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Krizman J, Colegrove D, Cunningham J, Bonacina S, Nicol T, Nerrie M, Kraus N. Concussion acutely disrupts auditory processing in division I football student-athletes. Brain Inj 2024:1-9. [PMID: 39224977 DOI: 10.1080/02699052.2024.2396012] [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: 06/04/2023] [Revised: 08/05/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Diagnosis, assessment, and management of sports-related concussion require a multi-modal approach. Yet, currently, an objective assessment of auditory processing is not included. The auditory system is uniquely complex, relying on exquisite temporal precision to integrate signals across many synapses, connected by long axons. Given this complexity and precision, together with the fact that axons are highly susceptible to damage from mechanical force, we hypothesize that auditory processing is susceptible to concussive injury. METHODS We measured the frequency-following response (FFR), a scalp-recorded evoked potential that assesses processing of complex sound features, including pitch and phonetic identity. FFRs were obtained on male Division I Collegiate football players prior to contact practice to determine a pre-season baseline of auditory processing abilities, and again after sustaining a sports-related concussion. We predicted that concussion would decrease pitch and phonetic processing relative to the student-athlete's preseason baseline. RESULTS We found that pitch and phonetic encoding was smaller post-concussion. Student-athletes who sustained a second concussion showed similar declines after each injury. CONCLUSIONS Auditory processing should be included in the multimodal assessment of sports-related concussion. Future studies that extend this work to other sports, other injuries (e.g. blast exposure), and to female athletes are needed.
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Affiliation(s)
- Jennifer Krizman
- Department of Communication Sciences, Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
| | - Danielle Colegrove
- Department of Sports Medicine, Northwestern University, Evanston, IL, USA
| | - Jenna Cunningham
- Department of Communication Sciences, Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
| | - Silvia Bonacina
- Department of Communication Sciences, Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
| | - Trent Nicol
- Department of Communication Sciences, Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
| | - Matt Nerrie
- Department of Sports Medicine, Northwestern University, Evanston, IL, USA
| | - Nina Kraus
- Department of Communication Sciences, Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Institute for Neuroscience, Northwestern University, Evanston, IL, USA
- Department of Neurobiology, Northwestern University, Evanston, IL, USA
- Department of Otolaryngology, Northwestern University, Chicago, IL, USA
- Department of Linguistics, Northwestern University, Evanston, IL, USA
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Karr JE, Zuccato BG, Ingram EO, McAuley TL, Merker B, Abeare CA. The Post-Concussion Symptom Scale: Normative Data for Adolescent Student-Athletes Stratified by Gender and Preexisting Conditions. Am J Sports Med 2023; 51:225-236. [PMID: 36427014 DOI: 10.1177/03635465221131987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Post-Concussion Symptom Scale (PCSS) is a self-report questionnaire measuring symptoms that commonly occur after a concussion; however, these symptoms are nonspecific and can be related to co-occurring orthopaedic injuries (eg, cervical strain) or patient characteristics and preexisting conditions, even in the absence of a recent injury. As such, clinicians may have difficulty determining whether symptom elevations are attributable to a recent concussion as opposed to a confounding injury or a preexisting condition, which may be especially difficult when preinjury baseline symptom data are unavailable. PURPOSE This study aimed to further validate the 4-factor model of the PCSS (ie, cognitive, sleep-arousal, physical, and affective symptoms) with adolescent student-athletes and provide normative reference data for each factor and the total score, stratified by gender and preexisting health conditions. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Participants were 9358 adolescent student-athletes who completed the PCSS during a preseason baseline evaluation (mean age, 14.9 years; SD, 1.3 years [range, 13-18 years]; 49.3% boys). The 4-factor model of the PCSS was tested for the full sample and separately for boys and girls using confirmatory factor analysis. Symptom severity percentiles were created for the PCSS total score and each factor, stratified by gender and preexisting conditions (ie, attention-deficit/hyperactivity disorder, mental health history, headache/migraine history, learning disability/dyslexia, academic problems, and concussion history). RESULTS The 4-factor model of the PCSS replicated in the full sample (comparative fit index [CFI] = 0.959) and in both gender groups (boys: CFI = 0.961; girls: CFI = 0.960). The total PCSS score at the 84th percentile varied by preexisting conditions as follows: healthy participants = 8, attention-deficit/hyperactivity disorder = 18, mental health history = 26, headache/migraine history = 18, learning disability = 19, and academic problems = 17. On all PCSS subscales, participants with a mental health history had the highest scores, and high scores were associated with having >1 preexisting condition. Girls had higher scores than boys for each stratification. CONCLUSION The 4-factor model of the PCSS replicates for adolescent student-athletes. Gender, number of preexisting conditions, and mental health history are important factors to account for when interpreting PCSS symptom severity. The normative data provided herein could assist clinicians in determining whether an adolescent student-athlete is presenting with persistent postconcussion symptoms or a typical symptom experience based on their gender and personal health history.
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Affiliation(s)
- Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Brandon G Zuccato
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Eric O Ingram
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Tara L McAuley
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Bradley Merker
- Department of Behavioral Health, Henry Ford Health System, Detroit, Michigan, USA
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Tang AR, Davis PJ, Williams KL, Grusky AZ, Hajdu KS, Hou BQ, Yengo-Kahn AM, Zuckerman SL, Terry DP. Use of acute cognitive symptom cluster to predict return-to-learn duration following a sport-related concussion. J Neurosurg Pediatr 2022; 30:378-385. [PMID: 35907196 DOI: 10.3171/2022.6.peds22182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/17/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Adolescents sustaining sport-related concussion often experience difficulties with the return-to-learn (RTL) process. Whereas the initial symptom burden has predicted prolonged RTL, no studies have established a relationship between acute cognitive symptoms and RTL duration. The authors sought to evaluate the relationship between initial cognitive symptoms and RTL duration. METHODS A retrospective single-institution cohort study of adolescent athletes aged 12-23 years who were evaluated within 5 days of a diagnosed sport-related concussion between November 2017 and October 2020 was conducted. Athletes missing cognitive symptom ratings and RTL data were excluded. The primary exposure variable was the Cognitive Symptom Ratio (CSR), defined as total cognitive symptom cluster score divided by total Post-Concussion Symptom Scale (PCSS) score from the initial clinic visit. Primary and secondary outcomes were time to RTL and total length of care, respectively. Multivariable Cox proportional hazards modeling was used to assess the effect of CSR on RTL duration. RESULTS Of 653 athletes evaluated within 5 days of injury, 346 patients were included in the final cohort. Athletes reported a median initial PCSS score of 21 (interquartile range [IQR] 6-37) and a median cognitive symptom score of 4 (IQR 0-9). Most patients endorsed some degree of difficulty concentrating (n = 212, 61.3%). The median CSR was 0.18 (IQR 0.00-0.27). On multivariable regression analysis, a higher CSR was associated with prolonged RTL duration (HR 0.30, 95% CI 0.13-0.69, p = 0.004). When initial PCSS score was added to the model, the previously significant association between CSR and RTL was no longer significant (HR 0.67, 95% CI 0.29-1.59, p = 0.367). When dichotomized based on frequency distribution, a higher proportion of patients with low CSR achieved RTL by 7 days postinjury (82.2% vs 69.9%, p = 0.007), a difference not seen at 14 days (92.2% vs 87.3%, p = 0.133). CONCLUSIONS An acute ratio of cognitive symptoms may predict patients at increased risk for prolonged RTL and those with normal PCSS scores who may experience difficulties once resuming school activities.
