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Traumatic brain injury is a significant public health issue and represents the main contributor to death and disability globally among all trauma-related injuries. Martial arts practitioners, military veterans, athletes, victims of physical abuse, and epileptic patients could be affected by the consequences of repetitive mild head injuries (RMHI) that do not resume only to short-termed traumatic brain injuries (TBI) effects but also to more complex and time-extended outcomes, such as post-concussive syndrome (PCS) and chronic traumatic encephalopathy (CTE). These effects in later life are not yet well understood; however, recent studies suggested that even mild head injuries can lead to an elevated risk of later-life cognitive impairment and neurodegenerative disease. While most of the PCS hallmarks consist in immediate consequences and only in some conditions in long-termed processes undergoing neurodegeneration and impaired brain functions, the neuropathological hallmark of CTE is the deposition of p-tau immunoreactive pre-tangles and thread-like neurites at the depths of cerebral sulci and neurofibrillary tangles in the superficial layers I and II which are also one of the main hallmarks of neurodegeneration. Despite different CTE diagnostic criteria in clinical and research approaches, their specificity and sensitivity remain unclear and CTE could only be diagnosed post-mortem. In CTE, case risk factors include RMHI exposure due to profession (athletes, military personnel), history of trauma (abuse), or pathologies (epilepsy). Numerous studies aimed to identify imaging and fluid biomarkers that could assist diagnosis and probably lead to early intervention, despite their heterogeneous outcomes. Still, the true challenge remains the prediction of neurodegeneration risk following TBI, thus in PCS and CTE. Further studies in high-risk populations are required to establish specific, preferably non-invasive diagnostic biomarkers for CTE, considering the aim of preventive medicine.

Abstract Concussion symptoms are nonspecific and may be related to other causes. Symptom scores and timeline of return to activity at many institutions are based on having no symptoms at baseline with the current measurement tools. This assumption in the diagnosis and treatment of concussions may lead to prolonged return to activity, compounded concussion symptoms, and unintended psychological and social sequelae. More baseline data is needed, especially in military academies, according to the CARE Consortium Study. During the high-stress initial training period at one mid-Atlantic military college a no-symptom baseline is unlikely for first-year students. The potential overlap of concussion and typical baseline symptoms make diagnosis and release to activity a challenge for providers. A baseline survey of first-year, non-concussed students using a standard concussion scoring tool showed that 95 % of participants were symptomatic at baseline. Stakeholders were presented the results and a policy analysis using Bardach's Eight-fold Path was performed comparing three other policy options. The policy analysis found that a narrower or less descriptive baseline description could have unintended negative impacts on clinical outcomes and provider liability. It also found that preseason baseline testing should be included for all students at the mid-Atlantic military college. Colleges, especially those in high-stress settings, should consider reevaluating baseline descriptions and testing recommendations in concussion policy to accommodate normal variations in symptomatology and provide freedom in clinical judgement.

The approach to and management of the athlete with concussion can be a challenging endeavor to physicians who care for athletes who have suffered a head injury—this group includes family physicians, pediatricians, internists, emergency medicine physicians, primary sports medicine physicians, orthopedic surgeons, neurologists, and neurosurgeons. Sometimes questions regarding the need for neurologic, psychological, or radiographic imaging can make the decision for return to play unclear. New legislation will undoubtedly increase physician visits for these athletes to return to play. Thus, the goal of this article is to review the latest guidelines regarding concussion management to help all physicians who care for athletes do so appropriately.

There has been a growing trend of local and national coverage of and interest in concussion injuries over the past 2 decades. Increasing public concern over potential catastrophic and unknown long-term effects of sports-related concussion injuries has led to an acknowledgment of the strong public health need for addressing all concussion injuries, regardless of mechanism of injury. In efforts to address this need for concussion prevention and management, both in sports and nonsports, The University of Kansas Health System initiated the interdisciplinary Center for Concussion Management program in 2012. The program was created as a virtual clinic concept and includes voluntary participation from various providers across the institution, limited budget, and space obstacles. Since its inception, the program has continued to operate as its initial design of a multidisciplinary team model outside the sole ownership of 1 department, and has expanded to include education and outreach to local and regional schools and groups.

