{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T03:22:59Z","timestamp":1782271379562,"version":"3.54.5"},"reference-count":46,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"unspecified","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007323","name":"Bundesinstitut f\u00fcr Sportwissenschaft","doi-asserted-by":"publisher","award":["ZMVI4-070105\/19-20"],"award-info":[{"award-number":["ZMVI4-070105\/19-20"]}],"id":[{"id":"10.13039\/501100007323","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Heinz Nixdorf Westfalian Foundation"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Sport Exerc Med"],"accepted":{"date-parts":[[2025,6,2]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This cross-sectional study aimed to investigate subjective and objective deficits of neurocognitive function, balance and vestibulo-ocular performance in athletes with sport-related concussion (SRC) compared with healthy control athletes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>72 patients with SRC and 72 matched healthy controls were included. All participants performed computerised testing of neurocognitive function, device-assisted balance testing and objective evaluation of vestibulo-ocular function (video head impulse and dynamic visual acuity test). Clinical symptom clusters (headache\/migraine, anxiety\/mood, fatigue, cognitive, vestibular, ocular) were determined for each patient using the Sport Concussion Assessment Tool, 5th edition symptom evaluation. Independent t-tests or Mann-Whitney U tests were calculated to test for group differences in the whole cohort and according to clinical symptom clusters.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>When investigating the whole cohort, significant differences between patients with SRC and control subjects were found in one parameter of balance testing (sway velocity double-firm), with lower performance in the SRC group (p&lt;0.001, r=0.345). The number of symptom clusters assigned to the SRC patients ranged from 0 (no definite cluster) to 6 (all clusters), and all clusters were frequent in the investigated cohort. Patients with vestibular, cognitive and fatigue symptom clusters demonstrated significantly lower performance in balance testing compared with SRC patients without those clusters (p&lt;0.001\u2009to p=0.005, r=0.368\u20130.439). Additionally, SRC patients presenting with symptoms of the fatigue cluster demonstrated significantly worse performance in vestibulo-ocular testing compared with SRC patients without the fatigue cluster (p=0.006, d=0.781).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>SRC patients presented with variable numbers and qualities of clinical symptom clusters. Some subjective clusters were associated with abnormal objective tests of other clusters (vestibular, cognitive and fatigue with abnormal balance; and fatigue with abnormal vestibulo-ocular performance). Clinical symptom clusters and their overlap should be considered when examining patients with SRC.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjsem-2024-002447","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T07:50:30Z","timestamp":1754034630000},"page":"e002447","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical symptom clusters, neurocognitive function, balance and vestibulo-ocular function in athletes with sport-related concussion"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0302-2400","authenticated-orcid":false,"given":"Lea","family":"Weike","sequence":"first","affiliation":[{"name":"Institute of Sports Medicine, Department of Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Reeschke","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine, Department of Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus","family":"Reinsberger","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine, Department of Exercise & Health, Faculty of Science, Paderborn University, Paderborn, Germany"},{"name":"Division of Sports Neurology & Neurosciences, Department of Neurology, Mass General Brigham, Boston, Massachusetts, USA"},{"name":"Sport Concussion Program, Mass General Brigham, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"2025083110583303000_11.3.e002447.1","doi-asserted-by":"publisher","DOI":"10.1097\/00001199-200609000-00001"},{"key":"2025083110583303000_11.3.e002447.2","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000720"},{"key":"2025083110583303000_11.3.e002447.3","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2023-106898"},{"key":"2025083110583303000_11.3.e002447.4","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-097403"},{"key":"2025083110583303000_11.3.e002447.5","doi-asserted-by":"crossref","first-page":"3604","DOI":"10.1177\/03635465221142855","article-title":"Sports-Related Concussion Affects Cognitive Function in Adolescents: A Systematic Review and Meta-analysis","volume":"51","author":"Hou","year":"2023","journal-title":"Am J Sports