{"id":6849,"date":"2020-02-07T06:30:00","date_gmt":"2020-02-07T12:30:00","guid":{"rendered":"http:\/\/thesportjournal.org\/?p=6849"},"modified":"2020-01-31T09:20:28","modified_gmt":"2020-01-31T15:20:28","slug":"concussion-in-the-collegiate-equestrian-athlete","status":"publish","type":"post","link":"https:\/\/thesportjournal.org\/article\/concussion-in-the-collegiate-equestrian-athlete\/","title":{"rendered":"Concussion in the Collegiate Equestrian Athlete"},"content":{"rendered":"\n

Authors:<\/strong> Tasneem Zahira PhD,\u00a0 Timothy Henry PhD ATC, Michael L. Pilato MS ATC<\/p>\n\n\n\n

Corresponding Author:<\/strong>
Michael L. Pilato MS ATC
1000 East Henrietta Road, Rochester, NY 14623
mikep316@yahoo.com
585-329-6463

Michael L. Pilato is an athletic trainer with Monroe Community College in Rochester, N.Y. He has been researching sports medicine for the equestrian athlete since 2003 and has been published in peer and non-peer reviewed journals.<\/p>\n\n\n\n

Tasneem Zaihra PhD.
Department of Mathematics State University New York College at Brockport
350 New Campus Dr, Brockport, NY 14420
tzahira@brockport.edu
585-3952075

Tasneem Zaihra is an assistant professor of statistics in the department of mathematics, SUNY Brockport. She has many presentations and publications in peer-reviewed journals, to her credit.<\/p>\n\n\n\n

Timothy Henry PhD. ATC
Department of HPERD State University New York College at Brockport
350 New Campus Dr, Brockport, NY 14420
thenry@borckport.edu
585-395-5357

Timothy Henry is director of the athletic training program at SUNY Brockport. He is also a reviewer for The Journal of Sport Rehabilitation and The Journal of Athletic Training.<\/p>\n\n\n\n

Concussion in the Collegiate Equestrian\nAthlete<\/strong><\/h3>\n\n\n\n

ABSTRACT<\/strong><\/p>\n\n\n\n

Equestrian sports, in general, pose a\nsignificant risk of concussion. Minimizing the risk of concussion has been a\nfocal point in recent years. The purpose of this paper is to describe\nconcussion and explore potential association(s) between groups of\nmusculoskeletal injuries and Body Mass Index (BMI) on the risk and odds of\nconcussion in the collegiate equestrian athlete. Forty-three schools, ranging\nfrom DI to DIII, from the Eastern United States were selected from the NCAA and\nIntercollegiate Horse Show Association\u2019s websites. Self-reported injury and\ndemographic data was collected through an online survey created in Mach Forms.\nSeventy-three participants completed the online survey (women n=71, men=2).\nAggregate descriptive data is reported on all subjects. After removing data on\n2 men, and a single female with incomplete data, the data from 70 females with\ncomplete data was analyzed using chi-squared and Fisher\u2019s exact tests and\nordinal logistic regression. Pearson\u2019s chi-squared as well as Fisher\u2019s exact\ntest (p-value =.0288 and.0297 respectively) indicates the risk of having\nconcussion with 0 UE injury is not the same as with 1 or 2+ injuries. The\naverage number of injuries per athlete increased from 0 to 2(+) concussions.\nConcussion is a commonly reported injury. Upper extremity injury is identified\nas having the strongest association with concussion risk in the equestrian\nathlete. Knowing UE injury status could be\nuseful in gaging the risk and odds of concussion in equestrian athletes. <\/p>\n\n\n\n\n\n\n\n

Keywords:<\/strong> Equestrian concussion, Equestrian athlete, Concussion, Equestrian injury
<\/p>\n\n\n\n

