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Hasan F, Hart CM, Graham SA, Kam JWY. Inside a child's mind: The relations between mind wandering and executive function across 8- to 12-year-olds. J Exp Child Psychol 2024; 240:105832. [PMID: 38157752 DOI: 10.1016/j.jecp.2023.105832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 10/26/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
Mind wandering refers to attention oriented away from a current task to thoughts unrelated to the task, often resulting in poorer task performance. In adults, mind wandering is a common occurrence that is associated with the executive function facets of inhibitory control, working memory capacity, and task switching. In this study, we cross-sectionally examined whether the relation between mind wandering frequency and executive function changes across 8- to 12-year-old children. A total of 100 children completed three tasks targeting three facets of executive function. During each task, participants were occasionally prompted to report whether they were focused on the task or mind wandering. In examining the association between mind wandering frequency and executive function across the age range, we found a significant interaction between age and working memory capacity, such that it was negatively associated with mind wandering frequency only in 12-year-olds. This interaction with age was not significant for inhibitory control and task switching ability. Our results revealed differential relations between mind wandering and executive function facets, which vary with developmental stages. These findings highlight potential areas for targeted intervention to improve mind wandering regulation in children.
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Affiliation(s)
- Fiza Hasan
- Department of Psychology, University of Calgary, Calgary, Alberta T2N 1N4, Canada.
| | - Chelsie M Hart
- Department of Psychology, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Susan A Graham
- Department of Psychology, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Owerko Centre and Department of Psychology, Alberta Children's Hospital Research Institute, Calgary, Alberta T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 4N1, Canada
| | - Julia W Y Kam
- Department of Psychology, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 4N1, Canada
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2
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Sicard V, Ledoux AA, Tang K, Yeates KO, Brooks BL, Anderson P, Keightley M, Desire N, Beauchamp MH, Zemek R. The association between symptom burden and processing speed and executive functioning at 4 and 12 weeks following pediatric concussion. J Int Neuropsychol Soc 2024:1-13. [PMID: 38273645 DOI: 10.1017/s1355617724000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVES Symptoms and cognition are both utilized as indicators of recovery following pediatric concussion, yet their interrelationship is not well understood. This study aimed to investigate: 1) the association of post-concussion symptom burden and cognitive outcomes (processing speed and executive functioning [EF]) at 4 and 12 weeks after pediatric concussion, and 2) the moderating effect of sex on this association. METHODS This prospective, multicenter cohort study included participants aged 5.00-17.99 years with acute concussion presenting to four Emergency Departments of the Pediatric Emergency Research Canada network. Five processing speed and EF tasks and the Post-Concussion Symptom Inventory (PCSI; symptom burden, defined as the difference between post-injury and retrospective [pre-injury] scores) were administered at 4 and 12 weeks post-concussion. Generalized least squares models were conducted with task performances as dependent variables and PCSI and PCSI*sex interaction as the main predictors, with important pre-injury demographic and injury characteristics as covariates. RESULTS 311 children (65.0% males; median age = 11.92 [IQR = 9.14-14.21 years]) were included in the analysis. After adjusting for covariates, higher symptom burden was associated with lower Backward Digit Span (χ2 = 9.85, p = .043) and Verbal Fluency scores (χ2 = 10.48, p = .033) across time points; these associations were not moderated by sex, ps ≥ .20. Symptom burden was not associated with performance on the Coding, Continuous Performance Test, and Color-Word Interference scores, ps ≥ .17. CONCLUSIONS Higher symptom burden is associated with lower working memory and cognitive flexibility following pediatric concussion, yet these associations were not moderated by sex. Findings may inform concussion management by emphasizing the importance of multifaceted assessments of EF.
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Affiliation(s)
- Veronik Sicard
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Andrée-Anne Ledoux
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ken Tang
- Independent Statistical Consultant, Richmond, BC, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Brian L Brooks
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Peter Anderson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Mental Health Neuropsychology Program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Michelle Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, TorontoON, Canada
- Departments of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Naddley Desire
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Ste-Justine Hospital Research Center, Montreal, QC, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
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3
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Burma JS, Lapointe AP, Wilson M, Penner LC, Kennedy CM, Newel KT, Galea OA, Miutz LN, Dunn JF, Smirl JD. Adolescent Sport-Related Concussion and the Associated Neurophysiological Changes: A Systematic Review. Pediatr Neurol 2024; 150:97-106. [PMID: 38006666 DOI: 10.1016/j.pediatrneurol.2023.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/20/2023] [Accepted: 10/28/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Sport-related concussion (SRC) has been shown to induce cerebral neurophysiological deficits, quantifiable with electroencephalography (EEG). As the adolescent brain is undergoing rapid neurodevelopment, it is fundamental to understand both the short- and long-term ramifications SRC may have on neuronal functioning. The current systematic review sought to amalgamate the literature regarding both acute/subacute (≤28 days) and chronic (>28 days) effects of SRC in adolescents via EEG and the diagnostic accuracy of this tool. METHODS The review was registered within the Prospero database (CRD42021275256). Search strategies were created and input into the PubMed database, where three authors completed all screening. Risk of bias assessments were completed using the Scottish Intercollegiate Guideline Network and Methodological Index for Non-Randomized Studies. RESULTS A total of 128 articles were identified; however, only seven satisfied all inclusion criteria. The studies ranged from 2012 to 2021 and included sample sizes of 21 to 81 participants, albeit only ∼14% of the included athletes were females. The studies displayed low-to-high levels of bias due to the small sample sizes and preliminary nature of most investigations. Although heterogeneous methods, tasks, and analytical techniques were used, 86% of the studies found differences compared with control athletes, in both the symptomatic and asymptomatic phases of SRC. One study used raw EEG data as a diagnostic indicator demonstrating promise; however, more research and standardization are a necessity. CONCLUSIONS Collectively, the findings highlight the utility of EEG in assessing adolescent SRC; however, future studies should consider important covariates including biological sex, maturation status, and development.
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Affiliation(s)
- Joel S Burma
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.
| | - Andrew P Lapointe
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Megan Wilson
- Faculty of Arts and Social Sciences, Carleton University, Ottawa, Ontario, Canada; Faculty of Arts, University of Alberta, Edmonton, Alberta, Canada
| | - Linden C Penner
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Courtney M Kennedy
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Kailey T Newel
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada; Faculty of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada
| | - Olivia A Galea
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Lauren N Miutz
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Jeff F Dunn
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
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4
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Coenen J, Reinsberger C. Neurophysiological Markers to Guide Return to Sport After Sport-Related Concussion. J Clin Neurophysiol 2023; 40:391-397. [PMID: 36930211 DOI: 10.1097/wnp.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
SUMMARY Sport-related concussion (SRC) has been defined as a subset of mild traumatic brain injury (mTBI), without structural abnormalities, reflecting a functional disturbance. Over the past decade, SRC has gained increasing awareness and attention, which coincides with an increase in incidence rates. Because this injury has been considered one of the most challenging encounters for clinicians, there is a need for objective biomarkers to aid in diagnosis (i.e., presence/severity) and management (i.e., return to sport) of SRC/mTBI.The primary aim of this article was to present state-of-the-art neurophysiologic methods (e.g., electroencephalography, magnetoencephalography, transcranial magnetic stimulation, and autonomic nervous system) that are appropriate to investigate the complex pathophysiological process of a concussion. A secondary aim was to explore the potential for evidence-based markers to be used in clinical practice for SRC management. The article concludes with a discussion of future directions for SRC research with specific focus on clinical neurophysiology.
