ISSN 2378-7910 (print)

ISSN 2376-3825 (online)

Review Journal
A Non-Profit Organization

Launches in 2015
Volume 1 Number 1

Review Journal

NFP

A Non-Profit Organization

Table of Contents
Adolescent vs. Young Adult Concussion: Should We Manage Adolescent
Concussions Differently? 

Sample 2 

Sample 3 

Sample 4 

Sample 5 

Sample 6 

Sample 7 

10

Sample 8 

11

Joshua Rothenberg, DO reviewing David Howell et al. Am J Sports Med 2014; 43(1) published online ahead of print

Joshua Rothenberg, DO reviewing David Howell et al. Am J Sports Med 2014; 43(1) published online ahead of print

Joshua Rothenberg, DO reviewing David Howell et al. Am J Sports Med 2014; 43(1) published online ahead of print

Joshua Rothenberg, DO reviewing David Howell et al. Am J Sports Med 2014; 43(1) published online ahead of print

Joshua Rothenberg, DO reviewing David Howell et al. Am J Sports Med 2014; 43(1) published online ahead of print

Joshua Rothenberg, DO reviewing David Howell et al. Am J Sports Med 2014; 43(1) published online ahead of print

Joshua Rothenberg, DO reviewing David Howell et al. Am J Sports Med 2014; 43(1) published online ahead of print

Joshua Rothenberg, DO reviewing David Howell et al. Am J Sports Med 2014; 43(1) published online ahead of print

2014 Joshua Rothenberg. All Rights Reserved.

Review Journal

NFP

A Non-Profit Organization

About the Editors:

Joshua Rothenberg, DO

Gerard Malanga, MD

Ken Mautner, MD

Founder & Publisher

Co-Editor-In-Chief

Co-Editor-In-Chief

Co-Editor-In-Chief

Resident Physician
University of Miami

Sports Fellowship Trained

Mayo Clinic

Sports Fellowship Trained

American Sports Medical
Institute, AL

Sports Fellowship Trained

University of Michigan

Jim Ross, MD

Editorial Board:
Alberto Panero, DO
Alexander Creighton, MD
Andrew Gregory, MD
Arthur Deluigi, DO
Brandee Waite, MD
Bryson Lesniak, MD
Brian Leo, MD
Carolyn Marquardt, MD
Cassandra Lee, MD
Charlie Cox, MD
Clifton Page, MD

David Berkoff, MD
Ellie Jelsing, MD
Evan Peck, MD
Ivette Guttman, MD
Jeffrey Nepple, MD
Jacob Sellon, MD
Jason Zaremski, MD
Joanne Borg-Stein, MD
Jose Ramirez Del Toro, MD
Joseph DeAngelis, MD
Joseph Herrera, DO

Matthew Matava, MD
Michael Baraga, MD
Michael Fredericson, MD
Omar Bhatti, MD
Ricardo Colberg, MD
Scott Faucett, MD
Tracy Ray, MD

Published Reviewers:

Acknowledgements:

Sample 1, DO
Sample 2, MD
Sample 3, MD
Sample 4, DO
Sample 5, MD
Sample 6, MD
Sample 7, MD
Sample 8, MD

A special thanks to a great mentor, supporter, and advisor.

Administrative Editor

Ricardo Vasquez-Duarte, MD

2014 Joshua Rothenberg. All Rights Reserved.

NFP

Review Journal
A Non-Profit Organization

Adolescent vs. Young Adult Concussion: Should

We Manage Adolescent Concussions Differently?

that dual task assessment of concussion appeared to be

the most sensitive testing done in the past. Thus, they
combined the two, and used the dual task model to
Concussion remains a heavily debated topic surrounding
our young adult and adolescent populations. David Howell include motor control, via gait analysis, while performing
the Stroop test. They were able to do so while having age,
et al. completed a level 2 prospective longitudinal cohort
study on dual task gait analysis, in which he hypothesized mass, and height-matched controls participate.

