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Alanazi N, Fitzgerald M, Hume P, Hellewell S, Horncastle A, Anyaegbu C, Papini MG, Hargreaves N, Halicki M, Entwistle I, Hind K, Chazot P. Concussion-Related Biomarker Variations in Retired Rugby Players and Implications for Neurodegenerative Disease Risk: The UK Rugby Health Study. Int J Mol Sci 2024; 25:7811. [PMID: 39063053 PMCID: PMC11276902 DOI: 10.3390/ijms25147811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
The health and well-being of retired rugby union and league players, particularly regarding the long-term effects of concussions, are of major concern. Concussion has been identified as a major risk factor for neurodegenerative diseases, such as Alzheimer's and Amyotrophic Lateral Sclerosis (ALS), in athletes engaged in contact sports. This study aimed to assess differences in specific biomarkers between UK-based retired rugby players with a history of concussion and a non-contact sports group, focusing on biomarkers associated with Alzheimer's, ALS, and CTE. We randomly selected a sample of male retired rugby or non-contact sport athletes (n = 56). The mean age was 41.84 ± 6.44, and the mean years since retirement from the sport was 7.76 ± 6.69 for participants with a history of substantial concussions (>5 concussions in their career) (n = 30). The mean age was 45.75 ± 11.52, and the mean years since retirement was 6.75 ± 4.64 for the healthy controls (n = 26). Serum biomarkers (t-tau, RBP-4, SAA, Nf-L, and retinol), plasma cytokines, and biomarkers associated with serum-derived exosomes (Aβ42, p-tau181, p-tau217, and p-tau231) were analyzed using validated commercial ELISA assays. The results of the selected biomarkers were compared between the two groups. Biomarkers including t-tau and p-tau181 were significantly elevated in the history of the substantial concussion group compared to the non-contact sports group (t-tau: p < 0.01; p-tau181: p < 0.05). Although between-group differences in p-tau217, p-tau231, SAA, Nf-L, retinol, and Aβ42 were not significantly different, there was a trend for higher levels of Aβ42, p-tau217, and p-tau231 in the concussed group. Interestingly, the serum-derived exosome sizes were significantly larger (p < 0.01), and serum RBP-4 levels were significantly reduced (p < 0.05) in the highly concussed group. These findings indicate that retired athletes with a history of multiple concussions during their careers have altered serum measurements of exosome size, t-tau, p-tau181, and RBP-4. These biomarkers should be explored further for the prediction of future neurodegenerative outcomes, including ALS, in those with a history of concussion.
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Affiliation(s)
- Norah Alanazi
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia; (M.F.); (S.H.); (M.G.P.)
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
| | - Patria Hume
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, AUT Millennium, 17 Antares Place, Mairangi Bay, Private Bag 92006, Auckland 1142, New Zealand;
- Traumatic Brain Injury Network (TBIN), Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
- Technology and Policy Laboratory, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Sarah Hellewell
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia; (M.F.); (S.H.); (M.G.P.)
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
- Centre for Neuromuscular & Neurological Disorders, University of Western Australia, Crawley, WA 6009, Australia
| | - Alex Horncastle
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
| | - Chidozie Anyaegbu
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia; (M.F.); (S.H.); (M.G.P.)
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
- Centre for Neuromuscular & Neurological Disorders, University of Western Australia, Crawley, WA 6009, Australia
| | - Melissa G. Papini
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia; (M.F.); (S.H.); (M.G.P.)
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
- Centre for Neuromuscular & Neurological Disorders, University of Western Australia, Crawley, WA 6009, Australia
| | - Natasha Hargreaves
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
| | - Michal Halicki
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
| | - Ian Entwistle
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham TS17 6BH, UK
| | - Karen Hind
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham TS17 6BH, UK
| | - Paul Chazot
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
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Monsour MA, Wolfson DI, Jo J, Terry DP, Zuckerman SL. Is contact sport participation associated with chronic traumatic encephalopathy or neurodegenerative decline? A systematic review and meta-analysis. J Neurosurg Sci 2024; 68:117-127. [PMID: 36779774 DOI: 10.23736/s0390-5616.22.05895-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
INTRODUCTION We sought to evaluate a potential association between contact vs. non-contact sport participation and long-term neurologic outcomes and chronic traumatic encephalopathy (CTE). EVIDENCE ACQUISITION PubMed/Embase/PsycINFO/CINAHL databases were queried for studies between 1950-2020 with contact and non-contact sports, longitudinal assessment >10 years, and long-term neurologic outcomes in four-domains: I) clinical diagnosis; II) CTE neuropathology; III) neurocognition; and IV) neuroimaging. EVIDENCE SYNTHESIS Of 2561 studies, 37 met inclusion criteria, and 19 contained homogenous outcomes usable in the meta-analysis. Domain I: Across six studies, no significant relationship was seen between contact sport participation and antemortem diagnosis of neurodegenerative disease or death related to such a diagnosis (RR1.88, P=0.054, 95%CI0.99, 3.49); however, marginal significance (P<0.10) was obtained. Domain II: Across three autopsy studies, no significant relationship was seen between contact sport participation and CTE neuropathology (RR42.39, P=0.086, 95%CI0.59, 3057.46); however, marginal significance (P<0.10) was obtained. Domain III: Across five cognitive studies, no significant relationship was seen between contact sport participation and cognitive function on the Trail Making Test (TMT) scores A/B (A:d=0.17, P=0.275,95% CI-0.13, 0.47; B:d=0.13, P=0.310, 95%CI-0.12, 0.38). Domain IV: In 10 brain imaging-based studies, 32% comparisons showed significant differences between those with a history of contact sport vs. those without. CONCLUSIONS No statistically significant increased risk of neurodegenerative diagnosis, CTE neuropathology, or neurocognitive changes was found to be associated with contact sport participation, yet marginal significance was obtained in two domains. A minority of imaging comparisons showed differences of uncertain clinical significance. These results highlight the need for longitudinal investigations using standardized contact sport participation and neurodegenerative criteria.
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Affiliation(s)
- Meredith A Monsour
- Vanderbilt Sports Concussion Center, Nashville, TN, USA
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel I Wolfson
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Jacob Jo
- Vanderbilt Sports Concussion Center, Nashville, TN, USA
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas P Terry
- Vanderbilt Sports Concussion Center, Nashville, TN, USA
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Nashville, TN, USA -
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Hou X, Zhang Y, Fei X, Zhou Q, Li J. Sports-Related Concussion Affects Cognitive Function in Adolescents: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:3604-3618. [PMID: 36799499 DOI: 10.1177/03635465221142855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Rates of sports-related concussion (SRC) are high in adolescents. Ambiguity exists regarding the effect of SRC on cognitive function in adolescents. PURPOSE To rigorously examine adolescents' cognitive function after SRC. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS Web of Science, Scopus, and PubMed were searched from database inception until September 2021. Studies were included if participants were adolescents aged 13 to 18 years, if the definition of SRC was fully consistent with the Berlin Consensus Statement on Concussion in Sport, if the study included a control group or in-group baseline test, and if the study reported cognitive outcomes (eg, visual memory, processing speed) that could be separately extracted. RESULTS A total of 47 studies were included in the systematic review, of which 31 were included in the meta-analysis, representing 8877 adolescents with SRC. Compared with individuals in the non-SRC group, individuals with SRC had worse performance in cognitive function and reported more symptoms not only in the acute phase but also in the prolonged phase (1-6 months after injury) (visual memory: d = -0.21, 95% CI, -0.37 to -0.05, P = .012; executive function: d = -0.56, 95% CI, -1.07 to -0.06, P = .028; and symptoms: d = 1.17, 95% CI, 0.13 to 2.22, P = .028). Lower scores in most of the outcomes of cognitive function were observed at <3 days and at 3 to 7 days, but higher scores for verbal memory (d = 0.10; 95% CI, 0.03 to 0.17; P = .008) and processing speed (d = 0.17; 95% CI, 0.10 to 0.24; P < .001) were observed at 7 to 14 days after SRC relative to baseline. The effects of SRC on cognitive function decreased over time (100% of the variance in reaction time, P < .001; 99.94% of the variance in verbal memory, P < .001; 99.88% of the variance in visual memory, P < .001; 39.84% of the variance in symptoms, P = .042) in control group studies. Study design, participant sex, measurement tools, and concussion history were found to be modulators of the relationship between cognitive function and SRC. CONCLUSION This study revealed that adolescent cognitive function is impaired by SRC even 1 to 6 months after injury. Results of this study point to the need for tools to measure cognitive function with multiple parallel versions that have demographically diversiform norms in adolescents. Effective prevention of SRC, appropriate treatment, and adequate evaluation of cognitive function before return to play are needed in adolescent SRC management. Moreover, caution is warranted when using the baseline-to-postconcussion paradigm in return-to-play decisions.
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Affiliation(s)
- Xianyun Hou
- School of Psychology, Beijing Sport University, Beijing, China
| | - Yu Zhang
- School of Psychology, Beijing Sport University, Beijing, China
| | - Xueyin Fei
- Sport Science School, Beijing Sport University, Beijing, China
| | - Qian Zhou
- School of Psychology, Beijing Sport University, Beijing, China
| | - Jie Li
- Center for Cognition and Brain Disorders, the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China
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Murray-Smith S, Williams S, Whalan M, Peoples GE, Sampson JA. The incidence and burden of injury in male adolescent community rugby union in Australia. SCI MED FOOTBALL 2023; 7:315-322. [PMID: 36134642 DOI: 10.1080/24733938.2022.2123556] [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] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To describe the incidence, location, mechanism and burden of injury in community male adolescent rugby. METHODS A prospective cohort injury surveillance study using sports trainers to record 'any physical complaint' over three seasons (2018/2019/2021) in 979 U13-U17 community male rugby union players. RESULTS One hundred and fifty-two time-loss injuries (27.6/1000 hours) with an associated burden of 2313 days (419.7 days/1000 hours), 169 non-time loss medical attention (30.1/1000 hours) and 813 physical complaints (147.5/1000 hours) were recorded from 5511.7 exposure hours (matches 3932.5 hours, training 1579.2 hours). Time-loss injury incidence was highest in U16 (45/1000 hours) and lowest in U17 (16.6/1000 hours), with U17 significantly lower than U16 and U15 age-grades (p < 0.05). Injury burden was greatest in U13 (561.4 days/1000 hours), and significantly higher than U15 and U17 (p < 0.05). Collectively, injury incidence was greatest for the head/neck (11.8/1000 hours), bruise/contusions were most common (8.7/1000 hours) and concussion (4.5/1000 hours) accounted for the greatest injury burden (102 days/1000 hours). Being tackled was the most observed injury mechanism (10.0/1000 hours). Forwards had significantly higher incidence in mild injury (p < 0.01). The total burden (p < 0.001) associated with mild (p < 0.001) and moderate injuries (p < 0.001) was significantly higher in forwards, as was the burden of being tackled (p < 0.001), collisions (p < 0.001), trunk (p < 0.001) and lower limb (p < 0.01) injury locations. In contrast, ruck-related injury burden was greater in backs (p < 0.001). CONCLUSION This study showed age-grade and positional differences in incidence and burden of injury in community adolescent rugby union. The rate of non-time loss relative to time-loss injury and muscle strain injury in U13-U14s suggests further research into injury risk and maturation in rugby is needed.