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Affiliation(s)
- Jessica Coenen
- Department of Exercise and Health, Institute of Sports Medicine, Paderborn University, Paderborn, Germany; and
| | - Claus Reinsberger
- Department of Exercise and Health, Institute of Sports Medicine, Paderborn University, Paderborn, Germany; and
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Brigham and Women's Hospital, Boston, Massachusetts
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5
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Thompson RC, Vaughn D, Hirst RB, Murley R, Baldini D. Back from the sideline, but back to baseline? A pediatric case study examining neuropsychological functioning after sustaining multiple sport-related concussions. Neurocase 2023; 29:29-36. [PMID: 38678304 DOI: 10.1080/13554794.2024.2343154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
Most individuals recover quickly from a concussion; however, youth who sustain multiple concussions may be at risk for long-term cognitive impairments. This case study examines the neuropsychological performance of a 13-year-old malewith five head injuries. After his first concussion during study participation (fourth injury overall), several improvements were observed, likely due to practice effects, yet after sustaining another concussion <2 years later,declines were observed in visuoconstruction, verbal memory, and intellectual functioning. Across serial re-evaluation, his vocabulary knowledge declined, and fewer improvements were observed than anticipated when accounting for serial practice effects, highlighting the possible cumulative impact of multiple concussions.
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Affiliation(s)
- Ryan C Thompson
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Dylan Vaughn
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Rayna B Hirst
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Rachel Murley
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Daniel Baldini
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
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6
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Adams Nejatbakhsh N, Dawson D, Hutchison M, Selby P. Association between pediatric TBI and mental health and substance use disorders: A scoping review. Brain Inj 2023; 37:525-533. [PMID: 36871963 DOI: 10.1080/02699052.2023.2184871] [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: 03/07/2023]
Abstract
BACKGROUND The relationship between pediatric Traumatic Brain Injury (TBI) and long-term mental health and substance use disorders is not well known, resulting in inadequate prevention and management strategies. The aim of this scoping review is to review the evidence on pediatric TBI and the development of mental health disorders and substance use later in life and to identify gaps in the literature to inform future research. METHODS We searched multiple databases for original articles published between September 2002 and September 2022 on TBI-related mental health and/or substance use disorders in children and youth. Two independent reviewers performed the screening using Arksey and O'Malley and Levac et al.'s scoping review framework. RESULTS A total of six papers are included in this scoping review. Studies included are comprised of cross-sectional and prospective longitudinal cohort studies. DISCUSSION A correlation between pediatric TBI and development of certain mental health disorders and substance use is suggested, although much of the current evidence is mixed and does not account for confounding variables. Future studies should aim to closely examine these links and identify modifiers that can influence these relationships.
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Affiliation(s)
- Nasrin Adams Nejatbakhsh
- Addiction Medicine, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Canada
| | - Danielle Dawson
- Addiction Medicine, Centre for Addiction and Mental Health, Toronto, Canada
| | | | - Peter Selby
- Addiction Medicine, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Canada.,Psychiatry, University of Toronto, Toronto, Canada.,Dalla Lana School of Medicine, University of Toronto, 155 College St, Toronto, Canada
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7
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Oeur RA, Palaniswamy M, Ha M, Fernandez-Corazza M, Margulies SS. Regional variations distinguish auditory from visual evoked potentials in healthy 4 week old piglets. Physiol Meas 2023; 44:025006. [PMID: 36657178 PMCID: PMC9972182 DOI: 10.1088/1361-6579/acb4da] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/19/2023] [Indexed: 01/21/2023]
Abstract
Objective.Evoked potentials (EP), measured using electroencephalographic (EEG) recordings provide an opportunity to monitor cognitive dysfunctions after neurological diseases or traumatic brain injury (TBI). The 4 week old piglet is an established model of paediatric TBI; therefore, healthy piglets were studied to establish feasibility of obtaining responses to auditory and visual stimuli. A secondary aim was to input the EEG data into a piglet computational model to localize the brain sources related to processing. We tested the hypotheses: (1) visual, auditory-standard, and auditory-target stimuli elicit responses, (2) there is an effect of stimulus type, day tested, and electrode region on EPs from EEG, (3) there is an effect of stimulus type, day tested, and brain region on localized sources from a computational model.Approach.Eleven 4 week old female piglets were fitted with a 32-electrode net and presented with a simple white light stimulus and an auditory oddball click train (70 standard; 30 target tones).Main results.N1 andP2 amplitudes were consistently observed for all stimulus types. Significant interaction effects between brain region and stimulus for EP and current density demonstrate that cognitive responses are specific to each modality with auditory localizing to the temporal region and visual to the occipital regions. There was a day effect where larger responses were found on the first day than day 2 and 3 and may be due to the novelty of the stimulus on the first day. Visual stimuli had largerP1 amplitudes and earlier latencies (P1,N1) than auditory which coincides with current density results at 50 ms where larger activations were observed for visual. At 85 ms, auditory had significantly larger current densities coincident with larger and longerN1 amplitudes and latencies than visual.Significance.Auditory and visual processing were successfully and consistently obtained in a porcine model and can be evaluated as a diagnostic assessment for TBI.
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Affiliation(s)
- R Anna Oeur
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Maduran Palaniswamy
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Matthew Ha
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Mariano Fernandez-Corazza
- LEICI Instituto de Investigaciones en Electrónica, Control y Procesamiento de Señales, Facultad de Ingeniería, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States of America,Author to whom any correspondence should be addressed
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The Effects of Attention-Deficit/Hyperactivity Disorder Symptoms on the Association between Head Impacts and Post-Season Neurocognitive and Behavioral Outcomes. J Int Neuropsychol Soc 2023; 29:24-34. [PMID: 35105403 DOI: 10.1017/s1355617721001491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Having attention-deficit/hyperactivity disorder (ADHD) is a risk factor for concussion that impacts concussion diagnosis and recovery. The relationship between ADHD and repetitive subconcussive head impacts on neurocognitive and behavioral outcomes is less well known. This study evaluated the role of ADHD as a moderator of the association between repetitive head impacts on neurocognitive test performance and behavioral concussion symptoms over the course of an athletic season. METHOD Study participants included 284 male athletes aged 13-18 years who participated in high school football. Parents completed the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior (SWAN) ratings about their teen athlete before the season began. Head impacts were measured using an accelerometer worn during all practices and games. Athletes and parents completed behavioral ratings of concussion symptoms and the Attention Network Task (ANT), Digital Trail Making Task (dTMT), and Cued Task Switching Task at pre- and post-season. RESULTS Mixed model analyses indicated that neither head impacts nor ADHD symptoms were associated with post-season athlete- or parent-reported concussion symptom ratings or neurocognitive task performance. Moreover, no relationships between head impact exposure and neurocognitive or behavioral outcomes emerged when severity of pre-season ADHD symptoms was included as a moderator. CONCLUSION Athletes' pre-season ADHD symptoms do not appear to influence behavioral or neurocognitive outcomes following a single season of competitive football competition. Results are interpreted in light of several study limitations (e.g., single season, assessment of constructs) that may have impacted this study's pattern of largely null results.
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9
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Ledwidge PS, Jones CM, Huston CA, Trenkamp M, Bator B, Laeng J. Electrophysiology reveals cognitive-linguistic alterations after concussion. BRAIN AND LANGUAGE 2022; 233:105166. [PMID: 35970083 DOI: 10.1016/j.bandl.2022.105166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
Language deficits and alterations to the N400 ERP are commonly reported in aphasia and moderate-to-severe traumatic brain injury (TBI), but have seldomly been investigated after mild TBI, such as concussion. In the present study, the N400 was recorded from young adults within 1-month after concussion and matched controls during a sentence processing task. The N400 recorded to semantically incongruent sentence-final words was significantly more negative and with a more anterior distribution in the concussion group than control group. Among the concussion group, a weaker N400 was associated with more concussion symptoms, slower response time, and poorer executive functioning. Multiple regression results showed that concussion occurrence and male gender were independently associated with a more negative N400-effect, whereas symptoms were associated with a weaker N400. These findings provide novel evidence that alterations to lexical-semantic networks may occur after concussion and vary based on individual differences in post-concussion symptoms and cognitive function.
