Understanding the impact that these factors may have on assessment, management, and return to activity/sport helps to ensure a well-balanced and evidence-informed approach to care. In part 1 of this commentary, we address etiology, risk factors, and detection of concussion. 11 This integrated model encompasses personal and situational moderating factors. Growth hormone is the most commonly affected hormone following concussion.56,63,114,115 Individuals with symptoms consistent with alteration in sex hormones, hypothyroidism, adrenal dysfunction, diabetes insipidus, syndrome of inappropriate antidiuretic hormone secretion, or growth hormone deficiency (fatigue, disrupted sleep patterns, and cognitive difficulties) should be investigated for hypothalamic-pituitary axis dysfunction.114, People with more, and more severe, acute and subacute symptoms take longer to recover following concussion.52 Adolescent age, female sex, the presence of a migraine history, and pre-existing mental health problems are predictors of slower recovery.52 Many other factors (eg, previous history of concussion, preschool age, race, genetics) have been evaluated as potential predictors of longer recovery, with mixed results.52 Attention deficit hyperactivity disorder and learning disabilities are unlikely to be risk factors for prolonged recovery.52 Among youths 5 to 18 years of age who presented to an emergency department, female sex, older than 13 years of age, migraine history, previous concussion with symptoms for greater than 1 week, sensitivity to noise, fatigue, headache, parent reporting that the child answers questions slowly, and more than 3 errors on the Balance Error Scoring System-tandem stance were predictors of longer recovery.127 Children with visual, vestibular, and cervical spine findings also recover more slowly.30,81, After an initial 24 to 48 hours of cognitive and physical rest,84,103 initiate a strategy of gradual return to school and sport.84 If symptoms persist beyond 7 to 10 days following injury, targeted treatment may be warranted.84,103 Rehabilitation following concussion should be informed by a multifaceted, interdisciplinary assessment aimed at identifying underlying sources of ongoing symptoms.78,103, In the presence of headache, differential diagnosis of headache type is imperative to inform management. NIH 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. Jetelina KK, Beauchamp AM, Reingle Gonzalez JM, Molsberry RJ, Bishopp SA, Lee SC. In other cases, findings suggest that central vestibular involvement may be present. Neuroendocrine dysfunction, caused by injury to the hypothalamic-pituitary axis following mild to severe traumatic brain injury5,6,90,114 and sport-related concussion,72,113,114,116 has been reported. 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? 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. Ericsson, K. A. The initial management of concussion involves both cognitive and physical rest for the first 24 to 48 hours following injury.84,103 After this time, gradually and progressively increase activities of daily living, as long as symptoms do not increase.84,103 Once concussion-related symptoms have resolved with typical activities, gradually resume physical and cognitive activities (FIGURE 2). In this section, we outline 9 common persistent symptoms following concussion,7,58,106 describe differential diagnoses, and offer an overview of evidence-based rehabilitation approaches. 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. Journal of Orthopaedic & Sports Physical Therapy, 21 April 2020 | Brain Injury, Vol. Further grief criticisms centre on the absence of denial in much of the research to date. Clin. 2020 Sep 1;55(9):967-976. doi: 10.4085/1062-6050-477-19.  |  Steffen K, Myklebust G, Andersen TE, Holme I, Bahr R. Am J Sports Med. Symptom onset can be delayed, with the duration of the delay predicting a longer time to recovery following injury. COVID-19 is an emerging, rapidly evolving situation. 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. Headaches are the most frequent symptom following concussion. van Winden D, van Rijn RM, Savelsbergh GJP, Oudejans RRD, Stubbe JH. Epidemiology of injury in child and adolescent sports: injury rates, risk factors, and prevention. Introduction. 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. 49, No. 11. Lower limb MSK injuries among school-aged rugby and football players: a systematic review. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. A dynamic model of etiology in sports injury: the recursive nature of risk and causation . The return-to-school protocol includes 4 steps: (1) daily activities that do not provoke symptoms, (2) school activities outside of school, (3) part-time return to school, and (4) full-time return to school (FIGURE 3).29,84 To facilitate return to school, a medical letter including recommendations for individual accommodations is recommended.94 Accommodations at school may include reduced hours at school, more time to complete assignments and examinations, frequent breaks, reduced screen time, and working in a quiet area.21 Return to school should occur before return to contact activity or full competition. Each individual who participates in an activity brings a specific set of intrinsic and extrinsic factors (FIGURE 1). 2008 Jan;27(1):19-50, vii. A concussion should be suspected after a direct blow to the head or following trauma to the body by which force has been transmitted to the head.84 Some of the observable signs of concussion are lying motionless, clutching the head, unsteadiness, or appearing dazed or confused immediately following a concussion (see the Concussion Recognition Tool Fifth Edition28). 1. 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. A Control Problem. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. A Dynamic Model of Etiology in Sport Injury: The Recursive Nature of Risk and Causation: Clinical Journal of Sport Medicine 17, 215–219 (2007). One such dynamic model is described by Meeuwisse.27 This model describes how multiple factors interact to produce injury (fig 1). In part 2, we address concussion assessment and management. The article then focuses on the dynamic core of the integrated response to sport injury and rehabilitation model. 2020 Oct 28;6(1):e000806. USA.gov. Recursive Preferences. response to sport injury. Interventions aimed at primary prevention have shown promise in decreasing the risk of concussion. 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. 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. 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. J Athl Train. A Dynamic Model of Etiology in Sport Injury: The Recursive Nature of Risk and Causation: Clinical Journal of Sport Medicine 17, 215–219 (2007). A DYNAMIC, RECURSIVE MODEL OF SPORT INJURY In a real life sporting environment, a participant’s risks are dynamic and can change frequently. A dynamic model of etiology in sport injury: the recursive nature of risk and causation Clin J Sport Med, 17 (3) (2007), pp. Every step, competition or practice is an exposure that impacts the body. 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. a dynamic model that accounts for the multifactorial nature of sports injuries, and in addition, takes the sequence of events eventually leading to an injury into account. Anderson DS, Cathcart J, Wilson I, Hides J, Leung F, Kerr D. BMJ Open Sport Exerc Med. 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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) This model has been adapted and graphically represented in ... A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Identifying these factors is part of an individualized, patient-centered approach to prevention, assessment, and management of concussion. 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. Symptoms alone do not distinguish physiologic concussion from cervical/vestibular injury, Exercise treatment for postconcussion syndrome: a pilot study of changes in functional magnetic resonance imaging activation, physiology, and symptoms, A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome, Regulatory and autoregulatory physiological dysfunction as a primary characteristic of post concussion syndrome: implications for treatment, rTMS in alleviating mild TBI related headaches — a case series, Left dorsolateral prefrontal cortex rTMS in alleviating MTBI related headaches and depressive symptoms, Trends in concussion incidence in high school sports: a prospective 11-year study, Utility of serum IGF-1 for diagnosis of growth hormone deficiency following traumatic brain injury and sport-related concussion, Posttraumatic headache: clinical characterization and management, A prospective study of prevalence and characterization of headache following mild traumatic brain injury, Variables affecting treatment in benign paroxysmal positional vertigo, Impact of mandatory helmet legislation on bicycle-related head injuries in children: a population-based study, Factors affecting time to recovery from sports concussion [abstract], Approach to investigation and treatment of persistent symptoms following sport-related concussion: a systematic review, Epidemiology of concussions among United States high school athletes in 20 sports, Epidemiology of sports-related concussion in seven US high school and collegiate sports, Vision and vestibular system dysfunction predicts prolonged concussion recovery in children, Prevalence of sleep disturbances, disorders, and problems following traumatic brain injury: a meta-analysis, Collaborative care for adolescents with persistent postconcussive symptoms: a randomized trial, Consensus statement on concussion in sport—the 5, Vestibular and oculomotor assessments may increase accuracy of subacute concussion assessment, Mild traumatic brain injury (mTBI) and chronic cognitive impairment: a scoping review, Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective TRACK-TBI study, A dynamic model of etiology in sport injury: the recursive nature of risk and causation, A brief Vestibular/Ocular Motor Screening (VOMS) assessment to evaluate concussions: preliminary findings, Abnormalities of pituitary function after traumatic brain injury in children, Insomnia in patients with traumatic brain injury: frequency, characteristics, and risk factors, The incidence of concussion in youth sports: a systematic review and meta-analysis, What factors must be considered in ‘return to school’ following concussion and what strategies or accommodations should be followed? 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. Statistical metrics c. Machine learning model validation 5. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Individual athletes have their own risk factors that predispose them to concussion (FIGURE 1). 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). 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. as well as cognitive, emotional. In elite rugby, the majority of concussions occur to the tackler, and the risk of concussion increases when the tackler accelerates, travels at a high speed, and has head contact.20. In this section, we summarize the key intrinsic and extrinsic risk factors for concussion. In youth athletes, growth and development may result in changes in performance and adaptations. Cumulative, high-stress calls impacting adverse events among law enforcement and the public. 49, No. Types of models c. Dataset i. Exploratory analysis d. Analysis e. Results f. Summary and exercises 6. Diagnosis directs appropriate management. 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).  |  Thus, consideration of sport-specific skills should be an integral part of a rehabilitation program. 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. 