|  An integrated model is illustrated which provides a synthesis of existing conceptual models depicting the dynamic process of psychological response to sport injury. Unsteadiness or imbalance may also be reported (suggesting difficulty with maintaining an upright position in space, possibly related to dysfunction of vestibulospinal function, proprioception, vision, or other systems that contribute to upright balance) and should be assessed. Extrinsic Risk Factors for Concussion The environment in which an athlete plays includes factors that can influence the risk of concussion, many of which may be modifiable. Cognitive symptoms can include difficulties remembering and concentrating, slowed processing, decreased attention, and difficulty with learning.58,86 Cognitive symptoms often resolve over the initial days to weeks following injury. This article applies the dynamic, recursive model of sport injury to sport-related concussion and summarizes the process of individualized assessment and management following concussion in athletes of all ages, with a focus on physical rehabilitation. In addition to a thorough history, targeted assessment tests help clinicians to understand the source of dizziness. Dizziness symptoms can be vertigo (ie, sensation of spinning of the environment or the person), light-headedness, presyncope, or a sense of disorientation. Symptoms may be reported by the player, such as headaches, dizziness, nausea, sensitivity to light or noise, fatigue, and feeling as though in a fog. There may be alterations in gait, reduced gait velocity, and increased sway when dividing attention following concussion.38,59 Further research to better understand changes in the ability to divide attention while accounting for growth and development is warranted. This model builds on the previous work, while emphasizing the fact that adaptations occur within the context of sport (both in the presence and absence of injury) that alter risk and affect etiology in a dynamic, recursive fashion. 2008 Jan;27(1):19-50, vii. Pre-injury factors lead to post-injury responses Dynamic Core of Model: Cognitive appraisals, emotional responses, behavioral responses, recovery outcomes. J Athl Train. Each individual who participates in an activity brings a specific set of intrinsic and extrinsic factors (FIGURE 1). Clinicians should use a multifaceted assessment that includes symptoms, a neurological screen, and assessment of multiple clinical domains.27,37 The Sport Concussion Assessment Tool Fifth Edition (SCAT5)29 includes an immediate/on-field assessment that incorporates red flags, observable signs, memory assessment (ie, the Maddocks questions), the Glasgow Coma Scale, and a cervical spine assessment.  |  A Dynamic Model of Etiology in Sport Injury: The Recursive Nature of Risk and Causation: Clinical Journal of Sport Medicine 17, 215–219 (2007). Recursive Risk Sensitive Control 369 16.1. Front Psychol. Recursive Models of Dynamic Linear Economies Lars Hansen University of Chicago Thomas J. Sargent New York University and ... agent model. The purpose of this manuscript is to outline a new model representing a dynamic approach that incorporates the consequences of repeated participation in sport, both with and without injury. Symptom onset can be delayed, with the duration of the delay predicting a longer time to recovery following injury. However, while protective equipment, such as helmets, headgear, and mouthguards, may mitigate the risk of concussion, the literature is inconclusive.  |  Please enable it to take advantage of the complete set of features! Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Of the children with convergence insufficiency, 46% had their symptoms resolve in the initial 4.5 weeks following injury, and another 41% reported recovery following vestibular rehabilitation that included convergence training.110 Deficits in smooth pursuit, saccades, near point of convergence, and accommodation also have been reported following concussion, often in the presence of vestibulo-ocular reflex deficits and altered balance.81 Thus, visual assessment should include smooth pursuit, saccades, near point of convergence, and accommodation, in combination with a vestibular and balance examination. Cervical spine pain may be accompanied by cervicogenic headache or cervicogenic dizziness.7,106 Cervical spine findings are common following concussion (eg, impairments following anterolateral strength, the head perturbation test, joint position to the left, or the cervical flexor endurance test).107 Many of the symptoms reported following whiplash are similar to those reported following concussion,51 suggesting that cervical spine injury might have occurred at the same time as the concussion. A systematic review, Detecting gait abnormalities after concussion or mild traumatic brain injury: a systematic review of single-task, dual-task, and complex gait, Active rehabilitation for children who are slow to recover following sport-related concussion, A pilot study of active rehabilitation for adolescents who are slow to recover from sport-related concussion, Helmet