Showing papers by "Gerard A. Gioia published in 2014"
TL;DR: The recommendations for concussion management provided here are based on the most current research and divided into sections on education and prevention, documentation and legal aspects, evaluation and return to play, and other considerations.
Abstract: Objective: To provide athletic trainers, physicians, and other health care professionals with best-practice guidelines for the management of sport-related concussions. Background: An estimated 3.8 ...
1,026 citations
TL;DR: With strong psychometric characteristics, the four versions of the PCSI capture important postconcussion symptoms and can be utilized to track recovery from pediatric concussion and guide treatment recommendations.
248 citations
TL;DR: It is demonstrated that a single season of football can produce brain MRI changes in the absence of clinical concussion, similar to that associated with mild traumatic brain injury.
Abstract: The aim of this study was to determine whether the cumulative effects of head impacts from a season of high school football produce magnetic resonance imaging (MRI) measureable changes in the brain in the absence of clinically diagnosed concussion Players from a local high school football team were instrumented with the Head Impact Telemetry System (HITS™) during all practices and games All players received pre- and postseason MRI, including diffusion tensor imaging (DTI) Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) was also conducted Total impacts and risk-weighted cumulative exposure (RWE), including linear (RWELinear), rotational (RWERotational), and combined components (RWECP), were computed from the sensor data Fractional, linear, planar, and spherical anisotropies (FA, CL, CP, and CS, respectively), as well as mean diffusivity (MD), were used to determine total number of abnormal white matter voxels defined as 2 standard deviations above or below the group mean Delta (post-preseason) ImPACT scores for each individual were computed and compared to the DTI measures using Spearman's rank correlation coefficient None of the players analyzed experienced clinical concussion (N=24) Regression analysis revealed a statistically significant linear relationship between RWECP and FA Secondary analyses demonstrated additional statistically significant linear associations between RWE (RWECP and RWELinear) and all DTI measures There was also a strong correlation between DTI measures and change in Verbal Memory subscore of the ImPACT We demonstrate that a single season of football can produce brain MRI changes in the absence of clinical concussion Similar brain MRI changes have been previously associated with mild traumatic brain injury
197 citations
01 Jan 2014
TL;DR: The Behavior Rating Inventory of Executive Function (BRIEF) as mentioned in this paper was one of the first attempts to measure executive function via self-and informant reports of everyday functioning in the real-world environment and was the first published measure of these self-regulatory capabilities in children and adolescents.
Abstract: The Behavior Rating Inventory of Executive Function (BRIEF) was one of the first attempts to measure executive function via self- and informant reports of everyday functioning in the real-world environment and was the first published measure of these self-regulatory capabilities in children and adolescents (Gioia, Isquith, Guy & Kenworthy, 2000a) The impetus for the BRIEF arose among the authors in 1994 while trying to reconcile the often discrepant parent and teacher reports of children’s everyday functioning at home and in school with their performance on putative performance measures (ie, “tests”) of executive function At that time, there were few such performance measures of executive function developed for children and adolescents, no rating scales or structured observational methods for evaluating executive functions, and very few published articles on executive function in children (Bernstein & Waber, 2007)
138 citations
TL;DR: The ACE tools, modified for ED use, were successfully implemented in the pediatric ED and increased patient follow-up and improved recall of and adherence to ED discharge recommendations was demonstrated.
Abstract: OBJECTIVES: Accurate recognition of pediatric concussion in the emergency department (ED) is important to ensure appropriate management for safe recovery. The study objective was to determine whether the Centers for Disease Control and Prevention’s Acute Concussion Evaluation (ACE) tools, modified for ED use, improved patient follow-up and post-injury behaviors. METHODS: The original ACE tools (ACE, ACE Care Plan) were modified for ED use via Delphi methodology with an expert panel and implemented in 2 urban pediatric EDs for patients aged 5 to 21 years evaluated within 24 hours of a head injury. Pre- (February 2009 to July 2009) and post- (December 2009 to June 2010) implementation, patient phone surveys were conducted 1, 2, and 4 weeks after ED discharge. Reported rates of patient follow-up and recovery measures were analyzed. ED clinician adherence was assessed. RESULTS: During the study, 164 patients were enrolled pre-implementation and 190 post-implementation. The mean patient age was 10.6 years (SD, 3.7); 65% were males, 49% were African American, and 46% were Caucasian. Post-implementation, 58% of patients received the modified ACE diagnostic tool and 84% received the modified ACE discharge instructions. Follow-up was improved at all time points (32% vs 61% at week 4; P CONCLUSIONS: The ACE tools, modified for ED use, were successfully implemented in the pediatric ED. Post-implementation, increased patient follow-up and improved recall of and adherence to ED discharge recommendations was demonstrated.
