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Sidhu A, Uiga L, Langley B, Masters RSW. Reduced influence of perceptual context in mild traumatic brain injury is not an illusion. Sci Rep 2024; 14:6434. [PMID: 38499578 PMCID: PMC10948892 DOI: 10.1038/s41598-024-56713-y] [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: 03/08/2023] [Accepted: 03/09/2024] [Indexed: 03/20/2024] Open
Abstract
Perceptual grouping is impaired following mild traumatic brain injury (mTBI). This may affect visual size perception, a process influenced by perceptual grouping abilities. We conducted two experiments to evaluate visual size perception in people with self-reported history of mTBI, using two different size-contrast illusions: the Ebbinghaus Illusion (Experiment 1) and the Müller-Lyer illusion (Experiment 2). In Experiment 1, individuals with mTBI and healthy controls were asked to compare the size of two target circles that were either the same size or different sizes. The target circles appeared by themselves (no-context condition), or were surrounded by smaller or larger circles (context condition). Similar levels of accuracy were evident between the groups in the no-context condition. However, size judgements by mTBI participants were more accurate in the context condition, suggesting that they processed the target circles separately from the surrounding circles. In Experiment 2, individuals with mTBI and healthy controls judged the length of parallel lines that appeared with arrowheads (context condition) or without arrowheads (no context condition). Consistent with Experiment 1, size judgements by mTBI participants were more accurate than size judgements by control participants in the context condition. These findings suggest that mTBI influences size perception by impairing perceptual grouping of visual stimuli in near proximity.
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Affiliation(s)
- A Sidhu
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, 3240, New Zealand.
| | - L Uiga
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - B Langley
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, 3240, New Zealand
| | - R S W Masters
- Te Huataki Waiora School of Health, University of Waikato, Hamilton, 3240, New Zealand
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Demetriades AK, Shah I, Marklund N, Clusmann H, Peul W. Sport-related concussion in soccer -a scoping review of available guidelines and a call for action to FIFA & soccer governing bodies. BRAIN & SPINE 2024; 4:102763. [PMID: 38510627 PMCID: PMC10951760 DOI: 10.1016/j.bas.2024.102763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 03/22/2024]
Abstract
Introduction Sport-related concussions (SRC) have been a concern in all sports, including soccer. The long-term effects of soccer-related head injuries are a public health concern. The Concussion in Sport Group (CISG) released a consensus statement in 2017 and several soccer governing associations have published their own SRC guidelines while referring to it but it is unclear whether this has been universally adopted. Research question We aimed to investigate whether guidelines published by soccer associations have any discrepancies; and the extent to which they follow the CISG recommendations. Materials and methods A scoping review of available soccer-specific SRC guidelines was performed via databases PubMed, Google Scholar, and official soccer association websites via web browser Google. The inclusion criteria were soccer-specific SRC guidelines. Comparisons between guidelines were made concerning the following index items: initial (on-site) assessment, removal from play, re-evaluation with neuroimaging, return-to-sport protocol, special populations, and education. Results Nine soccer associations with available guidelines were included in this review. Guidelines obtained were from official associations in the United Kingdom, United States of America, Canada, Australia, and New Zealand. When compared to each other and the CISG recommendations, discrepancies were found within guidelines regarding the index items. Additionally, major soccer associations in some countries famous for soccer were found to have not published any publicly available guidelines. Discussion and conclusion SRC guidelines from different soccer associations contain discrepancies which may be detrimental to athletes, both short and long-term. We recommend that all major soccer governing associations publish guidelines that are standardised and accessible to all athletes.
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Affiliation(s)
- Andreas K. Demetriades
- Leiden University Neurosurgical Center Holland, HMC-HAGA the Hague & LUMC Leiden, Netherlands
- Department of Neurosurgery, Royal Infirmary, Edinburgh, UK
| | - Imran Shah
- Department of Neurosurgery, Royal Infirmary, Edinburgh, UK
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Lund, Sweden
- Department of Neurosurgery, Skåne University Hospital, Lund, Sweden
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Wilco Peul
- Leiden University Neurosurgical Center Holland, HMC-HAGA the Hague & LUMC Leiden, Netherlands
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Weishaar MG, Stephens JA, Conner BT. Personality Predictors of Sports-Related Concussion Incidence: Analysis of Data From a Large, Heterogeneous Undergraduate Sample. Am J Phys Med Rehabil 2022; 101:738-745. [PMID: 34596098 PMCID: PMC8958175 DOI: 10.1097/phm.0000000000001901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Studies investigating the associations between personality and sports-related concussion are limited. The current study aimed to address this gap by examining whether specific personality dimensions predicted self-reported sports-related concussion outcomes. DESIGN This study included 1141 undergraduate students ( Mage = 19.47, SD = 2.14, female = 64.5%) who completed a battery of online personality measures and self-reported sports-related concussion items. The self-reported sports-related concussion outcomes included a single diagnosed sports-related concussion incident (i.e., "diagnosed sports-related concussion incidence") and incidents of multiple diagnosed sports-related concussions (i.e., "multiple diagnosed sports-related concussion incidents"). Analyses included splitting data randomly into training and validation data sets. Multivariate logistic regression models were then fit to each data set to determine predictors of sports-related concussion. RESULTS In both training and validation data sets, extraversion and experience seeking were found to be positively and most strongly associated with both sports-related concussion outcomes, whereas motor inhibition was found to be negatively associated with both outcomes. Additional personality dimensions showed differential relations with each sports-related concussion outcome. CONCLUSIONS The current study highlights the importance of considering personality dimensions in the context of self-reported sports-related concussion outcomes, as there are differential relations between personality dimensions and these outcomes. Thus, prevention efforts for sports-related concussion may benefit from evaluating additional athlete factors, like personality traits.
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Affiliation(s)
- Megan G Weishaar
- From the Department of Psychology-Counseling Psychology, Colorado State University, Fort Collins, Colorado (MGW, BTC); and Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado (JAS)
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Weishaar MG, Stephens JA, Conner BT. Personality Predictors of Time to Return to Play After Sports-Related Concussion: Analysis of Survey Data From an Undergraduate Sample. Am J Phys Med Rehabil 2022; 101:105-112. [PMID: 34310348 PMCID: PMC8758520 DOI: 10.1097/phm.0000000000001851] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to address a gap in concussion literature by investigating the relation between personality and return to play. It is important to know that earlier return to play places individuals at higher risk of sustaining a new concussion after an initial concussion. DESIGN Participants were undergraduate students recruited from psychology courses in 2019 who reported medically confirmed sports-related concussion and medically advised return to play (N = 202). Participants completed an online battery in a supervised laboratory setting that included self-report survey measures, concussion history items, and behavioral impulsivity tasks. Kaplan-Meier analysis and Cox proportional hazards models were used to analyze time to return to play after participants' first reported sports-related concussion. RESULTS Results showed that one subdimension of sensation seeking, experience seeking, and two subdimensions of self-reported impulsivity, attentional and motor impulsivity, were positively associated with earlier return to play after a sports-related concussion. In contrast, higher levels of conscientiousness were associated with later return to play. CONCLUSIONS Despite a heterogeneous sample, significant relations were found between timing of return to play and sensation seeking, impulsivity, and conscientiousness. Because earlier return to play can heighten the risk of sustaining a new concussion after an initial concussion, it is important to identify characteristics-such as personality traits-that influence individuals' return-to-play behaviors. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Distinguish between personality traits that resulted in earlier versus later return to play in this sample; (2) Describe why certain personality traits might be related to an earlier or later return-to-play timeline; and (3) List practical ways that these study results could be used to reduce adverse outcomes related to early return to play. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Megan G Weishaar
- From the Department of Psychology-Counseling Psychology, Colorado State University, Fort Collins, Colorado (MGW, BTC); and Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado (JAS)
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Annual Baseline King-Devick Oculomotor Function Testing Is Needed Due to Scores Varying by Age. Sports (Basel) 2021; 9:sports9120166. [PMID: 34941804 PMCID: PMC8707896 DOI: 10.3390/sports9120166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: To document baseline King-Devick (K-D) oculomotor function scores for male and female participants aged between 4 and 20 years old. Methods: Utilising a cross section of schools, rugby clubs and gymnastic clubs, 1936 participants (1300 male, 636 female) completed the spiral-bound K-D test for the identification of disturbed oculomotor function. Results: This study identified that overall, the baseline scores of the K-D test became faster by 1.4 (0.3 to 4.5) s per year, when compared with the previous age group in the same number of reading card groups. When comparing normative values of the original K-D validation study with the same age groups of the current cohort, participants aged 6 to 11 years recorded a faster baseline time (range 3.5 to 8.6 s), while those in the 12 to 14 years. age group recorded slower baseline times (range −3.9 to −7.9 s). Discussion: In general, there were age group differences, but not sex differences, for K-D test times in the current cohort. Analysis of single card times, across all age groups, showed changes likely due to improved reading time. Conclusion: The results support the need for individualised annual pre-injury baseline testing of the K-D test.