fit assessment and concussion risk in youth ice hockey players ages 11–18 years [abstract], Attention problems as a risk factor for concussion in youth ice-hockey players [abstract], Concussions among United States high school and collegiate athletes, Inadequate helmet fit increases concussion severity in American high school football players, Vestibular rehabilitation for peripheral vestibular hypofunction: an evidence-based clinical practice guideline, The International Classification of Headache Disorders, 3rd edition, Contact technique and concussions in the South African under-18 Coca-Cola Craven Week Rugby tournament, Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial, Mild traumatic brain injury among a cohort of rugby union players: predictors of time to injury, Is there a relationship between whiplash-associated disorders and concussion in hockey? Clin. If symptoms persist following the initial days to weeks following injury, a multifaceted assessment to identify areas that may require rehabilitation is warranted.37,65,78,103 Refer the patient for additional assessment and rehabilitation if the individual has not recovered in the 10 to 14 days following injury. Keywords: Dynamic systems in team sports , prototypical configuration of play , matrix of play , team sport … In most cases, the symptoms of concussion resolve in the initial few days following the injury, and a strategy involving a gradual return to sport and school is recommended. ELECTRONIC Farley JB, Barrett LM, Keogh JWL, Woods CT, Milne N. Sports Med Open. Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment, Risk factors for sports concussion: an evidence-based systematic review, Vestibular rehabilitation for dizziness and balance disorders after concussion, Exercise prescription patterns in patients treated with vestibular rehabilitation after concussion, Immediate removal from activity after sport-related concussion is associated with shorter clinical recovery and less severe symptoms in collegiate student-athletes, Hypopituitarism in pediatric survivors of inflicted traumatic brain injury, Pituitary dysfunction after blast traumatic brain injury: the UK BIOSAP study, A prospective study of concussions among National Hockey League players during regular season games: the NHL-NHLPA Concussion Program, Clinical practice guideline: benign paroxysmal positional vertigo (update), Physical activity and concussion risk in youth ice hockey players: pooled prospective injury surveillance cohorts from Canada, Risk factors associated with sustaining a sport-related concussion: an initial synthesis study of 12,320 student-athletes, Vestibular rehabilitation for unilateral peripheral vestibular dysfunction, Peripheral vestibular disorders in children and adolescents with concussion, National Institute of Neurological Disorders and Stroke and Department of Defense Sport-Related Concussion Common Data Elements version 1.0 recommendations, Football players' head-impact exposure after limiting of full-contact practices, Systematic review of return to work after mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis, The epidemiology of new versus recurrent sports concussions among high school athletes, 2005–2010, Prevalence and consequences of sleep disorders in traumatic brain injury, An exploratory study of the potential effects of vision training on concussion incidence in football, Neck strength: a protective factor reducing risk for concussion in high school sports, Tackling concussion in professional rugby union: a case–control study of tackle-based risk factors and recommendations for primary prevention, The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5): background and rationale, Descriptive epidemiology of collegiate men's football injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 through 2003–2004. A quick introduction to R b. Enter your email address below and we will send you the reset instructions, If the address matches an existing account you will receive an email with instructions to reset your password, Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. ERAIQ. Once a concussion is suspected, the player should be removed from play and further assessed by a qualified health care professional (FIGURE 2). 49, No. Sociodemographic predictors of sport injury in adolescents. Blurred vision, double vision, and difficulty reading may be reported following a concussion. Individual athletes have their own risk factors that predispose them to concussion (FIGURE 1). Assessment of the cervical spine should include range of motion, manual spinal exam, general strength, and cervical sensorimotor and neuromotor control.61,118,120 The clinical tests that have established utility in the cervical spine literature, including joint position sense, cervical movement control, the craniocervical flexion test, cervical flexor and extensor endurance, the cervical flexion-rotation test, and manual spinal exam, may be useful in identifying potential areas of dysfunction in concussion.53,55,61,97,106,107,119. Integrated model of psychological response to the sport injury and rehabilitation process (adapted from Weise-Bjornstal et al., 1998). Findings of convergence insufficiency have been identified in children following concussion; however, further research is needed to identify whether these deficits are pre-existing or have their onset following trauma. A dynamic, recursive model of etiology in sport injury. 