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Affiliation(s)
- Patrick S Ledwidge
- Department of Psychology, Baldwin Wallace University, 275 Eastland Rd., Berea, OH 44017, USA.
| | - Christa M Jones
- Department of Communication Sciences & Disorders, Baldwin Wallace University, 275 Eastland Rd., Berea, OH 44017, USA
| | - Chloe A Huston
- Department of Psychology, Baldwin Wallace University, 275 Eastland Rd., Berea, OH 44017, USA
| | - Madison Trenkamp
- Department of Psychology, Baldwin Wallace University, 275 Eastland Rd., Berea, OH 44017, USA
| | - Bryan Bator
- Department of Psychology, Baldwin Wallace University, 275 Eastland Rd., Berea, OH 44017, USA
| | - Jennie Laeng
- Cleveland Clinic, Taussig Cancer Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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10
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Persistent post-concussive syndrome in children after mild traumatic brain injury is prevalent and vastly underdiagnosed. Sci Rep 2022; 12:4364. [PMID: 35288616 PMCID: PMC8921281 DOI: 10.1038/s41598-022-08302-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Data on epidemiology and prognosticators of persistent post-concussion syndrome (PPCS) after mild traumatic brain injury (mTBI) in the pediatric population is scarce. The aim of this study was to evaluate the prevalence of PPCS in children after mTBI and to identify clinical variables in children who are at high risk for developing PPCS. A multicenter, retrospective matched cohort in which PPCS symptoms were evaluated in children 8–15-year-old, 6–60 months after being admitted to the emergency department because of mTBI. The control group included children admitted to the emergency department because of uncomplicated distal radius fractures. The children's guardians were interviewed for the presence of PPCS symptoms using the "Rivermead Post-Concussion Questionnaire". A multivariable logistic regression model was used to identify predictors of PPCS. Two-hundred and five children were included in the mTBI group and 205 in the control. The median time from the injury was 33.5 months in the mTBI group and 33.8 in the control. The prevalence of PPCS in the mTBI group was 25.3% and PPCS like symptoms in the control was 2.4%, p < 0.001. Within the 6–60 months period, the PPCS prevalence was not influenced by the time that elapsed from the injury. In the mTBI group, motor vehicle accidents and adolescence were found to be risk factors for PPCS. PPCS is underdiagnosed in the pediatric population and 25% of children admitted to the ED due to mTBI may suffer from PPCS. Screening guidelines should be implemented to identify and properly treat these children.
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11
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Redlinger F, Sicard V, Caron G, Ellemberg D. Long-Term Cognitive Impairments of Sports Concussions in College-Aged Athletes: A Meta-Analysis. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2022. [DOI: 10.1249/tjx.0000000000000193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Narad ME, Epstein J, Peugh J, Barber Foss KD, Diekfuss JA, Bonnette S, Orban S, Yuan W, Dudley J, DiCesare CA, Reddington DL, Zhong W, Nissen KS, Shafer J, Avedesian JM, Slutsky-Ganesh AB, Lloyd RS, Howell D, Myer GD. The effect of subconcussive head impact exposure and jugular vein compression on behavioral and cognitive outcomes after a single season of high-school football: A prospective longitudinal trial. J Neurotrauma 2021; 39:49-57. [PMID: 34779241 DOI: 10.1089/neu.2021.0078] [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: 11/12/2022] Open
Abstract
This prospective longitudinal trial aimed to 1) determine the role of head impact exposure on behavioral/cognitive outcomes, and 2) assess the protective effect(s) of a jugular vein compression (JVC) collar on behavioral/cognitive outcomes following one season of high-school football. Participants included 284 male high-school football players aged 13-18 years enrolled from seven midwestern high-schools. Schools were allocated to the JVC collar intervention(four teams, 140 players) or non-collar/no intervention control (three teams, 144 players) condition. Head impact exposure was measured throughout the season using CSx accelerometers. Outcome measures included post season parent and adolescent report on Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale (SWAN) and Post-Concussion Symptom Inventory (PCSI), as well as adolescent performance on Attention Network Task (ANT), digital Trail Making Task (dTMT), and Cued Switching task. No significant effect of head impact exposure or JVC collar use on post-season SWAN or PCSI scores or performance on dTMT and Cued Switching task were noted. There was no effect of head impact exposure on ANT performance; however, the JVC collar group had greater post-season Alerting network scores than the non-collar group (p=.026, d=.22). Findings provide preliminary evidence that the JVC collar may provide some protection to the alerting attention system. These findings should be interpreted cautiously as a greater understanding of the long-term sequalae of head impact exposure and the role of cumulative head impact exposure behavioral/cognitive outcomes is required.
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Affiliation(s)
- Megan E Narad
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine & Clinical Psychology, 3333 Burnet Ave, mlc 10006, Cincinnati, Ohio, United States, 45229;
| | - Jeffery Epstein
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, United States;
| | - James Peugh
- Cincinnati Children's Hospital Medical Center, 2518, Behavioral Medicine & Clinical Psychology, Cincinnati, Ohio, United States;
| | - Kim D Barber Foss
- Emory University, 1371, Emory Sport Performance and Research Center, Atlanta, Georgia, United States;
| | - Jed A Diekfuss
- Emory University, 1371, Emory Sport Performance and Research Center, Atlanta, Georgia, United States;
| | - Scott Bonnette
- Cincinnati Children's Hospital Medical Center, 2518, The SPORT Center, Division of Sports Medicine, Cincinnati, Ohio, United States;
| | - Sarah Orban
- University of Tampa, Department of psychology, Tampa, FL, United States;
| | - Weihong Yuan
- Cincinnati Children's Hospital Medical Center, 2518, 3333 Burnew Ave, Cincinnati, Ohio, United States, 45229-3026;
| | - Jonathan Dudley
- Cincinnati Children's Hospital Medical Center, 2518, 3333 Burnet Ave, Cincinnati, Ohio, United States, 45229-3026;
| | - Christopher A DiCesare
- University of Michigan, 1259, Department of Mechanical engineering, Ann Arbor, Michigan, United States;
| | - Danielle L Reddington
- Cincinnati Children's Hospital Medical Center, 2518, Cincinnati, Ohio, United States;
| | - Wen Zhong
- Cincinnati Children's Hospital Medical Center, 2518, Cincinnati, Ohio, United States;
| | | | - Jessica Shafer
- Cincinnati Children's Hospital Medical Center, 2518, Cincinnati, Ohio, United States;
| | | | - Alexis B Slutsky-Ganesh
- The University of North Carolina at Greensboro, Department of Kinesiology, Greensboro, North Carolina, United States;
| | - Rhodri S Lloyd
- Cardiff Metropolitan University, 11352, Cardiff, Cardiff, United Kingdom of Great Britain and Northern Ireland.,AUT University, Auckland, New Zealand.,Waikato Institute of Technology, 3715, Hamilton, New Zealand;
| | - David Howell
- University of Colorado Denver School of Medicine, 12225, Department of Orthopedics , Aurora, Colorado, United States;
| | - Greg D Myer
- Emory University School of Medicine, 12239, Atlanta, Georgia, United States.,the Micheli Center for Sports Injury Prevention, Waltham, Ma, United States;
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13
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Wilkerson GB, Nabhan DC, Perry TS. A Novel Approach to Assessment of Perceptual-Motor Efficiency and Training-Induced Improvement in the Performance Capabilities of Elite Athletes. Front Sports Act Living 2021; 3:729729. [PMID: 34661098 PMCID: PMC8517233 DOI: 10.3389/fspor.2021.729729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Standard clinical assessments of mild traumatic brain injury are inadequate to detect subtle abnormalities that can be revealed by sophisticated diagnostic technology. An association has been observed between sport-related concussion (SRC) and subsequent musculoskeletal injury, but the underlying neurophysiological mechanism is not currently understood. A cohort of 16 elite athletes (10 male, 6 female), which included nine individuals who reported a history of SRC (5 male, 4 female) that occurred between 4 months and 8 years earlier, volunteered to participate in a 12-session program for assessment and training of perceptual-motor efficiency. Performance metrics derived from single- and dual-task whole-body lateral and diagonal reactive movements to virtual reality targets in left and right directions were analyzed separately and combined in various ways to create composite representations of global function. Intra-individual variability across performance domains demonstrated very good SRC history classification accuracy for the earliest 3-session phase of the program (Reaction Time Dispersion AUC = 0.841; Deceleration Dispersion AUC = 0.810; Reaction Time Discrepancy AUC = 0.825, Deceleration Discrepancy AUC = 0.794). Good earliest phase discrimination was also found for Composite Asymmetry between left and right movement directions (AUC = 0.778) and Excursion Average distance beyond the minimal body displacement necessary for virtual target deactivation (AUC = 0.730). Sensitivity derived from Youden's Index for the 6 global factors ranged from 67 to 89% and an identical specificity value of 86% for all of them. Median values demonstrated substantial improvement from the first 3-session phase to the last 3-session phase for Composite Asymmetry and Excursion Average. The results suggest that a Composite Asymmetry value ≥ 0.15 and an Excursion Average value ≥ 7 m, provide reasonable qualitative approximations for clinical identification of suboptimal perceptual-motor performance. Despite acknowledged study limitations, the findings support a hypothesized relationship between whole-body reactive agility performance and functional connectivity among brain networks subserving sensory perception, cognitive decision-making, and motor execution. A complex systems approach appears to perform better than traditional data analysis methods for detection of subtle perceptual-motor impairment, which has the potential to advance both clinical management of SRC and training for performance enhancement.
