COVID has changed almost all aspects of our lives. For kids, one area that has been changed, is returning to sports participation. Please read below to find out how we determine when and if a child is safe to return to these activities. Though in most scenarios, we cannot change school requirements, we can feel empowered to help our kids use screens with certain guidelines. We are all for healthy, active engagement, but it is of great service to look at the risk factors and reduce them.
Start by driving short distances and avoid rush hour or driving in bad weather if you can. If you are unable to drive, talk to your doctor or health care provider about other transportation options in your community. Your doctor will tell you if they are worried about your driving or if you have a medical condition that can make it unsafe to drive.
They will also tell the Ministry of Transportation because it is the law. They will also tell you what you need to do to get your license back.
In some cases, you might get referred to a special driving centre for an assessment of your driving ability. Some people find that flying makes their symptoms worse. To prevent problems, make sure you are well rested before going on a plane and sleep during the flight if you can.
Not all submitted comments are published. Please see our commenting policy for details. Question Is flying soon after concussion associated with longer recovery or greater symptoms? Findings This cohort study found no association between flying and worsened recovery or symptoms after concussion. Meaning These findings may provide reassurance to athletic trainers, clinicians, patients, and coaches on the safety of air travel for collegiate athletes and military cadets after concussion.
Importance Concussions are a common occurrence in young athletes. Hypobaric hypoxemia, such as that experienced during airplane travel, can potentially cause alterations to cerebral blood flow and increased neuroinflammatory response.
It remains unknown whether flying early after a concussion may influence the clinical course of injury. Objective To determine whether there is an association between concussion recovery and airplane travel in collegiate athletes and military cadets. Participant groups were categorized by those who flew within 72 hours of injury and those who did not fly.
All participants included in the final analyses had complete data of interest and only 1 injury during the study. Data analysis was performed from September to March Main Outcomes and Measures Recovery outcome measures were defined as time in days from injury to return to activity, school, and baseline symptoms. Scores for both groups were taken at baseline and a median of 2 days after injury. Results A total of 92 participants who flew mean [SD] age, Similarly, participants who flew mean [SD] age, No significant group differences were found regarding recovery outcome measures.
Likewise, there were no group differences in symptom estimated mean difference, 0. Conclusions and Relevance Airplane travel early after concussion was not associated with recovery or severity of concussion symptoms. These findings may help guide future recommendations on flight travel after concussion in athletes. Concussion, a form of mild traumatic brain injury TBI , is a neurological disturbance following a biomechanical force to the brain and is characterized by a constellation of symptoms including but not limited to headache, dizziness, fatigue, irritability, insomnia, and difficulty with concentration and memory.
Some of these stressors include sleep deprivation, pharmaceuticals, psychiatric disorders eg, anxiety or depression , and dehydration. Air travel is common among athletes participating in major competitions.
Cabin altitude of a pressurized aircraft is maintained at to m feet , which equals an inspired oxygen pressure of to mm Hg compared with mm Hg at sea level. Therefore, passengers traveling on flights can be exposed to reduced oxygen pressure for many hours. Studies done in animal models suggest that exposure to aeromedical evacuation at a simulated altitude of to ft m after mild TBI is associated with decreased arterial oxygen saturation and increased cerebral cytokine expression.
To our knowledge, there are no clinical studies evaluating the effects of airplane travel focused on concussion recovery and severity of symptoms. In this study, we evaluated the effect of airplane travel on postconcussion symptom severity and time to recovery in a large cohort of National Collegiate Athletic Association NCAA athletes and military cadets.
We hypothesized that flying would exacerbate concussion symptoms and prolong recovery. Knowledge regarding this topic is critical for the development of evidence-based clinical practice recommendations following concussion. All study procedures were reviewed and approved by the University of Michigan institutional review board, the US Army Medical Research and Materiel Command Human Research Protection Office, and the local institutional review board at each of the performance sites.
Participants provided written informed consent before participation. This study analyzed data from a prospective observational cohort obtained from the Concussion Assessment, Research, and Education Consortium database. The data set provided for this study included only the NCAA athletes and military service academy cadets who experienced a concussion from August 3, , to September 13, We combined both military cadets and NCAA athletes because both groups have high incidence of concussion and share similar physical and demographic characteristics.
We only included participants who flew within 72 hours of injury to capture participants who flew soon after injury without substantially decreasing our sample size.
