In the above-titled article, Kontos and Collins (2018) argue that while the general population is vulnerable to concussion as well as its related conditions and symptoms, there are sub-populations whose concussion risk profile is distinctly higher. Specifically, they are sporting participants, the youth, military personnel, and clinically underserved populations. Moreover, they state that there are numerous elements responsible for their elevated risk. Therefore, Kontos and Collins (2018) note the clinical importance of understanding the nature of populations with heightened exposure to concussions.
Sport and recreation-related concussion
Despite the volumes of literature on sport and recreation-related concussion (SRC), Kontos and Collins (2018) note the need to address identification, return to play, and youth-centric sporting concerns. They highlight that it is difficult to accurately and proactively distinguish concussion symptoms from suspicions. For this reason, they state that initial concussion assessments for athletes must eliminate other causes for concussion-like symptoms. Kontos and Collins (2018) note that playing while concussed only increases impairment and recovery time, there is no definitive concussion identifying approach. This stresses the need to develop tools for clinical identification of concussions that accommodate on-field assessment realities. SRCs are uniquely associated with return to play concerns. Kontos and Collins (2018) urge researchers and clinicians to update their return to play assessment to conform with new clinical profiles.
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Concussion in pediatric populations
The effects of concussion on the growth of the brain in children and adolescents inform this section. Kontos and Collins (2018) note that the transition from childhood to adolescence is marked by an expansion of cognitive function and vulnerability to brain injuries. While current literature suggests that this risk heightens in puberty and declines with the conclusion of the brain’s advancement in adulthood, it is unclear whether concussions have lasting or short-term effects on evolving brains. Conversely, there is a distinct lack of age and developmentally appropriate concussion assessment tools. This mandates clinicians to depend on unreliable patient/parent symptom reports. Kontos and Collins (2018) suggest an age and development sensitive assessment approach.
Concussion in underserved populations
The need to enhance awareness, schooling and access to care among this sub-population group informs this section. Kontos and Collins (2018) define this collection as those who lack suitable concussion care. They speculate that ignorance about concussion or the lack of appropriate resources for concussion care and treatment are the causes. Not only did their survey findings confirm their theoretical expectations, but they also stress the need for concussion awareness and appropriate care and treatment resources. Kontos and Collins (2018) found that clinical care in rural communities is physically limited. Therefore, the use of telehealth is an effective approach towards improving their access to care.
Concussions in the military
Concussions in the military context are distinct from those in the general population or the already discussed sub-groups. As well as the association with post-traumatic stress (PTS) and post-traumatic stress disorder (PTSD), military-related concussions have the unique distinction of being additionally caused by blast mechanism. Animal prototypical findings imply that pure blast injuries are different from pure blunt injuries and associate the former with practical changes to brain cells. Likewise, the return to duty consideration is higher because the military performance environment comparatively elevated risk. Further, Kontos and Collins (2018) link repeated blast exposure to major cerebral impairments and suggest that clinicians consider the association in cases involving law enforcement and military personnel.
Repetitive impacts to the head
Kontos and Collins (2018) note that soccer has attracted cross-sectional attention because of its use of the head to control, pass, or shoot the ball. Despite the attention, there is no definitive connection between heading in soccer and concussion-related symptoms. Likewise, the findings on youth American football are inconclusive. Strikingly, despite the massive media attention on chronic traumatic encephalopathy (CTE) due to its association to concussion and sub-concussive effects, there is no direct link between them and the prevalence of CTE is unknown. Therefore, there is a need for more research.
Reference
Kontos, P., A., & Collins, W., M. (2018). At-risk populations. In Concussion: A Clinical Profile Approach to Assessment and Treatment (pp 159-173). Washington, DC: American Psychological Association
