Landon B Lempke

Virginia Commonwealth University | VCU · Department of Physical Medicine and Rehabilitation

Context Athletic trainers (ATs) are often the first health care providers to conduct concussion assessments and carry out postinjury management. Best practices for concussion evaluation and management have changed rapidly in recent years, outdating previous reports of ATs' concussion practices. Objective To examine ATs' current concussion-assessme...

Purpose: Examine the association between clinical and functional reaction time (RT) assessments with and without simultaneous cognitive tasks among healthy individuals. Methods: Participants (n=41, 49% female; 22.5±2.1yrs; 172.5±11.9cm; 71.0±13.7kg) completed clinical (drop stick, Stroop) and functional (gait, jump landing, single leg hop, antic...

Background Reaction time (RT) deficits are reported following concussion, but it is unknown when these deficits normalize to pre-injury status. It is also unclear how factors such as RT measurement technique and participant characteristics influence post-concussion RT.Objective The purpose of this systematic review and meta-analysis was to (1) char...

Background Youth flag football participation has rapidly grown and is a potentially safer alternative to tackle football. However, limited research has quantitatively assessed youth flag football head impact biomechanics. Purpose To describe head impact biomechanics outcomes in youth flag football and explore factors associated with head impact ma...

Background Concussion pre-injury (i.e., baseline) assessments serve as a benchmark comparison point in the event an individual sustains a concussion and allows clinicians to compare to post-injury measures. However, baseline assessments must reflect the individual’s true and most optimized performance to serve as a useful comparison. Mental fatigue...

Context : Dual-task (simultaneous cognitive–motor activities) assessments have been adapted into reliable and valid clinical concussion measures. However, abundant motor and cognitive variations leave researchers and clinicians uncertain about which combinations elicit the intended dual-task effect. Our objective was to examine differences between...

Background The Sport Concussion Assessment Tool (SCAT) is the most widely used tool following sport-related concussion (SRC) and yields strong sensitivity and specificity. Initial SCAT symptom burden is reportedly the strongest predictor of recovery in collegiate athletes, however; it is unknown if symptom presentation varies within the acute (<48...

Objective Reaction time is commonly impaired following concussion, but recent work indicates current clinical reaction time measures lack sport-related applicability. We aimed to determine the intra-rater, inter-rater, and test-retest reliability, standard error of measurement (SEM), and minimal detectable change (MDC) of a sport-emulating measure...

Objective To determine if the timing of light exercise initiation influences persisting post-concussion symptom (PPCS) prevalence in collegiate student-athletes with concussion. Design Prospective, longitudinal cohort. Setting National College Athletic Association institutions (n=30). Participants Collegiate student-athletes experiencing concuss...

Objective To determine if light exercise initiation timing associated with symptom recovery and unrestricted return-to-play (RTP) time among collegiate student-athletes. Design Prospective, longitudinal cohort. Setting Thirty National College Athletic Association institutions. Participants Student-athletes experiencing concussion (n=1228; age=18...

The purpose of this study was to determine sex differences in recovery trajectories of assessments for sport-related concussion using Concussion Assessment, Research and Education (CARE) Consortium data. National Collegiate Athletic Association athletes (N = 906; 61% female) from sex-comparable sports completed a pre-season baseline assessment and...

Objective It has been posited that alcohol use may confound the association between greater concussion history and poorer neurobehavioral functioning. However, while greater alcohol use is positively correlated with neurobehavioral difficulties, the association between alcohol use and concussion history is not well understood. Therefore, this study...

Objective Traumatic brain injury and cardiovascular disease (CVD) are modifiable risk factors for cognitive decline and dementia. Greater concussion history can potentially increase risk for cerebrovascular changes associated with cognitive decline and may compound effects of CVD. We investigated the independent and dynamic effects of CVD/risk fact...

Context: Single- and dual-task walking gait assessments have been used to identify persistent movement and cognitive dysfunction among athletes with concussions. However, it is unclear whether previous ankle sprain injuries confound these outcomes during baseline testing. The purpose of this study was to determine the effects of (1) ankle sprain h...

Concussion has been described in the United States (US) collegiate student–athlete population, but female-specific findings are often underrepresented and underreported. Our study aimed to describe female collegiate student–athletes’ initial injury characteristics and return to activity outcomes following concussion. Female collegiate student–athle...

Mild traumatic brain injury (mTBI) has been described in the United States (US) military service academy cadet population, but female-specific characteristics and recovery outcomes are poorly characterized despite sex being a confounder. Our objective was to describe female cadets’ initial characteristics, assessment performance, and return-to-acti...

