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Griffith O, Fornini R, Walter AE, Wilkes J, Bai X, Slobounov SM. Comorbidity of concussion and depression alters brain functional connectivity in collegiate student-athletes. Brain Res 2024; 1845:149200. [PMID: 39197571 DOI: 10.1016/j.brainres.2024.149200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 08/19/2024] [Accepted: 08/25/2024] [Indexed: 09/01/2024]
Abstract
Depression and concussion are highly prevalent neuropsychological disorders that often occur simultaneously. However, due to the high degree of symptom overlap between the two events, including but not limited to headache, sleep disturbances, appetite changes, fatigue, and difficulty concentrating, they may be treated in isolation. Thus, clinical awareness of additive symptom load may be missed. This study measures neuropsychological and electroencephalography (EEG) alpha band coherence differences in collegiate student-athletes with history of comorbid depression and concussion, in comparison to those with a single morbidity and healthy controls (HC). 35 collegiate athletes completed neuropsychological screenings and EEG measures. Participants were grouped by concussion and depression history. Differences in alpha band coherence were calculated using two-way ANOVA with post hoc correction for multiple comparisons. Comorbid participants scored significantly worse on neuropsychological screening, BDI-FS, and PCSS than those with a single morbidity and HC. Two-way ANOVA by group revealed significant main effects of alpha band coherence for concussion, depression, and their interaction term. Post-hoc analysis showed that comorbid participants had more abnormal alpha band coherence than single morbidity, when compared to HC. Comorbidity of concussion and depression increased symptom reporting and revealed more altered alpha band coherence than single morbidity, compared to HC. The abnormalities of the comorbid group exclusively showed decreased alpha band coherence in comparison to healthy controls. The comorbidity of depression and SRC has a compounding effect on depression symptoms, post-concussion symptoms, and brain functional connectivity. This research demonstrates a promising objective measure in comorbid individuals, previously only measured via subjective symptom reporting.
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Affiliation(s)
- Owen Griffith
- Department of Kinesiology, Penn State University, 19 Recreation Building, University Park, PA 16802, USA.
| | - Robert Fornini
- College of Osteopathic Medicine, University of New England, 11 Hills Beach Road, Biddeford, ME 04005, USA.
| | - Alexa E Walter
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19103, USA.
| | - James Wilkes
- Department of Kinesiology, Penn State University, 19 Recreation Building, University Park, PA 16802, USA.
| | - Xiaoxiao Bai
- Social, Life, and Engineering Sciences Imaging Center, Social Science Research Institute, Penn State University, 120F Chandlee Laboratory, University Park, PA 16802, USA.
| | - S M Slobounov
- Department of Kinesiology, Penn State University, 19 Recreation Building, University Park, PA 16802, USA.
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2
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Hagen AC, Tracy BL, Stephens JA. Altered neural recruitment despite dual task performance recovery in athletes with repeat concussion. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.19.24312271. [PMID: 39228732 PMCID: PMC11370505 DOI: 10.1101/2024.08.19.24312271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Sports-related concussions (SRCs) pose significant challenges to college-aged athletes, eliciting both immediate symptoms and subacute cognitive and motor function impairment. While most symptoms and impairments resolve within weeks, athletes with repeat SRCs may experience heightened risk for prolonged recovery trajectories, future musculoskeletal injuries, and long-term neurocognitive deficits. This includes impaired dual task performance and altered neurophysiology that could persist across the lifespan and elicit future pathophysiology and neurodegeneration. Thus, it is imperative to improve our understanding of neurophysiology after SRC. This study aimed to investigate the impact of repeat SRCs on dual task performance and associated neural recruitment using functional near-infrared spectroscopy (fNIRS). A total of 37 college-aged athletes (ages 18-24) participated in this cross-sectional observational study. Among these athletes, 20 had a history of two or more SRCs, while 17 had never sustained a SRC and served as controls. Participants completed the Neuroimaging-Compatible Dual Task Screen (NC-DTS) while fNIRS measured neural recruitment in the frontoparietal attention network and the primary motor and sensory cortices. Behavioral analysis revealed that athletes with repeat SRCs exhibited comparable single task and dual task performance to control athletes. Additionally, dual task effects (DTE), which capture performance declines in dual tasks versus single tasks, did not significantly differ between groups. Notably, the cohort of athletes with repeat SRC in this study had a longer time since their last SRC (mean = 1.75 years) than majority of previous SRC studies. Neuroimaging results indicated altered neural recruitment patterns in athletes with multiple repeat SRCs during both single and dual tasks. Specifically, athletes with repeat SRCs demonstrated increased prefrontal cortex (PFC) activation during single motor tasks compared to controls (P < 0.001, d = 0.47). Conversely, during dual tasks, these same athletes exhibited reduced PFC activation (P < 0.001, d = 0.29) and primary motor cortex (M1) activation (P = 0.038, d = 0.16) compared to their single task activation. These findings emphasize the complex relationship between SRC history, dual task performance, and changes in neurophysiology. While athletes with repeat SRCs demonstrate recovery in behavioral dual task performance, persistent alterations in neural recruitment patterns suggest ongoing neurophysiological changes, possibly indicating compensatory neural strategies and inefficient neural resource allocation, even beyond symptom resolution and medical clearance. Understanding the compensatory neural recruitment strategies that support behavioral performance following repeat SRCs can inform return-to-play decisions, future musculoskeletal injury risk, and the long-term impact of SRCs on neurocognitive function.
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Affiliation(s)
- Andrew C Hagen
- Department of Health and Exercise Science, Colorado State University, Fort Collins CO, 80523, USA
| | - Brian L Tracy
- Department of Health and Exercise Science, Colorado State University, Fort Collins CO, 80523, USA
| | - Jaclyn A Stephens
- Department of Health and Exercise Science, Colorado State University, Fort Collins CO, 80523, USA
- Molecular Cellular and Integrative Neurosciences Program, Colorado State University, Fort Collins, CO, 80523
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3
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Li X, Qu X, Shi K, Yang Y, Sun J. Physical exercise for brain plasticity promotion an overview of the underlying oscillatory mechanism. Front Neurosci 2024; 18:1440975. [PMID: 39176382 PMCID: PMC11338794 DOI: 10.3389/fnins.2024.1440975] [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: 05/30/2024] [Accepted: 07/26/2024] [Indexed: 08/24/2024] Open
Abstract
The global recognition of the importance of physical exercise (PE) for human health has resulted in increased research on its effects on cortical activity. Neural oscillations, which are prominent features of brain activity, serve as crucial indicators for studying the effects of PE on brain function. Existing studies support the idea that PE modifies various types of neural oscillations. While EEG-related literature in exercise science exists, a comprehensive review of the effects of exercise specifically in healthy populations has not yet been conducted. Given the demonstrated influence of exercise on neural plasticity, particularly cortical oscillatory activity, it is imperative to consolidate research on this phenomenon. Therefore, this review aims to summarize numerous PE studies on neuromodulatory mechanisms in the brain over the past decade, covering (1) effects of resistance and aerobic training on brain health via neural oscillations; (2) how mind-body exercise affects human neural activity and cognitive functioning; (3) age-Related effects of PE on brain health and neurodegenerative disease rehabilitation via neural oscillation mechanisms; and (4) conclusion and future direction. In conclusion, the effect of PE on cortical activity is a multifaceted process, and this review seeks to comprehensively examine and summarize existing studies' understanding of how PE regulates neural activity in the brain, providing a more scientific theoretical foundation for the development of personalized PE programs and further research.
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Affiliation(s)
| | | | - Kaixuan Shi
- Physical Education Department, China University of Geosciences Beijing, Beijing, China
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Nwakamma MC, Stillman AM, Gabard-Durnam LJ, Cavanagh JF, Hillman CH, Morris TP. Slowing of Parameterized Resting-State Electroencephalography After Mild Traumatic Brain Injury. Neurotrauma Rep 2024; 5:448-461. [PMID: 38666007 PMCID: PMC11044859 DOI: 10.1089/neur.2024.0004] [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] [Indexed: 04/28/2024] Open
Abstract
Reported changes in electroencephalography (EEG)-derived spectral power after mild traumatic brain injury (mTBI) remains inconsistent across existing literature. However, this may be a result of previous analyses depending solely on observing spectral power within traditional canonical frequency bands rather than accounting for the aperiodic activity within the collected neural signal. Therefore, the aim of this study was to test for differences in rhythmic and arrhythmic time series across the brain, and in the cognitively relevant frontoparietal (FP) network, and observe whether those differences were associated with cognitive recovery post-mTBI. Resting-state electroencephalography (rs-EEG) was collected from 88 participants (56 mTBI and 32 age- and sex-matched healthy controls) within 14 days of injury for the mTBI participants. A battery of executive function (EF) tests was collected at the first session with follow-up metrics collected approximately 2 and 4 months after the initial visit. After spectral parameterization, a significant between-group difference in aperiodic-adjusted alpha center peak frequency within the FP network was observed, where a slowing of alpha peak frequency was found in the mTBI group in comparison to the healthy controls. This slowing of week 2 (collected within 2 weeks of injury) aperiodic-adjusted alpha center peak frequency within the FP network was associated with increased EF over time (evaluated using executive composite scores) post-mTBI. These findings suggest alpha center peak frequency within the FP network as a candidate prognostic marker of EF recovery and may inform clinical rehabilitative methods post-mTBI.