Weaknesses were also evident in the study. The
that adolescents may need more time for recovery
total N of the study was 38, and in future studies, a
than their young adult counterparts after sustaining a
greater power would be beneficial to corroborate results.
concussion. His research was predicated on looking at
gait stability while performing the Stroop test, a secondary Also, the adolescent group had 17 males and only 2
females, while the disparity between sexes among young
task that has been shown to engage executive function,
adults was not evident. We still do not know if there
namely conflict resolution.
are true differences in rate and recovery of concussion

The adolescent and young adult groups were
amongst the two sexes, but this may have played a role in
selected using a single concussion definition published
the results. Also noteworthy was that the management
by McCrory. The testing was performed at 72 hours, 1
of the concussed subjects was done independently of the
week, 2 weeks, 1 month, and 2 months post-concussion.
Matched controls were selected by age, height, sex, mass, study, thus, some adolescents and/or young adults may
have received medication and therapies that could have
and activity participation. They completed the same
testing at the same time periods. Both groups underwent affected their testing. Lastly, different certified athletic
trainers and physicians selected the concussed participants,
gait analysis, in which body motion analysis was
conducted using a 10-camera motion analysis system. The which ultimately may have led to a selection bias.
gait analysis was done while performing the Stroop test,
which was listening to the words high or low spoken
in a high or low pitch, and determining which pitch
the word was spoken in. Center of mass (COM) position
data was then calculated using the weighted sum of body
segments.

Statistically significant results were primarily
noted in the adolescent group. Concussed adolescents
demonstrated larger peak COM medial-lateral velocity
(p=0.001) and greater COM medial-lateral displacement
(p=0.001) at 72 hours. They also demonstrated greater
total medial-lateral COM displacement (p=0.001) over
the entire 2 months. The concussed young adults only
demonstrated statistical significance for less peak COM
anterior velocity (p=0.01) at 72 hours. Thus, the authors
suggest that that post concussive injuries may need to be
managed more cautiously in the adolescent age group.

Although weaknesses exist, the conclusions
deduced by the authors are appropriately reflected in their
data. The methods and statistics used were appropriate,
and demonstrate a well thought out study. After careful
review, the findings prove to be valid. The take home
point of this article that I will take into my practice is
to allow a longer time period to elapse in the concussed
adolescent population before consideration of resuming
activities. These conclusions were formed on the basis that
this study confirms the presence of motor control issues
in adolescents 2 months post-concussion. Future studies
corroborating or denying this manuscript are warranted to
lead to more discussion and effective decisions regarding
these populations.
Joshua Rothenberg, DO reviewing David Howell et al. Am J
Sports Med 2014; 43(1) published online ahead of print

The manuscript demonstrated several strengths.
The authors recognized the lack of published data on
motor control in concussion studies. They also found

2014 Joshua Rothenberg. All Rights Reserved.

NFP

Review Journal
A Non-Profit Organization

Sample 2

the most sensitive testing done in the past. Thus, they

combined the two, and used the dual task model to
Concussion remains a heavily debated topic surrounding
our young adult and adolescent populations. David Howell include motor control, via gait analysis, while performing
the Stroop test. They were able to do so while having age,
et al. completed a level 2 prospective longitudinal cohort
study on dual task gait analysis, in which he hypothesized mass, and height-matched controls participate.