2020 Jul 10;11:1452. doi: 10.3389/fpsyg.2020.01452. If we are to truly understand the etiology of injury and target appropriate prevention strategies, we must look beyond the initial set of risk factors that are thought to precede an injury and take into consideration how those risk factors may have changed through preceding cycles of participation, whether associated with prior injury or not. It is important for sports professionals to know why certain athletes may be at risk of injury risk factors and how injuries occur (i… as well as cognitive, emotional. Intrinsic Risk Factors for Concussion Intrinsic risk factors may be modifiable (such as neuromuscular or sensorimotor control) or nonmodifiable (such as previous history of concussion, sex, age, and genetics). The For individuals with ongoing dizziness, neck pain, and headaches, cervicovestibular physical therapy can be beneficial.103,104,106 Sport-specific training, related to the context in which the individual would be participating, should form an integral part of the rehabilitation program.106 For children and adolescents with visual and vestibular findings, vestibular rehabilitation may be of benefit.111 In addition, low-level aerobic exercise may promote recovery following concussion.40,62,67, Collaborative care, including cognitive-behavioral therapy, care management, and psychopharmacological evaluation, has positive effects on symptom reduction after 6 months.83 An active approach to rehabilitation, including aerobic exercise, visualization, and coordination, has positive effects on symptoms and function.39,40 Future research to best understand timing, order, frequency, and other parameters of combination treatments is warranted.103. Ericsson, K. A. 11 Junge A, Engebretsen L, Alonso JM, Renström P, Mountjoy M, Aubry M, Dvorak J. Br J Sports Med. Autonomic function may be disrupted following concussion.25 An increase in symptoms can occur for some individuals when they increase the intensity of physical activity. Steffen K, Myklebust G, Andersen TE, Holme I, Bahr R. Am J Sports Med. Adapting the dynamic, recursive model of sport injury to concussion: an individualized approach to concussion prevention, detection, assessment, and treatment - Schneider KJ, Emery CA, Black A, Yeates KO, Debert CT, Lun V, Meeuwisse WH. Limit naps to less than 1 hour, and prior to mid afternoon. The stress-injury model also proposed a number of factors, such as personality, history of stress, and coping resources, that may moderate a stress response, but there was less clarity and exposition of mediating pathways, particularly those related to stress physiology, by which stress response may increase risk of injury. Stage of the return to sport models In order to explain the psychological stages of the rehabilitation, stage models provide a succession of emotions and attitudes occurring following sport injury. Previous history of concussion is a risk factor for future concussion.1 The exact mechanism by which this occurs is not yet well understood and may be related to genetics, epigenetics, sensorimotor or neuromuscular control, and other factors. Journal of Orthopaedic & Sports Physical Therapy, 21 April 2020 | Brain Injury, Vol. This article applies the dynamic, recursive model of sport injury to sport-related concussion and summarizes the process of individualized assessment and management following concussion in athletes of all ages, with a focus on physical rehabilitation. Less common diagnoses may include temporal bone fracture (with resultant damage to the eighth cranial nerve), labyrinthine concussion, peri-lymphatic fistula, and semicircular canal dehiscence.12,35, Vestibular rehabilitation may be of benefit for individuals with peripheral vestibular disorders (including BPPV) and stable central vestibular disorders.8,45,75 Positive effects on recovery following vestibular rehabilitation after concussion have been reported in the literature.2,106 Typically, vestibular rehabilitation includes canalith repositioning maneuvers (for BPPV) and individually targeted exercises aimed at facilitating sensorimotor compensation (including adaptation, habituation, substitution, and standing and dynamic balance exercises).3,8,106. This model builds on the previous work, while emphasizing the fact that adaptations occur within the context of sport (both in the presence and absence of injury) that alter risk and affect etiology in a dynamic, recursive fashion. Other screening tools, such as the Vestibular/Ocular Motor Screening and a combination of optokinetic stimulation, gaze stabilization testing, and near point of convergence, may have clinical utility as screening tools for concussion in the subacute period (2–10 days) following concussion.85,89 The SCAT5 and