INTRODUCTION<\/strong><\/p>\n\n\n\n

Female\nparticipants dominate the approximately 10,000 athletes competing in U.S.\ncollegiate equestrian sports (6,23). While\nnot as well researched as other female collegiate sports (e.g. soccer),\nequestrian sports, in general, are otherwise widely recognized by researchers\nas dangerous (16). In a 2002 data analysis, it was noted \u201chorse-riders\ncan expect a serious accident once in every 350 hours of participation, which\nis twenty times more dangerous than motor cycling\u201d (Silver 264).  The head was the most commonly injured body\npart amongst riders 19-49, with upper extremity fractures just ahead of\nconcussion (16.6 vs. 15.2%) in riders age 0-18 (2). Data compiled from the National Electronic Injury Surveillance\nSystem (NEISS) for the years 1997-2015 showed an average of 24.19% of all\nequestrian injuries came from the sport setting, with injuries to the head\nmaking up an average of 20.07% of all injuries; Concussion made up an average\n5.01% of all injuries(19).<\/a>  <\/sup>Winkler\n(2016) noted 45.2% of the over all population and 21% of those aged 18\u201329 years\nold sports-related traumatic brain injury (TBI) were from equestrian and\nrelated sports. In an Australian population, equestrian activities accounted\nfor the second highest level of mean participation-adjusted rates of\nhospitalization for concussion over a 9-year period (130.3\/100 000)(8). Falls have been\nshown to be responsible for 51%- 82% of the injuries that occur in equestrian sports (2,4,5,14,20).  Indicative\nfall times,(i.e. time it takes to contact the ground) based on rider center of\nmass height, from four to ten feet have been calculated and range from\n505-782ms (20). <\/p>\n\n\n\n

Non-collegiate\nsources were utilized to estimate the rate of falling from the horse as data\nregarding the rate of falling in collegiate competition is not available. The\nrate of falling, as reported in the 2010 United States Eventing Association\nCross Country Competition Safety Report, for each starter is 1 in 42 and the\nprobability of a fall for each jump is 1 in 879\n(24). Despite the limited data, the mechanism creates a fall is\nconsistent across disciplines and skill levels. There is a loss of Center of\nMass (CoM) control and position as it relates to movement of the horse. This\ncan be intentional (e.g. bucking, rapid stop) or unintentional (e.g. rider\nerror) and most often associated with an obstacle (e.g. fence) (10, 24).<\/p>\n\n\n\n

The\nhigh incidence of injury has led to increased attention on reducing the risks\nassociated with falling as a way to decrease the number of injuries, especially\nconcussions. Continuing efforts include improving personal protective equipment\nfor the athlete, designing safer competition obstacles and teaching an\nemergency dismount to help athletes escape from the horse under certain\nsituations. Prior to 1970, gymnastic style tuck and roll training was also\ntaught as part of the Pony Club curriculum and as such, widely accepted as a\nway to minimize the risk of injury should the rider fall from the horse (16). This type of training has been revived on\nan extremely limited basis and is presently not part of the equestrian\u2019s standard training or curriculum.<\/p>\n\n\n\n

Research\nindicates that concussion, musculoskeletal injury and body mass index (BMI) can\ninfluence injury and re-injury risk in subjects, secondary to increased demands\non postural control (3,7,9,11-13,15,17). While\nequestrians accept the high risk of falling as well as the association between\nfalling from the horse and concussion, the risk and odds of concussion that can\nbe associated with musculoskeletal injury and\nBMI is unknown in female collegiate\nequestrians. <\/p>\n\n\n\n

The\npurpose of this paper is to present a description of concussion in collegiate\nequestrian athletes and to explore further potential association(s) between\nlower extremity (LE), upper extremity (UE) and spinal (SP) injuries, and body\nmass index (BMI), on the risk and odds of concussion in the female collegiate equestrian athlete.<\/p>\n\n\n\n

METHODS<\/strong><\/p>\n\n\n\n

This study was approved by the\ninstitution\u2019s IRB. An online survey instrument was developed in Mach Forms to\ngather demographic and self-reported, whole body, injury data from the\nrespondents.\nConcussion history was\nself-reported\nas a separate\ncategory. Consent was assumed upon voluntary completion and submission of the\nsurvey. Anonymity was assured to all participants. The form reduced mailing\ncosts and encouraged participation in an uncomplicated manner. An outside\nexpert in the field of equestrian reviewed the survey instrument for\nappropriateness of the content, content validity and also provided feedback\nrelative to the format of the questionnaire. A link to the\nsurvey was sent to 43 equestrian teams, representing 10 percent of the total number of teams, randomly\nselected from the National Collegiate\nAthletic Association and Intercollegiate\nHorse Show Association\u2019s websites. Seventy-three athletes (male=2, female=71)\ncompleted and submitted the survey. We report descriptive data\non the entire group of 73 athletes. The data from the\ntwo male subjects was removed to avoid potential gender bias and one female\nwith incomplete data was also removed, resulting in 70 total subjects for\nfurther analysis (mean age of age = 20.3 years +1.90yrs, mean\nweight=62.15kg +9.42kg, mean height+8.2cm).<\/p>\n\n\n\n