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Affiliation(s)
- S Murray-Smith
- Centre of Medical and Exercise Physiology, University of Wollongong, Wollongong, Australia
| | - S Williams
- Department for Health, University of Bath, Bath, UK
| | - M Whalan
- Medical Department, Sydney Football Club, Sydney, Australia
- NSW Football Medicine Association, Sydney, Australia
- Football Australia, Sydney, Australia
| | - G E Peoples
- Centre of Medical and Exercise Physiology, University of Wollongong, Wollongong, Australia
| | - J A Sampson
- Centre of Medical and Exercise Physiology, University of Wollongong, Wollongong, Australia
- NSW Football Medicine Association, Sydney, Australia
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Mitchell CV, Nagai T, Bates NA, Schilaty ND. Neck strength and force in reaction time task of adolescent athletes with and without concussion history: A pilot study. Phys Ther Sport 2023; 61:192-197. [PMID: 37119609 DOI: 10.1016/j.ptsp.2023.04.008] [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: 03/08/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVES Assess the impact of concussion by comparing reaction time, peak force recruitment, and rate of force development of adolescent athletes returning from concussion against age- and sex-matched controls in visual-elicited neck movement. DESIGN Athletes sat secured in a custom-built isometric device with their heads secured in a helmet and attached to a 6-axis load cell. They performed neck flexion, extension, and lateral flexion in response to a visual cue. Three trials in each direction were used for statistical analyses; peak force and rate of force development were normalized against athlete mass. SETTING Laboratory. PARTICIPANTS 26 adolescent/young adult athletes (8F/18M), either recently concussed (and cleared for return to sport) or an age- and sex-matched healthy control. MAIN OUTCOME MEASURES Reaction time, angle, standard deviation of angle, deviation from target angle, peak force, and RFD over 50, 100, 150,and 200 ms of movement were measured for each trial. RESULTS Concussed athletes had decreased normalized peak force (P = 0.008) and rate of force development (P < 0.001-0.007). In neck extension, concussed athletes also had decreased movement precision (P = 0.012). CONCLUSIONS Concussion is associated with alterations of neck biomechanics that decrease overall neck strength.
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Affiliation(s)
| | - Takashi Nagai
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; United States Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Nathaniel A Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopaedics, The Ohio State University, Columbus, OH, USA
| | - Nathan D Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery & Brain Repair, University of South Florida, Tampa, FL, USA; Department of Medical Engineering, University of South Florida, Tampa, FL, USA; Center for Neuromusculoskeletal Research, University of South Florida, Tampa, FL, USA.
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Hallock H, Mantwill M, Vajkoczy P, Wolfarth B, Reinsberger C, Lampit A, Finke C. Sport-Related Concussion: A Cognitive Perspective. Neurol Clin Pract 2023; 13:e200123. [PMID: 36891462 PMCID: PMC9987206 DOI: 10.1212/cpj.0000000000200123] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/03/2022] [Indexed: 02/25/2023]
Abstract
Purpose of Review The incidence of sport-related concussion (SRC) has been increasing in different sports and its impact on long-term cognitive function is increasingly recognized. In this study, we review the epidemiology, neuropathophysiology, clinical symptoms, and long-term consequences of SRC with a specific focus on cognition. Recent Findings Repeated concussions are associated with an increased risk of several neurologic diseases and long-term cognitive deficits. To improve cognitive outcomes in athletes with SRC, standardized guidelines for the assessment and management of SRC are vital. However, current concussion management guidelines lack procedures for rehabilitating acute and long-term cognitive symptoms. Summary Increased awareness for the management and rehabilitation of cognitive symptoms in SRC is needed in all clinical neurologists treating professional and amateur athletes. We propose cognitive training as a prehabilitation tool to alleviate the severity of cognitive symptoms and as a rehabilitative tool to improve cognitive recovery postinjury.
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Affiliation(s)
- Harry Hallock
- Berlin School of Mind and Brain (HH, MM, AL, CF), Humboldt-Universität zu Berlin; Departments of Neurology (HH, MM, AL, CF) and Neurosurgery (PV) and of Sports Medicine (BW), Charité Universitätsmedizin, Berlin; Institute of Sports Medicine (CR), University of Paderborn, Germany; and Department of Psychiatry (AL), University of Melbourne, Parkville, Australia
| | - Maron Mantwill
- Berlin School of Mind and Brain (HH, MM, AL, CF), Humboldt-Universität zu Berlin; Departments of Neurology (HH, MM, AL, CF) and Neurosurgery (PV) and of Sports Medicine (BW), Charité Universitätsmedizin, Berlin; Institute of Sports Medicine (CR), University of Paderborn, Germany; and Department of Psychiatry (AL), University of Melbourne, Parkville, Australia
| | - Peter Vajkoczy
- Berlin School of Mind and Brain (HH, MM, AL, CF), Humboldt-Universität zu Berlin; Departments of Neurology (HH, MM, AL, CF) and Neurosurgery (PV) and of Sports Medicine (BW), Charité Universitätsmedizin, Berlin; Institute of Sports Medicine (CR), University of Paderborn, Germany; and Department of Psychiatry (AL), University of Melbourne, Parkville, Australia
| | - Bernd Wolfarth
- Berlin School of Mind and Brain (HH, MM, AL, CF), Humboldt-Universität zu Berlin; Departments of Neurology (HH, MM, AL, CF) and Neurosurgery (PV) and of Sports Medicine (BW), Charité Universitätsmedizin, Berlin; Institute of Sports Medicine (CR), University of Paderborn, Germany; and Department of Psychiatry (AL), University of Melbourne, Parkville, Australia
| | - Claus Reinsberger
- Berlin School of Mind and Brain (HH, MM, AL, CF), Humboldt-Universität zu Berlin; Departments of Neurology (HH, MM, AL, CF) and Neurosurgery (PV) and of Sports Medicine (BW), Charité Universitätsmedizin, Berlin; Institute of Sports Medicine (CR), University of Paderborn, Germany; and Department of Psychiatry (AL), University of Melbourne, Parkville, Australia
| | - Amit Lampit
- Berlin School of Mind and Brain (HH, MM, AL, CF), Humboldt-Universität zu Berlin; Departments of Neurology (HH, MM, AL, CF) and Neurosurgery (PV) and of Sports Medicine (BW), Charité Universitätsmedizin, Berlin; Institute of Sports Medicine (CR), University of Paderborn, Germany; and Department of Psychiatry (AL), University of Melbourne, Parkville, Australia
| | - Carsten Finke
- Berlin School of Mind and Brain (HH, MM, AL, CF), Humboldt-Universität zu Berlin; Departments of Neurology (HH, MM, AL, CF) and Neurosurgery (PV) and of Sports Medicine (BW), Charité Universitätsmedizin, Berlin; Institute of Sports Medicine (CR), University of Paderborn, Germany; and Department of Psychiatry (AL), University of Melbourne, Parkville, Australia
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Campbell TR, Reilly N, Zamponi M, Leathers D, Mollica PA, Cavallario J, Martinez JC. Salivary microRNA as a prospective tool for concussion diagnosis and management: A scoping review. Brain Inj 2023; 37:588-595. [PMID: 36867013 DOI: 10.1080/02699052.2023.2184867] [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: 03/04/2023]
Abstract
BACKGROUND Despite increased efforts directed toward research, concussions are a growing concern and can be a complex injury for healthcare professionals to manage. Current practices are largely dependent on patients self-reporting symptoms and a clinical assessment, which uses objective tools that lack effectiveness. With the demonstrated effects of concussions, it is imperative that a more valid or reliable objective tool, like a clinical biomarker, be identified to improve outcomes. One potential biomarker that has shown promise is salivary microRNA. However, there is no objective consensus as to which microRNA offers the most clinical value regarding concussions, hence this review. Therefore, the purpose of this scoping review was to identify salivary miRNAs associated with concussions. METHODS Two independent reviewers performed a literature search to identify research articles. Studies using human subjects, collected salivary miRNA, and were published in English were included. Data of interest were salivary miRNA, collection timing, and relation to concussion diagnosis or management. RESULTS This paper reviews nine studies that analyzed salivary miRNA for concussion diagnosis and management. CONCLUSIONS In total, the studies have identified 49 salivary miRNA that show promise in assisting with concussion practices. With continued research, the use of salivary miRNA may enhance clinicians' abilities to diagnose and manage concussions.
