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A Preliminary Investigation of Accelerometer-Derived Sleep and Physical Activity Following Sport-Related Concussion

Sufrinko, Alicia M., PhD; Howie, Erin K., PhD; Elbin, R. J., PhD; Collins, Michael W., PhD; Kontos, Anthony P., PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP; Brenner, Lisa PhD, ABPP; Malec, James PhD, ABPP

The Journal of Head Trauma Rehabilitation: September/October 2018 - Volume 33 - Issue 5 - p E64–E74
doi: 10.1097/HTR.0000000000000387
Focus on Clinical Research and Practice

Objective: Describe changes in postconcussion activity levels and sleep throughout recovery in a sample of pediatric sport-related concussion (SRC) patients, and examine the predictive value of accelerometer-derived activity and sleep on subsequent clinical outcomes at a follow-up clinic visit.

Setting: Outpatient concussion clinic.

Participants: Twenty athletes aged 12 to 19 years with diagnosed SRC.

Methods: Prospective study including visit 1 (<72 hours postinjury) and visit 2 (6-18 days postinjury). Linear regressions used to predict scores (ie, neurocognitive, vestibular/oculomotor) at visit 2 from accelerometer-derived data collected 0 to 6 days postinjury. Linear mixed models evaluated changes in activity and sleep across recovery.

Main Measures: Symptom, neurocognitive, and vestibular/oculomotor scores; sleep and activity data (Actigraph GT3x+)

Results: The maximum intensity of physical activity increased (P = .009) and time in bed decreased throughout recovery (P = .026). Several physical activity metrics from 0 to 6 days postinjury were predictive of worse vestibular/oculomotor scores at visit 2 (P < .05). Metrics indicative of poor sleep 0 to 6 days postinjury were associated with worse reaction time at visit 2 (P < .05).

Conclusions: This exploratory study suggests physical activity and sleep change from the acute to subacute postinjury time period in adolescent SRC patients. In our small sample, excess physical activity and poor sleep the first week postinjury may be associated with worse outcomes at follow-up in the subacute stage of recovery. This study further supported the feasibility of research utilizing wearable technology in concussion patients, and future research in a large, diverse sample of concussion patients examined at concise time intervals postinjury is needed.

UPMC Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (Drs Sufrinko, Collins, and Kontos); and Department of Health, Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas, Fayetteville (Drs Howie and Elbin).

Corresponding Author: Alicia M. Sufrinko, PhD, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S. Water st, Pittsburgh, PA 15221 (

Michael W. Collins is a cofounder and 10% shareholder of ImPACT Applications, Inc. There is no other conflict of interest to report.

This study was funded through Manner's Foundation Award (2016).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.