Helmet study shows risk of brain injury reduced with proper protection

Wikipedia project
What’s the story?
What do you need to know?

This photo shows the damage done to bicyclist Laurie Nommsen-Rivers' helmet after a
pick-up truck hit her on MLK Blvd. on August 29, 2014.
(Photo: Provided by Laurie A. Nommsen-Rivers)

Thankfully, a helmet is much more than a "piece of
Styrofoam." As a recent scientific study reports,
the risk of severe brain injury after head impact at
12 mph (realistic in downtown traffic) is 99.9
percent without a helmet, but declines to 9.3
percent with a helmet.
My experience corroborates these results. After being
struck by the truck and swept under it, I will never forget
the split second when I saw the truck axle coming
straight at my head and thinking my life was over.

Learning objectives
• Distinguish and recall steps of the peer
review process. (finish from Monday)
• Recognize that science in the news comes
from science research.
• Identify the differences between a case
study, a scientific study, a review or a meta-analysis
for a scholarly article.
• Review creating a hypothesis to research.

What does
peer-review look like?

WHAT IS A PEER REVIEWED ARTICLE?
http://vimeo.com/27119325

Peer Review Process
Manuscript
(potential article)
Sent to journal editor
Sent to three to five experts in the field
Blind review Blind review Blind review
Manuscript
(potential article)
1. Accept
2. Revise
3. Reject

You found the perfect criteria for
showing that a student-athlete was
fully recovered from a concussion,
how would you let the world know?

Practice telling the story: ulcers
Send someone from your group for a stack of
① Citations
② Articles

①Match the citations to the article
②Fix the citations
③Put them in chronological order
④What’s the story these citations tell?

Legislation about concussions
4 1
Event
happens
3 2
Arrange on the
cycle
A. Newspapers/magazi
nes
B. Books/movies
C. Legislation
D. Blogs/twitter/FB/tv/r
adio
E. Journal articles

Legislation about concussions
4 1
Blogs/twitter/
FB/TV/radio
Books/m
ovies
Event
happens
Newspapers/m
agazines
Journal
articles based
on research
3 2

4 1
Research
3 2
Arrange in order
A. news –(
twitter,TV, blogs,
newspapers)
B. chapter/book/te
xtbook
C. journal article
D. peer-review
process
E. Poster/conferen
ce talk

4 1
Peer
review
process
Poster/conf
erence talk
Research
Journal
article
Chapter/
book/textb
ook
News
(twitter,
blogs, TV,
newspaper)
3 2

Fix and Tell
What’s the story?

Astrophysicist Brian Schmidt - 2011 Nobel Physics Prize
for co-discovering dark energy
“When I won this, my grandma, who lives in Fargo, North Dakota, wanted to see
it…[I]t was uneventful, until I tried to leave ... It was in my laptop bag. It’s made of
gold, so it absorbs all the X-rays—it’s completely black. And they had never seen
anything completely black.
“They’re like, ‘Sir, there’s something in your bag.’
I said, ‘Yes, I think it’s this box.’
They said, ‘What’s in the box?’
I said, ‘a large gold medal,’ as one does.
So they opened it up and they said, ‘What’s it made out of?’
I said, ‘gold.’
And they’re like, ‘Uhhhh. Who gave this to you?’
‘The King of Sweden.’
‘Why did he give this to you?’
‘Because I helped discover the expansion rate of the universe was accelerating.’
At which point, they were beginning to lose their sense of humor. I explained to them
it was a Nobel Prize, and their main question was, ‘Why were you in Fargo?’

Wikipedia project
What are we going to do next to tell the story?

Your ideas included:
A. Fix the citations (find better sources, fix dead links,
etc.)
B. Fix the citations and check for accuracy (see if the
articles say what the wiki entry says they should
say, are there better sources to use for those
sections/improve the citations, etc.)
C. Improve the citations used and revise the existing
information in the article.
D. Expand the article (sports concussions, gender
differences, treatment options, brain activity,
severity, causes, etc.)
E. Do research on a concussion related topic of your
own.