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Affiliation(s)
- Alan R Tang
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Philip J Davis
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Kristen L Williams
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alan Z Grusky
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Katherine S Hajdu
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Brian Q Hou
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Aaron M Yengo-Kahn
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott L Zuckerman
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas P Terry
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Abstract
BACKGROUND: Post-traumatic headache is the most common sequela of brain injury and can last months or years after the damaging event. Many headache types are associated with visual concerns also known to stem from concussion. OBJECTIVES: To describe the various headache types seen after head injury and demonstrate how they impact or are impacted by the visual system. METHODS: We will mirror the International Classification of Headache Disorders (ICHD) format to demonstrate the variety of headaches following brain injury and relate correlates to the visual pathways. The PubMed database was searched using terms such as headache, head pain, vision, concussion, traumatic brain injury, glare, visuomotor pathways. RESULTS: Every type of headache described in the International Classification of Headache Disorders Edition III can be initiated or worsened after head trauma. Furthermore, there is very often a direct or indirect impact upon the visual system for each of these headaches. CONCLUSION: Headaches of every described type in the ICHD can be caused by brain injury and all are related in some way to the afferent, efferent or association areas of the visual system.
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Affiliation(s)
- Patrick T. Quaid
- Head of Optometry, VUE Cubed Vision Therapy Clinics, ON, Canada
- College of Optometrists of Ontario (Regulatory Body), ON, Canada
| | - Eric L. Singman
- Ophthalmology & Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
- Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
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Spanish and English Language-Based Differences in Cognitive Performance and Symptom Reporting on ImPACT Baseline Concussion Assessment. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2021. [DOI: 10.1007/s40817-021-00114-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Warmath D, Winterstein AP. A Social-Marketing Intervention and Concussion-Reporting Beliefs. J Athl Train 2020; 55:1035-1045. [DOI: 10.4085/1062-6050-242-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Context
Concussion-symptom education remains the primary approach used by athletic trainers to address underreporting of possible sport-related concussions. Social marketing represents an untapped approach to promote concussion reporting by communicating the benefits or consequences of reporting or not reporting, respectively.
Objective
To apply expectancy value theory and identify how marketing the possible consequences of concealing concussion symptoms influenced young adults' concussion-reporting beliefs to increase the likelihood of reporting.
Design
Randomized controlled clinical trial.
Setting
Laboratory.
Patients or Other Participants
A total of 468 competitive collegiate club sport athletes at a large US university who engaged in 1 of 46 sports with various levels of concussion risk.
Intervention(s)
Participants were randomly assigned by team to 1 of 3 conditions. The treatment condition was a social-marketing program focused on the possible consequences of the reporting decision. The control condition was traditional concussion-symptom education based on the National Collegiate Athletic Association's publication, “Concussion: A Fact Sheet for Student-Athletes.” An additional condition mirrored the traditional symptom education but included a less clinical delivery.
Main Outcome Measure(s)
Positive and negative beliefs regarding concussion reporting were assessed. We applied expectancy value theory, which posits that changing beliefs in the short term will produce greater reporting intentions in the long term.
Results
Club sport athletes exposed to consequence-based social marketing showed higher levels of positive reporting beliefs and lower levels of negative reporting beliefs than athletes exposed to traditional or revised symptom education. We observed no differences between the traditional and revised symptom-education programs. Exposure to consequence-based marketing decreased negative beliefs about reporting (B = −0.165, P = .01) and increased positive beliefs about reporting (B = 0.165, P = .01).
Conclusions
Social marketing offers athletic trainers another strategic tool for motivating athletes to report concussion symptoms by translating scientific findings into marketable statements and then communicating the benefits of reporting or the negative consequences of concealing concussion symptoms.
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Affiliation(s)
- Dee Warmath
- Department of Financial Planning, Housing, and Consumer Economics, College of Family and Consumer Sciences, University of Georgia, Athens
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Kristjánsdóttir H, Brynjarsdóttir RM, Kristensen ISU, Sigurjónsdóttir HÁ, Claessen LÓE, Jónsdóttir MK. Self-reported concussion history among Icelandic female athletes with and without a definition of concussion. Clin Neuropsychol 2020; 34:70-82. [PMID: 32990154 DOI: 10.1080/13854046.2020.1814873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study examined whether Icelandic female athletes in contact sports, based their self-reported concussion history on adequate medical definitions, by assessing self-reported concussion history with and without a definition of concussion. Another aim was to examine whether currently active athletes were more knowledgeable of concussions than retired athletes. METHODS Participants (age = 26.9, SD = 7.1) were 508 former (34.5%) and current (65.5%) elite female athletes in soccer (41%), handball (30.6%), basketball (19.1%), ice hockey (4.5%) and combat sports (4.7%). An online questionnaire (QuestionPro) was distributed to females in contact sports (snowball sampling). Participants later came for an in-person interview where the authenticity of previous responses was confirmed. In the questionnaire, participants answered background questions and questions about concussion history. First, they reported the total number of sustained concussions without a prompt. They reported the number of sustained concussions again after reading a definition of concussion. Participants could not correct their previous answers. Pearson's Chi-square was used for group comparisons. RESULTS The prevalence of reported concussions increased from 40.2% to 64.8% following a definition. There was no significant difference in how many participants changed their answer when asked about sustaining SRCs before and after reading the definition based on whether the participants were still competitive or retired X 2(1) = 0.69, p = 0.41. CONCLUSIONS Our data suggest that understanding of concussions is inadequate among female athletes. Self-report will continue to be an essential source of clinical information and prompting with a definition can increase the reliability of self-reported concussions.
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Affiliation(s)
- Hafrún Kristjánsdóttir
- Physical Activity, Physical Education, Sport and Health (PAPESH) Research Centre, Sports Science Department, School of Social Sciences, Reykjavik University, Reykjavík, Iceland
| | | | - Ingunn S U Kristensen
- Psychology Department, School of Social Sciences, Reykjavik University, Reykjavík, Iceland
| | - Helga Á Sigurjónsdóttir
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland.,Landspitali - The National Hospital of Iceland, Reykjavík, Iceland
| | - Lára Ósk Eggertsdóttir Claessen
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland.,Landspitali - The National Hospital of Iceland, Reykjavík, Iceland
| | - María K Jónsdóttir
- Psychology Department, School of Social Sciences, Reykjavik University, Reykjavík, Iceland.,Landspitali - The National Hospital of Iceland, Reykjavík, Iceland
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Remigio-Baker RA, Gregory E, Cole WR, Bailie JM, McCulloch KL, Cecchini A, Stuessi K, Andrews TR, Mullins L, Ettenhofer ML. Beliefs About the Influence of Rest During Concussion Recovery May Predict Activity and Symptom Progression Within an Active Duty Military Population. Arch Phys Med Rehabil 2020; 101:1204-1211. [PMID: 32234413 DOI: 10.1016/j.apmr.2020.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/26/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate relationships between beliefs about the impact of rest and the level of activities and symptoms over time among active duty Service members sustaining concussion, and whether these relationships vary by provision of concussion education. DESIGN Longitudinal study using multilevel modeling to assess the relationship between beliefs about rest within 72 hours of concussion and change in activity and symptom level over time, as well as interaction by concussion education at the initial clinic visit. SETTING Three military treatment facilities. PARTICIPANTS Study participants included active duty Service members diagnosed with a concussion (N=111; median age, 24 y). Individuals with previous history of concussion within 12 months of study enrollment were excluded. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Activity questionnaire and the Neurobehavioral Symptom Inventory assessed within 72 hours of concussion; at 1 week; and at 1, 3, and 6 month(s) postinjury. RESULTS Receipt of concussion education from providers was significantly associated with greater belief that rest influences concussion recovery. Greater belief that rest influences symptom recovery at the acute stage of concussion was associated with a greater increase in activities over time, but only among those who received education from their provider. Additionally, greater belief about the influence of rest was related to a more rapid decrease in symptoms over time. CONCLUSIONS Concussed Service members who underestimate the influence of rest during acute recovery may be at risk for poorer recovery. Treatment of Service members with postconcussive symptoms should consider patient knowledge and/or beliefs about rest and recovery, which may influence prognosis. Our results support the provider's use of concussion education to correct potential misconceptions that may negatively impact symptom recovery.