This was also a time point used in some animal studies of simulated aeromedical evacuation. Participants were excluded if they had missing data of interest and more than 1 injury during the study eFigure 1 and eFigure 2 in the Supplement.
Two separate cohorts were created for each analysis, symptom recovery analysis 1 and symptom severity analysis 2 , to include more participants who flew with complete demographic and injury information. Demographic variables chosen are factors associated with prolonged concussion recovery and, thus, are potential confounders if they are not comparable between groups. These include age, 23 , 24 sex, 25 - 28 sport type, 29 concussion history, 30 - 32 preexisting nonmigraine and migraine headaches, 33 , 34 and depression.
Delayed reporting of symptoms was recorded as the time between the onset of postconcussive symptoms and the time these symptoms were reported to medical staff. We also compared demographic and injury characteristics between each analysis group and the original population to confirm that groups were similar and selection bias was minimal.
All site personnel were trained on a standardized protocol for baseline testing and postinjury assessments before data collection and participant written informed consent were obtained. The Concussion Assessment, Research, and Education data set includes a broad range of demographic, injury, and outcome variables.
We selected variables that have been previously used in published studies and were collected on the greatest number of participants. These included number of days after injury until starting a graded return to play protocol RTP start , returning to learn in full school RTL , and symptom resolution SR. SR was defined as the number of days after the injury when concussion-related symptoms returned to the preinjury state ie, baseline symptom severity on Sport Concussion Assessment Tool—Third Edition [SCAT3].
Information for total symptom and headache severity secondary to concussion was derived from the SCAT3. Clinical assessments included measures of concussion symptoms SCAT3. For participants who flew, we analyzed postinjury SCAT3 symptom and headache severity scores taken after flight.
For t tests, degrees of freedom were corrected when the Levene test indicated inequality of variance between groups. Medians and interquartile ranges IQRs were reported for days after injury until SCAT3 evaluation, time from injury to flight, and duration of flight given the skewed distribution of the data.
Analyses used the general linear model, which incorporates both continuous and discrete variables, to assess the effect of airplane travel on selected outcome measures together with covariates see the eAppendix in the Supplement for statistical software commands and outputs.
Because not reporting a concussion immediately after injury has been associated with longer symptom recovery, we adjusted for delayed symptom reporting as described already in the Participant subsection of the Methods.
All outcome variables and covariates were logarithmically transformed given the nonnormal distribution of the data, and 0.
Tukey honestly significantly different test was used post hoc to determine estimated mean difference between groups. An analysis of variance was used to determine whether there was an association between the number of time zones crossed ie, 0, 1, 2, 3, or 4 and logarithmically transformed symptom recovery and severity variables.
This is important because crossing multiple time zones may result in sleep deprivation, fatigue, and mood issues, which can potentially worsen concussion symptoms and prolong recovery. To control for sex, sport type, and overrepresentation of football players in the concussed cohort participants [ A total of 92 participants who flew mean [SD] age, Analyzed cohorts were similar to the original population except for number of days after injury concussion symptoms were reported late and percentage of non-NCAA level athletes eTable 2 in the Supplement.
Groups flew vs did not fly were similar, with no significant differences in demographic variables except for history of depression and percentage of non-NCAA athletes Table 1. For NCAA level athletes, numbers of participants for each sport category and type are presented in eTable 1 in the Supplement.
The median IQR time from injury to flight was 12 hours. The median IQR flight time was 2 1. Frequency distributions of logarithmically transformed symptom recovery and symptom and headache severity outcome variables at postinjury and baseline time points were conducted and are presented in eFigure 3 and eFigure 4 in the Supplement.
Participants who recovered shortly after injury were documented as 0 days and thus presented as negative log values eFigure 3 in the Supplement. There was no significant difference between groups in terms of RTP start flew vs did not fly estimated mean difference, —0. There was no significant difference between groups in terms of symptom severity flew vs did not fly estimated mean difference, 0.
There was no association between time zones crossed and symptom recovery variables or symptom and headache severity scores Table 2 and eFigure 5 in the Supplement. When looking at football players only, the group of participants who flew were similar to the group of participants who did not fly, showing no significant difference in demographic variables see Table 3 for demographic characteristics, group sizes, and comparison. There were no significant differences between groups in RTP start flew vs did not fly estimated mean difference, —0.
There was also no significant difference between groups in symptom severity flew vs did not fly estimated mean difference, —0.
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