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Affiliation(s)
- Thomas R Campbell
- College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - Nicholas Reilly
- The Geneva Foundation, Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - Martina Zamponi
- College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - Delaney Leathers
- College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - Peter A Mollica
- College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - Julie Cavallario
- College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - Jessica C Martinez
- College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
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Hunzinger KJ, Cameron KL, Roach MH, Jackson JC, McGinty GT, Robb JB, Susmarski AJ, Estevez CA, Broglio SP, McAllister TW, McCrea M, Pasquina PF, Buckley TA. Baseline concussion assessment performance by sex in military service academy rugby players: findings from the CARE Consortium. BMJ Mil Health 2023:e002358. [PMID: 36804739 DOI: 10.1136/military-2023-002358] [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: 01/25/2023] [Accepted: 02/08/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Normative student-athlete concussion assessment data may not be appropriate for service academy members (SAMs), particularly rugby players, because of the uniqueness of their academic/military training environment. Having accurate baseline data for this population is important because of their high risk for concussion and frequent lack of assigned sports medicine professional. The primary purpose of this study was to characterise baseline performance on a concussion assessment battery, with secondary purpose to determine effect of sex and concussion history on these measures among SAM rugby players. METHODS 601 rugby-playing SAMs (19.3±1.5 years, 37.9% female) completed baseline concussion assessments: the Sport Concussion Assessment Tool (SCAT) Symptom and Symptom Severity Checklist, Standard Assessment of Concussion (SAC) and a neuropsychological test (either ImPACT (Immediate Post Concussion Assessment and Cognitive Testing) or ANAM (Automated Neuropsychological Assessment Metrics)). Groups were compared using an independent samples t-test or Mann-Whitney U test. A 2 (sex) × 2 (concussion history) ANOVA was conducted to determine the effects of sex and concussion history on outcomes. RESULTS Women reported greater SCAT total symptoms (3.3 vs 2.8, p<0.001, r=0.143) and symptom severities (5.7 vs 4.3, p<0.001, r=0.139), and performed worse on ImPACT Visual Memory (79.3 vs 82.6, p=0.002, r=0.144) than men. Women performed better than men on SAC (28.0 vs 27.7, p=0.03, r=0.088), ImPACT Reaction Time Composite (0.59 vs 0.61, p=0.04, r=0.092) and ANAM Code Substitution Delayed (64.3 vs 61.5, p=0.04, d=0.433). Individuals with a history of concussion reported lower ImPACT Symptom Severity (2.6 vs 4.2, p=0.02, r=0.110). There was no interaction between concussion history and sex on outcomes. CONCLUSIONS These findings provide reference data for SAM rugby players on baseline assessments and to help in clinical decision-making when managing sports-related concussion in absence of baseline data.
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Affiliation(s)
- Katherine J Hunzinger
- Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - K L Cameron
- Keller Army Community Hospital, West Point, New York, USA
| | - M H Roach
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Research & Surveillance Division, Fort Bragg, North Carolina, USA
- Clinical Investigation, Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - J C Jackson
- United States Air Force Academy, USAF Academy, Colorado, USA
| | - G T McGinty
- United States Air Force Academy, USAF Academy, Colorado, USA
| | - J B Robb
- 10th Medical Group, United States Air Force Academy, USAF Academy, Colorado, USA
| | - A J Susmarski
- Orthopedic Sports Medicine, United States Naval Academy, Annapolis, Maryland, USA
| | - C A Estevez
- Physical Therapy, United States Coast Guard Academy, New London, Connecticut, USA
| | - S P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - T W McAllister
- Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - M McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - P F Pasquina
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - T A Buckley
- Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware, USA
- Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, 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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10
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Raikes AC, Hernandez GD, Mullins VA, Wang Y, Lopez C, Killgore WDS, Chilton FH, Brinton RD. Effects of docosahexaenoic acid and eicosapentaoic acid supplementation on white matter integrity after repetitive sub-concussive head impacts during American football: Exploratory neuroimaging findings from a pilot RCT. Front Neurol 2022; 13:891531. [PMID: 36188406 PMCID: PMC9521411 DOI: 10.3389/fneur.2022.891531] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Context Repetitive sub-concussive head impacts (RSHIs) are common in American football and result in changes to the microstructural integrity of white matter. Both docosahexaenoic acid (DHA) and eicosapentaoic acid (EPA) supplementation exerted neuroprotective effects against RSHIs in animal models and in a prior study in football players supplemented with DHA alone. Objective Here, we present exploratory neuroimaging outcomes from a randomized controlled trial of DHA + EPA supplementation in American football players. We hypothesized that supplementation would result in less white matter integrity loss on diffusion weighted imaging over the season. Design setting participants We conducted a double-blind placebo-controlled trial in 38 American football players between June 2019 and January 2020. Intervention Participants were randomized to the treatment (2.442 g/day DHA and 1.020 g/day EPA) or placebo group for five times-per-week supplementation for 7 months. Of these, 27 participants were included in the neuroimaging data analysis (n = 16 placebo; n = 11 DHA + EPA). Exploratory outcome measures Changes in white matter integrity were quantified using both voxelwise diffusion kurtosis scalars and deterministic tractography at baseline and end of season. Additional neuroimaging outcomes included changes in regional gray matter volume as well as intra-regional, edge-wise, and network level functional connectivity. Serum neurofilament light (NfL) provided a peripheral biomarker of axonal damage. Results No voxel-wise between-group differences were identified on diffusion tensor metrics. Deterministic tractography using quantitative anisotropy (QA) revealed increased structural connectivity in ascending corticostriatal fibers and decreased connectivity in long association and commissural fibers in the DHA+EPA group compared to the placebo group. Serum NfL increases were correlated with increased mean (ρ = 0.47), axial (ρ = 0.44), and radial (ρ = 0.51) diffusivity and decreased QA (ρ = -0.52) in the corpus callosum and bilateral corona radiata irrespective of treatment group. DHA + EPA supplementation did preserve default mode/frontoparietal control network connectivity (g = 0.96, p = 0.024). Conclusions These exploratory findings did not provide strong evidence that DHA + EPA prevented or protected against axonal damage as quantified via neuroimaging. Neuroprotective effects on functional connectivity were observed despite white matter damage. Further studies with larger samples are needed to fully establish the relationship between omega-3 supplementation, RSHIs, and neuroimaging biomarkers. Trial registration ClinicalTrials.gov-NCT04796207.
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Affiliation(s)
- Adam C. Raikes
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, United States
| | - Gerson D. Hernandez
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, United States
| | - Veronica A. Mullins
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, United States
| | - Yiwei Wang
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, United States
| | - Claudia Lopez
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, United States
| | - William D. S. Killgore
- Social, Cognitive, and Affective Neuroscience Lab, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Floyd H. Chilton
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, United States
| | - Roberta D. Brinton
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, United States
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11
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Morris A, Casucci T, McFarland MM, Cassidy B, Pelo R, Kreter N, Dibble LE, Fino PC. Reactive Balance Responses After Mild Traumatic Brain Injury: A Scoping Review. J Head Trauma Rehabil 2022; 37:311-317. [PMID: 35125435 PMCID: PMC9339587 DOI: 10.1097/htr.0000000000000761] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Balance testing after concussion or mild traumatic brain injury (mTBI) can be useful in determining acute and chronic neuromuscular deficits that are unapparent from symptom scores or cognitive testing alone. Current assessments of balance do not comprehensively evaluate all 3 classes of balance: maintaining a posture; voluntary movement; and reactive postural response. Despite the utility of reactive postural responses in predicting fall risk in other balance-impaired populations, the effect of mTBI on reactive postural responses remains unclear. This review sought to (1) examine the extent and range of available research on reactive postural responses in people post-mTBI and (2) determine whether reactive postural responses (balance recovery) are affected by mTBI. DESIGN Scoping review. METHODS Studies were identified using MEDLINE, EMBASE, CINAHL, Cochrane Library, Dissertations and Theses Global, PsycINFO, SportDiscus, and Web of Science. Inclusion criteria were injury classified as mTBI with no confounding central or peripheral nervous system dysfunction beyond those stemming from the mTBI, quantitative measure of reactive postural response, and a discrete, externally driven perturbation was used to test reactive postural response. RESULTS A total of 4747 publications were identified, and a total of 3 studies (5 publications) were included in the review. CONCLUSION The limited number of studies available on this topic highlights the lack of investigation on reactive postural responses after mTBI. This review provides a new direction for balance assessments after mTBI and recommends incorporating all 3 classes of postural control in future research.
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Affiliation(s)
- Amanda Morris
- Department of Health and Kinesiology, University of Utah, 250 S 1850 E,Salt Lake City, UT, USA
| | - Tallie Casucci
- J. Willard Marriot Library, University of Utah, 295 1500 E, Salt Lake City, UT, USA
| | - Mary M. McFarland
- Eccles Health Sciences Library, 10 N 1900 E, Salt Lake City, UT, USA
| | - Benjamin Cassidy
- Department of Health and Kinesiology, University of Utah, 250 S 1850 E,Salt Lake City, UT, USA
| | - Ryan Pelo
- Department of Physical Therapy and Athletic Training, University of Utah, 520 S Wakara Way, Salt Lake City, UT, USA
| | - Nicholas Kreter
- Department of Health and Kinesiology, University of Utah, 250 S 1850 E,Salt Lake City, UT, USA
| | - Leland E. Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, 520 S Wakara Way, Salt Lake City, UT, USA
| | - Peter C. Fino
- Department of Health and Kinesiology, University of Utah, 250 S 1850 E,Salt Lake City, UT, USA
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12
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Powell D, Godfrey A, Parrington L, Campbell KR, King LA, Stuart S. Free-living gait does not differentiate chronic mTBI patients compared to healthy controls. J Neuroeng Rehabil 2022; 19:49. [PMID: 35619112 PMCID: PMC9137158 DOI: 10.1186/s12984-022-01030-6] [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: 07/21/2021] [Accepted: 05/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Physical function remains a crucial component of mild traumatic brain injury (mTBI) assessment and recovery. Traditional approaches to assess mTBI lack sensitivity to detect subtle deficits post-injury, which can impact a patient’s quality of life, daily function and can lead to chronic issues. Inertial measurement units (IMU) provide an opportunity for objective assessment of physical function and can be used in any environment. A single waist worn IMU has the potential to provide broad/macro quantity characteristics to estimate gait mobility, as well as more high-resolution micro spatial or temporal gait characteristics (herein, we refer to these as measures of quality). Our recent work showed that quantity measures of mobility were less sensitive than measures of turning quality when comparing the free-living physical function of chronic mTBI patients and healthy controls. However, no studies have examined whether measures of gait quality in free-living conditions can differentiate chronic mTBI patients and healthy controls. This study aimed to determine whether measures of free-living gait quality can differentiate chronic mTBI patients from controls. Methods Thirty-two patients with chronic self-reported balance symptoms after mTBI (age: 40.88 ± 11.78 years, median days post-injury: 440.68 days) and 23 healthy controls (age: 48.56 ± 22.56 years) were assessed for ~ 7 days using a single IMU at the waist on a belt. Free-living gait quality metrics were evaluated for chronic mTBI patients and controls using multi-variate analysis. Receiver operating characteristics (ROC) and Area Under the Curve (AUC) analysis were used to determine outcome sensitivity to chronic mTBI. Results Free-living gait quality metrics were not different between chronic mTBI patients and controls (all p > 0.05) whilst controlling for age and sex. ROC and AUC analysis showed stride length (0.63) was the most sensitive measure for differentiating chronic mTBI patients from controls. Conclusions Our results show that gait quality metrics determined through a free-living assessment were not significantly different between chronic mTBI patients and controls. These results suggest that measures of free-living gait quality were not impaired in our chronic mTBI patients, and/or, that the metrics chosen were not sensitive enough to detect subtle impairments in our sample.