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Affiliation(s)
- Rosemay A Remigio-Baker
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Hospital Camp Pendleton, Camp Pendleton, CA; Henry M. Jackson Foundation, Bethesda, MD.
| | - Emma Gregory
- Defense and Veterans Brain Injury Center, Silver Spring, MD
| | - Wesley R Cole
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Womack Army Medical Center, Fort Bragg, NC
| | - Jason M Bailie
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Hospital Camp Pendleton, Camp Pendleton, CA; General Dynamics Health Solutions, Silver Spring, MD
| | - Karen L McCulloch
- Henry M. Jackson Foundation, Bethesda, MD; Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Amy Cecchini
- Womack Army Medical Center, Fort Bragg, NC; Geneva Foundation, Tacoma, WA
| | - Keith Stuessi
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Hospital Camp Pendleton, Camp Pendleton, CA; General Dynamics Health Solutions, Silver Spring, MD
| | - Taylor R Andrews
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Medical Center San Diego, San Diego, CA
| | - Lynita Mullins
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Medical Center San Diego, San Diego, CA
| | - Mark L Ettenhofer
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Medical Center San Diego, San Diego, CA; American Hospital Services Group LLC, Exton, PA
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Effect of a Concussion on Anterior Cruciate Ligament Injury Risk in a General Population. Sports Med 2020; 50:1203-1210. [PMID: 31970718 DOI: 10.1007/s40279-020-01262-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recent studies indicate concussion increases risk of musculoskeletal injury in specific groups of patients. The purpose of this study was to determine the odds of anterior cruciate ligament (ACL) injury after concussion in a population-based cohort. METHODS International Classification of Diseases, 9th and 10th Revision (ICD-9, ICD-10) codes relevant to the diagnosis and treatment of a concussion and ACL tear were utilized to search the Rochester Epidemiology Project (REP) between 2000 and 2017. A total of 1653 unique patients with acute, isolated ACL tears were identified. Medical records for cases were reviewed to confirm ACL tear diagnosis and to determine history of concussion within 3 years prior to the ACL injury. Cases were matched by age, sex, and REP availability date to patients without an ACL tear (1:3 match), resulting in 4959 controls. The medical records of the matched control patients were reviewed to determine history of concussion. RESULTS 39 patients with a concussion suffered an ACL injury up to 3 years after the concussion. The rate of prior concussion was higher in ACL-injured cases (2.4%) compared to matched controls with no ACL injury (1.5%). This corresponds to an odds ratio of 1.6 (95% CI 1.1-2.4; p = 0.015). CONCLUSIONS Although activity level could not be assessed, there are increased odds of ACL injury after concussion in a general population. Based on the evidence of increased odds of musculoskeletal injury after concussion, standard clinical assessments should consider concussion symptom resolution as well as assessment of neuromuscular factors associated with risk of injuries.
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Bailie JM, Remigio-Baker RA, Cole WR, McCulloch KL, Ettenhofer ML, West T, Ahrens A, Sargent P, Cecchini A, Malik S, Mullins L, Stuessi K, Qashu FM, Gregory E. Use of the Progressive Return to Activity Guidelines May Expedite Symptom Resolution After Concussion for Active Duty Military. Am J Sports Med 2019; 47:3505-3513. [PMID: 31718246 DOI: 10.1177/0363546519883259] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Clinical recommendations for concussion management encourage reduced cognitive and physical activities immediately after injury, with graded increases in activity as symptoms resolve. Empirical support for the effectiveness of such recommendations is needed. PURPOSE To examine whether training medical providers on the Defense and Veterans Brain Injury Center's Progressive Return to Activity Clinical Recommendation (PRA-CR) for acute concussion improves patient outcomes. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS This study was conducted from 2016 to 2018 and compared patient outcomes before and after medical providers received an educational intervention (ie, provider training). Patients, recruited either before or after intervention, were assessed at ≤72 hours, 1 week, 1 month, 3 months, and 6 months after a concussion. The participant population included 38 military medical providers and 106 military servicemembers with a diagnosed concussion and treated by one of the military medical providers: 58 patient participants received care before the intervention (ie, provider training) and 48 received care after intervention. The primary outcome measure was the Neurobehavioral Symptom Inventory. RESULTS The patients seen before and after the intervention were predominantly male (89.7% and 93.8%, respectively) of military age (mean ± SD, 26.62 ± 6.29 years and 25.08 ± 6.85 years, respectively) and a mean ± SD of 1.92 ± 0.88 days from injury. Compared with patients receiving care before intervention, patients receiving care after intervention had smaller increases in physical activities (difference in mean change; 95% CI, 0.39 to 6.79) and vestibular/balance activities (95% CI, 0.79 to 7.5) during the first week of recovery. Although groups did not differ in symptoms at ≤72 hours of injury (d = 0.22; 95% CI, -2.21 to 8.07), the postintervention group reported fewer symptoms at 1 week (d = 0.61; 95% CI, 0.52 to 10.92). Postintervention patients who completed the 6-month study had improved recovery both at 1 month (d = 1.55; 95% CI, 5.33 to 15.39) and 3 months after injury (d = 1.10; 95% CI, 2.36 to 11.55), but not at 6 months (d = 0.35; 95% CI, 5.34 to 7.59). CONCLUSION Training medical providers on the PRA-CR for management of concussion resulted in expedited recovery of patients.
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Affiliation(s)
- Jason M Bailie
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Rosemay A Remigio-Baker
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Wesley R Cole
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Karen L McCulloch
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Mark L Ettenhofer
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Therese West
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Angelica Ahrens
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Paul Sargent
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Amy Cecchini
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Saafan Malik
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Lynita Mullins
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Keith Stuessi
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Felicia M Qashu
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
| | - Emma Gregory
- Investigation performed at Camp Pendleton, California, USA, Fort Bragg, California, USA and Naval Medical Center San Diego, San Diego, California, USA
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Stockbridge MD, Newman R. Enduring Cognitive and Linguistic Deficits in Individuals With a History of Concussion. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1554-1570. [PMID: 31487473 DOI: 10.1044/2019_ajslp-18-0196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The purpose of this research is to determine whether individuals with a history of concussion retain enduring differences in narrative writing tasks, which necessitate rapid and complex integration of both cognitive and linguistic faculties. Method Participants aged 12-40 years old, who did or did not have a remote history of concussion, were recruited to take an online survey that included writing both a familiar and a novel narrative. They also were asked to complete multiple tasks targeting word-level and domain general cognitive skills, so that their performance could be interpreted across these dimensions. Results Participants with a concussion history were largely similar to participants with no history of brain injury across tasks that targeted a single skill in isolation. However, participants with prior concussions demonstrated difficulty in providing both key content and details when presented with a novel video and asked to provide a summary of what they had just seen. Number of lifetime concussions predicted the inclusion of key content when summarizing the video. Thus, differences in cognitive and linguistic skills required for written narrative language may continue to be present far after concussion, despite average normative levels of performance on tasks targeting these skills in isolation. Conclusions These findings suggest that individuals with a concussion history, particularly a history of multiple concussions, may continue to experience difficulties for a long period after injury and are likely to benefit from more complex and ecologically valid assessment prior to discharge. Individuals with a concussion history who return to full participation in work, school, and recreational activities may continue to benefit from assistance when asked to rapidly acquire and distill novel information, as is often required in academic and professional environments.