Vestibular/Ocular Motor Screening tools can be used as part of the clinical assessment but should not replace other aspects of the clinical exam that may be warranted, based on the individual circumstances of the injury.21,29,84. doi:10.2519/jospt.2019.8926, Sport-related concussion is among the most frequently reported injuries in sport and recreation.80 A sport-related concussion is “a traumatic brain injury induced by biomechanical forces.”84 Symptoms and signs that occur following a concussion are believed to represent a functional rather than structural injury, as structural neuroimaging studies do not detect abnormalities.84 Recovery can occur in the initial days to weeks for most adults, but up to one third of children and youth may take longer than 4 weeks to recover.108,127. Whether its recreational or professional, injury is a common occurrence at all levels of sport and exercise. This article applies the dynamic, recursive model of sport injury to sport-related concussion and summarizes the process of individualized assessment and management following concussion in athletes of all ages, with a focus on physical rehabilitation. eCollection 2020. the context of sport (both in the presence and absence of injury) that alter risk and affect etiology in a dynamic, recursive fashion. When the 2 injuries occur concurrently, they must be treated appropriately. Sports injuries surveillance during the 2007 IAAF World Athletics Championships. Headaches are the most frequent symptom following concussion. In this paper, the authors build on Meeuwisse’s dynamic, recursive model but argue a complex system approach is necessary to understand the nature of injury aetiology. Each individual can present with a unique set of symptoms and aggravating or relieving factors following concussion.84 Individualized assessments are imperative to best understand the etiology of symptoms.37,78,102,106 A multifaceted, interdisciplinary approach to assessment and management is vital. BMC Public Health. and behavioral responses of athletes to sport injury. 215-219 View Record in Scopus Google Scholar These factors may change over time. Identifying these factors is part of an individualized, patient-centered approach to prevention, assessment, and management of concussion. FIGURE 2. Cognitive behavioral therapy may be beneficial for insomnia.36 Melatonin may have benefits for sleep following concussion, but is not currently recommended for sleep onset or maintenance problems.100 In the presence of ongoing sleep difficulties, refer to a sleep specialist to further investigate potential underlying causes. A Control Problem. Epub 2008 Jan 28. Irritability, sadness, anxiety, and feeling more emotional than normal are often reported following concussion, although they may not be acute.58 The psychological response to concussion may be similar to that to musculoskeletal injury, and improves over time.121 Some adults may have generalized anxiety disorder, panic attacks, and posttraumatic stress disorder following injury, which may reflect a new diagnosis or an exacerbation of a previous condition.128 Anxiety and depression are more common in women than in men, and may predict a longer recovery.52,109 Ongoing psychological or psychiatric problems are rare in children and youth without preinjury problems.31 Management of mental health problems will depend on the specific diagnosis (eg, pharmacological or psychological treatment). USA.gov. Get the latest public health information from CDC: https://www.coronavirus.gov. Once again, literature on health and disease outcomes has a large influence as the source of the ‘web of determinants’ concept (Philippe and Mansi, 1998). ↑ Alonso JM, Junge A, Renstrom P, Engebretsen L, Mountjoy M, Dvorak J. Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment Journal of Orthopaedic & Sports Physical Therapy, Vol. 1. The questions - how do I get better and how do I stay healthy - are part a dynamic and constantly changing system. 2007;17(3):215–219. Clipboard, Search History, and several other advanced features are temporarily unavailable. A systematic review, The Concussion Recognition Tool 5th Edition (CRT5): background and rationale, The Sport Concussion Assessment Tool 5th Edition (SCAT5): background and rationale, Cervical spine dysfunction following pediatric sports-related head trauma, A systematic review of psychiatric, psychological, and behavioural outcomes following mild traumatic brain injury in children and adolescents, What strategies can be used to effectively reduce the risk of concussion in sport? 