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Affiliation(s)
- Gary B Wilkerson
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Dustin C Nabhan
- Oslo Sports Trauma Research Center, Norwegian School of Sport Science, Oslo, Norway
| | - Tyler S Perry
- Orthopedics and Sports Medicine, Emory Healthcare, Atlanta, GA, United States
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14
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Psycho-affective health, cognition, and neurophysiological functioning following sports-related concussion in symptomatic and asymptomatic athletes, and control athletes. Sci Rep 2021; 11:13838. [PMID: 34226626 PMCID: PMC8257649 DOI: 10.1038/s41598-021-93218-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/31/2021] [Indexed: 11/08/2022] Open
Abstract
Little is known about the neuropsychiatric and neurophysiological differences that characterize abnormal recovery following a concussion. The present study aimed to investigate the psycho-affective, cognitive, and neurophysiological profiles of symptomatic, slow-to-recover, concussed athletes, asymptomatic concussed athletes, and control athletes. Seventy-eight athletes (26 symptomatic, 26 asymptomatic, 26 control) completed the Beck Depression Inventory-II, Profile of Mood States, and 2-Back task. Additionally, event-related brain potentials were recorded during an experimental three-stimulus visual Oddball paradigm. Compared to asymptomatic and control groups, the symptomatic group reported greater depression symptoms and negatively altered mood states. Symptomatic athletes also exhibited poorer cognitive performance on the 2-Back task, indicated by more errors and slower reaction time. ERP analyses indicated prolonged P3b latency for both symptomatic and asymptomatic groups, but symptomatic athletes also exhibited reduced P3b amplitude compared to both asymptomatic and control groups. For the asymptomatic group, correlations were observed between time since last concussion and functioning, but no relations were observed within the symptomatic group for any measure. The current findings provide valuable information regarding the psycho-affective, cognitive, and neurophysiological profiles of athletes with and without persistent symptoms following a concussion and highlight the need to assess and treat symptomatic, slow-to-recover athletes from a multidimensional and integrative perspective.
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15
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Krokhine SN, Ewers NP, Mangold KI, Boshra R, Lin CYA, Connolly JF. N2b Reflects the Cognitive Changes in Executive Functioning After Concussion: A Scoping Review. Front Hum Neurosci 2021; 14:601370. [PMID: 33424568 PMCID: PMC7793768 DOI: 10.3389/fnhum.2020.601370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: The N2b is an event-related potential (ERP) component thought to index higher-order executive function. While the impact of concussion on executive functioning is frequently discussed in the literature, limited research has been done on the role of N2b in evaluating executive functioning in patients with concussion. The aims of this review are to consolidate an understanding of the cognitive functions reflected by the N2b and to account for discrepancies in literature findings regarding the N2b and concussion. Methods: A scoping review was conducted on studies that used the N2b to measure cognitive functioning in healthy control populations, as well as in people with concussions. Results: Sixty-six articles that met inclusion criteria demonstrated that the N2b effectively represents stimulus-response conflict management, response selection, and response inhibition. However, the 19 included articles investigating head injury (using terms such as concussion, mild head injury, and mild traumatic brain injury) found widely varied results: some studies found the amplitude of the N2b to be increased in the concussion group, while others found it to be decreased or unchanged. Conclusion: Based on the available evidence, differences in the amplitude of the N2b have been linked to response selection, conflict, and inhibition deficits in concussion. However, due to large variations in methodology across studies, findings about the directionality of this effect remain inconclusive. The results of this review suggest that future research should be conducted with greater standardization and consistency.
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Affiliation(s)
- Sophie N Krokhine
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL) Research Centre, McMaster University, Hamilton, ON, Canada
| | - Nathalee P Ewers
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL) Research Centre, McMaster University, Hamilton, ON, Canada.,Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Kiersten I Mangold
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL) Research Centre, McMaster University, Hamilton, ON, Canada.,Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Rober Boshra
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL) Research Centre, McMaster University, Hamilton, ON, Canada.,School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Chia-Yu A Lin
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL) Research Centre, McMaster University, Hamilton, ON, Canada
| | - John F Connolly
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL) Research Centre, McMaster University, Hamilton, ON, Canada.,Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada.,School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
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16
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Boshra R, Ruiter KI, Dhindsa K, Sonnadara R, Reilly JP, Connolly JF. On the time-course of functional connectivity: theory of a dynamic progression of concussion effects. Brain Commun 2020; 2:fcaa063. [PMID: 32954320 PMCID: PMC7491441 DOI: 10.1093/braincomms/fcaa063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/15/2020] [Accepted: 04/24/2020] [Indexed: 12/27/2022] Open
Abstract
The current literature presents a discordant view of mild traumatic brain injury and its effects on the human brain. This dissonance has often been attributed to heterogeneities in study populations, aetiology, acuteness, experimental paradigms and/or testing modalities. To investigate the progression of mild traumatic brain injury in the human brain, the present study employed data from 93 subjects (48 healthy controls) representing both acute and chronic stages of mild traumatic brain injury. The effects of concussion across different stages of injury were measured using two metrics of functional connectivity in segments of electroencephalography time-locked to an active oddball task. Coherence and weighted phase-lag index were calculated separately for individual frequency bands (delta, theta, alpha and beta) to measure the functional connectivity between six electrode clusters distributed from frontal to parietal regions across both hemispheres. Results show an increase in functional connectivity in the acute stage after mild traumatic brain injury, contrasted with significantly reduced functional connectivity in chronic stages of injury. This finding indicates a non-linear time-dependent effect of injury. To understand this pattern of changing functional connectivity in relation to prior evidence, we propose a new model of the time-course of the effects of mild traumatic brain injury on the brain that brings together research from multiple neuroimaging modalities and unifies the various lines of evidence that at first appear to be in conflict.