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Affiliation(s)
- Mark C. Nwakamma
- Department of Physical Therapy Human Movement Sciences, Northeastern University, Boston, Massachusetts, USA
- Center for Cognitive and Brain Health, Northeastern University, Boston, Massachusetts, USA
| | - Alexandra M. Stillman
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Laurel J. Gabard-Durnam
- Department of Psychology, Northeastern University, Boston, Massachusetts, USA
- Center for Cognitive and Brain Health, Northeastern University, Boston, Massachusetts, USA
| | - James F. Cavanagh
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Charles H. Hillman
- Department of Physical Therapy Human Movement Sciences, Northeastern University, Boston, Massachusetts, USA
- Department of Psychology, Northeastern University, Boston, Massachusetts, USA
- Center for Cognitive and Brain Health, Northeastern University, Boston, Massachusetts, USA
| | - Timothy P. Morris
- Department of Physical Therapy Human Movement Sciences, Northeastern University, Boston, Massachusetts, USA
- Center for Cognitive and Brain Health, Northeastern University, Boston, Massachusetts, USA
- Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA
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5
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Hadi Z, Mahmud M, Seemungal BM. Brain Mechanisms Explaining Postural Imbalance in Traumatic Brain Injury: A Systematic Review. Brain Connect 2024; 14:144-177. [PMID: 38343363 DOI: 10.1089/brain.2023.0064] [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] [Indexed: 03/27/2024] Open
Abstract
Introduction: Persisting imbalance and falls in community-dwelling traumatic brain injury (TBI) survivors are linked to reduced long-term survival. However, a detailed understanding of the impact of TBI upon the brain mechanisms mediating imbalance is lacking. To understand the state of the art concerning the brain mechanisms mediating imbalance in TBI, we performed a systematic review of the literature. Methods: PubMed, Web of Science, and Scopus were searched and peer-reviewed research articles in humans, with any severity of TBI (mild, moderate, severe, or concussion), which linked a postural balance assessment (objective or subjective) with brain imaging (through computed tomography, T1-weighted imaging, functional magnetic resonance imaging [fMRI], resting-state fMRI, diffusion tensor imaging, magnetic resonance spectroscopy, single-photon emission computed tomography, electroencephalography, magnetoencephalography, near-infrared spectroscopy, and evoked potentials) were included. Out of 1940 articles, 60 were retrieved and screened, and 25 articles fulfilling inclusion criteria were included. Results: The most consistent finding was the link between imbalance and the cerebellum; however, the regions within the cerebellum were inconsistent. Discussion: The lack of consistent findings could reflect that imbalance in TBI is due to a widespread brain network dysfunction, as opposed to focal cortical damage. The inconsistency in the reported findings may also be attributed to heterogeneity of methodology, including data analytical techniques, small sample sizes, and choice of control groups. Future studies should include a detailed clinical phenotyping of vestibular function in TBI patients to account for the confounding effect of peripheral vestibular disorders on imbalance and brain imaging.
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Affiliation(s)
- Zaeem Hadi
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Mohammad Mahmud
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Barry M Seemungal
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
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Martini DN, Mancini M, Antonellis P, McDonnell P, Vitorio R, Stuart S, King LA. Prefrontal Cortex Activity During Gait in People With Persistent Symptoms After Concussion. Neurorehabil Neural Repair 2024:15459683241240423. [PMID: 38506532 DOI: 10.1177/15459683241240423] [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: 03/21/2024]
Abstract
BACKGROUND Concussions result in transient symptoms stemming from a cortical metabolic energy crisis. Though this metabolic energy crisis typically resolves in a month, symptoms can persist for years. The symptomatic period is associated with gait dysfunction, the cortical underpinnings of which are poorly understood. Quantifying prefrontal cortex (PFC) activity during gait may provide insight into post-concussion gait dysfunction. The purpose of this study was to explore the effects of persisting concussion symptoms on PFC activity during gait. We hypothesized that adults with persisting concussion symptoms would have greater PFC activity during gait than controls. Within the concussed group, we hypothesized that worse symptoms would relate to increased PFC activity during gait, and that increased PFC activity would relate to worse gait characteristics. METHODS The Neurobehavior Symptom Inventory (NSI) characterized concussion symptoms. Functional near-infrared spectroscopy quantified PFC activity (relative concentration changes of oxygenated hemoglobin [HbO2]) in 14 people with a concussion and 25 controls. Gait was assessed using six inertial sensors in the concussion group. RESULTS Average NSI total score was 26.4 (13.2). HbO2 was significantly higher (P = .007) for the concussed group (0.058 [0.108]) compared to the control group (-0.016 [0.057]). Within the concussion group, HbO2 correlated with NSI total symptom score (ρ = .62; P = .02), sagittal range of motion (r = .79; P = .001), and stride time variability (r = -.54; P = .046). CONCLUSION These data suggest PFC activity relates to symptom severity and some gait characteristics in people with persistent concussion symptoms. Identifying the neurophysiological underpinnings to gait deficits post-concussion expands our knowledge of motor behavior deficits in people with persistent concussion symptoms.
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Affiliation(s)
- Douglas N Martini
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | | | - Paul McDonnell
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Rodrigo Vitorio
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Samuel Stuart
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
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7
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Sandri Heidner G, O'Connell C, Domire ZJ, Rider P, Mizelle C, Murray NP. Concussed Neural Signature is Substantially Different than Fatigue Neural Signature in Non-concussed Controls. J Mot Behav 2023; 55:302-312. [PMID: 36990462 DOI: 10.1080/00222895.2023.2194852] [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: 03/31/2023]
Abstract
Traumatic brain injuries can result in short-lived and long-lasting neurological impairment. Identifying the correct recovery timeframe is challenging, as balance-based metrics may be negatively impacted if testing is performed soon after exercise. Thirty-two healthy controls and seventeen concussed individuals performed a series of balance challenges, including virtual reality optical flow perturbation. The control group completed a backpacking protocol to induce moderate fatigue. Concussed participants had lower spectral power in the motor cortex and central sulcus when compared to fatigued controls. Moreover, concussed participants experienced a decrease in overall theta band spectral power while fatigued controls showed an increase in theta band spectral power. This neural signature may be useful to distinguish between concussed and non-concussed fatigued participants in future assessments.
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Affiliation(s)
- Gustavo Sandri Heidner
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
- Department of Kinesiology, Montclair State University, Montclair, NJ, USA
| | - Caitlin O'Connell
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | - Zachary J Domire
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | - Patrick Rider
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | - Chris Mizelle
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | - Nicholas P Murray
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
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8
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Corbin-Berrigan LA, Teel E, Vinet SA, P De Koninck B, Guay S, Beaulieu C, De Beaumont L. The Use of Electroencephalography as an Informative Tool in Assisting Early Clinical Management after Sport-Related Concussion: a Systematic Review. Neuropsychol Rev 2023; 33:144-159. [PMID: 32577950 DOI: 10.1007/s11065-020-09442-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 06/07/2020] [Indexed: 12/21/2022]
Abstract
Sport-related concussion (SRC) is managed primarily through serial clinical evaluations throughout recovery. However, studies suggest that clinical measures may not be suitable to detect subtle alterations in functioning and are limited by numerous internal and external factors. Electroencephalography (EEG) has been used for over eight decades to discern altered function following illnesses and injuries, including traumatic brain injury. This study evaluated the associations between EEG measures and clinical presentation within three-months following SRC. A systematic review of the literature was performed in Medline, Embase, PsycINFO, CINAHL and Web of Science databases following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines, yielding a total of 13 peer-reviewed articles. Most studies showed low to moderate bias and moderate to high quality. The majority of the existing literature on the impact of concussion within the first 3 months post-injury suggests that individuals with concussion show altered brain function, with EEG abnormalities outlasting clinical dysfunction. Of all EEG biomarkers evaluated, P300 shows the most promise and should be explored further. Despite the relatively high quality of included articles, significant limitations are still present within this body of literature, including potential conflicts of interest and proprietary algorithms, making it difficult to draw strong and meaningful conclusions on the use of EEG in the early stages of SRC. Therefore, further exploration of the relationship between EEG measures and acute clinical presentation is warranted to determine if EEG provides additional benefits over current clinical assessments and is a feasible tool in clinical settings.
