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Fu Z, Liu M, Wang S, Zhang H, Sun Y, Zhou Y, Li X, Ming P, Song J, Xu G. Impairment of inhibitory control due to repetitive subconcussions from indirect brain impacts: Evidence from event-related potentials and resting-state EEG complexity in parachuters. Brain Res Bull 2024; 216:111053. [PMID: 39173778 DOI: 10.1016/j.brainresbull.2024.111053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 07/27/2024] [Accepted: 08/17/2024] [Indexed: 08/24/2024]
Abstract
The present study aims to investigate the unknown relationship between inhibitory control and repetitive subconcussion induced by the indirect brain impacts. We enrolled 28 parachuters exposed to repetitive subconcussion (SC) and 27 matched health controls (HC). Parachuters who have completed at least 70 actual parachuting (71-112 times) and at least 1500 simulated platform jumps (1500-4500 times) were included in the SC group. The SC group had a reduced accuracy rate in both the Stroop congruent and incongruent conditions. Larger N2 and N450 amplitudes were elicited in the frontal regions of the SC group, which indicate compensatory adaptations to the deficit in conflict monitoring. The reduced frontal resting-state EEG complexity in full-band (1-40 Hz) may demonstrate the frontal structural damage following the indirect brain impacts of repetitive subconcussion. Pearson correlation analysis showed that in the SC group, the frontal beta-band sample entropy values are positively correlated with the accuracy rate of the Stroop incongruent condition, suggesting the frontal beta-band sample entropy values may serve as potential electrophysiological markers of impaired inhibitory control after indirectly repetitive brain impacts. This study provides the robust evidence that repetitive subconcussion resulting from indirect brain impacts may lead to impairment of inhibitory control.
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Affiliation(s)
- Zhenghao Fu
- The First School of Clinical Medicine, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou 510515, China; Department of Neurosurgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wuhan 430070, China
| | - Min Liu
- Airborne Troop Hospital, Wuhan, China
| | - Shuochen Wang
- Department of Neurosurgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wuhan 430070, China
| | - Haoran Zhang
- Department of Neurosurgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wuhan 430070, China; Medical College, Wuhan University of Science and Technology, 947 Heping Avenue, Wuhan 430081, China
| | - Yuanyi Sun
- The First School of Clinical Medicine, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou 510515, China; Department of Neurosurgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wuhan 430070, China
| | - Yang Zhou
- Department of Neurosurgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wuhan 430070, China; Hubei University of Medicine, 16 Shanghai Road, Shiyan, Hubei Province 442000, China
| | - Xiang Li
- Department of Neurosurgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wuhan 430070, China; Hubei University of Medicine, 16 Shanghai Road, Shiyan, Hubei Province 442000, China
| | | | - Jian Song
- The First School of Clinical Medicine, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou 510515, China; Department of Neurosurgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wuhan 430070, China.
| | - Guozheng Xu
- The First School of Clinical Medicine, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou 510515, China; Department of Neurosurgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wuhan 430070, China.
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Jennings T, Islam MS. Examining the interdisciplinary approach for treatment of persistent post-concussion symptoms in adults: a systematic review. BRAIN IMPAIR 2023; 24:290-308. [PMID: 38167190 DOI: 10.1017/brimp.2022.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The objective of this review is to examine the evidence for the interdisciplinary approach in treatment of persistent post-concussion symptoms in adults. METHODS This systematic literature search was undertaken according to the Preferred Reporting Items for Systematic and Meta-Analysis (PRISMA) guidelines. Five electronic databases were searched: CINAHL, Informit, ProQuest, PubMed and Scopus. After screening and quality assessment, the review included six studies published in English and peer-reviewed journals, between 2011 and 2021 to return contemporary evidence. RESULTS The results revealed that there was significant variation between measures used and the timing of the pre- and post-treatment assessment. The studies found an interdisciplinary approach to be beneficial, however, the challenges of inherent heterogeneity, lack of clarity for definitions and diagnosis, and mixed results were apparent. The interdisciplinary interventions applied in all identified studies were found to reduce post-concussion symptoms across the symptom subtypes: headache/migraine, vestibular, cognitive, ocular motor and anxiety/mood. CONCLUSIONS The results demonstrated evidence for a reduction in persistent post-concussion symptoms following interdisciplinary intervention. This evidence will inform health services, clinicians, sports administrators and researchers with regard to concussion clinic and rehabilitation team design and service delivery.
