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Gänsslen A, Neubauer T, Hartl C, Moser N, Rickels E, Lüngen H, Nerlich M, Krutsch W. [School re-integration after child brain dislocation : The trauma surgeon's role]. Unfallchirurg 2017; 120:442-448. [PMID: 28130573 DOI: 10.1007/s00113-017-0317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Concussion injury of the brain is still a frequently underestimated injury, which can be associated with long-lasting consequences. Compared to adults, the recovery phase is often prolonged in childhood. Primary treatment consists of symptom-dependent physical and mental activities. Re-integration into daily life is crucial. In childhood, the primary focus is therefore on returning to school. New symptoms, or an increased presence of symptoms must be detected, to avoid prolonged recovery courses. School restrictions have to be minimized. Corresponding concepts are already implemented in North America. Comparable concepts are not established in Germany. In addition to well-known standard return-to-play protocols for sport re-integration, it is urgently recommended to integrate gradual return-to-learn protocols.Thus, academic adaptations and support must be established as well as symptom-oriented organizational and teaching modules.
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Affiliation(s)
- A Gänsslen
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Wolfsburg, Sauerbruchstr. 7, 38440, Wolfsburg, Deutschland.
| | - T Neubauer
- Unfallchirurgie, Landesklinikum Horn, Spitalgasse 10, 3580, Horn, Österreich
| | - C Hartl
- Unfallchirurgie, Landeskrankenhaus Steyr, Sierninger Str. 170, 4400, Steyr, Österreich
| | - N Moser
- Verwaltungs-Berufsgenossenschaft, Bezirksverwaltung München, Postfach 20 20 42, 80020, München, Deutschland
| | - E Rickels
- Klink für Unfallchirurgie, Orthopädie und Neurotraumatologie, Allgemeines Krankenhaus Celle, Siemensplatz 4, 29223, Celle, Deutschland
| | - H Lüngen
- ZNS - Hannelore Kohl Stiftung, Rochusstr. 24, 53123, Bonn, Deutschland
| | - M Nerlich
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - W Krutsch
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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52
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Elkington LJ, Hughes DC. Australian Institute of Sport and Australian Medical Association position statement on concussion in sport. Med J Aust 2017; 206:46-50. [DOI: 10.5694/mja16.00741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/20/2016] [Indexed: 11/17/2022]
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53
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Évaluation des connaissances autour de la commotion cérébrale dans le rugby amateur du comité Midi-Pyrénées. Sci Sports 2016. [DOI: 10.1016/j.scispo.2016.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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54
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Broglio SP, Baldwin G, Castellani RJ, Chrisman SP, Duma S, Hainline B, Gerstner JC, Guskiewicz K, Kutcher J, Lamba A, McCrea M, Pachman S, Randolph C, McLeod TCV. Summary of the 2015 University of Michigan Sport Concussion Summit. Concussion 2016; 1:CNC23. [PMID: 30202565 PMCID: PMC6096432 DOI: 10.2217/cnc-2016-0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/26/2016] [Indexed: 12/14/2022] Open
Abstract
Discussions surrounding concussion have made their way into the public sphere over the previous decade with media attention and coverage of the injury fueling public debate. These conversations have devolved into discussions on banning contact and collision sports and raised legal questions surrounding injury management. Questions raised about concussion eclipse what science can answer, but the University of Michigan Injury Center (MI, USA) hosted a Concussion Summit in September 2015 as a means to condense, solidify and disseminate what is currently known on the topic. Areas for discussion included concussion incidence and prevention, diagnosis and management, legislation and education, legal and social aspects and future directions. A summary of those presentations are included within.