For\nthe purpose of analysis, concussion was organized into 0, 1 and 2 or more (2+),\ncategories. Independent risk factors were total number of SP, LE and UE\ninjuries. The data was analyzed using Chi-squared and Fishers Exact tests.<\/p>\n\n\n\n

RESULTS<\/strong><\/p>\n\n\n\n

Aggregate total number of concussion are reported in Table 1.\nThe 32 individuals reporting concussion represent\n44.5% of the population. There were 61 total\nconcussions (ave. appx 2 per individual reporting concussion). Concussion\nrepresents 11% of the 568 total number of\ninjuries (which includes concussion) reported. The\nno concussion group accounted for 39% (221\/568)of injuries; while the\nconcussion group accounted for 61% (347\/568) of injuries. <\/p>\n\n\n\n

Table 1. <\/strong>Aggregate Number of Concussions <\/strong><\/p>\n\n\n\n
\n  \n <\/td>\n 1<\/strong>\n <\/td>\n 2<\/strong>\n <\/td>\n 3<\/strong>\n <\/td>\n 4<\/strong>\n <\/td>\n 0<\/strong>\n <\/td><\/tr>
\n No.\n of Athletes\n <\/td>\n 17(22.9%)\n <\/td>\n 5(2.7%)\n <\/td>\n 10(13.5%)\n <\/td>\n 1(1.3%)\n <\/td>\n 40(44.5)\n <\/td><\/tr><\/tbody><\/table>\n\n\n\n

We then homogenized the group into four concussion categories\nx body part (head, neck, R. shoulder, etc). \nThe zero concussion group contained 39 athletes, totaled 155 affected\nbody parts and appx. 4 inj\/athlete); Single concussion (N=15, Total 62 body parts\naffected, appx 4inj\/athlete); Two concussions (N=5, Total 27 body parts\naffected, appx. 5 inj\/athlete) and more than two concussions (N=11, Total 96\nbody parts affected, appx. 9 inj\/athlete). <\/p>\n\n\n\n

For BMI, values ranged from16.31 to 30.18. Mean BMI was\n22.57. According to standard BMI interpretation, 1subject was graded as obese,\n11 overweight, 4 underweight and 55\nnormal weight. The discussion regarding\nBMI is limited as after further analysis demonstrating the association between\nBMI and concussion was not significant for our data.<\/p>\n\n\n\n

The three tables below report the distribution of athletes\ncategorized by concussions and number of injuries.<\/p>\n\n\n\n

Table 2. <\/strong>Athlete Distribution by Concussions and UE Injuries Categorized into 0, 1 and 2+ <\/strong><\/p>\n\n\n\n
\n  <\/strong>\n <\/td>\n No Conc<\/strong>\n <\/td>\n 1 Conc<\/strong>\n <\/td>\n 2+Conc<\/strong>\n <\/td><\/tr><\/thead>
\n 0\n <\/td>\n 25\n <\/td>\n 8\n <\/td>\n 6\n <\/td><\/tr>
\n 1\n <\/td>\n 8\n <\/td>\n 1\n <\/td>\n 1\n <\/td><\/tr>
\n 2+\n <\/td>\n 6\n <\/td>\n 6\n <\/td>\n 9\n <\/td><\/tr><\/tbody><\/table>\n\n\n\n

Table 3.<\/strong> Subject Distribution by Concussions and LE injuries<\/p>\n\n\n\n
\n  \n <\/td>\n No Conc<\/strong>\n <\/td>\n 1 Conc<\/strong>\n <\/td>\n 2+Conc<\/strong>\n <\/td><\/tr><\/thead>
\n 0\n <\/td>\n 11\n <\/td>\n 6\n <\/td>\n 2\n <\/td><\/tr>
\n 1\n <\/td>\n 4\n <\/td>\n 0\n <\/td>\n 0\n <\/td><\/tr>
\n 2+\n <\/td>\n 24\n <\/td>\n 9\n <\/td>\n 14\n <\/td><\/tr><\/tbody><\/table>\n\n\n\n

