The Journal of Head Trauma Rehabilitation最新文献

{"title":"Age-Related Changes in the Association Between Traumatic Brain Injury and Dementia in Older Men and Women.","authors":"Louis Jacob,&nbsp;Philippe Azouvi,&nbsp;Karel Kostev","doi":"10.1097/HTR.0000000000000624","DOIUrl":"https://doi.org/10.1097/HTR.0000000000000624","url":null,"abstract":"<p><strong>Objective: </strong>To investigate age-related changes in the association between traumatic brain injury (TBI) and dementia in older men and women separately.</p><p><strong>Setting: </strong>A total of 243 general practices in the UK.</p><p><strong>Participants: </strong>This study included 4760 patients who received a first TBI diagnosis between 1995 and 2010 (index date), and 4760 patients without TBI who were matched to those with TBI by age, sex, index year, Charlson Comorbidity Index, alcohol dependence, and physician (index date: a randomly selected visit date).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Main measures: </strong>Incidence of dementia in the decade following index date.</p><p><strong>Results: </strong>Within 10 years of index date, 8.8% of men with TBI and 4.8% of those without TBI were diagnosed with dementia, while the respective figures were 9.0% and 6.7% in women (P values < .01). There was a significant association between TBI and dementia in men (hazard ratio [HR] = 2.29, 95% confidence interval [CI]: 1.64-3.19) and in women (HR = 1.33, 95% CI: 1.07-1.64). Furthermore, the association between TBI and dementia was significant in men aged 60 to 70 (HR = 2.51, 95% CI: 1.27-4.96) and 71 to 80 years (HR = 3.00, 95% CI: 1.82-4.93), whereas the relationship was only significant and potentially unreliable in women aged 81 to 90 years (HR = 1.49, 95% CI: 1.03-2.14).</p><p><strong>Conclusions: </strong>The age-related relationship between TBI and dementia differed between men and women. More research of a prospective nature and including behavioral data is needed to better understand these differences.</p>","PeriodicalId":519229,"journal":{"name":"The Journal of Head Trauma Rehabilitation","volume":" ","pages":"E139-E146"},"PeriodicalIF":2.4,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38610669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"miRNAs as Potential Biomarkers for Traumatic Brain Injury: Pathway From Diagnosis to Neurorehabilitation.","authors":"Amy A Herrold,&nbsp;Sandra L Kletzel,&nbsp;Eileen M Foecking,&nbsp;Karen L Saban,&nbsp;Magdalena M Przybycien-Szymanska,&nbsp;Michael Zilliox,&nbsp;Dulal Bhaumik,&nbsp;Dustin Lange,&nbsp;Jay R Radke,&nbsp;Ilse Salinas,&nbsp;Theresa L Bender Pape","doi":"10.1097/HTR.0000000000000632","DOIUrl":"https://doi.org/10.1097/HTR.0000000000000632","url":null,"abstract":"<p><strong>Background: </strong>Biomarkers that can advance precision neurorehabilitation of the traumatic brain injury (TBI) are needed. MicroRNAs (miRNAs) have biological properties that could make them well suited for playing key roles in differential diagnoses and prognoses and informing likelihood of responsiveness to specific treatments.</p><p><strong>Objective: </strong>To review the evidence of miRNA alterations after TBI and evaluate the state of science relative to potential neurorehabilitation applications of TBI-specific miRNAs.</p><p><strong>Methods: </strong>This scoping review includes 57 animal and human studies evaluating miRNAs after TBI. PubMed, Scopus, and Google Scholar search engines were used.</p><p><strong>Results: </strong>Gold standard analytic steps for miRNA biomarker assessment are presented. Published studies evaluating the evidence for miRNAs as potential biomarkers for TBI diagnosis, severity, natural recovery, and treatment-induced outcomes were reviewed including statistical evaluation. Growing evidence for specific miRNAs, including miR21, as TBI biomarkers is presented.</p><p><strong>Conclusions: </strong>There is evidence of differential miRNA expression in TBI in both human and animal models; however, gaps need to be filled in terms of replication using rigorous, standardized methods to isolate a consistent set of miRNA changes. Longitudinal studies in TBI are needed to understand how miRNAs could be implemented as biomarkers in clinical practice.