Vote:
A. Fix the citations and check for accuracy (see if
the articles say what the wiki entry says they
should say, are there better sources to use for
those sections/improve the citations, etc.)
B. Expand the article (sports concussions, gender
differences, treatment options, brain activity,
severity, causes, etc.)
C. Wikipedia To-Do List
D. Wikipedia images list
E. Other

Using the spreadsheets you created
Find the 5 most cited articles in the wikipedia
article on concussions
circle your answers on the spreadsheets

Concussion
Reference
number
Cited by

Your results so far: Concussion
Reference
number
Cited by
(GS)
Part of the title
7 1015 "Consensus statement on concussion in sport: the 3rd
International Conference on Concussion in Sport held in
Zurich, November 2008.” Journal of athletic training.
77 796 Alexander MP (1995). "Mild traumatic brain injury:
Pathophysiology, natural history, and clinical management".
Neurology 45 (7): 1253–60.
34 679 (April 2005). "Summary and agreement statement of the 2nd
International Conference on Concussion in Sport, Prague
2004". Br J Sports Med 39 (4): 196–204
19 670 (2002). "Summary and agreement statement of the first
International Conference on Concussion in Sport, Vienna
2001*". British Journal of Sports Medicine 36 (1): 6–10.

Your results so far: Concussion
Referenc
e number
Times Cited
(WoS)
Part of the title
90 616 Langlois JA, Rutland-Brown W, Wald MM (2006). "The
epidemiology and impact of traumatic brain injury: A brief
overview". J of Head Trauma Rehabilitation 21 (5): 375–8.
77 429 Alexander MP (1995). "Mild traumatic brain injury:
Pathophysiology, natural history, and clinical management".
Neurology 45 (7): 1253–60.
34 316 (April 2005). "Summary and agreement statement of the 2nd
International Conference on Concussion in Sport, Prague
2004". Br J Sports Med 39 (4): 196–204
31 202 Iverson GL (2005). "Outcome from mild traumatic brain
injury". Current Opinion in Psychiatry 18 (3): 301–17.
doi:10.1097/01.yco.0000165601.29047.ae. PMID 16639155.
19 162 (2002). "Summary and agreement statement of the first
International Conference on Concussion in Sport, Vienna
2001*". British Journal of Sports Medicine 36 (1): 6–10.

Explain the steps of the google form
• Look up the article.
• Look it up in WoS and GS
• Citation count

Hierarchy of Evidence
or
levels of evidence
 Meta-analyses
 Review
 Scientific studies
(e.g., cross-sectional vs longitudinal,
randomised controlled trials)
 Case reports

Hierarchy of Evidence –
Meta-analyses
Reviews
Scientific studies
Case studies

Concussions – wiki references
How many are…..
Meta-analyses = 12
Reviews = 28
Scientific studies = 52
Case studies = 11

Display Settings: Abstract
Neuroimage. 2009 Aug;47 Suppl 2:T152-3. doi: 10.1016/j.neuroimage.2009.01.060. Epub 2009 Feb 10.
Case report of a soldier with primary blast brain injury.
Warden DL 1
, French LM, Shupenko L, Fargus J, Riedy G, Erickson ME, Jaffee MS, Moore DF.
Author information
Abstract
Primary blast injury of the central nervous system is described in a service-member exposed to a
large ordinance explosion. Neuroimaging abnormalities are described together with normalization of
the fractional anisotrophy on diffusion tensor imaging after follow-up imaging studies.
PubMed Commons home
PMID: 19457364 [PubMed - indexed for MEDLINE]
Publication Types, MeSH Terms
LinkOut - more resources
PubMed Commons
0 comments
Full text links
PubMed 19457364[uid]
Case Reports
….in a service-member exposed to a large ordinance
explosion.
#13 - Concussion entry

