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Author ORCID Identifier
https:/orcid.org/0000-0002-6806-8998.
Date Available
4-24-2028
Year of Publication
2026
Document Type
Doctoral Dissertation
Degree Name
Doctor of Philosophy (PhD)
College
Arts and Sciences
Department/School/Program
Psychology
Faculty
Justin E. Karr
Faculty
Michael Bardo
Abstract
Background: Presentations after sport-related concussion are heterogenous, often characterized by varied levels of objective impairment and non-specific self-report symptoms. Historically, complete rest has been the standard recommendation for concussion care, but with relatively high rates of persistent symptoms, interventions that are active and domain-specific have popularized. Determining which intervention is warranted can be difficult when concurrent psychological and pre-existing health factors exacerbate injury-related sequelae. With network analysis, quantifying symptom interrelations and maintenance mechanisms may elucidate interventional targets for acute and persistent symptom. Objectives: Use within- and between-person network analysis to characterize temporal patterns in acute symptoms, and potential maintenance factors for persistent symptoms, respectively. Methods: Participants were student-athletes from the CARE Consortium with sufficient data on the Sport Concussion Assessment Tool3 (SCAT3), Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), and Vestibular/Ocular-Motor Screening (VOMS), measuring symptoms, neurocognition, and vestibular/ocular functioning, respectively. Using within-person (n=410) partial correlation analyses of SCAT3 serial evaluations, we derived symptom centrality and bridge strength for contemporaneous and time series networks. Using between-person analysis, we summarized bridge strengths and edge weights from a multidomain assessment of SCAT3, ImPACT, and VOMS scores at baseline (n=4,197) and post-injury (24–48 hours, return-to-play, unrestricted return-to-play, and 6 months; n range: 230 to 366). Results: Difficulty concentrating (M=0.77) and Feeling slowed down (M=0.75) were the most central symptoms in the contemporaneous networks, while Fatigue or low energy (M=0.46) and Dizziness (M=0.61) had the greatest in- and out-strengths, respectively. Cross-sectionally, VOMS (M range: 0.52 to 1.16) and SCAT3 physical symptoms (M range: 0.29 to 0.63) were consistently the most central domains across evaluations. The strongest edge weights were SCAT3 physical symptoms to VOMS (M range: 0.29 to 0.63) and same domain edges, like SCAT3 cognitive symptoms to all other SCAT3 symptoms (M range: 0.39 to 0.55). Discussion: Energy dysregulation manifesting as fatigue is a central component of acute concussion and contributes bidirectionally to overall symptom burden. Vestibular sensitivity is central to acute and post-acute symptom burden, and persistent cognitive complaints may reflect affective symptom rather than objective cognitive deficits.
Digital Object Identifier (DOI)
https://doi.org/10.13023/etd.2026.113
Archival?
Archival
Funding Information
This work was supported by the Clinical Science Student Training Award from the Academy of Psychological Clinical Science (2025).
This work was also supported by the University of Kentucky’s Jesse G. Harris, Jr. Dissertation Award (2025) and the Presidential Graduate Fellowship (2025-2026).
Recommended Citation
Ingram, Eric, "TOWARD A NETWORK UNDERSTANDING OF ACUTE AND PERSISTENT SYMPTOMS IN COLLEGIATE ATHLETES FOLLOWING SPORT-RELATED CONCUSSION" (2026). Theses and Dissertations--Psychology. 300.
https://uknowledge.uky.edu/psychology_etds/300
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