</p>","PeriodicalId":519229,"journal":{"name":"The Journal of Head Trauma Rehabilitation","volume":" ","pages":"E155-E169"},"PeriodicalIF":2.4,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38706443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Utility of the Patient Health Questionnaire-Adolescent in Adolescents With Traumatic Brain Injury.","authors":"Rachel Zachar-Tirado,&nbsp;Ziqi Chen,&nbsp;Jacobus Donders","doi":"10.1097/HTR.0000000000000610","DOIUrl":"https://doi.org/10.1097/HTR.0000000000000610","url":null,"abstract":"<p><strong>Objective: </strong>To determine the clinical utility of the Patient Health Questionnaire-Adolescent (PHQ-A) in screening for depressive disorders in adolescents following traumatic brain injury (TBI).</p><p><strong>Design: </strong>Retrospective analysis of data collected as a part of routine clinical care over a period of 4 years.</p><p><strong>Setting: </strong>Regional rehabilitation facility.</p><p><strong>Participants: </strong>Adolescents (n = 101) with mild to moderate-severe TBI who were referred for an outpatient neuropsychological evaluation within 1 to 12 months postinjury.</p><p><strong>Main outcome measures: </strong>PHQ-A, PHQ-A_2 (2-item version), and Processing Speed Index (PSI) from the Wechsler scales of intelligence.</p><p><strong>Results: </strong>Both premorbid depressive disorder and PHQ-A scores predicted a postinjury diagnosis of depressive disorder, with a combined sensitivity of 0.91 and specificity of 0.59. PHQ-A_2 did not reach acceptable levels of sensitivity in predicting suicidal thoughts. PHQ-A scores did not add significantly to the prediction of PSI results after accounting for TBI severity.</p><p><strong>Conclusions: </strong>PHQ-A has clinical utility as a screening instrument for depressive disorders in outpatient adolescents with TBI when the cutoff for clinically significant concern is set at more than 4 and premorbid psychiatric history is also taken into account.</p>","PeriodicalId":519229,"journal":{"name":"The Journal of Head Trauma Rehabilitation","volume":" ","pages":"E118-E125"},"PeriodicalIF":2.4,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38353219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatigue in Children With Moderate or Severe Traumatic Brain Injury Compared With Children With Orthopedic Injury: Characteristics and Associated Factors.","authors":"Stefan Bogdanov,&nbsp;Naomi Brookes,&nbsp;Adrienne Epps,&nbsp;Sharon L Naismith,&nbsp;Arthur Teng,&nbsp;Suncica Lah","doi":"10.1097/HTR.0000000000000585","DOIUrl":"https://doi.org/10.1097/HTR.0000000000000585","url":null,"abstract":"<p><strong>Objective: </strong>To characterize fatigue in children with moderate or severe traumatic brain injury (TBI) and to identify associated factors.</p><p><strong>Setting: </strong>Urban tertiary pediatric healthcare facility.</p><p><strong>Participants: </strong>Children aged 5 to 15 years with a moderate TBI (n = 21), severe TBI (n = 23), or an orthopedic injury (OI; n = 38).</p><p><strong>Design: </strong>Case-control study.</p><p><strong>Main measures: </strong>(i) Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL-MFS), completed by parents and children; (ii) Sleep Disturbance Scale for Children, completed by parents. Data on injury-specific factors and other factors of interest were also collected.</p><p><strong>Results: </strong>The 2 TBI groups did not differ on any of the fatigue outcomes (child or parent ratings). Relative to the OI group, parents rated children in both TBI groups as experiencing greater fatigue. However, on self-ratings, only children with moderate TBI endorsed greater fatigue. Sleep was commonly associated with fatigue, with child sleep disturbance and child sleep hygiene associated with parent-rated and self-rated child fatigue, respectively. Individually, there were no cases of \"normal\" fatigue coinciding with severe sleep disturbance. However, there were several cases of severe fatigue coinciding with normal sleep. Additional factors associated with fatigue were older age at injury, longer time since injury, and/or greater internalizing difficulties.</p><p><strong>Conclusion: </strong>Children with moderate and severe TBI experience greater fatigue than OI controls. Parent and child ratings of fatigue appear to be associated with different factors, indicating that fatigue management may require a broad range of treatments.