Weaknesses were also evident in the study. The
that adolescents may need more time for recovery
total N of the study was 38, and in future studies, a
than their young adult counterparts after sustaining a
greater power would be beneficial to corroborate results.
concussion. His research was predicated on looking at
gait stability while performing the Stroop test, a secondary Also, the adolescent group had 17 males and only 2
females, while the disparity between sexes among young
task that has been shown to engage executive function,
adults was not evident. We still do not know if there
namely conflict resolution.
are true differences in rate and recovery of concussion

The adolescent and young adult groups were
amongst the two sexes, but this may have played a role in
selected using a single concussion definition published
the results. Also noteworthy was that the management
by McCrory. The testing was performed at 72 hours, 1
of the concussed subjects was done independently of the
week, 2 weeks, 1 month, and 2 months post-concussion.
Matched controls were selected by age, height, sex, mass, study, thus, some adolescents and/or young adults may
have received medication and therapies that could have
and activity participation. They completed the same
testing at the same time periods. Both groups underwent affected their testing. Lastly, different certified athletic
trainers and physicians selected the concussed participants,
gait analysis, in which body motion analysis was
conducted using a 10-camera motion analysis system. The which ultimately may have led to a selection bias.
gait analysis was done while performing the Stroop test,
which was listening to the words high or low spoken
in a high or low pitch, and determining which pitch
the word was spoken in. Center of mass (COM) position
data was then calculated using the weighted sum of body
segments.

Statistically significant results were primarily
noted in the adolescent group. Concussed adolescents
demonstrated larger peak COM medial-lateral velocity
(p=0.001) and greater COM medial-lateral displacement
(p=0.001) at 72 hours. They also demonstrated greater
total medial-lateral COM displacement (p=0.001) over
the entire 2 months. The concussed young adults only
demonstrated statistical significance for less peak COM
anterior velocity (p=0.01) at 72 hours. Thus, the authors
suggest that that post concussive injuries may need to be
managed more cautiously in the adolescent age group.

Although weaknesses exist, the conclusions
deduced by the authors are appropriately reflected in their
data. The methods and statistics used were appropriate,
and demonstrate a well thought out study. After careful
review, the findings prove to be valid. The take home
point of this article that I will take into my practice is
to allow a longer time period to elapse in the concussed
adolescent population before consideration of resuming
activities. These conclusions were formed on the basis that
this study confirms the presence of motor control issues
in adolescents 2 months post-concussion. Future studies
corroborating or denying this manuscript are warranted to
lead to more discussion and effective decisions regarding
these populations.
Joshua Rothenberg, DO reviewing David Howell et al. Am J
Sports Med 2014; 43(1) published online ahead of print

The manuscript demonstrated several strengths.
The authors recognized the lack of published data on
motor control in concussion studies. They also found
that dual task assessment of concussion appeared to be

2014 Joshua Rothenberg. All Rights Reserved.

NFP

Review Journal
A Non-Profit Organization

Sample 3

the most sensitive testing done in the past. Thus, they

combined the two, and used the dual task model to
Concussion remains a heavily debated topic surrounding
our young adult and adolescent populations. David Howell include motor control, via gait analysis, while performing
the Stroop test. They were able to do so while having age,
et al. completed a level 2 prospective longitudinal cohort
study on dual task gait analysis, in which he hypothesized mass, and height-matched controls participate.

Weaknesses were also evident in the study. The
that adolescents may need more time for recovery
total N of the study was 38, and in future studies, a
than their young adult counterparts after sustaining a
greater power would be beneficial to corroborate results.
concussion. His research was predicated on looking at
gait stability while performing the Stroop test, a secondary Also, the adolescent group had 17 males and only 2
females, while the disparity between sexes among young
task that has been shown to engage executive function,
adults was not evident. We still do not know if there
namely conflict resolution.
are true differences in rate and recovery of concussion

The adolescent and young adult groups were
amongst the two sexes, but this may have played a role in
selected using a single concussion definition published
the results. Also noteworthy was that the management
by McCrory. The testing was performed at 72 hours, 1
of the concussed subjects was done independently of the
week, 2 weeks, 1 month, and 2 months post-concussion.
Matched controls were selected by age, height, sex, mass, study, thus, some adolescents and/or young adults may
have received medication and therapies that could have
and activity participation. They completed the same
testing at the same time periods. Both groups underwent affected their testing. Lastly, different certified athletic
trainers and physicians selected the concussed participants,
gait analysis, in which body motion analysis was
conducted using a 10-camera motion analysis system. The which ultimately may have led to a selection bias.
gait analysis was done while performing the Stroop test,
which was listening to the words high or low spoken
in a high or low pitch, and determining which pitch
the word was spoken in. Center of mass (COM) position
data was then calculated using the weighted sum of body
segments.

