Sports Medicine Research: In the Lab & In the Field: Concussions: Sex Differences in Symptoms & Long-term Balance Issues (Sports Med Res)
Wednesday, January 19, 2011

Concussions: Sex Differences in Symptoms & Long-term Balance Issues

This Post Reviews 2 Articles:
     Sex differences in concussion symptoms of high school athletes.
       Frommer LJ, Gurka KK, Cross KM, Ingersoll CD, Comstock RD, Saliba SA. J Athl Train. 2011;46(1):76-84.

     Previous mild traumatic brain injury and postural-control dynamics.
       Sosnoff JJ, Broglio SP, Shin S, Ferrara MS. J Athl Train. 2011;46(1):85-91.

This month the Journal of Athletic Training published two studies evaluating the acute and chronic influence of concussions. Frommer et al. supplemented a growing body of literature that suggests females are at a greater risk for concussions and experience worse outcomes (for example, cognitive impairment). Certified athletic trainers from 100 United States high schools used an internet-based injury surveillance system for 2 years to record concussions and clinically relevant information (for example, symptoms, return to play time, symptom resolution time). The study found that males experienced amnesia and confusion/disorientation more than females. Furthermore, females reported drowsiness and sensitivity to light more often than males. Males and females reported headaches as the most common symptom as well as had similar number of symptoms, return to play time, and symptom resolution time. It can not be ruled out if these differences are sports-related; since females did not play football or wrestle and males did not participate in volleyball or softball.  

This is a nice reminder that our evaluations should not just focus on amnesia, disorientation, and functional impairments because these tests may not identify symptoms often reported by females. We need to perform complete symptom assessments and be aware of symptoms that are often “attributed to other conditions, such as stress, depression or anxiety.” These symptoms should be related to the head impact until other conditions can be ruled out.

Once we get passed the acute phase of a concussion and the athletes return to play it has long been thought that they are “back to normal”. Unfortunately, more and more data suggests that there may be long-term consequences to head injuries. Sosnoff et al. used advanced postural control (balance) assessments and analyses to evaluate 224 college athletes. 62 athletes had a self-reported history of a physician-diagnosed concussion on average 44.3 months prior to the testing (note: this definition of concussion may mean that some of the controls had a history of concussions). Their results showed that collegiate athletes with a history of concussion(s) had altered postural control compared to those without a history of a concussion. They found no relationship between the postural control outcomes and time since concussion. It is important to keep in mind that these are subtle differences using very sensitive measures; therefore the clinical and functional implications of these findings are unclear. 

This study supports a growing body of evidence suggesting that at least minor changes linger long after a concussion. It would be interesting to see if sex, number of concussions, or injury severity influence these outcomes. More data will be needed to help guide clinical decisions. This study represents another piece of the concussion puzzle and should be included in our explanations to patients as well as coaches about the long-term implications of concussions. Hopefully, by making our patients and coaches more informed they will recognize the severity of concussion-related signs and symptoms as well as seek out medical attention. Plus, who knows; perhaps these new postural control assessments may one day be feasible in sports medicine clinics.

Written by: Jeffrey Driban
Reviewed by: Stephen Thomas
No brains were harmed in the writing of this summary.

1 comments:

Mara said...

Great job, guys! This site is going to take a lot of stress out of staying up to date with the latest research!

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