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Affiliation(s)
- Tamara Jennings
- Master of Health Management, Barwon Health, Geelong 3215, Victoria, Australia
| | - Md Shahidul Islam
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
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Halliday DWR, Karr JE, Shahnazian D, Gordon I, Sanchez Escudero JP, MacDonald SWS, Macoun SJ, Hundza SR, Garcia-Barrera MA. Electrophysiological variability during tests of executive functioning: A comparison of athletes with and without concussion and sedentary control participants. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-10. [PMID: 37598380 DOI: 10.1080/23279095.2023.2247512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
OBJECTIVE Sport participation may benefit executive functioning (EF), but EF can also be adversely affected by concussion, which can occur during sport participation. Neural variability is an emerging proxy of brain health that indexes the brain's range of possible responses to incoming stimuli (i.e., dynamic range) and interconnectedness, but has yet to be characterized following concussion among athletes. This study examined whether neural variability was enhanced by athletic participation and attenuated by concussion. METHOD Seventy-seven participants (18-25 years-old) were classified as sedentary controls (n = 33), athletes with positive concussion history (n = 21), or athletes without concussion (n = 23). Participants completed tests of attention switching, response inhibition, and updating working memory while undergoing electroencephalography recordings to index neural variability. RESULTS Compared to sedentary controls and athletes without concussion, athletes with concussion exhibited a restricted whole-brain dynamic range of neural variability when completing a test of inhibitory control. There were no group differences observed for either the switching or working memory tasks. CONCLUSIONS A history of concussion was related to reduced dynamic range of neural activity during a task of response inhibition in young adult athletes. Neural variability may have value for evaluating brain health following concussion.
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Affiliation(s)
- Drew W R Halliday
- Department of Psychology, University of Victoria, Victoria, Canada
- CORTEX Laboratory, University of Victoria, Victoria, Canada
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, Canada
| | - Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | | | - Iris Gordon
- Department of Psychology, University of Victoria, Victoria, Canada
- CORTEX Laboratory, University of Victoria, Victoria, Canada
| | | | - Stuart W S MacDonald
- Department of Psychology, University of Victoria, Victoria, Canada
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, Canada
| | - Sarah J Macoun
- Department of Psychology, University of Victoria, Victoria, Canada
| | - Sandra R Hundza
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, Canada
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, Canada
| | - Mauricio A Garcia-Barrera
- Department of Psychology, University of Victoria, Victoria, Canada
- CORTEX Laboratory, University of Victoria, Victoria, Canada
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, Canada
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Incremental Effects of Subsequent Concussions on Cognitive Symptoms in the Sport Concussion Assessment Tool. Clin J Sport Med 2022; 32:e568-e572. [PMID: 35447628 DOI: 10.1097/jsm.0000000000001042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/14/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patients who are fully recovered from a concussion may still be more vulnerable in the face of subsequent concussions. This study examines symptoms associated with repeated concussions in young and otherwise healthy adults. DESIGN Cross sectional. SETTING Institutional study at a university setting. PARTICIPANTS University students with a history of concussion. INDEPENDENT VARIABLES Participants were grouped based on numbers of concussions. MAIN OUTCOME MEASURES The impact of incremental concussion on symptom clusters in Sport Concussion Assessment Tools 5 and Spearman ranking correlation coefficients between symptom clusters. RESULTS One hundred thirty-five participants reported having had 1 concussion, 63 reported 2 concussions, 50 reported 3 concussions, and 43 reported 4 to 6 concussions. Total severity scores over the range of concussion number (1, 2, 3, and greater than 3) did not show a clear incremental effect. However, average scores of cognitive symptoms rose with each subsequent concussion ( P ≤ 0.05). The largest incremental effect observed was that of second concussions on emotional symptom scores (t = 5.85, P < 0.01). Symptoms in the emotional and cognitive clusters were the most correlated regardless of the number of reported concussions; the correlations were lowest with symptoms associated with sensitivity to light or noise. CONCLUSIONS The incremental rise of cognitive symptom scores with each concussion affirms the importance of cognitive impairment in concussion assessment and implies a cumulative brain vulnerability that persists even after symptom resolution. The cognitive-emotional symptom clusters may reflect underlying concussion-induced impairments in the corticostriatothalamocortical (CSTC) networks, although sensitivity symptoms are potentially attributable to different neural correlates.
