Development of stuttering following a sport related concussion in an 18 year-old football athlete: A case study
Presentation Type
Oral Presentation
Abstract/Artist Statement
Background: An 18-year-old collegiate offensive lineman was participating in individual drills at practice when another lineman was thrown into him, initiating a low-intensity helmet-to-helmet impact. After practice, concussion-like symptoms including headache, nausea, sensitivity to light and dizziness developed. As symptoms progressed in a short time, his speech fluency began to deteriorate. Within an hour after head impact, the dysfluency evolved into a neurogenic stutter with the inability to produce full sentences. The patient reported a similar instance while playing football 4 years prior, where the stutter lasted 3 days. The patient reported a history of ADD/ADHD; however, there was no history of mental health disorders. A SCAT5 and cranial nerve assessment was performed by an athletic trainer resulting in an initial diagnosis of a sport related concussion (SRC). Differential Diagnosis: Potential differential diagnosis includes sport related concussion, cranial hemorrhage, and anxiety/psychological episode. Treatment: The patient was referred to a neurologist/concussion specialist for further evaluation. Upon evaluation, the physician confirmed the diagnosis of a SRC and placed the patient in the return to play protocol per the AT staff. The athlete was referred to a speech and language pathologist (SLP) for management of his stutter. The pathologist addressed psychological and neurocognitive therapy for the stutter management. The goal was to reduce anxiety from the stutter and challenge neurocognitive functions through various assessments to properly retrain the brain. These assessments heavily focused on verbal working memory and retention and recognition memory. Word fluency and motor coordination was addressed in early sessions. The AT staff managed the graduated return-to-sport concussion protocol. At six weeks, the patient was re-evaluated by the physician where it was determined that he was continuing to improve and his stutter had resolved. Although the athlete was still managing chronic headaches and light sensitivity, the stuttering had resolved, concluding the case. Uniqueness: Based upon recent infodemiological studies, few unique cases of new-onset stuttering following sport related concussions have been reported. Although there is no known research comparing the relationship of ADHD and neurogenic stuttering, similarities have been identified in the hypothesized pathophysiology of the two disorders. Interprofessional teams consisting of ATs, SLPs and physicians are recommended for concussion management. These teams use a variety of tools for neurocognitive rehabilitation and assessment to identify areas of vulnerability from a SRC. This consists of established tests that focus on areas such as verbal working memory, retention and recognition memory, visual scanning, cognitive speed, mental flexibility, and even word fluency and retrieval. These programs help rehabilitate patients in an efficient and holistic fashion that return them back to the playing field in a timely manner. Conclusions: It is necessary for athletic trainers to know, understand and recognize the possibilities of the development of severe symptoms like neurogenic stuttering in post-concussive patients. Although healthcare providers cannot prevent these complications, they can be properly and effectively managed through a comprehensive treatment and rehabilitation plan. Return to play, academics and life following SRCs should be equal priorities when managing both neurobehavioral and neurocognitive symptoms.
Mentor Name
Valerie Moody
Development of stuttering following a sport related concussion in an 18 year-old football athlete: A case study
UC 332
Background: An 18-year-old collegiate offensive lineman was participating in individual drills at practice when another lineman was thrown into him, initiating a low-intensity helmet-to-helmet impact. After practice, concussion-like symptoms including headache, nausea, sensitivity to light and dizziness developed. As symptoms progressed in a short time, his speech fluency began to deteriorate. Within an hour after head impact, the dysfluency evolved into a neurogenic stutter with the inability to produce full sentences. The patient reported a similar instance while playing football 4 years prior, where the stutter lasted 3 days. The patient reported a history of ADD/ADHD; however, there was no history of mental health disorders. A SCAT5 and cranial nerve assessment was performed by an athletic trainer resulting in an initial diagnosis of a sport related concussion (SRC). Differential Diagnosis: Potential differential diagnosis includes sport related concussion, cranial hemorrhage, and anxiety/psychological episode. Treatment: The patient was referred to a neurologist/concussion specialist for further evaluation. Upon evaluation, the physician confirmed the diagnosis of a SRC and placed the patient in the return to play protocol per the AT staff. The athlete was referred to a speech and language pathologist (SLP) for management of his stutter. The pathologist addressed psychological and neurocognitive therapy for the stutter management. The goal was to reduce anxiety from the stutter and challenge neurocognitive functions through various assessments to properly retrain the brain. These assessments heavily focused on verbal working memory and retention and recognition memory. Word fluency and motor coordination was addressed in early sessions. The AT staff managed the graduated return-to-sport concussion protocol. At six weeks, the patient was re-evaluated by the physician where it was determined that he was continuing to improve and his stutter had resolved. Although the athlete was still managing chronic headaches and light sensitivity, the stuttering had resolved, concluding the case. Uniqueness: Based upon recent infodemiological studies, few unique cases of new-onset stuttering following sport related concussions have been reported. Although there is no known research comparing the relationship of ADHD and neurogenic stuttering, similarities have been identified in the hypothesized pathophysiology of the two disorders. Interprofessional teams consisting of ATs, SLPs and physicians are recommended for concussion management. These teams use a variety of tools for neurocognitive rehabilitation and assessment to identify areas of vulnerability from a SRC. This consists of established tests that focus on areas such as verbal working memory, retention and recognition memory, visual scanning, cognitive speed, mental flexibility, and even word fluency and retrieval. These programs help rehabilitate patients in an efficient and holistic fashion that return them back to the playing field in a timely manner. Conclusions: It is necessary for athletic trainers to know, understand and recognize the possibilities of the development of severe symptoms like neurogenic stuttering in post-concussive patients. Although healthcare providers cannot prevent these complications, they can be properly and effectively managed through a comprehensive treatment and rehabilitation plan. Return to play, academics and life following SRCs should be equal priorities when managing both neurobehavioral and neurocognitive symptoms.