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Affiliation(s)
- Dylan Powell
- Department of Computer and Information Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - Alan Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - Lucy Parrington
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA.,Department of Dietetics, Human Nutrition and Sport, La Trobe University, Victoria, Australia
| | - Kody R Campbell
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Laurie A King
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Sam Stuart
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA. .,Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, UK. .,North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
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13
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Smeha N, Kalkat R, Sergio LE, Hynes LM. Sex-related differences in visuomotor skill recovery following concussion in working-aged adults. BMC Sports Sci Med Rehabil 2022; 14:72. [PMID: 35443693 PMCID: PMC9022305 DOI: 10.1186/s13102-022-00466-6] [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: 09/07/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The ability to perform visually-guided motor tasks requires the transformation of visual information into programmed motor outputs. When the guiding visual information does not align spatially with the motor output, the brain processes rules to integrate somatosensory information into an appropriate motor response. Performance on such rule-based, "cognitive-motor integration" tasks is affected in concussion. Here, we investigate the relationship between visuomotor skill performance, concussion history, and sex during the course of a post-concussion management program. METHODS Fifteen acutely concussed working-aged adults, 11 adults with a history of concussion, and 17 healthy controls all completed a recovery program over the course of 4 weeks. Prior to, mid-way, and following the program, all participants were tested on their visuomotor skills. RESULTS We observed an overall change in visuomotor behaviour in all groups, as participants completed the tasks faster and more accurately. Specifically, we observed significant visuomotor skill improvement between the first and final sessions in participants with a concussion history compared to no-concussion-history controls. Notably, we observed a stronger recovery of these skills in females. CONCLUSIONS Our findings indicate that (1) concussion impairs visuomotor skill performance, (2) the performance of complex, rule-based tasks showed improvement over the course of a recovery program, and (3) stronger recovery in females suggests sex-related differences in the brain networks controlling skilled performance, and the effect of injury on these networks.
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Affiliation(s)
- Nicole Smeha
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.,Centre for Vision Research, York University, Toronto, Canada
| | - Ravneet Kalkat
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Lauren E Sergio
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada. .,York University Sport Medicine Team, York University, Toronto, Canada. .,Centre for Vision Research, York University, Toronto, Canada.
| | - Loriann M Hynes
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.,York University Sport Medicine Team, York University, Toronto, Canada
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14
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Plasma Lipid Profiles Change with Increasing Numbers of Mild Traumatic Brain Injuries in Rats. Metabolites 2022; 12:metabo12040322. [PMID: 35448509 PMCID: PMC9025508 DOI: 10.3390/metabo12040322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
Mild traumatic brain injury (mTBI) causes structural, cellular and biochemical alterations which are difficult to detect in the brain and may persist chronically following single or repeated injury. Lipids are abundant in the brain and readily cross the blood-brain barrier, suggesting that lipidomic analysis of blood samples may provide valuable insight into the neuropathological state. This study used liquid chromatography-mass spectrometry (LC-MS) to examine plasma lipid concentrations at 11 days following sham (no injury), one (1×) or two (2×) mTBI in rats. Eighteen lipid species were identified that distinguished between sham, 1× and 2× mTBI. Three distinct patterns were found: (1) lipids that were altered significantly in concentration after either 1× or 2× F mTBI: cholesterol ester CE (14:0) (increased), phosphoserine PS (14:0/18:2) and hexosylceramide HCER (d18:0/26:0) (decreased), phosphoinositol PI(16:0/18:2) (increased with 1×, decreased with 2× mTBI); (2) lipids that were altered in response to 1× mTBI only: free fatty acid FFA (18:3 and 20:3) (increased); (3) lipids that were altered in response to 2× mTBI only: HCER (22:0), phosphoethanolamine PE (P-18:1/20:4 and P-18:0/20:1) (increased), lysophosphatidylethanolamine LPE (20:1), phosphocholine PC (20:0/22:4), PI (18:1/18:2 and 20:0/18:2) (decreased). These findings suggest that increasing numbers of mTBI induce a range of changes dependent upon the lipid species, which likely reflect a balance of damage and reparative responses.
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15
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Powell D, Stuart S, Godfrey A. Exploring Inertial-Based Wearable Technologies for Objective Monitoring in Sports-Related Concussion: A Single-Participant Report. Phys Ther 2022; 102:6534728. [PMID: 35196371 PMCID: PMC9155164 DOI: 10.1093/ptj/pzac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/29/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Challenges remain in sports-related concussion (SRC) assessment to better inform return to play. Reliance on self-reported symptoms within the Sports Concussion Assessment Tool means that there are limited data on the effectiveness of novel methods to assess a player's readiness to return to play. Digital methods such as wearable technologies may augment traditional SRC assessment and improve objectivity in making decisions regarding return to play. METHODS The participant was a male university athlete who had a recent history of SRC. The single-participant design consisted of baseline laboratory testing immediately after SRC, free-living monitoring, and follow-up supervised testing after 2 months. The primary outcome measures were from traditional assessment (eg, Sports Concussion Assessment Tool and 2-minute instrumented walk/gait test; secondary outcome measures were from remote (free-living) assessment with a single wearable inertial measurement unit (eg, for gait and sleep). RESULTS The university athlete (age = 20 years, height = 175 cm, weight = 77 kg [176.37 lb]) recovered and returned to play 20 days after SRC. Primary measures returned to baseline levels after 12 days. However, supervised (laboratory-based) wearable device assessment showed that gait impairments (increased step time) remained even after the athlete was cleared for return to play (2 months). Similarly, a 24-hour remote gait assessment showed changes in step time, step time variability, and step time asymmetry immediately after SRC and at return to play (1 month after SRC). Remote sleep analysis showed differences in sleep quality and disturbance (increased movement between immediately after SRC and once the athlete had returned to play [1 month after SRC]). CONCLUSION The concern about missed or delayed SRC diagnosis is growing, but methods to objectively monitor return to play after concussion are still lacking. This report showed that wearable device assessment offers additional objective data for use in monitoring players who have SRC. This work could better inform SRC assessment and return-to-play protocols. IMPACT Digital technologies such as wearable technologies can yield additional data that traditional self-report approaches cannot. Combining data from nondigital (traditional) and digital (wearable) methods may augment SRC assessment for improved return-to-play decisions. LAY SUMMARY Inertia-based wearable technologies (eg, accelerometers) may be useful to help augment traditional, self-report approaches to sports-related concussion assessment and management by better informing return-to-play protocols.
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Affiliation(s)
- Dylan Powell
- Department of Computer and Information Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Alan Godfrey
- Address all correspondence to Dr Godfrey to: ; Follow the author(s): @godfreybiomed; @PhysioPowell; @samstuart87
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16
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Vike NL, Bari S, Stetsiv K, Walter A, Newman S, Kawata K, Bazarian JJ, Martinovich Z, Nauman EA, Talavage TM, Papa L, Slobounov SM, Breiter HC. A preliminary model of football-related neural stress that integrates metabolomics with transcriptomics and virtual reality. iScience 2022; 25:103483. [PMID: 35106455 PMCID: PMC8786649 DOI: 10.1016/j.isci.2021.103483] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/23/2021] [Accepted: 11/19/2021] [Indexed: 12/06/2022] Open
Abstract
Research suggests contact sports affect neurological health. This study used permutation-based mediation statistics to integrate measures of metabolomics, neuroinflammatory miRNAs, and virtual reality (VR)-based motor control to investigate multi-scale relationships across a season of collegiate American football. Fourteen significant mediations (six pre-season, eight across-season) were observed where metabolites always mediated the statistical relationship between miRNAs and VR-based motor control (pSobelperm≤ 0.05; total effect > 50%), suggesting a hypothesis that metabolites sit in the statistical pathway between transcriptome and behavior. Three results further supported a model of chronic neuroinflammation, consistent with mitochondrial dysfunction: (1) Mediating metabolites were consistently medium-to-long chain fatty acids, (2) tricarboxylic acid cycle metabolites decreased across-season, and (3) accumulated head acceleration events statistically moderated pre-season metabolite levels to directionally model post-season metabolite levels. These preliminary findings implicate potential mitochondrial dysfunction and highlight probable peripheral blood biomarkers underlying repetitive head impacts in otherwise healthy collegiate football athletes. Permutation-based mediation statistics can be applied to multi-scale biology problems Fatty acids were a critical link between elevated miRNAs and motor control HAEs interacted with pre-season metabolite levels to model post-season levels Together, our observations point to brain-related mitochondrial dysfunction
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Affiliation(s)
- Nicole L Vike
- Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Sumra Bari
- Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Khrystyna Stetsiv
- Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Alexa Walter
- Department of Kinesiology, Pennsylvania State University, University Park, PA 16801, USA
| | - Sharlene Newman
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405, USA
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA.,Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN 47405, USA
| | - Jeffrey J Bazarian
- Department of Emergency Medicine, University of Rochester, Rochester, NY 14627, USA
| | - Zoran Martinovich
- Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Eric A Nauman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA.,School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA.,Department of Basic Medical Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - Thomas M Talavage
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA.,School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN 47907, USA.,Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Linda Papa
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL 32806, USA
| | - Semyon M Slobounov
- Department of Kinesiology, Pennsylvania State University, University Park, PA 16801, USA
| | - Hans C Breiter
- Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.,Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard School of Medicine, Boston, MA 02114, USA
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17
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Powell D, Stuart S, Godfrey A. Sports related concussion: an emerging era in digital sports technology. NPJ Digit Med 2021; 4:164. [PMID: 34857868 PMCID: PMC8639973 DOI: 10.1038/s41746-021-00538-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/19/2021] [Indexed: 11/24/2022] Open
Abstract
Sports-related concussion (SRC) is defined as a mild traumatic brain injury (mTBI) leading to complex impairment(s) in neurological function with many seemingly hidden or difficult to measure impairments that can deteriorate rapidly without any prior indication. Growing numbers of SRCs in professional and amateur contact sports have prompted closer dialog regarding player safety and welfare. Greater emphasis on awareness and education has improved SRC management, but also highlighted the difficulties of diagnosing SRC in a timely manner, particularly during matches or immediately after competition. Therefore, challenges exist in off-field assessment and return to play (RTP) protocols, with current traditional (subjective) approaches largely based on infrequent snapshot assessments. Low-cost digital technologies may provide more objective, integrated and personalized SRC assessment to better inform RTP protocols whilst also enhancing the efficiency and precision of healthcare assessment. To fully realize the potential of digital technologies in the diagnosis and management of SRC will require a significant paradigm shift in clinical practice and mindset. Here, we provide insights into SRC clinical assessment methods and the translational utility of digital approaches, with a focus on off-field digital techniques to detect key SRC metrics/biomarkers. We also provide insights and recommendations to the common benefits and challenges facing digital approaches as they aim to transition from novel technologies to an efficient, valid, reliable, and integrated clinical assessment tool for SRC. Finally, we highlight future opportunities that digital approaches have in SRC assessment and management including digital twinning and the "digital athlete".