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Morriss NJ, Conley GM, Hodgson N, Boucher M, Ospina-Mora S, Fagiolini M, Puder M, Mejia L, Qiu J, Meehan W, Mannix R. Visual Dysfunction after Repetitive Mild Traumatic Brain Injury in a Mouse Model and Ramifications on Behavioral Metrics. J Neurotrauma 2021; 38:2881-2895. [PMID: 34375128 PMCID: PMC10495212 DOI: 10.1089/neu.2021.0165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mild traumatic brain injury (mTBI) is a major cause of morbidity and mortality with a poorly understood pathophysiology. Animal models have been increasingly utilized to better understand mTBI and recent research has identified visual deficits in these models that correspond to human literature. While visual impairment is being further characterized within TBI, the implications of impaired vision on behavioral tasks commonly utilized in animal models has not been well described thus far. Visual deficits may well confound behavioral tests that are believed to be isolated to cognitive functioning such as learning and memory. We utilized a mouse model of repetitive mTBI (rmTBI) to further characterize visual deficits using an optomotor task, electroretinogram, and visually evoked potential, and located likely areas of damage to the visual pathway. Mice were tested on multiple behavioral metrics, including a touchscreen conditional learning task to better identify the contribution of visual dysfunction to behavioral alterations. We found that rmTBI caused visual dysfunction resulting from damage distal to the retina that likely involves pathology within the optic nerve. Moreover, loss of vision led to poorer performance of rmTBI animals on classic behavioral tests such as the Morris water maze that would otherwise be attributed solely to learning and memory deficits. The touchscreen conditional learning task was able to differentiate rmTBI induced learning and memory dysfunction from visual impairment and is a valuable tool for elucidating subtle changes resulting from TBI.
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Affiliation(s)
- Nicholas J. Morriss
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Grace M. Conley
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Nathaniel Hodgson
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Masen Boucher
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sara Ospina-Mora
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michaela Fagiolini
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Mark Puder
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Leo Mejia
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jianhua Qiu
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - William Meehan
- Harvard Medical School, Boston, Massachusetts, USA
- The Micheli Center for Sports Injury Prevention, Boston, Massachusetts, USA
- Sports Concussion Clinic, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Kneavel M, Ernst W, Brandsma L. Collegiate athletes' perceptions of the culture of concussion reporting. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:435-443. [PMID: 31662115 DOI: 10.1080/07448481.2019.1679816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/13/2019] [Accepted: 10/06/2019] [Indexed: 06/10/2023]
Abstract
The current study was designed to understand the culture of concussion among college student-athletes. Participants: Eight men's lacrosse and seven women's soccer players. Methods: A focus group was conducted to understand thoughts, barriers, team culture, and what was needed to feel safe reporting symptoms. Thematic analysis was conducted to identify key themes. Results: Themes included concerns about being taken out, pushing through, wanting to play, severity influencing reporting, changes about concussion reporting, uncertainty about symptoms, concussion have changed the game, reporting a teammate, wanting someone else to make the call, desire to raise awareness, deception, wanting professors to have more understanding, circumstances influencing reporting, helmets specific for concussion, malingering, and the return to play protocol being too long. Conclusion: Factors ranging from intrinsic to more distal cultural and environmental factors appear to influence reporting concussions. Student-athletes identified factors unique to the college athlete environment.
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Affiliation(s)
- Meredith Kneavel
- Department of Psychology, Chestnut Hill College, Philadelphia, Pennsylvania, USA
| | - William Ernst
- Department of Professional Psychology, Chestnut Hill College, Philadelphia, Pennsylvania, USA
| | - Lynn Brandsma
- Department of Psychology, Chestnut Hill College, Philadelphia, Pennsylvania, USA
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8
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Papas EB. Contact lens technology to 2020 and beyond: a review of recent patent literature. Clin Exp Optom 2021; 100:529-536. [DOI: 10.1111/cxo.12596] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/16/2017] [Accepted: 07/05/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Eric B Papas
- School of Optometry and Vision Science,The University of New South Wales, Kensington, New South Wales, Australia,
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Ajayi PT, Garavito DM, Reyna VF. Socioeconomic status and concussion reporting: The distinct and mediating roles of gist processing, knowledge, and attitudes. JOURNAL OF BEHAVIORAL DECISION MAKING 2021. [DOI: 10.1002/bdm.2235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Peter T. Ajayi
- Department of Human Development, Human Neuroscience Institute Cornell University Ithaca New York USA
| | - David M.N. Garavito
- Department of Human Development, Human Neuroscience Institute Cornell University Ithaca New York USA
| | - Valerie F. Reyna
- Department of Human Development, Human Neuroscience Institute Cornell University Ithaca New York USA
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Khurana VG, Jithoo R, Barnett M. Aerospace Implications of Key Neurological Conditions. Aerosp Med Hum Perform 2021; 92:113-119. [PMID: 33468292 DOI: 10.3357/amhp.5744.2021] [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: 11/24/2022]
Abstract
INTRODUCTION: The neurological impact (or lack thereof) of certain medical histories and imaging findings is important to understand in the context of air and spaceflight. There are a number of neurological conditions that, if present in pilots and astronauts, carry variable (and sometimes adverse) functional implications for safety and overall mission success. In this systematic overview, the authors will refer to the relevant clinical and radiological features of brain tumors and vascular anomalies, cerebral edema and intracranial hypertension, concussion and the traumatic brain injury (TBI) spectrum, hematomas, cerebrospinal fluid circulation anomalies including hydrocephalus and sequestrations, spinal degenerative changes, and cerebral ischemia and demyelination. It is notable that these last two conditions have recently been reported to be a complication in some people with coronavirus disease 2019 (COVID-19). A paradigm for practical neurological workup of symptomatic pilots and astronauts will be discussed, as will the controversial notion of pre-emptive radiological screening (vs. not screening) in asymptomatic or clinically occult situations. The concepts of medical surveillance in the setting of known or diagnosed pathologies, and expert panel review and simulator and flight checks in complex neurological cases, are also elaborated on in this paper. We believe this overview will contribute toward the enhancement of a broad understanding of neurological conditions, their clinical workup, and their precautionary management in the setting of aviation and aerospace.Khurana VG, Jithoo R, Barnett M. Aerospace implications of key neurological conditions. Aerosp Med Hum Perform. 2021; 92(2):113119.
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Concussion in Motorsport? Experience, Knowledge, Attitudes, and Priorities of Medical Personnel and Drivers. Clin J Sport Med 2020; 30:568-577. [PMID: 30113965 DOI: 10.1097/jsm.0000000000000647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess concussion experiences, knowledge, and attitudes of motorsport medical personnel and drivers and to determine priority areas regarding concussion within the sport. DESIGN Sequential mixed-method design. Part 1: stakeholder interviews; part 2: cross-sectional online survey. SETTING United Kingdom. PARTICIPANTS Part 1: key motorsport stakeholders (N = 8); part 2: motorsport medical personnel and drivers (N = 209) representing amateur and/or professional 4-wheeled motorsport. MAIN OUTCOME MEASURES Concussion experience, knowledge, attitudes, and perceived priority areas. RESULTS Thirty-one percent of surveyed drivers (age = 37.91 ± 13.49 years: 89% male) reported suffering from concussion in motorsport. Eighty-seven percent of surveyed medical personnel (age = 48.60 ± 10.68 years: 74% male) reported experience with concussed drivers, and 34% reported feeling pressured to clear a driver with concussion. Gaps in knowledge and misperceptions about concussion were reported in both groups, and disparity between concussion attitudes emerged between drivers and medical personnel. Application of assessment and management procedures varied between medical personnel and there was evidence motorsport policy and concussion guidelines may not be directly followed. According to both medical personnel (77%) and drivers (85%), "education and training" is the top priority area for the sport. CONCLUSIONS There is clear evidence of concussions in motorsport, but accurate knowledge about this injury is missing. Concussion education and training for all drivers and medical personnel is required. Additional investigations into concussion attitudes are advised to complement and advance simple educational initiatives. Further investigation is also required to determine how to best support motorsport medical personnel, and general practitioners, who hold significant responsibility in guiding drivers from diagnosis to return to racing, and to support the effective implementation of policy.
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Garavito DMN, Reyna VF, DeTello JE, Landow BR, Tarpinian LM. Intentions to report concussion symptoms in nonprofessional athletes: A fuzzy‐trace theory approach. APPLIED COGNITIVE PSYCHOLOGY 2020. [DOI: 10.1002/acp.3734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
| | - Valerie F. Reyna
- Department of Human Development Cornell University Ithaca New York USA
| | - Joseph E. DeTello
- Department of Human Development Cornell University Ithaca New York USA
| | - Bailey R. Landow
- Department of Human Development Cornell University Ithaca New York USA
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Horan B, Heckenberg R, Maruff P, Wright B. Development of a new virtual reality test of cognition: assessing the test-retest reliability, convergent and ecological validity of CONVIRT. BMC Psychol 2020; 8:61. [PMID: 32532362 PMCID: PMC7291630 DOI: 10.1186/s40359-020-00429-x] [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: 02/26/2020] [Accepted: 06/05/2020] [Indexed: 01/26/2023] Open
Abstract
Background Technological advances provide an opportunity to refine tools that assess central nervous system performance. This study aimed to assess the test-retest reliability and convergent and ecological validity of a newly developed, virtual-reality, concussion assessment tool, ‘CONVIRT’, which uses eye-tracking technology to assess visual processing speed, and manual reaction time (pushing a button on a riding crop) to assess attention and decision-making. CONVIRT was developed for horse jockeys, as of all sportspersons, they are most at risk of concussion. Methods Participants (N = 165), were assessed with CONVIRT, which uses virtual reality to give the user the experience of riding a horse during a horserace. Participants were also assessed with standard Cogstate computer-based concussion measures in-between two completions of the CONVIRT battery. The physiological arousal induced by the test batteries were assessed via measures of heart rate and heart rate variability (LF/HF ratio). Results Satisfactory test-retest reliability and convergent validity with Cogstate attention and decision-making subtests and divergent validity in visual processing speed measures were observed. CONVIRT also increased heart rate and LF/HF ratio, which may better approximate participant arousal levels in their workplace. Conclusions CONVIRT may be a reliable and valid tool to assess elements of cognition and CNS disruption. The increased ecological validity may also mean better informed ‘return-to-play’ decisions and stronger industry acceptance due to the real-world meaningfulness of the assessment. However, before this can be achieved, the sensitivity of the CONVIRT battery needs to be demonstrated.
