Combined Sections Meeting 2025 “Concussion Discussion in the Performing Arts” References,

By Slide Title:

Definitions: Concussion

American Academy of Neurology, April 2024

https://www.aans.org/patients/conditions-treatments/concussion/ Accessed December 2024.

Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022. British Journal of Sports Medicine 2023; 57: 695-711.

The Numbers…

https://www.cdc.gov/nchs/data/databriefs/db441.pdf (accessed 2/3/25)

Centers for Disease Control and Prevention. Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. Atlanta, GA: National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention, 2015.

McLeod TV, Hale T. Vestibular and balance issues following sport-related concussion. Brain Inj. 2014; 29: 175-184.

Belanger HG, Vanderploeg RD, McAllister T. Subconcussive Blows to the Head: A Formative Review of Short-term Clinical Outcomes. J Head Trauma Rehabil. 2016 May-Jun;31(3):159-66. doi: 10.1097/HTR.0000000000000138. PMID: 25931186.

https://www.nbcconnecticut.com/investigations/possible-link-between-figure-skating-spins-and-concussions/98804/ Wang D. (Accessed 2/3/25)

Romeas T, Croteau F, Leclerc S. Where is the research on sport-related concussion in Olympic athletes? A descriptive report and assessment of the impact of access to multidisciplinary care on recovery. Br J Sports Med. 2024 Sep 4;58(17):993-1000. doi: 10.1136/bjsports-2024-108211. PMID: 39013617.

Definitions of Concussion

Barlow KM, Crawford S, Stevenson A, et al. Epidemiology of Postconcussion syndrome in pediatric mild traumatic brain injury. Pediatrics 2010;126:e374–81.

Zemek R, Barrowman N, Freedman SB, et al. Clinical risk score for persistent Postconcussion symptoms among children with acute concussion in the ED. JAMA 2016;315:1014.

Rajabali F, Ibrahimova A, Turcotte K, et al. Concussion among children and youth in British Columbia. 20

Eapen N, Davis GA, Borland ML, et al. Clinically important Sport-Related traumatic brain injuries in children. Med J Aust 2019;211:365–6.

Concussion Sequelae

Giza C, Hovda D. The New Neurometabolic Cascade of Concussion. J Athl Train 2001; 36: 228-235.

Stern, R. A., Riley, D. O., Daneshvar, D. H., Nowinski, C. J., Cantu, R. C., & McKee, A. C. (2011). Long-term consequences of repetitive brain trauma: Chronic traumatic encephalopathy. PM & R : The Journal of Injury, Function, and Rehabilitation, 3(10 Suppl 2), S460-7. https://10.1016/j.pmrj.2011.08.008 [doi]

Albrecht J, Lindback M, Bradford S. What Physical Education Teachers and Sport Coaches Should Know About the Assessment of Concussions. Phys Health Educ J. 2013; 79: 6.

Lynall RC, Mauntel TC, Pohlig RT, Kerr ZY, Dompier TP, Hall EE, Buckley TA. Lower Extremity Musculoskeletal Injury Risk After Concussion Recovery in High School Athletes. J Athl Train. 2017 Nov;52(11):1028-1034. doi: 10.4085/1062-6050-52.11.22. Epub 2017 Nov 15. PMID: 29140128; PMCID: PMC5737038.

Ling GSF and Marshall SA. Management of Traumatic Brain Injury in the Intensive Care Unit. Neurologic Clinics 2008; 26(2): 409-426.

McCrory P, Meeuwisse, WH, Kutcher, JS, Jordan, BD, & Gardner A. What is the evidence for chronic concussion-related changes in retired athletes: Behavioural, pathological and clinical outcomes? British Journal of Sports Medicine, (2013b); 47(5), 327-330.

Rabinowitz, A. R., & Levin, H. S. (2014). Cognitive sequelae of traumatic brain injury. Psychiatric Clinics of North America, 37(1), 1.

McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte ET, Gavett BE, Budson AE, Santini VE, Lee HS, Kubilus CA, Stern RA. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol. 2009 Jul;68(7):709-35. doi: 10.1097/NEN.0b013e3181a9d503. PMID: 19535999; PMCID: PMC2945234.

Armstrong RA, McKee AC, Alvarez VE, Cairns NJ. Clustering of tau-immunoreactive pathology in chronic traumatic encephalopathy. J Neural Transm (Vienna). 2017 Feb;124(2):185-192. doi: 10.1007/s00702-016-1635-1. Epub 2016 Oct 21. PMID: 27770214; PMCID: PMC5288283.

Factors the May Delay Recovery

Guskiewicz KM, McCrea M, Marshall SW, et al. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003;290(19):2549-2555.