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Affiliation(s)
- Dylan Powell
- Department of Computer and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Sam Stuart
- Department of Sports, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Alan Godfrey
- Department of Computer and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.
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Owens TS, Calverley TA, Stacey BS, Rose G, Fall L, Tsukamoto H, Jones G, Corkill R, Tuaillon E, Hirtz C, Lehmann S, Marchi N, Marley CJ, Bailey DM. Concussion history in rugby union players is associated with depressed cerebrovascular reactivity and cognition. Scand J Med Sci Sports 2021; 31:2291-2299. [PMID: 34487582 DOI: 10.1111/sms.14046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/24/2021] [Accepted: 09/03/2021] [Indexed: 01/06/2023]
Abstract
Recurrent contact and concussion in rugby union remains a significant public health concern given the potential increased risk of neurodegeneration in later life. This study determined to what extent prior-recurrent contact impacts molecular-hemodynamic biomarkers underpinning cognition in current professional rugby union players with a history of concussion. Measurements were performed in 20 professional rugby union players with an average of 16 (interquartile range [IQR] 13-19) years playing history reporting 3 (IQR 1-4) concussions. They were compared to 17 sex-age-physical activity-and education-matched non-contact controls with no prior history of self-reported concussion. Venous blood was assayed directly for the ascorbate free radical (A•- electron paramagnetic resonance spectroscopy) nitric oxide metabolites (NO reductive ozone-based chemiluminescence) and select biomarkers of neurovascular unit integrity (NVU chemiluminescence/ELISA). Middle cerebral artery blood flow velocity (MCAv doppler ultrasound) was employed to determine basal perfusion and cerebrovascular reactivity (CVR) to hyper/hypocapnia ( CVR CO 2 Hyper / Hypo ). Cognition was assessed by neuropsychometric testing. Elevated systemic oxidative-nitrosative stress was confirmed in the players through increased A•- (p < 0.001) and suppression of NO bioavailability (p < 0.001). This was accompanied by a lower CVR range ( CVR CO 2 Range ; p = 0.045) elevation in neurofilament light-chain (p = 0.010) and frontotemporal impairments in immediate-memory (p = 0.001) delayed-recall (p = 0.048) and fine-motor coordination (p < 0.001). Accelerated cognitive decline subsequent to prior-recurrent contact and concussion history is associated with a free radical-mediated suppression of CVR and neuronal injury providing important mechanistic insight that may help better inform clinical management.
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Affiliation(s)
- Thomas S Owens
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Thomas A Calverley
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Benjamin S Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - George Rose
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Lewis Fall
- Faculty of Computing, Engineering and Science, University of South Wales, Pontypridd, UK
| | - Hayato Tsukamoto
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.,Faculty of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Gareth Jones
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Robin Corkill
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Edouard Tuaillon
- Department of Infectious Diseases, University of Montpellier, INSERM, Montpellier, France
| | - Christophe Hirtz
- University of Montpellier, CHU of Montpellier, INSERM, Montpellier, France
| | - Sylvain Lehmann
- University of Montpellier, CHU of Montpellier, INSERM, Montpellier, France
| | - Nicola Marchi
- Laboratory of Cerebrovascular and Glia Research, Department of Neuroscience, Institute of Functional Genomics, University of Montpellier, Montpellier, France
| | - Christopher J Marley
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
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19
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Crasta JE, Raja AE, Caffo BS, Hluchan CM, Suskauer SJ. The Effect of Age and Competition Level on Subtle Motor Performance in Adolescents Medically Cleared Postconcussion: Preliminary Findings. Am J Phys Med Rehabil 2021; 100:563-569. [PMID: 32932362 PMCID: PMC8744001 DOI: 10.1097/phm.0000000000001589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine the effect of age and level of competition on subtle motor performance in adolescents who have recently been medically cleared postconcussion and never-injured controls. DESIGN Thirty adolescents who were recently medically cleared postconcussion (12-18 yrs) and 30 never-concussed, typically developing controls were examined using the Revised Physical and Neurological Examination of Subtle Signs (PANESS) and the Immediate Post-Concussion Assessment and Cognitive Testing. RESULTS Older age was associated with better Immediate Post-Concussion Assessment and Cognitive Testing scores in both groups, whereas only the control group showed improved motor performance on the PANESS with increasing age. Adolescents across both groups participating at a higher level of competition (school or travel level) had better motor performance on the PANESS than those participating at a lower level of competition (recreational level or no sports participation). Adolescents medically cleared postconcussion had greater motor deficits on the PANESS than controls did. CONCLUSION After medical clearance, adolescents with a history of recent concussion demonstrate alterations in the relationship between motor function and age. The PANESS merits further exploration as a measure that is sensitive to factors affecting motor performance, such as age and level of athletic competition, as well as to persistent subtle motor deficits in adolescents medically cleared postconcussion.
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Affiliation(s)
- Jewel E Crasta
- Kennedy Krieger Institute, The Ohio State University
- Division of Occupational Therapy, The Ohio State University
| | - Altamash E Raja
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine
| | - Brian S Caffo
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health
| | - Christine M Hluchan
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine
| | - Stacy J Suskauer
- Kennedy Krieger Institute, The Ohio State University
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine
- Department of Pediatrics, Johns Hopkins University School of Medicine
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20
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Anyaegbu CC, Mao Y, McGonigle T, Raja S, Clarke T, Black AMB, Solomon T, Fuller K, Fitzgerald M. Simultaneous flow cytometric characterization of multiple cell types and metabolic states in the rat brain after repeated mild traumatic brain injury. J Neurosci Methods 2021; 359:109223. [PMID: 34004202 DOI: 10.1016/j.jneumeth.2021.109223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cellular responses at the sub-acute phase of mild traumatic brain injury (mTBI), and their contribution to ongoing damage, are unclear, complex and require simultaneous assessment of multiple cells to elucidate. NEW METHOD An 11-colour flow cytometry method for analysing brain cells was evaluated in a weight-drop rat model of repeated mTBI. Animals received sham, one, two or three mTBI delivered at 24 h intervals (n = 6/group). Cerebrum homogenates were prepared 11 days after first mTBI, in two cohorts of n = 3/group to enable same-day staining of fresh tissue. Percentages of neurons, astrocytes, microglia, mature oligodendrocytes and NeuN + CC1+ cells, neutrophils, macrophages and non-myeloid leukocytes, and their immunoreactivity for cell damage indicators (inducible nitric oxide synthase; iNOS, proliferating cell nuclear antigen; PCNA, 8-Oxo-2'-deoxyguanosine; 8OHDG and 4-hydroxynonenal; HNE), were assessed. RESULTS Median fluorescence intensity (MFI) of iNOS in activated microglia increased following two, but not one or three, mTBI (p = 0.04). However, there were differences between processing cohorts in terms of percentages and MFI of some PCNA+, iNOS+, 8OHDG + and HNE + cell populations. COMPARISON WITH EXISTING METHODS Previous applications of flow cytometry for rat brain analysis were typically limited to three or four markers. This method uses 11 markers to identify nine cell populations and evaluate their immunoreactivity to four metabolic indicators of cell damage. CONCLUSIONS Flow cytometry can be useful for discerning injury-related changes in multiple rat brain cells. However, markers sensitive to subtle changes in experimental conditions must be identified in pilot experiments and subsequently analysed in the same tissue-processing cohort.
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Affiliation(s)
- Chidozie C Anyaegbu
- Curtin Health Innovation Research Institute, Curtin University, Belmont, Western Australia, Australia.
| | - Yilin Mao
- Curtin Health Innovation Research Institute, Curtin University, Belmont, Western Australia, Australia
| | - Terry McGonigle
- Curtin Health Innovation Research Institute, Curtin University, Belmont, Western Australia, Australia
| | - Sushmitha Raja
- Curtin Health Innovation Research Institute, Curtin University, Belmont, Western Australia, Australia
| | - Thomas Clarke
- Curtin Health Innovation Research Institute, Curtin University, Belmont, Western Australia, Australia
| | - Anna M B Black
- Curtin Health Innovation Research Institute, Curtin University, Belmont, Western Australia, Australia
| | - Tanya Solomon
- Curtin Health Innovation Research Institute, Curtin University, Belmont, Western Australia, Australia
| | - Kathy Fuller
- Division of Cancer Biology, School of Biomedical Sciences, The University of Western Australia, 35 Stirling Hwy, Nedlands 6009 Western Australia, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Belmont, Western Australia, Australia; Perron Institute for Neurological and Translational Science, Sarich Neuroscience Research Institute Building, 8 Verdun St, Nedlands 6009 Western Australia, Australia
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21
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N-docosahexaenoylethanolamine reduces neuroinflammation and cognitive impairment after mild traumatic brain injury in rats. Sci Rep 2021; 11:756. [PMID: 33436960 PMCID: PMC7804312 DOI: 10.1038/s41598-020-80818-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/28/2020] [Indexed: 12/14/2022] Open
Abstract
At present, there is a growing interest in the study of the neurotropic activity of polyunsaturated fatty acids ethanolamides (N-acylethanolamines). N-docosahexaenoylethanolamine (DHEA, synaptamide) is an endogenous metabolite and structural analogue of anandamide, a widely studied endocannabinoid derived from arachidonic acid. The results of this study demonstrate that DHEA, when administered subcutaneously (10 mg/kg/day, 7 days), promotes cognitive recovery in rats subjected to mild traumatic brain injury (mTBI). In the cerebral cortex of experimental animals, we analyzed the dynamics of Iba-1-positive microglia activity changes and the expression of pro-inflammatory markers (IL1β, IL6, CD86). We used immortalized mouse microglial cells (SIM-A9) to assess the effects of DHEA on LPS-induced cytokines/ROS/NO/nitrite, as well as on CD206 (anti-inflammatory microglia) and the antioxidant enzyme superoxide dismutase (SOD) production. In vivo and in vitro experiments showed that DHEA: (1) improves indicators of anxiety and long-term memory; (2) inhibits the pro-inflammatory microglial cells activity; (3) decrease the level of pro-inflammatory cytokines/ROS/NO/nitrites; (4) increase CD206 and SOD production. In general, the results of this study indicate that DHEA has a complex effect on the neuroinflammation processes, which indicates its high therapeutic potential.