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Manning Franke L, Perera RA, Aygemang AA, Marquardt CA, Teich C, Sponheim SR, Duncan CC, Walker WC. Auditory evoked brain potentials as markers of chronic effects of mild traumatic brain injury in mid-life. Clin Neurophysiol 2021; 132:2979-2988. [PMID: 34715422 DOI: 10.1016/j.clinph.2021.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/31/2021] [Accepted: 09/20/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Auditory event-related potential (ERP) correlates of pre-dementia in late-life may also be sensitive to chronic effects of mild traumatic brain injury (mTBI) in mid-life. In addition to mTBI history, other clinical factors may also influence ERP measures of brain function. This study's objective was to evaluate the relationship between mTBI history, auditory ERP metrics, and common comorbidities. METHODS ERPs elicited during an auditory target detection task, psychological symptoms, and hearing sensitivity were collected in 152 combat-exposed veterans and service members, as part of a prospective observational cohort study. Participants, with an average age of 43.6 years, were grouped according to positive (n = 110) or negative (n = 42) mTBI history. Positive histories were subcategorized into repetitive mTBI (3 + ) (n = 40) or non-repetitive (1-2) (n = 70). RESULTS Positive history of mTBI was associated with reduced N200 amplitude to targets and novel distractors. In participants with repetitive mTBI compared to non-repetitive and no mTBI, P50 was larger in response to nontargets and N100 was smaller in response to nontargets and targets. Changes in N200 were mediated by depression and anxiety symptoms and hearing loss, with no evidence of a supplementary direct mTBI pathway. CONCLUSIONS Auditory brain function differed between the positive and negative mTBI groups, especially for repetitive injury, which implicated more basic, early auditory processing than did any mTBI exposure. Symptoms of internalizing psychopathology (depression and anxiety) and hearing loss are implicated in mTBI's diminished brain responses to behaviorally relevant and novel stimuli. SIGNIFICANCE A mid-life neurologic vulnerability conferred by mTBI, particularly repetitive mTBI, may be detectable using auditory brain potentials, and so auditory ERPs are a target for study of dementia risk in this population.
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Affiliation(s)
- Laura Manning Franke
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, USA; Hunter Holmes McGuire VA Medical Center, USA.
| | - Robert A Perera
- Department of Biostatistics, Virginia Commonwealth University, USA.
| | - Amma A Aygemang
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, USA.
| | - Craig A Marquardt
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, USA.
| | | | - Scott R Sponheim
- Minneapolis VA Health Care System, USA; Department of Psychiatry & Behavioral Sciences, University of Minnesota, USA; Department of Psychology, University of Minnesota, USA.
| | - Connie C Duncan
- Departments of Psychiatry and Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, USA.
| | - William C Walker
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, USA; Hunter Holmes McGuire VA Medical Center, USA.
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Tiberini P, D'Antona G, Cicchella A. Brain Oxygenation in Post-concussion Combat Sport Athletes. Front Sports Act Living 2021; 3:725096. [PMID: 34917937 PMCID: PMC8669507 DOI: 10.3389/fspor.2021.725096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Investigate the feasibility of a non-invasive method to evaluate the physical and cognitive repercussions of long-lasting post-concussion effects in professional combat sports athletes. To help athletes return to professional combat, there is a need for unbiased objective tools and techniques used as a prognostic method of recovery after Sport Related Concussion (SRC). Methods: Six mild Traumatic Brain Injury (mTBI) athletes, age 20 ÷ 43 yr (1 female, 5 males) and 7 not concussed (NC) participants (amateur), age 24 ÷ 38 yr (3 females, 4 males), were tested Inspired/expired gas concentration, Cerebral changes in oxygenated hemoglobin (Δ[HbO2]) and deoxygenated hemoglobin (Δ[HHb]) were measured using near infrared spectroscopy (NIRS) with a 3-step protocol: rest before maximal oxygen uptake (VO2max) test, hypercapnia, and recovery after VO2max test. The brain oxygenation and respiratory parameters of both sample sets were calculated using a non-parametric test (Mann-Whitney U test). Aerobic fitness outcome was quantified through mean average using the Bruce test. Participants performed Fitt's test using a laptop and analysis of medio-lateral and anterior-posterior range of oscillation was carried out via a force platform Romberg test. Results: mTBI group showed statistically significant differences in saturated hemoglobin Δ[HbO2] (p < 0.001) during rest and recovery phase after maximal incremental exercise, in medio-lateral sway eyes open (p = 0.008, NC 25.35 ± 4.11 mm and mTBI 17.65 ± 4.79 mm). VO2max revealed no significant differences between the two groups: NC 47.47 ± 4.91 mTBI 49.58 ± 5.19 ml/kg/min-1. The 2 groups didn't differ for maximum power output (NC 220 ± 34, mTBI 255 ± 50 W). End-tidal fractional concentration of O2 (FetO2 NC15.20 ± 0.41, mTBI 16.09 ± 0.68) throughout hypercapnia, saturated blood hemoglobin (Δ[HbO2]) revealed significant differences with the mTBI group. No differences emerged from Fitt's test. Conclusions: It emerges that NIRS is able to reveal differences in long time outcomes of mTBI. The medio-lateral variations cannot be considered as a marker of long-term damage in athletes specifically trained for balance.