Table 4.<\/strong> Subject Distribution by Concussions and Spinal Injuries<\/p>\n\n\n\n
\n  <\/strong>\n <\/td>\n No Conc<\/strong>\n <\/td>\n 1 Conc<\/strong>\n <\/td>\n 2+Conc<\/strong>\n <\/td><\/tr><\/thead>
\n 0\n <\/td>\n 19\n <\/td>\n 8\n <\/td>\n 6\n <\/td><\/tr>
\n 1\n <\/td>\n 5\n <\/td>\n 0\n <\/td>\n 1\n <\/td><\/tr>
\n 2+\n <\/td>\n 15\n <\/td>\n 7\n <\/td>\n 9\n <\/td><\/tr><\/tbody><\/table>\n\n\n\n

The chi-squared test indicates the risk of having a\nconcussion with 0 UE injuries is not the same as with 1 or 2+ injuries\n(p-value=.0288). Since, some of the cells are sparse (less than 5 subjects) we\nalso used Fisher\u2019s exact test to study association between concussions and UE,\nLE and Spinal injuries. Fisher\u2019s exact test also showed a significant\nassociation (Fishers p=.0297) between Concussions and UE but not the other two\n(LE, Fisher\u2019s exact p=0.205 and Spinal, Fisher\u2019s exact p=0.568). Thus, an\nassociation between incidence of concussions and UE injuries was indicated by\nchi-squared test as well as the Fisher\u2019s exact test. However, BMI, Spinal\ninjury and LE injury did not show any association with concussion occurrence. <\/p>\n\n\n\n

DISCUSSION<\/strong><\/p>\n\n\n\n

Our finding of 11% of all injuries being concussion is more\nthan double than the cumulative NEISS average of 5% from 1997-2014 and within\nthe range (9.7-15%) of all injuries reported by Zuckerman (2015). While no data to\ncompare collegiate concussion rates is available, in a survey of concussion and\nconcussion symptoms in equestrian athletes registered with the United States\nEquestrian Federation, Buetow (2016) found 71.6% of the population reported\nconcussion symptoms, with 40.9% being officially diagnosed with a concussion.\nWhile we did not ask about concussion symptoms, the 45% of our population\nreporting at least one concussion is comparable. Only motor vehicle-based\nsports are consistently reported as having higher TBI rates (8, 21, 26).<\/p>\n\n\n\n

Perhaps more\nimportantly, in a study of Swedish equestrians, the head was reported as the\nmost frequently injured region and the most commonly injured region associated\nwith a fatality<\/em> (18).<\/p>\n\n\n\n

Helmet use is chronically emphasized as a way to reduce\nconcussion in equestrians. While helmet use is mandatory during competition\n(25), and perhaps the most easily modifiable factor in terms of reducing head\ninjury\/concussion, it\u2019s overall use is chronically low (27). So\nwhile important to continue to emphasize overall helmet use among equestrians and improve helmet function, it is perhaps necessary to\nexpand industry focus to include complementary modes of protection.<\/p>\n\n\n\n

The average difference in number of body parts injured\nbetween zero and one concussion is negligible (3.97 vs. 3.87) and in fact, one\nconcussion having a lower average is interesting. While we cannot suggest a\nscientific reason for the lower value, it is possible that athletes are taking\nextra precautions to minimize the risk of a second concussion. The 20% increase\nfrom 0\/1 to 2 concussion (4 vs 5) and then almost doubling (5 vs. 9) in\ninjuries per body part when more than 2 concussions occurs is a revealing, but\nnot surprising finding. The interaction of concussion and the variables that\ninfluence postural control is not fully understood; yet it is clear postural\ncontrol (Howell 2018) and or neurocognitive performance (Herman 2015) is\nnegatively affected, hence influencing injury risk. In riding athletes, this\nwould be an especially critical problem, as they would be falling from height\nand often at significantly higher speeds than other athlete\u2019s experience.<\/p>\n\n\n\n

We would however suggest that, as it relates to equestrians,\nthe pathway proposed by Herman (2015) would be circular vs. linear. The\nhypothesis being, as the effects of concussion compound, the athlete\u2019s ability\nand capacity to minimize the risk of falling and hence the risk of injury\ndecrease. Thus more injury leads to greater risk of falling and more injury.<\/p>\n\n\n\n