Med"},{"key":"2025083110583303000_11.3.e002447.6","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-020-01281-0"},{"key":"2025083110583303000_11.3.e002447.7","doi-asserted-by":"publisher","DOI":"10.3109\/02699052.2014.965206"},{"key":"2025083110583303000_11.3.e002447.8","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1007\/s40279-020-01409-2","article-title":"Vestibular and Ocular\/Oculomotor Assessment Strategies and Outcomes Following Sports-Related Concussion: A Scoping Review","volume":"51","author":"Quintana","year":"2021","journal-title":"Sports Med"},{"key":"2025083110583303000_11.3.e002447.9","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1249\/JSR.0000000000000573","article-title":"Sport-related Concussion Clinical Profiles: Clinical Characteristics, Targeted Treatments, and Preliminary Evidence","volume":"18","author":"Kontos","year":"2019","journal-title":"Curr Sports Med Rep"},{"key":"2025083110583303000_11.3.e002447.10","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-013-2791-6"},{"key":"2025083110583303000_11.3.e002447.11","doi-asserted-by":"crossref","first-page":"2996","DOI":"10.1177\/03635465231189211","article-title":"Association Between Symptom Cluster Endorsement at Initiation of a Graduated Return-to-Activity Protocol and Time to Return to Unrestricted Activity After Concussion in United States Service Academy Cadets","volume":"51","author":"Aderman","year":"2023","journal-title":"Am J Sports Med"},{"key":"2025083110583303000_11.3.e002447.12","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000629"},{"key":"2025083110583303000_11.3.e002447.13","doi-asserted-by":"publisher","DOI":"10.1111\/apa.13486"},{"key":"2025083110583303000_11.3.e002447.14","doi-asserted-by":"crossref","DOI":"10.1177\/23259671231163581","article-title":"Primary and Secondary Risk Factors Associated With Concussion Symptom Clusters in Collegiate Athletes: Results From the NCAA-DoD Grand Alliance CARE Consortium","volume":"11","author":"Nolan","year":"2023","journal-title":"Orthop J Sports Med"},{"key":"2025083110583303000_11.3.e002447.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2025083110583303000_11.3.e002447.16","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-097506"},{"key":"2025083110583303000_11.3.e002447.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.acn.2006.05.007"},{"key":"2025083110583303000_11.3.e002447.18","article-title":"A computerized test battery sensitive to mild and severe brain injury","volume":"10","author":"Gualtieri","year":"2008","journal-title":"Medscape J Med"},{"key":"2025083110583303000_11.3.e002447.19","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1123\/jsr.2016-0163","article-title":"Test-Retest Reliability and Practice Effects of the Stability Evaluation Test","volume":"26","author":"Williams","year":"2017","journal-title":"J Sport Rehabil"},{"key":"2025083110583303000_11.3.e002447.20","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0b013e31828d676d"},{"key":"2025083110583303000_11.3.e002447.21","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181bacf85"},{"key":"2025083110583303000_11.3.e002447.22","doi-asserted-by":"crossref","first-page":"33","DOI":"10.5152\/iao.2023.21387","article-title":"Test-Retest Reliability, Effects of Age and Comparison of Horizontal 2 Semicircular Canals Gain Values between Head Impulse and Suppression Head Impulse Paradigms","volume":"19","author":"Sayed","year":"2023","journal-title":"J Int Adv Otol"},{"key":"2025083110583303000_11.3.e002447.23","doi-asserted-by":"crossref","first-page":"744","DOI":"10.3766\/jaaa.17080","article-title":"Test-Retest Reliability of Video Head Impulse Test in Healthy Individuals and Individuals with Dizziness","volume":"30","author":"Singh","year":"2019","journal-title":"J Am Acad Audiol"},{"key":"2025083110583303000_11.3.e002447.24","first-page":"790","article-title":"Computerized dynamic visual acuity test in the assessment of vestibular deficits","volume":"19","author":"Herdman","year":"1998","journal-title":"Am J Otol"},{"key":"2025083110583303000_11.3.e002447.25","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.ptsp.2013.10.002","article-title":"Test-retest reliability and responsiveness of gaze stability and dynamic visual acuity in high school and college football players","volume":"15","author":"Kaufman","year":"2014","journal-title":"Phys Ther Sport"},{"key":"2025083110583303000_11.3.e002447.26","unstructured":"Cohen J . Statistical power analysis for the behavioral sciences. 2nd edn. Hillsdale, NJ: Lawrence Erlbaum Associates, 1988."