Papers by Johna Register-Mihalik
Medicine and Science in Sports and Exercise, 2010
Medicine and Science in Sports and Exercise, 2009
Medicine and Science in Sports and Exercise, 2010
Pm&r, 2011
Return-to-play and retirement decisions after concussion are often difficult and complex. The com... more Return-to-play and retirement decisions after concussion are often difficult and complex. The complexity of these decisions may be influenced by many factors, including the number, proximity, and severity of previous concussions; gender; age; sport played; exposure to head impacts; and predisposing or pre-existing conditions. These circumstances and conditions can confound the decisions concerning return to play and retirement. Clinicians should carefully weigh how these circumstances and conditions influence quality of life and how they interact with the effects of concussion. Furthermore, clinicians should consider past and potential exposures to both subconcussive and concussive impacts during the athlete's lifetime when deliberating a return to play or retirement. The purpose of this overview is to highlight and discuss these issues as they factor into the return-to-play and retirement decisions after a concussive injury in an effort to provide clinicians with evidence-based information that can be used in the decision-making process.
Medicine and Science in Sports and Exercise, 2007
Purpose: The purpose of our study was to investigate the association between prior head injury an... more Purpose: The purpose of our study was to investigate the association between prior head injury and the likelihood of being diagnosed with clinical depression among retired professional football players with prior head injury exposure. Methods: A general health questionnaire, including information about prior injuries, the SF-36 (Short Form 36), and other markers for depression, was completed by 2552 retired professional football players with an average age of 53.8 (T 13.4) yr and an average professional football-playing career of 6.6 (T 3.6) yr. A second questionnaire focusing on mild cognitive impairment (MCI)-related issues was completed by a subset of 758 retired professional football players (50 yr and older). Results: Two hundred sixty-nine (11.1%) of all respondents reported having prior or current diagnosis of clinical depression. There was an association between recurrent concussion and diagnosis of lifetime depression (W 2 = 71.21, df = 2, P G 0.005), suggesting that the prevalence increases with increasing concussion history. Compared with retired players with no history of concussion, retired players reporting three or more previous concussions (24.4%) were three times more likely to be diagnosed with depression; those with a history of one or two previous concussions (36.3%) were 1.5 times more likely to be diagnosed with depression. The analyses controlled for age, number of years since retirement, number of years played, physical component score on the SF-36, and diagnosed comorbidities such as osteoarthritis, coronary heart disease, stroke, cancer, and diabetes. Conclusion: Our findings suggest a possible link between recurrent sport-related concussion and increased risk of clinical depression. The findings emphasize the importance of understanding potential neurological consequences of recurrent concussion.
Sports Health: A Multidisciplinary Approach, 2009
Background: A graded symptom checklist is a commonly used concussion evaluation measure. Little i... more Background: A graded symptom checklist is a commonly used concussion evaluation measure. Little is known about preseason baseline symptomatology of high school and college athletes with and without a previous concussion history.
Medicine and Science in Sports and Exercise, 2008
Pm&r, 2010
Objective: To investigate differences in clinical outcomes on the basis of gender and age after a... more Objective: To investigate differences in clinical outcomes on the basis of gender and age after a moderate or severe concussion in a cohort of physically active subjects examined by a single clinician. Design: A descriptive, cross-sectional, retrospective chart review of consecutive patients. Setting: Outpatient assessments by a single clinician with expertise in sports concussion. Patients: Physically active subjects seen for evaluation after a concussion experienced while participating in sports (N ϭ 194; 215 concussions; age mean Ϯ standard deviation ϭ 19.19 Ϯ 8.53 years) were included. Interventions (Independent Variables): Intergroup differences and associations were examined by gender, age group (Ͻ18 years and 18ϩ years), and concussion grade for all outcome measures. Main Outcome Measurements: Separate 2 tests were used to assess associations between gender, age group, and symptom duration group (Յ7 days, 8-90 days, Ͼ90 days), the presence of depression, the presence of loss of consciousness, altered school or work, and concussion grade. Separate independent samples t-tests was used to examine differences in symptom reporting and time to recovery. Results: No association was observed between gender and any measured characteristics (P Ͼ .05). Subjects 18 years or older took longer to recover (315.77 days), compared with younger subjects (91.31 days) (t 213 ϭ Ϫ2.01, P ϭ .049). Older subjects also reported more concussions than did younger ones, 4.33 and 2.37, respectively (t 213 ϭ Ϫ3.77, P Ͻ .001). Conclusions: All concussions included in this study were moderate to severe in nature as defined by the Revised Cantu Grading Scale. Contrary to existing literature regarding gender differences in concussion of a lesser severity, no gender differences were observed in this sample. Age differences were observed, with the population of subjects who were 18 years and older experiencing a greater number and duration of concussion symptoms than the younger group. Developing evidence-based return-to-play progressions and rehabilitation strategies in this population is the next frontier for concussion researchers.