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Affiliation(s)
- Laurie-Ann Corbin-Berrigan
- Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | | | | | - Béatrice P De Koninck
- Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Université de Montréal, Montréal, Quebec, Canada
| | - Samuel Guay
- Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Université de Montréal, Montréal, Quebec, Canada
| | | | - Louis De Beaumont
- Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Quebec, Canada. .,Université de Montréal, Montréal, Quebec, Canada.
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9
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Mortazavi M, Lucini FA, Joffe D, Oakley DS. Electrophysiological trajectories of concussion recovery: From acute to prolonged stages in late teenagers. J Pediatr Rehabil Med 2023; 16:287-299. [PMID: 36710690 PMCID: PMC10894572 DOI: 10.3233/prm-210114] [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: 11/02/2021] [Accepted: 10/17/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Numerous studies have reported electrophysiological differences between concussed and non-concussed groups, but few studies have systematically explored recovery trajectories from acute concussion to symptom recovery and the transition from acute concussion to prolonged phases. Questions remain about recovery prognosis and the extent to which symptom resolution coincides with injury resolution. This study therefore investigated the electrophysiological differences in recoveries between simple and complex concussion. METHODS Student athletes with acute concussion from a previous study (19(2) years old) were tracked from pre-injury baseline, 24-48 hours after concussion, and through in-season recovery. The electroencephalography (EEG) with P300 evoked response trajectories from this acute study were compared to an age-matched population of 71 patients (18(2) years old) with prolonged post-concussive symptoms (PPCS), 61 (SD 31) days after concussion. RESULTS Acute, return-to-play, and PPCS groups all experienced a significant deficit in P300 amplitude compared to the pre-injury baseline group. The PPCS group, however, had significantly different EEG spectral and coherence patterns from every other group. CONCLUSION These data suggest that while the evoked response potentials deficits of simple concussion may persist in more prolonged stages, there are certain EEG measures unique to PPCS. These metrics are readily accessible to clinicians and may provide useful parameters to help predict trajectories, characterize injury (phenotype), and track the course of injury.
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Affiliation(s)
- Mo Mortazavi
- SPARCC Sports Medicine, Rehabilitation, and Concussion Center, Tucson, AZ, USA
- Department of Pediatrics, Tucson Medical Center, Tucson, AZ, USA
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10
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Harrison A, Lane-Cordova A, La Fountaine MF, Moore RD. Concussion History and Heart Rate Variability During Bouts of Acute Stress. J Athl Train 2022; 57:741-747. [PMID: 36356617 PMCID: PMC9661928 DOI: 10.4085/1062-6050-0314.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT After a sport-related concussion, many athletes experience persisting neurophysiological alterations. These alterations may be absent at rest but emerge during moments of physiological stress. Unnoticed and untreated neurophysiological dysfunction may negatively affect long-term neurologic health in adolescent athletes, as they are at a critical point in development. OBJECTIVE To assess cardio-autonomic functioning in athletes with and those without a history of concussion by quantifying measures of heart rate variability (HRV) during times of physical and mental exertion. DESIGN Case-control study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty-four male Hockey Quebec Midget-AAA hockey players were separated into those with (n = 16; age = 16.06 ± 0.73 years, body mass index = 23.29 ± 1.79) and those without (n = 18; age = 15.98 ± 0.62 years, body mass index = 23.60 ± 2.49) a history of concussion. INTERVENTION(S) All athletes underwent a series of HRV recording sessions (1) at rest, (2) while completing a cognitive task at rest, and (3) while completing a cognitive task after a bout of submaximal aerobic exercise. MAIN OUTCOME MEASURE(S) Time-domain measures of HRV, including mean NN intervals, SD of NN intervals, and root mean square of successive NN interval differences, were quantified for each assessment. RESULTS No differences in characteristics were evident between groups. No between-groups differences in HRV at rest were observed. However, during the cognitive task at rest and after aerobic exercise, athletes with a history of concussion demonstrated a higher SD of NN intervals (78.1 ± 4.3 versus 63.2 ± 4.1 milliseconds and 71.2 ± 4.3 versus 65.2 ± 3.8 milliseconds, respectively; F1,31 = 4.31, P = .046) and root mean square of successive NN interval differences (75.8 ± 6.0 versus 59.0 ± 5.6 milliseconds and 74.0 ± 5.5 versus 59.0 ± 5.2 milliseconds, respectively; F1,31 = 4.88, P = .04) than athletes without a history of concussion. CONCLUSIONS Concussive injuries may result in long-term cardio-autonomic dysfunction. These deficits may not be present at rest but may be triggered by physiological stress.
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Affiliation(s)
- Adam Harrison
- Department of Exercise Science, University of South Carolina, Columbia
| | - Abbi Lane-Cordova
- Department of Exercise Science, University of South Carolina, Columbia
| | - Michael F. La Fountaine
- Department of Physical Therapy, The Institute for Advanced Study of Rehabilitation and Sports Science, Seton Hall University, Nutley, NJ
- Departments of Medical Sciences and Neurology, Hackensack Meridian School of Medicine, Seton Hall University, Nutley, NJ
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11
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McCann R, Schussler E, Martinez J, Ramirez V. The Effect of Concussion History on Lower Extremity Injury Risk in College Athletes: A Systematic Review and Meta-Analysis. Int J Sports Phys Ther 2022; 17:753-765. [PMID: 35949388 PMCID: PMC9340842 DOI: 10.26603/001c.36810] [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: 10/18/2021] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Collegiate athletes who suffer a concussion may possess prolonged impairments even after clearance for return-to-participation, which may place them at an increased risk of lower extremity injury. Objective To conduct a systematic review and meta-analysis of studies examining risk of lower extremity musculoskeletal injury following a concussion in collegiate athletes. Methods A literature search was performed using the following databases: PubMed, CINAHL, SPORTDiscus. The following search terms were used to identify relevant articles, ["concussion" OR "brain injury" OR "mild traumatic brain injury" OR "mTBI"] AND ["lower extremity injury" OR "musculoskeletal injury"]. Articles were included if they were published between January 2000 and July 2021 and examined collegiate athletes' risk of sustaining a lower extremity musculoskeletal injury following a concussion. Methodological quality of included studies was performed with a modified Downs and Black Checklist. The primary outcome of interest was the risk of sustaining a lower extremity musculoskeletal injury following a concussion. A random effects meta-analysis was conducted in which a summative relative risk (RR) for sustaining a lower extremity injury in athletes with and without a history of concussion was calculated. Results Seven studies met the eligibility criteria to be included in the systematic review. There were 348 athletes in the concussion group and 482 control athletes in the included studies. Most of the studies were of good or excellent quality. Five of the seven studies were able to be included in the meta-analysis. College athletes who suffered a concussion possessed a 58% greater risk of sustaining a lower extremity musculoskeletal injury than those who did not have a history of a concussion (RR = 1.58[1.30, 1.93]). Conclusions Lower extremity injury risk is potentially increased in college athletes following a concussion compared to those without a history of a concussion. Further research is needed to investigate the mechanism behind this increased risk. Clinical assessments throughout the concussion return-to-play protocol may need to be improved in order to detect lingering impairments caused by concussions. Level of Evidence 1.
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Affiliation(s)
- Ryan McCann
- Rehabilitation Sciences, Old Dominion University
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12
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Mansouri A, Ledwidge P, Sayood K, Molfese DL. A Routine Electroencephalography Monitoring System for Automated Sports-Related Concussion Detection. Neurotrauma Rep 2021; 2:626-638. [PMID: 35018364 PMCID: PMC8742301 DOI: 10.1089/neur.2021.0047] [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] [Indexed: 11/12/2022] Open
Abstract
Cases of concussions in the United States keep increasing and are now up to 2 million to 3 million incidents per year. Although concussions are recoverable and usually not life-threatening, the degree and rate of recovery may vary depending on age, severity of the injury, and past concussion history. A subsequent concussion before full recovery may lead to more-severe brain damage and poorer outcomes. Electroencephalography (EEG) recordings can identify brain dysfunctionality and abnormalities, such as after a concussion. Routine EEG monitoring can be a convenient method for reducing unreported injuries and preventing long-term damage, especially among groups with a greater risk of experiencing a concussion, such as athletes participating in contact sports. Because of the relative availability of EEG compared to other brain-imaging techniques (e.g., functional magnetic resonance imaging), the use of EEG monitoring is growing for various neurological disorders. In this longitudinal study, EEG was analyzed from 4 football athletes before their athletic season and also within 7 days of concussion. Compared to a control group of 4 additional athletes, a concussion was detected with up to 99.5% accuracy using EEG recordings in the Theta-Alpha band. Classifiers that use data from only a subset of the EEG electrodes providing reliable detection are also proposed. The most effective classifiers used EEG recordings from the Central scalp region in the Beta band and over the Temporal scalp region using the Theta-Alpha band. This proof-of-concept study and preliminary findings suggest that EEG monitoring may be used to identify a sports-related concussion occurrence with a high level of accuracy and thus reduce the chance of unreported concussion.