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Affiliation(s)
- Ben Horan
- School of Engineering, Deakin University, Geelong, VIC, 3216, Australia
| | - Rachael Heckenberg
- School of Psychology and Public Health, La Trobe University, Wodonga, Victoria, 3690, Australia
| | - Paul Maruff
- The Florey Institute, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Bradley Wright
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, 3086, Australia.
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Kneavel ME, Ernst W, McCarthy KS. Randomized Controlled Trial of a Novel Peer Concussion-Education Program for Collegiate Athletes. J Athl Train 2020; 55:456-468. [PMID: 32298143 DOI: 10.4085/1062-6050-0182.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The National Collegiate Athletic Association and US Department of Defense have called for educational programs to change the culture of concussion reporting, increase reporting behavior, and enhance the safety of players and service members. OBJECTIVE To evaluate the effects of a novel peer concussion-education program (PCEP) in changing knowledge, attitudes, and norms about concussion reporting among collegiate student-athletes and assess program implementation. DESIGN Randomized controlled trial and qualitative analysis of interviews. SETTING National Collegiate Athletic Association athletic teams from randomly selected colleges or universities. PATIENTS OR OTHER PARTICIPANTS A total of 1614 male and female student-athletes from 60 teams at 10 colleges and universities and 8 athletic trainers. INTERVENTION(S) The PCEP intervention trains 2 peer concussion educators to provide 2 education modules to their teammates. Knowledge, attitudes (oneself and teammates), and concussion occurrence or reporting were assessed at baseline, postintervention, and 1 month later. Eight athletic trainers were interviewed about program implementation. RESULTS Compared with the control group, the intervention group showed greater increases occurred postintervention and at 1 month in concussion knowledge (F1,2648 = 51.3, P < .0001), intention to report (oneself, F2,2633 = 82.3, P < .0001; teammates, F2,2624 = 53.9, P < .0001), return-to-play protocol knowledge, (F2,2632 = 28.4, P < .0001), direct subjective norms (oneself, F2,2625 = 51.7, P < .0001; teammates, F2,2644 = 40.6, P < .0001), direct perceived behavioral control (oneself, F2,2628 = 53.7, P < .0001; teammates, F2,2615 = 68.2, P < .0001), and indirect attitudes (oneself, F2,2626 = 47.1, P < .001; teammates, F2,2623 = 40.9, P < .0001). Peer concussion-education program participants discussed concussion more often with a teammate (F1,1396 = 13.96, P < .0001) or athletic staff (F1,1396 = 6.62, P < .001). Qualitative program analysis revealed both positive aspects of the PCEP and areas for improvement. CONCLUSIONS The PCEP showed promise in increasing concussion knowledge, intention to report concussion, reporting a teammate's concussion, and facilitating attitudinal changes that support reporting among student-athletes.
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Affiliation(s)
- Meredith E Kneavel
- School of Nursing and Health Sciences, La Salle University, Philadelphia, PA.,Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA
| | - William Ernst
- Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA.,Department of Professional Psychology, Chestnut Hill College, Philadelphia, PA
| | - Kevin S McCarthy
- Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA
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Salmon DM, Mcgowan J, Sullivan SJ, Murphy I, Walters S, Whatman C, Keung S, Clacy A, Romanchuk J. What they know and who they are telling: Concussion knowledge and disclosure behaviour in New Zealand adolescent rugby union players. J Sports Sci 2020; 38:1585-1594. [PMID: 32264762 DOI: 10.1080/02640414.2020.1749409] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to survey high school rugby players from a range of ethnic, geographic and socioeconomic backgrounds in New Zealand (NZ) to gain an understanding of concussion knowledge, awareness of NZ Rugby's (NZR) guidelines and attitudes towards reporting behaviours. Male and female high school rugby players (n= 416) from across NZ were surveyed. The findings indicated that 69% of players had sustained a suspected concussion, and 31% had received a medical diagnosis of concussion. 63% of players indicated they were aware of NZR's guidelines. Māori and Pasifika players were less likely to be aware of the guidelines compared to NZ European, Adjusted OR 0.5, p = 0.03. Guideline awareness was significantly higher for those from high decile schools when compared to low (Unadjusted OR 1.63, p = 0.04); however, when ethnicity and school locations were controlled for this became non-significant (Adjusted OR= 1.3, p=0.37). The coach was the key individual for the provision of concussion information and disclosure of symptoms for players. The findings of this study will inform the development and delivery of NZR's community concussion initiative and how these examined factors influence a high school player's concussion knowledge and reporting behaviour.
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Affiliation(s)
- Danielle M Salmon
- Health Safety and Welfare, New Zealand Rugby , Wellington, New Zealand
| | - Jody Mcgowan
- Health Safety and Welfare, New Zealand Rugby , Wellington, New Zealand
| | - S John Sullivan
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago , Dunedin, New Zealand
| | - Ian Murphy
- Health Safety and Welfare, New Zealand Rugby , Wellington, New Zealand
| | - Simon Walters
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology , Auckland, New Zealand
| | - Chris Whatman
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology , Auckland, New Zealand
| | - Sierra Keung
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology , Auckland, New Zealand
| | - Amanda Clacy
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast , Birtinya, Australia
| | - Janelle Romanchuk
- Health Safety and Welfare, New Zealand Rugby , Wellington, New Zealand
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16
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Beaudouin F, Aus der Fünten K, Tröß T, Reinsberger C, Meyer T. Match Situations Leading to Head Injuries in Professional Male Football (Soccer)-A Video-Based Analysis Over 12 Years. Clin J Sport Med 2020; 30 Suppl 1:S47-S52. [PMID: 32132477 DOI: 10.1097/jsm.0000000000000572] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify risk situations promoting head injuries in professional male football (soccer) and to investigate the impact of a rule change in 2006 punishing elbow-head contacts. DESIGN Analysis of video sequences of head events leading to head injury. PARTICIPANTS Professional football players of the first male German Bundesliga. MAIN OUTCOME MEASURES Observational criteria of head impacts on video recordings (players' actions preceding head injuries, foul play-referee's decision and assessment of rater, ball possession, on-pitch medical treatment, and consequences of head impact). RESULTS Three hundred thirty-four head injuries were reported in kicker Sportmagazin corresponding to an incidence rate of 2.25 (95% confidence interval 2.01-2.51) per 1000 player match hours. The injured player predominantly jumped (60%), headed the ball (36%), or ran forwards (20%); the noninjured players mainly jumped (64%), headed the ball (27%), or raised the elbow to the head (23%). Free ball situations (2 players challenge for the ball) caused most of the head injuries (81%). The players' action "raising the elbow" during a head injury seemed to be lower after the rule change. CONCLUSIONS Jumping for the ball with the intention of heading is the predominant action associated with head injury risk. Head injuries occur most often when players challenge for the ball in a header duel. As head injuries bear the potential risk of long-term health sequelae, the identification of situational circumstances is essential to develop preventative means in the future.