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22
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Frith E, Miller SE, Loprinzi PD. Effects of Verbal Priming With Acute Exercise on Convergent Creativity. Psychol Rep 2020; 125:375-397. [PMID: 33356896 DOI: 10.1177/0033294120981925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The acute effects of moderate-intensity treadmill exercise during anagram problem solving on subsequent creativity performance has yet to be empirically investigated, which was this study's purpose. A two-visit (counterbalanced order), within-subject experiment was conducted among individuals aged 18-35. For the acute exercise visit, participants engaged in a 15-minute bout of moderate-intensity treadmill exercise while solving anagram problems. For the anagram only visit, participants engaged in 15 minutes of seated rest while solving anagram problems. Average RAT performance was higher for the exercise + anagram problem-solving visit (M = 10.51, SD = 3.25) compared to anagram-solving + seated rest (M = 9.29, SD = 4.12). The difference between conditions was statistically significant, t(44) = 2.385, p = .021, Cohen's d = 0.36. These findings demonstrate that acute exercise coupled with anagram problem-solving, prior to RAT completion, is a potential strategy for enhancing verbal convergent creative thinking.
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Affiliation(s)
- Emily Frith
- Cognitive Neuroscience of Creativity Laboratory, Pennsylvania State University, State College, PA, USA
| | - Stephanie E Miller
- Department of Psychology, The University of Mississippi, University, MS, USA
| | - Paul D Loprinzi
- Exercise & Memory Laboratory, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, University, MS, USA
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23
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Schranz AL, Dekaban GA, Fischer L, Blackney K, Barreira C, Doherty TJ, Fraser DD, Brown A, Holmes J, Menon RS, Bartha R. Brain Metabolite Levels in Sedentary Women and Non-contact Athletes Differ From Contact Athletes. Front Hum Neurosci 2020; 14:593498. [PMID: 33324185 PMCID: PMC7726472 DOI: 10.3389/fnhum.2020.593498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/28/2020] [Indexed: 01/31/2023] Open
Abstract
White matter tracts are known to be susceptible to injury following concussion. The objective of this study was to determine whether contact play in sport could alter white matter metabolite levels in female varsity athletes independent of changes induced by long-term exercise. Metabolite levels were measured by single voxel proton magnetic resonance spectroscopy (MRS) in the prefrontal white matter at the beginning (In-Season) and end (Off-Season) of season in contact (N = 54, rugby players) and non-contact (N = 23, swimmers and rowers) varsity athletes. Sedentary women (N = 23) were scanned once, at a time equivalent to the Off-Season time point. Metabolite levels in non-contact athletes did not change over a season of play, or differ from age matched sedentary women except that non-contact athletes had a slightly lower myo-inositol level. The contact athletes had lower levels of myo-inositol and glutamate, and higher levels of glutamine compared to both sedentary women and non-contact athletes. Lower levels of myo-inositol in non-contact athletes compared to sedentary women indicates long-term exercise may alter glial cell profiles in these athletes. The metabolite differences observed between contact and non-contact athletes suggest that non-contact athletes should not be used as controls in studies of concussion in high-impact sports because repetitive impacts from physical contact can alter white matter metabolite level profiles. It is imperative to use athletes engaged in the same contact sport as controls to ensure a matched metabolite profile at baseline.
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Affiliation(s)
- Amy L Schranz
- Department of Medical Biophysics, Robarts Research Institute, Centre for Functional and Metabolic Mapping, Western University, London, ON, Canada
| | - Gregory A Dekaban
- Molecular Medicine Research Laboratories, Robarts Research Institute, Western University, London, ON, Canada.,Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Lisa Fischer
- Fowler Kennedy Sport Medicine Clinic, Department of Family Medicine, Western University, London, ON, Canada
| | - Kevin Blackney
- Molecular Medicine Research Laboratories, Robarts Research Institute, Western University, London, ON, Canada.,Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Christy Barreira
- Molecular Medicine Research Laboratories, Robarts Research Institute, Western University, London, ON, Canada
| | - Timothy J Doherty
- Physical Medicine and Rehabilitation, Western University, London, ON, Canada
| | - Douglas D Fraser
- Paediatrics Critical Care Medicine, London Health Sciences Centre, London, ON, Canada
| | - Arthur Brown
- Molecular Medicine Research Laboratories, Robarts Research Institute, Western University, London, ON, Canada.,Department of Anatomy and Cell Biology, Western University, London, ON, Canada
| | - Jeff Holmes
- School of Occupational Therapy, Western University, London, ON, Canada
| | - Ravi S Menon
- Department of Medical Biophysics, Robarts Research Institute, Centre for Functional and Metabolic Mapping, Western University, London, ON, Canada
| | - Robert Bartha
- Department of Medical Biophysics, Robarts Research Institute, Centre for Functional and Metabolic Mapping, Western University, London, ON, Canada
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24
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Esopenko C, Coury JR, Pieroth EM, Noble JM, Trofa DP, Bottiglieri TS. The Psychological Burden of Retirement from Sport. Curr Sports Med Rep 2020; 19:430-437. [PMID: 33031209 DOI: 10.1249/jsr.0000000000000761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Participation in sport is associated with numerous physical and psychological health benefits, but also can have negative consequences, such as career ending injuries, which may have long-term effects on mental health. Recent research suggests that involuntary retirement, due to injury, illness, or being cut from a sport, can be particularly detrimental. As such, this review focuses on the impact athletic retirement has on the psychological well-being of collegiate athletes. We provide an algorithm to inform clinical decision making regarding involuntary retirement, as well as recommendations for the development of support programs and educational resources for athletes struggling with career transition. Our aim is that in developing retirement algorithms, support programs, and educational resources for athletes who are retired from sport, we can intervene early thus reducing the potential long-term psychological burden they may experience.
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Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation and Movement Sciences, Rutgers Biomedical Health Sciences, Newark, NJ
| | - Josephine R Coury
- Department of Sports Medicine, New York-Presbyterian, Columbia University Irving Medical Center, New York, NY
| | | | - James M Noble
- Department of Neurology, GH Sergievsky Center, and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY
| | - David P Trofa
- Department of Sports Medicine, New York-Presbyterian, Columbia University Irving Medical Center, New York, NY
| | - Thomas S Bottiglieri
- Department of Sports Medicine, New York-Presbyterian, Columbia University Irving Medical Center, New York, NY
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25
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Buckley TA, Munkasy BA, Krazeise DA, Oldham JR, Evans KM, Clouse B. Differential Effects of Acute and Multiple Concussions on Gait Initiation Performance. Arch Phys Med Rehabil 2020; 101:1347-1354. [PMID: 32343972 DOI: 10.1016/j.apmr.2020.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify the effect of acute and multiple concussions on gait initiation performance. DESIGN Cohort study. SETTING University research center. PARTICIPANTS A population-based sample of participants (N=45) divided into 3 groups: No Prior Concussion, ≥3 Prior Concussions, and Acute Concussion. The Acute Concussion participants were assessed within 24 hours of their concussion. Participants were matched based on (1) sport, (2) position, and (3) anthropometric measures. INTERVENTIONS Participants were tested on a single occasion and performed 5 trials of gait initiation on 4 force plates. The No Prior Concussion and ≥3 Prior Concussions groups were tested out of their primary athletic season. MAIN OUTCOME MEASURES The dependent variables were the posterior and lateral displacement and velocity of the center of pressure (COP) during the anticipatory postural adjustment phase and initial step kinematics (step length and step velocity). Comparisons between groups used a 1-way analysis of variance with Tukey post hoc when significant effects were identified and effect sizes were calculated. RESULTS There were significant effects for group for all 6 outcome measures with large effect sizes. Post hoc tests identified differences between Acute Concussion and No Prior Concussion groups for all measures. The ≥3 Prior Concussions group and No Prior Concussion group were different for COP posterior displacement (4.91±1.09 and 4.91±1.09cm, respectively, P=.032, d=0.91) and velocity (0.18±0.06 and 0.27±0.08m/s, respectively, P=.002, d=1.27). CONCLUSION There was continuum of performance identified whereby the Acute Concussion participants performed worse and the No Prior Concussion participants performed the best. The ≥3 Prior Concussions generally fell between these 2 groups, but only statistical significance on COP posterior displacement and velocity. These results suggest there may be subtle neurophysiological deficits present in collegiate student-athletes with ≥3 Prior Concussions group, and further investigation over the lifespan is warranted.