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Affiliation(s)
- Steven P Broglio
- NeuroTrauma Research Laboratory, University of Michigan Injury Center, University of Michigan, Ann Arbor, MI, USA.,NeuroTrauma Research Laboratory, University of Michigan Injury Center, University of Michigan, Ann Arbor, MI, USA
| | - Grant Baldwin
- Centers for Disease Control & Prevention, Atlanta, GA, USA.,Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Rudy J Castellani
- University of Maryland, Baltimore, MD, USA.,University of Maryland, Baltimore, MD, USA
| | - Sara Pd Chrisman
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA.,Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Stefan Duma
- School of Biomedical Engineering & Sciences, Virginia Tech, Blacksburg, VA, USA.,School of Biomedical Engineering & Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Brian Hainline
- National Collegiate Athletic Association, Indianapolis, IN, USA.,National Collegiate Athletic Association, Indianapolis, IN, USA
| | - Joanne C Gerstner
- School of Journalism, Michigan State University, East Lansing, MI, USA.,School of Journalism, Michigan State University, East Lansing, MI, USA
| | - Kevin Guskiewicz
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeffrey Kutcher
- The Sports Neurology Clinic, CORE Institute, Brighton, MI, USA.,The Sports Neurology Clinic, CORE Institute, Brighton, MI, USA
| | - Adria Lamba
- Georgetown University Law Center, Washington DC, USA.,Georgetown University Law Center, Washington DC, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steven Pachman
- Montgomery McCracken, Philadelphia, PA, USA.,Montgomery McCracken, Philadelphia, PA, USA
| | - Christopher Randolph
- Department of Neurology, Loyola University Chicago, Chicago, IL, USA.,Department of Neurology, Loyola University Chicago, Chicago, IL, USA
| | - Tamara C Valovich McLeod
- School of Health Sciences, A.T. Still University, Mesa, AZ, USA.,School of Health Sciences, A.T. Still University, Mesa, AZ, USA
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55
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Anosognosia for Memory Impairment in Addiction: Insights from Neuroimaging and Neuropsychological Assessment of Metamemory. Neuropsychol Rev 2016; 26:420-431. [PMID: 27447979 DOI: 10.1007/s11065-016-9323-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/22/2016] [Indexed: 01/27/2023]
Abstract
In addiction, notably Alcohol Use Disorder (AUD), patients often have a tendency to fail to acknowledge the reality of the disease and to minimize the physical, psychological, and social difficulties attendant to chronic alcohol consumption. This lack of awareness can reduce the chances of initiating and maintaining sobriety. Presented here is a model focusing on compromised awareness in individuals with AUD of mild to moderate cognitive deficits, in particular, for episodic memory impairment-the ability to learn new information, such as recent personal experiences. Early in abstinence, alcoholics can be unaware of their memory deficits and overestimate their mnemonic capacities, which can be investigated with metamemory paradigms. Relevant neuropsychological and neuroimaging results considered suggest that the alcoholics' impairment of awareness of their attenuated memory function can be a clinical manifestation explained mechanistically by neurobiological factors, including compromise of brain systems that result in a mild form of mnemonic anosognosia. Specifically, unawareness of memory impairment in AUD may result from a lack of personal knowledge updating attributable to damage in brain regions or connections supporting conscious recollection in episodic memory. Likely candidates are posterior parietal and medial frontal regions known to be integral part of the Default Mode Network (DMN) and the insula leading to an impaired switching mechanism between the DMN and the Central-Executive Control (i.e., Lateral Prefronto-Parietal) Network. The cognitive concepts and neural substrates noted for addictive disorders may also be relevant for problems in self-identification of functional impairment resulting from injury following war-related blast, sport-related concussion, and insidiously occurring dementia.