Statistically significant results were primarily
noted in the adolescent group. Concussed adolescents
demonstrated larger peak COM medial-lateral velocity
(p=0.001) and greater COM medial-lateral displacement
(p=0.001) at 72 hours. They also demonstrated greater
total medial-lateral COM displacement (p=0.001) over
the entire 2 months. The concussed young adults only
demonstrated statistical significance for less peak COM
anterior velocity (p=0.01) at 72 hours. Thus, the authors
suggest that that post concussive injuries may need to be
managed more cautiously in the adolescent age group.

Although weaknesses exist, the conclusions
deduced by the authors are appropriately reflected in their
data. The methods and statistics used were appropriate,
and demonstrate a well thought out study. After careful
review, the findings prove to be valid. The take home
point of this article that I will take into my practice is
to allow a longer time period to elapse in the concussed
adolescent population before consideration of resuming
activities. These conclusions were formed on the basis that
this study confirms the presence of motor control issues
in adolescents 2 months post-concussion. Future studies
corroborating or denying this manuscript are warranted to
lead to more discussion and effective decisions regarding
these populations.
Joshua Rothenberg, DO reviewing David Howell et al. Am J
Sports Med 2014; 43(1) published online ahead of print

The manuscript demonstrated several strengths.
The authors recognized the lack of published data on
motor control in concussion studies. They also found
that dual task assessment of concussion appeared to be

2014 Joshua Rothenberg. All Rights Reserved.

NFP

Review Journal
A Non-Profit Organization

Sample 4

the most sensitive testing done in the past. Thus, they

combined the two, and used the dual task model to
Concussion remains a heavily debated topic surrounding
our young adult and adolescent populations. David Howell include motor control, via gait analysis, while performing
the Stroop test. They were able to do so while having age,
et al. completed a level 2 prospective longitudinal cohort
study on dual task gait analysis, in which he hypothesized mass, and height-matched controls participate.

Weaknesses were also evident in the study. The
that adolescents may need more time for recovery
total N of the study was 38, and in future studies, a
than their young adult counterparts after sustaining a
greater power would be beneficial to corroborate results.
concussion. His research was predicated on looking at
gait stability while performing the Stroop test, a secondary Also, the adolescent group had 17 males and only 2
females, while the disparity between sexes among young
task that has been shown to engage executive function,
adults was not evident. We still do not know if there
namely conflict resolution.
are true differences in rate and recovery of concussion

The adolescent and young adult groups were
amongst the two sexes, but this may have played a role in
selected using a single concussion definition published
the results. Also noteworthy was that the management
by McCrory. The testing was performed at 72 hours, 1
of the concussed subjects was done independently of the
week, 2 weeks, 1 month, and 2 months post-concussion.
Matched controls were selected by age, height, sex, mass, study, thus, some adolescents and/or young adults may
have received medication and therapies that could have
and activity participation. They completed the same
testing at the same time periods. Both groups underwent affected their testing. Lastly, different certified athletic
trainers and physicians selected the concussed participants,
gait analysis, in which body motion analysis was
conducted using a 10-camera motion analysis system. The which ultimately may have led to a selection bias.
gait analysis was done while performing the Stroop test,
which was listening to the words high or low spoken
in a high or low pitch, and determining which pitch
the word was spoken in. Center of mass (COM) position
data was then calculated using the weighted sum of body
segments.