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Affiliation(s)
- Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE; Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE.
| | - Barry A Munkasy
- School of Health and Kinesiology, Georgia Southern University, Statesboro, GA
| | | | - Jessie R Oldham
- Micheli Center for Sports Injury Prevention, Boston Children's Hospital, Waltham, MA
| | - Kelsey M Evans
- Brody School of Medicine, Each Carolina University, Greenville, NC
| | - Brandy Clouse
- Department of Intercollegiate Athletics, Georgia Southern University, Statesboro, GA
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26
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Cookinham B, Swank C. Concussion History and Career Status Influence Performance on Baseline Assessments in Elite Football Players. Arch Clin Neuropsychol 2020; 35:257-264. [PMID: 30927353 DOI: 10.1093/arclin/acz012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/17/2019] [Accepted: 02/23/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine if concussion history and career status is associated with neurocognitive performance in elite football players. METHODS The study design was a cross-sectional single assessment. Fifty-seven elite football players (age 29.39 ± 7.49 years) categorized as draft prospects, active professional players, and retired professional players were assessed on the Sport Concussion Assessment Tool - third edition (SCAT-3), in an outpatient therapy setting. RESULTS Common symptoms were the following: fatigue (45.6%), trouble falling asleep (35.1%), difficulty remembering (33.3%) and irritability (22.8%); 36.8% reported no symptoms. The low concussion (0-1) group reported fewer symptoms (U = 608.50, p < .001), less symptom severity (U = 598.00, p = -.001), and produced greater scores on the Standardized Assessment of Concussion (SAC) total scores compared to the multiple concussion (2+) group (U = 253.00, p = .024), but no differences were observed on modified Balance Error Scoring System (m-BESS) scores (U = 501.50, p = .066) on the Mann-Whitney U test. The Kruskal-Wallis test and post-hoc analysis indicated retired players were significantly different from draft prospects and current professional players for total symptom scores (p < .001), total symptom severity (p < .001), SAC total scores (p = .030), and m-BESS (p < .001). CONCLUSIONS Concussion history and career status appear associated with total symptoms, symptom severity, performance on the SAC, and the m-BESS in elite football players. With this in mind, future research is recommended to determine longitudinal impact for elite football players.
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Affiliation(s)
| | - Chad Swank
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
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27
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Caccese JB, DeWolf RM, Kaminski TW, Broglio SP, McAllister TW, McCrea M, Buckley TA. Estimated Age of First Exposure to American Football and Neurocognitive Performance Amongst NCAA Male Student-Athletes: A Cohort Study. Sports Med 2020; 49:477-487. [PMID: 30747378 DOI: 10.1007/s40279-019-01069-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Repetitive head impacts in young athletes are potentially detrimental to later life (e.g., age 50 + years) neurological function; however, it is unknown what the short-term effects (e.g., age 20 years) are in collegiate student-athletes. OBJECTIVE The purpose of this study was to determine the effect of the estimated age of first exposure to American tackle football participation on neurocognitive performance and symptom severity scores in collegiate student-athletes. METHODS We used a cohort study in which neurocognitive performance was assessed using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test in 4376 male athletes (age 19.3 ± 1.5 years, mass 96.3 ± 20.3 kg, height 185.0 ± 7.4 cm). Athletes were grouped by sport participation [American football (n = 3462) or non-contact (n = 914)] and estimated age of first exposure [< 12 years (n = 3022) or ≥ 12 years (n = 1354)]. The outcome measures were the four primary cognitive scores and the symptom severity score from ImPACT. We assessed primary outcomes across groups, controlling for age, learning accommodations, and concussion history. RESULTS Neurocognitive performance was not associated with the estimated age of first exposure-by-group interaction. CONCLUSION Our findings indicate that participation in American tackle football before age 12 years does not result in neurocognitive deficits in college. Therefore, we suggest the following: the consequences of early exposure to repetitive head impacts do not manifest by college, the ImPACT test was not sensitive enough to identify the effects of an earlier estimated age of first exposure, or there is no association between an earlier estimated age of first exposure and neurocognitive functioning. Future longitudinal studies are warranted.
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Affiliation(s)
- Jaclyn B Caccese
- Department of Kinesiology and Applied Physiology, University of Delaware, 349 Tower at STAR, 100 Discovery Blvd, Newark, DE, 19713, USA
| | - Ryan M DeWolf
- Massachusetts General Hospital, Institute of Health Professions, Boston, MA, USA
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, 349 Tower at STAR, 100 Discovery Blvd, Newark, DE, 19713, USA
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA
| | - Steven P Broglio
- NeuroTrauma Research Laboratory, University of Michigan Injury Center, University of Michigan, Ann Arbor, MI, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, 349 Tower at STAR, 100 Discovery Blvd, Newark, DE, 19713, USA.
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA.
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28
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Stuart S, Parrington L, Martini DN, Kreter N, Chesnutt JC, Fino PC, King LA. Analysis of Free-Living Mobility in People with Mild Traumatic Brain Injury and Healthy Controls: Quality over Quantity. J Neurotrauma 2020; 37:139-145. [DOI: 10.1089/neu.2019.6450] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Samuel Stuart
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Lucy Parrington
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Douglas N. Martini
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Nicholas Kreter
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
| | - James C. Chesnutt
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
| | - Peter C. Fino
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, Utah
| | - Laurie A. King
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
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29
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Pearce AJ, Kidgell DJ, Frazer AK, King DA, Buckland ME, Tommerdahl M. Corticomotor correlates of somatosensory reaction time and variability in individuals with post concussion symptoms. Somatosens Mot Res 2019; 37:14-21. [PMID: 31809669 DOI: 10.1080/08990220.2019.1699045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Persistent post concussion symptoms (PPCS) describe the condition when an individual experiences chronic symptoms, particularly fatigue, beyond the expected time of recovery. The aim of this study was to quantify the effect of fatigue and related ongoing symptoms on somatosensory and corticomotor pathways using reaction time (RT) testing, and single-pulse and paired-pulse transcranial magnetic stimulation (TMS). Eighty-three participants (nine female, mean age 37.9 ± 11.5 years) were divided into two groups (persistent symptoms versus asymptomatic) following self-report based upon previously published clinical symptom scores. All participants completed somatosensory and visuomotor RT testing, as well as corticomotor excitability and inhibition measurements via TMS. Participants in the persistent symptom group (n = 38) reported greater number of previous concussions (t = 2.81, p = 0.006) and significantly higher levels of fatigue and related symptoms in the asymptomatic group (n = 45; t = 11.32, p < 0.006). Somatosensory RT showed significant slowing and increased variability in the persistent symptoms group (p < 0.001), however no significant differences were observed between groups for visuomotor RTs. Transcranial magnetic stimulation revealed differences between groups for intracortical inhibition at all stimulus intensities and paired pulse measures. The results indicate that somatosensory and corticomotor systems reflect on-going fatigue. From a practical perspective, objective and simplistic measures such as somatosensory and corticomotor measures can be used in the assessment of PPCS and gauging the efficacy of post concussion rehabilitation programmes.
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Affiliation(s)
- Alan J Pearce
- College of Health Science and Engineering, La Trobe University, Melbourne, Australia
| | - Dawson J Kidgell
- Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Ashlyn K Frazer
- Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia
| | - Doug A King
- Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
| | - Michael E Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, Sydney, Australia.,Brain and Mind Centre, University Sydney, Camperdown, Australia
| | - Mark Tommerdahl
- Cortical Metrics, USA.,Department of Biomedical Engineering, University of North Carolina, NC, USA
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Adame BJ, Corman SR. Vested Interests and Perceived Risk of Concussion Consequences among Power-5 College Athletes. HEALTH COMMUNICATION 2019; 34:1673-1682. [PMID: 30216096 DOI: 10.1080/10410236.2018.1517707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Concussion injuries among young athletes are a growing public health concern; concussion injuries pose threats to both short-term and long-term brain health. Significant, multidisciplinary efforts are underway to improve detection, diagnosis and treatment. Concussion symptoms are ambiguous and not outwardly visible; successful detection and diagnosis efforts depend on veridical athlete communication with health practitioners. To date, education programs to enhance reporting behaviors have not been successful. This research reports findings from the first phase of a project designed to understand athlete's perceived risk of concussion consequences with the goal of informing theory-based motivational and educational interventions. Using a novel theoretical approach, this research examines the vested interests of 435 collegiate athletes from 12 universities, participating in six Division I level, high concussion-risk sports, sanctioned by a Power-5 conference. Our findings confirm that the vestedness model predicts a consequential amount of variance in perceived concussion risk, perceived levels of concussion education, and recalled head impacts. The model identifies several opportunities to craft theory-based messages that can motivate reporting behaviors. This research contributes to the literature on concussion safety by offering a unique theoretical framework that accounts for factors influencing risk perception and takes a step in a call for deliberate, theory-based optimization and translation of concussion education for high-risk athletes.
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Affiliation(s)
- Bradley J Adame
- The Hugh Downs School of Human Communication, Arizona State University
| | - Steven R Corman
- The Hugh Downs School of Human Communication, Arizona State University
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31
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Long-Term Cognitive Performance of Retired Athletes with Sport-Related Concussion: A Systematic Review and Meta-Analysis. Brain Sci 2019; 9:brainsci9080199. [PMID: 31412586 PMCID: PMC6721785 DOI: 10.3390/brainsci9080199] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/07/2019] [Accepted: 08/10/2019] [Indexed: 01/07/2023] Open
Abstract
Objective: The purpose of this systematic review is to quantitatively estimate (or invest) the impacts of sports-related concussions (SRCs) on cognitive performance among retired athletes more than 10 years after retirement. Methods: Six databases including (MEDLINE, Scopus, Web of Science, SPORTDiscus, CINAHL, and PsycArtilces) were employed to retrieve the related studies. Studies that evaluate the association between cognitive function and the SRC of retired athletes sustaining more than 10 years were included. Results: A total of 11 studies that included 792 participants (534 retired athletes with SRC) were identified. The results indicated that the retired athletes with SRCs, compared to the non-concussion group, had significant cognitive deficits in verbal memory (SMD = -0.29, 95% CI -0.59 to -0.02, I2 = 52.8%), delayed recall (SMD = -0.30, 95% CI -0.46 to 0.07, I2 = 27.9%), and attention (SMD = -0.33, 95% CI -0.59 to -0.06, I2 = 0%). Additionally, meta-regression demonstrated that the period of time between testing and the last concussion is significantly associated with reduced verbal memory (β = -0.03681, p = 0.03), and increasing age is significantly associated with the verbal memory (β = -0.03767, p = 0.01), immediate recall (β = -0.08684, p = 0.02), and delay recall (β = -0.07432, p = 0.02). Conclusion: The retired athletes who suffered from SRCs during their playing career had declined cognitive performance in partial domains (immediate recall, visuospatial ability, and reaction time) later in life.