Scientific Study
J Cogn Neurosci. 1998 Sep;10(5):640-56.
Frontal lobe contributions to theory of mind.
Stone VE , Baron-Cohen S, Knight RT.
Abstract
"Theory of mind," the ability to make inferences about others" mental cognitive capacity that underlies humans" ability to engage in complex in several distinct stages, which can be measured with social reasoning Individuals with Asperger"s syndrome, a mild form of autism, perform tests but show deficits on more developmentally advanced theory of with bilateral damage to orbito-frontal cortex (n = 5) and unilateral damage prefrontal orbito-frontal
cortex (n = 5) on a series of theory of mind tasks varying in lesion patients performed similarly to individuals with Asperger"on simpler tests and showing deficits on tasks requiring more subtle social Display Settings: Abstract
1
1
Author information
Author information
PubMed Commons home
How to join PubMed Commons
J Cogn Neurosci. 1998 Sep;10(5):640-56.
Frontal lobe contributions to theory of mind.
Stone VE , Baron-Cohen S, Knight RT.
Abstract
"Theory of mind," the ability to make inferences about others" mental states, seems to be a modular
cognitive capacity that underlies humans" ability to engage in complex social interaction. It develops
in several distinct stages, which can be measured with social reasoning tests of increasing difficulty.
Individuals with Asperger"s syndrome, a mild form of autism, perform well on simpler theory of mind
tests but show deficits on more developmentally advanced theory of mind tests. We tested patients
with bilateral damage to orbito-frontal cortex (n = 5) and unilateral damage in left dorsolateral
prefrontal cortex (n = 5) on a series of theory of mind tasks varying in difficulty. Bilateral orbito-frontal
lesion patients performed similarly to individuals with Asperger"s syndrome, performing well
on simpler tests and showing deficits on tasks requiring more subtle social reasoning, such as the
ability to recognize a faux pas. In contrast, no specific theory of mind deficits were evident in the
unilateral dorsolateral frontal lesion patients. The dorsolateral lesion patients had difficulty only on
versions of the tasks that placed demands on working memory.
Publication Types, MeSH Terms, Grant Support
PubMed Commons
0 comments
Full text links
PubMed "Frontal lobe contributions to theory of mind" 1998
We tested patients with
bilateral damage to orbito-frontal
cortex (n = 5) and
unilateral damage in left
dorsolateral prefrontal
cortex (n = 5) on a series of
theory of mind tasks
varying in difficulty.
#36 -TBI

PubMed howell 2013 stroop
Scientific study
Full text links
Arch Phys Med Rehabil. 2013 Aug;94(8):1513-20. doi: 10.1016/j.apmr.2013.04.015. Epub 2013 Apr 30.
Dual-PubMed task howell 2013 stroop
effect on gait balance control in adolescents with concussion.
Full text links
Howell DR , Osternig LR, Chou LS.
Arch Phys Med Rehabil. 2013 Aug;94(8):1513-20. doi: 10.1016/j.apmr.2013.04.015. Epub 2013 Apr 30.
Dual-task effect on gait balance control in adolescents with concussion.
Howell DR 1
, Osternig LR, Chou LS.
Author information
Author information
Abstract
OBJECTIVE:
To prospectively and longitudinally examine how concussion affects gait balance
Abstract
1
control in adolescents during single- and dual-task walking.
DESIGN:
SETTING:
PARTICIPANTS:
Cohort, prospective, repeated-measures design.
Motion analysis laboratory.
OBJECTIVE:
Adolescents (N=20) identified as suffering a concussion were matched with healthy
control subjects (N=20) and tested 5 times across a 2-month period after injury.
INTERVENTIONS:
MAIN OUTCOME MEASURES:
Not applicable.
Gait temporal-distance parameters included average walking speed,
DESIGN:
SETTING:
PARTICIPANTS:
step length, and step width; whole body center of mass (COM) parameters included medial/lateral
displacement and peak COM medial/lateral and anterior velocities; dual-task cost, which was defined
as percent change from single- to dual-task conditions; and Stroop test accuracy.
dual-task
RESULTS:
No between-group differences were observed for step length and step width. The cost for average walking speed for subjects with concussion was greater than control subjects
across the 2-month testing period (main effect of group P=.019), as was the dual-task costs for peak
anterior COM velocity (main effect of group P=.017) and total COM medial/lateral displacement (main
effect of group P=.013). The total COM medial/lateral displacement (group × task interaction P=.006)
and peak COM medial/lateral velocity (main effect of group P=.027; main effect of task P=.01) were
significantly greater in subjects with concussion compared with control subjects during dual-task
walking. Subjects with concussion were significantly less accurate than controls on the Stroop test
(main effect of group P=.004).
CONCLUSIONS:
The findings suggest that concussion affects the ability of adolescents to control
INTERVENTIONS:
MAIN OUTCOME MEASURES:
body posture during gait up to 2 months after injury. Furthermore, dual-task paradigms may provide
additional useful information in the clinical assessment and recovery of concussion.
Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights
reserved.
KEYWORDS:
Attention, Brain concussion, Brain injuries, COM, Gait, Postural balance, Rehabilitation, center of
mass
RESULTS:
…longitudinally examine
how concussion affects
gait….
To prospectively and longitudinally examine how concussion affects gait balance
control in adolescents during single- and dual-task walking.
Cohort, prospective, repeated-measures design.
Motion analysis laboratory.
Adolescents (N=20) identified
as suffering a concussion were
matched with healthy control
subjects (N=20) and tested 5
times across a 2-month period
after injury.
Adolescents (N=20) identified as suffering a concussion were matched with healthy
control subjects (N=20) and tested 5 times across a 2-month period after injury.
Not applicable.
Gait temporal-distance parameters included average walking speed,
step length, and step width; whole body center of mass (COM) parameters included medial/lateral
displacement and peak COM medial/lateral and anterior velocities; dual-task cost, which was defined
as percent change from single- to dual-task conditions; and Stroop test accuracy.
No between-group differences were observed for step length and step width. The dual-task
cost for average walking speed for subjects with concussion was greater than control subjects

