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Bhende BU, Muehlschlegel S. Echoes of the past: does prior TBI shape future TBI outcomes? Trauma Surg Acute Care Open 2024; 9:e001569. [PMID: 39171082 PMCID: PMC11337666 DOI: 10.1136/tsaco-2024-001569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Affiliation(s)
- Bhagyashri U Bhende
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susanne Muehlschlegel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Neurosciences Critical Care, Departments of Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Halabi C, Norton L, Norton K, Smith WS. Headpulse Biometric Measures Following Concussion in Young Adult Athletes. JAMA Netw Open 2023; 6:e2328633. [PMID: 37566413 PMCID: PMC10422194 DOI: 10.1001/jamanetworkopen.2023.28633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/24/2023] [Indexed: 08/12/2023] Open
Abstract
Importance Concussions are common in sports. Return-to-play protocols can be enhanced by objective biometrics. Objective To characterize temporal changes of headpulse, a digital biometric, in athletes with sports-related concussion; to explore the association of unstructured physical activity with headpulse changes. Design, Setting, and Participants This cohort study included headpulse measurements from players in the highest level of amateur Australian Rules Football in South Australia. Analysis included feasibility and validation phases, with the feasibility cohort recruited between August 5, 2021, and September 10, 2021, and the validation cohort recruited between May 5, 2022, and September 3, 2022. Data were analyzed October 2022 through January 2023. Interventions Cranial accelerometry detected micromovements of the head following cardiac contraction (what we have described as "headpulse"). Headpulse was serially recorded for 1 month in concussed individuals. Main Outcomes and Measures Headpulse waveforms underwent frequency transformation analysis per prespecified algorithm. Result Z scores were calculated. Headpulse Z scores exceeding 2 (2 SDs from control means) met an abnormality threshold. Headpulse sensitivity, timing, and duration of change were determined. Results A total of 59 control and 43 concussed individuals (44 total concussions; 1 control also concussed, 1 concussed individual injured twice) provided headpulse measurements. The feasibility cohort (all male) included 17 control (median [IQR] age, 23 [19-28] years) and 15 concussed individuals (median [IQR] age, 21 [19-23] years). The validation cohort included 25 female (median [IQR] age, 21 [20-22] years) and 17 male (median [IQR] age, 26 [23-29] years) control individuals, and 8 female (median [IQR] age, 28 [20-31] years) and 20 male (median [IQR] age, 21 [19-23] years) concussed individuals. Headpulse reached abnormality threshold in 26 of 32 concussed individuals (81%; 9% on day 0, 50% by day 2, 90% by day 14). Headpulse alterations lasted 14 days longer than symptoms and were exacerbated by return-to-play or unsupervised physical activity. Conclusions and Relevance In this study of 101 amateur Australian Rules Football athletes, the digital headpulse biometric was evaluated in 44 sports-related concussions. Compared with controls, new headpulse changes occurred after concussion; this objective metric may complement return-to-play protocols.
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Affiliation(s)
- Cathra Halabi
- Department of Neurology, University of California, San Francisco
- Weill Institute for Neurosciences, University of California, San Francisco
| | - Lynda Norton
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Kevin Norton
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Wade S. Smith
- Department of Neurology, University of California, San Francisco
- Weill Institute for Neurosciences, University of California, San Francisco
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Rao AL, Song L, Griffin G. Head Injuries and Emergencies in Sports. Clin Sports Med 2023; 42:473-489. [PMID: 37208060 DOI: 10.1016/j.csm.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Head injuries are a common occurrence in sports and can involve injuries to the brain, skull, and superficial soft tissues. The most commonly discussed diagnosis is a concussion. Head and cervical spine injuries must be considered together at times, due to the overlapping nature of symptoms present during on-field evaluation. This article presents a range of head injuries, along with critical steps in evaluation and management.