Research has shown that exposure to a concussion definition (CD) increases self-reported concussion history (SRCH) immediately, however, no research has been performed that examines the effects of exposure to a CD on SRCH over time. Collegiate recreational student-athletes (RSAs) have limited access to monitoring and supervision by medical staff. As such, recognition of concussion symptoms and need for medical management oftentimes falls upon the RSA. The purpose of this study was to assess the effect of a novel questionnaire on the SRCH of RSAs. A two-part questionnaire was sent to RSAs participating is sports with a greater than average risk of concussion at a university in Arizona. Data from 171 RSAs were analyzed to assess the change in RSAs' suspected concussion estimates pre- and post-exposure to a CD and concussion symptom worksheet, as well as over the short-term (2.5 months). Approximately one-third of RSAs reported an increase in suspected concussion estimates immediately following exposure to the questionnaire, but the change was not maintained over the short-term. The results suggest that a single exposure to a CD is ineffective at increasing short-term SRCH estimates.

The study of heart rate variability (HRV) has emerged as an essential component of cardiovascular health, as well as a physiological mechanism by which one can increase the interactive communication between the cardiac and the neurocognitive systems (i.e., the body and the brain). It is well-established that lack of HRV implies cardiopathology, morbidity, reduced quality-of-life, and precipitous mortality. On the positive, optimal HRV has been associated with good cardiovascular health, autonomic nervous system (ANS) control, emotional regulation, and enhanced neurocognitive processing. In addition to health benefits, optimal HRV has been shown to improve neurocognitive performance by enhancing focus, visual acuity and readiness, and by promoting emotional regulation needed for peak performance. In concussed athletes and soldiers, concussions not only alter brain connectivity, but also alter cardiac functioning and impair cardiovascular performance upon exertion. Altered sympathetic and parasympathetic balance in the ANS has been postulated as a critical factor in refractory post concussive syndrome (PCS). This article will review both the pathological aspects of reduced HRV on athletic performance, as well as the cardiovascular and cerebrovascular components of concussion and PCS. Additionally, this article will review interventions with HRV biofeedback (HRV BFB) training as a promising and underutilized treatment for sports and military-related concussion. Finally, this article will review research and promising case studies pertaining to use of HRV BFB for enhancement of cognition and performance, with applicability to concussion rehabilitation.

Self-reporting of concussion is essential to appropriate intervention, and failure to report concussion-like symptoms is a significant issue. In the current study we sought to investigate factors that contribute to the process of self-reporting concussion symptoms within the context of the Canadian Football League. A constructivist grounded theory methodology was adopted, employing in-depth, semi-structured interviews with ten Canadian League Football (CFL) players. We found significant complexity within the decision-making process for CFL players, when assessing whether or not to report a concussion. In the preliminary grounded theory emerging from the study, we identified two stages involving 1. pre-game preparation, and 2. assessing the impact. In addition, we determined three related processes (themes): 1. intrapersonal symptom checklists, 2. perceived pressures to play, and 3. certainty of symptoms.

Self-report measures, particularly symptom inventories, are critical tools for identifying patients with persistent post-concussion symptoms and their follow-up. Unlike in military or sports-related assessment, in general civilian settings pre-injury levels of concussion-like symptoms are lacking. Normative data are available in adolescent and college populations, but no reference data exist to guide clinical adult explorations. The purpose of this study was to use the second edition of the Sport Concussion Assessment Tool (SCAT2) to profile a cohort of 60 healthy community volunteers who had not sustained a head injury. Participating volunteers underwent MRI scanning and were evaluated with the Hospital Anxiety and Depression Scale (HADS). Participants reported a median of 3 concussion-like symptoms and the 97.5 percentile score was found at 10.5 symptoms, out of a total of 22. The median severity score was 4.9 points, and 28.9 was the upper limit of the reference interval. Only 10 participants (16.7%) did not endorse any symptom. The most frequently endorsed symptom was feeling difficulty in concentrating, with 41.7% of the sample reporting it. Age, sex and general distress, anxiety and depressive symptoms were not associated with concussion-like symptoms. Our data yielded elevated cut-offs scores for both the number of symptoms and the symptom severity. In conclusion, postconcussive-like symptoms are frequent in the general non-concussed adult population and it should be taken into account in any future models developed for screening patients at risk of developing physical, cognitive, and psychological complaints following mild traumatic injury.