Pm&r, 2011
Objective: To examine the proportion of athletes with concussion and with impairment disagreement... more Objective: To examine the proportion of athletes with concussion and with impairment disagreements across various clinical concussion assessment measures. Design: Quasi-experimental repeated measures design. Setting: Clinical research laboratory. Participants: A sample of 100 collegiate-aged athletes participated in the study (mean [SD] age, 18.5 Ϯ 1.1 years; mean [SD] height, 180.6 Ϯ 9.9 cm; mean [SD] weight, 84.1 Ϯ 20.6 kg). Methods or Interventions: Participants completed preseason baseline and postconcussive injury assessments on a clinical assessment battery, including a 17-item graded symptom checklist, a computerized neurocognitive assessment, and a balance performance assessment. Main Outcome Measurements: Symptom severity total score, 8 cognitive domain scores from the Automated Neuropsychological Assessment Metrics, and the composite balance score obtained from the Sensory Organization Test served as outcome measures for the study. McNemar tests of paired proportions were then used to analyze impairment disagreements (where one measure identified impairments not identified by the other) between the study outcome measures. The ␣ level was set to .05 a priori. Results: We observed significant disagreements between symptom severity total scores, and all other measures used in the study in which symptom severity total scores identified more impairments than all other measures. In addition, we observed significant disagreements for half of the clinical measures used in the study, with disagreement proportions that ranged from 22%-52%. Conclusions: Our study underscores the importance of using a multifaceted approach for management of concussion that includes assessment of symptom severity, cognitive function, and balance. Use of this multifaceted approach also can aid clinicians in understanding other comorbidities that may complicate the management of concussion.
Neurosurgery, 2008
Posttraumatic headache (PTH) may affect neurocognition after sports-related concussion. To our kn... more Posttraumatic headache (PTH) may affect neurocognition after sports-related concussion. To our knowledge, no studies have examined how PTH affects balance after concussion using dynamic posturography. The purpose of this study is to compare balance after concussion between athletes reporting PTH and athletes not reporting PTH. We conducted a retrospective, repeated-measures design with participants grouped by presence of postinjury report of headache. Balance testing was conducted on 108 concussed collegiate athletes (age, 18.83 +/- 1.27 yr; height, 180.92 +/- 10.01 cm; mass, 83.29 +/- 19.62 kg). Presence of PTH during the first postinjury test session (group) and test time (baseline, postinjury) served as the independent variables. The composite equilibrium score and the somatosensory, vestibular, and visual ratio scores served as dependent variables. A 2 x 2 mixed model analysis of variance was used to analyze each outcome measure. Significant decreases in all four measures assessed were noted after concussion compared with preseason baseline measures (P < 0.05). Significant group by test-time interactions were observed, suggesting that composite equilibrium (F1106 = 6.6089; P = 0.012) and vestibular ratio (F1106 = 7.156; P = 0.009) scores are affected by the presence of PTH. Athletes reporting PTH also demonstrated worse visual ratio scores compared with individuals not experiencing PTH (F1106 = 4.26; P = 0.041). No other significant findings were observed for the somatosensory ratio score. Current literature proposes that PTH is associated with cognitive deficits. Our study indicates that PTH may also contribute to increased balance deficits. We believe the deficits may be a result of increased sensory organization challenges after injury. Clinicians should be mindful of these findings when managing concussed athletes reporting headache.
Athletic Training & Sports Health Care, 2009
Clinical Journal of Sport Medicine, 2007
To examine effects of preseason baseline headache and posttraumatic headache (PTH) on neurocognit... more To examine effects of preseason baseline headache and posttraumatic headache (PTH) on neurocognitive function. Retrospective repeated measures study with headache groups formed regarding baseline headache score (0 = negative headache; 1-6 = positive headache) and day 1 postinjury headache score (0 = no headache; 1-2 = mild headache; 3-6 = moderate-severe headache). Clinical athletic training setting and sports medicine research laboratory. High-school and collegiate athletes with a concussion. Preseason baseline headache, PTH, test-day. A Graded Symptom Checklist (GSC) was used to assess symptoms. The Automated Neuropsychological Assessment Metrics (ANAM) and the Standardized Assessment of Concussion (SAC) were used to assess neuropsychological function and mental status. The Balance Error Scoring System (BESS) was used to assess postural stability. Both baseline headache groups displayed a higher symptom endorsement and higher symptom severity at day 1 postinjury and improved by day 7 postinjury. The positive headache group reported an even greater increase in symptom severity and presence (P < 0.05). ANAM revealed deficits in both groups 1 day postinjury. All PTH headache groups displayed a difference in symptom number and severity with the increase being magnified by headache severity (P < 0.05). Individuals reporting moderate-severe PTH displayed increased deficits subacutely but improved by 5-7 days postinjury on overall neuropsychological performance, reaction time, and working memory (P < 0.05). Deficits were observed for all ANAM measures except simple reaction time 1 (SRT 1) and match to sample subacutely and improved over time (P < 0.05). The SAC yielded an interaction (P < 0.05) for baseline headache. The BESS yielded no significant findings. Clinicians should consider headache when assessing concussion and during preseason baseline assessments because headache may affect symptom presence and other clinical measures of concussion.
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Papers by Johna Register-Mihalik