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Mild traumatic brain injury: The effect of age at trauma onset on brain structure integrity. NEUROIMAGE-CLINICAL 2019; 23:101907. [PMID: 31233955 PMCID: PMC6595074 DOI: 10.1016/j.nicl.2019.101907] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 12/14/2022]
Abstract
Mounting evidence suggests that mild traumatic brain injuries (mTBI) have long-term effects that interact with the aging process to precipitate cognitive decline. This line of research predicts that early exposure to brain trauma is particularly detrimental to long-term brain integrity. However, a second line of research into the effects of age at trauma onset predict that older brains are more vulnerable to the effects of mTBI than younger brains. We sought to determine whether patients who sustain a mTBI earlier in life fare better than patients who sustain a mTBI at an older age. We conducted a multi-cohort, case-control study, with participants randomly sampled from a population of patients with a history of mTBI. We recruited two cohorts of aging participants (N = 74, mean [SD] = 61.16 [6.41]) matched in age and education levels that differed in only one respect: age at mTBI onset. One cohort sustained their concussion in their early twenties (24.60 [6.34] y/o), the other in their early sixties (61.05 [4.90] y/o). Each mTBI cohort had its own matched control group. Participants underwent high-resolution MRI at 3 Tesla for T1 and diffusion-weighted images (DWI) acquisition. Images were processed and analyzed using Deformation-Based Morphometry and DWI Tract-Based Spatial Statistics to identify group differences in a 2 × 2 ANOVA design. Results showed a significant interaction on DWI measures of white matter integrity indicating larger anomalies in participants who sustained a mTBI at a younger age (F1,70, P < .05, FDR corrected). These findings suggest that mTBI initiates a lifelong neurodegeneration process that outweighs the risks associated with sustaining a mTBI at an older age. Implications are important for young athletes' populations exposed to the risk of mTBI in the practice of their sports and for retired athletes aging with a history of concussions sustained at a younger age. In aging adults, early-life mTBI leads to worst brain outcome than late-life mTBI. Brain anomalies are mostly visible using DWI measures of white matter integrity. Brain anomalies are visible even in neurologically normal individuals.
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Fehily B, Bartlett CA, Lydiard S, Archer M, Milbourn H, Majimbi M, Hemmi JM, Dunlop SA, Yates NJ, Fitzgerald M. Differential responses to increasing numbers of mild traumatic brain injury in a rodent closed-head injury model. J Neurochem 2019; 149:660-678. [PMID: 30702755 DOI: 10.1111/jnc.14673] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/20/2018] [Accepted: 01/14/2019] [Indexed: 01/13/2023]
Abstract
Following mild traumatic brain injury (mTBI), further mild impacts can exacerbate negative outcomes. To compare chronic damage and deficits following increasing numbers of repeated mTBIs, a closed-head weight-drop model of repeated mTBI was used to deliver 1, 2 or 3 mTBIs to adult female rats at 24 h intervals. Outcomes were assessed at 3 months following the first mTBI. No gross motor, sensory or reflex deficits were identified (p > 0.05), consistent with current literature. Cognitive function assessed using a Morris water maze revealed chronic memory deficits following 1 and 2, but not 3 mTBI compared to shams (p ≤ 0.05). Oxidative damage to DNA was assessed immunohistochemically in the dentate hilus of the hippocampus and splenium of the corpus callosum; no changes were observed. IBA1-positive microglia were increased in size in the cortex following 1 mTBI and in the corpus callosum following 2 mTBI compared to shams (p ≤ 0.05); no changes were observed in the dentate hilus. Glial fibrillary acidic protein (GFAP)-positive astrocyte immunoreactivity was assessed in all three brain regions and no chronic changes were observed. Integrity of myelin ultrastructure in the corpus callosum was assessed using transmission electron microscopy. G ratio was decreased following 2 mTBIs compared to shams (p ≤ 0.05) at post hoc level only. The changing patterns of damage and deficits following increasing numbers of mTBI may reflect dynamic responses to small numbers of mTBIs or a conditioning effect such that increasing numbers of mTBIs do not necessarily result in worsening pathology. OPEN SCIENCE BADGES: This article has received a badge for *Open Materials* because it provided all relevant information to reproduce the study in the manuscript. The complete Open Science Disclosure form for this article can be found at the end of the article. More information about the Open Practices badges can be found at https://cos.io/our-services/open-science-badges/. Cover Image for this issue: doi: 10.1111/jnc.14508.
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Affiliation(s)
- Brooke Fehily
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
- School of Human Sciences, The University of Western Australia, Nedlands, WA, Australia
| | - Carole A Bartlett
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
| | - Stephen Lydiard
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
| | - Michael Archer
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
| | - Hannah Milbourn
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
| | - Maimuna Majimbi
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Bentley, WA, Australia
| | - Jan M Hemmi
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
| | - Sarah A Dunlop
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
| | - Nathanael J Yates
- School of Human Sciences, The University of Western Australia, Nedlands, WA, Australia
| | - Melinda Fitzgerald
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Bentley, WA, Australia
- The Perron Institute for Neurological and Translational Science, Sarich Neuroscience Research Institute Building, Nedlands, WA, Australia
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34
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Dai JB, Li AY, Haider SF, Tomaselli R, Gometz A, Sobotka S, Post AF, Adams R, Maniya AY, Lau GK, Kaye-Kauderer HP, Lovell MR, Choudhri TF. Effects of Game Characteristics and Player Positions on Concussion Incidence and Severity in Professional Football. Orthop J Sports Med 2018; 6:2325967118815448. [PMID: 30627588 PMCID: PMC6311573 DOI: 10.1177/2325967118815448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Increasing efforts have been made to reduce the incidence and severity of concussion in high-contact sports. Despite these efforts, a relative lack of knowledge is available regarding modulating factors affecting concussion injury. Purpose: To analyze the potential influence of game characteristics and outcomes on concussion incidence and severity in professional football. Study Design: Descriptive epidemiology study. Methods: PBS Frontline Concussion Watch was used to collect concussion injury data from regular-season games of 32 National Football League (NFL) teams from 2012 to 2015. Game characteristic variables such as rushing and passing attempts, turnovers, and margin of victory were collected from ESPN. Analysis included descriptive statistics, analysis of variance, t tests, and correlation tests. Results: Away teams demonstrated a significantly greater concussion incidence per game than home teams. Losing teams had a significantly greater concussion incidence per game than winning teams. Being both the away team and the losing team appeared to have an additive effect. The home-versus-away and win-versus-loss effects were significant for offensive but not defensive positions. Within individual positions, significantly greater concussion incidence was associated with tight ends, running backs, wide receivers, and cornerbacks. When running versus passing positions were compared, passing positions (wide receiver, tight end, cornerback, safety) had significantly greater concussion incidence. A total of 626 games were missed as a result of reported concussions. Away teams had significantly more games missed due to concussion when they lost. Play time did not significantly differ before or after concussion injury. Other game characteristic variables did not significantly affect concussion frequency or intensity. Conclusion: Position, game location, and game outcome affect concussion incidence for professional football players. In a subset of analyses, the number of games missed aligned with concussion incidence, but this appeared to be an imperfect measure. These findings highlight new factors that may modulate concussion incidence and merit further study on how they may influence concussion evaluation.
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Affiliation(s)
- Jennifer B Dai
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam Y Li
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Syed F Haider
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Alex Gometz
- Concussion Management of New York, New York, New York, USA
| | - Stanislaw Sobotka
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexander F Post
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ryan Adams
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Akbar Y Maniya
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George K Lau
- Touro College of Osteopathic Medicine, New York, New York, USA
| | | | - Mark R Lovell
- ImPACT Applications Inc, Pittsburgh, Pennsylvania, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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35
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Raikes AC, Killgore WDS. Potential for the development of light therapies in mild traumatic brain injury. Concussion 2018; 3:CNC57. [PMID: 30370058 PMCID: PMC6199671 DOI: 10.2217/cnc-2018-0006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022] Open
Abstract
Light affects almost all aspects of human physiological functioning, including circadian rhythms, sleep-wake regulation, alertness, cognition and mood. We review the existing relevant literature on the effects of various wavelengths of light on these major domains, particularly as they pertain to recovery from mild traumatic brain injuries. Evidence suggests that light, particularly in the blue wavelengths, has powerful alerting, cognitive and circadian phase shifting properties that could be useful for treatment. Other wavelengths, such as red and green may also have important effects that, if targeted appropriately, might also be useful for facilitating recovery. Despite the known effects of light, more research is needed. We recommend a personalized medicine approach to the use of light therapy as an adjunctive treatment for patients recovering from mild traumatic brain injury.
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Affiliation(s)
- Adam C Raikes
- Social, Cognitive & Affective Neuroscience Lab, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
- ORCID: 0000-0002-1609-6727
| | - William DS Killgore
- Social, Cognitive & Affective Neuroscience Lab, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
- ORCID: 0000-0002-5328-0208
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36
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Fueger C, Huddleston WE. Effects of concussions on visually guided motor actions: A literature review. J Clin Exp Neuropsychol 2018; 40:1074-1080. [PMID: 29690820 DOI: 10.1080/13803395.2018.1458823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Athletes must be able to successfully navigate the soccer pitch or hockey rink to win the game, requiring maximal cognitive resources to successfully compete. Concussions potentially deplete these resources, and the long-term impact of concussions on an individual's goal-directed visually guided behavior continues to elude the scientific community. While the acute effects on cognition and the motor system have been elucidated elsewhere, long-term effects on performance have been less clear. Additionally, most investigations into long-term postinjury motor behaviors have focused on balance and gait, with little focus on functional upper extremity movements. These arm movements require both cognitive and motor functions to successfully complete the task, such as visually guided reaching, and have received little attention. This review examines the current state of the literature to date on the long-term effects of concussions on cognitive and motor deficits affecting visuomotor behavior.
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Affiliation(s)
- Christopher Fueger
- a Department of Kinesiology, Integrative Health Care and Performance , University of Wisconsin-Milwaukee , Milwaukee , WI , USA
| | - Wendy E Huddleston
- a Department of Kinesiology, Integrative Health Care and Performance , University of Wisconsin-Milwaukee , Milwaukee , WI , USA
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