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Affiliation(s)
| | - Rochelle Newman
- Department of Hearing and Speech Sciences, University of Maryland, College Park
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The Role of Subsymptom Threshold Aerobic Exercise for Persistent Concussion Symptoms in Patients With Postconcussion Syndrome. Am J Phys Med Rehabil 2019; 99:257-264. [DOI: 10.1097/phm.0000000000001340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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DeMatteo CA, Randall S, Lin CYA, Claridge EA. What Comes First: Return to School or Return to Activity for Youth After Concussion? Maybe We Don't Have to Choose. Front Neurol 2019; 10:792. [PMID: 31396150 PMCID: PMC6664873 DOI: 10.3389/fneur.2019.00792] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/09/2019] [Indexed: 12/16/2022] Open
Abstract
Objectives: Return to School (RTS) and Return to Activity/Play (RTA) protocols are important in concussion management. Minimal evidence exists as to sequence and whether progression can occur simultaneously. Experts recommend that children/youth fully return to school before beginning RTA protocols. This study investigates recovery trajectories of children/youth while following RTA and RTS protocols simultaneously, with the following objectives: (1) to compare rates and patterns of progression through the stages of both protocols; (2) to evaluate symptom trajectories of youth post-concussion while progressing through stages of RTS and RTA; and (3) to propose a new model for concussion management in youth that involves the integration of Return to Activity and Return to School protocols. Methods: In a 3-year prospective-cohort study of 139 children/youth aged 5-18 years with concussive injury, self-reported symptoms using PCSS and stage of protocols were evaluated every 48 h using electronic surveys until full return to school and activity/sport were attained. Information regarding school accommodation and achievement was collected. Results: Sample mean age is 13 years, 46% male. Youth are returning to school with accommodations significantly quicker than RTA (p = 0.001). Significant negative correlations between total PCSS score and stage of RTS protocol were found at: 1-week (r = -0.376, p < 0.0001; r = -0.317, p = 0.0003), 1-month (r = -0.483, p < 0.0001; r = -0.555, p < 0.0001), and 3-months (r = -0.598, p < 0.0001; r = -0.617, p < 0.0001); indicating lower symptom scores correlated with higher guideline stages. Median full return to school time is 35 days with 21% of youth symptomatic at full return. Median return time to full sport competition is 38 days with 15% still symptomatic. Sixty-four percent of youth reported experiencing school problems during recovery and 30% at symptom resolution, with 31% reporting a drop in their grades during recovery and 18% at study completion. Conclusions: Children/youth return to school faster than they return to play in spite of the self-reported, school-related symptoms they experience while moving through the protocols. Youth can progress simultaneously through the RTS and RTA protocols during stages 1-3. Considering the numbers of youth having school difficulties post-concussion, full contact sport, stage 6, of RTA, should be delayed until full and successful reintegration back to school has been achieved. In light of the huge variability in recovery, determining how to resume participation in activities despite ongoing symptoms is still the challenge for each individual child. There is much to be learned with further research needed in this area.
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Affiliation(s)
- Carol A. DeMatteo
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Disability Research, McMaster University, Hamilton, ON, Canada
| | - Sarah Randall
- CanChild Centre for Disability Research, McMaster University, Hamilton, ON, Canada
| | - Chia-Yu A. Lin
- CanChild Centre for Disability Research, McMaster University, Hamilton, ON, Canada
- ARiEAL, Centre for Advanced Research in Experimental and Applied Linguistics, McMaster University, Hamilton, ON, Canada
| | - Everett A. Claridge
- CanChild Centre for Disability Research, McMaster University, Hamilton, ON, Canada
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Tone-induced cervical and ocular vestibular-evoked myogenic potentials: comparing abnormalities in traumatic and non-traumatic vestibular disease. The Journal of Laryngology & Otology 2018; 132:906-910. [PMID: 30295212 DOI: 10.1017/s002221511800172x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Otolithic function is poorly understood, but vestibular-evoked myogenic potential testing has allowed the documentation of pathology in patients who complain of imbalance. METHODS Seventy-four patients with traumatic and non-traumatic vestibular disease were sequentially assessed at a tertiary referral neuro-otology unit in a teaching hospital. A detailed history of all patients was taken and standard vestibular assessment was conducted using the technique described in the companion paper. The results of both groups of patients were analysed and the rate of abnormalities was assessed. RESULTS There was a high rate of abnormalities, including bilateral pathology, in a significant number of patients. Many patients in both groups inexplicably failed to recover. CONCLUSION Vestibular-evoked myogenic potentials are helpful in documenting pathology, including bilateral pathology, which is outlined in the literature as being exceedingly difficult to compensate for.
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Assessing Balance in an Athletic Population: Normative Data for the Concussion Balance Test (COBALT©). INTERNATIONAL JOURNAL OF ATHLETIC THERAPY & TRAINING 2018. [DOI: 10.1123/ijatt.2017-0042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Concussions are becoming increasingly important to manage properly as sports participation continues to rise. Repeated injuries occurring before the brain has had a chance to recover from an initial insult are particularly dangerous and must be prevented. Although much national media attention has been devoted to concussions in professional sports, it is important to appreciate that athletes in any age group, children and adolescents in particular, are at risk of sports-related concussion. It is crucial to remove an athlete from play any time concussion is suspected. Once removed from play, recovery then begins with a period of cognitive and physical rest, followed by a gradual return to cognitive and athletic activities as symptoms resolve. Children and adolescents pose a unique challenge to the clinician managing their recovery, as the physical and cognitive rest periods required often involve time away from school and sports, which can be academically detrimental and socially isolating. Recently developed sideline assessment tools have greatly aided the urgent sideline assessment of an athlete suspected of having a concussion. In this article, a brief review of current guidelines is presented in tandem with the authors' preferred treatment of concussion.
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Benedict RH, DeLuca J, Phillips G, LaRocca N, Hudson LD, Rudick R. Validity of the Symbol Digit Modalities Test as a cognition performance outcome measure for multiple sclerosis. Mult Scler 2017; 23:721-733. [PMID: 28206827 PMCID: PMC5405816 DOI: 10.1177/1352458517690821] [Citation(s) in RCA: 521] [Impact Index Per Article: 74.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cognitive and motor performance measures are commonly employed in multiple sclerosis (MS) research, particularly when the purpose is to determine the efficacy of treatment. The increasing focus of new therapies on slowing progression or reversing neurological disability makes the utilization of sensitive, reproducible, and valid measures essential. Processing speed is a basic elemental cognitive function that likely influences downstream processes such as memory. The Multiple Sclerosis Outcome Assessments Consortium (MSOAC) includes representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. Among the MSOAC goals is acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step for these neuroperformance metrics is elucidation of clinically relevant benchmarks, well-defined degrees of disability, and gradients of change that are deemed clinically meaningful. This topical review provides an overview of research on one particular cognitive measure, the Symbol Digit Modalities Test (SDMT), recognized as being particularly sensitive to slowed processing of information that is commonly seen in MS. The research in MS clearly supports the reliability and validity of this test and recently has supported a responder definition of SDMT change approximating 4 points or 10% in magnitude.
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Affiliation(s)
- Ralph Hb Benedict
- Department of Neurology and Buffalo General Medical Center, University at Buffalo, Buffalo, NY, USA
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA; Rutgers New Jersey Medical School, Newark, NJ, USA
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- Multiple Sclerosis Outcome Assessments Consortium (MSOAC), Critical Path Institute, Tucson, AZ, USA
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Radhakrishnan R, Garakani A, Gross LS, Goin MK, Pine J, Slaby AE, Sumner CR, Baron DA. Neuropsychiatric aspects of concussion. Lancet Psychiatry 2016; 3:1166-1175. [PMID: 27889010 DOI: 10.1016/s2215-0366(16)30266-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/13/2016] [Accepted: 08/15/2016] [Indexed: 10/20/2022]
Abstract
Over the past decade, concussion has become the most widely discussed injury in contact sports. However, concussions also occur in several other settings, such as non-contact sports, elderly individuals, young children, military personnel, and victims of domestic violence. Concussion is frequently undiagnosed as a cause of psychiatric morbidity, especially when the patient has no history of loss of consciousness or direct head trauma. Almost all of the extant literature focuses on traumatic brain injury and assumes that concussion is merely a mild form of traumatic brain injury, which has resulted in a lack of understanding about what concussion is, and how to diagnose, monitor, and treat its varied neuropsychiatric symptoms. In this Review, we address key issues so that the psychiatric clinician can better understand and treat patients with a clinical phenotype that might be the direct result of, or be exacerbated by, concussion. Future research needs to focus on prospective clinical trials in all affected patient populations (ie, those affected by concussion and those affected by various degrees of traumatic brain injury), the identification of reliable biomarkers that can be used to assist with diagnosis and treatment response, and the development of effective treatment interventions. Clearly differentiating concussion from traumatic brain injury is essential to achieve reliable and clinically relevant outcomes.