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Affiliation(s)
- Florian Beaudouin
- Institute of Sports and Preventive Medicine, Saarland University, FIFA-Medical Centre of Excellence, Saarbrücken, Germany; and
| | - Karen Aus der Fünten
- Institute of Sports and Preventive Medicine, Saarland University, FIFA-Medical Centre of Excellence, Saarbrücken, Germany; and
| | - Tobias Tröß
- Institute of Sports and Preventive Medicine, Saarland University, FIFA-Medical Centre of Excellence, Saarbrücken, Germany; and
| | - Claus Reinsberger
- Institute of Sports Medicine, University of Paderborn, Paderborn, Germany
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, FIFA-Medical Centre of Excellence, Saarbrücken, Germany; and
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17
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Garavito DM, Reyna VF, DeTello JE. A concussion by any other name: Differences in willingness to risk brain injury by label and level of participation in high-school and college sports. APPLIED COGNITIVE PSYCHOLOGY 2018. [DOI: 10.1002/acp.3481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Valerie F. Reyna
- Department of Human Development; Cornell University; Ithaca New York USA
| | - Joseph E. DeTello
- Department of Human Development; Cornell University; Ithaca New York USA
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18
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Vriend I, Gouttebarge V, Finch CF, van Mechelen W, Verhagen EALM. Intervention Strategies Used in Sport Injury Prevention Studies: A Systematic Review Identifying Studies Applying the Haddon Matrix. Sports Med 2018; 47:2027-2043. [PMID: 28303544 PMCID: PMC5603636 DOI: 10.1007/s40279-017-0718-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Prevention of sport injuries is crucial to maximise the health and societal benefits of a physically active lifestyle. To strengthen the translation and implementation of the available evidence base on effective preventive measures, a range of potentially relevant strategies should be considered. OBJECTIVE Our aim was to identify and categorise intervention strategies for the prevention of acute sport injuries evaluated in the scientific literature, applying the Haddon matrix, and identify potential knowledge gaps. METHODS Five electronic databases were searched (PubMed, EMBASE, SPORTDiscus, CINAHL, Cochrane) for studies that evaluated the effect of interventions on the occurrence of acute sport injuries. Studies were required to include a control group/condition, prospective data collection, and a quantitative injury outcome measure. RESULTS A total of 155 studies were included, mostly randomised controlled trials (43%). The majority of studies (55%) focussed on strategies requiring a behavioural change on the part of athletes. Studies predominantly evaluated the preventive effect of various training programmes targeted at the 'pre-event' phase (n = 73) and the use of equipment to avoid injury in the 'event phase' (n = 29). A limited number of studies evaluated the preventive effect of strategies geared at rules and regulations (n = 14), and contextual modifications (n = 18). Studies specifically aimed at preventing re-injuries were a minority (n = 8), and were mostly related to ankle sprains (n = 5). CONCLUSIONS Valuable insight into the extent of the evidence base of sport injury prevention studies was obtained for 20 potential intervention strategies. This approach can be used to monitor potential gaps in the knowledge base on sport injury prevention.
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Affiliation(s)
- Ingrid Vriend
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands.,Consumer Safety Institute VeiligheidNL, Amsterdam, The Netherlands
| | - Vincent Gouttebarge
- Amsterdam Collaboration on Health and Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands.,Consumer Safety Institute VeiligheidNL, Amsterdam, The Netherlands.,Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Caroline F Finch
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Australia
| | - Willem van Mechelen
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands.,School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia.,Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Evert A L M Verhagen
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Amsterdam Collaboration on Health and Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands. .,Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. .,Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Australia.
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19
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Brokaw EB, Fine MS, Kindschi KE, Santago Ii AC, Lum PS, Higgins M. Cross-sectional evaluation of visuomotor tracking performance following subconcussive head impacts. Technol Health Care 2018; 26:109-118. [PMID: 29125529 DOI: 10.3233/thc-171079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Repeated mild traumatic brain injury (mTBI) has been associated with increased risk of degenerative neurological disorders. While the effects of mTBI and repeated injury are known, studies have only recently started examining repeated subconcussive impacts, impacts that do not result in a clinically diagnosed mTBI. In these studies, repeated subconcussive impacts have been connected to cognitive performance and brain imaging changes. OBJECTIVE Recent research suggests that performance on a visuomotor tracking (VMT) task may help improve the identification of mTBI. The goal of this study was to investigate if VMT performance is sensitive to the cumulative effect of repeated subconcussive head impacts in collegiate men's lacrosse players. METHODS A cross-sectional, prospective study was completed with eleven collegiate men's lacrosse players. Participants wore helmet-mounted sensors and completed VMT and reaction time assessments. The relationship between cumulative impact metrics and VMT metrics were investigated. RESULTS In this study, VMT performance correlated with repeated subconcussive head impacts; individuals approached clinically diagnosed mTBI-like performance as the cumulative rotational velocity they experienced increased. CONCLUSION This suggests that repeated subconcussive impacts can result in measurable impairments and indicates that visuomotor tracking performance may be a useful tool for monitoring the effects of repeated subconcussive impacts.
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Affiliation(s)
- E B Brokaw
- Emerging Technologies Department, The MITRE Corporation, McLean, VA, USA
| | - M S Fine
- Emerging Technologies Department, The MITRE Corporation, McLean, VA, USA
| | - K E Kindschi
- Department of Sports Medicine, The MedStar Health Union Memorial Hospital, Baltimore, MD, USA
| | - A C Santago Ii
- Emerging Technologies Department, The MITRE Corporation, McLean, VA, USA
| | - P S Lum
- Center for Applied Biomechanics and Rehabilitation Research, The MedStar Health National Rehabilitation Hospital, Washington, DC, USA.,Department of Biomedical Engineering, The Catholic University of America, Washington, DC, USA
| | - M Higgins
- Kinesiology Department, Towson University, Towson, MD, USA
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20
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Costello DM, Ernest J, Kaye AH, O'Brien TJ, Shultz SR. Concussion incidence in amateur Australian Rules Footballers. J Clin Neurosci 2018; 56:88-89. [PMID: 30115504 DOI: 10.1016/j.jocn.2018.07.003] [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] [Received: 04/29/2018] [Accepted: 07/08/2018] [Indexed: 10/28/2022]
Abstract
Australian Rules Football is a collision sport that is associated with increased sport-related concussion risk. Sport-related concussion is a common form of mild traumatic brain injury that is now recognised as a serious health issue. This study measured the concussion incidence rate for amateur Australian Rules players over 3 seasons (2015-2017) by athlete exposures-a metric used widely in the literature. This study also reported concussion incidence based on player match hours, a less common yet more accurate method of reporting concussion incidence which takes match duration into account. Accurate concussion incidence reporting in amateur Australian Rules Football quantifies the problem of concussion in this sport. This may be necessary to inform players of their concussion injury risk and to help guide rule changes to protect players from this injury.
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Affiliation(s)
- Daniel M Costello
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC 3010, Australia.
| | - Joel Ernest
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC 3010, Australia
| | - Andrew H Kaye
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, VIC 3010, Australia
| | - Terence J O'Brien
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC 3010, Australia; Departments of Neuroscience and Medicine, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, VIC 3004, Australia
| | - Sandy R Shultz
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, VIC 3010, Australia; Departments of Neuroscience and Medicine, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, VIC 3004, Australia
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21
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Coffey N, Lawless M, Kelly S, Buggy C. Frequency of Self-Reported Concussion Amongst Professional and Semi-Professional Footballers in Ireland During the 2014 Season: a Cross-Sectional Study. SPORTS MEDICINE - OPEN 2018; 4:4. [PMID: 29313156 PMCID: PMC5758485 DOI: 10.1186/s40798-017-0118-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 12/20/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND This paper examines the occupational risk of concussion amongst professional and semi-professional footballers in Ireland during the 2014 League of Ireland season. As part of a broader nationally representative study examining occupational safety and health (OSH) awareness amongst professional footballers, this empirical quantitative study, utilising a convenience sample is the first and largest investigation of the frequency of, and attitudes towards, concussion and concussion reporting amongst Irish senior professional and semi-professional footballers. METHODS A census survey using an anonymous questionnaire was provided to available League of Ireland clubs between March and May 2015. Permission to access players was provided by the Professional Footballers Association of Ireland. This convenience sample was determined by club availability in relation to match fixtures. Participation by the footballers was voluntary. At the time, there were 250 professional and semi-professional players within the League available to participate. RESULTS A total of 149 footballers participated in the study. Sixty percent of the participants were employed on a semi-professional basis and the majority of all participants were aged between 18 and 30. 15.7% of the participants reported having received a concussion in the 2014 season with semi-professional players having a noticeably higher (though not significant) reporting rate. Analysis indicated that there was a significant association between playing position and concussion reporting with defenders having the greater odds of reporting a concussion than other playing positions. Professional and semi-professional footballers have a relatively equal risk of receiving a concussion. CONCLUSION This research is the first major investigation of the self-reported frequency of, and attitudes towards, concussion amongst Irish senior professional and semi-professional footballers. The results have important implications for coaches, clinicians, parents, players and national governing bodies. Further research is needed to ascertain whether professional footballers perceive concussion as an occupational risk, and whether they appreciate that accepting such risks can have long-term implications for health.
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Affiliation(s)
- Nicola Coffey
- UCD Centre for Safety and Health at Work, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Martin Lawless
- UCD Centre for Safety and Health at Work, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Seamus Kelly
- UCD Centre for Sports Studies, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Conor Buggy
- UCD Centre for Safety and Health at Work, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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22
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Abstract
OBJECTIVES We quantified the length of recovery time by week in a cohort of pediatric sports-related concussion patients treated at concussion clinics, and examined patient and injury characteristics associated with prolonged recovery. DESIGN A retrospective, cohort design. SETTING Seven concussion clinics at a Midwest children's hospital. PATIENTS Patients aged 10 to 17 years with a diagnosed sports-related concussion presenting to the clinic within 30 days of injury. MAIN OUTCOME MEASURES Length of recovery by week. METHODS Unadjusted and adjusted multinomial logistic regression analyses were used to model the effect of patient and injury characteristics on length of recovery by week. RESULTS Median length of recovery was 17 days. Only 16.3% (299/1840) of patients recovered within one week, whereas 26.4% took longer than four weeks to recover. By 2 months postinjury, 6.7% of patients were still experiencing symptoms. Higher symptom scores at injury and initial visit were significantly associated with prolonged symptoms by week. Patients who presented to the clinic more than 2 weeks postinjury or who had 2 or more previous concussions showed increased risk for prolonged recovery. Females were at greater risk for prolonged recovery than males (odds ratio = 2.08, 95% confidence interval = 1.49-2.89). Age was not significantly associated with recovery length. CONCLUSIONS High symptom scores at injury and initial visit, time to initial clinical presentation, presence of 2 or more previous concussions, and female sex are associated with prolonged concussion recovery. Further research should aim to establish objective measures of recovery, accounting for treatment received during the recovery. CLINICAL RELEVANCE The median length of recovery is 17 days among pediatric sports-related concussion patients treated at concussion clinics. Only 16.3% of patients recovered within one week, whereas 26.4% took longer than 4 weeks to recover.