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. A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Dizziness symptoms can be vertigo (ie, sensation of spinning of the environment or the person), light-headedness, presyncope, or a sense of disorientation. 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. 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 injury88 framework. Use case 1: Survival analysis a. Get the latest public health information from CDC: https://www.coronavirus.gov. 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. ↑ Alonso JM, Junge A, Renstrom P, Engebretsen L, Mountjoy M, Dvorak J. Emotional Responses to Athletic Injury Questionnaire. Recursive Models of Dynamic Linear Economies Lars Hansen University of Chicago Thomas J. Sargent New York University and ... agent model. 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. 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. In addition to a thorough history, targeted assessment tests help clinicians to understand the source of dizziness. It is important for sports professionals to know why certain athletes may be at risk of injury risk factors and how injuries occur (i… Increasing knowledge regarding concussion burden and identifying factors contributing to multifaceted and recursive risk for concussion will inform the development and evaluation of effective concussion prevention strategies. and behavioral 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. Treatment may be more effective when initiated early in the recovery process.104 However, further research is warranted to identify the ideal timing and type of intervention. When symptoms persist for longer than 7 to 10 days, a multifaceted interdisciplinary assessment to guide treatment is recommended. 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. 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. A dynamic, recursive model of etiology in sport injury. 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.  |  as well as cognitive, emotional. doi: 10.1097/jsm ... sport, injury… 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. Get the latest research from NIH: https://www.nih.gov/coronavirus. 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. 34, No. 16.4.1. 2008 Jun;42(6):413-21. doi: 10.1136/bjsm.2008.046631. Bittencourt et al. @article{Meeuwisse2007ADM, title={A dynamic model of etiology in sport injury: the recursive nature of risk and causation. doi: 10.1016/j.csm.2007.10.008. For instance, the skills required of a volleyball player will differ from those expected of an ice hockey player. Curr Sports Med Rep. 2008 Nov-Dec;7(6):359-66. doi: 10.1249/JSR.0b013e31818f0bed. Once the individual has completed 1 to 2 days of rest, a gradual return to sport and school/work is recommended. Pessimistic Inter-pretation. 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. FIGURE 2. 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. 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? 16. 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? 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). Clin Sports Med. 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. A model originally described by Meeuwisse (1994) and adapted and expanded upon by Barr and Krosshaug (2005)may guide sports professionals. Ericsson, K. A. 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. Sport-specific and performance-related skills may be necessary to return to full participation. In youth rugby players, there was a reduction in overall risk of game-related concussion when a neuromuscular training program was performed at least 3 times weekly.49 A vision training program may reduce the risk of concussion in collegiate football players.18 There was a 67% reduction in the risk of concussion in youth ice hockey following rule changes to disallow bodychecking.32 Tackle training and rules related to tackling in rugby as a way of decreasing risk of concussion are areas of ongoing evaluation.47 Finally, restricting the number of collision practices in youth football may reduce the frequency of head impacts in games and practice.14. The best way to decrease the burden of concussion is to prevent the injury before it occurs (ie, through primary prevention). Treatment of sleep disorders often includes pharmacological and nonpharmacological management.123,124 Education regarding sleep hygiene may improve sleep quality. and behavioral responses of athletes to sport injury. Survival analysis i. 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. Neurological examination, assessment of vestibulo-ocular reflex function, static balance, dynamic balance, assessment of nystagmus with and without fixation, positional testing, and vestibular function testing can inform diagnosis and management. 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. 6, International Journal of Athletic Therapy and Training, 31 October 2019 | Journal of Orthopaedic & Sports Physical Therapy, Vol. Risk behaviors in high school and college sport. J. 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. ELECTRONIC Integrated model of psychological response to the sport injury and rehabilitation Psychological Responses Having discussed the integrated model that depicts how the psycho- logical consequences of sport injury relate to the overall injury experi- Keywords: Dynamic systems in team sports , prototypical configuration of play , matrix of play , team sport … Many individuals who have suffered a concussion may report difficulty with reading at school, work, or during screen time (eg, computers, smartphones, tablets). Injury, rehabilitation and psychology Written by Jack Marlow. 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) doi: 10.1136/bmjsem-2020-000806. 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. 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).