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Affiliation(s)
- Rober Boshra
- ARiEAL Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada.,School of Biomedical Engineering, McMaster University, Hamilton, ON L8S 4K1, Canada.,Vector Institute, Toronto, ON M5G 1M1, Canada
| | - Kyle I Ruiter
- ARiEAL Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada.,Linguistics and Languages, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Kiret Dhindsa
- ARiEAL Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada.,Vector Institute, Toronto, ON M5G 1M1, Canada.,Department of Surgery, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Ranil Sonnadara
- ARiEAL Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada.,Vector Institute, Toronto, ON M5G 1M1, Canada.,Department of Surgery, McMaster University, Hamilton, ON L8S 4K1, Canada.,Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - James P Reilly
- ARiEAL Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada.,School of Biomedical Engineering, McMaster University, Hamilton, ON L8S 4K1, Canada.,Vector Institute, Toronto, ON M5G 1M1, Canada.,Department of Electrical & Computer Engineering, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - John F Connolly
- ARiEAL Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada.,School of Biomedical Engineering, McMaster University, Hamilton, ON L8S 4K1, Canada.,Vector Institute, Toronto, ON M5G 1M1, Canada.,Linguistics and Languages, McMaster University, Hamilton, ON L8S 4K1, Canada.,Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4K1, Canada
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17
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Sicard V, Lortie JC, Moore RD, Ellemberg D. Cognitive Testing and Exercise to Assess the Readiness to Return to Play After a Concussion. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2020. [DOI: 10.1249/tjx.0000000000000130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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McGowan AL, Bretzin AC, Savage JL, Petit KM, Covassin T, Pontifex MB. Acute and protracted disruptions to inhibitory control following sports-related concussion. Neuropsychologia 2019; 131:223-232. [DOI: 10.1016/j.neuropsychologia.2019.05.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 05/13/2019] [Accepted: 05/27/2019] [Indexed: 11/26/2022]
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19
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Hajiaghamemar M, Seidi M, Oeur RA, Margulies SS. Toward development of clinically translatable diagnostic and prognostic metrics of traumatic brain injury using animal models: A review and a look forward. Exp Neurol 2019; 318:101-123. [PMID: 31055005 PMCID: PMC6612432 DOI: 10.1016/j.expneurol.2019.04.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/11/2019] [Accepted: 04/30/2019] [Indexed: 12/11/2022]
Abstract
Traumatic brain injury is a leading cause of cognitive and behavioral deficits in children in the US each year. There is an increasing interest in both clinical and pre-clinical studies to discover biomarkers to accurately diagnose traumatic brain injury (TBI), predict its outcomes, and monitor its progression especially in the developing brain. In humans, the heterogeneity of TBI in terms of clinical presentation, injury causation, and mechanism has contributed to the many challenges associated with finding unifying diagnosis, treatment, and management practices. In addition, findings from adult human research may have little application to pediatric TBI, as age and maturation levels affect the injury biomechanics and neurophysiological consequences of injury. Animal models of TBI are vital to address the variability and heterogeneity of TBI seen in human by isolating the causation and mechanism of injury in reproducible manner. However, a gap between the pre-clinical findings and clinical applications remains in TBI research today. To take a step toward bridging this gap, we reviewed several potential TBI tools such as biofluid biomarkers, electroencephalography (EEG), actigraphy, eye responses, and balance that have been explored in both clinical and pre-clinical studies and have shown potential diagnostic, prognostic, or monitoring utility for TBI. Each of these tools measures specific deficits following TBI, is easily accessible, non/minimally invasive, and is potentially highly translatable between animals and human outcomes because they involve effort-independent and non-verbal tasks. Especially conspicuous is the fact that these biomarkers and techniques can be tailored for infants and toddlers. However, translation of preclinical outcomes to clinical applications of these tools necessitates addressing several challenges. Among the challenges are the heterogeneity of clinical TBI, age dependency of some of the biomarkers, different brain structure, life span, and possible variation between temporal profiles of biomarkers in human and animals. Conducting parallel clinical and pre-clinical research, in addition to the integration of findings across species from several pre-clinical models to generate a spectrum of TBI mechanisms and severities is a path toward overcoming some of these challenges. This effort is possible through large scale collaborative research and data sharing across multiple centers. In addition, TBI causes dynamic deficits in multiple domains, and thus, a panel of biomarkers combining these measures to consider different deficits is more promising than a single biomarker for TBI. In this review, each of these tools are presented along with the clinical and pre-clinical findings, advantages, challenges and prospects of translating the pre-clinical knowledge into the human clinical setting.
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Affiliation(s)
- Marzieh Hajiaghamemar
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
| | - Morteza Seidi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - R Anna Oeur
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
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20
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Fickling SD, Smith AM, Ghosh Hajra S, Liu CC, Song X, Stuart MJ, D'Arcy RCN. Reply: P300 amplitudes after concussions are usually decreased not increased. Brain 2019; 142:e33. [PMID: 31203375 DOI: 10.1093/brain/awz147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shaun D Fickling
- Faculty of Applied Sciences, Simon Fraser University, Metro Vancouver, BC, Canada
| | - Aynsley M Smith
- Department of Physical Medicine and Rehabilitation, Sports Medicine Center, Mayo Clinic, Rochester, MN, USA.,Department of Orthopedic Surgery, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
| | - Sujoy Ghosh Hajra
- Faculty of Applied Sciences, Simon Fraser University, Metro Vancouver, BC, Canada
| | - Careesa C Liu
- Faculty of Applied Sciences, Simon Fraser University, Metro Vancouver, BC, Canada
| | - Xiaowei Song
- Faculty of Applied Sciences, Simon Fraser University, Metro Vancouver, BC, Canada.,Health Sciences and Innovation, Surrey Memorial Hospital, Fraser Health, Metro Vancouver, BC, Canada
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
| | - Ryan C N D'Arcy
- Faculty of Applied Sciences, Simon Fraser University, Metro Vancouver, BC, Canada.,Health Sciences and Innovation, Surrey Memorial Hospital, Fraser Health, Metro Vancouver, BC, Canada.,HealthTech Connex Inc, Surrey, BC, Canada
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21
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Theta-Band Functional Connectivity and Single-Trial Cognitive Control in Sports-Related Concussion: Demonstration of Proof-of-Concept for a Potential Biomarker of Concussion. J Int Neuropsychol Soc 2019; 25:314-323. [PMID: 30681045 DOI: 10.1017/s135561771800108x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This report examined theta-band neurodynamics for potential biomarkers of brain health in athletes with concussion. METHODS Participants included college-age contact/collision athletes with (N=24) and without a history of concussion (N=16) in Study 1. Study 2 (N=10) examined changes over time in contact/collision athletes. There were two primary dependent variables: (1) theta-band phase-synchronization (e.g., functional connectivity) between medial and right-lateral electrodes; and (2) the within-subject correlation between synchronization strength on error trials and post-error reaction time (i.e., operationalization of cognitive control). RESULTS Head injury history was inversely related with medial-lateral connectivity. Head injury was also related to declines in a neurobehavioral measure of cognitive control (i.e., the single-trial relationship between connectivity and post-error slowing). CONCLUSIONS Results align with a theory of connectivity-mediated cognitive control. Mild injuries undetectable by behavioral measures may still be apparent on direct measures of neural functioning. This report demonstrates that connectivity and cognitive control measures may be useful for tracking recovery from concussion. Theoretically relevant neuroscientific findings in healthy adults may have applications in patient populations, especially with regard to monitoring brain health. (JINS 2019, 25, 314-323).
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22
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Sensitivity of the Cogstate Test Battery for Detecting Prolonged Cognitive Alterations Stemming From Sport-Related Concussions. Clin J Sport Med 2019; 29:62-68. [PMID: 29023272 DOI: 10.1097/jsm.0000000000000492] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if the Cogstate test battery contains the requisite sensitivity to detect prolonged cognitive alterations. METHODS One hundred twenty collegiate athletes (71 with a history of concussion; 49 controls) completed the Cogstate test battery, to which we added a 2-back condition. In addition to the Cogstate clinical (transformed variables), we analyzed the raw data. RESULTS The clinical variables failed to reveal any group differences. Further, although the raw data failed to reveal group differences for tasks measuring lower-level cognition, group differences were observed for accuracy on the 1- and 2-back tasks, which require multiple aspects of higher cognition. The overall classification accuracy was higher using the raw data than the clinical variables. The combined sensitivity of the 1- and 2-back task was moderate and specificity was high. CONCLUSIONS These results suggest that using the raw scores over clinical variables increases the sensitivity of the test battery. Moreover, these results add another piece of evidence suggesting that concussive injuries are associated with subtle long-term alterations in aspects of higher cognition. Importantly, these deficits would have gone unobserved if we had relied solely on automated clinical variables. The current results further our scientific understanding of concussion and may be used to advance clinical practices.
