Injury severity and neuropsychological and balance outcomes of four college athletes.

Recent evidence suggests significant short-term neurocognitive deficits following mild traumatic brain injury (MTBI) in sports. However, sequelae of mild head injuries is complicated by many factors including a history of multiple head injuries and injury severity. Few studies have considered the influence these variables may have on proper classification of a MTBI and their meaning for return-to-play guidelines. This study presents the short-term neuropsychological and balance outcomes of four college athletes who sustained mild head injuries of different severity (grade I, grade II, grade III and multiple head injured with a grade II based on American Academy of Neurology guidelines). The results demonstrated that self-report symptoms of concussion were slow to resolve in the grade III and multiple concussed individuals. For neuropsychological testing, Trails A & B, Symbol Digit Modalities Test and Digits Span Backwards were the most sensitive in identifying differences between the injuries. For balance assessments using the Neurocom Smart Balance System, the Sensory Organization Test and Reaction Time were also important variables in detecting differences among the various injuries. When these data are used together, it can assist physicians in determining safe return-to-play for athletes who sustain MTBI. There are contradindications in the numerous grading systems and return-to-play guidelines for MTBI. The results from this study provides new evidence which can be assimilated into a valid grading scale for MTBI sustained in sport.

Pain assessment in journal of athletic training articles 1992-1998: implications for improving research and practice.

OBJECTIVE: To examine, evaluate, and summarize the techniques used to assess pain in all the Original Research articles published in the Journal of Athletic Training from 1992 through 1998. A second objective was to determine whether any of the Original Research investigations that did not assess pain were on topics that included a pain component. A third purpose was to make recommendations for assessing pain in a clinical athletic training setting. DATA SOURCES: Every Original Research article published from 1992 through 1998 was reviewed independently by 2 of the authors to determine whether a pain assessment was included in the investigation and, if so, to evaluate the pain assessment technique used. DATA SYNTHESIS: A total of 23 (12.5%) of the 184 Original Research articles included some type of pain assessment. Most of these articles addressed the topics of delayed-onset muscle pain (43.5%), knee pain (17.4%), or pain resulting from cryotherapeutic procedures (17.4%). Most of the articles that included some type of pain measurement focused on the assessment of pain intensity using a category scale (17/23, 73.9%). In a substantial percentage of studies, a pain assessment tool that either lacked published supportive validity evidence (8/23, 34.8%) or was poorly constructed (because pain affect and pain intensity were confounded within a single scale) (7/23, 30.4%) was used. In a small number of articles on a topic directly relevant to pain (4/184, 2.2%), pain was not assessed, even though it could have provided useful information. CONCLUSIONS/RECOMMENDATIONS: Pain is a construct of interest to those conducting athletic training research. Pain measures were included in approximately 1 of every 8 Original Research articles published in the Journal of Athletic Training. However, investigators have too frequently measured pain in a limited fashion, often focusing only on pain intensity. Measuring other components of pain could provide additional opportunities for learning more about the relationships between pain and athletic training procedures. We recommend that athletic trainers involved in research, as well as those engaged in clinical practice, consider systematically employing valid, multidimensional measures of pain to better understand the relationships between pain and athletic training outcomes.