Case Reports
• chief complaint
• Diagnosis
• treatment, and
• deviation from the expected
Observations , not planned studies

Scientific studies
includes:
randomized controlled trials
cross-sectional
and/or longitudinal studies
In addition to the parts of a scholarly article this
article describes how the authors
Test a hypothesis

A good clinical trial will use these 3
guiding principles
• Compare like with like
• The bigger the group studied the more reliable
the conclusions
• Bayes theorem: things that should be true and
have good supporting evidence to back them up,
are likely to be true
For more details see Appendix 1 of:
Greenhalgh T. How to Read a Paper: The Basics of Evidence-based Medicine. 3rd ed. BMJ Books; 2006.

Meta-analysis
PubMed
Full text links
Cochrane PubMed
Database Syst Rev. 2004 Oct 18;(4):CD004609.
Full text links
Hyperbaric oxygen therapy for the adjunctive treatment of traumatic brain
Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004609.
injury.
Hyperbaric oxygen therapy for the adjunctive treatment of traumatic brain
injury.
Bennett MH 1
, Trytko B, Jonker B.
Bennett Author information
MH 1
, Trytko B, Jonker B.
Update in
Cochrane Database Syst Rev. 2012;12:CD004609.
Author information
Abstract
BACKGROUND:
SEARCH STRATEGY:
DATA COLLECTION AND ANALYSIS:
Three reviewers independently evaluated
the quality of the relevant trials using the
validated Oxford-Scale (Jadad 1996) and
extracted the data ….
Update in
Cochrane OBJECTIVES:
Database Syst Rev. 2012;12:CD004609.
SEARCH STRATEGY:
Abstract
SELECTION CRITERIA:
BACKGROUND:
effect DATA COLLECTION on AND quality ANALYSIS:
of life. Hyperbaric oxygen therapy (HBOT) has been suggested to improve oxygen
supply to the injured brain and, therefore, to reduce the volume of brain that will ultimately perish. It MAIN RESULTS:
postulated that the addition of HBOT to the standard intensive care regimen may result in a reduction
in patient death and disability as a result of these additional brain-preserving effects.
Traumatic brain injury is common and presents a health problem with significant
effect on quality of life. Hyperbaric oxygen therapy (HBOT) has been suggested to improve oxygen
supply to the injured brain and, therefore, to reduce the volume of brain that will ultimately perish. It is
postulated that the addition of HBOT to the standard intensive care regimen may result in a reduction
in patient death and disability as a result of these additional brain-preserving effects.
To assess the benefits and harms of adjunctive HBOT for treating traumatic brain
injury.
We searched CENTRAL (The Cochrane Library Issue 4, 2003), MEDLINE
(1966 - 2003), EMBASE (1974 - 2003), CINAHL (1982 - 2003), DORCTHIM (1996 - 2003), and
reference lists of articles. Relevant journals were handsearched and researchers in the field were
contacted.
Randomised studies comparing the effect on traumatic brain injury of
Traumatic brain injury is common and presents a health problem with significant
therapeutic regimens which include HBOT with those that exclude HBOT (with or without sham
therapy).
Three reviewers independently evaluated the quality of the
relevant trials using the validated Oxford-Scale (Jadad 1996) and extracted the data from the
included trials.
Four trials contributed to this review (382 patients, 199 receiving HBOT and 183
control). There was a trend towards, but no significant increase in, the chance of a favourable
outcome when defined as full recovery, Glasgow outcome score 1 or 2, or return to normal activities
of daily living (relative risk [RR] for good outcome with HBOT 1.94, 95% confidence interval [CI] 0.92
to 4.08, P=0.08). Pooled data from the three trials with 327 patients that reported mortality, showed a
significant reduction in the risk of dying when HBOT was added to the treatment regimen (RR 0.69,
95% CI 0.54 to 0.88, P=0.003). Heterogeneity between studies was low (I(2) =0%), and sensitivity
analysis for the allocation of dropouts did not affect that result. This analysis suggests we would have
OBJECTIVES:
Pooled data from the three trials with 327 patients
that reported mortality, showed a significant
reduction in the risk of dying when HBOT was
added to the treatment regimen (RR 0.69, 95% CI
0.54 to 0.88, P=0.003).
To assess the benefits and harms of adjunctive HBOT for treating traumatic brain
injury.
SEARCH STRATEGY:
We searched CENTRAL (The Cochrane Library Issue 4, 2003), MEDLINE
(1966 - 2003), EMBASE (1974 - 2003), CINAHL (1982 - 2003), DORCTHIM (1996 - 2003), and
reference lists of articles. Relevant journals were handsearched and researchers in the field were
#54 - TBI