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23
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Moore RD, Sicard V, Pindus D, Raine LB, Drollette ES, Scudder MR, Decker S, Ellemberg D, Hillman CH. A targeted neuropsychological examination of children with a history of sport-related concussion. Brain Inj 2018; 33:291-298. [PMID: 30427210 DOI: 10.1080/02699052.2018.1546408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Experimental research suggests that sport-related concussion can lead to persistent alterations in children's neurophysiology and cognition. However, the search for neuropsychological tests with a similar ability to detect long-term deficits continues. PRIMARY OBJECTIVE The current study assessed whether a target battery of neuropsychological measures of higher cognition and academic achievement would detect lingering deficits in children 2 years after injury. RESEARCH DESIGN Cross-sectional. METHODS AND PROCEDURE A total of 32 pre-adolescent children (16 concussion history, 16 control) completed a targeted battery of neuropsychological and academic tests. MAIN OUTCOMES AND RESULTS Children with a history of concussion exhibited selective deficits during the Raven's Coloured Progressive Matrices, Comprehensive Trail-Making Test, and the mathematics sub-section of the WRAT-3. Deficit magnitude was significantly related to age at injury, but not time since injury. CONCLUSIONS The current results suggest that neuropsychological measures of higher cognition and academic achievement may be sensitive to lingering deficits, and that children injured earlier in life may exhibit worse neuropsychological and academic performance.
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Affiliation(s)
- R D Moore
- a Arnold School of Public Health , University of South Carolina , Columbia , SC , USA
| | - V Sicard
- b Department of Kinesiology , Université de Montréal , Montreal , QC , Canada.,c Centre de recherche en neuropsychologie et cognition , Université de Montréal , Montreal , QC , Canada
| | - D Pindus
- d College of Science , Northeastern University , Boston , MA , USA
| | - L B Raine
- d College of Science , Northeastern University , Boston , MA , USA
| | - E S Drollette
- e Department of Kinsiology School of Health and Human Sciences , University of North Carolina-Greensboro , Greensboro , NC , USA
| | - M R Scudder
- f Departement of Psychiatry , University of Pittsburgh , Pittsburgh , PA , USA
| | - S Decker
- g Department of Psychology , University of South Carolina , Columbia , SC , USA
| | - D Ellemberg
- b Department of Kinesiology , Université de Montréal , Montreal , QC , Canada.,c Centre de recherche en neuropsychologie et cognition , Université de Montréal , Montreal , QC , Canada
| | - C H Hillman
- h Department of Kinesiology and Community Health , College of Applied Health Sciences, Univeristy of Illinois at Urbana-Champaign , Champaign , IL , USA
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24
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Geraldo A, Azeredo A, Pasion R, Dores AR, Barbosa F. Fostering advances to neuropsychological assessment based on the Research Domain Criteria: The bridge between cognitive functioning and physiology. Clin Neuropsychol 2018; 33:327-356. [DOI: 10.1080/13854046.2018.1523467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Andreia Geraldo
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- School of Health, Institute Polytechnic of Porto, Porto, Portugal
| | - Andreia Azeredo
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Rita Pasion
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Artemisa Rocha Dores
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- School of Health, Institute Polytechnic of Porto, Porto, Portugal
| | - Fernando Barbosa
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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25
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The long-term outcomes of sport-related concussion in pediatric populations. Int J Psychophysiol 2018; 132:14-24. [DOI: 10.1016/j.ijpsycho.2018.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/08/2018] [Accepted: 04/04/2018] [Indexed: 12/14/2022]
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26
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Herman DC, Jones D, Harrison A, Moser M, Tillman S, Farmer K, Pass A, Clugston JR, Hernandez J, Chmielewski TL. Concussion May Increase the Risk of Subsequent Lower Extremity Musculoskeletal Injury in Collegiate Athletes. Sports Med 2018; 47:1003-1010. [PMID: 27544666 DOI: 10.1007/s40279-016-0607-9] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laboratory-based studies on neuromuscular control after concussion and epidemiological studies suggest that concussion may increase the risk of subsequent musculoskeletal injury. OBJECTIVE The purpose of this study was to determine if athletes have an increased risk of lower extremity musculoskeletal injury after return to play from a concussion. METHODS Injury data were collected from 2006 to 2013 for men's football and for women's basketball, soccer and lacrosse at a National Collegiate Athletic Association Division I university. Ninety cases of in-season concussion in 73 athletes (52 male, 21 female) with return to play at least 30 days prior to the end of the season were identified. A period of up to 90 days of in-season competition following return to play was reviewed for time-loss injury. The same period was studied in up to two control athletes who had no concussion within the prior year and were matched for sport, starting status and position. RESULTS Lower extremity musculoskeletal injuries occurred at a higher rate in the concussed athletes (45/90 or 50 %) than in the non-concussed athletes (30/148 or 20 %; P < 0.01). The odds of sustaining a musculoskeletal injury were 3.39 times higher in the concussed athletes (95 % confidence interval 1.90-6.05; P < 0.01). Overall, the number of days lost because of injury was similar between concussed and non-concussed athletes (median 9 versus 15; P = 0.41). CONCLUSIONS The results of this study demonstrate a relationship between concussion and an increased risk of lower extremity musculoskeletal injury after return to play, and may have implications for current medical practice standards regarding evaluation and management of concussion injuries.
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Affiliation(s)
- Daniel C Herman
- Department of Orthopaedics and Rehabilitation, University of Florida, PO Box 112727, Gainesville, FL, 32611, USA.
| | - Debi Jones
- UF Health Rehab Center, Orthopaedics and Sports Medicine Institute, Gainesville, FL, USA
| | | | - Michael Moser
- Department of Orthopaedics and Rehabilitation, University of Florida, PO Box 112727, Gainesville, FL, 32611, USA.,University of Florida Athletic Association, University of Florida, Gainesville, FL, USA
| | - Susan Tillman
- UF Health Rehab Center, Orthopaedics and Sports Medicine Institute, Gainesville, FL, USA
| | - Kevin Farmer
- Department of Orthopaedics and Rehabilitation, University of Florida, PO Box 112727, Gainesville, FL, 32611, USA.,University of Florida Athletic Association, University of Florida, Gainesville, FL, USA
| | | | - James R Clugston
- University of Florida Athletic Association, University of Florida, Gainesville, FL, USA.,Department of Community Health and Family Medicine, Student Health Care Center, University of Florida, Gainesville, FL, USA
| | - Jorge Hernandez
- College of Veterinary Sciences, University of Florida, Gainesville, FL, USA
| | - Terese L Chmielewski
- TRIA Orthopedic Center, Bloomington, MN, USA.,Department of Physical Therapy, University of Florida, Gainesville, FL, USA
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27
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Schmidt J, Hayward KS, Brown KE, Zwicker JG, Ponsford J, van Donkelaar P, Babul S, Boyd LA. Imaging in Pediatric Concussion: A Systematic Review. Pediatrics 2018; 141:peds.2017-3406. [PMID: 29678928 DOI: 10.1542/peds.2017-3406] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Pediatric mild traumatic brain injury (mTBI) is a common and poorly understood injury. Neuroimaging indexes brain injury and outcome after pediatric mTBI, but remains largely unexplored. OBJECTIVE To investigate the differences in neuroimaging findings in children/youth with mTBI. Measures of behavior, symptoms, time since injury, and age at injury were also considered. DATA SOURCES A systematic review was conducted up to July 6, 2016. STUDY SELECTION Studies were independently screened by 2 authors and included if they met predetermined eligibility criteria: (1) children/youth (5-18 years of age), (2) diagnosis of mTBI, and (3) use of neuroimaging. DATA EXTRACTION Two authors independently appraised study quality and extracted demographic and outcome data. RESULTS Twenty-two studies met the eligibility criteria, involving 448 participants with mTBI (mean age = 12.7 years ± 2.8). Time postinjury ranged from 1 day to 5 years. Seven different neuroimaging methods were investigated in included studies. The most frequently used method, diffusion tensor imaging (41%), had heterogeneous findings with respect to the specific regions and tracts that showed group differences. However, group differences were observed in many regions containing the corticospinal tract, portions of the corpus callosum, or frontal white-matter regions; fractional anisotropy was increased in 88% of the studies. LIMITATIONS This review included a heterogeneous sample with regard to participant ages, time since injury, symptoms, and imaging methods which prevented statistical pooling/modelling. CONCLUSIONS These data highlight essential priorities for future research (eg, common data elements) that are foundational to progress the understanding of pediatric concussion.
