February 26, 2021
2 min read
Disclosures: Caccese reports no relevant financial disclosures. This publication was made possible, in part, with support from the Grand Alliance Concussion Assessment, Research and Education Consortium, funded, in part, by the National Collegiate Athletic Association and the Department of Defense.
The diagnosis of post-concussion syndrome is often based on patients’ self-reported symptoms, but it is important to know that symptom reports can be affected by pre-injury factors like poor sleep or stress.
My colleagues and I evaluated the records of nearly 31,000 healthy student athletes and cadets attending 26 U.S. universities and four military academies, all of which participate in the Concussion Assessment, Research and Education (CARE) Consortium. All study participants completed the Sport Assessment Concussion Tool (SCAT-3), a symptom evaluation questionnaire, and responded to health history questions as part of their pre-season baseline evaluation.
Between 11% and 28% of these college athletes reported a cluster of symptoms consistent with the ICD-10 definition of post-concussion syndrome (PCS), although none of them had suffered a concussion recently. The types of symptoms covered in the assessment tool included headache, dizziness, fatigue, insomnia and problems with memory or concentration. Lack of sleep the night before the baseline assessment, pre-existing mental health diagnoses and stress were most likely to predict PCS-like symptoms. A history of an earlier concussion was not a factor in symptom reporting.
Military academy cadets were more likely to report symptoms than the civilian athletes. However, some of the cadets were assessed during their basic training, a highly stressful and physically active period. Women in both groups were more likely than men to report symptoms.
Jaclyn B. Caccese
It is interesting that simple lack of sleep — something that is common among college students — can produce symptoms that mimic the typical symptoms after brain injury. We know that poor sleep has many health consequences, and it also can impede recovery after a concussion. Meanwhile, brain injury can disrupt the sleep cycle and increase stress and anxiety.
But as brain injury researchers, my colleagues and I really wanted to know what factors are associated with symptom reporting. We discovered that very few people, even in a population of elite athletes, report no symptoms at all. This means that we should also not expect all athletes who have suffered a concussion to get to a zero-symptom state before they are cleared to return to sport or otherwise engage in physical activity.
Clearly, it is important for any therapist or clinician who is working with brain-injured patients to evaluate them on an individual basis. While questionnaires are useful for screening, the results may be confounded by pre-existing symptoms and should be evaluated in the context of a good medical and sleep history. It is important to ask when the patient’s symptoms started, how they have changed over time, and what situations or activities make them better or worse.
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Jaclyn B. Caccese, PhD, is assistant professor of health and rehabilitation sciences at The Ohio State University, where she is also a member of the Chronic Brain Injury Program, an interdisciplinary team of brain injury researchers. She also has a background in bioengineering and neuroscience, with extensive experience evaluating head impact biomechanics in sport and using virtual reality to probe human cognitive and motor function.
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