49, No. One such dynamic model is described by Meeuwisse.27 This model describes how multiple factors interact to produce injury (fig 1). Symptoms are often provoked with rapid head motions, and blurred vision may be reported in association with head movement (suggesting altered vestibulo-ocular reflex dysfunction). This paper presents a dynamic forward-looking multi-regional general equilibrium model developed at the Joint Program on the Science and Policy of Global Change of the Massachusetts Institute of Technology (MIT) and applies it in comparison with the latest version of the recursive-dynamic MIT Emissions Prediction and Policy Analysis (EPPA) model. As concussions differ so widely, an awareness of risk factors and individual clinical characteristics can facilitate an individualized approach. Statistical metrics c. Machine learning model validation 5. Once the individual has completed 1 to 2 days of rest, a gradual return to sport and school/work is recommended. Recursive Preferences. The purpose of this clinical commentary was to summarize prevention, detection, assessment, and treatment factors that affect individuals across the continuum of concussion care, using the dynamic, recursive model of sport injury 88 framework. Such a rehabilitation strategy, tailored to the individual, can facilitate high-quality, evidence-informed care and injury prevention. For example, BPPV may occur in approximately 5% of cases of ongoing dizziness following concussion.2,106 Suspect BPPV when the patient describes seconds of vertigo with positional changes (eg, lying down/getting up, rolling in bed, looking up, bending over).8 For BPPV to be diagnosed, a positive Dix-Hallpike test with seconds of vertigo and a characteristic pattern of nystagmus should be present.8 Canalith repositioning maneuvers (eg, the Epley maneuver) are effective for treating BPPV (up to 98% of cases resolve within 3 treatments).8,75, In up to 10% to 26% of cases of ongoing dizziness following concussion, assessment findings suggest peripheral vestibular hypofunction (ie, decreased vestibular labyrinth function).11,12 Suspect a peripheral vestibular problem in patients who report intense dizziness and unsteadiness following the concussion, followed by a gradual improvement of symptoms over the initial few weeks. These various concepts, along with elements of movement in play, are integrated in a model intended to help players and observers grasp a systemic view of action play and its underlying fulcrums. Studies in basketball, hockey, and rugby have suggested a protective effect of mouthguards on concussion risk; however, a meta-analysis found no significant effect.32 In American youth football, appropriate helmet fit was associated with lower symptom severity and shorter duration of symptoms.44 In ice hockey, appropriate helmet fit may protect against concussion, although further research is needed.41 Studies examining the use of headgear in rugby and soccer are inconclusive.32,95 Further research is needed to better understand the role of protective equipment by sport. Use standardized tools when screening for mood and mental health problems.13, Up to 1 in 2 individuals with concussion report sleep problems (insomnia, difficulty falling asleep, difficulty staying asleep).17,82 In the early postinjury phase, individuals may be more fatigued than normal and require more sleep.96 Individuals with pain may also require more sleep.64,112 Addressing sleep difficulties is important to improve recovery.92. Injury, rehabilitation and psychology Written by Jack Marlow. Return-to-sport and return-to-school strategies include a gradual return to activities, which may vary depending on the environment to which the athlete returns. Thus, consideration of sport-specific skills should be an integral part of a rehabilitation program. This article applies the dynamic, recursive model of sport injury to sport-related concussion and summarizes The Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary is one of eleven International Research Centres supported by the International Olympic Committee for Prevention of Injury and Protection of Athlete Health. The return-to-sport strategy includes 6 steps: (1) symptom-limited activity, (2) light aerobic exercise, (3) sport-specific exercise, (4) noncontact training drills, (5) full-contact practice, and (6) return to sport (FIGURE 3).29,84 Medical clearance to return to sport occurs once the individual is able to complete the return-to-sport protocol with no symptom exacerbation and when no other clinical assessment findings suggest ongoing problems that would preclude returning to sport.84, Return-to-work recommendations are based on similar principles as those of return to school and return to sport.91 Gradually and progressively increase activities, provided there is no increase in symptoms. Ericsson, K. A. If symptoms recur or are exacerbated, reduce the demands of the task to a level that does not provoke symptoms. A dynamic model of etiology in sports injury: the recursive nature of risk and causation . 