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Affiliation(s)
- Rajiv Radhakrishnan
- Yale University School of Medicine, New Haven, CT, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA
| | - Amir Garakani
- Yale University School of Medicine, New Haven, CT, USA; Silver Hill Hospital, New Canaan, CT, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA
| | - Lawrence S Gross
- University of Southern California, Los Angeles, CA, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA
| | - Marcia K Goin
- University of Southern California, Los Angeles, CA, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA
| | - Janet Pine
- University of Southern California, Los Angeles, CA, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA
| | - Andrew E Slaby
- New York University, New York, NY, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA
| | - Calvin R Sumner
- Pearson North America, Boston, MA, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA
| | - David A Baron
- University of Southern California, Los Angeles, CA, USA; Psychopharmacology Committee, Group for Advancement of Psychiatry, Dallas, TX, USA.
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Gregory E, West TA, Cole WR, Bailie JM, McCulloch KL, Ettenhofer ML, Cecchini A, Qashu FM. Use of a multi-level mixed methods approach to study the effectiveness of a primary care progressive return to activity protocol after acute mild traumatic brain injury/concussion in the military. Contemp Clin Trials 2016; 52:95-100. [PMID: 27836507 DOI: 10.1016/j.cct.2016.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/31/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
The large number of U.S. service members diagnosed with concussion/mild traumatic brain injury each year underscores the necessity for clear and effective clinical guidance for managing concussion. Relevant research continues to emerge supporting a gradual return to pre-injury activity levels without aggravating symptoms; however, available guidance does not provide detailed standards for this return to activity process. To fill this gap, the Defense and Veterans Brain Injury Center released a recommendation for primary care providers detailing a step-wise return to unrestricted activity during the acute phase of concussion. This guidance was developed in collaboration with an interdisciplinary group of clinical, military, and academic subject matter experts using an evidence-based approach. Systematic evaluation of the guidance is critical to ensure positive patient outcomes, to discover barriers to implementation by providers, and to identify ways to improve the recommendation. Here we describe a multi-level, mixed-methods approach to evaluate the recommendation incorporating outcomes from both patients and providers. Procedures were developed to implement the study within complex but ecologically-valid settings at multiple military treatment facilities and operational medical units. Special consideration was given to anticipated challenges such as the frequent movement of military personnel, selection of appropriate design and measures, study implementation at multiple sites, and involvement of multiple service branches (Army, Navy, and Marine Corps). We conclude by emphasizing the need to consider contemporary approaches for evaluating the effectiveness of clinical guidance.
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Affiliation(s)
- Emma Gregory
- Defense and Veterans Brain Injury Center, 1335 East West Highway, Silver Spring, MD 20910, United States; General Dynamics Health Solutions, 8601 Georgia Ave Ste. 900, Silver Spring, MD 20910, United States.
| | - Therese A West
- US Army Medical Research and Materiel Command, Combat Casualty Care Research Program, 722 Doughten Street, Fort Detrick, MD 21792, United States
| | - Wesley R Cole
- Defense and Veterans Brain Injury Center, 1335 East West Highway, Silver Spring, MD 20910, United States; General Dynamics Health Solutions, 8601 Georgia Ave Ste. 900, Silver Spring, MD 20910, United States; Womack Army Medical Center, MCXC-TBI 2817 Reilly Road, Fort Bragg, NC 28310, United States
| | - Jason M Bailie
- Defense and Veterans Brain Injury Center, 1335 East West Highway, Silver Spring, MD 20910, United States; General Dynamics Health Solutions, 8601 Georgia Ave Ste. 900, Silver Spring, MD 20910, United States; Naval Hospital Camp Pendleton, 33 Area, Camp Margarita, Mental Health Building 33305, Camp Pendleton, CA 92055, United States
| | - Karen L McCulloch
- University of North Carolina Chapel Hill, 321 S. Columbia Street, Bondurant Hall Ste 3024, Chapel Hill, NC 27599, United States; Venesco LLC, 14801 Murdock Street Suite 125, Chantilly, VA 20151, United States
| | - Mark L Ettenhofer
- Defense and Veterans Brain Injury Center, 1335 East West Highway, Silver Spring, MD 20910, United States; Naval Medical Center San Diego, Department of Physical Medicine and Rehabilitation, 34730 Bob Wilson Dr. Ste #201 Bldg 3, San Diego, CA. 92134, United States; American Hospital Services Group LLC, 1 E. Uwchlan Ave, Suite 407, Exton, PA 19341, United States
| | - Amy Cecchini
- Defense and Veterans Brain Injury Center, 1335 East West Highway, Silver Spring, MD 20910, United States; Venesco LLC, 14801 Murdock Street Suite 125, Chantilly, VA 20151, United States
| | - Felicia M Qashu
- Defense and Veterans Brain Injury Center, 1335 East West Highway, Silver Spring, MD 20910, United States
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Vander Werff Kathy R. The Application of the International Classification of Functioning, Disability and Health to Functional Auditory Consequences of Mild Traumatic Brain Injury. Semin Hear 2016; 37:216-32. [PMID: 27489400 DOI: 10.1055/s-0036-1584409] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This article reviews the auditory consequences of mild traumatic brain injury (mTBI) within the context of the International Classification of Functioning, Disability and Health (ICF). Because of growing awareness of mTBI as a public health concern and the diverse and heterogeneous nature of the individual consequences, it is important to provide audiologists and other health care providers with a better understanding of potential implications in the assessment of levels of function and disability for individual interdisciplinary remediation planning. In consideration of body structures and function, the mechanisms of injury that may result in peripheral or central auditory dysfunction in mTBI are reviewed, along with a broader scope of effects of injury to the brain. The activity limitations and participation restrictions that may affect assessment and management in the context of an individual's personal factors and their environment are considered. Finally, a review of management strategies for mTBI from an audiological perspective as part of a multidisciplinary team is included.
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TBI and Concussions in Student Athletes: How do Severity of Injury, Age, and Gender Influence Recovery. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2015. [DOI: 10.1007/s40817-015-0010-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Merritt VC, Meyer JE, Arnett PA. A novel approach to classifying postconcussion symptoms: The application of a new framework to the Post-Concussion Symptom Scale. J Clin Exp Neuropsychol 2015; 37:764-75. [DOI: 10.1080/13803395.2015.1060950] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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24
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Development of Clinical Recommendations for Progressive Return to Activity After Military Mild Traumatic Brain Injury. J Head Trauma Rehabil 2015; 30:56-67. [DOI: 10.1097/htr.0000000000000104] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sinopoli KJ, Chen JK, Wells G, Fait P, Ptito A, Taha T, Keightley M. Imaging “Brain Strain” in Youth Athletes with Mild Traumatic Brain Injury during Dual-Task Performance. J Neurotrauma 2014; 31:1843-59. [DOI: 10.1089/neu.2014.3326] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Katia J. Sinopoli
- Department of Psychology, Division of Neurology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jen-Kai Chen
- McGill University Health Centre and Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Greg Wells
- Department of Kinesiology and Physical Education, University of Toronto, Ontario, Canada
- Department of Physiology and Experimental Medicine, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Philippe Fait
- Department of Physical Activity Science, University of Quebec at Trois-Rivières, Canada
- Research Group on Neuromusculoskeletal Dysfunctions, University of Quebec at Trois-Rivières, Canada
| | - Alain Ptito
- McGill University Health Centre and Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Tim Taha
- Department of Kinesiology and Physical Education, University of Toronto, Ontario, Canada
| | - Michelle Keightley
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy and Graduate Department of Rehabilitation Science and Psychology, University of Toronto, Ontario, Canada
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26
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Putukian M, Kutcher J. Current Concepts in the Treatment of Sports Concussions. Neurosurgery 2014; 75 Suppl 4:S64-70. [DOI: 10.1227/neu.0000000000000492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Sabini RC, Nutini DN, Nutini M. Return-to-play guidelines in concussion: revisiting the literature. PHYSICIAN SPORTSMED 2014; 42:10-9. [PMID: 25295761 DOI: 10.3810/psm.2014.09.2070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Return-to-play (RTP) guidelines in concussion management and treatment continue to challenge clinicians, despite recent updates to the protocols and the ongoing media attention. The current guidelines address individualized treatment planning but are difficult to apply to athletes who experience prolonged symptoms, are younger, or have sustained multiple concussions. Recent literature findings have contributed to an improved understanding and applicability of the guidelines while emphasizing a multidisciplinary paradigm in formulating an individualized RTP decision. Successful implementation of the RTP guidelines will ensure that athletes are protected from further injury and return to their baseline functional status.
