Overview
Concussion stands out as a frequent injury in sports and recreational activities, with significant clinical challenges in managing prolonged recovery [PMID:27477472].
This consensus document, developed by an international panel including McCrory et al. [PMID:20048521], aims to refine and expand upon previous recommendations from Vienna and Prague, offering comprehensive guidance for healthcare professionals involved in athlete care [PMID:20048521].
Pathophysiology
The study found an inverse association between the number of previous concussions (assessed by both CISG and ACRM criteria) and hippocampal volume, suggesting structural brain changes [PMID:33397203].
The paper discusses CTE, characterized by motor, psychological, and cognitive symptoms, which is thought to result from single or repetitive concussions and shares some pathological features with Alzheimer's disease [PMID:32107272].
Quantitative susceptibility mapping revealed statistically significant increases in white matter susceptibility in concussed athletes at acute (24 hours) and subacute (8 days) time points, suggesting persistent physiologic changes beyond clinical recovery [PMID:29880474].
When the head is impacted, the brain lags behind due to inertia, leading to relative motion and resultant strains and pressure gradients that can exceed tolerable limits, causing injury [PMID:27482775].
Linear acceleration typically results in focal injuries like hematomas and contusions through intracranial pressure gradients, while rotational acceleration causes diffuse injuries such as diffuse axonal injuries and concussion through shear strain [PMID:27482775].
Contact with the ice generated the greatest-magnitude head accelerations, which could contribute to higher concussion rates [PMID:25098659].
Karton C, Hoshizaki TB [PMID:33187609] emphasize the importance of understanding biomechanical measures to establish relationships between traumatic forces and neurological injuries, highlighting the necessity for precise exposure metrics in assessing concussion risk.
The study highlights that clinical symptoms and underlying physiological changes in concussion are related yet independent, necessitating further scientific exploration [PMID:30482355].
The study suggests that biomechanical differences, such as higher PLA and HITsp magnitudes in female athletes, could play a role in the increased concussion incidence rates observed in female athletes [PMID:29856659].
This review [PMID:27184060] elucidates that understanding cellular-level changes from more severe traumatic brain injuries can provide insights into acute concussion symptoms and potential mechanisms for persistent post-concussive symptoms.
Recent imaging and biomarker studies discussed in [PMID:27184060] suggest that cumulative subconcussive forces could have detrimental long-term effects, warranting further investigation into their clinical implications.
Epidemiology
The paper notes that a substantial percentage of athletes globally, including 74% of Jordanian, 24% of Irish, and 9% of American collegiate athletes, have not received concussion information, underscoring the necessity for more accessible educational methods [PMID:40694542].
A systematic review identified that most studies of sports-related concussions relied on samples that were 80.1% male, with 40.4% not including female participants at all [PMID:39078562].
Japanese athletes engaged in contact sports reported a significantly higher prevalence of SRC history compared to those in limited contact or non-contact sports [PMID:38243738].
A total of 1900 HAEs were recorded over 48 training and 53 competition days, highlighting the consistent exposure to head impacts in this sliding sport [PMID:37648215].
Kerschner et al. ([PMID:32941381]) note that a significant portion of SRC-related emergency department visits occur among young athletes, emphasizing the critical need for standardized management protocols in high school and college settings.
While much literature focuses on older children, this study highlights the importance of considering younger children, especially those involved in sports, who can incur concussions and require parental management (PMID:34399916).
In the United States (high publicity), only 9.4% of athletes reported never receiving concussion information, compared to 24.2% in Ireland (moderate publicity) and 73.6% in Jordan (low publicity) [PMID:33259602].
A nested case-control study involving 72 concussed players and controls found that inadequate helmet fit (defined as missing more than one fit criterion) was associated with greater odds of concussion (OR = 2.67 [95% CI = 1.04, 6.81], P = .040) when compared to uninjured players [PMID:33238008].
Clinical Presentation
The study highlights that despite available concussion education resources, knowledge gaps persist among athletes, suggesting that alternative mediums like Sport-based Video Games (SBVGs) could play a role in enhancing concussion recognition and appropriate behaviors [PMID:40694542].