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56
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Williams JM, Langdon JL, McMillan JL, Buckley TA. English professional football players concussion knowledge and attitude. JOURNAL OF SPORT AND HEALTH SCIENCE 2016; 5:197-204. [PMID: 30356509 PMCID: PMC6188711 DOI: 10.1016/j.jshs.2015.01.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/20/2014] [Accepted: 01/12/2015] [Indexed: 06/08/2023]
Abstract
BACKGROUND Concussions are a common pathology in football and multiple misconceptions exist amongst the players and managers. To address these misconceptions, and potentially reduce concussion associated sequela, effective educational interventions need to be developed. However, the current knowledge and attitude status must be ascertained to appropriately develop these interventions. The purpose of this study was to assess the concussion knowledge and attitude of English professional footballers. METHODS Twenty-six participants from one English Football League Championship club completed the study. A mixed methods approach included the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS) and a semi-structured interview. The RoCKAS contains separate knowledge (0-25) and attitude (15-75) scores and was followed by a semi-structured interview consisting of concussion knowledge, attitude, and behavior related questions. RESULTS The mean score on the RoCKAS knowledge was 16.4 ± 2.9 (range 11-22) and the attitude score was 59.6 ± 8.5 (range 41-71). The interview responses identified inconsistencies between the RoCKAS and the intended behaviors, endorsing multiple concussion misconceptions, and revealed barriers to concussion reporting. CONCLUSION The results of this study suggest that Championship Level English footballers have moderate concussion knowledge, safe attitudes, and good concussion symptom recognition when assessed with pen and paper questionnaires. However, within the semi-structured interview many respondents reported unsafe concussion behaviors despite accurately identifying the potential risks. Further, multiple barriers to concussion reporting were identified which included perceived severity of the injury, game situations, and the substitution rule. These findings can help form the foundation of educational interventions to potentially improve concussion reporting behaviors amongst professional footballers.
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Affiliation(s)
- Joshua M. Williams
- Department of Intercollegiate Athletics, Wagner College, Staten Island, NY 10301, USA
| | - Jody L. Langdon
- School of Health and Kinesiology, Georgia Southern University, Statesboro, GA 30460, USA
| | - James L. McMillan
- School of Health and Kinesiology, Georgia Southern University, Statesboro, GA 30460, USA
| | - Thomas A. Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19716, USA
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57
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Miyashita TL, Diakogeorgiou E, VanderVegt C. Gender Differences in Concussion Reporting Among High School Athletes. Sports Health 2016; 8:359-63. [PMID: 27233957 PMCID: PMC4922521 DOI: 10.1177/1941738116651856] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: An athlete’s lack of concussion knowledge could lead to significant underreporting and injury mismanagement. To provide more effective management strategies of concussions in adolescent athletes, further examination of reporting behaviors is of critical importance. Hypothesis: The hypotheses for this study were as follows: (1) Girls are more likely to report concussion, (2) girls are more likely to report future concussions after an educational intervention, and (3) a difference in rationale for not reporting concussion will be found between sexes. Study Design: Cross-sectional, cohort design. Level of Evidence: Level 3. Methods: Survey answers were collected on 454 high school athletes (212 girls, 242 boys; mean age, 15.7 ± 1.15 years). Individual team meetings lasting approximately 30 minutes were held to collect data and provide an educational lecture. Participants were randomly provided an iClicker to submit a response to questions asked. Results: Girls were more likely to report a concussion (χ2 = 8.32, df = 3, N = 454, P = 0.040) and more likely to report future concussions after educational intervention (χ2 = 8.54, df = 2, N = 454, P = 0.014). There were no differences between sexes regarding rationale for not reporting a concussion (χ2 = 6.42, df = 4, N = 454, P = 0.170). Conclusion: There is concern these athletes still fail to understand the severity and potential sequelae of concussion injury. Both sexes cited that concussion is not a serious enough injury to warrant reporting to a medical professional. Clinical Relevance: High school athletes recover more slowly from concussions compared with college athletes; therefore, educating this population and promoting the importance of being knowledgeable regarding concussion recognition may increase reporting prevalence.