},{"key":"2025083110583303000_11.3.e002447.27","first-page":"263","article-title":"Postural Stability and Neuropsychological Deficits After Concussion in Collegiate Athletes","volume":"36","author":"Guskiewicz","year":"2001","journal-title":"J Athl Train"},{"key":"2025083110583303000_11.3.e002447.28","first-page":"19","article-title":"Effects of mild head injury on postural stability as measured through clinical balance testing","volume":"35","author":"Riemann","year":"2000","journal-title":"J Athl Train"},{"key":"2025083110583303000_11.3.e002447.29","doi-asserted-by":"publisher","DOI":"10.1001\/jama.290.19.2556"},{"key":"2025083110583303000_11.3.e002447.30","doi-asserted-by":"publisher","DOI":"10.1097\/00042752-200307000-00006"},{"key":"2025083110583303000_11.3.e002447.31","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1089\/neu.2014.3356","article-title":"Neurocognition in the emergency department after a mild traumatic brain injury in youth","volume":"31","author":"Brooks","year":"2014","journal-title":"J Neurotrauma"},{"key":"2025083110583303000_11.3.e002447.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2008.10.015"},{"key":"2025083110583303000_11.3.e002447.33","doi-asserted-by":"publisher","DOI":"10.1177\/1941738119865262"},{"key":"2025083110583303000_11.3.e002447.34","doi-asserted-by":"crossref","first-page":"439","DOI":"10.3233\/VES-160598","article-title":"The usefulness of the video head impulse test in children and adults post-concussion","volume":"26","author":"Alshehri","year":"2016","journal-title":"J Vestib Res"},{"key":"2025083110583303000_11.3.e002447.35","doi-asserted-by":"crossref","first-page":"974","DOI":"10.2519\/jospt.2018.8258","article-title":"Changes in Measures of Cervical Spine Function, Vestibulo-ocular Reflex, Dynamic Balance, and Divided Attention Following Sport-Related Concussion in Elite Youth Ice Hockey Players","volume":"48","author":"Schneider","year":"2018","journal-title":"J Orthop Sports Phys Ther"},{"key":"2025083110583303000_11.3.e002447.36","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200310000-00016"},{"key":"2025083110583303000_11.3.e002447.37","doi-asserted-by":"publisher","DOI":"10.1177\/0194599815576720"},{"key":"2025083110583303000_11.3.e002447.38","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1089\/neu.2021.0447","article-title":"Post-Concussive Vestibular Dysfunction Is Related to Injury to the Inferior Vestibular Nerve","volume":"39","author":"Gard","year":"2022","journal-title":"J Neurotrauma"},{"key":"2025083110583303000_11.3.e002447.39","doi-asserted-by":"publisher","DOI":"10.1016\/j.gaitpost.2012.10.015"},{"key":"2025083110583303000_11.3.e002447.40","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.parkreldis.2019.06.014","article-title":"Cognitive associations with comprehensive gait and static balance measures in Parkinson\u2019s disease","volume":"69","author":"Morris","year":"2019","journal-title":"Parkinsonism Relat Disord"},{"key":"2025083110583303000_11.3.e002447.41","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.neuchi.2021.01.002","article-title":"Vestibular-ocular reflex dysfunction following mild traumatic brain injury: A narrative review","volume":"67","author":"Crampton","year":"2021","journal-title":"Neurochirurgie"},{"key":"2025083110583303000_11.3.e002447.42","doi-asserted-by":"crossref","unstructured":"Cochrane GD , Christy JB , Motl RW . Central Vestibular Functions Correlate With Fatigue and Walking Capacity in People With Multiple Sclerosis. Phys Ther 2021;101. doi:10.1093\/ptj\/pzab168","DOI":"10.1093\/ptj\/pzab168"},{"key":"2025083110583303000_11.3.e002447.43","first-page":"172","article-title":"Postural performance and strategy in the unipedal stance of soccer players at different levels of competition","volume":"41","author":"Paillard","year":"2006","journal-title":"J Athl Train"},{"key":"2025083110583303000_11.3.e002447.44","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0144580","article-title":"Cognitive Functions in Elite and Sub-Elite Youth Soccer Players Aged 13 to 17 Years","volume":"10","author":"Huijgen","year":"2015","journal-title":"PLoS One"},{"key":"2025083110583303000_11.3.e002447.45","doi-asserted-by":"crossref","DOI":"10.1177\/2325967118817515","article-title":"Influence of Self-reported Fatigue and Sex on Baseline Concussion Assessment Scores","volume":"7","author":"Combs","year":"2019","journal-title":"Orthop J Sports Med"},{"key":"2025083110583303000_11.3.e002447.46","doi-asserted-by":"crossref","first-page":"77","DOI":"10.4085\/1062-6050-51.12.21","article-title":"Concussion Baseline Testing: Preexisting Factors, Symptoms, and Neurocognitive Performance","volume":"52","author":"Cottle","year":"2017","journal-title":"J Athl Train"}],"container-title":["BMJ Open Sport &amp; Exercise Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsem-2024-002447","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:58:47Z","timestamp":1756663127000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopensem.bmj.com\/lookup\/doi\/10.1136\/bmjsem-2024-002447"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,31]]},"references-count":46,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,7,31]]},"published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1136\/bmjsem-2024-002447"],"URL":"https:\/\/doi.org\/10.1136\/bmjsem-2024-002447","relation":{},"ISSN":["2055-7647"],"issn-type":[{"value":"2055-7647","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,31]]}}}