Post-acute Outcomes of Sport-related Concussion

Most research on concussion outcome has focused primarily on understanding acute effects, either at the time of the incident (compared to baseline) or up until medical clearance to play (commonly within 2 weeks, but up to 2 months, of injury). Recent research has also examined long-term outcomes of concussion and traumatic brain injury (TBI), typically more than 12 months postinjury. Both areas of research have found changes in fatigue, sleep, mood, and cognition following head injury, as well as physiological alterations. Severity of outcome can vary significantly, but has been related to an individual's age, gender and number of previous concussions. Fatigue and sleep have also been indicated to influence mood and cognition in individuals experiencing head injury. Research addressing the time period between 2 and 12 months post injury has examined individuals with Post-Concussion Syndrome (PCS), a condition characterized by lingering concussion-related symptoms. However, the vast majority of individuals experiencing a concussion do not suffer from PCS, and thus a gap in concussion research exists for this non-PCS population between 2 and 12 months. The purpose of the present study was to address this need by examining fatigue, sleep, mood and cognition in 19 non-PCS individuals experiencing a concussion 2 to 12 months prior. Participants who had been diagnosed and cleared by a designated Drexel University College of Medicine (DUCoM) physician were recruited for this study. All participants completed self-report forms/questionnaires at home and returned them. In addition, a subgroup of this sample underwent in-person cognitive evaluation. Measures used to assess main outcomes included: the Fatigue Severity Scale (FSS) and Causes of Fatigue (COF) questionnaire for fatigue; the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) for sleep; the Beck Depression Inventory-II (BDI-II) for depression; the State-Trait Anxiety Inventory-Y (STAI-Y) for anxiety; the Behavior Rating Inventory of Executive Function-Adult (BRIEF-A), Trail Making Test and Symbol Digits Modality Test (SDMT) for executive functioning; and the WAIS-IV Digit Span test for attention and working memory/information processing. Compared to normative data and recommended clinical cutoffs, participants endorsed overall deficits in sleep and mood. Females reported significantly more daytime sleepiness than males, and anxiety was positively correlated with age and sleep difficulty. However, significant fatigue and cognitive deficits were not present. Furthermore, outcomes were not significantly correlated with previous concussions or time since last concussion. Results suggest that sleep and mood deficits may be present in non-PCS individuals who experienced a sport-related concussion 2-12 months prior. Indicating a potential need for follow-up appointments and more thorough assessments, this pilot study warrants further research into post-acute sleep and mood for non-PCS individuals.