2008 Apr;36(4):700-8. doi: 10.1177/0363546507311598. This integrated model encompasses personal and situational moderating factors. doi: 10.1016/j.csm.2007.10.008. [abstract], Sport-related concussion: optimizing treatment through evidence-informed practice, Rest and treatment/rehabilitation following sport-related concussion: a systematic review, Cervicovestibular rehabilitation following sport-related concussion [letter], Preseason reports of neck pain, dizziness, and headache as risk factors for concussion in male youth ice hockey players, Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial, Changes in measures of cervical spine function, vestibulo-ocular reflex, dynamic balance, and divided attention following sport-related concussion in elite youth ice hockey players, Concussion burden, recovery, and risk factors in elite youth ice hockey players, Prevalence of and risk factors for anxiety and depressive disorders after traumatic brain injury: a systematic review, Near point of convergence after concussion in children, Vestibular rehabilitation is associated with visuovestibular improvement in pediatric concussion, Individuals with pain need more sleep in the early stage of mild traumatic brain injury. 2008 Mar;40(3):444-50. doi: 10.1249/MSS.0b013e31815ce61a. 16.2. Sometimes, cognitive symptoms persist and may be associated with ongoing difficulties with school and with occupational, sport, and social activities.86 Cognitive symptoms often occur in the presence of other symptoms, such as pain, headaches, difficulties with vision, and sleep problems.87 Referral to a neuropsychologist may be warranted for a thorough assessment to clarify the etiology of the cognitive complaints and to assist in developing an individualized management plan. 11 A preliminary study, Predictors of clinical recovery from concussion: a systematic review, Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients, A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache, Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test, GH and pituitary hormone alterations after traumatic brain injury, Epidemiology of football injuries in the National Collegiate Athletic Association, 2004–2005 to 2008–2009, Concussion symptoms and return to play time in youth, high school, and college American football athletes, Dual-task assessment protocols in concussion assessment: a systematic literature review, Noninvasive brain stimulation for persistent postconcussion symptoms in mild traumatic brain injury, Sensorimotor function and dizziness in neck pain: implications for assessment and management, Aerobic exercise for adolescents with prolonged symptoms after mild traumatic brain injury: an exploratory randomized clinical trial, Neuroendocrine dysfunction in a young athlete with concussion: a case report, Pain and sleep in post-concussion/mild traumatic brain injury, Brain or strain? This model has been adapted and graphically represented in ... A dynamic model of etiology in sport injury: the recursive nature of risk and causation. van Winden D, van Rijn RM, Savelsbergh GJP, Oudejans RRD, Stubbe JH. Immediate removal from activity may improve outcomes.4, At the time of injury, screening for more severe injury (eg, intracranial bleeding, cervical spine fracture) is imperative. Every step, competition or practice is an exposure that impacts the body. Following concussion, it is necessary to recognize and remove the player from additional risk and refer the player to appropriate medical management as early as possible.28,84 Trauma followed by observable signs or symptoms of concussion should trigger an assessment to screen for concussion.28,84 A multifaceted assessment can inform appropriate management.37,78,84,102 Once the player has recovered and received clearance to return to play, the player may re-enter the dynamic process of adapting through recurrent participation. Emotional Responses to Athletic Injury Questionnaire. A posttraumatic headache (1) is a secondary headache that can be attributed to the injury when a new headache occurs following trauma, and (2) must occur within the initial 7 days after the trauma.46 If a preinjury headache worsens or becomes persistent, the primary headache diagnosis, in addition to the posttraumatic diagnosis as described above, is to be used.46 Headache diagnoses following concussion might also include medication overuse headache, migraine headache (with or without aura), tension-type headache, cervicogenic headache, occipital neuralgia, and mixed headache type.73,74,126. How Do We Meet the Challenges of Assessing and Managing Concussion? Get the latest research from NIH: https://www.nih.gov/coronavirus. A model originally described by Meeuwisse (1994) and adapted and expanded upon by Barr and Krosshaug (2005)may guide sports professionals. An integrated model is illustrated which provides a syn- thesis of existing conceptual models depicting the dynamic process of psycholog- ical response to sport injury. 