Evidence suggests that female athletes experience distinct manifestations of concussion symptoms and recovery patterns, highlighting the need for sex-specific considerations in clinical presentation [PMID:39078562].
Previous SRC history and exposure to SRC education independently contributed to higher SRC knowledge scores among the surveyed athletes [PMID:38243738].
No differences were found in the number of HAEs, workload, peak linear velocity, peak angular velocity, peak linear acceleration, or peak angular acceleration between sexes [PMID:37648215].
Children aged 5-10 are more likely to depend on parents for concussion education and care, emphasizing the need for parents to be well-informed about concussion symptoms and management (PMID:34399916).
Participants with a history of concussions, identified using ACRM criteria, exhibited significantly higher levels of concussion-related and psychological symptoms compared to those without such a history [PMID:33397203].
US athletes demonstrated significantly higher concussion knowledge scores (40.9 ± 4.5) compared to Irish (32.1 ± 3.5) and Jordanian (35.1 ± 5.6) athletes [PMID:33259602].
The study underscores that parents play a vital role in identifying delayed concussion symptoms, highlighting the necessity for comprehensive education that empowers them to recognize and act on these signs [PMID:32830117].
Helmich et al. (2016) [PMID:31954336] found that concussed athletes with ongoing symptoms show decreased brain oxygenation in frontal cortices during balance tasks, yet increased activation in frontopolar cortices under conditions of visual and tactile manipulation compared to asymptomatic athletes and controls.
No significant differences were found in SRC signs and symptoms knowledge between athletes in traditional (n = 244) versus nontraditional (n = 165) sports, suggesting a uniform baseline of awareness [PMID:30273011].
The MULES test highlights impairments in visual perception and language processing, reflecting the multifaceted impact of concussion on brain function [PMID:29571863].
Diagnosis
The impact of previous concussions on symptom reporting and brain structure varied depending on whether ACRM or CISG criteria were used, highlighting the importance of diagnostic standards [PMID:33397203].
Helmich et al. (2016) [PMID:31954336] demonstrated that concussed athletes with persistent symptoms display distinct patterns of decreased frontal cortex oxygenation and increased frontopolar cortex activation during balance tasks, offering a potential diagnostic biomarker.
Susceptibility changes in white matter were observed to outlast self-reported clinical recovery metrics at a group level, indicating potential for this imaging technique to identify ongoing brain changes [PMID:29880474].
The MULES test assesses color perception, object identification, conceptual representation, phonology, and articulation, providing a new tool for sideline concussion screening [PMID:29571863].
Compared to the King-Devick test, MULES evaluates broader cognitive and visual functions, potentially offering a more comprehensive sideline assessment for concussion [PMID:29571863].
While subjective symptom assessments are crucial, rs-fMRI offers an objective measure linking brain function alterations to symptom severity, potentially improving diagnostic accuracy and management decisions [PMID:29560308].
Preexisting conditions such as ADHD and neurological disorders significantly influence baseline neurocognitive scores, suggesting careful consideration is needed when diagnosing concussions [PMID:28071936].
Clinical assessment of concussion should consider kinematic characteristics such as linear and rotational skull accelerations, as these parameters reflect the brain's inertial response and are indicative of injury mechanisms [PMID:27482775].
This study utilized the HIT System to monitor head impacts in female collegiate ice hockey players, offering a method to quantify and analyze impacts linked to diagnosed concussions [PMID:25913243].
The study by Eckner et al. [PMID:21944073] demonstrates that a clinically administered reaction time test (RT(clin)) has good test-retest reliability (intraclass correlation coefficient of 0.645) over consecutive seasons in collegiate athletes, comparable to a computerized measure (RT(comp)). This suggests its potential as part of a concussion assessment battery.
RT assessment is crucial as it increases the sensitivity of clinical examinations for detecting concussion effects and can remain impaired even in asymptomatic athletes [PMID:21402367].
The review underscores the potential of incorporating cerebral physiologic measures during aerobic exercise as part of concussion diagnosis and monitoring [PMID:38482939].