Guskiewicz KM, Weaver NL, Padua DA, Garrett WE., Jr Epidemiology of concussion in collegiate and high school football players. Am J Sports Med. 2000;28(5):643-650.

Hollis SJ, Stevenson MR, McIntosh AS, et al. Incidence, risk, and protective factors of mild traumatic brain injury in a cohort of Australian nonprofessional male rugby players. Am J Sports Med. 2009;37(12):2328-2333.

Iverson GL. Misdiagnosis of the persistent postconcussion syndrome in patients with depression. Arch Clin Neuropsychol. 2006;21(4):303-310.

Sport-related concussion: factors associated with prolonged return to play. Clin J Sport Med. 2004;14(6):339-343.

McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Clin J Sport Med. 2009;19(3):185-200

Master, Christina L. MD, CAQSM*,†; Master, Stephen R. MD, PhD‡; Wiebe, Douglas J. PhD§; Storey, Eileen P. AB*; Lockyer, Julia E. MS*; Podolak, Olivia E. MD*; Grady, Matthew F. MD, CAQSM*,†. Vision and Vestibular System Dysfunction Predicts Prolonged Concussion Recovery in Children. Clinical Journal of Sport Medicine 28(2):p 139-145, March 2018.

Reddy CC, Collins MW. Sports concussion: management and predictors of outcome. Curr Sports Med Rep. 2009;8(1):10-15

Snell DL, Faulkner JW, Williman JA, Silverberg ND, Theadom A, Surgenor LJ, Hackney J, Siegert RJ. Fear avoidance and return to work after mild traumatic brain injury. Brain Inj. 2023 May 12;37(6):541-550. doi: 10.1080/02699052.2023.2180663. Epub 2023 Feb 22. PMID: 36856140.

Pluhar E, McCracken C, Griffith KL, Christino MA, Sugimoto D, Meehan WP 3RD. Team sport athletes may be less likely to suffer anxiety or depression than individual sport athletes. J Sports Sci Med. 2019; 18(3): 490-96.

Refakis, C. A., Turner, C. D., & Cahill, P. J. (2017). Sports-related concussion in children and adolescents. Clinical Spine Surgery, 30(5), 191-196.

Ilie, G., Trenholm, M., Boak, A., Mann, R. E., Adlaf, E. M., Asbridge, M., Hamilton, H., Rehm, J., Rutledge, R., & Cusiman, M. D. (2020). Adolescent traumatic brain injuries: Onset, mechanism and links with current academic performance and physical injuries. PloS One, 15(3), e0229489-e0229489.

Ilie, G., Adlaf, E. M., Mann, R. E., Boak, A., Hamilton, H., Asbridge, M., Colantonio, A., Turner, N. E., Rehm, J., & Cusimano, M. D. (2014). The moderating effects of sex and age on the association between traumatic brain injury and harmful psychological correlates among adolescents. PloS One, 9(9), e108167-e108167.

Gillett, G. (2018). Concussion in sport: The unheeded evidence. Cambridge Quarterly of Healthcare Ethics : CQ : The International Journal of Healthcare Ethics Committees, 27(4), 710-716. https://10.1017/S0963180118000191 [doi]

Campanelli V, Piscitelli F, Verardi L, Maillard P, Sbarbati A. Lower extremity overuse conditioning affecting figure skaters during daily training. Orthop J Sports Med. 2015; 3(7):2325967115596517.

Standard of Practice: Past vs. Present

Zackary Lystedt law https://www.cdc.gov/heads-up/media/pdfs/stories/031210-zack-story.pdf

Rowan’s law Rowan's Law (Concussion Safety), 2018, S.O. 2018, c. 1 | ontario.ca

Performing Arts Discipline-Specific Concerns: General

Mohney GL. Incidence of Head Injury Among Synchronized Skaters: Rates, Risks, and Behaviors. 2018. Dissertations. 3328.

Register-Mihalik JK, Marshall SW, Kay MC, Kerr ZY, Peck KY, Houston MN, Linnan LA, Hennink-Kaminski H, Gildner P, Svoboda SJ, Cameron KL. Perceived social norms and concussion-disclosure behaviours among first-year NCAA student-athletes: implications for concussion prevention and education. Res Sports Med. 2021 Jan-Feb;29(1):1-11. doi: 10.1080/15438627.2020.1719493. Epub 2020 Jan 25. PMID: 31984812.

Performing Arts Discipline-Specific Concerns: Specific

Pritchard, N. S., E. Urban, J., Miller, L. E., Lintner, L., & Stitzel, J. D. (2020). AN ANALYSIS OF HEAD KINEMATICS IN WOMEN’S ARTISTIC GYMNASTICS. Science of Gymnastics Journal, 12(3), 229-242.

