The majority of adult sport-related concussions (SRCs) occur in a recreational setting or amateur sports arena. Professional athletes typically have policies for management of their SRC defined by their organization. This chapter considers athletes over 21 years old and considers arenas of professional and recreational sports. There is limited research outside of the professional leagues that address management in adult athletes. Review of applicable components in management for adult athletes is considered. Further research is needed to understand the functional effects of diaschisis in the concussed adult athlete to assist with return-to-play decisions, long-term effects, and neuroplasticity.

Impairments in the auditory, vestibular, and visual domains are among the most common sensory deficits observed following concussion/mild traumatic brain injury (mTBI). This chapter will briefly discuss the assessment, management, and rehabilitation of patients with mTBI when presenting with auditory, vestibular, and visual sensory dysfunction/impairments occurring in isolation or combination with concussion.

Aim:Students re-entering the academic setting after a concussion is commonly referred to as return-to-learn and, to date, very few studies have examined the return-to-learn aspect of concussion recovery.Methodology:Nine college-aged, full-time students who were diagnosed with concussions were monitored throughout their concussion recovery. The severity for five chief symptoms (headache, dizziness, difficulty concentrating, fatigue, anxiety) were recorded six-times per day through text messages, and daily phone calls recorded participant's behavioral traits.Results:We identified five behavioral variables which significantly influenced symptom resolution (music, sleep, physical activity, water and time) (p = 0.0004 to p = 0.036). Additionally, subjects reported math and computer-oriented courses as the most difficult (33 and 44%, respectively).Conclusion:We introduce a novel approach to monitor concussed students throughout their recovery, as well as factors that may influence concussion recovery process.

Aim:The objective of this study was to administer and analyze results of a survey targeting knowledge about concussion symptoms, diagnosis, treatment and expected recovery among family medicine specialists in the Split–Dalmatia County of Croatia.Methods:An electronic survey questionnaire was developed utilizing concepts from previously published studies on concussion knowledge, attitudes and beliefs completed by physicians. The survey was intended to briefly and broadly assess concussion knowledge of Croatian healthcare providers. The first section of the survey included five questions clarifying professional practice, years of experience and experience with concussions; the second section included 15 questions about typical concussion symptoms; the third section included 12 questions focused upon three primary components of concussion knowledge: concussion diagnosis, treatment and recovery.Results:Out of 242 surveys mailed, 81 questionnaires (33%) were completed while 161 respondents (67%) did not answer. Out of the 81 completed surveys, 76 (94%) were returned by family physicians specialist and five (6%) by resident physicians in training. 39 (48%) had treated less than ten patients with concussion during last year: 40 (49%) treated 11–20 patients with concussion; and two (3%) treated greater than 20 patients with concussion during last year. While most responses did accurately reflect knowledge of common symptoms (90–100% correct), there was significant lack of knowledge in three areas: only 19% of participants stated that diagnosis of concussion does not require loss of consciousness; three quarters of respondents believed that a diagnosis of concussion requires direct contact to the head and 83% of the respondents believed that persistent subjective complaints are always the result of a more severe initial injury.Discussion:This is the first investigation conducted in Croatia to examine knowledge of concussion diagnosis, as well as the management practices held by medical professionals. Overall, the findings suggest that the knowledge and management practices among family doctors in the region are not consistent with current worldwide views and recommendations. There was not an accurate knowledge of concussion diagnosis, treatment, recovery and prognosis among family physicians. Continued education of medical staff to better identify concussion and increased reliance on objective methods for managing concussion will improve patient management and outcome.

Understanding how a concussion affects an individual is oftentimes difficult for clinicians due to the varying symptom profiles reported by the patient and the multifaceted and heterogeneous nature of the injury. Accordingly, the interpretation of postconcussion performance can be challenging, because many different testing paradigms have been reported as potentially useful in the literature. Among the types of tests clinicians use to understand how concussion affects an individual, both gait and neurocognitive evaluations have demonstrated utility. Our purpose is to describe how combined gait and cognitive (i.e., dual task), as well as single-task gait and computerized neurocognitive examinations can assist clinical decision-making.

Aim:The purpose of this study was to determine the amount of visual acuity loss with head movement in actively training mixed martial arts (MMA) fighters.Methods:Vestibulo-ocular reflex function of 22 asymptomatic, male MMA fighters (age = 29.2 ± 5.1) was assessed by taking the difference between static visual acuity and the dynamic visual acuity test, in both yaw and pitch planes.Results:The mean static visual acuity testing logMAR was -0.173 (standard deviation [SD] = 0.114). Mean dynamic visual acuity test values decreased with head movement to 0.196 logMAR (SD = 0.103) in yaw; p < 0.001, and to 0.283 logMAR (SD = 0.133) in pitch; p < 0.001.Conclusion:MMA fighters had a decay, beyond normal ranges, in visual acuity during head movement. These decreases may suggest vestibulo-ocular reflex impairment and were unrelated to self-reported concussion history. These results should be cautiously interpreted since there was not a control group.

Blast injuries, including blast-induced neurotrauma (BINT), are caused by blast waves generated during an explosion. Accordingly, their history coincides with that of explosives. Hence, it is intriguing that, after more than 1000 years of using explosives, our understanding of the pathological consequences of blast and body/brain interactions is extremely limited. Postconflict recovery mechanisms seemingly include the suppression of painful experiences, such as explosive injuries. Unfortunately, ignoring the knowledge generated by previous generations of scientists retards research progress, leading to superfluous and repetitive studies. This article summarizes clinical and experimental findings published about blast injuries and BINT following the wars of the 20th and 21th centuries. Moreover, it offers a personal view on potential factors interfering with the progress of BINT research working toward providing better diagnosis, treatment and rehabilitation for military personnel affected by blast exposure.

Discussions surrounding concussion have made their way into the public sphere over the previous decade with media attention and coverage of the injury fueling public debate. These conversations have devolved into discussions on banning contact and collision sports and raised legal questions surrounding injury management. Questions raised about concussion eclipse what science can answer, but the University of Michigan Injury Center (MI, USA) hosted a Concussion Summit in September 2015 as a means to condense, solidify and disseminate what is currently known on the topic. Areas for discussion included concussion incidence and prevention, diagnosis and management, legislation and education, legal and social aspects and future directions. A summary of those presentations are included within.

Aim:To observe the effects of concussion history on cognitive-motor integration in elite-level athletes.Methods:The study included 102 National Hockey League draft prospects (n = 51 concussion history [CH]; n = 51 no history [NC]). Participants completed two computer-based visuomotor tasks, one involved ‘standard’ visuomotor mapping and one involved ‘nonstandard’ mapping in which vision and action were decoupled.Results:We observed a significant effect of group on reaction time (CH slower) and accuracy (CH worse), but a group by condition interaction only for reaction time (p < 0.05). There were no other deficits found. We discussed these findings in comparison to our previous work with non-elite athletes.Conclusion:Previously concussed elite-level athletes may have lingering neurological deficits that are not detected using standard clinical assessments.