</p>","PeriodicalId":519229,"journal":{"name":"The Journal of Head Trauma Rehabilitation","volume":" ","pages":"E108-E117"},"PeriodicalIF":2.4,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40453980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concussion Symptom Treatment and Education Program: A Feasibility Study.","authors":"Tess S Simpson,&nbsp;Robin L Peterson,&nbsp;Kristina E Patrick,&nbsp;Jeri E Forster,&nbsp;Kelly A McNally","doi":"10.1097/HTR.0000000000000592","DOIUrl":"https://doi.org/10.1097/HTR.0000000000000592","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility and potential benefits of a manualized, brief cognitive-behavioral therapy-based intervention program for children and adolescents with persistent postconcussive symptoms.</p><p><strong>Setting: </strong>Two outpatient pediatric concussion programs in the United States.</p><p><strong>Participants: </strong>Patients aged 8 to 17 years who sustained concussions between 2 and 12 months prior to enrollment.</p><p><strong>Design: </strong>Pre-/postretrospective study.</p><p><strong>Main measures: </strong>SCAT-3; HBI; PedsQL 4.0 Generic Core Scales; and RCADS.</p><p><strong>Results: </strong>Thirty children and adolescents completed the treatment program. Self- and parent-reported postconcussive symptoms, quality of life, and internalizing symptoms significantly improved with treatment. Mixed-effects models revealed a significant decline in self-reported postconcussive symptoms across treatment sessions, a = -2.07, SE = 0.25, P < .001. The largest change occurred between sessions 2 and 3, following the session focusing on concussion psychoeducation and sleep hygiene (estimated mean change between sessions 2 and 3 = -4.72, P < .0001).</p><p><strong>Conclusions: </strong>Our findings indicate that a 6-session manualized cognitive behavioral intervention is feasible to initiate in an outpatient clinic 1 to 12 months following a pediatric mild traumatic brain injury. With a manualized format, clinicians at most levels of training should be able to implement this treatment manual and flexibly adapt as needed when working with children and adolescents who are experiencing delayed symptom recovery following concussion.</p>","PeriodicalId":519229,"journal":{"name":"The Journal of Head Trauma Rehabilitation","volume":" ","pages":"E79-E88"},"PeriodicalIF":2.4,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40454354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptual Cognitive Training Does Not Improve Clinical Outcomes at 4 and 12 Weeks Following Concussion in Children and Adolescents: A Randomized Controlled Trial.","authors":"Elizabeth Teel,&nbsp;Marie Brossard-Racine,&nbsp;Laurie-Ann Corbin-Berrigan,&nbsp;Isabelle Gagnon","doi":"10.1097/HTR.0000000000000633","DOIUrl":"https://doi.org/10.1097/HTR.0000000000000633","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether a perceptual-cognitive training program using 3D-multiple object tracking (3D-MOT) can improve symptoms following acute pediatric concussion.</p><p><strong>Setting: </strong>Research laboratory within a pediatric trauma center.</p><p><strong>Participants: </strong>Children and adolescents (n = 62, age= 13.27 ± 2.50) with diagnosed concussion.</p><p><strong>Design: </strong>Randomized controlled trial. Children were randomized into either 3D-MOT, 2048 game, or standard care-only groups. Participants and parents completed the Post-Concussion Symptom Inventory (PCSI) at baseline, 4, 8, and 12 weeks postinjury. Intervention participants completed either the 3D-MOT protocol or the 2048 game at 6 sessions between the baseline and 4-week assessment.</p><p><strong>Main measures: </strong>A 3 (group) × 10 (time) mixed-model analysis of variance evaluated PCSI total scores. The rate of persistent postconcussive symptom (PPCS) was evaluated at 4 weeks using χ2 analysis.</p><p><strong>Results: </strong>Symptoms decreased throughout the study using both child-reported (F(9,374) = 22.03, P < .001) and parent-reported scores (F(9,370) = 28.06, P < .001). Twenty-four (44.4%) children met the study definition for PPCS using the child-reported PCSI, while 20 (37.7%) children had PPCS using parent reports. The intervention did not significantly affect symptom resolution or PPCS rates.</p><p><strong>Conclusion: </strong>There is no benefit to prescribing 3D-MOT training for acute rehabilitation in pediatric patients with concussion and clinicians should instead focus on more effective programs.