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Affiliation(s)
- Paolo Tiberini
- Department of Movement Sciences and Well-being, University of Naples Parthenope, Naples, Italy
| | - Giuseppe D'Antona
- Criams-Sport Medicine Centre Voghera, University of Pavia, Pavia, Italy
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Antonio Cicchella
- Department for Quality of Life Studies, University of Bologna, Bologna, Italy
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7
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Pezzetta R, Wokke ME, Aglioti SM, Ridderinkhof KR. Doing it Wrong: A Systematic Review on Electrocortical and Behavioral Correlates of Error Monitoring in Patients with Neurological Disorders. Neuroscience 2021; 486:103-125. [PMID: 33516775 DOI: 10.1016/j.neuroscience.2021.01.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 12/23/2022]
Abstract
Detecting errors in one's own and other's actions is a crucial ability for learning and adapting behavior to everchanging, highly volatile environments. Studies in healthy people demonstrate that monitoring errors in one's own and others' actions are underpinned by specific neural systems that are dysfunctional in a variety of neurological disorders. In this review, we first briefly discuss the main findings concerning error detection and error awareness in healthy subjects, the current theoretical models, and the tasks usually applied to investigate these processes. Then, we report a systematic search for evidence of dysfunctional error monitoring among neurological populations (basal ganglia, neurodegenerative, white-matter diseases and acquired brain injury). In particular, we examine electrophysiological and behavioral evidence for specific alterations of error processing in neurological disorders. Error-related negativity (ERN) amplitude were reduced in most (although not all) neurological patient groups, whereas Positivity Error (Pe) amplitude appeared not to be affected in most patient groups. Also theta activity was reduced in some neurological groups, but consistent evidence on the oscillatory activity has not been provided thus far. Behaviorally, we did not observe relevant patterns of pronounced dysfunctional (post-) error processing. Finally, we discuss limitations of the existing literature, conclusive points, open questions and new possible methodological approaches for clinical studies.
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Affiliation(s)
- R Pezzetta
- IRCCS San Camillo Hospital, Venice, Italy.
| | - M E Wokke
- Programs in Psychology and Biology, The Graduate Center of the City University of New York, New York, NY, USA; Department of Psychology, The University of Cambridge, Cambridge, UK
| | - S M Aglioti
- Sapienza University of Rome and CNLS@Sapienza at Istituto Italiano di Tecnologia, Via Regina Elena 295, 00161 Rome, Italy; Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - K R Ridderinkhof
- Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, 1018, WS, Amsterdam, The Netherlands; Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, The Netherlands
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Oeur RA, Margulies SS. Target detection in healthy 4-week old piglets from a passive two-tone auditory oddball paradigm. BMC Neurosci 2020; 21:52. [PMID: 33287727 PMCID: PMC7720395 DOI: 10.1186/s12868-020-00601-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/06/2020] [Accepted: 11/16/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Passive auditory oddball tests are effort independent assessments that evaluate auditory processing and are suitable for paediatric patient groups. Our goal was to develop a two-tone auditory oddball test protocol and use this clinical assessment in an immature large animal model. Event-related potentials captured middle latency P1, N1, and P2 responses in 4-week old (N = 16, female) piglets using a custom piglet 32- electrode array on 3 non-consecutive days. The effect of target tone frequency (250 Hz and 4000 Hz) on middle latency responses were tested in a subset of animals. RESULTS Results show that infrequent target tone pulses elicit greater N1 amplitudes than frequent standard tone pulses. There was no effect of day. Electrodes covering the front of the head tend to elicit greater waveform responses. P2 amplitudes increased for higher frequency target tones (4000 Hz) than the regular 1000 Hz target tones (p < 0.05). CONCLUSIONS Two-tone auditory oddball tests produced consistent responses day-to-day. This clinical assessment was successful in the immature large animal model.