Objective: Investigate the relationships between concussion history and years of football participation (repetitive head impact proxy) with alcohol use across multiple decades in former professional football players. Methods: Participants (n = 348; mean age = 49.0 ± 9.4) completed health questionnaires in 2001 and 2019, which included self-repor...

Background: Current medical practices and recommendations largely ignore the safety of postconcussion driving, even though commonly used measures of neurocognition, balance, and vestibulo-ocular function show impairment. Purpose: To compare simulated driving between patients with concussion and controls throughout concussion recovery using a cas...

This prospective cohort study aimed to determine whether pre-injury characteristics and performance on baseline concussion assessments predicted future concussions among collegiate student-athletes. Participant cases (concussed = 2,529; control = 30,905) completed pre-injury: demographic forms (sport, concussion history, sex), Immediate Post-Concus...

Background Growing evidence indicates early exercise may improve symptoms and reduce clinical recovery time after concussion, but research examining collegiate student-athletes is scarce. Objective The aim of this study was to compare symptom recovery time, clinical recovery time, and persisting post-concussion symptom (i.e., symptoms ≥ 28 days) p...

Introduction: Wearable accelerometry devices quantify on-field frequency and severity of head impacts to further improve sport safety. Commonly employed post-data collection cleaning techniques may affect these outcomes. Objective: Our purpose was to compare game impact rates and magnitudes between three different cleaning levels (Level-1: impac...

Context: Aberrant movement patterns among individuals with concussion history have been reported during sport-related movement. However, the acute postconcussion kinematic and kinetic biomechanical movement patterns during a rapid acceleration-deceleration task have not been profiled and leaves their progressive trajectory unknown. Our study aimed...

Transition from professional football life has important implications for the health and well-being of former National Football League (NFL) players. The study purpose was to examine former NFL players’ experiences of transitioning from sport including factors that helped and factors that made transition difficult. This study used a convenience sam...

Background The age of first exposure (AFE) to American football participation is a growing concern for late-life function. Mixed evidence exists surrounding AFE and may be attributed to varied methods employed across studies. Objective To examine the associations between AFE to American football participation with measures of cognitive, behavioral...

Context: Post-concussion reaction time deficits are common, but existing assessments lack sport-related applicability. We developed the Standardized Assessment of Reaction Time (StART) to emulate simultaneous cognitive and motor function demands in sport, but its reliability is unestablished. Objective: To determine the intra-rater, inter-rater,...

Background Racial and ethnic differences in emergency department (ED) visits have been reported among adolescent patients but are unsubstantiated among adults. Therefore, our purpose in this study was to examine the relationship between race/ethnicity and adult ED visits for concussions, their injury mechanisms, and computed tomography (CT) scan us...

Shumski, EJ, Lempke, LB, Johnson, RS, Oh, J, Schmidt, JD, and Lynall, RC. Jump height and hip power decrease during cognitive loading regardless of sex: implications for sport performance metrics. J Strength Cond Res XX(X): 000-000, 2022-Sex and cognitive loading separately influence jumping performance. However, it is unknown how cognitive loading...

Context: Neuromuscular function is altered acutely following concussion and theoretically linked to the subsequent postconcussion musculoskeletal injury risk. Existing research has only examined voluntary muscle activation, limiting mechanistic understanding. Therefore, our study aimed to examine voluntary and involuntary muscle activation between...

Objective: To examine the relationships and latent factors within the Standardized Assessment of Reaction Time (StART), and between StART and current clinical assessments. Design: Cross-sectional study. Setting: Clinical medicine facility. Participants: Eighty-nine healthy collegiate student-athletes (63% male, age: 19.5 ± 0.9 years, 28% ≥1...

Context Certified athletic therapists in Ireland and Canada serve essential concussion assessment and management roles, but their healthcare practices and concussion knowledge are unestablished. Objective To examine Irish and Canadian athletic therapist cohorts: 1) concussion knowledge, 2) current concussion assessment and management techniques ac...

Objective: Balance impairments may suggest somatosensory disruption beyond concussion clinical recovery, but somatosensory subsystems have never been directly assessed. Our objective was to examine somatosensory function between individuals with a concussion and healthy matched-controls at acute (<7 days) and asymptomatic (<72 hours of being sympt...

Context: Clinical reaction time (RT) measures are frequently used when examining concussion, but do not correlate with functional movement RT. We developed the Standardized Assessment of RT (StART) to emulate the rapid cognitive and whole-body movement needed in sport. Purpose: To 1) assess StART differences across six cognitive-motor combinatio...