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Affiliation(s)
- Amirsalar Mansouri
- Department of Electrical and Computer Engineer, Baldwin Wallace University, Berea, Ohio, USA
| | - Patrick Ledwidge
- Department of Psychology, Baldwin Wallace University, Berea, Ohio, USA
| | - Khalid Sayood
- Department of Electrical and Computer Engineer, Baldwin Wallace University, Berea, Ohio, USA
| | - Dennis L. Molfese
- Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, Nebraska, USA Baldwin Wallace University, Berea, Ohio, USA
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Cao C, Wang Y, Liu J, Chen A, Lu J, Xu G, Song J. Altered Connectivity of the Frontoparietal Network During Attention Processing in Prolactinomas. Front Neurol 2021; 12:638851. [PMID: 34526949 PMCID: PMC8435841 DOI: 10.3389/fneur.2021.638851] [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: 04/09/2021] [Accepted: 07/12/2021] [Indexed: 11/22/2022] Open
Abstract
Prolactinomas have been reported for the failure of cognitive functions. However, the electrophysiological mechanisms of attention processing in prolactinomas remain unclear. In a visual mission, we monitored the scalp electroencephalography (EEG) of the participants. Compared with the healthy controls (HCs), larger frontoparietal theta and alpha coherence were found in the patients, especially in the right-lateralized hemisphere, which indicated a deficit in attention processing. Moreover, the frontoparietal coherence was positively correlated with altered prolactin (PRL) levels, implying the significance of PRL for adaptive brain compensation in prolactinomas. Taken together, this research showed the variations in attention processing between the HCs and prolactinomas. The coherence between frontal and parietal regions may be one of the possible electrophysiological biomarkers for detecting deficient attention processing in prolactinomas.
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Affiliation(s)
- Chenglong Cao
- Department of Neurosurgery, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Yu Wang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Jia Liu
- Foreign Linguistics and Applied Linguistics, Research Institute of Foreign Languages, Beijing Foreign Studies University, Beijing, China
| | - Aobo Chen
- Department of Neurosurgery, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jinjiang Lu
- Department of Neurosurgery, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Guozheng Xu
- Department of Neurosurgery, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China
| | - Jian Song
- Department of Neurosurgery, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China
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14
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Neustadtl AL, Bukowski WK, Neustadtl A, Milzman D. Performance After Concussion in National Hockey League Players. J Athl Train 2021; 56:404-407. [PMID: 33878175 DOI: 10.4085/1062-6050-126.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Concussions in ice hockey players are an interesting area of study due to the fast-paced and high-impact nature of the sport. Recently, researchers have focused on player performance after return from concussion to evaluate subclinical deficits that were previously missed. OBJECTIVE To examine National Hockey League (NHL) player performance from 2013 to 2019 and compare performance before a concussion with performance immediately after recovering to assess the current NHL return-to-play protocol. DESIGN Cross-sectional study. SETTING The NHL Injury Viz and sports reporting websites. PATIENTS OR OTHER PARTICIPANTS Players in the NHL who sustained concussions from 2013 to 2019. MAIN OUTCOME MEASURE(S) Goals, assists, points, plus-minus, time on ice (TOI), and hits. RESULTS When goals, assists, points, plus-minus, TOI, and hits were examined, only TOI was different after the players returned from injury, and this TOI difference was not substantively important. CONCLUSIONS After concussion, NHL player performance did not change.
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Affiliation(s)
| | | | - Alan Neustadtl
- Department of Sociology, University of Maryland, College Park
| | - David Milzman
- School of Medicine, University of Maryland, Baltimore
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15
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Jacquin AE, Bazarian JJ, Casa DJ, Elbin RJ, Hotz G, Schnyer DM, Yeargin S, Prichep LS, Covassin T. Concussion assessment potentially aided by use of an objective multimodal concussion index. JOURNAL OF CONCUSSION 2021. [DOI: 10.1177/20597002211004333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Prompt, accurate, objective assessment of concussion is crucial as delays can lead to increased short and long-term consequences. The purpose of this study was to derive an objective multimodal concussion index (CI) using EEG at its core, to identify concussion, and to assess change over time throughout recovery. Methods Male and female concussed ( N = 232) and control ( N = 206) subjects 13–25 years were enrolled at 12 US colleges and high schools. Evaluations occurred within 72 h of injury, 5 days post-injury, at return-to-play (RTP), 45 days after RTP (RTP + 45); and included EEG, neurocognitive performance, and standard concussion assessments. Concussed subjects had a witnessed head impact, were removed from play for ≥ 5 days using site guidelines, and were divided into those with RTP < 14 or ≥14 days. Part 1 describes the derivation and efficacy of the machine learning derived classifier as a marker of concussion. Part 2 describes significance of differences in CI between groups at each time point and within each group across time points. Results Sensitivity = 84.9%, specificity = 76.0%, and AUC = 0.89 were obtained on a test Hold-Out group representing 20% of the total dataset. EEG features reflecting connectivity between brain regions contributed most to the CI. CI was stable over time in controls. Significant differences in CI between controls and concussed subjects were found at time of injury, with no significant differences at RTP and RTP + 45. Within the concussed, differences in rate of recovery were seen. Conclusions The CI was shown to have high accuracy as a marker of likelihood of concussion. Stability of CI in controls supports reliable interpretation of CI change in concussed subjects. Objective identification of the presence of concussion and assessment of readiness to return to normal activity can be aided by use of the CI, a rapidly obtained, point of care assessment tool.
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Affiliation(s)
| | - Jeffrey J Bazarian
- Department of Emergency Medicine, University of Rochester, Rochester, NY, USA
| | - Douglas J Casa
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
| | - Robert J Elbin
- Department of Health, Human Performance and Recreation, Office for Sport Concussion Research, University of Arkansas, Fayetteville, AR, USA
| | - Gillian Hotz
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David M Schnyer
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Susan Yeargin
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | | | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
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16
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Quantitative Multimodal Assessment of Concussion Recovery in Youth Athletes. Clin J Sport Med 2021; 31:133-138. [PMID: 30762699 DOI: 10.1097/jsm.0000000000000722] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/21/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate recovery trajectories among youth athletes with a concussion and healthy controls across different domains using a quantitative and multifaceted protocol. STUDY DESIGN Prospective repeated measures. PARTICIPANTS Youth athletes diagnosed with a concussion between the ages of 8 and 18 years were evaluated (1) within 10 days after injury, (2) approximately 3 weeks after injury, and (3) after return-to-play clearance. Control participants completed the same protocol. SETTING Sport concussion clinic. INTERVENTIONS N/A. MAIN OUTCOME MEASURES Participants underwent a multifaceted protocol that assessed symptoms (postconcussion symptom scale [PCSS]), dual-task gait, event-related potentials (ERPs), and eye tracking. RESULTS Sixty-seven athletes participated: 36 after concussion (age = 14.0 ± 2.6 years; 44% female) and 31 controls (age = 14.6 ± 2.2 years; 39% female). Concussion symptoms were higher for the concussion group compared with controls at the first (PCSS = 31.7 ± 18.8 vs 1.9 ± 2.9; P < 0.001) and second time points (PCSS = 10.8 ± 11.2 vs 1.8 ± 3.6; P = 0.001) but resolved by the final assessment (PCSS = 1.7 ± 3.6 vs 2.0 ± 3.8; P = 0.46). The concussion group walked slower during dual-task gait than controls at all 3 tests including after return-to-play clearance (0.83 ± 0.19 vs 0.95 ± 0.15 m/s; P = 0.049). There were no between-group differences for ERP connectivity or eye tracking. Those with concussions had a decrease in ERP connectivity recovery over the 3 time points, whereas control participants' scores increased (concussion Δ = -8.7 ± 28.0; control Δ = 13.9 ± 32.2; χ2 = 14.1, P = 0.001). CONCLUSIONS Concussion is associated with altered dual-task gait speeds after resolution of concussion symptoms, but ERP and eye tracking measures did not demonstrate between-group differences across time. Some objective approaches to concussion monitoring may support with identifying deficits after concussion, but further work is required to delineate the role of gait, electrophysiological, and eye tracking methods for clinical decision-making.