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23
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Fischer JD, Smith GH, Rodrigues RS, Afzal MR, van den Heever DJ, Viviers PL, Viljoen JT. Concussion management application for amateur sports. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:2594-2597. [PMID: 29060430 DOI: 10.1109/embc.2017.8037388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Concussion management has become one of the most popular topics in sports medicine. Significant resources are being invested in developing protocols for professional sport associations such as the NFL and FIFA. These protocols are often expensive and require substantial resources to implement. The problem, however, runs much deeper than just professional sports. Currently there exists little infrastructure to effectively manage concussion in amateur settings such as high school, club and university sport. A more holistic approach is required to ensure that the same standard of concussion management is being implemented across the board, regardless of the available medical and financial resources. An application was developed that will allow for easily accessible baseline testing and access to a player's concussion history from anywhere in the world. The application will be used to monitor players from the day they start playing sport until they potentially become professional sport players.
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24
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Affiliation(s)
- Alexander A. Tarnutzer
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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25
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McAteer KM, Turner RJ, Corrigan F. Animal models of chronic traumatic encephalopathy. Concussion 2017; 2:CNC32. [PMID: 30202573 PMCID: PMC6093772 DOI: 10.2217/cnc-2016-0031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/25/2017] [Indexed: 12/14/2022] Open
Abstract
Repeated head impacts have been suggested to be associated with the development of the neurodegenerative disorder, chronic traumatic encephalopathy (CTE). CTE is characterized by the accumulation of hyperphosphorylated tau within the brain, with accompanying cognitive and behavioral deficits. How a history of repeated head impacts can lead to the later development of CTE is not yet known, and as such appropriate animal models are required. Over the last decade a number of rodent models of repeated mild traumatic brain injury have been developed that are broadly based on traditional traumatic brain injury models, in controlled cortical impact, fluid percussion and weight drop models, with adaptations to allow for better modeling of the mechanical forces associated with concussion.
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Affiliation(s)
- Kelly M McAteer
- Discipline of Anatomy & Pathology, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Renee J Turner
- Discipline of Anatomy & Pathology, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Frances Corrigan
- Discipline of Anatomy & Pathology, Adelaide Medical School, University of Adelaide, Adelaide, Australia
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26
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Abstract
For several years both cognitive and physical rest remained at the forefront in pediatric postconcussion management. However, the concept of "rest" has not been well defined and there remains significant variability both in terms of rest recommendations provided as well as adherence to such recommendations. More recently, there has been growing evidence to suggest that an earlier return to light or moderate activity is not detrimental and may, in fact, facilitate symptomatic improvement, thereby highlighting a new role for active rehabilitation in recovery from concussion. In this article, we compare historic recommendations for rest with emerging strategies focused on active rehabilitation. [Pediatr Ann. 2017;46(4):e139-e144.].
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27
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Oberlander TJ, Olson BL, Weidauer L. Test-Retest Reliability of the King-Devick Test in an Adolescent Population. J Athl Train 2017; 52:439-445. [PMID: 28362161 DOI: 10.4085/1062-6050-52.2.12] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The King-Devick (KD) test is a screening tool designed to assess cognitive visual impairments, namely saccadic rhythm, postconcussion. Test-retest reliability of the KD in a healthy adolescent population has not yet been established. OBJECTIVE To investigate the overall test-retest reliability of the KD among a sample of healthy adolescents. Additionally, we sought to determine if sex and age influenced reliability. DESIGN Cross-sectional study. SETTING Secondary school. PATIENTS OR OTHER PARTICIPANTS Sixty-eight healthy adolescents, 41 boys (age = 15.4 ± 1.9 years) and 27 girls (age = 15.4 ± 1.9 years). MAIN OUTCOME MEASURE(S) Participants completed the KD (version 1) at 3 testing sessions (days 1, 30, and 45) following standard instructions. We recorded total time to complete the reading of 3 cards for each participant during each testing session. Two-way random-effects intraclass correlation coefficients (ICCs) using single measurements repeated over time and repeatability coefficients were calculated. Linear mixed models were used to determine whether differences existed at each testing time and to examine whether changes that took place among visits were different by sex or age. RESULTS Adolescents who completed the KD demonstrated acceptable reliability (ICC = 0.81; 95% confidence interval = 0.73, 0.87); however, the repeatability coefficient was large (±8.76 seconds). The sample demonstrated improvements between visits 1 and 2 (mean ± standard error = 4.3 ± 0.5 seconds, P < .001) and between visits 2 and 3 (2.4 ± 0.5 seconds, P < .001) for a total improvement of 6.9 seconds over 3 tests. No significant visit-by-sex or visit-by-age interactions were observed. CONCLUSIONS Despite the ICC being clinically acceptable, providers using the KD test for serial assessment of concussion in adolescents should be cautious in interpreting the results due to a large learning effect. Incorporating multiple measures can ensure accurate detection of sport concussion.
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Affiliation(s)
| | - Bernadette L Olson
- Health and Nutritional Sciences, South Dakota State University, Brookings
| | - Lee Weidauer
- Health and Nutritional Sciences, South Dakota State University, Brookings
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28
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Ainsley Dean PJ, Arikan G, Opitz B, Sterr A. Potential for use of creatine supplementation following mild traumatic brain injury. ACTA ACUST UNITED AC 2017; 2:CNC34. [PMID: 30202575 PMCID: PMC6094347 DOI: 10.2217/cnc-2016-0016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 02/07/2017] [Indexed: 01/27/2023]
Abstract
There is significant overlap between the neuropathology of mild traumatic brain injury (mTBI) and the cellular role of creatine, as well as evidence of neural creatine alterations after mTBI. Creatine supplementation has not been researched in mTBI, but shows some potential as a neuroprotective when administered prior to or after TBI. Consistent with creatine’s cellular role, supplementation reduced neuronal damage, protected against the effects of cellular energy crisis and improved cognitive and somatic symptoms. A variety of factors influencing the efficacy of creatine supplementation are highlighted, as well as avenues for future research into the potential of supplementation as an intervention for mTBI. In particular, the slow neural uptake of creatine may mean that greater effects are achieved by pre-emptive supplementation in at-risk groups.
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Affiliation(s)
- Philip John Ainsley Dean
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Gozdem Arikan
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Bertram Opitz
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Annette Sterr
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
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29
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Stovitz SD, Weseman JD, Hooks MC, Schmidt RJ, Koffel JB, Patricios JS. What Definition Is Used to Describe Second Impact Syndrome in Sports? A Systematic and Critical Review. Curr Sports Med Rep 2017; 16:50-55. [PMID: 28067742 DOI: 10.1249/jsr.0000000000000326] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Concern about what has been termed, "second impact syndrome" (SIS) is a major factor determining return-to-play decisions after concussion. However, definitions of SIS vary. We used Scopus to conduct a systematic review and categorize the definitions used to describe SIS. Of the 91 sources identified, 79 (87%) clearly specified that SIS involved either cerebral edema or death after a concussion when a prior concussion had not resolved. Twelve articles (13%) could be interpreted as merely the events of two consecutive concussions. Among the articles that listed mortality rates, nearly all (33/35, 94%) said the rate of death was "high" (e.g., 50% to 100%). Our review found that most articles define SIS as a syndrome requiring catastrophic brain injury after consecutive concussive episodes. Given that it is unclear how common it is to have a second concussion while not fully recovered from a first concussion, the actual mortality rate of SIS is unknown.