</p>","PeriodicalId":519229,"journal":{"name":"The Journal of Head Trauma Rehabilitation","volume":" ","pages":"E97-E107"},"PeriodicalIF":2.4,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38611041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Detection and Recovery of Vestibular and Oculomotor Impairments Among Amateur Athletes Following Sport-Related Concussion: A Prospective, Matched-Cohort Study.","authors":"Fionn Büttner,&nbsp;David R Howell,&nbsp;Cailbhe Doherty,&nbsp;Catherine Blake,&nbsp;John Ryan,&nbsp;Eamonn Delahunt","doi":"10.1097/HTR.0000000000000608","DOIUrl":"https://doi.org/10.1097/HTR.0000000000000608","url":null,"abstract":"<p><strong>Objective: </strong>To (1) quantify the diagnostic accuracy of the vestibular/oculomotor screening (VOMS), and (2) determine the recovery of vestibular and oculomotor impairments exhibited by concussed athletes compared with nonconcussed athletes using the VOMS.</p><p><strong>Setting: </strong>Clinical assessment laboratory.</p><p><strong>Participants: </strong>Amateur athletes who were diagnosed with sport-related concussion by emergency department physicians, and non-concussed, control athletes.</p><p><strong>Design: </strong>Prospective, longitudinal study.</p><p><strong>Main measures: </strong>Participants were assessed 1 week following sport-related concussion, upon clearance to return-to-sporting activity, and 2 weeks following return-to-sporting activity by a study investigator who administered the VOMS. We calculated test sensitivity, specificity, and positive and negative predictive values to estimate the diagnostic accuracy of the VOMS. We performed a mixed-design analysis of variance to assess differences in VOMS symptom scores reported by concussed athletes compared with control athletes.</p><p><strong>Results: </strong>Fifty concussion participants and 50 control participants completed the study. The VOMS demonstrated sensitivity and specificity of 96% and 46%, respectively, and produced positive and negative predictive values of 64% and 92%, respectively. The concussion group exhibited a significantly greater symptom provocation change score from baseline than the control group for all test domains of the VOMS only in the first week following concussion.</p><p><strong>Conclusion: </strong>The VOMS may be most useful as a clinical screening tool to rule out, rather than confirm, the presence of sport-related concussion. The VOMS may be appropriate to inform the recovery of vestibular and oculomotor impairments exhibited by concussed individuals over time.</p>","PeriodicalId":519229,"journal":{"name":"The Journal of Head Trauma Rehabilitation","volume":" ","pages":"87-95"},"PeriodicalIF":2.4,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38353649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introducing the ImPACT-5: An Empirically Derived Multivariate Validity Composite.","authors":"Laszlo Erdodi,&nbsp;Kassandra Korcsog,&nbsp;Ciaran Considine,&nbsp;Joseph Casey,&nbsp;Alan Scoboria,&nbsp;Christopher Abeare","doi":"10.1097/HTR.0000000000000576","DOIUrl":"https://doi.org/10.1097/HTR.0000000000000576","url":null,"abstract":"<p><strong>Objective: </strong>To create novel Immediate Post-Concussion and Cognitive Testing (ImPACT)-based embedded validity indicators (EVIs) and to compare the classification accuracy to 4 existing EVIImPACT.</p><p><strong>Method: </strong>The ImPACT was administered to 82 male varsity football players during preseason baseline cognitive testing. The classification accuracy of existing EVIImPACT was compared with a newly developed index (ImPACT-5A and B). The ImPACT-5A represents the number of cutoffs failed on the 5 ImPACT composite scores at a liberal cutoff (0.85 specificity); ImPACT-5B is the sum of failures on conservative cutoffs (≥0.90 specificity).</p><p><strong>Results: </strong>ImPACT-5A ≥1 was sensitive (0.81), but not specific (0.49) to invalid performance, consistent with EVIImPACT developed by independent researchers (0.68 sensitivity at 0.73-0.75 specificity). Conversely, ImPACT-5B ≥3 was highly specific (0.98), but insensitive (0.22), similar to Default EVIImPACT (0.04 sensitivity at 1.00 specificity). ImPACT-5A ≥3 or ImPACT-5B ≥2 met forensic standards of specificity (0.91-0.93) at 0.33 to 0.37 sensitivity. Also, the ImPACT-5s had the strongest linear relationship with clinically meaningful levels of invalid performance of existing EVIImPACT.</p><p><strong>Conclusions: </strong>The ImPACT-5s were superior to the standard EVIImPACT and comparable to existing aftermarket EVIImPACT, with the flexibility to optimize the detection model for either sensitivity or specificity. The wide range of ImPACT-5 cutoffs allows for a more nuanced clinical interpretation.