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Affiliation(s)
- R Anna Oeur
- Wallace H. Coulter Department of Biomedical Engineering, Emory University, 615 Michael St. Suite 655, Atlanta, GA, USA
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Emory University, 615 Michael St. Suite 655, Atlanta, GA, USA.
- Emory University, Health Sciences Research Building 1760 Haygood Drive, Suite W242, 30322, Atlanta, Georgia.
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9
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Papesh MA, Stefl AA, Gallun FJ, Billings CJ. Effects of Signal Type and Noise Background on Auditory Evoked Potential N1, P2, and P3 Measurements in Blast-Exposed Veterans. Ear Hear 2020; 42:106-121. [PMID: 32520849 DOI: 10.1097/aud.0000000000000906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Veterans who have been exposed to high-intensity blast waves frequently report persistent auditory difficulties such as problems with speech-in-noise (SIN) understanding, even when hearing sensitivity remains normal. However, these subjective reports have proven challenging to corroborate objectively. Here, we sought to determine whether use of complex stimuli and challenging signal contrasts in auditory evoked potential (AEP) paradigms rather than traditional use of simple stimuli and easy signal contrasts improved the ability of these measures to (1) distinguish between blast-exposed Veterans with auditory complaints and neurologically normal control participants, and (2) predict behavioral measures of SIN perception. DESIGN A total of 33 adults (aged 19-56 years) took part in this study, including 17 Veterans exposed to high-intensity blast waves within the past 10 years and 16 neurologically normal control participants matched for age and hearing status with the Veteran participants. All participants completed the following test measures: (1) a questionnaire probing perceived hearing abilities; (2) behavioral measures of SIN understanding including the BKB-SIN, the AzBio presented in 0 and +5 dB signal to noise ratios (SNRs), and a word-level consonant-vowel-consonant test presented at +5 dB SNR; and (3) electrophysiological tasks involving oddball paradigms in response to simple tones (500 Hz standard, 1000 Hz deviant) and complex speech syllables (/ba/ standard, /da/ deviant) presented in quiet and in four-talker speech babble at a SNR of +5 dB. RESULTS Blast-exposed Veterans reported significantly greater auditory difficulties compared to control participants. Behavioral performance on tests of SIN perception was generally, but not significantly, poorer among the groups. Latencies of P3 responses to tone signals were significantly longer among blast-exposed participants compared to control participants regardless of background condition, though responses to speech signals were similar across groups. For cortical AEPs, no significant interactions were found between group membership and either stimulus type or background. P3 amplitudes measured in response to signals in background babble accounted for 30.9% of the variance in subjective auditory reports. Behavioral SIN performance was best predicted by a combination of N1 and P2 responses to signals in quiet which accounted for 69.6% and 57.4% of the variance on the AzBio at 0 dB SNR and the BKB-SIN, respectively. CONCLUSIONS Although blast-exposed participants reported far more auditory difficulties compared to controls, use of complex stimuli and challenging signal contrasts in cortical and cognitive AEP measures failed to reveal larger group differences than responses to simple stimuli and easy signal contrasts. Despite this, only P3 responses to signals presented in background babble were predictive of subjective auditory complaints. In contrast, cortical N1 and P2 responses were predictive of behavioral SIN performance but not subjective auditory complaints, and use of challenging background babble generally did not improve performance predictions. These results suggest that challenging stimulus protocols are more likely to tap into perceived auditory deficits, but may not be beneficial for predicting performance on clinical measures of SIN understanding. Finally, these results should be interpreted with caution since blast-exposed participants did not perform significantly poorer on tests of SIN perception.
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Affiliation(s)
- Melissa A Papesh
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon, USA.,Department of Otolaryngology Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Alyssa A Stefl
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon, USA
| | - Frederick J Gallun
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon, USA.,Department of Otolaryngology Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA.,Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Curtis J Billings
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon, USA.,Department of Otolaryngology Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
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Boshra R, Ruiter KI, Dhindsa K, Sonnadara R, Reilly JP, Connolly JF. On the time-course of functional connectivity: theory of a dynamic progression of concussion effects. Brain Commun 2020; 2:fcaa063. [PMID: 32954320 PMCID: PMC7491441 DOI: 10.1093/braincomms/fcaa063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/15/2020] [Accepted: 04/24/2020] [Indexed: 12/27/2022] Open
Abstract
The current literature presents a discordant view of mild traumatic brain injury and its effects on the human brain. This dissonance has often been attributed to heterogeneities in study populations, aetiology, acuteness, experimental paradigms and/or testing modalities. To investigate the progression of mild traumatic brain injury in the human brain, the present study employed data from 93 subjects (48 healthy controls) representing both acute and chronic stages of mild traumatic brain injury. The effects of concussion across different stages of injury were measured using two metrics of functional connectivity in segments of electroencephalography time-locked to an active oddball task. Coherence and weighted phase-lag index were calculated separately for individual frequency bands (delta, theta, alpha and beta) to measure the functional connectivity between six electrode clusters distributed from frontal to parietal regions across both hemispheres. Results show an increase in functional connectivity in the acute stage after mild traumatic brain injury, contrasted with significantly reduced functional connectivity in chronic stages of injury. This finding indicates a non-linear time-dependent effect of injury. To understand this pattern of changing functional connectivity in relation to prior evidence, we propose a new model of the time-course of the effects of mild traumatic brain injury on the brain that brings together research from multiple neuroimaging modalities and unifies the various lines of evidence that at first appear to be in conflict.