The study indicates that computerized reaction time assessments, commonly used post-concussion, do not correlate with functional reaction times during sport-like activities in female collegiate athletes [PMID:36906428].
Analysis of serum protein biomarkers in concussed amateur Australian rules football players revealed that while some biomarkers like BLBP and 4-hydroxynoneal showed changes post-concussion, their AUROC values indicated poor clinical utility for diagnostic purposes [PMID:35176905].
Key imaging findings such as midline shift and hemorrhage size >10 mm significantly influenced surgical decisions among experts, highlighting their importance in diagnosis and subsequent management [PMID:33693899].
Differential Diagnosis
Guskiewicz et al. (1997) and subsequent studies, including Helmich et al. (2016) [PMID:31954336], suggest evaluating postural control under varied sensory conditions (e.g., closed eyes, unstable surfaces) to differentiate sensory integration issues from other post-concussion symptoms.
The study highlights the importance of recognizing that repetitive head impacts, even without immediate concussion symptoms, could contribute to long-term neurological issues in rodeo athletes [PMID:39311737].
Multiple regression analyses indicated that factors such as treatment for psychiatric conditions, headaches, learning disabilities (specifically in boys), and ADHD were stronger predictors of symptom reporting than concussion history, particularly in girls [PMID:35030638].
The study underscores the importance of proactive questioning and awareness of symptom underreporting to ensure accurate diagnosis and appropriate management [PMID:34605752].
While acute disorientation or a vacant look were observed, these symptoms did not correlate with cognitive changes meeting the reliable change threshold, suggesting they may not be primary indicators of severe concussion [PMID:33210122].
In diagnosing concussions among hockey players, clinicians must consider the context of potential rule violations and head impact scenarios, as these factors are crucial in distinguishing concussion from other injuries [PMID:25757010].
The study found no statistical distinction in symptom reporting between patients with physiologic PCD and those with cervicogenic/vestibular PCD, indicating the need to consider non-brain sources for cognitive symptoms [PMID:25051194].
Management
Given the inconsistent engagement with traditional concussion education methods, SBVGs could serve as an innovative tool to model and reinforce proper concussion management practices [PMID:40694542].
The paper emphasizes the potential of neuroinformatics, including multimodal neuroimaging and data science techniques, to better understand and manage concussions in female athletes, addressing current biases in assessment and treatment [PMID:39078562].
Athletes with access to medical staff (MEDYES) demonstrated higher SRC knowledge scores compared to those without such access (MEDNO) [PMID:38243738].
The study concludes that further investigation is needed to determine the effects of repetitive head impacts on neurocognitive function and mental health in these athletes [PMID:37648215].
The study by Kerschner et al. ([PMID:32941381]) highlights that despite standardized protocols like those from the International Concussion in Sport Group, there are notable differences in RTP practices between high school and college athletes, though overall management has improved significantly since the early 2000s.
Although prior studies suggested no significant differences in RTP management between high school and college athletes, Kerschner et al. ([PMID:32941381]) highlight the need for further investigation into longitudinal differences and annual variations in these practices.
Parents' beliefs about concussion reporting and seeking care are influenced by factors such as socioeconomic status, personal concussion history, child's previous concussions, and their occupation in healthcare (PMID:34399916). Concerns about missing playing time or affecting sports performance can also impact parental decisions regarding concussion reporting and medical care.
Given that different diagnostic criteria (ACRM vs. CISG) yield varying clinical associations, management strategies should account for the specific criteria used to identify previous concussions [PMID:33397203].
A higher percentage of US and Irish athletes reported both diagnosed concussions (29.6% and 31.8%, respectively) and nondisclosure of concussions (15.5% and 25.2%, respectively) compared to Jordanian athletes (2.3% and 0.0%, respectively) [PMID:33259602].
The study suggests that ensuring proper helmet fit could potentially reduce concussion risk among youth ice hockey players, highlighting the importance of fit assessment in protective equipment management [PMID:33238008].
This study highlights that while concussion education increases knowledge among parents and coaches, its effect on actual behaviors remains less explored, emphasizing the need for interventions that bridge the intention-to-behavior gap [PMID:32830117].
