{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T20:00:22Z","timestamp":1772568022554,"version":"3.50.1"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,23]],"date-time":"2022-06-23T00:00:00Z","timestamp":1655942400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R00AG056670"],"award-info":[{"award-number":["R00AG056670"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["U2C060408"],"award-info":[{"award-number":["U2C060408"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:p>Concussion is a mild traumatic brain injury that is characterized by a wide range of physical, emotional, and cognitive symptoms as well as neurocognitive, vestibular, and ocular impairments that can negatively affect daily functioning and quality of life. Clinical consensus statements recommend a targeted, clinical profile-based approach for management and treatment. This approach requires that clinicians utilize information obtained via a clinical interview and a multi-domain assessment battery to identify clinical profile(s) (e.g., vestibular, mood\/anxiety, ocular, migraine, cognitive fatigue) and prescribe a corresponding treatment\/rehabilitation program. Despite this comprehensive approach, the clinical picture can be limited by the accuracy and specificity of patient reports (which often conflate timing and severity of symptomology), as well as frequency and duration of exposure to symptom exacerbating environments (e.g., busy hallways, sitting in the back seat of a car). Given that modern rehabilitation programs leverage the natural environment as a tool to promote recovery (e.g., expose-recover approach), accurate characterization of the patient clinical profile is essential to improving recovery outcomes. Ambulatory assessment methodology could greatly benefit concussion clinical care by providing a window into the symptoms and impairments experienced by patients over the course of their daily lives. Moreover, by evaluating the timing, onset, and severity of symptoms and impairments in response to changes in a patient's natural environment, ambulatory assessments can provide clinicians with a tool to confirm clinical profiles and gauge effectiveness of the rehabilitation program. In this perspective report, we review the motivations for utilizing ambulatory assessment methodology in concussion clinical care and report on data from a pilot project utilizing smart phone-based, ambulatory assessments to capture patient reports of symptom severity, environmental exposures, and performance-based assessments of cognition for 7 days following their initial evaluation.<\/jats:p>","DOI":"10.3389\/fdgth.2022.924965","type":"journal-article","created":{"date-parts":[[2022,6,23]],"date-time":"2022-06-23T07:59:28Z","timestamp":1655971168000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Ambulatory Assessment in Concussion Clinical Care and Rehabilitation"],"prefix":"10.3389","volume":"4","author":[{"given":"R. J.","family":"Elbin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa N.","family":"Womble","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel B.","family":"Elbich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Dollar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheri","family":"Fedor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan G.","family":"Hakun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,6,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1227\/01.NEU.0000200441.92742.46","article-title":"Examining concussion rates and return to play in high school football players wearing newer helmet technology: a three-year prospective cohort study","volume":"58","author":"Collins","year":"2006","journal-title":"Neurosurgery."},{"key":"B2","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1227\/NEU.0000000000001041","article-title":"Examining recovery trajectories after sport-related concussion with a multimodal clinical assessment approach","volume":"78","author":"Henry","year":"2016","journal-title":"Neurosurgery."},{"key":"B3","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1097\/HTR.0000000000000536","article-title":"Recovery following sport-related concussion: integrating pre- and postinjury factors into multidisciplinary care","volume":"34","author":"Kontos","year":"2019","journal-title":"J Head Trauma Rehabil."},{"key":"B4","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1080\/13854046.2011.647085","article-title":"The Miserable Minority following mild traumatic brain injury: who are they and do meta-analyses hide them?","volume":"26","author":"Rohling","year":"2012","journal-title":"Clin Neuropsychol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1044\/nnsld25.1.4","article-title":"Factors inflencing risk and recovery from sport-related concussion: reviewing the evidence","volume":"25","author":"Elbin","year":"2015","journal-title":"Persp Neurophysiol Neuro Speech Lang Dis."