2008 Jun;42(6):413-21. doi: 10.1136/bjsm.2008.046631. Anderson DS, Cathcart J, Wilson I, Hides J, Leung F, Kerr D. BMJ Open Sport Exerc Med. The Journal of Sport Rehabilitation (JSR) is your source for the latest peer-reviewed research in the field of sport rehabilitation.All members of the sports-medicine team will benefit from the wealth of important information in each issue. In part 2, we address concussion assessment and management. Integrated Model of Psychological Responses to Sport Injury. A systematic review, Risk of injury associated with body checking among youth ice hockey players, Injury rates, risk factors, and mechanisms of injury in minor hockey, Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice, What domains of clinical function should be assessed after sport-related concussion? A widely referenced model in the area of sport injury research has proposed that multiple factors influence the etiology of sport injury.88 Various etiological factors can vary over time and change the risk that is associated with injury.88 The literature in the area of concussion is evolving and, as such, enables adaptation of this model to better understand the etiology of concussion. Treatment of sleep disorders often includes pharmacological and nonpharmacological management.123,124 Education regarding sleep hygiene may improve sleep quality. Sports physiotherapists and other sports professionals recognise that the identification of the causes of injury is an important step in injury prevention as this can lead to the development of effective injury prevention programs. A dynamic model of etiology in sport injury: the recursive nature of risk and causation Clin J Sport Med, 17 (3) (2007), pp. When feasible, future studies on sport injury prevention should adopt a methodology and analysis strategy that takes the cyclic nature of changing risk factors into account to create a dynamic, recursive picture of etiology. Cumulative, high-stress calls impacting adverse events among law enforcement and the public. Return to participation in sport should occur along a continuum, with respect to the individual's risk of concussion and the characteristics of the environment to which the person is returning. The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. @article{Meeuwisse2007ADM, title={A dynamic model of etiology in sport injury: the recursive nature of risk and causation. In youth athletes, growth and development may result in changes in performance and adaptations. Lower limb MSK injuries among school-aged rugby and football players: a systematic review. 6, International Journal of Athletic Therapy and Training, 31 October 2019 | Journal of Orthopaedic & Sports Physical Therapy, Vol. 2020 Sep 14;6(1):45. doi: 10.1186/s40798-020-00264-9. as well as cognitive, emotional. 16.3. 16.4.1. AN LNTEGRATED MODEL OF RESPONSE TO SPORT INJURY 49 Figure I. process. cancer mortality). Recursive Models of Dynamic Linear Economies. Many individuals who have suffered a concussion may report difficulty with reading at school, work, or during screen time (eg, computers, smartphones, tablets). Curr Sports Med Rep. 2008 Nov-Dec;7(6):359-66. doi: 10.1249/JSR.0b013e31818f0bed. One frequently referenced models of injury prevention is the van Mechelen model.122 In this model, understanding the overall burden of injury in the population and identifying risk factors inform interventions aimed at injury prevention. the context of sport (both in the presence and absence of injury) that alter risk and affect etiology in a dynamic, recursive fashion. The relationship between physical fitness attributes and sports injury in female, team ball sport players: a systematic review. An integrated model is illustrated which provides a synthesis of existing conceptual models depicting the dynamic process of psychological response to sport injury. In some cases, targeted rehabilitation (eg, vestibular rehabilitation, cervical spine rehabilitation, subsymptom threshold aerobic exercise) is warranted.106 In other cases, further medical investigations, referral to additional interdisciplinary health care professionals, or referral for interdisciplinary care may be required (FIGURE 4). Individuals with visual symptoms following concussion may benefit from accommodations to enable earlier return to school or work in a less visually provocative environment (eg, printed materials rather than electronic, change in contrast on a screen).94 Frequent breaks, pacing of activities, and working in a quieter environment may facilitate return to function. The article then focuses on the dynamic core of the integrated response to sport injury and rehabilitation model. Bittencourt et al. Address correspondence to Dr Kathryn J. Schneider, Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4. Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment Journal of Orthopaedic & Sports Physical Therapy, Vol. A dynamic, recursive model of etiology in sport injury. 11. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial, Sport-related concussion induces transient cardiovascular autonomic dysfunction, Pediatric post-traumatic headaches and peripheral nerve blocks of the scalp: a case series and patient satisfaction survey, What tests and measures should be added to the SCAT3 and related tests to improve their reliability, sensitivity and/or specificity in sideline concussion diagnosis? Combining specific exercises with manual therapy is effective for treating cervical spine pain.54 After concussion, include neuromotor control, sensorimotor control, manual therapy, and soft tissue techniques, in combination with vestibular rehabilitation.106 A sequential approach to addressing headaches and cervical spine findings (including neuromotor control) as an initial step of rehabilitation is appropriate, given the connections