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Affiliation(s)
- Steven D Stovitz
- 1Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; 2University of Minnesota Medical School, Minneapolis, MN; 3Bio-Medical Library, University of Minnesota, Minneapolis, MN; 4Section of Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and 5Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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30
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King D, Hume P, Gissane C, Brughelli M, Clark T. The Influence of Head Impact Threshold for Reporting Data in Contact and Collision Sports: Systematic Review and Original Data Analysis. Sports Med 2016; 46:151-69. [PMID: 26545363 DOI: 10.1007/s40279-015-0423-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Head impacts and resulting head accelerations cause concussive injuries. There is no standard for reporting head impact data in sports to enable comparison between studies. OBJECTIVE The aim was to outline methods for reporting head impact acceleration data in sport and the effect of the acceleration thresholds on the number of impacts reported. METHODS A systematic review of accelerometer systems utilised to report head impact data in sport was conducted. The effect of using different thresholds on a set of impact data from 38 amateur senior rugby players in New Zealand over a competition season was calculated. RESULTS Of the 52 studies identified, 42% reported impacts using a >10-g threshold, where g is the acceleration of gravity. Studies reported descriptive statistics as mean ± standard deviation, median, 25th to 75th interquartile range, and 95th percentile. Application of the varied impact thresholds to the New Zealand data set resulted in 20,687 impacts of >10 g, 11,459 (45% less) impacts of >15 g, and 4024 (81% less) impacts of >30 g. DISCUSSION Linear and angular raw data were most frequently reported. Metrics combining raw data may be more useful; however, validity of the metrics has not been adequately addressed for sport. Differing data collection methods and descriptive statistics for reporting head impacts in sports limit inter-study comparisons. Consensus on data analysis methods for sports impact assessment is needed, including thresholds. Based on the available data, the 10-g threshold is the most commonly reported impact threshold and should be reported as the median with 25th and 75th interquartile ranges as the data are non-normally distributed. Validation studies are required to determine the best threshold and metrics for impact acceleration data collection in sport. CONCLUSION Until in-field validation studies are completed, it is recommended that head impact data should be reported as median and interquartile ranges using the 10-g impact threshold.
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Affiliation(s)
- D King
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand. .,Emergency Department, Hutt Valley District Health Board, Private Bag 31-907, Lower Hutt, New Zealand.
| | - P Hume
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - C Gissane
- School of Sport, Health and Applied Science, St Mary's University, Twickenham, Middlesex, UK
| | - M Brughelli
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - T Clark
- Faculty of Human Performance, Australian College of Physical Education, Sydney Olympic Park, NSW, Australia
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31
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Dambinova SA, Maroon JC, Sufrinko AM, Mullins JD, Alexandrova EV, Potapov AA. Functional, Structural, and Neurotoxicity Biomarkers in Integrative Assessment of Concussions. Front Neurol 2016; 7:172. [PMID: 27761129 PMCID: PMC5050199 DOI: 10.3389/fneur.2016.00172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/21/2016] [Indexed: 12/20/2022] Open
Abstract
Concussion is a complex, heterogeneous process affecting the brain. Accurate assessment and diagnosis and appropriate management of concussion are essential to ensure that athletes do not prematurely return to play or others to work or active military duty, risking re-injury. To date, clinical diagnosis relies primarily on evaluating subjects for functional impairment using instruments that include neurocognitive testing, subjective symptom report, and neurobehavioral assessments, such as balance and vestibular-ocular reflex testing. Structural biomarkers, defined as advanced neuroimaging techniques and biomarkers assessing neurotoxicity and immunoexcitotoxicity, may complement the use of functional biomarkers. We hypothesize that neurotoxicity AMPA, NMDA, and kainite receptor biomarkers might be utilized as a part of comprehensive approach to concussion evaluations, with the goal of increasing diagnostic accuracy and facilitating treatment planning and prognostic assessment.
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Affiliation(s)
| | - Joseph C. Maroon
- Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Fuller CW, Fuller GW, Kemp SPT, Raftery M. Evaluation of World Rugby's concussion management process: results from Rugby World Cup 2015. Br J Sports Med 2016; 51:64-69. [DOI: 10.1136/bjsports-2016-096461] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2016] [Indexed: 01/06/2023]
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Hendricks S, Düking P, Mellalieu SD. Twitter Strategies for Web-Based Surveying: Descriptive Analysis From the International Concussion Study. JMIR Res Protoc 2016; 5:e179. [PMID: 27589958 PMCID: PMC5025563 DOI: 10.2196/resprot.4542] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 01/11/2016] [Accepted: 04/17/2016] [Indexed: 11/13/2022] Open
Abstract
Background Social media provides researchers with an efficient means to reach and engage with a large and diverse audience. Twitter allows for the virtual social interaction among a network of users that enables researchers to recruit and administer surveys using snowball sampling. Although using Twitter to administer surveys for research is not new, strategies to improve response rates are yet to be reported. Objective To compare the potential and actual reach of 2 Twitter accounts that administered a Web-based concussion survey to rugby players and trainers using 2 distinct Twitter-targeting strategies. Furthermore, the study sought to determine the likelihood of receiving a retweet based on the time of the day and day of the week of posting. Methods A survey based on previous concussion research was exported to a Web-based survey website Survey Monkey. The survey comprised 2 questionnaires, one for players, and one for those involved in the game (eg, coaches and athletic trainers). The Web-based survey was administered using 2 existing Twitter accounts, with each account executing a distinct targeting strategy. A list of potential Twitter accounts to target was drawn up, together with a list of predesigned tweets. The list of accounts to target was divided into ‘High-Profile’ and ‘Low-Profile’, based on each accounts’ position to attract publicity with a high social interaction potential. The potential reach (number of followers of the targeted account), and actual reach (number of retweets received by each post) between the 2 strategies were compared. The number of retweets received by each account was further analyzed to understand when the most likely time of day, and day of the week, a retweet would be received. Results The number of retweets received by a Twitter account decreased by 72% when using the ‘high-profile strategy’ compared with the ‘low-profile strategy’ (incidence rate ratio (IRR); 0.28, 95% confidence interval (CI) 0.21-0.37, P<.001). When taking into account strategy and day of the week, the IRR for the number of retweets received during the hours of 12 AM to 5:59 AM (IRR 2.98, 95% CI 1.88-4.71, P>.001) and 6 PM to 11:59 PM (IRR 1.48, 95% CI 1.05-2.09, P>.05) were significantly increased relative to 6 AM to 11:59 AM. However, posting tweets during the hours of 12 PM to 5:59 PM, decreased the IRR for retweets by 40% (IRR 0.60, 95% CI 0.46-0.79, P<.001) compared with 6 AM to 11:59 AM. Posting on a Monday (IRR 3.57, 95% CI 2.50-5.09, P<.001) or Wednesday (IRR 1.50, 95% CI 1.11-1.11, P<.01) significantly increased the IRR compared with posting on a Thursday. Conclusions Surveys are a useful tool to measure the knowledge, attitudes, and behaviors of a given population. Strategies to improve Twitter engagement include targeting low-profile accounts, posting tweets in the morning (12 AM-11:59 AM) or late evenings (6 PM-11:59 PM), and posting on Mondays and Wednesdays.
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Affiliation(s)
- Sharief Hendricks
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.
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Wright DK, Trezise J, Kamnaksh A, Bekdash R, Johnston LA, Ordidge R, Semple BD, Gardner AJ, Stanwell P, O'Brien TJ, Agoston DV, Shultz SR. Behavioral, blood, and magnetic resonance imaging biomarkers of experimental mild traumatic brain injury. Sci Rep 2016; 6:28713. [PMID: 27349514 PMCID: PMC4923906 DOI: 10.1038/srep28713] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/07/2016] [Indexed: 12/14/2022] Open
Abstract
Repeated mild traumatic brain injuries (mTBI) may lead to serious neurological consequences, especially if re-injury occurs within the period of increased cerebral vulnerability (ICV) triggered by the initial insult. MRI and blood proteomics might provide objective measures of pathophysiological changes in mTBI, and indicate when the brain is no longer in a state of ICV. This study assessed behavioral, MRI, and blood-based markers in a rat model of mTBI. Rats were given a sham or mild fluid percussion injury (mFPI), and behavioral testing, MRI, and blood collections were conducted up to 30 days post-injury. There were cognitive impairments for three days post-mFPI, before normalizing by day 5 post-injury. In contrast, advanced MRI (i.e., tractography) and blood proteomics (i.e., vascular endothelial growth factor) detected a number of abnormalities, some of which were still present 30 days post-mFPI. These findings suggest that MRI and blood proteomics are sensitive measures of the molecular and subtle structural changes following mTBI. Of particular significance, this study identified novel tractography measures that are able to detect mTBI and may be more sensitive than traditional diffusion-tensor measures. Furthermore, the blood and MRI findings may have important implications in understanding ICV and are translatable to the clinical setting.
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Affiliation(s)
- David K Wright
- Anatomy and Neuroscience, The University of Melbourne, Parkville, VIC, 3010, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, 3052, Australia
| | - Jack Trezise
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, 3050, Australia
| | - Alaa Kamnaksh
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Ramsey Bekdash
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Leigh A Johnston
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, 3052, Australia.,Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Roger Ordidge
- Anatomy and Neuroscience, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Bridgette D Semple
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, 3050, Australia
| | - Andrew J Gardner
- Centre for Stroke and Brain Injury, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Peter Stanwell
- School of Health Sciences, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Terence J O'Brien
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, 3050, Australia
| | - Denes V Agoston
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Sandy R Shultz
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, 3050, Australia
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Abstract
Obesity is widespread, associated with several physical and psychosocial comorbidities, and is difficult to treat. Prevention of obesity across the lifespan is critical to improving the health of individuals and society. Screening and prevention efforts in primary care are an important step in addressing the obesity epidemic. Each period of human development is associated with unique risks, challenges, and opportunities for prevention and intervention. Screening tools for overweight/obesity, although imperfect, are quick and easy to administer. Screening should be conducted at every primary care visit and tracked longitudinally. Screening tools and cutoffs for overweight and obesity vary by age group.