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Affiliation(s)
- Julia Schmidt
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada; .,School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Kathryn S Hayward
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,Florey Institute of Neuroscience and Mental Health, National Health and Medical Research Council and University of Melbourne, Parkville, Australia.,Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Katlyn E Brown
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Jill G Zwicker
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada; and
| | | | - Paul van Donkelaar
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Shelina Babul
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada; and
| | - Lara A Boyd
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
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28
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Olson RL, Brush CJ, Ehmann PJ, Buckman JF, Alderman BL. A history of sport-related concussion is associated with sustained deficits in conflict and error monitoring. Int J Psychophysiol 2018; 132:145-154. [PMID: 29355581 DOI: 10.1016/j.ijpsycho.2018.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 11/19/2017] [Accepted: 01/11/2018] [Indexed: 12/22/2022]
Abstract
Previous research has demonstrated long-term deficits in neurocognitive function in individuals with a history of sport-related concussion. The purpose of this study was to examine the relationship between a history of concussion and behavioral and event-related potential (ERP) indices of pre- and post-response conflict and error monitoring. A secondary aim was to determine whether years of high risk sport participation were related to impairments in these cognitive control processes. Forty-seven former athletes (age = 20.8 ± 2.2 years) with (n = 25; 5 females) and without (n = 22; 9 females) a history of concussion completed a modified flanker task while behavioral performance, N2, error-related negativity (ERN), and error positivity (Pe) components were assessed. An increase in post-response error-related (ERN) brain activity and a nonsignificant trend of increased pre-response conflict (N2) was observed in individuals with a prior sport-related concussion relative to non-concussed controls; however, no behavioral performance differences were found between groups. No significant associations were found between ERP and behavioral measures and the number of years of high-risk sport participation; however, time since last head injury was associated with shorter N2 latency. Together, these findings suggest a persistent impairment in cognitive control and error-related processing in individuals with a history of concussion. These findings are interpreted within the framework of the compensatory error-monitoring hypothesis.
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Affiliation(s)
- Ryan L Olson
- Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, TX, USA
| | - Christopher J Brush
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Peter J Ehmann
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Jennifer F Buckman
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Brandon L Alderman
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.
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29
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Stockbridge MD, Doran A, King K, Newman RS. The effects of concussion on rapid picture naming in children. Brain Inj 2018; 32:506-514. [DOI: 10.1080/02699052.2018.1429660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Melissa D Stockbridge
- Department of Hearing and Speech Sciences, University of Maryland, College Park, MD, USA
| | - Anthony Doran
- HeadFirst Sports Injury and Concussion Care, Waugh Chapel, MD, USA
| | | | - Rochelle S Newman
- Department of Hearing and Speech Sciences, University of Maryland, College Park, MD, USA
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30
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Guth T, Ketcham CJ, Hall EE. Influence of Concussion History and Genetics on Event-Related Potentials in Athletes: Potential Use in Concussion Management. Sports (Basel) 2018; 6:E5. [PMID: 29910309 PMCID: PMC5969191 DOI: 10.3390/sports6010005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/14/2018] [Accepted: 01/15/2018] [Indexed: 11/17/2022] Open
Abstract
Sports-related concussions are an increasing public health issue with much concern about the possible long-term decrements in cognitive function and quality of life that may occur in athletes. The measurement of cognitive function is a common component of concussion management protocols due to cognitive impairments that occur after sustaining a concussion; however, the tools that are often used may not be sensitive enough to expose long term problems with cognitive function. The current paper is a brief review, which suggests that measuring cognitive processing through the use of event related potentials (ERPs) may provide a more sensitive assessment of cognitive function, as shown through recent research showing concussion history to influence ERPs components. The potential influence of genetics on cognitive function and ERPs components will also be discussed in relation to future concussion management.
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Affiliation(s)
- Taylor Guth
- College of Science, University of Notre Dame, Notre Dame, IN 46556, USA.
| | - Caroline J Ketcham
- Department of Exercise Science, Elon University, 2525 Campus Box, Elon, NC 27244, USA.
| | - Eric E Hall
- Department of Exercise Science, Elon University, 2525 Campus Box, Elon, NC 27244, USA.
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31
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Brush CJ, Ehmann PJ, Olson RL, Bixby WR, Alderman BL. Do sport-related concussions result in long-term cognitive impairment? A review of event-related potential research. Int J Psychophysiol 2017; 132:124-134. [PMID: 29054540 DOI: 10.1016/j.ijpsycho.2017.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 01/05/2023]
Abstract
Sport-related concussions have become a major public health concern although the long-term effects on cognitive function remain largely unknown. Event-related potentials (ERPs) are ideal for studying the long-term impact of sport-related concussions, as they have excellent temporal precision and provide insight that cannot be obtained from behavioral or neuropsychological measures alone. We reviewed all available published studies that have used stimulus or response-locked ERPs to document cognitive control processes in individuals with a history of concussion. Collectively, cross-sectional evidence suggests consistent reductions in P3 amplitude in previously concussed individuals, as well as a possible impairment in cognitive processing speed (P3 latency) and error monitoring processes (ERN). The persistent neurophysiological changes found may be related to the number of previous concussions sustained and the time since injury. Future studies incorporating prospective research designs are warranted before definitive statements can be offered regarding the long-term impact of sport-related concussions on cognitive control.
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Affiliation(s)
- Christopher J Brush
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Peter J Ehmann
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Ryan L Olson
- Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, TX, USA
| | - Walter R Bixby
- Department of Exercise Science, Elon University, Elon, NC, USA
| | - Brandon L Alderman
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.
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32
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Hudac CM, Cortesa CS, Ledwidge PS, Molfese DL. History of concussion impacts electrophysiological correlates of working memory. Int J Psychophysiol 2017; 132:135-144. [PMID: 29024682 DOI: 10.1016/j.ijpsycho.2017.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 09/12/2017] [Accepted: 09/25/2017] [Indexed: 01/26/2023]
Abstract
Sports-related concussions occur in approximately 21% of college athletes with implications for long-term cognitive impairments in working memory. Working memory involves the capacity to maintain short-term information and integrate with higher-order cognitive processing for planning and behavior execution, critical skills for optimal cognitive and athletic performance. This study quantified working memory impairments in 36 American football college athletes (18-23years old) using event-related potentials (ERPs). Despite performing similarly in a standard 2-back working memory task, athletes with history of concussion exhibited larger P1 and P3 amplitudes compared to Controls. Concussion History group latencies were slower for the P1 and faster for the N2. Source estimation analyses indicated that previously concussed athletes engaged different brain regions compared to athletes with no concussion history. These findings suggest that ERPs may be a sensitive and objective measure to detect long-term cognitive consequences of concussion.
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Affiliation(s)
- Caitlin M Hudac
- Department of Psychology, University of Nebraska-Lincoln, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, United States.
| | - Cathryn S Cortesa
- Department of Psychology, University of Nebraska-Lincoln, United States; Department of Cognitive Science, Johns Hopkins University, United States.
| | - Patrick S Ledwidge
- Department of Psychology, University of Nebraska-Lincoln, United States; Center for Brain, Biology, & Behavior, University of Nebraska-Lincoln, United States; Department of Psychology, Baldwin Wallace University, United States
| | - Dennis L Molfese
- Department of Psychology, University of Nebraska-Lincoln, United States; Center for Brain, Biology, & Behavior, University of Nebraska-Lincoln, United States.