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Affiliation(s)
- Rosanna C Sabini
- Department of Physical Medicine and Rehabilitation, Southside Hospital- North Shore Long Island Jewish, Bay Shore, NY.
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28
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Farnsworth JL, McElhiney D, David S, Sinha G, Ragan BG. Objective functional assessment after a head injury using movement and activity in physical space scores: a case report. J Athl Train 2014; 49:568-75. [PMID: 24840582 DOI: 10.4085/1062-6050-49.3.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the potential benefit of using a global positioning system (GPS) and accelerometry as an objective functional-activity measure after concussion by creating Movement and Activity in Physical Space (MAPS) scores. BACKGROUND A 21-year-old female soccer player suffered a blow to the back of the head from an opponent's shoulder during an away match. No athletic trainer was present. She played the remainder of the match and reported to the athletic training facility the next day for evaluation. DIFFERENTIAL DIAGNOSIS Concussion. TREATMENT The athlete was removed from all athletic activities. Her symptoms were monitored based on the Zurich guidelines. She was also instructed to wear an accelerometer on her hip and to carry an on-person GPS receiver at all times for 10 days. Her total symptom scores for the 4 symptomatic days were 82, 39, 49, and 36. Her mean MAPS functional score for symptomatic days 3 through 5 was 900.9 and for asymptomatic days 6 through 11 was 2734.9. UNIQUENESS We monitored the patient's function during the concussion-recovery process using an on-person GPS receiver and accelerometer to calculate personalized MAPS scores. This novel approach to measuring function after injury may provide a useful complementary tool to help with return-to-play decisions. CONCLUSIONS An on-person GPS receiver and accelerometer were used to observe the patient's physical activity in a free-living environment, allowing for an objective measure of function during recovery. Her MAPS scores were low while she was symptomatic and increased as she became asymptomatic. We saw the expected inverse relationship between symptoms and function. In situations where accuracy of reported symptoms may be a concern, this measure may provide a way to verify the validity of, or raise doubts about, self-reported symptoms.
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Affiliation(s)
- James L Farnsworth
- Division of Athletic Training, School of Applied Health Science and Wellness, Ohio University, Athens
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Poltavski DV, Biberdorf D. Screening for lifetime concussion in athletes: importance of oculomotor measures. Brain Inj 2014; 28:475-85. [PMID: 24702485 DOI: 10.3109/02699052.2014.888771] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
HYPOTHESIS/OBJECTIVE The purpose of the present study was to determine the utility of oculomotor-based evaluation protocols in screening for lifetime concussion incidence in elite hockey players. METHODS Forty-two Division I collegiate male and female hockey players were evaluated using the guidelines of an overall oculomotor-based diagnostic clinical test protocol for the mTBI population. The sensitivity of the collected measures to lifetime concussion was then compared with the corresponding sensitivity of measures of neuropsychological functioning (ImPACT) often used with athletes for acute concussion diagnosis. RESULTS This model showed that a hockey player with a Near Point of Fixation Disparity (NPFD) equal to or greater than 15 cm, Visagraph comprehension rate less than 85% and the total score on part A of an ADHD questionnaire equal to or greater than 11 was on average 10.72-times more likely to have previously suffered a concussion than an athlete with lower values on the NPFD and ADHD questionnaire and a higher comprehension rate on the Visagraph. None of the IMPACT baseline assessment measures were significantly predictive of the individual's concussion history. CONCLUSION The study provides a relatively sensitive screening tool to assess the probability of previous concussion(s) in an athlete. This model may allow athletic personnel to address in a timely manner the risks associated with repeat concussions and to develop individualized concussion management protocols.
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Affiliation(s)
- Dmitri V Poltavski
- Department of Psychology, University of North Dakota , Grand Forks, ND , USA and
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30
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Assessment, Management and Knowledge of Sport-Related Concussion: Systematic Review. Sports Med 2014; 44:449-71. [DOI: 10.1007/s40279-013-0134-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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31
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McCrory P, Meeuwisse WH, Aubry M, Cantu RC, Dvořák J, Echemendia RJ, Engebretsen L, Johnston K, Kutcher JS, Raftery M, Sills A, Benson BW, Davis GA, Ellenbogen R, Guskiewicz KM, Herring SA, Iverson GL, Jordan BD, Kissick J, McCrea M, McIntosh AS, Maddocks D, Makdissi M, Purcell L, Putukian M, Schneider K, Tator CH, Turner M. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport, Zurich, November 2012. J Athl Train 2013; 48:554-75. [PMID: 23855364 DOI: 10.4085/1062-6050-48.4.05] [Citation(s) in RCA: 315] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.
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McKeon JMM, Livingston SC, Reed A, Hosey RG, Black WS, Bush HM. Trends in concussion return-to-play timelines among high school athletes from 2007 through 2009. J Athl Train 2013; 48:836-43. [PMID: 24143901 DOI: 10.4085/1062-6050-48.6.17] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Whereas guidelines about return-to-play (RTP) after concussion have been published, actual prognoses remain elusive. OBJECTIVE To develop probability estimates for time until RTP after sport-related concussion. DESIGN Descriptive epidemiology study. SETTING High school. PATIENTS OR OTHER PARTICIPANTS Injured high school varsity, junior varsity, or freshman athletes who participated in 1 of 13 interscholastic sports at 7 area high schools during the 2007-2009 academic years. INTERVENTION(S) Athletic trainers employed at each school collected concussion data. The athletic trainer or physician on site determined the presence of a concussion. Athlete-exposures for practices and games also were captured. MAIN OUTCOME MEASURE(S) Documented concussions were categorized by time missed from participation using severity outcome intervals (same-day return, 1- to 2-day return, 3- to 6-day return, 7- to 9-day return, 10- to 21-day return, >21-day return, no return [censored data]). We calculated Kaplan-Meier time-to-event probabilities that included censored data to determine the probability of RTP at each of these time intervals. RESULTS A total of 81 new concussions were documented in 478 775 athlete-exposures during the study period. After a new concussion, the probability of RTP (95% confidence interval) was 2.5% (95% confidence interval = 0.3, 6.9) for a 1- to 2-day return, 71.3% (95% confidence interval = 59.0, 82.9) for a 7- to 9-day return, and 88.8% (95% confidence interval = 72.0, 97.2) for a 10- to 21-day return. CONCLUSIONS For high school athletes, RTP within the first 2 days after concussion was unlikely. After 1 week, the probability of return rose substantially (approximately 71%). Prognostic indicators are used to educate patients about the likely course of disease. Whereas individual symptoms and recovery times vary, prognostic time-to-event probabilities allow clinicians to provide coaches, parents, and athletes with a prediction of the likelihood of RTP within certain timeframes after a concussion.
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Parsey CM, Schmitter-Edgecombe M. Applications of technology in neuropsychological assessment. Clin Neuropsychol 2013; 27:1328-61. [PMID: 24041037 DOI: 10.1080/13854046.2013.834971] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Most neuropsychological assessments include at least one measure that is administered, scored, or interpreted by computers or other technologies. Despite supportive findings for these technology-based assessments, there is resistance in the field of neuropsychology to adopt additional measures that incorporate technology components. This literature review addresses the research findings of technology-based neuropsychological assessments, including computer- and virtual reality-based measures of cognitive and functional abilities. We evaluate the strengths and limitations of each approach, and examine the utility of technology-based assessments to obtain supplemental cognitive and behavioral information that may be otherwise undetected by traditional paper-and-pencil measures. We argue that the potential of technology use in neuropsychological assessment has not yet been realized, and continued adoption of new technologies could result in more comprehensive assessment of cognitive dysfunction and in turn, better informed diagnosis and treatments. Recommendations for future research are also provided.