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Affiliation(s)
- Eleanor R Mackey
- Department of Psychology and Behavioral Health, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA.
| | - Alexandra Olson
- Children's National Health System, Center for Translational Science, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
| | - Marc DiFazio
- Department of Neurology, Children's National Health System, 9850 Key West Avenue, 4th Floor, Rockville, MD 20850, USA
| | - Omni Cassidy
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
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Snell DL, Macleod ADS, Anderson T. Post-Concussion Syndrome after a Mild Traumatic Brain Injury: A Minefield for Clinical Practice. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/jbbs.2016.66023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vartiainen MV, Holm A, Lukander J, Lukander K, Koskinen S, Bornstein R, Hokkanen L. A novel approach to sports concussion assessment: Computerized multilimb reaction times and balance control testing. J Clin Exp Neuropsychol 2015; 38:293-307. [PMID: 26647221 DOI: 10.1080/13803395.2015.1107031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
OBJECTIVES Compare and assess information available on the Internet about the definition, symptoms, treatment, and return to play recommendations after a concussion. METHODS The top 10 websites generated by a Google search on the keyword "concussion" were evaluated by two independent researchers and three medical professionals for definition, signs, symptoms, home treatment, care-seeking advice, and return to play recommendations. The medical professionals also rated their willingness to recommend each website to patients. RESULTS Each website contained a general list of signs, symptoms, and home treatment. One website advised the use of ibuprofen, four advised against ibuprofen, and five made no medication recommendations. Nine websites contained guidance on seeking physician care, and eight recommended athletes not return to play until cleared by a healthcare professional. CONCLUSION Nine of the websites contained information for each section evaluated; however, information was inconsistent. Healthcare providers should be aware of the variable quality of information available on the Internet and guide patients to more optimal resources.
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Abstract
PRIMARY OBJECTIVE The aim of this literature review was to systematically describe the sequential metabolic changes that occur following concussive injury, as well as identify and characterize the major concepts associated with the neurochemical cascade. RESEARCH DESIGN Narrative literature review. CONCLUSIONS Concussive injury initiates a complex cascade of pathophysiological changes that include hyper-acute ionic flux, indiscriminant excitatory neurotransmitter release, acute hyperglycolysis and sub-acute metabolic depression. Additionally, these metabolic changes can subsequently lead to impaired neurotransmission, alternate fuel usage and modifications in synaptic plasticity and protein expression. The combination of these metabolic alterations has been proposed to cause the transient and prolonged neurological deficits that typically characterize concussion. Consequently, understanding the implications of the neurochemical cascade may lead to treatment and return-to-play guidelines that can minimize the chronic effects of concussive injury.
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Larson-Dupuis C, Chamard É, Falardeau V, Frasnelli J, Beaulieu C, Poirier J, Carrier J, Lassonde M, Théoret H, Bacon BA, De Beaumont L. Impact of BDNF Val66Met polymorphism on olfactory functions of female concussed athletes. Brain Inj 2015; 29:963-70. [DOI: 10.3109/02699052.2015.1016452] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Semple BD, Lee S, Sadjadi R, Fritz N, Carlson J, Griep C, Ho V, Jang P, Lamb A, Popolizio B, Saini S, Bazarian JJ, Prins ML, Ferriero DM, Basso DM, Noble-Haeusslein LJ. Repetitive concussions in adolescent athletes - translating clinical and experimental research into perspectives on rehabilitation strategies. Front Neurol 2015; 6:69. [PMID: 25883586 PMCID: PMC4382966 DOI: 10.3389/fneur.2015.00069] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/13/2015] [Indexed: 12/23/2022] Open
Abstract
Sports-related concussions are particularly common during adolescence, a time when even mild brain injuries may disrupt ongoing brain maturation and result in long-term complications. A recent focus on the consequences of repetitive concussions among professional athletes has prompted the development of several new experimental models in rodents, as well as the revision of guidelines for best management of sports concussions. Here, we consider the utility of rodent models to understand the functional consequences and pathobiology of concussions in the developing brain, identifying the unique behavioral and pathological signatures of concussive brain injuries. The impact of repetitive concussions on behavioral consequences and injury progression is also addressed. In particular, we focus on the epidemiological, clinical, and experimental evidence underlying current recommendations for physical and cognitive rest after concussion, and highlight key areas in which further research is needed. Lastly, we consider how best to promote recovery after injury, recognizing that optimally timed, activity-based rehabilitative strategies may hold promise for the adolescent athlete who has sustained single or repetitive concussions. The purpose of this review is to inform the clinical research community as it strives to develop and optimize evidence-based guidelines for the concussed adolescent, in terms of both acute and long-term management.
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Affiliation(s)
- Bridgette D. Semple
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Sangmi Lee
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Raha Sadjadi
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nora Fritz
- Kennedy Krieger Institute, John Hopkins University, Baltimore, MD, USA
| | - Jaclyn Carlson
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Carrie Griep
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Vanessa Ho
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Patrice Jang
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Annick Lamb
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Beth Popolizio
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Sonia Saini
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey J. Bazarian
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Mayumi L. Prins
- Department of Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Donna M. Ferriero
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - D. Michele Basso
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, USA
| | - Linda J. Noble-Haeusslein
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Physical Therapy and Rehabilitation Sciences, University of California San Francisco, San Francisco, CA, USA
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Minodier P, Guillaume JM, Coudreuse JM, Viton JM, Jouve JL, Merrot T. Commotions cérébrales chez le jeune sportif. Arch Pediatr 2015; 22:435-9. [DOI: 10.1016/j.arcped.2014.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/01/2014] [Accepted: 11/01/2014] [Indexed: 11/26/2022]
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Tong DC, Winter TJ, Jin J, Bennett AC, Waddell JN. Quantification of subconcussive impact forces to the head using a forensic model. J Clin Neurosci 2015; 22:747-51. [PMID: 25744077 DOI: 10.1016/j.jocn.2014.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 11/04/2014] [Indexed: 11/15/2022]
Abstract
Concussive and subconcussive head injury is a global phenomenon that affects millions of people each year. Concussive injury has been extensively studied in sport, which has led to a greater understanding of the biomechanical forces involved and guidelines aimed at preventing athletes from playing while concussed. Subconcussive forces by definition do not meet the threshold for concussion but nonetheless may have significant long term consequences due to the repetitive pattern of injury to the head. Quantifying these impact forces using a forensic head model provides the groundwork for future studies by establishing a range or threshold of subconcussive impact forces that could be correlated with clinical assessments. The use of a forensic head model has distinct advantages in terms of ethics and safety.
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Affiliation(s)
- D C Tong
- Sir John Walsh Research Institute, University of Otago, 310 Great King Street, Dunedin 9010, New Zealand.
| | - T J Winter
- Sir John Walsh Research Institute, University of Otago, 310 Great King Street, Dunedin 9010, New Zealand
| | - J Jin
- Sir John Walsh Research Institute, University of Otago, 310 Great King Street, Dunedin 9010, New Zealand
| | - A C Bennett
- Division of International Affairs, Kansai University, Suita-shi, Osaka, Japan
| | - J N Waddell
- Sir John Walsh Research Institute, University of Otago, 310 Great King Street, Dunedin 9010, New Zealand
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Abstract
OBJECTIVE To determine whether skull motion produced by pulsatile cerebral blood flow, as measured by cranial accelerometry, is altered during concussion. DESIGN In phase 1, to identify a specific pattern indicative of concussion, cranial accelerometry of subjects who sustained a concussion underwent analysis of waveforms, which was compared with accelerometry from subjects without a concussion (baseline). In phase 2, this concussion pattern was tested against prospectively acquired, blinded data. SETTING High school tackle football practice and game play. PARTICIPANTS Eighty-four football players. INTERVENTIONS Subjects had accelerometry measurements and concurrent 2-lead electrocardiograms. In players with a concussion, multiple sequential measurements were obtained. Sport Concussion Assessment Tool 2 was used to assist clinical determination of concussion. MAIN OUTCOME MEASURES Whether a characteristic waveform pattern of cranial accelerometry occurs in subjects with concussion. RESULTS Phase 1 demonstrated a consistent pattern correlated to concussion. Phase 2 found this pattern in 10 of 13 subjects with concussion (76.9% sensitivity). Seventy-nine of 82 baseline plus nine postseason (total = 91) recordings from nonconcussed subjects did not show the concussion pattern (87% specificity). CONCLUSIONS In subjects with concussion, we observed a unique pattern determined by cranial accelerometry. This may provide a method to noninvasively detect and longitudinally observe concussion. CLINICAL RELEVANCE There is no objective, real-time, noninvasive, and easily accessible measure for concussion. If accelerometry is validated, it could provide a critical diagnostic tool for sports medicine physicians.
