Functional Assessment of Concussion Tool Application in a Pediatric Concussion Clinic.

BACKGROUND: Traditional concussion symptom scales do not assess function. We piloted a mobile app-based assessment that aims to measure the functional impact of symptoms. METHODS: Patients with concussion completed the Functional Assessment of Concussion Tool and traditional symptom scales postinjury. RESULTS: Linear regression assessed the predictive value of the Functional Assessment of Concussion Tool symptom number and function rating compared to scores on 2 traditional symptom scales across 4 symptom domains. The mobile app symptom number predicted scores on traditional symptom scales across domains. The rating score predicted traditional scale scores in 2 domains. The mobile health tool did not predict recovery. DISCUSSION: This mobile health concussion symptom assessment may measure the functional impact of symptoms, though further study is needed.

Risk Factors for Prolonged Symptoms of Mild Traumatic Brain Injury: A Pediatric Sports Concussion Clinic Cohort.

OBJECTIVE: To examine predictors of prolonged symptom duration from mild traumatic brain injury (mTBI) in a pediatric sports medicine specialty clinic cohort as these predictors may be distinct in this population. DESIGN: Retrospective chart review. SETTING: Outpatient specialty clinic. PATIENTS: Charts of 549 patients (age range: 10-18 years) with concussions were reviewed in an outpatient clinic that predominantly managed sports-related injuries (77.3%). Patients (n = 431) included in the final analysis met the criteria for mTBI and were symptomatic at their first visit. ASSESSMENT OF RISK FACTORS: Patient history, injury, and recovery variables were evaluated. MAIN OUTCOME MEASURES: Predictors of prolonged time to reach self-reported symptom recovery were evaluated using Cox proportional hazards. RESULTS: Median time to symptom recovery of the 431 patients who presented to clinic with symptoms was 40 days (full clinic sample median = 34 days). Analyses identified 3 unique predictors of symptom recovery: loss of consciousness (LOC) [hazard ratio (HR) = 0.56, P < 0.0001], female sex (HR = 0.57, P < 0.0001), and concussion symptom score at first clinic visit (HR = 0.76, P < 0.0001). CONCLUSIONS: Prolonged duration of mTBI symptoms in patients who present to a pediatric sports-based concussion clinic is related to initial symptom severity, female sex, and LOC.

Elbow Biomechanics of Pitching: Does Age or Experience Make a Difference?

BACKGROUND: Elbow pain and elbow injuries are common in youth baseball players. It is not clear whether pitching experience and/or age creates biomechanical differences at the elbow and whether these differences place an athlete at greater risk. HYPOTHESES: (1) Youth pitchers will have differing elbow kinematics with regard to flexion/extension, internal/external rotation, and pronation/supination when compared with nonbaseball athletes and (2) younger youth pitchers will have differing elbow kinematics when compared with older youth pitchers. STUDY DESIGN: Case-control study. LEVEL OF EVIDENCE: Level 4. METHODS: Twenty-seven healthy male youths age 10 to 18 years were recruited and divided into an experience group (n = 18 pitchers) and a no experience group (n = 9 nonbaseball athletes). The experience group was subdivided by age into the younger experience subgroup (n = 10 pitchers) and the older experience subgroup (n = 8 pitchers). Biomechanics were recorded using an electromagnetic motion tracking system. Subjects from each group were averaged together, and a Mann-Whitney U test was utilized for statistical analysis. RESULTS: The experience group had greater external rotation during late cocking (-47.8° vs 5.8°) and greater flexion during early cocking (112.8° vs 100.1°). The younger experience subgroup had greater range of motion with supination-pronation during early cocking (21.9° vs 11.2°) and late cocking (5.9° vs 2.0°). CONCLUSION: Youth athletes with pitching experience had an increase in maximal external rotation in late cocking and maximal flexion in early cocking, which suggests experience may be a factor to these parameters. The age of experienced baseball pitchers may be a factor due to differences observed with supination and pronation. CLINICAL RELEVANCE: Learning to throw is a skill that leads to changes in elbow motion; however, these changes may be stable once athletes reach grade school age. Minimal differences were noted between the younger and older experience subgroups, which may underscore the importance of teaching proper mechanics at a young age.