between the upper cervical spine and the vestibular and visual systems. Introduction. In many cases, medical management is required; for some headache types, such as cervicogenic headaches, physical therapy may be of benefit.54,125 Botulinum toxin injection can be considered for posttraumatic chronic migraine headaches.24 Repetitive transcranial magnetic stimulation may be effective in the treatment of posttraumatic headache.60,69,70 Often, a multimodal approach to headache management includes both acute and prophylactic medication. HHS Moreover, one expo-sure to a potential inciting event can alter an athlete’s intrinsic risk factors and change their predisposition to injury. If an injury does occur, withdrawal from further the basis of the interaction of the event attributes and pre-exposure may be the result; more often, recovery will facilitate existing risks. When symptoms persist for longer than 7 to 10 days, a multifaceted interdisciplinary assessment to guide treatment is recommended. Sport Med. For instance, the skills required of a volleyball player will differ from those expected of an ice hockey player. Sports injury incidence should preferably be expressed as the number of sports injuries per exposure time (e.g. In these cases, the athlete continues to play, and ongoing adaptation and changes in the set of risk factors to which the athlete is exposed may occur, resulting in higher or lower concussion risk. Regardless of the type of injury, it is often preceded by a chain of shifting circumstances that, when they come together, constitute sufficient cause to result in an injury. The office (off-field) assessment portion of the SCAT5 includes history, symptoms, cognitive screening (from the Standardized Assessment of Concussion, which includes orientation, immediate and delayed memory questions, and digits and months of the year in reverse order), a neurological screen (including reading, cervical spine range of motion, ocular motor function, coordination, and balance), and a modified version of the Balance Error Scoring System.29 The Child Sport Concussion Assessment Tool Fifth Edition should be used with children aged 5 to 12 years.21, The clinical utility of the SCAT5 diminishes after the initial 3 to 5 days following injury.84 However, the symptom scale on the SCAT5 can be used to evaluate change in symptoms over time. A special edition from JOSPT, focusing on concussion, has published Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment (Schneider et al) To address this issue, Meeuwisse et al9 developed a dynamic, recursive model for risk and causes of sports injuries, considering that the injury has a non-linear behavior. The Concussion Recognition Tool Fifth Edition (CRT5) is a sideline tool that can be used by parents, coaches, officials, and players to recognize when a concussion may have occurred.28 In some sports, a “spotter” watches for potential signs of concussion and identifies individuals who may require screening for concussion. Knowledge of modifiable risk factors helps to efficiently direct injury prevention efforts, and knowledge of nonmodifiable risk factors helps the clinician achieve an understanding of the overall risk to the athlete and informs return-to-play decision making. Consider occupation-specific activities (eg, cognitive and physical demands, safety requirements) in any return-to-work recommendations.15,91 Positive health outcomes have been reported with return to work or staying at work.99 However, reintroduction of risk and timing in the early recovery period must be carefully monitored.91. Evidence has shown that physical factors such as over-training, equipment and playing conditions are the major contributors towards an athlete’s injuries. Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment Journal of Orthopaedic&Sports Physical Therapy, Ahead of Print. In sports with similar rules, women may be at greater risk of concussion than men.1,16,43,71,79 Risk may differ due to physical characteristics or because women may be more likely to report symptoms.23,117, As age increases through adolescence, the risk of concussion increases, before declining in the early twenties.1,34,43,50, History of attention deficit hyperactivity disorder or learning disability may increase the risk of concussion and/or detection of concussion in youth and collegiate athletes.10,42, Pre-existing symptoms of dizziness, neck pain, and headache may increase the risk of concussion in male youth ice hockey players.105 Possible explanations for the increased risk include altered neuromuscular control, sensorimotor control, balance, or cervical spine strength.101, High school athletes with lower neck strength may have a greater risk of concussion.19 In youth ice hockey players, an increased risk of concussion has been reported in players who did not meet the Canadian recommendations for daily physical activity (1 hour of daily physical activity) in the 6 weeks prior to study entry.9 Player skills and strategy of sport-specific techniques may also influence concussion risk. 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