Concussion treatment through Baria zasal: An exploration of Traditional Mongolian Medicine

There is no specific treatment for concussion in modern medicine; existing treatments are limited to resting and restoring cognition. For Mongolians, seeking concussion treatment from a bariachi, an advanced practitioner of the baria zasal traditional massage therapy, is very common. The baria zasal technique has been passed down the generations for millions of years, keeping with the Mongolian nomadic culture and way of life. However, this Mongolian treatment is little known or researched internationally. Due to the lack of literature on this subject, conducting a meta-analysis or systematic review was impossible. We reviewed the literature published in Mongolian about this technique. We also searched articles published from 1 January 1921 to 20 June 2021 in PubMed using "concussion", "baria zasal", and "Bariachi" keywords. Although informal observation indicates this is a commonly sought treatment among patients, there are very few published scientific articles about the practice outside the realm of cultural anthropology. This may be due to a few reasons: the informal, semi-religious setting in which the treatment takes place makes it difficult to conduct scientific field research; concussion is a mild traumatic brain injury, making it impossible to identify changes in the brain as a result of the treatment using imaging methods and therefore difficult to verify; and lastly, baria zasal is generally uncontested as a treatment even by Mongolian medical professionals, therefore it has not been the subject of empirical debate. Moreover, it is not classified under a specific system, each bariachi having its technique. As bariachis do not receive formal training, their treatments often depend on instincts, natural talents, and personal abilities. Therefore, it is recommended to study the techniques of baria zasal of concussion to explain its enduring popularity in Mongolia and to ascertain how it interacts with standard western medical treatment.

A - 19 Prime Time for Treatment: Considerations for Active Rehabilitation following Sport-Related Concussion

Objective The aim of the current study is to examine the efficacy of physical therapy for concussion treatment. Methods A retrospective chart review was conducted of 210 participants (62.9% female), aged 12–22 years (M = 15.27, SD = 2.03), who sustained sport-related concussions between 2015–2018 and were referred to active rehabilitation for treatment at a private physical therapy practice in New Jersey. Treatment groups were assigned based on intake within 12 weeks of injury (Early, 84.8%) or after 12 weeks elapsed (Prolonged). Efficacy was measured by reduction in number and severity of symptoms (i.e., PCSS, CISS, DHI scores) from intake (T1) to discharge (T2). Moderating variables included presence and severity of neck pain (57.1% with neck pain, 42.4% without) and presence and quantity of reported concussion modifiers (32.4% none, 34.8% one, 32.9% two+). Results A significant reduction in scores was found from T1 to T2 for the complete sample (PCSS: t(165) = 11.76, p < 0.001; CISS: t(162) = 15.73, p < 0.001; DHI functional disability ratings: t(74) = 6.393, p < 0.001). Crosstabs comparison showed participants reported significant symptom reduction from T1 to T2 (Early: 90%, n = 126; Prolonged: 87.5%, n = 21), with no appreciable difference in the rate of symptom reduction between groups. Treatment duration was not moderated by presence of neck pain, presence of modifiers, or number of modifiers. Conclusions Physical therapy appears to be an effective intervention, regardless of time elapsed, presence or severity of neck pain, or presence or quantity of concussion modifiers.

PATIENT REPORT OUTCOME MEASURE USE FOR CONCUSSION AMONG HIGH SCHOOL ATHLETIC TRAINERS

Background: Recent recommendations suggest incorporating patient-report outcome measures (PROMs) into concussion assessment batteries. Utilizing PROMs provides information on the patient’s perspective and how the concussion may influence the patient’s health status. Past studies evaluating PROM use among athletic trainers (ATs) found varying practices and barriers to implementation. However, there is limited data on use of PROMs in managing concussion among adolescent patients. Hypothesis/Purpose: To describe the use of PROMs as part of concussion assessment and treatment practices of ATs working in middle and high school settings. Methods: An online survey regarding concussion treatment perceptions and practices was distributed to a convenience sample of 5000 ATs through the NATA Survey Research Program. The survey included personal and institutional demographics, healthcare provider access and referral practices, perceptions of concussion treatment, clinical practice characteristics of concussion treatment and PROM use. The survey was pilot tested and validated in a sample of ATs prior to distribution. Analysis of the PROM section was conducted using descriptive statistics (percentages, frequencies) for this study. Results: The survey was accessed by 304 ATs (6.1% access rate) and completed by 153 ATs (58.3% completion rate). Of those, 27.2% (n=57) were employed in the middle school or high school setting and were analyzed for this study. Just over half of respondents had <10 years of experience (52.7%, n=30). Only 35.1% (n=20) of ATs reported they use PROMs as part of their clinical management of concussion. Of those who use PROMs, 75% (n=15) indicated that they use them always or almost always. The most commonly used generic PROMs were the Short Form 12 or 36 (25%, n=5) and Patient Reported Outcomes Measurement Information System (25%, n=5) and the most common specific PROMs were the Headache Impact Test (45%, n=9) and Dizziness Handicap Inventory (15%, n=3). Figure 1 shows the level of self-reported confidence of those utilizing PROMs. Barriers for PROM use included it being too time consuming (24.6%, n=14/57), lacking a support structure (15.8%, n=9/57), and not familiar with PROMs (14%, n=8/57). Close to one-fourth (22.8%, n=13/57) of respondents would be willing to use PROMs, but lacked time. Conclusion: While the use of PROMs is recommended in the evaluation and treatment of adolescent athletes, just over one-third of ATs providing care to these patients, use PROMs. Educational efforts for ATs should look to increase their familiarity and confidence when using PROMs for concussion while suggesting strategies to incorporate PROMs into practice. [Figure: see text]

