Concussion Symptoms In Law Enforcement Cadets Undergoing Defensive Tactics Training

Law enforcement cadets (LECs) are trained in defensive tactics, which can result in injuries, including concussions. Concussion symptoms are non-specific and may indicate brain trauma, as well as other physiological states (e.g., fatigue). PURPOSE: To determine day-to-day variability of concussion symptoms concussion and changes across types of defensive tactics training. METHODS: An electronic version of the SCAT6 22-symptom severity scale was distributed to LECs immediately before and after 9 defensive tactics training sessions, including 6 subject control trainings (Jiu-Jitsu-inspired), 2 boxing classes, and 1 defensive tactics assessment (all tactics). RESULTS: 252 pre- or post-session surveys were completed by 18 participants (4 females), including 111 pre/post paired surveys. Pre-session (N = 137), within-subject standard deviations (SDw/i) ranged from 0-3.58 for number of symptoms on the 22-item scale, and 0-7.2 on the 0-132 total severity score (TSS) scale. The symptoms with the largest within-subject variability were Feeling slowed down (average SDw/i: 0.36 on the 0-6 scale), Fatigue (0.36) and Headache (0.30). Across all sessions (N = 111), the average pre/post number of symptoms increased by 0.20 (1.40 to 1.60) and the TSS increased by 0.54 (2.25 to 2.79). Pre/post changes varied by activity (ANOVA, p < 0.01), showing larger symptom increases for the second boxing class (7 min of sparring, TSS +4) than the first (2 min of sparring, TSS -0.47) and the subject control sessions (TSS -0.18 to +1.80)(Tukey-Kramer comparisons, p < 0.05). The number of symptoms and the TSS stayed the same pre/post in 54% of cases, increased in 24-26%, and decreased in 20-22%. Fatigue and Headache symptoms increased most often (14% of cases and mean of 0.30 on the 0-6 scale, 21% and 0.20, respectively). Large increases (>3 symptoms or > 5 TSS points) were seen in 9 sessions (<1%) across 6 subjects, averaging 6.43 ± 2.37 symptoms and 11.00 ± 8.86 TSS points. CONCLUSIONS: The large within-subject variability for pre-session symptoms, along with the low increases in symptoms, supports the use of pre/post comparisons to identify changes that may present a clinical interest. The increase in symptoms was larger for the session involving a longer exposure to head impacts, which will be investigated in future analyses. Department of Defense, Traumatic Brain Injury and Psychological Health Research Program - Award No. HT9425-23-1-0520 and HT9425-23-1-0521