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17
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Bazarian JJ, Elbin RJ, Casa DJ, Hotz GA, Neville C, Lopez RM, Schnyer DM, Yeargin S, Covassin T. Validation of a Machine Learning Brain Electrical Activity-Based Index to Aid in Diagnosing Concussion Among Athletes. JAMA Netw Open 2021; 4:e2037349. [PMID: 33587137 PMCID: PMC7885039 DOI: 10.1001/jamanetworkopen.2020.37349] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE An objective, reliable indicator of the presence and severity of concussive brain injury and of the readiness for the return to activity has the potential to reduce concussion-related disability. OBJECTIVE To validate the classification accuracy of a previously derived, machine learning, multimodal, brain electrical activity-based Concussion Index in an independent cohort of athletes with concussion. DESIGN, SETTING, AND PARTICIPANTS This prospective diagnostic cohort study was conducted at 10 clinical sites (ie, US universities and high schools) between February 4, 2017, and March 20, 2019. A cohort comprising a consecutive sample of 207 athletes aged 13 to 25 years with concussion and 373 matched athlete controls without concussion were assessed with electroencephalography, cognitive testing, and symptom inventories within 72 hours of injury, at return to play, and 45 days after return to play. Variables from the multimodal assessment were used to generate a Concussion Index at each time point. Athletes with concussion had experienced a witnessed head impact, were removed from play for 5 days or more, and had an initial Glasgow Coma Scale score of 13 to 15. Participants were excluded for known neurologic disease or history within the last year of traumatic brain injury. Athlete controls were matched to athletes with concussion for age, sex, and type of sport played. MAIN OUTCOMES AND MEASURES Classification accuracy of the Concussion Index at time of injury using a prespecified cutoff of 70 or less (total range, 0-100, where ≤70 indicates it is likely the individual has a concussion and >70 indicates it is likely the individual does not have a concussion). RESULTS Of 580 eligible participants with analyzable data, 207 had concussion (124 male participants [59.9%]; mean [SD] age, 19.4 [2.5] years), and 373 were athlete controls (187 male participants [50.1%]; mean [SD] age, 19.6 [2.2] years). The Concussion Index had a sensitivity of 86.0% (95% CI, 80.5%-90.4%), specificity of 70.8% (95% CI, 65.9%-75.4%), negative predictive value of 90.1% (95% CI, 86.1%-93.3%), positive predictive value of 62.0% (95% CI, 56.1%-67.7%), and area under receiver operator characteristic curve of 0.89. At day 0, the mean (SD) Concussion Index among athletes with concussion was significantly lower than among athletes without concussion (75.0 [14.0] vs 32.7 [27.2]; P < .001). Among athletes with concussion, there was a significant increase in the Concussion Index between day 0 and return to play, with a mean (SD) paired difference between these time points of -41.2 (27.0) (P < .001). CONCLUSIONS AND RELEVANCE These results suggest that the multimodal brain activity-based Concussion Index has high classification accuracy for identification of the likelihood of concussion at time of injury and may be associated with the return to control values at the time of recovery. The Concussion Index has the potential to aid in the clinical diagnosis of concussion and in the assessment of athletes' readiness to return to play.
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Affiliation(s)
- Jeffrey J. Bazarian
- Department of Emergency Medicine, University of Rochester School of Medicine, Rochester, New York
| | - Robert J. Elbin
- Office for Sports Concussion Research, University of Arkansas, Fayetteville
| | | | - Gillian A. Hotz
- UHealth Concussion Program, University of Miami, Miami, Florida
| | - Christopher Neville
- Department of Physical Therapy Education, SUNY Upstate Medical University, Syracuse, New York
| | - Rebecca M. Lopez
- Morsani College of Medicine, Orthopedics and Sports Medicine, University of South Florida, Tampa
| | | | - Susan Yeargin
- Arnold School of Public Health, University of South Carolina, Columbia
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing
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18
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Yue JK, Phelps RRL, Chandra A, Winkler EA, Manley GT, Berger MS. Sideline Concussion Assessment: The Current State of the Art. Neurosurgery 2021; 87:466-475. [PMID: 32126135 DOI: 10.1093/neuros/nyaa022] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 12/15/2019] [Indexed: 02/03/2023] Open
Abstract
More than 200 million American adults and children participate in organized physical activity. Growing awareness has highlighted that concussion, especially when repeated, may be associated with prolonged neurological, cognitive, and/or neuropsychiatric sequelae. Objective diagnosis of concussion remains challenging. Although some concussion symptoms may be apparent even to nonmedical observers, diagnosis and removal from play for evaluation depend on validated assessment tools and trained, vigilant healthcare personnel. Over the past 2 decades, sideline concussion measures have undergone significant revision and augmentation to become more comprehensive batteries in order to detect a wide spectrum of symptomatology, eg, neurocognitive function, postconcussive symptoms, gait/balance, and saccadic eye movements. This review summarizes the current state-of-the-art concussion evaluation instruments, ranging from the Sports Concussion Assessment Tool (SCAT) and tools that may enhance concussion detection, to near-term blood-based biomarkers and emerging technology (eg, head impact sensors, vestibulo-ocular/eye-tracking, and mobile applications). Special focus is directed at feasibility, utility, generalizability, and challenges to implementation of each measure on-field and on the sidelines. This review finds that few instruments beyond the SCAT provide guidance for removal from play, and establishing thresholds for concussion detection and removal from play in qualification/validation of future instruments is of high importance. Integration of emerging sideline concussion evaluation tools should be supported by resources and education to athletes, caregivers, athletic staff, and medical professionals for standardized administration as well as triage, referral, and prevention strategies. It should be noted that concussion evaluation instruments are used to assist the clinician in sideline diagnosis, and no single test can diagnose concussion as a standalone investigation.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Ryan R L Phelps
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Ankush Chandra
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, California
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19
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Monroe DC, Cecchi NJ, Gerges P, Phreaner J, Hicks JW, Small SL. A Dose Relationship Between Brain Functional Connectivity and Cumulative Head Impact Exposure in Collegiate Water Polo Players. Front Neurol 2020; 11:218. [PMID: 32300329 PMCID: PMC7145392 DOI: 10.3389/fneur.2020.00218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/09/2020] [Indexed: 12/13/2022] Open
Abstract
A growing body of evidence suggests that chronic, sport-related head impact exposure can impair brain functional integration and brain structure and function. Evidence of a robust inverse relationship between the frequency and magnitude of repeated head impacts and disturbed brain network function is needed to strengthen an argument for causality. In pursuing such a relationship, we used cap-worn inertial sensors to measure the frequency and magnitude of head impacts sustained by eighteen intercollegiate water polo athletes monitored over a single season of play. Participants were evaluated before and after the season using computerized cognitive tests of inhibitory control and resting electroencephalography. Greater head impact exposure was associated with increased phase synchrony [r(16) > 0.626, p < 0.03 corrected], global efficiency [r(16) > 0.601, p < 0.04 corrected], and mean clustering coefficient [r(16) > 0.625, p < 0.03 corrected] in the functional networks formed by slow-wave (delta, theta) oscillations. Head impact exposure was not associated with changes in performance on the inhibitory control tasks. However, those with the greatest impact exposure showed an association between changes in resting-state connectivity and a dissociation between performance on the tasks after the season [r(16) = 0.481, p = 0.043] that could also be attributed to increased slow-wave synchrony [F(4, 135) = 113.546, p < 0.001]. Collectively, our results suggest that athletes sustaining the greatest head impact exposure exhibited changes in whole-brain functional connectivity that were associated with altered information processing and inhibitory control.
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Affiliation(s)
- Derek C Monroe
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Nicholas J Cecchi
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Paul Gerges
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Jenna Phreaner
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - James W Hicks
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Steven L Small
- Department of Neurology, University of California, Irvine, Irvine, CA, United States.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, United States
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20
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Harriss A, Johnson AM, Thompson JWG, Walton DM, Dickey JP. Cumulative soccer heading amplifies the effects of brain activity observed during concurrent moderate exercise and continuous performance task in female youth soccer players. JOURNAL OF CONCUSSION 2020. [DOI: 10.1177/2059700220912654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alexandra Harriss
- Health and Rehabilitation Sciences, The University of Western Ontario, London, Ontario, Canada
| | - Andrew M Johnson
- School of Health Studies, The University of Western Ontario, London, Ontario, Canada
| | | | - David M Walton
- Health and Rehabilitation Sciences, The University of Western Ontario, London, Ontario, Canada
- School of Health Studies, The University of Western Ontario, London, Ontario, Canada
- School of Physical Therapy, The University of Western Ontario, London, Ontario, Canada
| | - James P Dickey
- School of Kinesiology, The University of Western Ontario, London, Ontario, Canada
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21
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Clayton G, Davis N, Holliday A, Joffe D, Oakley DS, Palermo FX, Poddar S, Rueda M. In-clinic event related potentials after sports concussion: A 4-year study. J Pediatr Rehabil Med 2020; 13:81-92. [PMID: 32176669 PMCID: PMC7242851 DOI: 10.3233/prm-190620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Electrophysiological event-related potentials (ERP's) have been reported to change after concussion. The objective of this study is to use a simple 2-tone auditory P300 ERP in routine clinical settings to measure changes from baseline after concussion and to determine if these changes persist at return to play when other standard measures have normalized. METHODS Three-hundred sixty-four (364) student athletes, aged 17-23 years, participating in contact sports were tracked over consecutive years. In this blinded study P300, plus physical reaction times and Trail Making tests, were collected alongside standard clinical evaluations. Changes in these measures after concussion were compared to clinical outcomes over various stages of post-injury recovery. RESULTS Concussed players experienced significant reaction time and/or P300 amplitude changes compared to pre-concussion baseline measurements (p< 0.005). P300 changes persisted in 38% of the players after standard measures, including reaction times, had cleared. Many of those players slow to normalize were part of the sub-concussive symptom group and/or appeared more prone to repeat concussions. CONCLUSION These data suggest significant P300 amplitude changes after concussion that are quantifiable and consistent. These changes often normalized slower than other standard assessments. More data are needed to determine if slow normalization relates to sub-concussive or repeated events.