Meta-analysis
• Single focused question or overview of several
related questions
• + data sources, study selection, data
extraction, data synthesis
• An analysis of the data.

Review
J Clin Exp Neuropsychol. 2001 Dec;23(6):837-51.
Prediction of outcome in mild to moderate head injury: a review.
van der Naalt J.
Author information
J Clin Exp Neuropsychol. 2001 Dec;23(6):837-51.
Prediction of outcome in mild to moderate head injury: a review.
van der Naalt J.
Abstract
This paper reviews the functional outcome of patients sustaining mild and moderate head injury (HI).
Discrepancies across studies in the definition of minor, mild, and moderate HI are discussed in terms
of hindering the interpretation of recovery. The predictive value of acute severity indices,
neuroimaging findings, and the results of other techniques are summarized. Measurement of
outcome based solely on the Glasgow Outcome Scale (GOS) is critiqued, and it is recommended that
a differentiated outcome scale involving emotional, behavioral, cognitive, and physical domains
should be used.
Author information
Abstract
This paper reviews the functional outcome of patients sustaining mild and moderate head injury (HI).
Discrepancies across studies in the definition of minor, mild, and moderate HI are discussed in terms
of hindering the interpretation of recovery. The predictive value of acute severity indices,
neuroimaging findings, and the results of other techniques are summarized. Measurement of
outcome based solely on the Glasgow Outcome Scale (GOS) is critiqued, and it is recommended that
a differentiated outcome scale involving emotional, behavioral, cognitive, and physical domains
should be used.
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PubMed
PubMed Commons home
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PubMed
Discrepancies across studies in the
definition of minor, mild, and moderate
head injuries….
#28 - concussion

Systematic Reviews
Reviews
Went through literature and found all articles
on a topic.
Similar to what you might do for a really well
researched term paper.
Bibliographies of these papers are a goldmine.

