Risk Reduction of Concussion in Athletes: Do Neck Size or Neck Strength Make a Difference?

ABSTRACT: Medical provider's ability to detect, diagnose, and treat sport-related concussion (SRC) has greatly improved in recent years. Though more is known about the biomechanical forces involved in concussion, it is still uncertain whether there are preventative measures athletes can take to prevent a SRC from occurring. The objective of this review was to determine if either neck size or neck strength is related to a decreased risk of sustaining a SRC. A literature review was conducted on Google Scholar and Ovid MEDLINE for pertinent articles. Findings indicate that isometric neck strength, but not neck size, has been shown to be a predictor for SRC prevention. Formal neck strengthening programs are feasible and lead to decreased SRC risk. Additionally, there may be greater opportunity to increase neck strength in amateur athletes compared to professional. In conclusion, cervical strengthening programs have been shown to be feasible and beneficial for athletes to decrease their risk of sustaining a SRC, though the optimal duration, intensity, and frequency has yet to be determined.

Treatment and Management of Work-Related Mild Traumatic Brain Injury in Physical Medicine and Rehabilitation.

ABSTRACT: The purpose of this narrative review was to assess work-related mild traumatic brain injury treatment approaches and outcomes. Literature indicates that incidence of work-related mild traumatic brain injury is high. Ability to return to work after injury is variable, with differences identified across industry sector, mechanisms of injury, sex, and timely treatment and referral. Additional challenges exist in the context of secondary gains (e.g., financial) and the potential for symptom exaggeration. Emerging evidence from studies outside the United States demonstrate the benefits of proactive assessment and treatment at the time of injury. These benefits can be further augmented by early referral to multidisciplinary treatment teams led by physical medicine and rehabilitation physicians. Opportunities for ongoing research and development of strategies to improve treatment, management, and more timely return to work for patients with occupational mild traumatic brain injury are discussed. It is concluded that challenges persist in treatment and management of patients with work-related mild traumatic brain injury as they present unique challenges not seen in those with nonwork-related mild traumatic brain injuries. The unique position of physical medicine and rehabilitation and the skills of physiatrists render them poised to lead multidisciplinary treatment teams for these patients and contribute to the development of a new guideline for return to work, with an emphasis on functional recovery.

Mild Traumatic Brain Injury Is Associated With Increased Dual-Task Cost During Ambulation: A Preliminary Study.

OBJECTIVE: The aim of the study was to determine the impact of dual-task conditions on mobility after mild traumatic brain injury. DESIGN: Eleven adults with mild traumatic brain injury within 1 wk of injury and 10 age- and sex-matched healthy controls completed gait trials with a single-task condition and three separate dual-task conditions: counting by 1 (low), serial subtraction by 3 (medium), and alternating letters and numbers (high). Dual-task cost was calculated as dual-task cost = ([dual-task performance] - [single-task performance]) / [single-task performance] × 100%. RESULTS: Participants with mild traumatic brain injury ambulated slower than control subjects (P < 0.001). Significant differences in dual-task cost were noted for both group (P < 0.001) and dual-task condition (P = 0.005). Dual-task cost was greater for those with mild traumatic brain injury compared with controls with significant group differences for the low and high cognitive loads (P < 0.05). Only 1 of the 11 individuals with mild traumatic brain injury and 1 of the 10 controls demonstrated gait speed less than 80 cm/sec, which is predictive of community mobility, during any dual-task condition. Dual-task cost exceeded 11.9%, previously determined to be the minimal detectable change in healthy adults, for 9 of the 11 individuals with mild traumatic brain injury compared with 3 of the 10 controls. CONCLUSIONS: Dual-task cost may be a more sensitive measure for impairment during dual-task conditions than gait speed after mild traumatic brain injury.

Treating persons with traumatic brain injury: history and updates.

The scientific traumatic brain injury (TBI) literature chronicles 50 years of epidemiologic data, neurobehavioral and cognitive symptoms, diagnostic tools for measuring outcomes, and treatments for persons with TBI. In this article, we review the state of our knowledge about TBI causes and symptom complexities, evidence-based treatments, and ongoing treatment needs.

Measures of injury severity and prediction of acute traumatic brain injury outcomes.

OBJECTIVE: To examine the comparative efficacy of 3 common measures of traumatic brain injury (TBI) severity for predicting inpatient outcomes upon hospital discharge. SETTING: Acute brain injury rehabilitation unit at level 1 trauma center. PARTICIPANTS: 100 patients with TBI. DESIGN: Retrospective analysis of injury severity, demographic, and outcome data. MAIN MEASURES: Glasgow Coma Scale (GCS) at admission, time to follow commands (TTC), duration of posttraumatic amnesia (PTA), and Functional Independence Measure at hospital discharge. RESULTS: A hierarchal multiple regression revealed that duration of PTA was a significant and powerful unique predictor of Functional Independence Measure scores at discharge (ß = -0.46, P = .001), while TTC (ß = 0.26, P = .056) and GCS (ß = 0.16, P = .143) were not. These effects were present even after controlling for age, gender, educational level, racial/ethnic minority status, cause of injury, history of substance abuse, and neurosurgical intervention. CONCLUSION: Although clinicians often use GCS scores and TTC when assessing acute TBI severity and during treatment formulation, this study provides evidence that duration of PTA may be a more meaningful predictor of patients' functional levels at discharge.