While\nno association between LE and concussion was found in our data, a short\ndiscussion of the potential interplay of these variables as it relates to\nequestrians is warranted as this is a noted finding in other sports (Herman\n2017). Equestrians accept falling off as an inevitable part of riding. However,\nthey rely on the strength of \u201ctheir seat\u201d, which is commonly understood as the\ninteraction between the LE, saddle, stirrup and movement of the horse, to\nminimize the risk of falling off. Equestrian athletes are not traditional foot\non the ground athletes; unlike as an example, soccer players. The lack of\nstable ground under foot provides fewer options to the athlete to maintain body\nposition and postural control compared to more traditional athletes.\nHypothetically then, a LE that is compromised by (multiple) injuries could\nincrease the risk of falling and hence head injury and or concussion.  <\/p>\n\n\n\n

The use of the UE to protect the head is\ninstinctual (e.g. attempting to catch\/deflect a projectile thrown at the head).\nHowever the concepts of when and how to use the UE to protect the head first,\nwhen a fall is inevitable, is not taught as a primary part of riding education.\nTraditional riding education teaches athletes to stay on the horse if at all\npossible. Riders are taught the UE\u2019s primary use is to maintain a connection\nwith the horses head through the reins. Athletes learn by feel and experience\nwhen their \u201cseat\u201d will no longer keep them in the saddle and a fall is\ninevitable. In this situation, they are instructed to grab the pommel of the\nsaddle, neck or mane of the horse or tighten up on the reins to stay on the\nhorse. By attempting to ride out the dangerous situation instead of dismounting when\nthe situation is less dangerous, the athletes can place themselves in a\nposition where an injury could be more likely to happen, as opposed to dismounting when their position could allow for less risk of injury. <\/p>\n\n\n\n

For\nexample, the fall time for an athlete falling from a horse is typically\nmeasured in milliseconds (20).\nIn this extremely small amount of time, he or she has to decide they are in\ndanger, plot an escape and generate a movement pattern. This is not likely\nenough time to place the UE in a position to protect effectively the head. The\noverall poorer body position and lack of time to properly position the UE,\nlikely compromises the UE\u2019s ability and capacity to spread out the increased\nground contact forces, allowing for increased chance of head contact with the\nground (think darting into the ground vs. tucking and rolling through the\nfall). When the above scenario is considered, the model results of UE injuries having the strongest association\nwith concussion appears plausible. Anecdotally, a 1997-2013 trend in the NEISS\ndata demonstrates an overall increase in concussion and flat trend of overall\nUE injuries, which could indicate anyone of the above scenarios (19).<\/p>\n\n\n\n

The\nthought to ride out the dangerous situation may be due to how falling is\ntreated in equestrian. While equestrian sports do air on the side of caution,\ngenerically, if an athlete is separated from the horse or touches the ground,\nand requires assistance to get back into the saddle, he or she is can be\npenalized either time or points. In the situation where a concussion could be\nsuspected, the athlete is removed from competition until cleared by a physician (25).<\/p>\n\n\n\n

We fitted an ordinal logistic regression model to explore the\nassociation of MS injury while adjusting for BMI. Although the odds of 2+ vs 0\nor 1 concussions were almost three-times greater going from 0 to 5+ UE injuries\n(OR=1.250 and 3.051 respectively), while adjusting for BMI but despite large\neffect size the results were not statistically significant. While a larger\nsample size is needed for further exploration and to reach stronger\nconclusions, the results are worth a short discussion. BMI\npresents an interesting challenge for equestrian athletes. Horses are taught to\nmove at a given pace during competition irrespective of the load it is\ncarrying. Physics dictate athletes having larger BMI\u2019s moving at like pace,\ncompared to athlete\u2019s with lower BMI\u2019s, are subject to not only larger\ndestabilizing forces that challenge body position, but larger ground contact\nforces. During the fall, the forces generated by\nthe horse and imparted on the rider can often place the rider in a head down\nposition or turn the rider into a head-first projectile. As such, the athlete\nmust now manage his or her body weight with the UE, which does not have the\nsame physical capacity as the LE to dissipate the ground contact forces. When\nthe above scenario is considered, the model results, albeit inconclusive,\nappears reasonable.<\/p>\n\n\n\n