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58
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Diduch BK, Hudson K, Resch JE, Shen F, Broshek DK, Brady W, Cole SL, Courson R, Castens T, Shimer A, Miller MD. Treatment of Head and Neck Injuries in the Helmeted Athlete. JBJS Rev 2016; 4:01874474-201603000-00002. [PMID: 27500432 DOI: 10.2106/jbjs.rvw.15.00077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Sport-related concussion treatment includes three major phases: initial evaluation at the time of the injury, treatment while the patient is symptomatic, and evaluation of the readiness for a gradual return to participation. Each concussion evaluation should include similar elements: assessment of symptoms, assessment of cognitive ability, assessment of coordination (of the eyes, upper extremities, and lower extremities), and assessment for additional injuries. The spine-boarding recommendations from the American College of Emergency Physicians, National Association of EMS Physicians, and National Athletic Trainers' Association have changed. These recommendations include both decreased use of spinal immobilization and removal of the helmet and shoulder pads prior to securing the athlete to the board when sufficient numbers of trained providers are present. Preseason training and pregame meetings or "medical time outs" should become standard practice for the sidelines medical team (including the athletic trainer, team physician, emergency response personnel, and possibly others).
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Affiliation(s)
- B Kent Diduch
- Department of Health Sciences, James Madison University, Harrisonburg, Virginia
| | - Korin Hudson
- Department of Emergency Medicine, MedStar Georgetown University Hospital & Washington Hospital Center, Washington, DC
| | - Jacob E Resch
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
| | - Francis Shen
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
| | - Donna K Broshek
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
| | - William Brady
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
| | | | | | - Titus Castens
- Albemarle County Fire Rescue, Charlottesville, Virginia
| | - Adam Shimer
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
| | - Mark D Miller
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
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Miles SH, Prasad S. Medical Ethics and School Football. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:6-10. [PMID: 26734735 DOI: 10.1080/15265161.2016.1128751] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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60
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Resch JE, Kutcher JS. The Acute Management of Sport Concussion in Pediatric Athletes. J Child Neurol 2015; 30:1686-94. [PMID: 25834282 DOI: 10.1177/0883073815574335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/28/2015] [Indexed: 11/17/2022]
Abstract
During the past two decades the focus on sport concussion has increased significantly. Young athletes represent the most vulnerable population to sustain a sport concussion yet receive the least amount of attention. Specifically, young athletes who sustain a sport concussion can go unrecognized and continue to participate in sport putting them at an increased risk for a more significant injury. The purpose of this review is to provide a clinical framework for the evaluation and management of sport concussion. In addition, this review provides considerations for health care professionals in regard to clinical measures and follow-up strategies during the acute phase following concussion in young concussed athletes following injury.
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61
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Rose SC, McNally KA, Heyer GL. Returning the student to school after concussion: what do clinicians need to know? ACTA ACUST UNITED AC 2015; 1:CNC4. [PMID: 30202549 PMCID: PMC6114019 DOI: 10.2217/cnc.15.4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 04/10/2015] [Indexed: 11/21/2022]
Abstract
Participation in school is vital to a child's academic and social development. Following concussion, returning the student to school can pose several challenges for families, healthcare providers and school personnel. The complex constellation of postconcussion symptoms can impair learning and can make the school environment intolerable. Research evidence to guide the return to school process is lacking, but protocols have been proposed that outline a gradual reintroduction to school with academic accommodations tailored to the student's specific symptoms. Key medical and school personnel must understand their respective roles to optimize the process. This review of the current literature examines the available data and expert recommendations that can support a student's successful return to school following concussion.
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Affiliation(s)
- Sean C Rose
- Division of Pediatric Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Neurology, The Ohio State University, Columbus, OH, USA.,Division of Pediatric Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Kelly A McNally
- Division of Pediatric Psychology & Neuropsychology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA.,Division of Pediatric Psychology & Neuropsychology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Geoffrey L Heyer
- Division of Pediatric Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Neurology, The Ohio State University, Columbus, OH, USA.,Division of Pediatric Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Neurology, The Ohio State University, Columbus, OH, USA
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