Context: With growing concerns surrounding exposure to head impacts in youth tackle football, it is essential that parents and players understand the exposure level when consenting/assenting to participate. Objective: We aimed to determine whether youth football parents and players could estimate on-field head impact frequency, severity, and loc...

Objective Describe concussion characteristics among general college students and compare post-injury outcomes to intercollegiate student-athletes. Design Retrospective cohort. Setting Large university in the Southeast region of the United States. Participants 179 college students (female=120; 67.0%; 23.9±3.9 years) and 49 athletes (female=28, 57...

Context: Basketball has remained a popular sport for players and spectators in the United States since before the first National Collegiate Athletic Association men's championship tournament in 1939. Background: Routine examinations of men's basketball injuries are important for identifying emerging temporal patterns. Methods: Exposure and inj...

Context: Frequent inspection of sports-related injury epidemiology among National Collegiate Athletic Association (NCAA) women's basketball student-athletes is valuable for identifying injury-related patterns. Background: Emerging patterns in epidemiology of NCAA women's basketball injuries are unknown though general sports medicine practices, a...

Context: Women's volleyball is a globally popular sport with widespread participation at the National Collegiate Athletic Association (NCAA) level. Background: Routine examinations of NCAA women's volleyball injuries are important for recognizing emerging injury-related patterns in this population. Methods: Exposure and injury data collected i...

Context: Reaction time is commonly assessed postconcussion through a computerized neurocognitive battery. Although this measure is sensitive to postconcussion deficits, it is not clear if computerized reaction time reflects the dynamic reaction time necessary to compete effectively and safely during sporting activities. Functional reaction time as...

Background Recent literature has indicated altitude may be a protective factor for concussion but it is unknown whether altitude or heat index affects recovery. Objective To examine whether on-field heat index and altitude at the time of injury alter acute (< 48 h) concussion assessments, days-to-asymptomatic, and days-to-return-to-play in collegi...

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Purpose: This study determined the effect of video-verified collision characteristics on head impact magnitudes in male youth tackle football. Methods: Participants (n=23, age=10.9±0.3yrs, height=150.0±8.3cm, mass=41.6±8.4kg) wore Triax Sim-G sensors throughout the Fall 2019 season. Ten filmed games were used to identify nine different collision c...

Context: Laboratory-based movement assessments are commonly performed without cognitive stimuli (ie, single-task) despite the simultaneous cognitive processing and movement (ie, dual task) demands required during sport. Cognitive loading may critically alter human movement and be an important consideration for truly assessing functional movement a...

Objective To compare simulated driving reaction time (RT) between concussed and control individuals and examine Driving-RTs relationship with computerized neurocognitive testing RT (CNT-RT). Background Concussed patients have impaired RT and neurocognition following injury that may linger and impair driving performance. Limited research has used d...

Objective: Concussed patients have impaired reaction time (RT) and cognition following injury that may linger and impair driving performance. Limited research has used direct methods to assess driving-RT post-concussion. Our study compared driving-RT during simulated scenarios between concussed and control individuals and examined driving-RT’s rela...

Context: Reaction time (RT) is fundamental to optimal sport performance and is commonly assessed post-concussion. Numerous studies indicate increased musculoskeletal injury risk following concussion that may be attributed to inhibited sport movement during simultaneous cognitive processing (i.e. dual-task) not directly measured on current clinical...

Context Athletic trainers (ATs) are heavily involved in concussion assessment and return-to-play (RTP) decision making. Despite ATs' crucial role, few researchers have directly examined ATs' knowledge of concussions or whether concussion knowledge or clinical experience affects clinical concussion-management practices. Objective To determine the o...

Purpose This study aimed to determine the effects of superficial cranial cryotherapy on cortical hemodynamics and neurocognitive performance in healthy young adults. Methods Thirty-four healthy individuals (21.3 ± 1.6 yr; 173.8 ± 10.6 cm; 73.3 ± 12.5 kg) participated. Cortical hemodynamic changes over the left prefrontal cortex was assessed using...

Concussion education have served as a keystone for improving concussion reporting. Numerous factors affecting concussion reporting have been explored; however, the role of socioeconomic status (SES) in reporting has not been established. We examined the influence of SES and academic achievement (high-school grade point average [HS-GPA] and American...

Objective: Despite widespread use of baseline neurocognitive testing in concussion management, suboptimal performance due to sandbagging still readily occurs without detection. The purpose of this study is to determine CNS Vital Signs validity indicator accuracy in detecting coached sandbagging compared to controls. Method: We compared rates of inv...