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1177\/0363546510392016","article-title":"Sensitivity and specificity of subacute computerized neurocognitive testing and symptom evaluation in predicting outcomes after sports-related concussion","volume":"39","author":"Lau","year":"2011","journal-title":"Am J Sports Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1136\/bjsports-2017-097878","article-title":"5th international conference on concussion in sport (Berlin)","volume":"51","author":"McCrory","year":"2017","journal-title":"Brit J Sports Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/B978-0-444-63954-7.00011-2","article-title":"Office-based concussion evaluation, diagnosis, management: pediatric","volume":"158","author":"Paquin","year":"2018","journal-title":"Handbook Clin Neurol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1227\/NEU.0000000000001447","article-title":"Statements of agreement from the targeted evaluation and active management (TEAM) approaches to treating concussion meeting held in pittsburgh, October 15-16, 2015","volume":"79","author":"Collins","year":"2016","journal-title":"Neurosurgery."},{"key":"B10","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1007\/s00167-013-2791-6","article-title":"A comprehensive, targeted approach to the clinical care of athletes following sport-related concussion","volume":"22","author":"Collins","year":"2014","journal-title":"Knee Surg Sports Traumatol Arthr."},{"key":"B11","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1093\/neuros\/nyz332","article-title":"Concussion guidelines step 2: evidence for subtype classification","volume":"86","author":"Lumba-Brown","year":"2020","journal-title":"Neurosurgery."},{"key":"B12","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1249\/JSR.0000000000000573","article-title":"Sport-related concussion clinical profiles: clinical characteristics, targeted treatments, preliminary evidence","volume":"18","author":"Kontos","year":"2019","journal-title":"Curr Sports Med Rep."},{"key":"B13","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1037\/spy0000098","article-title":"Anxiety and mood clinical profile following sport-related concussion: from risk factors to treatment","volume":"6","author":"Sandel","year":"2017","journal-title":"Sport Exerc Perform Psychol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/B978-0-444-63954-7.00010-0","article-title":"Office-based concussion evaluation, diagnosis, management: adult","volume":"158","author":"Charek","year":"2018","journal-title":"Handbook Clin Neurol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1212\/WNL.0000000000001700","article-title":"Early symptom burden predicts recovery after sport-related concussion","volume":"85","author":"Casson","year":"2015","journal-title":"Neurology."},{"key":"B16","doi-asserted-by":"publisher","first-page":"S61","DOI":"10.1097\/JSM.0000000000000581","article-title":"Do initial symptom factor scores predict subsequent impairment following concussion?","volume":"30","author":"Cohen","year":"2018","journal-title":"Clin J Sport Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e426","DOI":"10.1111\/apa.13486","article-title":"Initial somatic symptoms are associated with prolonged symptom duration following concussion in adolescents","volume":"105","author":"Howell","year":"2016","journal-title":"Acta Paediatrica."},{"key":"B18","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1016\/j.jpeds.2013.03.012","article-title":"Symptom severity predicts prolonged recovery after sport-related concussion, but age and amnesia do not","volume":"163","author":"Meehan","year":"2013","journal-title":"J Pediatr."},{"key":"B19","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1093\/neuros\/nyz545","article-title":"Concussion clinical profiles screening (CP Screen) tool: preliminary evidence to inform a multidisciplinary approach","volume":"87","author":"Kontos","year":"2020","journal-title":"Neurosurgery"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1856","DOI":"10.1212\/WNL.0000000000002679","article-title":"Preinjury somatization symptoms contribute to clinical recovery after sport-related concussion","volume":"86","author":"Nelson","year":"2016","journal-title":"Neurology."},{"key":"B21","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.jpeds.2016.03.020","article-title":"History of somatization is associated with prolonged recovery from concussion","volume":"174","author":"Root","year":"2016","journal-title":"J Pediatr."},{"key":"B22","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.socscimed.2015.04.011","article-title":"Concussion under-reporting and pressure from coaches, teammates, fans, and parents","volume":"134","author":"Kroshus","year":"2015","journal-title":"Soc Sci Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1542\/peds.2019-2317","article-title":"Parent-child agreement on postconcussion symptoms in the acute postinjury period","author":"Gagnon","year":"2020","journal-title":"Pediatrics."