Through Education,one has to be better adaptand adjust oneselfin order to change oneself and the society at large. In such stable and sustainable situation one can develop with individuals possessing the best mental and moral qualities. As a result, education enables an individual to face all kinds of challenges in life.The main purpose of the study was to investigate the playingof Player Unknowns Battle Grounds(PubG)of Secondary school students. The objectives of the study wereto study playing of PubG of Secondary school students on the basis of gender, standard of the students, boards of study, type of school and medium of study of secondary school students. The researcher employed survey method by executing Self-constructed and validated tool on 135secondary school students ofPatna in Bihar to assess the objectives of the study.The scholar used mean, Median, S.D. and t testfor the calculation of the collected data. The result revealed that there is no significant difference between the mean scores of male and female, IX and X standard students, CBSE and ICSE students intheir playing of PubG of Secondary School students whereas there is a significant difference between the mean scores of ICSE and BSEB, CBSE and BSEB, Private and Government,English and Hindi mediumsecondary school students in their playing of PubG.

AbstractWe make two main contributions to the literature on work-related injury risk and economic outcomes in the context of American professional football. One is to examine an increasingly important specific injury, concussions, and compare its subsequent economic effects to those of other types of football injuries. Our other contribution is to study the role of race in understanding injury risk and severity and their resulting economic consequences, which has been overlooked in previous sports injury research. Using a specific position, tight ends, which allows conditioning on fine-grained relevant measures of player demographics, playing time, and performance, we find that whether a player continues to play NFL football from year to year is affected by type of injury and the player's race. We calculate that the average ex post loss in annual compensation from a concussion is about 7%. Moreover, the effect of games missed due to concussion on continued employment is triple that of other injuries. Being white positively affects length of playing career independent of the measured productivity of the players involved. The racial gap in career length is approximately equal to the effect of an additional game missed from concussion. With respect to heterogeneity in the effects of injuries, both concussions and other injury types affect ex post economic outcomes equally for white and nonwhite players. Both injuries and race affect compensation solely through their effects on career length.

This research examines the effects that concussion legislation has had on how Certified Athletic Trainers practice medicine in the state of Ohio. In the spring of 2009, the state of Washington passed a bill that would change how concussions are handled in youth sports. According to the legislation, all athletes who display any signs and symptoms of a concussion are to be removed immediately from play and are not able to return to play until cleared by a licensed professional health care provider. Since then, concussion legislation of some form has been passed in every state, with Ohio passing its own law in the spring of 2013. However, the Ohio High School Athletic Association (OHSAA) made a unique amendment to it by giving sporting officials the power to remove an athlete they deem is "concussed" without having to confirm a diagnosis with a licensed professional health care provider such as the Certified Athletic Trainers (ATCs) who are normally present during sporting competitions. The purpose of this study was to determine how Athletic Trainers who work in high schools in the state of Ohio feel about this law and its various stipulations. A 20-question survey was sent to Athletic Trainers who work in a high school setting in the state of Ohio asking for their opinion and views on various components of law. Of the 302 ATCs who received the survey, 49 (16%) submitted it completed. Results of the survey yielded a mix of positive and negative emotions related to various aspects of the legislation, and though there was some disagreement, responding ATCs agreed with the main purpose of the legislation, which was to raise awareness of concussions and prevent mishandling of cases involving concussed athletes. What it came down to was whether ATCs feel that their knowledge and expertise in recognizing and treating concussions is not being utilized to its fullest potential.