The paper suggests that uncovering a definitive association between concussion and cognitive decline could necessitate changes in concussion prevention, management policies, and sports regulations [PMID:32107272].
The study by Helmich et al. (2016) [PMID:31954336] suggests that interventions targeting frontopolar brain activation could be beneficial for athletes experiencing prolonged balance deficits post-concussion, indicating a need for more nuanced rehabilitation approaches.
Chi-square tests revealed significant differences in reasons for not reporting concussions between athletes in traditional versus nontraditional sports, underscoring the necessity for sport-specific management strategies [PMID:30273011].
The persistence of white matter susceptibility changes beyond clinical recovery suggests that quantitative susceptibility mapping might provide clinicians with a more sensitive method to evaluate recovery progress [PMID:29880474].
The study indicates that downsizing the MULES test to a more portable format (8.5" × 11") maintains its effectiveness in assessing cognitive functions post-concussion [PMID:29571863].
Identifying specific connectivity patterns linked to symptom severity through rs-fMRI could guide tailored rehabilitation and return-to-play protocols, enhancing clinical management [PMID:29560308].
The study indicates that simple reaction time did not recover to baseline levels until day 14 post-concussion, suggesting a prolonged monitoring period is necessary for recovery assessment [PMID:28722468].
During tournament games, increased ice time was associated with increased severity of head impacts (P = .03) [PMID:28715282].
Complications
The presence of a diagnosed psychiatric disorder was associated with a HR of 0.5, indicating a longer time to recovery compared to patients without such disorders (p < 0.001) [PMID:35430429].
Prognosis & Follow-up
The research indicates a substantial increase in the median time to RTP for collegiate athletes from 3 days (1999-2001) to 12 days (2014-2017), suggesting evolving clinical practices and possibly improved safety measures ([PMID:32941381]).
The observed reduction in hippocampal volume suggests that longitudinal assessments could be crucial for tracking cognitive health in athletes with a history of multiple concussions [PMID:33397203].
The review emphasizes the importance of assessing long-term cognitive outcomes in former professional athletes to determine the significance of concussion on later cognitive function [PMID:32107272].
Research indicates that sensitive measures of postural stability reveal alterations lasting months to years post-concussion, with Helmich et al. (2016) [PMID:31954336] highlighting persistent frontopolar brain activation patterns in symptomatic athletes, suggesting the need for extended follow-up.
At an individual level, higher susceptibility increases in white matter were significantly correlated with extended return-to-play durations, suggesting a potential biomarker for recovery assessment [PMID:29880474].
Quantitative susceptibility mapping showed no significant differences between concussed athletes and controls at the 6-month follow-up, indicating recovery of white matter susceptibility over time [PMID:29880474].
Studies indicate that reduced DMN connectivity post-concussion correlates with more severe and persistent symptoms, suggesting potential prognostic value for long-term follow-up [PMID:29560308].
The timeline for recovery of simple reaction time aligns with other cognitive performance measures, typically returning to baseline around 14 days post-concussion, providing a useful metric for follow-up evaluations [PMID:28722468].
Special Populations
The CARE Consortium and similar initiatives aim to bridge the knowledge gap by focusing on sex-specific factors to develop more effective injury prevention and management strategies for female athletes [PMID:39078562].
The study underscores the importance of considering age-specific factors in managing SRC, as differences in recovery times and RTP protocols between high school and college athletes may influence clinical outcomes ([PMID:32941381]).
The study underscores a gap in research focusing on parents of younger children (ages 5-10) compared to those of high school-aged children, indicating a need for tailored interventions for this age group (PMID:34399916).
The study focuses on professional or elite sport-persons, indicating a specific need for monitoring and managing concussion risks in this population due to potential long-term cognitive sequelae [PMID:32107272].
The study highlights the necessity for specific concussion management strategies in female youth ice hockey players, given the occurrence of head impacts despite the absence of body checking [PMID:28715282].
The research underscores the necessity for sex-specific biomechanical studies in female athletes, particularly in ice hockey, to better understand concussion mechanisms and outcomes [PMID:25913243].
Current RT assessment tools are limited by their dependence on specialized software, making them less accessible for youth athletes and those in leagues with limited financial resources [PMID:21402367].
