What can family medicine providers learn about concussion non-disclosure from former collegiate athletes?

BACKGROUND: Despite the risks, concussion symptoms often go underreported by athletes, leading to delayed or forgone treatment and increased potential for concussion recurrence. One of the most serious long-term consequences of sports-related concussions is Chronic Traumatic Encephelopathy (CTE), a disorder associated with progressive neurological deterioration. The purpose of this study was to explore former collegiate athletes' understanding of concussions and motivations behind concussion non-disclosure in order to better assist family medicine providers in screening for and managing a history of concussions. METHODS: Informed by the theoretical framework Social Cognitive Theory, we conducted focus groups with former collegiate athletes using a field-tested discussion guide. Discussions were transcribed, coded, and analyzed via content and thematic analyses using NVivo 10 software. RESULTS: Thirty-two former collegiate athletes (24.5 ± 2.9 years old, 59.4% female, 87.5% white) participated in 7 focus groups. Three predominant themes emerged: 1) Concussions are Part of the Game: Participants believed that concussions were part of sports, and that by agreeing to play a sport they were accepting the inherent risk of concussions. Importantly, many were not familiar with concussion symptoms and what constituted a concussion; 2) Hiding Concussion Symptoms: Participants said they often hid concussion symptoms from coaches and trainers in order to avoid being taken out of or missing games. Participants were able to hide their concussions because most symptoms were indiscernible to others; and 3) Misconceptions about Concussions in Low Contact Sports: Several participants did not understand that concussions could occur in all sports including low contact or noncontact sports. The former athletes who participated in low contact sports and experienced concussions attributed their concussions to personal clumsiness rather than their sport. CONCLUSIONS: Family medicine providers as well as coaches, athletic trainers, teachers, and parents/guardians should reinforce the message that concussions can occur in all sports and inform patients about the signs and symptoms of concussions. Further, providers should ask all patients if they engaged in high school or collegiate athletics; and if yes, to describe their hardest hit to their head in order to obtain a complete medical history.

Characterizing Information Processing With a Mobile Device: Measurement of Simple and Choice Reaction Time.

Information processing is typically evaluated using simple reaction time (SRT) and choice reaction time (CRT) paradigms in which a specific response is initiated following a given stimulus. The measurement of reaction time (RT) has evolved from monitoring the timing of mechanical switches to computerized paradigms. The proliferation of mobile devices with touch screens makes them a natural next technological approach to assess information processing. The aims of this study were to determine the validity and reliability of using of a mobile device (Apple iPad or iTouch) to accurately measure RT. Sixty healthy young adults completed SRT and CRT tasks using a traditional test platform and mobile platforms on two occasions. The SRT was similar across test modality: 300, 287, and 280 milliseconds (ms) for the traditional, iPad, and iTouch, respectively. The CRT was similar within mobile devices, though slightly faster on the traditional: 359, 408, and 384 ms for traditional, iPad, and iTouch, respectively. Intraclass correlation coefficients ranged from 0.79 to 0.85 for SRT and from 0.75 to 0.83 for CRT. The similarity and reliability of SRT across platforms and consistency of SRT and CRT across test conditions indicate that mobile devices provide the next generation of assessment platforms for information processing.

Using Accelerometer and Gyroscopic Measures to Quantify Postural Stability.

CONTEXT: Force platforms and 3-dimensional motion-capture systems provide an accurate method of quantifying postural stability. Substantial cost, space, time to administer, and need for trained personnel limit widespread use of biomechanical techniques in the assessment of postural stability in clinical or field environments. OBJECTIVE: To determine whether accelerometer and gyroscope data sampled from a consumer electronics device (iPad2) provide sufficient resolution of center-of-gravity (COG) movements to accurately quantify postural stability in healthy young people. DESIGN: Controlled laboratory study. SETTING: Research laboratory in an academic medical center. PATIENTS OR OTHER PARTICIPANTS: A total of 49 healthy individuals (age = 19.5 ± 3.1 years, height = 167.7 ± 13.2 cm, mass = 68.5 ± 17.5 kg). INTERVENTION(S): Participants completed the NeuroCom Sensory Organization Test (SOT) with an iPad2 affixed at the sacral level. MAIN OUTCOME MEASURE(S): Primary outcomes were equilibrium scores from both systems and the time series of the angular displacement of the anteroposterior COG sway during each trial. A Bland-Altman assessment for agreement was used to compare equilibrium scores produced by the NeuroCom and iPad2 devices. Limits of agreement was defined as the mean bias (NeuroCom - iPad) ± 2 standard deviations. Mean absolute percentage error and median difference between the NeuroCom and iPad2 measurements were used to evaluate how closely the real-time COG sway measured by the 2 systems tracked each other. RESULTS: The limits between the 2 devices ranged from -0.5° to 0.5° in SOT condition 1 to -2.9° to 1.3° in SOT condition 5. The largest absolute value of the measurement error within the 95% confidence intervals for all conditions was 2.9°. The mean absolute percentage error analysis indicated that the iPad2 tracked NeuroCom COG with an average error ranging from 5.87% to 10.42% of the NeuroCom measurement across SOT conditions. CONCLUSIONS: The iPad2 hardware provided data of sufficient precision and accuracy to quantify postural stability. Accuracy, portability, and affordability make using the iPad2 a reasonable approach for assessing postural stability in clinical and field environments.

Distinguishing the transition to chaos in a spherical pendulum.

Complex responses are studied for a spherical pendulum whose support is excited with a translational periodic motion. Governing equations are studied analytically to allow prediction of responses under various excitation conditions. Stability for certain cases of damping is predicted by means of existing analysis and compared with experimental data. Numerical time-step integration of the governing equations is developed to predict responses for various types of excitation and damping conditions. Predicted results are compared with corresponding motions measured in an experimental spherical pendulum system. A data acquisition system is included whereby detailed digitized time histories of the pendulum motion can be established and various parameters can be computed to characterize the type of motion present. Two new vector spaces are defined for describing complex responses which occur for certain specified excitation conditions. It is shown in these parameter spaces that the transition from quasiperiodic to chaotic motions can be carefully quantified in systems with very light damping. This discovery provides a convenient means for comparison of complex motions in the numerical and experimental air pendulum systems. The implications of the results are important for dynamic response in various applications, including fluid motions in satellite tanks and other nonlinear time-dependent physical processes which include very light damping. (c) 1995 American Institute of Physics.