Symptom Exacerbation With Physical and Mental Activity and the Association With Clinical Outcomes After Sport-Related Concussion in Youth and Adults

OBJECTIVES: To evaluate the association between self-reported symptom exacerbation with physical/mental activity and cervical spine (CSp), vestibulo-ocular reflex (VOR), oculomotor (OM), balance, and delayed recall scores in individuals diagnosed with a sport-related concussion (SRC). DESIGN: Cross-Sectional. SETTING: Acute Sport Concussion Clinic. PARTICIPANTS: Individuals diagnosed by a physician with an SRC. INDEPENDENT VARIABLES: Exposure variables included CSp, VOR, or OM abnormalities; SCAT5 5-word delayed recall scores; and total numbers of errors on the modified balance error scoring system. MAIN OUTCOMES: Outcome variables included self-report of symptom exacerbation (yes/no) with physical activity and mental activity. To determine the association between exposure and outcome variables, multiple variable logistic regressions were conducted including adjustment for age, sex, number of previous concussions, time to initial assessment, and symptom severity scores. RESULTS: A total of 243 participants were included in the final analysis with 79% and 81% of individuals self-reporting symptom exacerbation with mental and physical activity, respectively. Positive CSp findings were associated with increased adjusted odds of symptom exacerbation with physical exertion (OR adj = 1.48; 97.5% CI: 1.04-2.19), whereas positive VOR findings were associated with increased adjusted odds of symptom exacerbation with mental exertion (OR adj = 2.29; 97.5% CI: 1.02-5.31). Having more previous concussions were associated with higher odds of symptom exacerbation with mental (OR adj = 1.47, 97.5% CI: 1.00-2.29) or physical (OR adj = 1.52, 97.5% CI: 1.52, 1.06, 2.35) exertion. CONCLUSIONS: These results demonstrate a potential physiological link between CSp and VOR deficits with self-reported symptom exacerbation during physical and mental activity, respectively. Future research is warranted to delineate the neurophysiological basis of these findings.