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Affiliation(s)
- Gerald Clayton
- School of Medicine, University of Colorado, Aurora, CO, USA.,Children's Hospital Colorado, Aurora, CO, USA
| | - Natalie Davis
- Department of Athletics, University of Colorado, Boulder, CO, USA
| | - Adam Holliday
- Department of Athletics, University of Colorado, Boulder, CO, USA
| | | | | | | | - Sourav Poddar
- School of Medicine, University of Colorado, Aurora, CO, USA
| | - Miguel Rueda
- Department of Athletics, University of Colorado, Boulder, CO, USA
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22
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Preliminary Use of the Physical and Neurological Examination of Subtle Signs for Detecting Subtle Motor Signs in Adolescents With Sport-Related Concussion. Am J Phys Med Rehabil 2019; 97:456-460. [PMID: 29762156 DOI: 10.1097/phm.0000000000000906] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sensitive examination tools are needed to optimize evaluation after sports-related concussion. The Physical and Neurological Examination of Subtle Signs was preliminarily examined for sensitivity to motor changes in a pilot cohort of adolescents aged 13-17 yrs with sports-related concussion. A total of 15 adolescents (5 female adolescents) with sports-related concussion were evaluated up to three times: within 2 wks of injury, approximately 1 mo later (mean, 35 days between visits), and for those not recovered at the second visit, again after clinical recovery (mean, 70 days between the first and last visits for all participants). Comparison data were acquired from 20 age- and sex-matched healthy control athletes with no history of concussion who were evaluated twice (mean, 32 days apart). Main effects of group, time, and interaction effects were evaluated with an analysis of covariance, which controlled for socioeconomic status, times tested, and days between testing sessions. Adolescents with concussion had poorer Physical and Neurological Examination of Subtle Signs performance than controls did at all time points. Performance improved between visits within the concussion group, with no change within the control group. These findings suggest that the Physical and Neurological Examination of Subtle Signs merits additional study in larger cohorts and in combination with other markers of injury to facilitate an enhanced understanding of sports-related concussion and recovery.
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23
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Cerebral cortical networking for mental workload assessment under various demands during dual-task walking. Exp Brain Res 2019; 237:2279-2295. [DOI: 10.1007/s00221-019-05550-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/24/2019] [Indexed: 01/22/2023]
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24
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Eagle SR, Kontos AP, Mi QI, Flanagan SD, Nindl BC, Beals K, Connaboy C. Shared Neuromuscular Performance Traits in Military Personnel with Prior Concussion. Med Sci Sports Exerc 2019; 51:1619-1625. [PMID: 30845049 DOI: 10.1249/mss.0000000000001974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Concussions are common in military personnel and may result in increased risk of musculoskeletal injury. One plausible explanation for this risk could be that neuromotor deficiencies enhance injury risk after a concussion through altered muscular activation/contraction timing. PURPOSE To compare military personnel with at least one concussion during the past 1 month to 2 yr (CONCUSSED) to military branch-matched, age-matched, and Special Operations Forces group-matched controls (CONTROL) on physiological, musculoskeletal, and biomechanical performance. METHODS A total of 48 (24 CONCUSSED, 24 CONTROL) male Air Force and Naval Special Warfare Operators age 19 to 34 yr participated in the study. Participants self-reported demographics/injury history and completed the following assessments: 1) physiological-body composition, anaerobic power and capacity, aerobic capacity and lactate threshold; 2) musculoskeletal-lower extremity isokinetic strength testing, including time to peak torque; and 3) biomechanical-single-leg jump and landing task, including landing kinematics of the hip, knee and ankle. A machine learning decision tree algorithm (C5.0) and one-way ANOVA were used to compare the two groups on these outcomes. RESULTS Despite nonsignificant differences using ANOVA, the C5.0 algorithm revealed CONCUSSED demonstrated quicker time to peak knee flexion angle during the single-leg landing task (≤0.170 s; CONCUSSED: n = 22 vs CONTROL: n = 14), longer time to peak torque in knee extension isokinetic strength testing (>500 ms; CONCUSSED: n = 18 vs CONTROL: n = 4) and larger knee flexion angle at initial contact (>7.7°; CONCUSSED: n = 18 vs CONTROL: n = 2). CONCLUSION The findings supported the hypothesis that CONCUSSED military personnel would demonstrate altered neuromuscular control in landing strategies and muscular activation. Future research should assess prospectively neuromuscular changes after a concussion and determine if these changes increase risk of subsequent musculoskeletal injuries.
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Affiliation(s)
- Shawn R Eagle
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA
| | - Anthony P Kontos
- UPMC Sports Medicine Concussion Program/Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Q I Mi
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA
| | - Shawn D Flanagan
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA
| | - Bradley C Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA
| | - Kim Beals
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA
| | - Chris Connaboy
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA
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Howell DR, Lynall RC, Buckley TA, Herman DC. Neuromuscular Control Deficits and the Risk of Subsequent Injury after a Concussion: A Scoping Review. Sports Med 2018; 48:1097-1115. [PMID: 29453743 DOI: 10.1007/s40279-018-0871-y] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
An emerging area of research has identified that an increased risk of musculoskeletal injury may exist upon returning to sports after a sport-related concussion. The mechanisms underlying this recently discovered phenomenon, however, remain unknown. One theorized reason for this increased injury risk includes residual neuromuscular control deficits that remain impaired despite clinical recovery. Thus, the objectives of this review were: (1) to summarize the literature examining the relationship between concussion and risk of subsequent injury and (2) to summarize the literature for one mechanism with a theorized association with this increased injury risk, i.e., neuromuscular control deficits observed during gait after concussion under dual-task conditions. Two separate reviews were conducted consistent with both specified objectives. Studies published before 9 December, 2016 were identified using PubMed, Web of Science, and Academic Search Premier (EBSCOhost). Inclusion for the objective 1 search included dependent variables of quantitative measurements of musculoskeletal injury after concussion. Inclusion criteria for the objective 2 search included dependent variables pertaining to gait, dynamic balance control, and dual-task function. A total of 32 studies were included in the two reviews (objective 1 n = 10, objective 2 n = 22). According to a variety of study designs, athletes appear to have an increased risk of sustaining a musculoskeletal injury following a concussion. Furthermore, dual-task neuromuscular control deficits may continue to exist after patients report resolution of concussion symptoms, or perform normally on other clinical concussion tests. Therefore, musculoskeletal injury risk appears to increase following a concussion and persistent motor system and attentional deficits also seem to exist after a concussion. While not yet experimentally tested, these motor system and attentional deficits may contribute to the risk of sustaining a musculoskeletal injury upon returning to full athletic participation.