},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.31234\/osf.io\/ewzg7","author":"Hakun","year":"2021","journal-title":"Ultra-Brief Ambulatory Assessment of Working Memory Capacity Via Smart Phones"},{"key":"B25","volume-title":"The Warp and the Woof of the Developmental Fabric","author":"Nesselroade","year":"1991"},{"key":"B26","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1111\/j.1751-9004.2007.00043.x","article-title":"Measurement-burst designs for social health research","volume":"2","author":"Sliwinski","year":"2008","journal-title":"Soc Person Psychol Compass."},{"key":"B27","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1177\/1073191116643164","article-title":"Reliability and validity of ambulatory cognitive assessments","volume":"25","author":"Sliwinski","year":"2018","journal-title":"Assessment."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1146\/annurev.clinpsy.3.022806.091415","article-title":"Ecological momentary assessment","volume":"4","author":"Shiffman","year":"2008","journal-title":"Ann Rev Clin Psychol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1023\/A:1023657221954","article-title":"Ecological momentary assessment research in behavioral medicine","volume":"4","author":"Smyth","year":"2003","journal-title":"Ann Rev Clin Psychol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1037\/a0017074","article-title":"Ecological momentary assessment (EMA) in studies of substance use","volume":"21","author":"Shiffman","year":"2009","journal-title":"Psychol Assess."},{"key":"B31","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1037\/a0019802","article-title":"Intraindividual variability in reaction time predicts cognitive outcomes 5 years later","volume":"24","author":"Bielak","year":"2010","journal-title":"Neuropsychology."},{"key":"B32","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1037\/neu0000608","article-title":"Longitudinal changes in response time mean and inconsistency exhibit predictive dissociations for risk of cognitive impairment","volume":"34","author":"MacDonald","year":"2020","journal-title":"Neuropsychology."},{"key":"B33","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1093\/geronb\/gbx115","article-title":"A comprehensive comparison of quantifications of intraindividual variability in response times: a measurement burst approach","volume":"74","author":"Stawski","year":"2019","journal-title":"J Gerontol Series B Psychol Sci Soc Sci."},{"key":"B34","doi-asserted-by":"publisher","first-page":"758031","DOI":"10.3389\/fdgth.2021.758031","article-title":"Variability in cognitive performance on mobile devices is sensitive to mild cognitive impairment: results from the einstein aging study","volume":"3","author":"Cerino","year":"2021","journal-title":"Frontier Digital Health"},{"key":"B35","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1037\/0882-7974.19.2.243","article-title":"Modeling age and retest processes in longitudinal studies of cognitive abilities","volume":"19","author":"Ferrer","year":"2004","journal-title":"Psychol Aging."},{"key":"B36","doi-asserted-by":"publisher","first-page":"2175","DOI":"10.3758\/s13423-018-1461-6","article-title":"Retest effects in working memory capacity tests: a meta-analysis","volume":"25","author":"Scharfen","year":"2018","journal-title":"Psychon Bull Rev."},{"key":"B37","first-page":"37","article-title":"Modeling retest and aging effects in a measurement burst design","volume-title":"Individual Pathways of Change: Statistical Models for Analyzing Learning and Development","author":"Sliwinski","year":""},{"key":"B38","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1016\/j.acn.2006.06.002","article-title":"The california verbal learning test\u2013second edition: test-retest reliability, practice effects, and reliable change indices for the standard and alternate forms","volume":"21","author":"Woods","year":"2006","journal-title":"Arch Clin Neuropsychol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1037\/pag0000036","article-title":"Global perceived stress predicts cognitive change among older adults","volume":"30","author":"Munoz","year":"2015","journal-title":"Psychol Aging."},{"key":"B40","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1093\/geroni\/igaa057.1870","article-title":"Bayesian modeling of cognitive impairment in the presence of retest effects","volume":"4","author":"Oravecz","year":"2020","journal-title":"Innov Aging."},{"key":"B41","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1081\/13803390490918435","article-title":"Validity of ImPACT for measuring processing speed following sports-related concussion","volume":"27","author":"Iverson","year":"2005","journal-title":"J Clin Exp Neuropsychol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1097\/JSM.0b013e31819d6edb","article-title":"Neurocognitive and symptom predictors of recovery in high school athletes","volume":"19","author":"Lau","year":"2009","journal-title":"Clin J Sport Med."