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Affiliation(s)
- Carolyn M Parsey
- a Department of Psychology , Washington State University , Pullman , WA , USA
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Returning service members to duty following mild traumatic brain injury: exploring the use of dual-task and multitask assessment methods. Phys Ther 2013; 93:1254-67. [PMID: 23766395 DOI: 10.2522/ptj.20120143] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Within the last decade, more than 220,000 service members have sustained traumatic brain injury (TBI) in support of military operations in Iraq and Afghanistan. Mild TBI may result in subtle cognitive and sensorimotor deficits that adversely affect warfighter performance, creating significant challenges for service members, commanders, and clinicians. In recent conflicts, physical therapists and occupational therapists have played an important role in evaluating service member readiness to return to duty (RTD), incorporating research and best practices from the sports concussion literature. Because premorbid (baseline) performance metrics are not typically available for deployed service members as for athletes, clinicians commonly determine duty readiness based upon the absence of postconcussive symptoms and return to "normal" performance on clinical assessments not yet validated in the military population. Although practices described in the sports concussion literature guide "return-to-play" determinations, resolution of symptoms or improvement of isolated impairments may be inadequate to predict readiness in a military operational environment. Existing clinical metrics informing RTD decision making are limited because they fail to emphasize functional, warrior task demands and they lack versatility to assess the effects of comorbid deficits. Recently, a number of complex task-oriented RTD approaches have emerged from Department of Defense laboratory and clinical settings to address this gap. Immersive virtual reality environments, field-based scenario-driven assessment programs, and militarized dual-task and multitask-based approaches have all been proposed for the evaluation of sensorimotor and cognitive function following TBI. There remains a need for clinically feasible assessment methods that can be used to verify functional performance and operational competence in a variety of practice settings. Complex and ecologically valid assessment techniques incorporating dual-task and multitask methods may prove useful in validating return-to-activity requirements in civilian and military populations.
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McCrory P, Meeuwisse W, Aubry M, Cantu B, Dvořák J, Echemendia R, Engebretsen L, Johnston K, Kutcher J, Raftery M, Sills A, Benson B, Davis G, Ellenbogen R, Guskiewicz K, Herring SA, Iverson G, Jordan B, Kissick J, McCrea M, McIntosh A, Maddocks D, Makdissi M, Purcell L, Putukian M, Schneider K, Tator C, Turner M. Consensus statement on Concussion in Sport – The 4th International Conference on Concussion in Sport held in Zurich, November 2012. Phys Ther Sport 2013; 14:e1-e13. [PMID: 23664041 DOI: 10.1016/j.ptsp.2013.03.002] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 02/25/2013] [Indexed: 12/14/2022]
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Consensus statement on Concussion in Sport—The 4th International Conference on Concussion in Sport held in Zurich, November 2012. J Sci Med Sport 2013; 16:178-89. [DOI: 10.1016/j.jsams.2013.02.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 02/25/2013] [Indexed: 12/14/2022]
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McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvořák J, Echemendia RJ, Engebretsen L, Johnston K, Kutcher JS, Raftery M, Sills A, Benson BW, Davis GA, Ellenbogan R, Guskiewicz K, Herring SA, Iverson GL, Jordan BD, Kissick J, McCrea M, McIntosh AS, Maddocks D, Makdissi M, Purcell L, Putukian M, Schneider K, Tator CH, Turner M. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. J Am Coll Surg 2013; 216:e55-71. [PMID: 23582174 DOI: 10.1016/j.jamcollsurg.2013.02.020] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 02/19/2013] [Indexed: 12/14/2022]
Affiliation(s)
- Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.
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38
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McCrory P, Meeuwisse WH, Aubry M, Cantu RC, Dvořák J, Echemendia RJ, Engebretsen L, Johnston KM, Kutcher JS, Raftery M, Sills A, Benson BW, Davis GA, Ellenbogen R, Guskiewicz KM, Herring SA, Iverson GL, Jordan BD, Kissick J, McCrea M, McIntosh AS, Maddocks DL, Makdissi M, Purcell L, Putukian M, Schneider K, Tator CH, Turner M. Consensus statement on concussion in sport--the 4th International Conference on Concussion in Sport held in Zurich, November 2012. PM R 2013; 5:255-79. [PMID: 23466418 DOI: 10.1016/j.pmrj.2013.02.012] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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Testoni D, Hornik CP, Smith PB, Benjamin DK, McKinney RE. Sports medicine and ethics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2013; 13:4-12. [PMID: 24024796 PMCID: PMC3899648 DOI: 10.1080/15265161.2013.828114] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Physicians working in the world of competitive sports face unique ethical challenges, many of which center around conflicts of interest. Team-employed physicians have obligations to act in the club's best interest while caring for the individual athlete. As such, they must balance issues like protecting versus sharing health information, as well as issues regarding autonomous informed consent versus paternalistic decision making in determining whether an athlete may compete safely. Moreover, the physician has to deal with an athlete's decisions about performance enhancement and return to play, pursuit of which may not be in the athlete's long-term best interests but may benefit the athlete and team in the short term. These difficult tasks are complicated by the lack of evidence-based standards in a field influenced by the lure of financial gains for multiple parties involved. In this article, we review ethical issues in sports medicine with specific attention paid to American professional football.
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Affiliation(s)
- Daniela Testoni
- Duke Clinical Research Institute, Durham, NC
- Division of Neonatal Medicine, Universidade Federal de São Paulo, SP, Brazil
| | - Christoph P. Hornik
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - P. Brian Smith
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Ross E. McKinney
- Department of Pediatrics, Duke University Medical Center, Durham, NC
- Trent Center for Bioethics, Humanities, and History of Medicine, Durham, NC
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Ma R, Miller CD, Hogan MV, Diduch BK, Carson EW, Miller MD. Sports-related concussion: assessment and management. J Bone Joint Surg Am 2012; 94:1618-27. [PMID: 22992853 DOI: 10.2106/jbjs.k.01127] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Richard Ma
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Zhang K, Johnson B, Gay M, Horovitz SG, Hallett M, Sebastianelli W, Slobounov S. Default mode network in concussed individuals in response to the YMCA physical stress test. J Neurotrauma 2012; 29:756-65. [PMID: 22040294 DOI: 10.1089/neu.2011.2125] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We hypothesize that the evolution of mild traumatic brain injury (mTBI) may be related to differential effects of a concussive blow on the functional integrity of the brain default mode network (DMN) at rest and/or in response to physical stress. Accordingly, in this resting-state functional magnetic resonance imaging (fMRI) study, we examined 14 subjects 10±2 days post-sports-related mTBI and 15 age-matched normal volunteers (NVs) to investigate the possibility that the integrity of the DMN is disrupted at the resting state and/or following the physical stress test. First, all mTBI subjects were asymptomatic based upon clinical evaluation and neuropsychological (NP) assessments prior to the MRI session. Second, the functional integrity within the DMN, a main resting-state network, remained resilient to a single concussive blow. Specifically, the major regions of interest (ROIs) constituting the DMN (e.g., the posterior cingulate cortex [PCC]/precuneus area, the medial prefrontal cortex [MPFC], and left and right lateral parietal cortices [LLP and RLP]) and the connectivity within these four ROIs was similar between NVs and mTBI subjects prior to the YMCA physical stress test. However, the YMCA physical stress test disrupted the DMN, significantly reducing the magnitude of the connection between the PCC and left lateral parietal ROI, and PCC and right lateral parietal ROI, as well as between the PCC and MPFC in mTBI subjects. Thus while the DMN remained resilient to a single mTBI without exertion at 10 days post-injury, it was altered in response to limited physical stress. This may explain some clinical features of mTBI and provide some insight into its mechanism. This important finding should be considered by clinical practitioners when making decisions regarding return-to-play and clearing mTBI athletes for sports participation.