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33
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Martini DN, Broglio SP. Long-term effects of sport concussion on cognitive and motor performance: A review. Int J Psychophysiol 2017; 132:25-30. [PMID: 29017781 DOI: 10.1016/j.ijpsycho.2017.09.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 09/14/2017] [Accepted: 09/25/2017] [Indexed: 02/05/2023]
Abstract
Motor and cognitive dysfunction is intractable sequela in the acute stage of concussion. While typical concussion recovery occurs in two weeks, empirical evidence suggests that some sequela persist beyond this period, though there is inconsistency surrounding the duration the sequela persist. In part, confusion around the issue is limited by the volume of literature evaluating those with a concussion history, permitting vast interpretations of significance. The purpose of this paper is to review the concussion history literature, summarizing the long-term effects of concussion history on motor and cognitive performance. Additionally, this review intends to provide direction and options of future investigations addressing the long-term effects of concussion on motor and cognitive performance.
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Affiliation(s)
- Douglas N Martini
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States.
| | - Steven P Broglio
- NeuroTrauma Research Laboratory, University of Michigan, School of Kinesiology, Ann Arbor, MI, United States
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34
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Alsalaheen B, Stockdale K, Pechumer D, Giessing A, He X, Broglio SP. Cumulative Effects of Concussion History on Baseline Computerized Neurocognitive Test Scores: Systematic Review and Meta-analysis. Sports Health 2017; 9:324-332. [PMID: 28661827 PMCID: PMC5496709 DOI: 10.1177/1941738117713974] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Context: It is unclear whether individuals with a history of single or multiple clinically recovered concussions exhibit worse cognitive performance on baseline testing compared with individuals with no concussion history. Objective: To analyze the effects of concussion history on baseline neurocognitive performance using a computerized neurocognitive test. Data sources: PubMed, CINAHL, and psycINFO were searched in November 2015. The search was supplemented by a hand search of references. Study Selection: Studies were included if participants completed the Immediate Post-concussion Assessment and Cognitive Test (ImPACT) at baseline (ie, preseason) and if performance was stratified by previous history of single or multiple concussions. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 2. Data Extraction: Sample size, demographic characteristics of participants, as well as performance of participants on verbal memory, visual memory, visual-motor processing speed, and reaction time were extracted from each study. Results: A random-effects pooled meta-analysis revealed that, with the exception of worsened visual memory for those with 1 previous concussion (Hedges g = 0.10), no differences were observed between participants with 1 or multiple concussions compared with participants without previous concussions. Conclusion: With the exception of decreased visual memory based on history of 1 concussion, history of 1 or multiple concussions was not associated with worse baseline cognitive performance.
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Affiliation(s)
- Bara Alsalaheen
- Department of Physical Therapy, University of Michigan-Flint, Flint, Michigan.,Department of Neurology, University of Michigan, Ann Arbor, Michigan.,Michigan NeuroSport, University of Michigan Health System, Ann Arbor, Michigan
| | - Kayla Stockdale
- Department of Physical Therapy, University of Michigan-Flint, Flint, Michigan
| | - Dana Pechumer
- Department of Physical Therapy, University of Michigan-Flint, Flint, Michigan
| | | | - Xuming He
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Steven P Broglio
- Neurotrauma Research Laboratory, University of Michigan, Ann Arbor, Michigan
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35
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Pabian PS, Oliveira L, Tucker J, Beato M, Gual C. Interprofessional management of concussion in sport. Phys Ther Sport 2017; 23:123-132. [DOI: 10.1016/j.ptsp.2016.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/12/2016] [Accepted: 09/07/2016] [Indexed: 12/14/2022]
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36
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Ledwidge PS, Molfese DL. Long-Term Effects of Concussion on Electrophysiological Indices of Attention in Varsity College Athletes: An Event-Related Potential and Standardized Low-Resolution Brain Electromagnetic Tomography Approach. J Neurotrauma 2016; 33:2081-2090. [PMID: 27025905 PMCID: PMC5124753 DOI: 10.1089/neu.2015.4251] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study investigated the effects of a past concussion on electrophysiological indices of attention in college athletes. Forty-four varsity football athletes (22 with at least one past concussion) participated in three neuropsychological tests and a two-tone auditory oddball task while undergoing high-density event-related potential (ERP) recording. Athletes previously diagnosed with a concussion experienced their most recent injury approximately 4 years before testing. Previously concussed and control athletes performed equivalently on three neuropsychological tests. Behavioral accuracy and reaction times on the oddball task were also equivalent across groups. However, athletes with a concussion history exhibited significantly larger N2 and P3b amplitudes and longer P3b latencies. Source localization using standardized low-resolution brain electromagnetic tomography indicated that athletes with a history of concussion generated larger electrical current density in the left inferior parietal gyrus compared to control athletes. These findings support the hypothesis that individuals with a past concussion recruit compensatory neural resources in order to meet executive functioning demands. High-density ERP measures combined with source localization provide an important method to detect long-term neural consequences of concussion in the absence of impaired neuropsychological performance.
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Affiliation(s)
- Patrick S. Ledwidge
- Department of Psychology, University of Nebraska–Lincoln, Lincoln, Nebraska
- Center for Brain, Biology, and Behavior, University of Nebraska–Lincoln, Lincoln, Nebraska
| | - Dennis L. Molfese
- Department of Psychology, University of Nebraska–Lincoln, Lincoln, Nebraska
- Center for Brain, Biology, and Behavior, University of Nebraska–Lincoln, Lincoln, Nebraska
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37
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Moore RD, Lepine J, Ellemberg D. The independent influence of concussive and sub-concussive impacts on soccer players' neurophysiological and neuropsychological function. Int J Psychophysiol 2016; 112:22-30. [PMID: 27867100 DOI: 10.1016/j.ijpsycho.2016.11.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/27/2016] [Accepted: 11/11/2016] [Indexed: 11/27/2022]
Abstract
Accumulating research demonstrates that repetitive sub-concussive impacts can alter the structure, function and connectivity of the brain. However, the functional significance of these alterations as well as the independent contribution of concussive and sub-concussive impacts to neurophysiological and neuropsychological health are unclear. Accordingly, we compared the neurophysiological and neuropsychological function of contact athletes with (concussion group) and without (sub-concussion group) a history of concussion, to non-contact athletes. We evaluated event-related brain potentials (ERPs) elicited during an oddball task and performance on a targeted battery of neuropsychological tasks. Athletes in the sub-concussion and concussion groups exhibited similar amplitude reductions in the ERP indices of attentional resource allocation (P3b) and attentional orienting (P3a) relative to non-contact athletes. However, only athletes in the concussion group exhibited reduced amplitude in the ERP index of perceptual attention (N1). Athletes in the sub-concussion and concussion groups also exhibited deficits in memory recall relative to non-contact athletes, but athletes in the concussion group also exhibited significantly more recall errors than athletes in the sub-concussion group. Additionally, only athletes in the concussion group exhibited response delays during the oddball task. The current findings suggest that sub-concussive impacts are associated with alterations in the neurophysiological and neuropsychological indices of essential cognitive functions, albeit to a lesser degree than the combination of sub-concussive and concussive impacts.
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Affiliation(s)
- R Davis Moore
- University of South Carolina, Arnold School of Public Health, 921 Assembly Street, Columbia, SC 29201, USA.
| | - Julien Lepine
- Université de Montréal, Départment de Kinésiologie, 100 boul. Édouard-Montpetit, Montréal, Québec H3T 1J4, Canada.
| | - Dave Ellemberg
- Université de Montréal, Départment de Kinésiologie, 100 boul. Édouard-Montpetit, Montréal, Québec H3T 1J4, Canada.
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38
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The persistent influence of concussion on attention, executive control and neuroelectric function in preadolescent children. Int J Psychophysiol 2016; 99:85-95. [DOI: 10.1016/j.ijpsycho.2015.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/02/2015] [Accepted: 11/18/2015] [Indexed: 11/23/2022]
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39
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The association between a history of concussion and variability in behavioral and neuroelectric indices of cognition. Int J Psychophysiol 2015; 98:426-34. [DOI: 10.1016/j.ijpsycho.2015.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/21/2015] [Accepted: 08/24/2015] [Indexed: 11/23/2022]
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