70 citations
TL;DR: Evidence supporting the use of rating scales of executive function to assess intervention outcome, how they may inform development of interventions, and how comparing rater perspectives can assess awareness of cognitive dysfunction are discussed.
Abstract: Executive dysfunction is present in children, adolescents, and adults with a wide range of clinical conditions. A growing body of literature has demonstrated the usefulness of rating scales designed to gauge executive functioning in everyday life. In this article, we discuss evidence supporting the use of such rating scales to assess intervention outcome, how they may inform development of interventions, and how comparing rater perspectives can assess awareness of cognitive dysfunction. We provide an example of how an executive function rating scale helped define intervention targets and measured outcomes in a recently published real-world intervention for children with autism spectrum disorder. Rating scales of executive function provide valuable information with respect to treatment planning and assessment of intervention outcome.
46 citations
TL;DR: Children given a baseline assessment in a group setting performed no differently than children tested individually when standardized administration procedures were used by trained test administrators, and symptom reporting was similar between settings on both measures.
Abstract: Background:Previous research has demonstrated differences in cognitive performance when baseline concussion assessment is performed in a group versus an individual setting. Accurate baseline assessment is imperative when such data are used to make clinical decisions regarding cognitive and symptom recovery after concussion.Hypothesis:The use of similar standardized test administration procedures and test conditions across group and individual settings results in no differences in cognitive performance or symptom reporting.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 939 participants (aged 5-18 years), including 313 tested individually and 626 tested in a group setting, matched on age, sex, and attention-deficit/hyperactivity disorder status, were administered concussion baseline assessment using the desktop version of the Immediate Post-Concussion Assessment and Cognitive Testing and a new pediatric measure, the Multimodal Assessment of Cognition & Symptoms for Children. Cognitive pe...
41 citations
01 Jan 2014
TL;DR: The Tasks of Executive Control (TEC) as mentioned in this paper is a standardized computer-administered measure of two fundamental aspects of executive control processes or functions, namely, working memory and inhibitory control.
Abstract: The Tasks of Executive Control (TEC; Isquith, Roth, & Gioia, 2010) is a standardized computer-administered measure of two fundamental aspects of executive control processes or functions, namely, working memory and inhibitory control. It is designed for use with children and adolescents between the ages of 5 and 18 years, including those with a wide variety of developmental and acquired neurological disorders including attention disorders, learning disabilities, autism spectrum disorders, and traumatic brain injuries, as well as those with psychiatric and other behavioral health concerns. Published in 2010, it represents a novel contribution to clinical assessment of executive function by adapting, integrating, and standardizing two of the most commonly used neuroscience methods designed to tap working memory and inhibitory control: an n-back paradigm that parametrically increases working memory load and a go/no-go task to manipulate inhibitory control demand. The combination of three levels of working memory load (0-, 1-, 2-back) and two levels of inhibitory control demand (no inhibit, inhibit) yields four sequential tasks for 5–7-year-old children and six tasks for 8–18-year-old children and adolescents. The TEC calculates multiple performance accuracy (e.g., omissions, commissions), response time, and response time variability scores within each task condition, across the instrument as a whole, and over time as demands increase. Three equivalent forms and two additional research forms are included, along with reliable change scores that facilitate interpretation of performance changes on repeated assessments. In addition to scores for each task and for the measure as a whole, the TEC captures accuracy and timing variables for each individual response and by quartile within each task. All data may be exported to spreadsheet and statistical software with labels for detailed analysis and research.
5 citations