See 1 citation in 2011 by Rabago CA and Wilken JM:
1. 2.
J Neurol Phys Ther. 2011 Dec;35(4):185-93. doi: 10.1097/NPT.0b013e318235d7e6.
Application of a mild traumatic brain injury rehabilitation program in a virtual
realty environment: a case study.
Rábago CA , Wilken JM.
Author information
Abstract
1
BACKGROUND AND PURPOSE:
CASE DESCRIPTION:
INTERVENTIONS:
OUTCOMES:
DISCUSSION:
Mild traumatic brain injury (mTBI) can compromise reaction time,
visual perception, memory, attention, balance, and gait. These deficits, especially if persistent, can
restrict participation in daily activities and the resumption of personal and profession roles. The
purpose of this case study is to describe an mTBI-specific clinical assessment and rehabilitation
intervention administered in a virtual reality environment.
The case involved a 31-year-old male service member who had sustained an
mTBI (concussion) during a recreational softball game 36 days prior to physical therapist evaluation.
He had complaints of severe visual and physical motion intolerance. He demonstrated impaired static
balance and was restricted from full military duty.
The assessment included measurements of postural and gait balance during
cognitive, visual, and vestibular challenges within a Computer-Assisted Rehabilitation Environment.
Phase 1 of the intervention consisted of clinical techniques (ie, optokinetic stimulation/habituation,
visual/physical perturbations, and postural stability exercises) targeting specific impairments. Phase 2
training consisted of weapon handling and target recognition tasks to simulate the requirements of his
military occupation.
At the conclusion of 6 treatments, the patient demonstrated significant increases in
postural and gait balance with a near complete resolution of all postconcussion symptoms. He
successfully returned to full duty and training for combat deployment.
Service members and civilians exhibit similar impairments, limitations, and restrictions
following mTBI. A rehabilitation program delivered in a virtual-reality environment can be structured to
manage Display complex Settings: mTBI symptoms Abstract
through the integration of multiple treatment modalities specific to
a patient's personal and professional roles.
Full text links
See 1 citation in 2006 by Chou LS and Osternig LR and Parker TM and Van Donkelaar P:
Med Sci Sports Exerc. 2006 Jun;38(6):1032-40.
Gait stability following concussion.
Parker TM 1
, Osternig LR, VAN Donkelaar P, Chou LS.
Author information
Abstract
INTRODUCTION:
PURPOSE:
METHODS:
RESULTS:
CONCLUSION:
The need to identify functional impairment following a brain injury is critical to
prevent reinjury during the period of recovery. However, little is known about the effect of concussion
on dynamic motor function.
The purpose of this study was to examine the effect of concussion on a dynamic motor
task under conditions of divided and undivided attention over the course of 28 d.
Fifteen subjects with concussions (CONC) and 15 uninjured controls (NORM) were
observed while walking with undivided attention and while concurrently completing simple mental
tasks. The CONC were assessed within 48 h of injury and again at 5, 14, and 28 d postinjury. The
NORM were evaluated at the same time intervals. Whole-body motion data were collected to
examine displacement and velocity of the center of mass (COM) and the maximum separation
between the COM and center of pressure (COP). Three-way repeated-measures mixed-design
ANOVA and Tukey post hoc tests were completed to determine differences between group, task, and
testing day (P<0.05).
Several aspects of gait stability were compromised in the CONC group for up to 4 wk after
injury. CONC were found to walk significantly slower during dual tasks on all testing days when
compared with the uninjured controls. The injured subjects were also found to have greater sway and
sway velocity than controls when attention was divided for up to 28 d postinjury.
The findings of this study suggest that concussion may have long-term observable
and measurable effects on the control of gait stability.
Full text links
See 1 citation in 2008 by Broglio SP and Puetz TW:
Sports Med. 2008;38(1):53-67.
The effect of sport concussion on neurocognitive function, self-report
symptoms and postural control : a meta-analysis.
Broglio SP 1
, Puetz TW.
Author information
Abstract
Sport concussion is commonly assessed using a battery of tests that evaluate neurocognitive
functioning, postural control and self-report symptoms. The degree to which concussion affects each
of these measures is unclear. Thus, the purpose of this meta-analysis is to systematically review and
quantify the effect of sport concussion on each assessment measure when administered immediately
post-injury and in the 2 weeks following injury. PubMed and PsychINFO databases were searched
from January 1970 to June 2006, from which 39 were included for review. Studies were selected for
review if they included concussed athletes who were evaluated using one of the three assessment
measures. One post-morbid assessment must have been completed within 14 days of injury and
compared with a baseline measure or control group. Study design, type of neurocognitive
assessment, timing of assessment following injury and number of post-concussion assessments were
extracted as potential moderators. Sport-related concussion had a large negative effect (mean Delta;
95% confidence interval) on neurocognitive functioning (-0.81; -1.01, -0.60), self-report symptoms
(-3.31; -6.35, -0.27) and postural control (-2.56; -6.44, 1.32) in the initial assessment following injury.
A reduced, but large effect, was also seen in the 14 days following the initial assessment for
neurocognitive functioning (-0.26; -0.46, -0.06), self-report symptoms (-1.09; -2.07, -0.11) and
postural control (-1.16; -2.59, 0.27). Our findings demonstrated large effects for each aspect of the
assessment battery. These findings support the use of the multifaceted concussion evaluation.
Comment in
The value of various assessment techniques in detecting the effects of concussion on cognition,
symptoms, and postural control. [J Athl Train. 2009]
Full text links
PubMed Broglio, S. P., & Puetz, T. W. (2008)
3.
4.