</p>","PeriodicalId":519229,"journal":{"name":"The Journal of Head Trauma Rehabilitation","volume":" ","pages":"103-113"},"PeriodicalIF":2.4,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37988433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Postconcussion Symptoms: An Expert Consensus-Based Definition Using the Delphi Method.","authors":"Corinne Lagacé-Legendre, Valérie Boucher, Sébastien Robert, Pier-Alexandre Tardif, Marie-Christine Ouellet, Elaine de Guise, Geneviève Boulard, Pierre Frémont, Marcel Émond, Lynne Moore, Natalie Le Sage","doi":"10.1097/HTR.0000000000000613","DOIUrl":"10.1097/HTR.0000000000000613","url":null,"abstract":"<p><strong>Objective: </strong>To provide an expert consensus definition of persistent postconcussion symptoms following a mild traumatic brain injury (mTBI).</p><p><strong>Participants: </strong>Canadian healthcare professionals caring for patients with mTBI.</p><p><strong>Design: </strong>Online Delphi process.</p><p><strong>Main measures: </strong>A first Delphi round documented important dimensions or criteria to consider when defining persistent symptoms. Expert opinions were then resubmitted in 4 subsequent Delphi rounds and their relevance was rated using a 9-point Likert scale. An item with a median rating of 7 or more and a sufficient level of agreement were considered consensual.</p><p><strong>Results: </strong>After 5 rounds, consensus was reached on a set of criteria that can be summarized as follows: presence of any symptom that cannot be attributed to a preexisting condition and that appeared within hours of an mTBI, that is still present every day 3 months after the trauma, and that has an impact on at least one sphere of a person's life.</p><p><strong>Conclusion: </strong>This Delphi consensus proposes a set of criteria that support a more uniform definition of persistent symptoms in mild TBI among clinicians and researchers. This definition may help clinicians better identify persistent postconcussion symptoms and improve patient management.</p>","PeriodicalId":519229,"journal":{"name":"The Journal of Head Trauma Rehabilitation","volume":" ","pages":"96-102"},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38299003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Within-Subjects Comparison of Clinical Outcomes for Patients' First and Second Concussions.","authors":"Jonathan French,&nbsp;Sabrina Jennings,&nbsp;Shawn R Eagle,&nbsp;Michael W Collins,&nbsp;Anthony P Kontos","doi":"10.1097/HTR.0000000000000612","DOIUrl":"https://doi.org/10.1097/HTR.0000000000000612","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the difference between an individual's first and second concussion using a comprehensive, multidomain assessment including symptoms, neurocognitive, vestibular, ocular, and individual demographic and medical history risk factors associated with protracted recovery.</p><p><strong>Setting: </strong>Concussion Specialty Clinic.</p><p><strong>Participants: </strong>Seventy-three patients (aged 13-21 years; 57% female) diagnosed with 2 separate concussions (380.5 ± 278.7 days between injuries) from August 2016 to August 2018.</p><p><strong>Design: </strong>Retrospective within-subjects cohort study.</p><p><strong>Main measures: </strong>ImPACT, PCSS, and Vestibular-Ocular Motor Screen (VOMS) at each visit. Patients were divided into \"normal\" (≤30 days) and \"protracted\" recovery (>30 days) for χ2 analyses.</p><p><strong>Results: </strong>There were no differences between the first and second injuries in recovery time, VOMS, visual and verbal memory, or reaction time. Visual motor speed scores were higher at the second injury time point and reported sleep symptoms were higher at the first injury time point. In addition, participants reported to the clinic on average 3 days earlier for an evaluation for their second injury. Results from χ2 analyses indicated that female sex predicted protracted recovery (>30 days) from concussion at the first injury time point (OR = 4.1; 95% CI, 1.5-11.6; P = .006).</p><p><strong>Conclusions: </strong>The findings provide preliminary evidence that there is no clinical difference between patients' first and second concussions when both injuries were treated through a concussion specialty clinic.</p>","PeriodicalId":519229,"journal":{"name":"The Journal of Head Trauma Rehabilitation","volume":" ","pages":"114-119"},"PeriodicalIF":2.4,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38610667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}