The research underscores the importance of recognizing collegiate athletes with a history of 2 or more concussions as a distinct group needing specific attention and potentially different recovery timelines [PMID:18345335].
The 6th International Conference on Concussion in Sport recommends the use of mouthguards for children and adolescents, alongside disallowing body checking for younger players [PMID:38950440].
Key Recommendations
To mitigate assessment and treatment biases, it is recommended that future research and clinical practices emphasize comprehensive data collection specifically from female athletes [PMID:39078562]. (Evidence: Expert opinion)
Given the lower SRC knowledge scores in non-contact and limited contact sports, targeted educational interventions may be necessary to bridge this knowledge gap [PMID:38243738]. (Evidence: Expert opinion)
Given the formative nature of early childhood and the reliance on parental guidance, interventions should focus on providing parents with age-appropriate concussion education to foster healthy attitudes towards injury reporting and care (PMID:34399916). (Evidence: Expert opinion)
The study highlights the need for more culturally appropriate concussion initiatives to ensure athletes worldwide can recognize concussions and understand the risks of playing while concussed [PMID:33259602]. (Evidence: Expert opinion)
While the findings indicate a potential link between inadequate helmet fit and increased concussion risk, the authors recommend further investigation with larger sample sizes to solidify helmet-fit recommendations [PMID:33238008]. (Evidence: Expert opinion)
The Health Action Process Approach (HAPA) model suggests that effective concussion education should focus on both motivational factors (risk perception, outcome expectancies) and volitional factors (self-efficacy, planning) to improve actual management behaviors [PMID:32830117]. (Evidence: Expert opinion)
Given that many athletes do not report concussions due to a lack of recognition of their seriousness, targeted educational initiatives are crucial to improve reporting behaviors [PMID:30273011]. (Evidence: Expert opinion)
Given the current study's limitations, there is a need for additional research that comprehensively captures physical activity intensity and includes diverse youth populations to better understand concussion risk factors [PMID:30181187]. (Evidence: Expert opinion)
Given the sensitivity of tests like MULES in capturing cognitive and visual impairments, integrating such tools into routine sideline evaluations is recommended for better concussion management [PMID:29571863]. (Evidence: Expert opinion)
Given the association between rs-fMRI markers and symptom severity, integrating these objective measures into concussion protocols alongside SCAT assessments may improve clinical decision-making [PMID:29560308]. (Evidence: Expert opinion)
Understanding the influence of factors like sex, ADHD, and neurological conditions on baseline ImPACT scores is crucial for developing personalized concussion management strategies [PMID:28071936]. (Evidence: Expert opinion)
References
1 Petrie FJ, Howarth N, Bureau SC, Nowinski CJ, Woodward JS, Lockett I. E-concussion? an investigation of the representation of head impact events and concussion within popular sport-based video games. PloS one 2025. link 2 Edelstein R, Gutterman S, Newman B, Van Horn JD. Assessment of Sports Concussion in Female Athletes: A Role for Neuroinformatics?. Neuroinformatics 2024. link 3 Tashima C, Otomo M, Hosokawa Y. History, Knowledge, and Education of Sport-Related Concussion Among College Athletes in Japan. Journal of athletic training 2024. link 4 McPherson AL, Anderson T, Finnoff JT, Adams WM. Head Kinematics and Injury Analysis in Elite Bobsleigh Athletes Throughout a World Cup Tour. Journal of athletic training 2024. link 5 Kerschner AE, Huber DL, Brett BL, Meier TB, Nelson LD, McCrea MA. Age-Group Differences and Annual Variation in Return-To-Play Practices After Sport-Related Concussion. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 2022. link 6 Haarbauer-Krupa JK, Register-Mihalik JK, Nedimyer AK, Chandran A, Kay MC, Gildner P et al.. Factors associated with concussion symptom knowledge and attitudes towards concussion care-seeking among parents of children aged 5-10 years. Journal of safety research 2021. link 7 Meier TB, España LY, Kirk AJ, Nader AM, Powell JE, Nelson LD et al.. Association of Previous Concussion with Hippocampal Volume and Symptoms in Collegiate-Aged Athletes. Journal of neurotrauma 2021. link 8 Beidler E, Wallace J, Alghwiri AA, O'Connor S. Collegiate Athletes' Concussion Awareness, Understanding, and -Reporting Behaviors in Different Countries With Varying Concussion Publicity. Journal of athletic training 2021. link 9 Gamble ASD, Bigg JL, Sick S, Krolikowski M, Patton DA, Hagel BE et al.. Helmet Fit Assessment and Concussion Risk in Youth Ice Hockey Players: A Nested Case-Control Study. Journal of athletic training 2021. link 10 Black AM, Yeates KO, Babul S, Nettel-Aguirre A, Emery CA. Association between concussion education and concussion knowledge, beliefs and behaviours among youth ice hockey parents and coaches: a cross-sectional study. BMJ open 2020. link 11 Gallo V, Motley K, Kemp SPT, Mian S, Patel T, James L et al.. Concussion and long-term cognitive impairment among professional or elite sport-persons: a systematic review. Journal of neurology, neurosurgery, and psychiatry 2020. link 12 Helmich I, Coenen J, Henckert S, Pardalis E, Schupp S, Lausberg H. Reduced frontopolar brain activation characterizes concussed athletes with balance deficits. NeuroImage. Clinical 2020. link 13 Beidler E, Bretzin AC, Hanock C, Covassin T. Sport-Related Concussion: Knowledge and Reporting Behaviors Among Collegiate Club-Sport Athletes. Journal of athletic training 2018. link 14 Blake TA, Doyle-Baker PK, Brooks BL, Palacios-Derflingher L, Emery CA. Physical activity and concussion risk in youth ice hockey players: pooled prospective injury surveillance cohorts from Canada. BMJ open 2018. link 15 Koch KM, Meier TB, Karr R, Nencka AS, Muftuler LT, McCrea M. Quantitative Susceptibility Mapping after Sports-Related Concussion. AJNR. American journal of neuroradiology 2018. link 16 Akhand O, Galetta MS, Cobbs L, Hasanaj L, Webb N, Drattell J et al.. The new Mobile Universal Lexicon Evaluation System (MULES): A test of rapid picture naming for concussion sized for the sidelines. Journal of the neurological sciences 2018. link 17 Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Connectomic markers of symptom severity in sport-related concussion: Whole-brain analysis of resting-state fMRI. NeuroImage. Clinical 2018. link 18 Del Rossi G. Evaluating the Recovery Curve for Clinically Assessed Reaction Time After Concussion. Journal of athletic training 2017. link 19 Reed N, Taha T, Greenwald R, Keightley M. Player and Game Characteristics and Head Impacts in Female Youth Ice Hockey Players. Journal of athletic training 2017. link 20 Cottle JE, Hall EE, Patel K, Barnes KP, Ketcham CJ. Concussion Baseline Testing: Preexisting Factors, Symptoms, and Neurocognitive Performance. Journal of athletic training 2017. link 21 Rowson S, Bland ML, Campolettano ET, Press JN, Rowson B, Smith JA et al.. Biomechanical Perspectives on Concussion in Sport. Sports medicine and arthroscopy review 2016. link 22 Wilcox BJ, Beckwith JG, Greenwald RM, Raukar NP, Chu JJ, McAllister TW et al.. Biomechanics of head impacts associated with diagnosed concussion in female collegiate ice hockey players. Journal of biomechanics 2015. link 23 Wilcox BJ, Machan JT, Beckwith JG, Greenwald RM, Burmeister E, Crisco JJ. Head-impact mechanisms in men's and women's collegiate ice hockey. Journal of athletic training 2014. link 24 Eckner JT, Kutcher JS, Richardson JK. Between-seasons test-retest reliability of clinically measured reaction time in National Collegiate Athletic Association Division I athletes. Journal of athletic training 2011. link 25 Eckner JT, Kutcher JS, Richardson JK. Effect