Aleccia, J (2014, February 14). Figure skating's high-flying beauty blurs a hazardous side effect. Today. https://www.today.com/health/figure-skatings-high-flying-beauty-blurs-hazardous-side-effect-2d12112777

Smith, A. D., & Ludington, R. (1989). Injuries in elite pair skaters and ice dancers. The American Journal of Sports Medicine, 17(4), 482-488.Wang DH, Kostyun RO, Solomito MJ. The Biomechanics of Cranial Forces During Figure Skating Spinning Elements. Conn Med. 2015 Mar;79(3):133-7. PMID: 26244218.

TD: Weiss D. Clinical Care on Broadway. Presented at PAMA International Symposium: July 9, 2016: Weill Cornell Medical Center, NY.

For Administration/Management: Areas of Disconnect?

Wallace J, Covassin T, Moran R. Racial disparities in concussion knowledge and symptom recognition in American adolescent athletes. Journal of Racial and Ethnic Health Disparities. 2018; 5(1): 221-228.

Gender and Sex Influences in Concussion

Tsushima WT, Siu AM, Ahn HJ, Chang BL, Murata NM. Incidence and risk of concussions in youth athletes: Comparisons of age, sex, concussion history, sport and football position. Archives of Clinical Neuropsychology. 2018; 34(1): 60-69.

Valera EM, Joseph AC, Snedaker K, Breiding MJ, Robertson CL, Colantonio A, Levin H, Pugh MJ, Yurgelun-Todd D, Mannix R, Bazarian JJ, Turtzo LC, Turkstra LS, Begg L, Cummings DM, Bellgowan PSF. Understanding Traumatic Brain Injury in Females: A State-of-the-Art Summary and Future Directions. J Head Trauma Rehabil. 2021 Jan 1;36(1):E1-E17. doi: 10.1097/HTR.0000000000000652. PMID: 33369993; PMCID: PMC9070050.

Saverino C, Swaine B, Jaglal S, et al. Rehospitalization after traumatic brain injury: a population-based study. Arch Phys Med Rehabil. 2016;97(2)(suppl):S19–S25. doi:10.1016/j.apmr.2015.04.016

Albrecht JS, Hirshon JM, McCunn M, et al. Increased rates of mild traumatic brain injury among older adults in US emergency departments, 2009-2010. J Head Trauma Rehabil. 2016;31(5):E1–E7. doi:10.1097/htr.0000000000000190

Wagner J, Dusick JR, McArthur DL, et al. Acute gonadotroph and somatotroph hormonal suppression after traumatic brain injury. J Neurotrauma. 2010;27(6):1007–1019. doi:10.1089/neu.2009.1092

Silva PP, Bhatnagar S, Herman SD, et al. Predictors of hypopituitarism in patients with traumatic brain injury. J Neurotrauma. 2015;32(22):1789–1795. doi:10.1089/neu.2015.3998 40.

Sutton M, Chan V, Escobar M, Mollayeva T, Hu Z, Colantonio A. Neck injury comorbidity in concussion-related emergency department visits: a population-based study of sex differences across the life span. J Womens Health (Larchmt). 2019;28(4):473–482. doi:10.1089/jwh.2018.7282

For the Administration/Management: Environment?

Shields BJ, Smith GA. The potential for brain injury on selected surfaces used by cheerleaders. J Athl Train. 2009 Nov-Dec;44(6):595-602. doi: 10.4085/1062-6050-44.6.595. PMID: 19911085; PMCID: PMC2775360.

Oeur, R.A., & Hoshizaki, T.B. (2016). The Effect of Impact Compliance, Velocity, and Location in Predicting Brain Trauma for Falls in Sport.

For the Faculty/Staff/Coaches: Accommodations

Holmes A, Chen Z, Yahng L, Fletcher D, Kawata K. Return to Learn: Academic Effects of Concussion in High School and College Student-Athletes. Front Pediatr. 2020 Mar 4;8:57. doi: 10.3389/fped.2020.00057. PMID: 32195210; PMCID: PMC7065268.

For the Faculty/Staff/Coaches: Practice Planning

Garnett D, Patricios J, Cobbing S. Physical Conditioning Strategies for the Prevention of Concussion in Sport: a Scoping Review. Sports Med Open. 2021 May 17;7(1):31. doi: 10.1186/s40798-021-00312-y. PMID: 33999301; PMCID: PMC8128965.

Batten, J., White, A. J., Anderson, E., & Bullingham, R. (2016). From management to prevention: The new cure for sports concussion. British Journal of Sports Medicine, 50(21), 1293-1294. https://10.1136/bjsports-2015-095949

For the Performer: How can they help RTP/RTL?

Santucci M. Protecting musicians from hearing damage: a review of the evidence-based research. Med Probl Perform Art. 2019; 24: 103-107.

