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dynamic, recursive model of sport injury

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Get the latest research from NIH: https://www.nih.gov/coronavirus. Therefore, ex… Br J Sports Med. As concussions differ so widely, an awareness of risk factors and individual clinical characteristics can facilitate an individualized approach. In many cases, medical management is required; for some headache types, such as cervicogenic headaches, physical therapy may be of benefit.54,125 Botulinum toxin injection can be considered for posttraumatic chronic migraine headaches.24 Repetitive transcranial magnetic stimulation may be effective in the treatment of posttraumatic headache.60,69,70 Often, a multimodal approach to headache management includes both acute and prophylactic medication. 2019 Nov;49(11):799-810. doi: 10.2519/jospt.2019.8926. In sports with similar rules, women may be at greater risk of concussion than men.1,16,43,71,79 Risk may differ due to physical characteristics or because women may be more likely to report symptoms.23,117, As age increases through adolescence, the risk of concussion increases, before declining in the early twenties.1,34,43,50, History of attention deficit hyperactivity disorder or learning disability may increase the risk of concussion and/or detection of concussion in youth and collegiate athletes.10,42, Pre-existing symptoms of dizziness, neck pain, and headache may increase the risk of concussion in male youth ice hockey players.105 Possible explanations for the increased risk include altered neuromuscular control, sensorimotor control, balance, or cervical spine strength.101, High school athletes with lower neck strength may have a greater risk of concussion.19 In youth ice hockey players, an increased risk of concussion has been reported in players who did not meet the Canadian recommendations for daily physical activity (1 hour of daily physical activity) in the 6 weeks prior to study entry.9 Player skills and strategy of sport-specific techniques may also influence concussion risk. Individual athletes have their own risk factors that predispose them to concussion (FIGURE 1). The purpose of this clinical commentary was to summarize prevention, detection, assessment, and treatment factors that affect individuals across the continuum of concussion care, using the dynamic, recursive model of sport injury 88 framework. Address correspondence to Dr Kathryn J. Schneider, Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4. Once the individual has completed 1 to 2 days of rest, a gradual return to sport and school/work is recommended. American Medical Society for Sports Medicine position statement: concussion in sport. Sport-specific and performance-related skills may be necessary to return to full participation. If an injury does occur, withdrawal from further the basis of the interaction of the event attributes and pre-exposure may be the result; more often, recovery will facilitate existing risks. This model considers the implications of repeated exposure, whether such exposure produces adaptation, maladaptation, injury or complete/incomplete recovery from injury. How Do We Meet the Challenges of Assessing and Managing Concussion? Learn data science by working on real-world problems on sports injury prediction Learn how to use data and create predictive models to predict and reduce injury incidence. Data Scientists will get an edge in applying for jobs in sports injury, whereas medical professionals will get an improved undrestanding and skills in how data science can help their practice. Epub 2019 Oct 9. In addition to a thorough history, targeted assessment tests help clinicians to understand the source of dizziness. Epub 2019 Oct 14. In youth rugby players, there was a reduction in overall risk of game-related concussion when a neuromuscular training program was performed at least 3 times weekly.49 A vision training program may reduce the risk of concussion in collegiate football players.18 There was a 67% reduction in the risk of concussion in youth ice hockey following rule changes to disallow bodychecking.32 Tackle training and rules related to tackling in rugby as a way of decreasing risk of concussion are areas of ongoing evaluation.47 Finally, restricting the number of collision practices in youth football may reduce the frequency of head impacts in games and practice.14. Get the latest public health information from CDC: https://www.coronavirus.gov. 2009 Jan;123(1):114-23. doi: 10.1542/peds.2008-0309. Integrated Model of Psychological Responses to Sport Injury. Neuroendocrine dysfunction, caused by injury to the hypothalamic-pituitary axis following mild to severe traumatic brain injury5,6,90,114 and sport-related concussion,72,113,114,116 has been reported. Sport-Related Concussion: Optimizing Treatment Through Evidence-Informed Practice. Extrinsic Risk Factors for Concussion The environment in which an athlete plays includes factors that can influence the risk of concussion, many of which may be modifiable. Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment Journal of Orthopaedic&Sports Physical Therapy, Ahead of Print. Clinicians should use a multifaceted assessment that includes symptoms, a neurological screen, and assessment of multiple clinical domains.27,37 The Sport Concussion Assessment Tool Fifth Edition (SCAT5)29 includes an immediate/on-field assessment that incorporates red flags, observable signs, memory assessment (ie, the Maddocks questions), the Glasgow Coma Scale, and a cervical spine assessment. The Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary is one of eleven International Research Centres supported by the International Olympic Committee for Prevention of Injury and Protection of Athlete Health. Neurological examination, assessment of vestibulo-ocular reflex function, static balance, dynamic balance, assessment of nystagmus with and without fixation, positional testing, and vestibular function testing can inform diagnosis and management. Sports injuries are often recurrent in that some people experience more than one sports injury over time. Recursion and dynamic programming (DP) are very depended terms. In the presence of ongoing cervical spine findings, further interventional procedures, such as comparative controlled medial branch blocks (to confirm facet joint–mediated pain), trigger point injections (in the presence of ongoing myofascial pain), and greater occipital nerve blockades (in the presence of greater occipital neuralgia), may be considered.26,98, Dizziness is typically the second most common symptom following concussion.7 As with headache, identifying the source of dizziness is important to direct treatment—some disorders respond well to physical therapy (eg, benign paroxysmal positional vertigo [BPPV], unilateral peripheral vestibular hypofunction), while others require medical evaluation and management (eg, superior semicircular canal dehiscence).2,45,48. a dynamic, recursive model for risk and causes of sports injuries, considering that the injury has a non-linear behavior. A preliminary study, Predictors of clinical recovery from concussion: a systematic review, Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients, A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache, Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test, GH and pituitary hormone alterations after traumatic brain injury, Epidemiology of football injuries in the National Collegiate Athletic Association, 2004–2005 to 2008–2009, Concussion symptoms and return to play time in youth, high school, and college American football athletes, Dual-task assessment protocols in concussion assessment: a systematic literature review, Noninvasive brain stimulation for persistent postconcussion symptoms in mild traumatic brain injury, Sensorimotor function and dizziness in neck pain: implications for assessment and management, Aerobic exercise for adolescents with prolonged symptoms after mild traumatic brain injury: an exploratory randomized clinical trial, Neuroendocrine dysfunction in a young athlete with concussion: a case report, Pain and sleep in post-concussion/mild traumatic brain injury, Brain or strain? In most cases, the symptoms of concussion resolve in the initial few days following the injury, and a strategy involving a gradual return to sport and school is recommended. For individuals with ongoing dizziness, neck pain, and headaches, cervicovestibular physical therapy can be beneficial.103,104,106 Sport-specific training, related to the context in which the individual would be participating, should form an integral part of the rehabilitation program.106 For children and adolescents with visual and vestibular findings, vestibular rehabilitation may be of benefit.111 In addition, low-level aerobic exercise may promote recovery following concussion.40,62,67, Collaborative care, including cognitive-behavioral therapy, care management, and psychopharmacological evaluation, has positive effects on symptom reduction after 6 months.83 An active approach to rehabilitation, including aerobic exercise, visualization, and coordination, has positive effects on symptoms and function.39,40 Future research to best understand timing, order, frequency, and other parameters of combination treatments is warranted.103. The office (off-field) assessment portion of the SCAT5 includes history, symptoms, cognitive screening (from the Standardized Assessment of Concussion, which includes orientation, immediate and delayed memory questions, and digits and months of the year in reverse order), a neurological screen (including reading, cervical spine range of motion, ocular motor function, coordination, and balance), and a modified version of the Balance Error Scoring System.29 The Child Sport Concussion Assessment Tool Fifth Edition should be used with children aged 5 to 12 years.21, The clinical utility of the SCAT5 diminishes after the initial 3 to 5 days following injury.84 However, the symptom scale on the SCAT5 can be used to evaluate change in symptoms over time. E-mail: The risk factors of concussion may be categorized as intrinsic (internal factors specific to the individual) or extrinsic (external factors related to the environment or sport). Each individual can present with a unique set of symptoms and aggravating or relieving factors following concussion.84 Individualized assessments are imperative to best understand the etiology of symptoms.37,78,102,106 A multifaceted, interdisciplinary approach to assessment and management is vital. In this section, we summarize the key intrinsic and extrinsic risk factors for concussion. If symptoms recur or are exacerbated, reduce the demands of the task to a level that does not provoke symptoms. The purpose of this clinical commentary was to summarize prevention, detection, assessment, and treatment factors that affect individuals across the continuum of concussion care, using the dynamic, recursive model of sport injury88 framework. In this section, we outline 9 common persistent symptoms following concussion,7,58,106 describe differential diagnoses, and offer an overview of evidence-based rehabilitation approaches. Each individual who participates in an activity brings a specific set of intrinsic and extrinsic factors (FIGURE 1). 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