Where in the Hierarchy of Evidence?
1. Rábago, C. A., & Wilken, J. M. (2011).
http://www.ncbi.nlm.nih.gov/pubmed/?term=22027473
See 1 citation in 2011 by Rabago CA and Wilken JM:
J Neurol Phys Ther. 2011 Dec;35(4):185-93. doi: 10.1097/NPT.0b013e318235d7e6.
Application of a mild traumatic brain injury rehabilitation program in a virtual
realty environment: a case study.
Rábago CA , Wilken JM.
Abstract
BACKGROUND AND PURPOSE:
A. Meta analysis
B. Review
C. Scientific Study
D. Case studies
CASE DESCRIPTION:
INTERVENTIONS:
Mild traumatic brain injury (mTBI) can compromise reaction time,
visual perception, memory, attention, balance, and gait. These deficits, especially if persistent, can
restrict participation in daily activities and the resumption of personal and profession roles. The
purpose of this case study is to describe an mTBI-specific clinical assessment and rehabilitation
intervention administered in a virtual reality environment.
The case involved a 31-year-old male service member who had sustained an
mTBI (concussion) during a recreational softball game 36 days prior to physical therapist evaluation.
He had complaints of severe visual and physical motion intolerance. He demonstrated impaired static
balance and was restricted from full military duty.
The assessment included measurements of postural and gait balance during
1
Author information
Full text links
PubMed Rábago, C. A., & Wilken, J. M. (2011)

2. Parker, T. M., Osternig, L. R., Van Donkelaar,
PubMed P., & Chou, L.-S. (2006)
Parker, T. M., Osternig, L. R., Van Donkelaar, P., & Chou, L.-S. (2006)
Full while walking with undivided attention and while concurrently completing simple tasks. The CONC were assessed within 48 h of injury and again at 5, 14, and 28 d postinjury. NORM were evaluated at the same time intervals. Whole-body motion data were collected See 1 citation in 2006 by Chou LS and Osternig LR and Parker TM and Van Donkelaar Med Sci Sports Exerc. 2006 Jun;38(6):1032-40.
Gait stability following concussion.
Parker TM 1
, Osternig LR, VAN Donkelaar P, Chou LS.
Author information
Abstract
INTRODUCTION:
The need to identify functional impairment following a brain injury is critical prevent reinjury during the period of recovery. However, little is known about the effect of on dynamic motor function.
A. Meta analysis
B. Review
C. Scientific Study
D. Case studies
PURPOSE:
The purpose of this study was to examine the effect of concussion on a dynamic task under conditions of divided and undivided attention over the course of 28 d.
METHODS:
Fifteen subjects with concussions (CONC) and 15 uninjured controls (NORM) observed

3. Broglio, S. P., & Puetz, T. W. (2008).
See 1 citation in 2008 by Broglio SP and Puetz TW:
Sports Med. 2008;38(1):53-67.
The effect of sport concussion on neurocognitive function, self-report
symptoms and postural control : a meta-analysis.
Broglio SP , Puetz TW.
Abstract
Sport concussion A. is commonly Meta assessed analysis
using a battery of tests that evaluate neurocognitive
functioning, postural control and self-report symptoms. The degree to which concussion affects each
of these measures B. is unclear. Review
Thus, the purpose of this meta-analysis is to systematically review and
quantify the effect of sport concussion on each assessment measure when administered immediately
post-injury and C. in the 2 Scientific weeks following injury. Study
PubMed and PsychINFO databases were searched
from January 1970 to June 2006, from which 39 were included for review. Studies were selected for
review if they included D. concussed Case athletes studies
who were evaluated using one of the three assessment
measures. One post-morbid assessment must have been completed within 14 days of injury and
compared with a baseline measure or control group. Study design, type of neurocognitive
1
Author information
Full text links
PubMed Broglio, S. P., & Puetz, T. W. (2008)

4. Leddy, J. J., Sandhu, H., Sodhi, V.,
Baker, J. G., & Willer, B. (2012).
A. Meta analysis
B. Review
C. Scientific Study
D. Case studies

Suggested reading - hierarchy of evidence
Greenhalgh, T. (1997). How to read a paper. Getting
your bearings (deciding what the paper is about).
BMJ (Clinical research ed.), 315(7102), 243–6.
Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC212
7173/pdf/9253275.pdf
Understanding and using the Hierarchy of Evidence
https://hive.library.uwa.edu.au/hive/cache/202902
/hive.cgi/zip/202902/LO2ACQ_FBE/html/understan
d.html

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