Statistically significant results were primarily
noted in the adolescent group. Concussed adolescents
demonstrated larger peak COM medial-lateral velocity
(p=0.001) and greater COM medial-lateral displacement
(p=0.001) at 72 hours. They also demonstrated greater
total medial-lateral COM displacement (p=0.001) over
the entire 2 months. The concussed young adults only
demonstrated statistical significance for less peak COM
anterior velocity (p=0.01) at 72 hours. Thus, the authors
suggest that that post concussive injuries may need to be
managed more cautiously in the adolescent age group.

Although weaknesses exist, the conclusions
deduced by the authors are appropriately reflected in their
data. The methods and statistics used were appropriate,
and demonstrate a well thought out study. After careful
review, the findings prove to be valid. The take home
point of this article that I will take into my practice is
to allow a longer time period to elapse in the concussed
adolescent population before consideration of resuming
activities. These conclusions were formed on the basis that
this study confirms the presence of motor control issues
in adolescents 2 months post-concussion. Future studies
corroborating or denying this manuscript are warranted to
lead to more discussion and effective decisions regarding
these populations.
Joshua Rothenberg, DO reviewing David Howell et al. Am J
Sports Med 2014; 43(1) published online ahead of print

The manuscript demonstrated several strengths.
The authors recognized the lack of published data on
motor control in concussion studies. They also found
that dual task assessment of concussion appeared to be

2014 Joshua Rothenberg. All Rights Reserved.

NFP

Review Journal
A Non-Profit Organization

Sample 5

the most sensitive testing done in the past. Thus, they

combined the two, and used the dual task model to
Concussion remains a heavily debated topic surrounding
our young adult and adolescent populations. David Howell include motor control, via gait analysis, while performing
the Stroop test. They were able to do so while having age,
et al. completed a level 2 prospective longitudinal cohort
study on dual task gait analysis, in which he hypothesized mass, and height-matched controls participate.

Weaknesses were also evident in the study. The
that adolescents may need more time for recovery
total N of the study was 38, and in future studies, a
than their young adult counterparts after sustaining a
greater power would be beneficial to corroborate results.
concussion. His research was predicated on looking at
gait stability while performing the Stroop test, a secondary Also, the adolescent group had 17 males and only 2
females, while the disparity between sexes among young
task that has been shown to engage executive function,
adults was not evident. We still do not know if there
namely conflict resolution.
are true differences in rate and recovery of concussion

The adolescent and young adult groups were
amongst the two sexes, but this may have played a role in
selected using a single concussion definition published
the results. Also noteworthy was that the management
by McCrory. The testing was performed at 72 hours, 1
of the concussed subjects was done independently of the
week, 2 weeks, 1 month, and 2 months post-concussion.
Matched controls were selected by age, height, sex, mass, study, thus, some adolescents and/or young adults may
have received medication and therapies that could have
and activity participation. They completed the same
testing at the same time periods. Both groups underwent affected their testing. Lastly, different certified athletic
trainers and physicians selected the concussed participants,
gait analysis, in which body motion analysis was
conducted using a 10-camera motion analysis system. The which ultimately may have led to a selection bias.
gait analysis was done while performing the Stroop test,
which was listening to the words high or low spoken
in a high or low pitch, and determining which pitch
the word was spoken in. Center of mass (COM) position
data was then calculated using the weighted sum of body
segments.

Statistically significant results were primarily
noted in the adolescent group. Concussed adolescents
demonstrated larger peak COM medial-lateral velocity
(p=0.001) and greater COM medial-lateral displacement
(p=0.001) at 72 hours. They also demonstrated greater
total medial-lateral COM displacement (p=0.001) over
the entire 2 months. The concussed young adults only
demonstrated statistical significance for less peak COM
anterior velocity (p=0.01) at 72 hours. Thus, the authors
suggest that that post concussive injuries may need to be
managed more cautiously in the adolescent age group.