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Affiliation(s)
- Rober Boshra
- ARiEAL Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada.,School of Biomedical Engineering, McMaster University, Hamilton, ON L8S 4K1, Canada.,Vector Institute, Toronto, ON M5G 1M1, Canada
| | - Kyle I Ruiter
- ARiEAL Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada.,Linguistics and Languages, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Kiret Dhindsa
- ARiEAL Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada.,Vector Institute, Toronto, ON M5G 1M1, Canada.,Department of Surgery, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Ranil Sonnadara
- ARiEAL Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada.,Vector Institute, Toronto, ON M5G 1M1, Canada.,Department of Surgery, McMaster University, Hamilton, ON L8S 4K1, Canada.,Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - James P Reilly
- ARiEAL Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada.,School of Biomedical Engineering, McMaster University, Hamilton, ON L8S 4K1, Canada.,Vector Institute, Toronto, ON M5G 1M1, Canada.,Department of Electrical & Computer Engineering, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - John F Connolly
- ARiEAL Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada.,School of Biomedical Engineering, McMaster University, Hamilton, ON L8S 4K1, Canada.,Vector Institute, Toronto, ON M5G 1M1, Canada.,Linguistics and Languages, McMaster University, Hamilton, ON L8S 4K1, Canada.,Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4K1, Canada
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11
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Boshra R, Ruiter KI, DeMatteo C, Reilly JP, Connolly JF. Neurophysiological Correlates of Concussion: Deep Learning for Clinical Assessment. Sci Rep 2019; 9:17341. [PMID: 31758044 PMCID: PMC6874583 DOI: 10.1038/s41598-019-53751-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/04/2019] [Indexed: 01/16/2023] Open
Abstract
Concussion has been shown to leave the afflicted with significant cognitive and neurobehavioural deficits. The persistence of these deficits and their link to neurophysiological indices of cognition, as measured by event-related potentials (ERP) using electroencephalography (EEG), remains restricted to population level analyses that limit their utility in the clinical setting. In the present paper, a convolutional neural network is extended to capitalize on characteristics specific to EEG/ERP data in order to assess for post-concussive effects. An aggregated measure of single-trial performance was able to classify accurately (85%) between 26 acutely to post-acutely concussed participants and 28 healthy controls in a stratified 10-fold cross-validation design. Additionally, the model was evaluated in a longitudinal subsample of the concussed group to indicate a dissociation between the progression of EEG/ERP and that of self-reported inventories. Concordant with a number of previous studies, symptomatology was found to be uncorrelated to EEG/ERP results as assessed with the proposed models. Our results form a first-step towards the clinical integration of neurophysiological results in concussion management and motivate a multi-site validation study for a concussion assessment tool in acute and post-acute cases.
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Affiliation(s)
- Rober Boshra
- ARiEAL Research Centre, McMaster University, Hamilton, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, Canada.
- Vector Institute, MaRS Centre, Toronto, Canada.
| | - Kyle I Ruiter
- ARiEAL Research Centre, McMaster University, Hamilton, Canada
- Linguistics and Languages, McMaster University, Hamilton, Canada
| | - Carol DeMatteo
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - James P Reilly
- ARiEAL Research Centre, McMaster University, Hamilton, Canada
- School of Biomedical Engineering, McMaster University, Hamilton, Canada
- Vector Institute, MaRS Centre, Toronto, Canada
- Electrical and Computer Engineering, McMaster University, Hamilton, Canada
| | - John F Connolly
- ARiEAL Research Centre, McMaster University, Hamilton, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, Canada.
- Vector Institute, MaRS Centre, Toronto, Canada.