CONCLUSION<\/strong><\/p>\n\n\n\n

Concussion is a common\ninjury in equestrian sports. This investigation is the first to report\npotential associations between concussion and categories of musculoskeletal\ninjury in collegiate equestrian athletes. Our findings of UE injuries having\nstronger associations, than LE and SP injury, as well as an increasing average\nnumber of injuries per athlete going from 0 to 2(+) concussions is unique.\nWhile focusing on improving obstacles and personal protective equipment to\ndecrease injury risk should continue, our findings provide a starting point\nfrom which to consider athlete specific factors\n(i.e. musculoskeletal injury, BMI)\nthat influence the\nrisk and odds of concussion in the collegiate equestrian athlete.<\/p>\n\n\n\n

Applications\nin Sport<\/strong><\/p>\n\n\n\n

Despite the large number of participants and teams in collegiate\nequestrian sports, the frequency of\nconcussion and potential interaction(s) with musculoskeletal injury on the athletes who participate in them are not well understood by the\npeople charged with their care. Concussion, and their\nco-factors, pose as significant a problem in this group of athletes, as in any\nother group of athletes. Our findings indicate concussion\nis common, average number of injuries per athlete increased with\nincreased concussions and upper extremity injuries potentially increase risk\nand odds of concussion. These findings provide a rationale to explore potential\ninjury prevention programs beyond the present focus of improving personal\nprotective equipment and obstacle design.<\/p>\n\n\n\n

ACKNOWLEDGMENTS<\/strong><\/p>\n\n\n\n

We declare no financial or non-financial gains nor funding used in creation of this paper. <\/strong><\/p>\n\n\n\n

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  27. Zuckerman SL, Morgan CD, Burks S, Forbes JA, Chambless LB, Solomon GS, Sills AK. (2015). Functional and Structural Traumatic Brain Injury in Equestrian Sports: A Review of the Literature. World Neurosurgery, 83(6), 1098-1113. DOI: 10.1016\/j.wneu.2014.12.0301.<\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"

    Authors: Tasneem Zahira PhD,\u00a0 Timothy Henry PhD ATC, Michael L. 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Hotz, PhD is a research professor at the University of \u00a0Miami, Miller School of Medicine and a nationally recognized behavioral neuroscientist and expert in\u2026","rel":"","context":"In "Research"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":366,"url":"https:\/\/thesportjournal.org\/article\/economic-impact-of-equestrians-on-aiken-south-carolina\/","url_meta":{"origin":6849,"position":1},"title":"Economic Impact of Equestrians on Aiken, South Carolina","date":"January 8, 2010","format":false,"excerpt":"Dr. Sanela Porca and Dr. J. Ralph Byington, School of Business Administration, University of South Carolina Aiken Abstract The equestrians have played a critical role in the growth and development of the Aiken County economy. 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Stier Jr. - The State University of New York at Brockport Abstract In an effort to determine the importance of desirable qualities, attributes and characteristics necessary for the success of interscholastic athletic trainers a Likert-type scale survey was mailed\u2026","rel":"","context":"In "Contemporary Sports Issues"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":5333,"url":"https:\/\/thesportjournal.org\/article\/st-lukes-virtual-concussion-clinic\/","url_meta":{"origin":6849,"position":3},"title":"St. Luke’s Virtual Concussion Clinic: A Unique Structure to Provide Comprehensive Care for Patients","date":"October 26, 2017","format":false,"excerpt":"Authors: Kurt J. Nilsson, MD, MS St. Luke's Health System St. Luke\u2019s Concussion Clinic Hilary Flint, PhD, MPH St. Luke\u2019s Health System St. Luke\u2019s Research Janet Reis, PhD Boise State University College of Health Sciences Office of Research Krisi Pardue, CCC-SLP, CBIS St. Luke's Health System St. Luke\u2019s Concussion Clinic\u2026","rel":"","context":"In "Sports Medicine"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":4683,"url":"https:\/\/thesportjournal.org\/article\/taking-concussion-vital-signs-neurocognitive-test-under-varied-conditions\/","url_meta":{"origin":6849,"position":4},"title":"Taking Concussion Vital Signs Neurocognitive Test Under Varied Conditions","date":"November 17, 2016","format":false,"excerpt":"Authors: Scott L. Bruce, EdD, AT, ATC Sarah Stauffer, AT, ATC Andrew Chaney, AT, ATC Kelsey Garrison, AT, ATC Wright State University Corresponding Author: Scott L. 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