were evaluated within approximately 1 week of injury and again after clinical recovery using all assessment modalities. RESULTS: This study found that abnormal fMRI results during the first week of recovery predicted clinical recovery. As a group, athletes who demonstrated hyperactivation on fMRI scans at the time of their first fMRI scan demonstrated a more prolonged clinical recovery than athletes who did not demonstrate hyperactivation at the time of their first fMRI scan. CONCLUSION: These results demonstrate the relationship between neurophysiological, neuropsychological, and subjective symptom data in a relatively large sample composed primarily of concussed high school athletes. fMRI represents an important evolving technology for the understanding of brain recovery after concussion and may help shape return-to-play guidelines in the future.

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Although it is widely accepted that mouthguards decrease the incidence of dental injuries, there is a controversy among sports medicine professionals as to the effectiveness of mouthguards in decreasing the incidence or severity of sports-related cerebral concussion (SRCC). While some experimental data suggest that this may be the case, there exist a number of reports suggesting that mouthguards do not serve this purpose. These conclusions have been drawn, however, without actually measuring the extent of neurocognitive dysfunction in athletes following sports-related concussion. The purpose of this study was to determine whether mouthguard use reduces the neurocognitive and symptomatic impairments that follow an injurious episode of SRCC. Preseason baseline data were collected as part of an ongoing clinical program that uses a computerized neurocognitive test to assess various faculties of brain function and symptoms reported at the time of testing. Follow-up testing from 180 student-athletes who had sustained an SRCC was analyzed for the purpose of this study. These athletes were separated into one of two groups: those who reported using mouthguards and those who did not. Neurocognitive testing was accomplished using the Immediate Post-Concussion and Assessment Test (ImPACT). Results suggest that neurocognitive deficits at the time of the athletes' first follow-up assessment did not differ between mouthguard users and non-users, suggesting that mouthguard use does little to reduce the severity of neurocognitive dysfunction and onset of symptoms following sports-related head trauma. However, an interesting finding in this study was that athletes experienced significantly lower neurocognitive test scores and reported higher symptom scores following SRCC regardless of mouthguard use. This emphasizes a thorough clinical evaluation of athletes that have sustained an SRCC. Although it was found in this study that mouthguard use does not decrease the severity of concussion, it is important to note that the use of mouthguards is paramount in reducing maxillofacial and dental trauma and their use should continue to be mandated by athletic associations and supported by all dental and sports medicine professionals.

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BACKGROUND: Neurocognitive testing has been endorsed as a "cornerstone" of concussion management by recent Vienna and Prague meetings of the Concussion in Sport Group. Neurocognitive testing is important given the potential unreliability of athlete self-report after injury. Relying only on athletes' reports of symptoms may result in premature return of athletes to contact sport, potentially exposing them to additional injury. HYPOTHESIS: Use of computer-based neurocognitive testing results in an increased capacity to detect postconcussive abnormalities after injury. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: High school and college athletes with a diagnosed concussion were tested 2 days after injury. Postinjury neurocognitive performance (Immediate Postconcussion Assessment and Cognitive Testing) and symptom (postconcussion symptom) scores were compared with preinjury (baseline) scores and with those of an age- and education-matched noninjured athlete control group. "Abnormal" test performance was determined statistically with Reliable Change Index scores. RESULTS: Sixty-four percent of concussed athletes reported a significant increase in symptoms, as judged by postconcussion symptom scores, compared with preinjury baseline at 2 days after injury. Eighty-three percent of the concussed sample demonstrated significantly poorer neurocognitive test results relative to their own baseline performance. The addition of neurocognitive testing resulted in a net increase in sensitivity of 19%. Ninety-three percent of the sample had either abnormal neurocognitive test results or a significant increase in symptoms, relative to their own baseline; 30% of a control group demonstrated either abnormalities in neurocognitive testing or elevated symptoms, as judged by postconcussion symptom scores. For the concussed group, use of symptom and neurocognitive test results resulted in an increased yield of 29% overreliance on symptoms alone. In contrast, 0% of the control group had both symptoms and abnormal neurocognitive testing. CONCLUSION: Reliance on patients' self-reported symptoms after concussion is likely to result in underdiagnosis of concussion and may result in premature return to play. Neurocognitive testing increases diagnostic accuracy when used in conjunction with self-reported symptoms.

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This study explored the diagnostic utility of the composite scores of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and Post Concussion Symptom Scale scores (PCSS). Recently concussed high school athletes (N=72) were tested within 72 h of sustaining a concussion, and data were compared to non-concussed high school athletes with no history of concussion (N=66). Between-groups MANOVA revealed a significant multivariate effect of concussion on test performance (p<.001); univariate ANOVAS revealed all six measures contributed to the between-groups differences. A discriminant function analyses was conducted to measure the ability of the five ImPACT composite scores, as well as the PCSS to classify concussion status. One discriminant function was identified that consisted of the Visual Memory, Processing Speed, and Impulse Control composite scores PCSS, which correctly classified 85.5% of the cases. Approximately 82% of participants in the concussion group and 89% of participants in the control group were correctly classified. Using these data, the sensitivity of ImPACT was 81.9%, and the specificity was 89.4%. As part of a formal concussion management program, ImPACT is a useful tool for the assessment of the neurocognitive and neurobehavioral sequelae of concussion, and can also provide post-injury cognitive and symptom data that can assist a practitioner in making safer return to play decisions.

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