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Affiliation(s)
- David R Howell
- Department of Orthopedics, Sports Medicine Center, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Avenue B060, Aurora, CO, 80045, USA. .,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.
| | - Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.,Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, USA
| | - Daniel C Herman
- Divisions of Physical Medicine and Rehabilitation, Sports Medicine, and Research, Department of Orthopaedics and Rehabilitation, Orthopaedics and Sports Medicine Institute, University of Florida, Gainesville, FL, USA
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Jacquin A, Kanakia S, Oberly D, Prichep LS. A multimodal biomarker for concussion identification, prognosis and management. Comput Biol Med 2018; 102:95-103. [DOI: 10.1016/j.compbiomed.2018.09.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 11/30/2022]
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Conley AC, Cooper PS, Karayanidis F, Gardner AJ, Levi CR, Stanwell P, Gaetz MB, Iverson GL. Resting State Electroencephalography and Sports-Related Concussion: A Systematic Review. J Neurotrauma 2018; 36:1-13. [PMID: 30014761 DOI: 10.1089/neu.2018.5761] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Sports-related concussion is associated with a range of short-term functional deficits that are commonly thought to recover within a two-week post-injury period for most, but certainly not all, persons. Resting state electroencephalography (rs-EEG) may prove to be an affordable, accessible, and sensitive method of assessing severity of brain injury and rate of recovery after a concussion. This article presents a systematic review of rs-EEG in sports-related concussion. A systematic review of articles published in the English language, up to June 2017, was retrieved via PsychINFO, Medline, Medline In Process, Embase, SportDiscus, CINAHL, and Cochrane Library, Reviews, and Trials. The following key words were used for database searches: electroencephalography, quantitative electroencephalography, qEEG, cranio-cerebral trauma, mild traumatic brain injury, mTBI, traumatic brain injury, brain concussion, concussion, brain damage, sport, athletic, and athlete. Observational, cohort, correlational, cross-sectional, and longitudinal studies were all included in the current review. Sixteen articles met inclusion criteria, which included data on 504 athletes and 367 controls. All 16 articles reported some abnormality in rs-EEG activity after a concussion; however, the cortical rhythms that were affected varied. Despite substantial methodological and analytical differences across the 16 studies, the current review suggests that rs-EEG may provide a reliable technique to identify persistent functional changes in athletes after a concussion. Because of the varied approaches, however, considerable work is needed to establish a systematic methodology to assess its efficacy as a marker of return-to-play.
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Affiliation(s)
- Alexander C Conley
- 1 Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle , Callaghan, New South Wales, Australia
- 2 Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan, New South Wales, Australia
- 3 Hunter Medical Research Institute , New Lambton Heights, New South Wales, Australia
- 4 Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Patrick S Cooper
- 1 Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle , Callaghan, New South Wales, Australia
- 2 Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan, New South Wales, Australia
- 3 Hunter Medical Research Institute , New Lambton Heights, New South Wales, Australia
| | - Frini Karayanidis
- 1 Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle , Callaghan, New South Wales, Australia
- 2 Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan, New South Wales, Australia
- 3 Hunter Medical Research Institute , New Lambton Heights, New South Wales, Australia
| | - Andrew J Gardner
- 2 Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan, New South Wales, Australia
- 5 School of Medicine and Public Health, University of Newcastle , Callaghan, New South Wales, Australia
- 6 Hunter New England Local Health District Sports Concussion Clinic, John Hunter Hospital , New Lambton Heights, New South Wales, Australia
| | - Chris R Levi
- 1 Functional Neuroimaging Laboratory, School of Psychology, University of Newcastle , Callaghan, New South Wales, Australia
- 2 Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan, New South Wales, Australia
- 3 Hunter Medical Research Institute , New Lambton Heights, New South Wales, Australia
- 5 School of Medicine and Public Health, University of Newcastle , Callaghan, New South Wales, Australia
- 6 Hunter New England Local Health District Sports Concussion Clinic, John Hunter Hospital , New Lambton Heights, New South Wales, Australia
| | - Peter Stanwell
- 2 Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan, New South Wales, Australia
- 7 School of Health Sciences, University of Newcastle , Callaghan, New South Wales, Australia
| | - Michael B Gaetz
- 8 Faculty of Health Sciences, University of the Fraser Valley , Chilliwack, British Columbia, Canada
| | - Grant L Iverson
- 9 Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts
- 10 Spaulding Rehabilitation Hospital , Boston, Massachusetts
- 11 MassGeneral Hospital for Children™ Sport Concussion Program , Boston, Massachusetts
- 12 Home Base, A Red Sox Foundation and Massachusetts General Hospital Program , Boston, Massachusetts
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Howell DR, Meehan WP, Barber Foss KD, Reches A, Weiss M, Myer GD. Reduced dual-task gait speed is associated with visual Go/No-Go brain network activation in children and adolescents with concussion. Brain Inj 2018; 32:1129-1134. [DOI: 10.1080/02699052.2018.1482424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- David R. Howell
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - William P. Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Division of Sports Medicine, Department of Orthopaedics, Boston Children’s Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery and Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Kim D. Barber Foss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | - Gregory D. Myer
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH, USA
- Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA, USA
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Return to Physical Activity Timing and Dual-Task Gait Stability Are Associated 2 Months Following Concussion. J Head Trauma Rehabil 2018; 31:262-8. [PMID: 26291630 DOI: 10.1097/htr.0000000000000176] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The effect of physical activity resumption on functional recovery following concussion is poorly understood. We sought to examine the relationship between physical activity resumption timing and gait stability 2 months following concussion. SETTING Motion analysis laboratory. PARTICIPANTS Twenty-nine individuals who sustained a concussion and were subsequently allowed to return to preinjury levels of physical activity within 2 months postinjury. DESIGN Prospective cohort study. MAIN MEASURES The return-to-activity day (RTA-day) was identified as the first day postinjury that each participant was medically cleared to resume regular physical activity. Whole-body center-of-mass (COM) motion during single-task and dual-task walking was assessed 2 months postinjury. Correlation coefficients were calculated between the RTA-day and single/dual-task gait stability as well as symptom severity measurements 2 months postinjury. RESULTS Dual-task medial-lateral COM displacement (r = -0.52, P = .004) and peak medial-lateral COM velocity (r = -0.37, P = .048) were significantly correlated with RTA-day. Dual-task peak forward velocity and single-task gait stability measures were not significantly correlated with RTA-day. CONCLUSIONS The time of RTA-day clearance, within a 2 months postinjury period, is significantly correlated with dual-task medial-lateral gait stability measured at the end of that period, suggesting that frontal plane gait stability recovery is sensitive to the timing of RTA-day.
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Howell DR, Kirkwood MW, Provance A, Iverson GL, Meehan WP. Using concurrent gait and cognitive assessments to identify impairments after concussion: a narrative review. Concussion 2018; 3:CNC54. [PMID: 30202596 PMCID: PMC6094155 DOI: 10.2217/cnc-2017-0014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 12/21/2017] [Indexed: 02/05/2023] Open
Abstract
Understanding how a concussion affects an individual is oftentimes difficult for clinicians due to the varying symptom profiles reported by the patient and the multifaceted and heterogeneous nature of the injury. Accordingly, the interpretation of postconcussion performance can be challenging, because many different testing paradigms have been reported as potentially useful in the literature. Among the types of tests clinicians use to understand how concussion affects an individual, both gait and neurocognitive evaluations have demonstrated utility. Our purpose is to describe how combined gait and cognitive (i.e., dual task), as well as single-task gait and computerized neurocognitive examinations can assist clinical decision-making.
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Affiliation(s)
- David R Howell
- The Micheli Center for Sports Injury Prevention, Waltham, MA 02453, USA
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA 02115, USA
- Brain Injury Center, Boston Children's Hospital, Boston, MA 02115, USA
- Sports Medicine Center, Children's Hospital Colorado & University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Michael W Kirkwood
- Department of Physical Medicine & Rehabilitation, University of Colorado, Aurora, CO 80045, USA
- Rehabilitation Medicine, Children's Hospital Colorado, Aurora, CO 80045, USA
| | - Aaron Provance
- Sports Medicine Center, Children's Hospital Colorado & University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Grant L Iverson
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02129, USA
- MassGeneral Hospital for Children Sport Concussion Program, Boston, MA 02114, USA
- Home Base, A Red Sox Foundation & Massachusetts General Hospital Program, Boston, MA 02129, USA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA 02453, USA
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA 02115, USA
- Brain Injury Center, Boston Children's Hospital, Boston, MA 02115, USA
- Department of Pediatrics & Orthopaedic Surgery, Harvard Medical School, Boston, MA 02115, USA
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Abstract
Research into sports-related concussion (SRC) or brain injury has vastly expanded our knowledge of the connection between brain activity and behavioral outcomes. Historical examination of concussion reveals components of structural changes in the brain resulting from injury. A constellation of clinical symptoms is typically present following concussion for several days and weeks. However, the intersection of structural changes and clinical examination still remains elusive to medical professionals. With emerging technologies and modalities such as quantitative electroencephalography (EEG), functional magnetic resonance imaging (fMRI), virtual reality (VR), and the study of movement, we can better understand the brain–behavior relationship on clinical findings post-injury. Our advancement in SRC study using athletics provides a unique window into the advances in our ability to study this public health crisis. SRC also allows us to understand how athletics and exercise influence brain health. The evolution of SRC diagnosis, treatment, and management informs our current abilities in the study of the brain.