of concussion on clinically measured reaction time in 9 NCAA division I collegiate athletes: a preliminary study. PM & R : the journal of injury, function, and rehabilitation 2011. link 26 Covassin T, Stearne D, Elbin R. Concussion history and postconcussion neurocognitive performance and symptoms in collegiate athletes. Journal of athletic training 2008. link 27 Carlson CD, Munce T, Miller J, Dorman JC, Valentine VD. Head Impacts in Collegiate Rodeo Athletes: An Observational Study. South Dakota medicine : the journal of the South Dakota State Medical Association 2024. link 28 Shlobin NA, Goel K, Chen JS, Kondziolka D. Concussions in ice hockey: mixed methods study including assessment of concussions on games missed and cap hit among National Hockey League players, systematic review, and concussion protocol analysis. Neurosurgical focus 2024. link 29 Cordingley DM, Gomez A, Ellis M, Zeiler FA. Identifying the Cerebral Physiologic Response to Aerobic Exercise Following Concussion: A Scoping Review. The Journal of head trauma rehabilitation 2024. link 30 Shumski EJ, Anderson MN, Oh J, Schmidt JD, Lynall RC. Computerized and functional reaction time in varsity-level female collegiate athletes with and without a concussion history. Journal of science and medicine in sport 2023. link 31 Pate J, Cummins I, Mooney J, Cooper K, McLeod C, Gould S. Socioeconomic and demographic considerations of pediatric concussion recovery. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 2022. link 32 Sun M, Symons GF, O'Brien WT, Mccullough J, Aniceto R, Lin IH et al.. Serum Protein Biomarkers of Inflammation, Oxidative Stress, and Cerebrovascular and Glial Injury in Concussed Australian Football Players. Journal of neurotrauma 2022. link 33 Iverson GL, Berkner PD, Zafonte R, Maxwell B, Terry DP. Preseason Symptom Reporting and Cognition in Middle School Athletes with Past Concussions. International journal of sports medicine 2022. link 34 Bloom DA, Whitney DC, Gonzalez-Lomas G, Carter CW. The Incidence of Concussion and Symptom Non-Reporting Among Professional Women's Ice Hockey Players. Bulletin of the Hospital for Joint Disease (2013) 2021. link 35 Zuckerman SL, Yengo-Kahn AM, Tang AR, Bailes JE, Beauchamp K, Berger MS et al.. Sport-Related Structural Brain Injury and Return to Play: Systematic Review and Expert Insight. Neurosurgery 2021. link 36 Kati P, Matti V, Sanna K, Jon P, Tiina L, Laura H. Post-Concussion Acute Signs and Reliable Cognitive Decline in a Finnish Youth Ice Hockey Sample. Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists 2021. link 37 Karton C, Hoshizaki TB. Biomechanics of Sport-Related Neurological Injury. Clinics in sports medicine 2021. link 38 Asken BM, Hack DC, McCrea MA. The modern landscape of sport-related concussion research: key achievements and future directions. Handbook of clinical neurology 2018. link 39 Eckner JT, O'Connor KL, Broglio SP, Ashton-Miller JA. Comparison of Head Impact Exposure Between Male and Female High School Ice Hockey Athletes. The American journal of sports medicine 2018. link 40 Schneider KJ. Sport-Related Concussion: Optimizing Treatment Through Evidence-Informed Practice. The Journal of orthopaedic and sports physical therapy 2016. link 41 Choe MC. The Pathophysiology of Concussion. Current pain and headache reports 2016. link 42 Smith AM, Stuart MJ, Dodick DW, Roberts WO, Alford PW, Ashare AB et al.. Ice Hockey Summit II: zero tolerance for head hits and fighting. Current sports medicine reports 2015. link 43 Leddy JJ, Baker JG, Merchant A, Picano J, Gaile D, Matuszak J et al.. Brain or strain? Symptoms alone do not distinguish physiologic concussion from cervical/vestibular injury. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 2015. link 44 McCrory P, Meeuwisse W, Johnston K, Dvorak J, Aubry M, Molloy M et al.. Consensus statement on concussion in sport - the Third International Conference on Concussion in Sport held in Zurich, November 2008. The Physician and sportsmedicine 2009. link
44 papers cited of 88 indexed.