- Linguistics and Languages, McMaster University, Hamilton, Canada.
- Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Canada.
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12
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Hajiaghamemar M, Seidi M, Oeur RA, Margulies SS. Toward development of clinically translatable diagnostic and prognostic metrics of traumatic brain injury using animal models: A review and a look forward. Exp Neurol 2019; 318:101-123. [PMID: 31055005 PMCID: PMC6612432 DOI: 10.1016/j.expneurol.2019.04.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/11/2019] [Accepted: 04/30/2019] [Indexed: 12/11/2022]
Abstract
Traumatic brain injury is a leading cause of cognitive and behavioral deficits in children in the US each year. There is an increasing interest in both clinical and pre-clinical studies to discover biomarkers to accurately diagnose traumatic brain injury (TBI), predict its outcomes, and monitor its progression especially in the developing brain. In humans, the heterogeneity of TBI in terms of clinical presentation, injury causation, and mechanism has contributed to the many challenges associated with finding unifying diagnosis, treatment, and management practices. In addition, findings from adult human research may have little application to pediatric TBI, as age and maturation levels affect the injury biomechanics and neurophysiological consequences of injury. Animal models of TBI are vital to address the variability and heterogeneity of TBI seen in human by isolating the causation and mechanism of injury in reproducible manner. However, a gap between the pre-clinical findings and clinical applications remains in TBI research today. To take a step toward bridging this gap, we reviewed several potential TBI tools such as biofluid biomarkers, electroencephalography (EEG), actigraphy, eye responses, and balance that have been explored in both clinical and pre-clinical studies and have shown potential diagnostic, prognostic, or monitoring utility for TBI. Each of these tools measures specific deficits following TBI, is easily accessible, non/minimally invasive, and is potentially highly translatable between animals and human outcomes because they involve effort-independent and non-verbal tasks. Especially conspicuous is the fact that these biomarkers and techniques can be tailored for infants and toddlers. However, translation of preclinical outcomes to clinical applications of these tools necessitates addressing several challenges. Among the challenges are the heterogeneity of clinical TBI, age dependency of some of the biomarkers, different brain structure, life span, and possible variation between temporal profiles of biomarkers in human and animals. Conducting parallel clinical and pre-clinical research, in addition to the integration of findings across species from several pre-clinical models to generate a spectrum of TBI mechanisms and severities is a path toward overcoming some of these challenges. This effort is possible through large scale collaborative research and data sharing across multiple centers. In addition, TBI causes dynamic deficits in multiple domains, and thus, a panel of biomarkers combining these measures to consider different deficits is more promising than a single biomarker for TBI. In this review, each of these tools are presented along with the clinical and pre-clinical findings, advantages, challenges and prospects of translating the pre-clinical knowledge into the human clinical setting.
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Affiliation(s)
- Marzieh Hajiaghamemar
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
| | - Morteza Seidi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - R Anna Oeur
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Susan S Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
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13
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Rosburg T, Mager R. P300 amplitudes after concussions are usually decreased not increased. Brain 2019; 142:e32. [PMID: 31203370 DOI: 10.1093/brain/awz145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Timm Rosburg
- University Psychiatric Clinics Basel, Forensic Department, Basel, Switzerland
| | - Ralph Mager
- University Psychiatric Clinics Basel, Forensic Department, Basel, Switzerland
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14
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Fickling SD, Smith AM, Ghosh Hajra S, Liu CC, Song X, Stuart MJ, D'Arcy RCN. Reply: P300 amplitudes after concussions are usually decreased not increased. Brain 2019; 142:e33. [PMID: 31203375 DOI: 10.1093/brain/awz147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shaun D Fickling
- Faculty of Applied Sciences, Simon Fraser University, Metro Vancouver, BC, Canada
| | - Aynsley M Smith
- Department of Physical Medicine and Rehabilitation, Sports Medicine Center, Mayo Clinic, Rochester, MN, USA.,Department of Orthopedic Surgery, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
| | - Sujoy Ghosh Hajra
- Faculty of Applied Sciences, Simon Fraser University, Metro Vancouver, BC, Canada