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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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Munia TTK, Haider A, Schneider C, Romanick M, Fazel-Rezai R. A Novel EEG Based Spectral Analysis of Persistent Brain Function Alteration in Athletes with Concussion History. Sci Rep 2017; 7:17221. [PMID: 29222477 PMCID: PMC5722818 DOI: 10.1038/s41598-017-17414-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/21/2017] [Indexed: 11/09/2022] Open
Abstract
The neurocognitive sequelae of a sport-related concussion and its management are poorly defined. Detecting deficits are vital in making a decision about the treatment plan as it can persist one year or more following a brain injury. The reliability of traditional cognitive assessment tools is debatable, and thus attention has turned to assessments based on electroencephalogram (EEG) to evaluate subtle post-concussive alterations. In this study, we calculated neurocognitive deficits combining EEG analysis with three standard post-concussive assessment tools. Data were collected for all testing modalities from 21 adolescent athletes (seven concussive and fourteen healthy) in three different trials. For EEG assessment, along with linear frequency-based features, we introduced a set of time-frequency (Hjorth Parameters) and nonlinear features (approximate entropy and Hurst exponent) for the first time to explore post-concussive deficits. Besides traditional frequency-band analysis, we also presented a new individual frequency-based approach for EEG assessment. While EEG analysis exhibited significant discrepancies between the groups, none of the cognitive assessment resulted in significant deficits. Therefore, the evidence from the study highlights that our proposed EEG analysis and markers are more efficient at deciphering post-concussion residual neurocognitive deficits and thus has a potential clinical utility of proper concussion assessment and management.
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Affiliation(s)
- Tamanna T K Munia
- Department of Electrical Engineering, University of North Dakota, Grand Forks, 58202, USA
| | - Ali Haider
- Department of Electrical Engineering, University of North Dakota, Grand Forks, 58202, USA
| | - Charles Schneider
- Department of Electrical Engineering, University of North Dakota, Grand Forks, 58202, USA
| | - Mark Romanick
- Department of Physical Therapy, University of North Dakota, Grand Forks, 58202, USA
| | - Reza Fazel-Rezai
- Department of Electrical Engineering, University of North Dakota, Grand Forks, 58202, USA.
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Munia TTK, Haider A, Fazel-Rezai R. Evidence of brain functional deficits following sport-related mild traumatic brain injury. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:3212-3215. [PMID: 29060581 DOI: 10.1109/embc.2017.8037540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sport related mild traumatic brain injury (mTBI), generally known as a concussion, is a worldwide critical public health concern nowadays. Despite growing concern emphasized by scientific research and recent media presentation regarding mTBI and its effect in athletics life, the management, and prevention of mTBI are still not properly done. The evaluation mainly hampered due to the lack of proper knowledge, subjective nature of assessment tools including the fact that the brain functional deficits after mTBI can be mild or hidden. As a result, development of an effective tool for proper management of these mild incidents is a subject of active research. In this paper, to examine the neural substrates following mTBI, an analysis based on electroencephalogram (EEG) from twenty control and twenty concussed athletes is presented. Preliminary results suggest that the concussed athletes have a significant increase in delta, theta and alpha power but a decrease in beta power. We also calculated the power for individual frequencies from 1 Hz to 40 Hz in order to find out the specific frequencies with the highest deficits. The significant deficiencies were found at 1-2 Hz of delta band, 6-7 Hz of theta band, 8-10 Hz of the alpha band, and 16-18 Hz and 24-29 Hz of the beta band. Though there was no significant difference as observed in gamma band, we found the deficit was significant at 34-36 Hz range within the gamma band. The observed deficits at various frequencies demonstrate that even if there is no significant difference in the traditional frequency bands, there may be hidden deficits at some specific frequencies within a frequency band. These preliminary results suggest that the EEG analysis at each unity frequency may be more promising means of identifying the neuronal damage than the traditional frequency band based analysis. Eventually, the proposed analysis can provide an improved approximation to monitor the pathophysiological recovery after a concussion.
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Munia TTK, Gendreau JL, Verma AK, Johnson BD, Romanick M, Tavakolian K, Fazel-Rezai R. Preliminary results of residual deficits observed in athletes with concussion history: combined EEG and cognitive study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:41-44. [PMID: 28268276 DOI: 10.1109/embc.2016.7590635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Assessment, treatment, and management of sport-related concussions are a widely recognized public health issue. Although several neuropsychological and motor assessment tools have been developed and implemented for sports teams at various levels and ages, the sensitivity of these tests has yet to be validated with more objective measures to make return-to-play (RTP) decisions more confidently. The present study sought to analyze the residual effect of concussions on a sample of adolescent athletes who sustained one or more previous concussions compared to those who had no concussion history. For this purpose, a wide variety of assessment tools containing both neurocognitive and electroencephalogram (EEG) elements were used. All clinical testing and EEG were repeated at 8 months, 10 months, and 12 months post-injury for both healthy and concussed athletes. The concussed athletes performed poorer than healthy athletes on processing speed and impulse control subtest of neurocognitive test on month 8, but no alterations were marked in terms of visual and postural stability. EEG analysis revealed significant differences in brain activities of concussed athletes through all three intervals. These long-term neurocognitive and EEG deficits found from this ongoing sport-related concussion study suggest that the post-concussion physiological deficits may last longer than the observed clinical recovery.
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McCrea M, Meier T, Huber D, Ptito A, Bigler E, Debert CT, Manley G, Menon D, Chen JK, Wall R, Schneider KJ, McAllister T. Role of advanced neuroimaging, fluid biomarkers and genetic testing in the assessment of sport-related concussion: a systematic review. Br J Sports Med 2017; 51:919-929. [DOI: 10.1136/bjsports-2016-097447] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2017] [Indexed: 01/17/2023]
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Carron SF, Alwis DS, Rajan R. Traumatic Brain Injury and Neuronal Functionality Changes in Sensory Cortex. Front Syst Neurosci 2016; 10:47. [PMID: 27313514 PMCID: PMC4889613 DOI: 10.3389/fnsys.2016.00047] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 05/19/2016] [Indexed: 01/21/2023] Open
Abstract
Traumatic brain injury (TBI), caused by direct blows to the head or inertial forces during relative head-brain movement, can result in long-lasting cognitive and motor deficits which can be particularly consequential when they occur in young people with a long life ahead. Much is known of the molecular and anatomical changes produced in TBI but much less is known of the consequences of these changes to neuronal functionality, especially in the cortex. Given that much of our interior and exterior lives are dependent on responsiveness to information from and about the world around us, we have hypothesized that a significant contributor to the cognitive and motor deficits seen after TBI could be changes in sensory processing. To explore this hypothesis, and to develop a model test system of the changes in neuronal functionality caused by TBI, we have examined neuronal encoding of simple and complex sensory input in the rat’s exploratory and discriminative tactile system, the large face macrovibrissae, which feeds to the so-called “barrel cortex” of somatosensory cortex. In this review we describe the short-term and long-term changes in the barrel cortex encoding of whisker motion modeling naturalistic whisker movement undertaken by rats engaged in a variety of tasks. We demonstrate that the most common form of TBI results in persistent neuronal hyperexcitation specifically in the upper cortical layers, likely due to changes in inhibition. We describe the types of cortical inhibitory neurons and their roles and how selective effects on some of these could produce the particular forms of neuronal encoding changes described in TBI, and then generalize to compare the effects on inhibition seen in other forms of brain injury. From these findings we make specific predictions as to how non-invasive extra-cranial electrophysiology can be used to provide the high-precision information needed to monitor and understand the temporal evolution of changes in neuronal functionality in humans suffering TBI. Such detailed understanding of the specific changes in an individual patient’s cortex can allow for treatment to be tailored to the neuronal changes in that particular patient’s brain in TBI, a precision that is currently unavailable with any technique.
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Affiliation(s)
- Simone F Carron
- Neuroscience Research Program, Biomedicine Discovery Institute, Department of Physiology, Monash University Monash, VIC, Australia
| | - Dasuni S Alwis
- Neuroscience Research Program, Biomedicine Discovery Institute, Department of Physiology, Monash University Monash, VIC, Australia
| | - Ramesh Rajan
- Neuroscience Research Program, Biomedicine Discovery Institute, Department of Physiology, Monash UniversityMonash, VIC, Australia; Ear Sciences Institute of AustraliaPerth, WA, Australia
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Herrold AA, Sander AM, Wilson KV, Scimeca LM, Cobia DJ, Breiter HC. Dual Diagnosis of Traumatic Brain Injury and Alcohol Use Disorder: Characterizing Clinical and Neurobiological Underpinnings. CURRENT ADDICTION REPORTS 2015. [DOI: 10.1007/s40429-015-0078-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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39
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HOWELL DAVIDR, OSTERNIG LOUISR, CHOU LISHAN. Return to Activity after Concussion Affects Dual-Task Gait Balance Control Recovery. Med Sci Sports Exerc 2015; 47:673-80. [DOI: 10.1249/mss.0000000000000462] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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