},{"key":"B43","doi-asserted-by":"publisher","first-page":"2311","DOI":"10.1177\/0363546511410655","article-title":"Which on-field signs\/symptoms predict protracted recovery from sport-related concussion among high school football players?","volume":"39","author":"Lau","year":"2011","journal-title":"Am J Sports Med."},{"key":"B44","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1227\/NEU.0b013e31823150f0","article-title":"Cutoff scores in neurocognitive testing and symptom clusters that predict protracted recovery from concussions in high school athletes","volume":"70","author":"Lau","year":"2012","journal-title":"Neurosurgery."},{"key":"B45","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1080\/21622965.2012.670580","article-title":"The relationship of symptoms and neurocognitive performance to perceived recovery from sports-related concussion among adolescent athletes","volume":"2","author":"Sandel","year":"2013","journal-title":"Appl Neuropsychol Child."},{"key":"B46","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1207\/s15324826an1303_4","article-title":"Measurement of symptoms following sports-related concussion: reliability and normative data for the post-concussion scale","volume":"13","author":"Lovell","year":"2006","journal-title":"Appl Neuropsychol."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.1177\/0363546513488751","article-title":"Posttraumatic migraine as a predictor of recovery and cognitive impairment after sport-related concussion","volume":"41","author":"Kontos","year":"2013","journal-title":"Am J Sports Med."},{"key":"B48","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1016\/j.pmr.2011.08.008","article-title":"School and the concussed youth: recommendations for concussion education and management","volume":"22","author":"Sady","year":"2011","journal-title":"Phys Med Rehabil Clin North Am."},{"key":"B49","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1097\/OPX.0000000000000977","article-title":"Academic difficulty and vision symptoms in children with concussion","volume":"94","author":"Swanson","year":"2017","journal-title":"Optometry Vision Sci."},{"key":"B50","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1249\/JSR.0000000000000008","article-title":"Use of graded exercise testing in concussion and return-to-activity management","volume":"12","author":"Leddy","year":"2013","journal-title":"Curr Sports Med Rep."},{"key":"B51","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1001\/jamapediatrics.2016.1187","article-title":"Activity-related symptom exacerbations after pediatric concussion","volume":"170","author":"Silverberg","year":"2016","journal-title":"JAMA Pediatr."},{"key":"B52","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1542\/peds.2014-0966","article-title":"Benefits of strict rest after acute concussion: a randomized controlled trial","volume":"135","author":"Thomas","year":"2015","journal-title":"Pediatrics."},{"key":"B53","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1542\/peds.2014-3434","article-title":"Academic effects of concussion in children and adolescents","volume":"135","author":"Ransom","year":"2015","journal-title":"Pediatrics."},{"key":"B54","doi-asserted-by":"publisher","first-page":"57","DOI":"10.3389\/fped.2020.00057","article-title":"Return to learn: academic effects of concussion in high school and college student-athletes","volume":"8","author":"Holmes","year":"2020","journal-title":"Front Pediatr."},{"key":"B55","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1016\/j.jemermed.2015.02.054","article-title":"Acute concussion management with remove-reduce\/educate\/adjust-accommodate\/pace (REAP)","volume":"50","author":"Kirelik","year":"2016","journal-title":"J Emerg Med."},{"key":"B56","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1097\/JSM.0b013e3181c6c22c","article-title":"A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome","volume":"20","author":"Leddy","year":"2010","journal-title":"Clin J Sport Med."},{"key":"B57","doi-asserted-by":"publisher","first-page":"256","DOI":"10.4085\/1062-6050-51.11.05","article-title":"Review of vestibular and oculomotor screening and concussion rehabilitation","volume":"52","author":"Kontos","year":"2017","journal-title":"J Athl Train."}],"container-title":["Frontiers in Digital Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2022.924965\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,23]],"date-time":"2022-06-23T07:59:34Z","timestamp":1655971174000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2022.924965\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,23]]},"references-count":57,"alternative-id":["10.3389\/fdgth.2022.924965"],"URL":"https:\/\/doi.org\/10.3389\/fdgth.2022.924965","relation":{},"ISSN":["2673-253X"],"issn-type":[{"value":"2673-253X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,23]]},"article-number":"924965"}}