Although weaknesses exist, the conclusions
deduced by the authors are appropriately reflected in their
data. The methods and statistics used were appropriate,
and demonstrate a well thought out study. After careful
review, the findings prove to be valid. The take home
point of this article that I will take into my practice is
to allow a longer time period to elapse in the concussed
adolescent population before consideration of resuming
activities. These conclusions were formed on the basis that
this study confirms the presence of motor control issues
in adolescents 2 months post-concussion. Future studies
corroborating or denying this manuscript are warranted to
lead to more discussion and effective decisions regarding
these populations.
Joshua Rothenberg, DO reviewing David Howell et al. Am J
Sports Med 2014; 43(1) published online ahead of print

The manuscript demonstrated several strengths.
The authors recognized the lack of published data on
motor control in concussion studies. They also found
that dual task assessment of concussion appeared to be

2014 Joshua Rothenberg. All Rights Reserved.

NFP

Review Journal
A Non-Profit Organization

Sample 6

the most sensitive testing done in the past. Thus, they

combined the two, and used the dual task model to
Concussion remains a heavily debated topic surrounding
our young adult and adolescent populations. David Howell include motor control, via gait analysis, while performing
the Stroop test. They were able to do so while having age,
et al. completed a level 2 prospective longitudinal cohort
study on dual task gait analysis, in which he hypothesized mass, and height-matched controls participate.

Weaknesses were also evident in the study. The
that adolescents may need more time for recovery
total N of the study was 38, and in future studies, a
than their young adult counterparts after sustaining a
greater power would be beneficial to corroborate results.
concussion. His research was predicated on looking at
gait stability while performing the Stroop test, a secondary Also, the adolescent group had 17 males and only 2
females, while the disparity between sexes among young
task that has been shown to engage executive function,
adults was not evident. We still do not know if there
namely conflict resolution.
are true differences in rate and recovery of concussion

The adolescent and young adult groups were
amongst the two sexes, but this may have played a role in
selected using a single concussion definition published
the results. Also noteworthy was that the management
by McCrory. The testing was performed at 72 hours, 1
of the concussed subjects was done independently of the
week, 2 weeks, 1 month, and 2 months post-concussion.
Matched controls were selected by age, height, sex, mass, study, thus, some adolescents and/or young adults may
have received medication and therapies that could have
and activity participation. They completed the same
testing at the same time periods. Both groups underwent affected their testing. Lastly, different certified athletic
trainers and physicians selected the concussed participants,
gait analysis, in which body motion analysis was
conducted using a 10-camera motion analysis system. The which ultimately may have led to a selection bias.
gait analysis was done while performing the Stroop test,
which was listening to the words high or low spoken
in a high or low pitch, and determining which pitch
the word was spoken in. Center of mass (COM) position
data was then calculated using the weighted sum of body
segments.

Statistically significant results were primarily
noted in the adolescent group. Concussed adolescents
demonstrated larger peak COM medial-lateral velocity
(p=0.001) and greater COM medial-lateral displacement
(p=0.001) at 72 hours. They also demonstrated greater
total medial-lateral COM displacement (p=0.001) over
the entire 2 months. The concussed young adults only
demonstrated statistical significance for less peak COM
anterior velocity (p=0.01) at 72 hours. Thus, the authors
suggest that that post concussive injuries may need to be
managed more cautiously in the adolescent age group.

Although weaknesses exist, the conclusions
deduced by the authors are appropriately reflected in their
data. The methods and statistics used were appropriate,
and demonstrate a well thought out study. After careful
review, the findings prove to be valid. The take home
point of this article that I will take into my practice is
to allow a longer time period to elapse in the concussed
adolescent population before consideration of resuming
activities. These conclusions were formed on the basis that
this study confirms the presence of motor control issues
in adolescents 2 months post-concussion. Future studies
corroborating or denying this manuscript are warranted to
lead to more discussion and effective decisions regarding
these populations.
Joshua Rothenberg, DO reviewing David Howell et al. Am J
Sports Med 2014; 43(1) published online ahead of print