Rest Evaluation for Active Concussion Treatment (ReAct) Protocol: a prospective cohort study of levels of physical and cognitive rest after youth sports-related concussion

IntroductionAlthough current guidelines for the early clinical management of sports-related concussion (SRC) call for a gradual return-to-activity, the optimal level of rest needed to promote recovery remains unknown. This paper describes the protocol of the Rest Evaluation for Active Concussion Treatment (ReAct) study which objectively measures physical and cognitive rest following SRC and its relation to recovery among youth athletes.Methods and analysisYouth athletes aged 11–17 years are recruited preinjury and enrolled within 72 hours following a physician-diagnosed concussion. Injury information and acute clinical presentation are assessed at the time of injury. Youth participants are prospectively followed to objectively monitor daily physical and cognitive rest using two electronic devices: ActiGraph (to measure physical rest and sleep) and Narrative Clip (to measure cognitive rest), along with self-reported postconcussive symptoms using daily surveys. Other concussion outcomes, including functional outcomes, are assessed by surveying youth and their parents at three time points: (1) within 72 hours of injury, (2) at day 7 postenrolment and (3) at symptom resolution (or a maximum of 45 days postconcussion).Ethics and disseminationThis study has received ethical approval from the Institutional Review Board (IRB) at the participating institution (IRB at Nationwide Children’s Hospital, IRB16-00613). The results of the study will be presented at national and international scientific conferences and published in peer-reviewed journals.

Using the Disclosure Decision-Making Model to Understand High School Football Players’ Disclosures of Concussion Symptoms

Despite advancements in concussion treatment and management, health and sports professionals largely depend on athletes’ self-reporting of symptoms to begin the process of diagnosis. With this in mind, recent scholarly attention has focused on understanding the barriers and processes of athletes’ self-disclosure of symptoms. The current study applied the disclosure decision-making model to understand high school football players’ disclosure decisions after experiencing symptoms of a concussion. Data obtained from 184 high school football players from across the United States demonstrated 2 significant paths by which players’ disclosures of concussion symptoms during a game can be understood. First, the perceived severity of these symptoms predicted athletes’ self-efficacy to disclose concussions, which subsequently predicted their intentions to disclose concussion symptoms during a game. Second, the felt stigma around disclosing concussion symptoms predicted athletes’ anticipated responses from coaches to such disclosures, which subsequently predicted their intentions to disclose concussion symptoms during a game. Furthermore, the effect of perceived stigma on the anticipated responses from coaches was moderated by the quality of athletes’ relationships with their coaches. These results highlight the importance of convincing athletes to take concussion symptoms seriously and the role of athlete–coach relationships in combatting stigma around concussion disclosures. These findings suggest that scholars and practitioners should acknowledge the social contexts surrounding disclosure of concussion symptom and shift educational efforts to focus on the dangers of concussions and the process by which athletes should report potential symptoms.

Attention Deficit Hyperactivity Disorder: Unique Considerations in Athletes

Context: Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition in the general population, with evidence suggesting that it may be more common among athletes. Evidence Acquisition: Literature searches were performed on PubMed, MEDLINE, and Cochrane databases for the years 2000 to 2016 utilizing the following key search terms: ADHD, ADD, guidelines, diagnosis, athlete, sports, treatment, pharmacotherapy, stimulants, risk, cardiovascular effects, concussion, and traumatic brain injury (TBI). Study Design: Clinical review. Level of Evidence: Level 4. Results: ADHD exists among athletes at all levels of play, and symptomatology overlaps significantly with that of concussion. Treatment with stimulants has cardiovascular effects and may not be permitted by the athlete’s governing body. An athlete’s level of competition and individual cardiovascular risk factors may therefore affect medication choices. Conclusion: ADHD diagnosis and treatment are paramount to optimal quality of life and functioning in affected individuals. Pharmacologic treatment options should not specifically be avoided in athletes; however, stimulant use is an independent risk factor for heat illness. Concussion, a common athletic injury, may have an altered course in those affected by ADHD, specifically with regard to neurocognitive testing and recovery.