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Leitch H, Ayers E, Andrews A. A Review of Concussion Management in the Young Adult; the Importance of Baseline Testing and Caregiver Education. J Natl Med Assoc 2015; 107:60-5. [PMID: 27282725 DOI: 10.1016/s0027-9684(15)30053-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED : Despite the increase in studies and media coverage, concussion continues to threaten the futures of young athletes and cause a great deal of concern among parents and practitioners. Questions continue regarding the management and return to play for injured adolescents and young adults, and regarding the long term consequences of repeated concussion in our youth. There appears to be a huge disparity between what health care professionals know and understand about concussion and what the average athlete and parent understands about what concussion is and the real risks involved. A review of current literature reveals a persistent lag between our knowledge and practice. This literature survey takes the athlete from the pre-participation sports physical, to the sidelines, to the doctor's office, to return to play and provides a comprehensive assessment of current recommendations. There is a significant need, especially in urban areas, for education and access to cheap and simple baseline functional assessments of adolescents and young adults. We recommend athletes be assessed at their yearly physical in order to properly determine their baseline function and readiness to return to play after concussion. Additionally, we recommend providing anticipatory guidance and a simple concussion evaluation tool to be used by parents and guardians to also annually assess a young person's baseline functional status and subsequent alterations. The goal of this review is to create an evidence-based, simple, cost-effective parental survey; increase awareness, understanding and diagnosis of concussion; and finally, expedited proper treatment and facilitate return to play. PUBLICATION INDICES PubMed, lib.wayne.edu.
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Affiliation(s)
| | - Eric Ayers
- Wayne State University School of Medicine.
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Goddeyne C, Nichols J, Wu C, Anderson T. Repetitive mild traumatic brain injury induces ventriculomegaly and cortical thinning in juvenile rats. J Neurophysiol 2015; 113:3268-80. [PMID: 25695652 DOI: 10.1152/jn.00970.2014] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/13/2015] [Indexed: 11/22/2022] Open
Abstract
Traumatic brain injury (TBI) most frequently occurs in pediatric patients and remains a leading cause of childhood death and disability. Mild TBI (mTBI) accounts for nearly 75% of all TBI cases, yet its neuropathophysiology is still poorly understood. While even a single mTBI injury can lead to persistent deficits, repeat injuries increase the severity and duration of both acute symptoms and long-term deficits. In this study, to model pediatric repetitive mTBI (rmTBI) we subjected unrestrained juvenile animals (postnatal day 20) to repeat weight-drop impacts. Animals were anesthetized and subjected to sham injury or rmTBI once per day for 5 days. Magnetic resonance imaging (MRI) performed 14 days after injury revealed marked cortical atrophy and ventriculomegaly in rmTBI animals. Specifically, beneath the impact zone the thickness of the cortex was reduced by up to 46% and the area of the ventricles increased by up to 970%. Immunostaining with the neuron-specific marker NeuN revealed an overall loss of neurons within the motor cortex but no change in neuronal density. Examination of intrinsic and synaptic properties of layer II/III pyramidal neurons revealed no significant difference between sham-injured and rmTBI animals at rest or under convulsant challenge with the potassium channel blocker 4-aminopyridine. Overall, our findings indicate that the neuropathological changes reported after pediatric rmTBI can be effectively modeled by repeat weight drop in juvenile animals. Developing a better understanding of how rmTBI alters the pediatric brain may help improve patient care and direct "return to game" decision making in adolescents.
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Affiliation(s)
- Corey Goddeyne
- University of Arizona, College of Medicine-Phoenix, Phoenix, Arizona; and School of Life Sciences, Arizona State University, Tempe, Arizona
| | - Joshua Nichols
- University of Arizona, College of Medicine-Phoenix, Phoenix, Arizona; and School of Life Sciences, Arizona State University, Tempe, Arizona
| | - Chen Wu
- University of Arizona, College of Medicine-Phoenix, Phoenix, Arizona; and
| | - Trent Anderson
- University of Arizona, College of Medicine-Phoenix, Phoenix, Arizona; and
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DeMatteo C, Stazyk K, Singh SK, Giglia L, Hollenberg R, Malcolmson CH, Mahoney W, Harper JA, Missiuna C, Law M, McCauley D. Development of a conservative protocol to return children and youth to activity following concussive injury. Clin Pediatr (Phila) 2015; 54:152-63. [PMID: 25422524 DOI: 10.1177/0009922814558256] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Consensus-based guidelines exist for adult athletes returning to play after concussion, but there are no protocols developed specifically for children. The goal of this knowledge translation research was to develop evidence-based materials to inform physicians about pediatric concussion. METHODS A pediatric concussion protocol was developed based on the National Institute for Health and Care Excellence procedures. RESULTS This return to activity protocol was developed to guide management when children/youth sustain a concussion. The protocol incorporated 3 main themes: (a) a protocol must include return to all activity, including sport and school; (b) existing consensus-based adult protocols are not appropriate for children; and (c) a more conservative protocol is needed. After pilot testing, the developed protocol is being used across Ontario. CONCLUSION Implementation of these new pediatric recommendations is an important addition to prevention of subsequent concussions during vulnerable recovery periods, with potential to facilitate recovery by preventing prolonged symptomatology, and secondary sequelae.
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Affiliation(s)
| | | | - Sheila K Singh
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Lucy Giglia
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Robert Hollenberg
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Charles H Malcolmson
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - William Mahoney
- McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada
| | | | | | - Mary Law
- McMaster University, Hamilton, Ontario, Canada
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Buki A, Kovacs N, Czeiter E, Schmid K, Berger RP, Kobeissy F, Italiano D, Hayes RL, Tortella FC, Mezosi E, Schwarcz A, Toth A, Nemes O, Mondello S. Minor and repetitive head injury. Adv Tech Stand Neurosurg 2015; 42:147-92. [PMID: 25411149 DOI: 10.1007/978-3-319-09066-5_8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability in the young, active population and expected to be the third leading cause of death in the whole world until 2020. The disease is frequently referred to as the silent epidemic, and many authors highlight the "unmet medical need" associated with TBI.The term traumatically evoked brain injury covers a heterogeneous group ranging from mild/minor/minimal to severe/non-salvageable damages. Severe TBI has long been recognized to be a major socioeconomical health-care issue as saving young lives and sometimes entirely restituting health with a timely intervention can indeed be extremely cost efficient.Recently it has been recognized that mild or minor TBI should be considered similarly important because of the magnitude of the patient population affected. Other reasons behind this recognition are the association of mild head injury with transient cognitive disturbances as well as long-term sequelae primarily linked to repeat (sport-related) injuries.The incidence of TBI in developed countries can be as high as 2-300/100,000 inhabitants; however, if we consider the injury pyramid, it turns out that severe and moderate TBI represents only 25-30 % of all cases, while the overwhelming majority of TBI cases consists of mild head injury. On top of that, or at the base of the pyramid, are the cases that never show up at the ER - the unreported injuries.Special attention is turned to mild TBI as in recent military conflicts it is recognized as "signature injury."This chapter aims to summarize the most important features of mild and repetitive traumatic brain injury providing definitions, stratifications, and triage options while also focusing on contemporary knowledge gathered by imaging and biomarker research.Mild traumatic brain injury is an enigmatic lesion; the classification, significance, and its consequences are all far less defined and explored than in more severe forms of brain injury.Understanding the pathobiology and pathomechanisms may aid a more targeted approach in triage as well as selection of cases with possible late complications while also identifying the target patient population where preventive measures and therapeutic tools should be applied in an attempt to avoid secondary brain injury and late complications.
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Affiliation(s)
- Andras Buki
- MTA-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary,
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Delahunty SE, Delahunt E, Condon B, Toomey D, Blake C. Prevalence of and attitudes about concussion in Irish schools' rugby union players. THE JOURNAL OF SCHOOL HEALTH 2015; 85:17-26. [PMID: 25440449 DOI: 10.1111/josh.12219] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 04/28/2014] [Accepted: 05/12/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Youth rugby players represent 45.2% (N = 69,472) of the Irish rugby union playing population. The risk and consequences of concussion injury are of particular concern in these young athletes, but limited epidemiological data exists. This study investigated annual and lifetime prevalence of concussion in an Irish schoolboy rugby union cohort. METHODS An anonymous cross-sectional survey of youth rugby players was conducted. Diagnosed concussion was defined as an incident where diagnosis was confirmed by a health professional or coach. Demographics, prevalence, and attitudes to concussion were collated. Data were analyzed with descriptive statistics, chi-square test, t-tests, Mann-Whitney tests, and logistic regression. RESULTS Overall, 304 youth (aged 12-18 years) responded. Lifetime prevalence of diagnosed concussion was 19.4%, with annual (2010) prevalence 6.6%. Approximately 25.4% of players with diagnosed concussions returned to play without medical advice. Internal motivation (11.8%) was the predominant factor in feeling pressure to play while concussed. A desire for further concussion education was expressed by 89.5% of participants. CONCLUSIONS Reform is required to prevent and manage concussion injuries among youth players in the rugby union, including mandatory education specific to concussion and implementation of return-to-play protocols. These findings have relevance for governing bodies, coaches, clinicians, schools, parents, and rugby union players.
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Affiliation(s)
- Sinéad E Delahunty
- School of Public Health, Physiotherapy and Population Science, Health Science Centre, University College Dublin, Belfield, Dublin 4, Ireland
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Kauffman DC, Clark JF, Smith JC. The influence of sport goggles on visual target detection in female intercollegiate athletes. J Sports Sci 2014; 33:1117-23. [DOI: 10.1080/02640414.2014.987156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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