The manuscript demonstrated several strengths.
The authors recognized the lack of published data on
motor control in concussion studies. They also found
that dual task assessment of concussion appeared to be

2014 Joshua Rothenberg. All Rights Reserved.

NFP

Review Journal
A Non-Profit Organization

Sample 7

the most sensitive testing done in the past. Thus, they

combined the two, and used the dual task model to
Concussion remains a heavily debated topic surrounding
our young adult and adolescent populations. David Howell include motor control, via gait analysis, while performing
the Stroop test. They were able to do so while having age,
et al. completed a level 2 prospective longitudinal cohort
study on dual task gait analysis, in which he hypothesized mass, and height-matched controls participate.

Weaknesses were also evident in the study. The
that adolescents may need more time for recovery
total N of the study was 38, and in future studies, a
than their young adult counterparts after sustaining a
greater power would be beneficial to corroborate results.
concussion. His research was predicated on looking at
gait stability while performing the Stroop test, a secondary Also, the adolescent group had 17 males and only 2
females, while the disparity between sexes among young
task that has been shown to engage executive function,
adults was not evident. We still do not know if there
namely conflict resolution.
are true differences in rate and recovery of concussion

The adolescent and young adult groups were
amongst the two sexes, but this may have played a role in
selected using a single concussion definition published
the results. Also noteworthy was that the management
by McCrory. The testing was performed at 72 hours, 1
of the concussed subjects was done independently of the
week, 2 weeks, 1 month, and 2 months post-concussion.
Matched controls were selected by age, height, sex, mass, study, thus, some adolescents and/or young adults may
have received medication and therapies that could have
and activity participation. They completed the same
testing at the same time periods. Both groups underwent affected their testing. Lastly, different certified athletic
trainers and physicians selected the concussed participants,
gait analysis, in which body motion analysis was
conducted using a 10-camera motion analysis system. The which ultimately may have led to a selection bias.
gait analysis was done while performing the Stroop test,
which was listening to the words high or low spoken
in a high or low pitch, and determining which pitch
the word was spoken in. Center of mass (COM) position
data was then calculated using the weighted sum of body
segments.

Statistically significant results were primarily
noted in the adolescent group. Concussed adolescents
demonstrated larger peak COM medial-lateral velocity
(p=0.001) and greater COM medial-lateral displacement
(p=0.001) at 72 hours. They also demonstrated greater
total medial-lateral COM displacement (p=0.001) over
the entire 2 months. The concussed young adults only
demonstrated statistical significance for less peak COM
anterior velocity (p=0.01) at 72 hours. Thus, the authors
suggest that that post concussive injuries may need to be
managed more cautiously in the adolescent age group.

Although weaknesses exist, the conclusions
deduced by the authors are appropriately reflected in their
data. The methods and statistics used were appropriate,
and demonstrate a well thought out study. After careful
review, the findings prove to be valid. The take home
point of this article that I will take into my practice is
to allow a longer time period to elapse in the concussed
adolescent population before consideration of resuming
activities. These conclusions were formed on the basis that
this study confirms the presence of motor control issues
in adolescents 2 months post-concussion. Future studies
corroborating or denying this manuscript are warranted to
lead to more discussion and effective decisions regarding
these populations.
Joshua Rothenberg, DO reviewing David Howell et al. Am J
Sports Med 2014; 43(1) published online ahead of print

The manuscript demonstrated several strengths.
The authors recognized the lack of published data on
motor control in concussion studies. They also found
that dual task assessment of concussion appeared to be

10

2014 Joshua Rothenberg. All Rights Reserved.

NFP

Review Journal
A Non-Profit Organization

Sample 8

the most sensitive testing done in the past. Thus, they

combined the two, and used the dual task model to
Concussion remains a heavily debated topic surrounding
our young adult and adolescent populations. David Howell include motor control, via gait analysis, while performing
the Stroop test. They were able to do so while having age,
et al. completed a level 2 prospective longitudinal cohort
study on dual task gait analysis, in which he hypothesized mass, and height-matched controls participate.