Primary objective: To describe and compare athletic trainer (AT) post-concussion driving management practices and opinions. Research design: Cross-sectional. Methods & procedures: A survey was sent via email to 8,723 ATs (10.8% response rate[945/8723]) to capture demographics, management practices, and opinions (agreement on a seven-point Likert sc...

PURPOSE: To examine if concussion knowledge predicts reporting intentions and identify concussion knowledge differences based on demographics (sex, age, and years of sport eligibility) in collegiate student-athletes. METHODS: Collegiate student-athletes (n = 105) from three universities completed a reporting intentions survey (symptom and concussi...

Purpose To explore the relationship between reaction time (RT) on a commonly used post-concussion computerized neurocognitive assessment and dynamic RT during sport-like movements, with and without a cognitive task. Methods Fourteen healthy individuals (7 females; age=22.3±2.5yrs, height=169.1±14.0cm, mass=71.1±16.8kg) completed a computerized Str...

Purpose To determine CNS Vital Signs validity indicator accuracy in detecting coached suboptimal performance (i.e. sandbagging) on neurocognitive testing. Methods Fifty college-aged students (age=20.8–1.1 years, range 18–25) were randomly assigned to two groups of 25. We compared neurocognitive test performance for two groups completing CNS Vital...

Purpose To describe post-concussion driving management practices and opinions among athletic trainers (ATs) and to compare practices across highest earned degree, setting, and years certified. Methods A survey weblink was emailed to a convenience sample of 8,723 ATs (10.8% response rate [945/8723]; years certified=14.5±10.7; years worked clinicall...

Youth flag football has been proposed as a safe alternative to tackle football due to rising concerns of neurodegeneration from repetitive blows, but the true head impact (HI) burden in youth flag football is unknown. PURPOSE: To examine overall and age-specific HI exposure and magnitude in youth flag football. METHODS: Five youth flag football tea...

There is growing fear among healthcare professionals and parents regarding youth tackle football, likely due to highly publicized concerns about potential long-term physical and cognitive health of professional football players. Parents and advocacy groups are pushing for state legislation to ban youth tackle football in favor of flag football to a...

Our purpose was to describe the youth flag football head impact burden and make comparisons with youth tackle football. Head impact frequency and magnitude (linear acceleration [g], rotational acceleration [rad/s2]) were collected from 25 tackle and 25 flag youth football players over one season. Athlete exposure (AE) was defined as one player part...

Background Concussion education programs have been implemented across sport associations to improve concussion recognition and reporting intentions. Despite widespread implementation, no studies have examined the influence of concussion knowledge on reporting intentions in collegiate athletes. Purpose To (1) examine if concussion knowledge is a pr...

Context: Superficial cranial cryotherapy is purported to alter cerebral blood perfusion and oxygen saturation, and has been suggested as a potential treatment for concussion. Currently, limited evidence exists supporting the effects of cryotherapy on altering cortical hemodynamics. Objective: To determine the effects of superficial cranial cryother...

Post-concussion driving restrictions are eminent, but we lack understanding of current behaviors and opinions about driving following concussion among populations at risk of concussion. We aimed to describe post-concussion driving behaviors and opinions among collegiate student-athletes. Student-athletes completed a survey (response rate=45.3%, 223...

Tackle football faces scrutiny and concerns regarding long-term health consequences; however, limited evidence exists on head impact biomechanics in youth. The purpose of this study was to examine youth tackle football head impact exposure and magnitude differences between practices and games. Throughout the 2017 season, head impact (HI) sensors (T...

Context: There is growing concern among healthcare professionals and parents regarding youth tackle football, likely due to highly publicized concern about potential long-term physical and cognitive health of professional football players. Repetitive head impacts are believed to be associated with cognitive deficits later in life, although the rela...

Clinical Scenario: Currently, rest following concussion serves as the keystone of concussion treatment, but substantial evidence to support it is lacking. Recent literature suggests that early physical activity may be beneficial in reducing concussion symptoms which may influence clinical recovery time. Clinical question: Does early physical acti...

Clinical Scenario: Stretching is applied for the purposes of injury prevention, increasing joint range of motion (ROM), and increasing muscle extensibility. Many researchers have investigated various methods and techniques to determine the most effective way to increase joint ROM and muscle extensibility. Despite the numerous studies conducted, con...

Introduction: Gymnasts land with many different forms to account for skill execution and judges scoring schemes. One such form is the punch-jump and land. To date, there is a paucity of data available that analyzes the amount of knee extensor torque occurring during a punch-jump landing. Knee extensor torque during landing is a biomechanical measur...