Sports-related
concussions: A look at the
compliance of patients.
Chris Cannizzaro
Rowan University:
April 23, 2013
Introduction
• Concussions have received an increasing amount of
attention in recent years, especially in relation to sports.
• Typical signs and symptoms include:
•
•
•
•
physical,
cognitive,
visual and
emotional symptoms
• If proper treatment is not followed by a patient, the
symptoms of a concussion can last far longer than suspected
and as cause lasting damage (Serruya & Franks 2014).
Background Literature
• McGrath, Dinn, Collins, Lovell, Elbin, and Kontos (2013)
studied 54 student-athletes who have had a baseline test
performed within the past 2 years and incurred a sport-related
concussion.
• It has been recommended that athletes do not return to play
until they are both free of symptoms and their neurocognitive
test results have returned to pre-injury baseline levels.
• 27.7% of concussed student-athletes who were symptom-free
returned to their baseline on the ImPACT test at rest, however
following moderate physical exertion the results showed
cognitive decline (McGrath et al, 2013).
Goal of Study & Hypothesis
• The current study will investigate whether or not activity level
during the recovery period results in slower recovery.
• Furthermore, this study aims to disentangle the effect of
cognitive verses physical activity.
• Hypothesis:
• I predict that the less physical and cognitive activity the
patient participates in, the shorter the healing time will
be and it will help the patient return to baseline more
rapidly.
Methods
• The standard of care restricts all physical and cognitive
activity preceding a concussion in order to recover properly.
• The problem with this is getting patients to adhere these
restrictions.
• In this quasi-experiment, we will look at three levels of our
independent variable, restriction level of physical and
cognitive activity.
Participants
• Participants will be recruited throughout one collegiate
athletic year, from August until June.
• Upon seeking treatment for a concussion the participants will
be asked if they are willing to participate in a study that
focuses on the effects of concussion treatment.
• This study aims to recruit about 50 participants, however will
be based on a convince sample as it is not possible to predict
how many concussion injuries will occur throughout the year.
Participants continued
• Inclusion criteria:
• Collegiate athletes ages 18-22 who have suffered a concusion.
• Exclusion Criteria:
• had prior concussions,
• heavy alcoholic drinkers,
• or have any prior neurological/ cognitive impairments.
Design
• Quasi-Experimental
• Non-equivalent group design
• Time-series design
Independent Variable &
Dependent Variable
• 3 levels of the Independent Variable:
• 1. A group who reports to have followed the doctor’s orders and
restricted all cognitive and physical activity,
• 2. A group who reports that they did mild cognitive activity
despite the doctors’ orders, and
• 3. A group who reports that they did some physical activity
despite the doctor’s orders
• Dependent Variable:
• The time that it takes each participant to reach their level of
baseline.
Procedure
• The participants’ concussive symptoms will be measured using
the ImPACT® (Immediate Post-Concussion Assessment and
Cognitive Testing).
• Using non-equivalent groups (dependent upon the level of
restriction) and
• Time series design, we will attempt to determine the best
level of treatment of concussions.
In the past 3 days
how many hours
have you:
More than 3
hours
1-2 hours
None
Read a book?
Watched TV?
Gone on your
cellphone?
(texting, social
media, etc.)
Gone on your
computer? (email,
social media, etc.)
Worked out?
Got your heart
rate above normal
for your age?
Become stressed?
Done schoolwork?
Do you believe it is important to restrict your cognitive and physical activity as
directed by your doctor? ( yes / no )
ImPACT results
Day 1
Day 4
Day 7
Day 10
Day 13
Survey Results ->
Level of restriction
Strengths
• Collegiate athletes were chosen because the NCAA to receive
a baseline test prior to each season, so there is a great
baseline to compare to.
• The study has high internal validity and can be useful in
determining the best plan of action for these patients who
receive concussions most frequently.
• While athletes seem to have the highest frequency of
concussions, it is an great starting point for a study like this.
• The use of the ImPACT test. Using this test helps to ensure
valid results.
Limitations
• Only testing individuals currently enrolled in college, ages 1823, and participating in a college level sport.
• The study may have limited external validity to the general
public..
Thank you for your kind
attention 
References
• Master, E.J.T, Kessels, A.G., Leak, M.D., Jordan, B.D., Troost, J.
(1999). Neurological impairment in amateur soccer players.
American Medical Association, 182, 971-973.
• McGrath, N., Dinn, W. M., Collins, M. W., Lovell, M. R., Elbin, R. J., &
Kontos, A. P. (2013). Post-exertion neurocognitive test failure
among student-athletes following concussion. Brain Injury,
27(1), 103-113. doi:10.3109/02699052.2012.729282
• Moser, R., Glatts, C., & Schatz, P. (2012). Efficacy of immediate and
delayed cognitive and physical rest for treatment of sportsrelated concussion. The Journal of Pediatrics, 161(5),
922-926. doi:10.1016/j.jpeds.2012.04.012
• Serruya, M., & Franks, R. (2014). Comprehensive concussion center.
Retrieved from http://www.jeffersonhospital.org/
departments-and-services/comprehensive-concussioncenter/_vsrefdom=neuro_search&gclid=CL6Kx4S6u70CFeMSOgod4C
MA9Q