Weaknesses were also evident in the study. The
that adolescents may need more time for recovery
total N of the study was 38, and in future studies, a
than their young adult counterparts after sustaining a
greater power would be beneficial to corroborate results.
concussion. His research was predicated on looking at
gait stability while performing the Stroop test, a secondary Also, the adolescent group had 17 males and only 2
females, while the disparity between sexes among young
task that has been shown to engage executive function,
adults was not evident. We still do not know if there
namely conflict resolution.
are true differences in rate and recovery of concussion

The adolescent and young adult groups were
amongst the two sexes, but this may have played a role in
selected using a single concussion definition published
the results. Also noteworthy was that the management
by McCrory. The testing was performed at 72 hours, 1
of the concussed subjects was done independently of the
week, 2 weeks, 1 month, and 2 months post-concussion.
Matched controls were selected by age, height, sex, mass, study, thus, some adolescents and/or young adults may
have received medication and therapies that could have
and activity participation. They completed the same
testing at the same time periods. Both groups underwent affected their testing. Lastly, different certified athletic
trainers and physicians selected the concussed participants,
gait analysis, in which body motion analysis was
conducted using a 10-camera motion analysis system. The which ultimately may have led to a selection bias.
gait analysis was done while performing the Stroop test,
which was listening to the words high or low spoken
in a high or low pitch, and determining which pitch
the word was spoken in. Center of mass (COM) position
data was then calculated using the weighted sum of body
segments.

Statistically significant results were primarily
noted in the adolescent group. Concussed adolescents
demonstrated larger peak COM medial-lateral velocity
(p=0.001) and greater COM medial-lateral displacement
(p=0.001) at 72 hours. They also demonstrated greater
total medial-lateral COM displacement (p=0.001) over
the entire 2 months. The concussed young adults only
demonstrated statistical significance for less peak COM
anterior velocity (p=0.01) at 72 hours. Thus, the authors
suggest that that post concussive injuries may need to be
managed more cautiously in the adolescent age group.

Although weaknesses exist, the conclusions
deduced by the authors are appropriately reflected in their
data. The methods and statistics used were appropriate,
and demonstrate a well thought out study. After careful
review, the findings prove to be valid. The take home
point of this article that I will take into my practice is
to allow a longer time period to elapse in the concussed
adolescent population before consideration of resuming
activities. These conclusions were formed on the basis that
this study confirms the presence of motor control issues
in adolescents 2 months post-concussion. Future studies
corroborating or denying this manuscript are warranted to
lead to more discussion and effective decisions regarding
these populations.
Joshua Rothenberg, DO reviewing David Howell et al. Am J
Sports Med 2014; 43(1) published online ahead of print

The manuscript demonstrated several strengths.
The authors recognized the lack of published data on
motor control in concussion studies. They also found
that dual task assessment of concussion appeared to be

2014 Joshua Rothenberg. All Rights Reserved.

11

About the Journal:

Sports Review Journal is a bimonthly publication produced and edited by Fellowship Trained Sports
Medicine Physicians which include backgrounds in Physical Medicine and Rehabilitation, Orthopedic
Surgery, Pediatrics, Emergency Medicine, and Family Medicine. The reviews and summaries included
in the publication are intended solely for the education of medical professionals as assistance in reviewing
the large volume of literature that exists in the sports medicine field. The summaries are not to be used
as the basis of clinical diagnosis, management, side effects, or complications, and are not a substitute
for analyzing the original research. Reviews may include subjective components, and are not entirely
objective, thus, it remains noteworthy to refer to the original research in the journal cited. All journal
reviews and summaries will include citation to the journal with the original research. Publication and
funding is provided by the publisher himself.

NFP

2014 Joshua Rothenberg. All Rights Reserved.