| | - Careesa C Liu
- Faculty of Applied Sciences, Simon Fraser University, Metro Vancouver, BC, Canada
| | - Xiaowei Song
- Faculty of Applied Sciences, Simon Fraser University, Metro Vancouver, BC, Canada.,Health Sciences and Innovation, Surrey Memorial Hospital, Fraser Health, Metro Vancouver, BC, Canada
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
| | - Ryan C N D'Arcy
- Faculty of Applied Sciences, Simon Fraser University, Metro Vancouver, BC, Canada.,Health Sciences and Innovation, Surrey Memorial Hospital, Fraser Health, Metro Vancouver, BC, Canada.,HealthTech Connex Inc, Surrey, BC, Canada
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15
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Boshra R, Dhindsa K, Boursalie O, Ruiter KI, Sonnadara R, Samavi R, Doyle TE, Reilly JP, Connolly JF. From Group-Level Statistics to Single-Subject Prediction: Machine Learning Detection of Concussion in Retired Athletes. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1492-1501. [DOI: 10.1109/tnsre.2019.2922553] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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16
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Cavanagh JF, Wilson JK, Rieger RE, Gill D, Broadway JM, Story Remer JH, Fratzke V, Mayer AR, Quinn DK. ERPs predict symptomatic distress and recovery in sub-acute mild traumatic brain injury. Neuropsychologia 2019; 132:107125. [PMID: 31228481 DOI: 10.1016/j.neuropsychologia.2019.107125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/02/2019] [Accepted: 06/14/2019] [Indexed: 01/07/2023]
Abstract
Mild traumatic brain injury (mTBI) can affect high-level executive functioning long after somatic symptoms resolve. We tested if simple EEG responses within an oddball paradigm could capture variance relevant to this clinical problem. The P3a and P3b components reflect bottom-up and top-down processes driving engagement with exogenous stimuli. Since these features are related to primitive decision abilities, abnormal amplitudes following mTBI may account for problems in the ability to exert executive control. Sub-acute (<2 weeks) mTBI participants (N = 38) and healthy controls (N = 24) were assessed at an initial session as well as a two-month follow-up (sessions 1 and 2). We contrasted the initial assessment to a comparison group of participants with chronic symptomatology following brain injury (N = 23). There were no group differences in P3a or P3b amplitudes. Yet in the sub-acute mTBI group, higher symptomatology on the Frontal Systems Behavior scale (FrSBe), a questionnaire validated as measuring symptomatic distress related to frontal lobe injury, correlated with lower P3a in session 1. This relationship was replicated in session 2. These findings were distinct from chronic TBI participants, who instead expressed a relationship between increased FrSBe symptoms and a lower P3b component. In the sub-acute group, P3b amplitudes in the first session correlated with the degree of symptom change between sessions 1 and 2, above and beyond demographic predictors. Controls did not show any relationship between FrSBe symptoms and P3a or P3b. These findings identify symptom-specific alterations in neural systems that vary along the time course of post-concussive symptomatology.
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Affiliation(s)
- James F Cavanagh
- University of New Mexico, Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, MSC03 2220, Albuquerque NM, 87131, USA.
| | - J Kevin Wilson
- University of New Mexico, Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, MSC03 2220, Albuquerque NM, 87131, USA
| | - Rebecca E Rieger
- University of New Mexico, Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, MSC03 2220, Albuquerque NM, 87131, USA
| | - Darbi Gill
- University of New Mexico Health Sciences Center, Department of Neuroscience, 1101 Yale Blvd, University of New Mexico, MSC 084740, Albuquerque, NM, 87131 USA
| | - James M Broadway
- University of New Mexico Health Sciences Center, Department of Neuroscience, 1101 Yale Blvd, University of New Mexico, MSC 084740, Albuquerque, NM, 87131 USA
| | - Jacqueline Hope Story Remer
- University of New Mexico Health Sciences Center, Department of Neuroscience, 1101 Yale Blvd, University of New Mexico, MSC 084740, Albuquerque, NM, 87131 USA
| | - Violet Fratzke
- University of New Mexico Health Sciences Center, Department of Neuroscience, 1101 Yale Blvd, University of New Mexico, MSC 084740, Albuquerque, NM, 87131 USA
| | - Andrew R Mayer
- University of New Mexico, Department of Psychology, University of New Mexico, Logan Hall, 1 University of New Mexico, MSC03 2220, Albuquerque NM, 87131, USA; University of New Mexico Health Sciences Center, Department of Neuroscience, 1101 Yale Blvd, University of New Mexico, MSC 084740, Albuquerque, NM, 87131 USA; Mind Research Network, 1101 Yale Blvd NE, Albuquerque, NM, 87106, USA
| | - Davin K Quinn
- University of New Mexico Health Sciences Center, Department of Psychiatry and Behavioral Sciences, 2600 Marble Avenue NE, Albuquerque, NM, 87106, USA
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