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Affiliation(s)
- Kai Zhang
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania 16802, USA
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Sahler CS, Greenwald BD. Traumatic brain injury in sports: a review. Rehabil Res Pract 2012; 2012:659652. [PMID: 22848836 PMCID: PMC3400421 DOI: 10.1155/2012/659652] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 01/25/2012] [Accepted: 02/06/2012] [Indexed: 11/23/2022] Open
Abstract
Traumatic brain injury (TBI) is a clinical diagnosis of neurological dysfunction following head trauma, typically presenting with acute symptoms of some degree of cognitive impairment. There are an estimated 1.7 to 3.8 million TBIs each year in the United States, approximately 10 percent of which are due to sports and recreational activities. Most brain injuries are self-limited with symptom resolution within one week, however, a growing amount of data is now establishing significant sequelae from even minor impacts such as headaches, prolonged cognitive impairments, or even death. Appropriate diagnosis and treatment according to standardized guidelines are crucial when treating athletes who may be subjected to future head trauma, possibly increasing their likelihood of long-term impairments.
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Affiliation(s)
- Christopher S. Sahler
- Department of Physical Medicine and Rehabilitation, The Mount Sinai Hospital, One Gustave L. Levy Place, P.O. Box 1240, New York, NY 10029, USA
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Cameron KL, Marshall SW, Sturdivant RX, Lincoln AE. Trends in the Incidence of Physician-Diagnosed Mild Traumatic Brain Injury among Active Duty U.S. Military Personnel between 1997 and 2007. J Neurotrauma 2012; 29:1313-21. [PMID: 22332633 DOI: 10.1089/neu.2011.2168] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kenneth L. Cameron
- Keller Army Hospital, United States Military Academy, West Point, New York
| | - Stephen W. Marshall
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rodney X. Sturdivant
- Department of Mathematical Sciences, United States Military Academy, West Point, New York
| | - Andrew E. Lincoln
- MedStar Health Research Institute at Union Memorial Hospital, Baltimore, Maryland
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Mayers LB, Redick TS. Clinical utility of ImPACT assessment for postconcussion return-to-play counseling: Psychometric issues. J Clin Exp Neuropsychol 2012; 34:235-42. [DOI: 10.1080/13803395.2011.630655] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
Traumatic brain injuries that occur during sports have gained significant attention in the literature. Despite improved education and research on proper identification, risk management, and treatment, standardized methods for returning an athlete to play after a concussion are lacking in universal applicability. Current return-to-play guidelines are considered appropriate for the majority of athletes who recover within a few weeks. However, applicability of such guidelines becomes difficult when treating those athletes who experience prolonged symptoms or do not have the resources available to adequately manage complex presentations of concussions. Understanding the guidelines with consideration to special populations will assist the treating physician in providing an appropriate and individualized evaluation and treatment plan to safely return an athlete with a concussion back to play without compromising his or her health.
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Creed JA, DiLeonardi AM, Fox DP, Tessler AR, Raghupathi R. Concussive brain trauma in the mouse results in acute cognitive deficits and sustained impairment of axonal function. J Neurotrauma 2011; 28:547-63. [PMID: 21299360 DOI: 10.1089/neu.2010.1729] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Concussive brain injury (CBI) accounts for approximately 75% of all brain-injured people in the United States each year and is particularly prevalent in contact sports. Concussion is the mildest form of diffuse traumatic brain injury (TBI) and results in transient cognitive dysfunction, the neuropathologic basis for which is traumatic axonal injury (TAI). To evaluate the structural and functional changes associated with concussion-induced cognitive deficits, adult mice were subjected to an impact on the intact skull over the midline suture that resulted in a brief apneic period and loss of the righting reflex. Closed head injury also resulted in an increase in the wet weight:dry weight ratio in the cortex suggestive of edema in the first 24 h, and the appearance of Fluoro-Jade-B-labeled degenerating neurons in the cortex and dentate gyrus of the hippocampus within the first 3 days post-injury. Compared to sham-injured mice, brain-injured mice exhibited significant deficits in spatial acquisition and working memory as measured using the Morris water maze over the first 3 days (p<0.001), but not after the fourth day post-injury. At 1 and 3 days post-injury, intra-axonal accumulation of amyloid precursor protein in the corpus callosum and cingulum was accompanied by neurofilament dephosphorylation, impaired transport of Fluoro-Gold and synaptophysin, and deficits in axonal conductance. Importantly, deficits in retrograde transport and in action potential of myelinated axons continued to be observed until 14 days post-injury, at which time axonal degeneration was apparent. These data suggest that despite recovery from acute cognitive deficits, concussive brain trauma leads to axonal degeneration and a sustained perturbation of axonal function.
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Affiliation(s)
- Jennifer A Creed
- Program in Neuroscience, Drexel University College of Medicine, Philadelphia, Pennsylvania 19129, USA
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Griesbach GS. Exercise After Traumatic Brain Injury: Is it a Double-Edged Sword? PM R 2011; 3:S64-72. [DOI: 10.1016/j.pmrj.2011.02.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 02/10/2011] [Indexed: 01/08/2023]
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Piland SG, Ferrara MS, Macciocchi SN, Broglio SP, Gould TE. Investigation of baseline self-report concussion symptom scores. J Athl Train 2011; 45:273-8. [PMID: 20446841 DOI: 10.4085/1062-6050-45.3.273] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Self-reported symptoms (SRS) scales comprise one aspect of a multifaceted assessment of sport-related concussion. Obtaining SRS assessments before a concussion occurs assists in determining when the injury is resolved. However, athletes may present with concussion-related symptoms at baseline. Thus, it is important to evaluate such reports to determine if the variables that are common to many athletic environments are influencing them. OBJECTIVE To evaluate the influence of a history of concussion, sex, acute fatigue, physical illness, and orthopaedic injury on baseline responses to 2 summative symptom scales; to investigate the psychometric properties of all responses; and to assess the factorial validity of responses to both scales in the absence of influential variables. DESIGN Cross-sectional study. SETTING Athletic training facilities of 6 National Collegiate Athletic Association institutions. PATIENTS OR OTHER PARTICIPANTS The sample of 1065 was predominately male (n = 805) collegiate athletes with a mean age of 19.81 +/- 1.53 years. MAIN OUTCOME MEASURE(S) Participants completed baseline measures for duration and severity of concussion-related SRS and a brief health questionnaire. RESULTS At baseline, respondents reporting a previous concussion had higher composite scores on both scales (P <or= .01), but no sex differences were found for concussion-related symptoms. Acute fatigue, physical illness, and orthopaedic injury increased composite SRS scores on both duration and severity measures (P <or= .01). Responses to both scales were stable and internally consistent. Confirmatory factor analysis provided strong evidence for the factorial validity of the responses of participants reporting no fatigue, physical illness, or orthopaedic injury on each instrument. CONCLUSIONS A history of concussion, acute fatigue, physical illness, and orthopaedic injury increased baseline SRS scores. These conditions need to be thoroughly investigated and controlled by clinicians before baseline SRS measures are collected.
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Affiliation(s)
- Scott G Piland
- University of Southern Mississippi, 118 College Drive, Box #5142, Hattiesburg, MS 39406, USA.
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Covassin T, Elbin R. The Female Athlete: The Role of Gender in the Assessment and Management of Sport-Related Concussion. Clin Sports Med 2011; 30:125-31, x. [DOI: 10.1016/j.csm.2010.08.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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d'Hemecourt P. Subacute Symptoms of Sports-Related Concussion: Outpatient Management and Return to Play. Clin Sports Med 2011; 30:63-72, viii. [PMID: 21074082 DOI: 10.1016/j.csm.2010.08.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Pierre d'Hemecourt
- Division of Sports Medicine, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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