Ojofeitimi S, McIntyre L, Barchi E, Rae SS, Winnitoy B, Russell, JA. Guidelines for Returning to Dance Following Concussion: Adaptations From Sport Concussion Literature, International Journal of Clinical Practice, 2024, 1449433, 14 pages, 2024.

Gold JE, Driban JB, Yingling VR, Komaroff E. Characterization of posture and comfort in laptop users in non-desk settings. Appl Ergon. 2012 Mar;43(2):392-9. doi: 10.1016/j.apergo.2011.06.014. Epub 2011 Jul 2. PMID: 21726854.

For the Performer: Optimize Well-being and Recovery

Ruxton CH, Reed SC, Simpson MJ, Millington KJ. The health benefits of omega-3 polyunsaturated fatty acids: a review of the evidence. J Hum Nutr Diet. 2004;17(5):449–459.

Davis CK, Vemuganti R. Antioxidant therapies in traumatic brain injury. Neurochemistry International. 2022; 152: 1-12.

Brain Armor Web site. 2019 http://www.brain-armor.com. (Accessed February 2, 2025)

Kelly GS. Clinical applications of N-acetylcysteine. Altern Med Rev. 1998;3(2):114–127.

For the Clinician

Collins FE, Fields S, Kluchurosky L, Rohrkemper MK, Comstock D, et al. Neck Strength: A Protective Factor Reducing Risk for Concussion in High School Sports. J Prim Prev. 2014;35:309–319. doi: 10.1007/s10935-014-0355-2.

Clark JF, Graman P, Ellis JK, et al. An exploratory study of the potential effects of vision training on concussion incidence in football. Optometry and Visual Performance 2015;3.

Howell DR, Seehusen CN, Carry PM, Walker GA, Reinking SE, Wilson JC. An 8-Week Neuromuscular Training Program After Concussion Reduces 1-Year Subsequent Injury Risk: A Randomized Clinical Trial. Am J Sports Med. 2022 Mar;50(4):1120-1129. doi: 10.1177/03635465211069372. Epub 2022 Jan 21. PMID: 35060759.

Kung SM, Suksreephaisan TK, Perry BG, Palmer BR, Page RA. The Effects of Anticipation and Visual and Sensory Performance on Concussion Risk in Sport: A Review. Sports Med Open. 2020 Nov 16;6(1):54. doi: 10.1186/s40798-020-00283-6. PMID: 33196878; PMCID: PMC7669979.

Wilkerson GB, Nabhan DC, Crane RT. Upper-Extremity Perceptual-Motor Training Improves Whole-Body Reactive Agility Among Elite Athletes With History of Sport-Related Concussion. J Sport Rehabil. 2021 Jan 8;30(6):844-849. doi: 10.1123/jsr.2020-0337. PMID: 33418536.

Concussion Prevention?

Kerr ZY, Yeargin SW, Valovich McLeod TC, et al. Comprehensive coach education reduces head impact exposure in American youth football. Orthopaedic Journal of Sports Medicine 2015;3:232596711561054.

Shanley E, Thigpen C, Kissenberth M, et al. Heads up football training decreases concussion rates in high school football players. Clin J Sport Med 2021;31:120–6.

American Association of Cheerleading Coaches and Administrators. 2007–08 high school safety rules. https://usacheer.org/aacca-is-now-usa-cheer

American Association of Cheerleading Coaches and Administrators. 2007–2008 AACCA college cheerleading safety rules. https://usacheer.org/aacca-is-now-usa-cheer

Myer GD, Yuan W, Barber Foss KD, et al. The effects of external jugular compression applied during head impact exposure on longitudinal changes in brain Neuroanatomical and neurophysiological biomarkers: A preliminary investigation. Front Neurol 2016;7:74.

Myer GD, Yuan W, Barber Foss KD, et al. Analysis of head impact exposure and brain Microstructure response in a season-long application of a jugular vein compression collar: A prospective, neuroimaging investigation in American football. Br J Sports Med 2016;50:1276–85.

Mohney GL. Incidence of Head Injury Among Synchronized Skaters: Rates, Risks, and Behaviors. 2018. Dissertations. 3328.

Occupational Health

Hinkamp D, Morton J, Krasnow DH, Wilmerding MV, Dawson WJ, Stewart MG, Sims HS, Reed JP, Duvall K, McCann M. Occupational Health and the Performing Arts: An Introduction. J Occup Environ Med. 2017 Sep;59(9):843-858. doi: 10.1097/JOM.0000000000001052. PMID: 28692606.

Occupational Safety and Health Administration: https://www.osha.gov/sites/default/files/publications/OSHA3746.pdf (Accessed Februrary 2, 2025)

Dr. Kristen Schuyten, PT, DPT, SCS, CSCS