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Affiliation(s)
- Ashwin L Rao
- Department of Family Medicine, Section of Sports Medicine, University of Washington, Seattle, WA, USA; University of Washington Sports Medicine Center, 3800 Montlake Boulevard NE, Box 354060, Seattle, WA 98195, USA.
| | - Leina'ala Song
- University of Washington Sports Medicine Center, 3800 Montlake Boulevard NE, Box 354060, Seattle, WA 98195, USA; Department of Family Medicine, Section of Sports Medicine, University of Washington, Seattle, WA, USA
| | - Georgia Griffin
- University of Washington Sports Medicine Center, 3800 Montlake Boulevard NE, Box 354060, Seattle, WA 98195, USA; Department of Family Medicine, Section of Sports Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
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Lee EB, Kennedy-Dietrich C, Geddes JF, Nicoll JAR, Revesz T, Smith DH, Stewart W. The perils of contact sport: pathologies of diffuse brain swelling and chronic traumatic encephalopathy neuropathologic change in a 23-year-old rugby union player. Acta Neuropathol 2023; 145:847-850. [PMID: 37086326 PMCID: PMC10175208 DOI: 10.1007/s00401-023-02576-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/13/2023] [Accepted: 04/16/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Edward B Lee
- Translational Neuropathology Research Laboratory, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | | | | | - James A R Nicoll
- Clinical Neurosciences, University of Southampton, Southampton, SO16 6YD, UK
| | - Tamas Revesz
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Douglas H Smith
- Department of Neurosurgery, Penn Center for Brain Injury and Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - William Stewart
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, G12 8QQ, UK.
- Department of Neuropathology, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, UK.
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Kamienski MC. Are You Ready for Some Football? Orthop Nurs 2022; 41:393-396. [PMID: 36413663 DOI: 10.1097/nor.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Football has become the most popular spectator sport in the United States today and attracts millions of players, both professional and amateur. This article discusses the risks of playing football. It is a contact sport and can result in a wide variety of injuries to the players. The rules of the game are based on adult participation; however, 2.8 million children participate in recreational tackle football every year. An understanding of the game and the risks associated with playing football is presented. The risks of the game are discussed with a focus on the prevention of injury. The most common injuries are presented, which include concussion and the major risk of traumatic brain injury. The importance of wearing appropriate protective gear and developing strategies to avoid head and neck injuries is presented. The role of parents and coaches is described, with tips on how to identify injuries and how to prevent them to guarantee the safety of players. Finally, the role of the nurse and other health care providers is discussed. This article presents an overview of the complexity of tackle football and strategies to keep the players safe.
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Affiliation(s)
- Mary C Kamienski
- Mary C. Kamienski, PhD, APRN, FAEN, FAAN , Professor, Specialty Director FNP in Emergency Care, Rutgers School of Nursing, Montville, NJ
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Oliver B, Ashton J, Welsby G, Simpson A. A comparison of the knowledge and attitudes of concussion within higher and lower leagues of the community rugby union game. Phys Ther Sport 2022; 58:151-159. [DOI: 10.1016/j.ptsp.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
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Rotimi O, Jung GYP, Ong J, Jeelani NUO, Dunaway DJ, James G. Sporting activity after craniosynostosis surgery in children: a source of parental anxiety. Childs Nerv Syst 2021; 37:287-290. [PMID: 32529547 PMCID: PMC7790766 DOI: 10.1007/s00381-020-04723-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/03/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Craniosynostosis correction involves major skull surgery in infancy-a potential source of worry for parents when their treated children begin involvement in sports. METHODS Electronic multiple choice survey of parents of children who had undergone craniosynostosis surgery in infancy using 5-point Likert scales. RESULTS Fifty-nine completed surveys were obtained from parents of children who had undergone previous craniosynostosis surgery. Mean age of children was 7.8 years (range 3 months to 22 years), with 36 non-syndromic and 23 syndromic cases. The most common surgery was fronto-orbital remodelling (18). Fifty-two of 59 were involved in athletic activity. The most intense sport type was non-contact in 23, light contact in 20, heavy contact in 4 and combat in 5. Participation level was school mandatory in 12, school club in 17, non-school sport club in 21 and regional representative in 2. One child had been advised to avoid sport by an external physician. Mean anxiety (1-5 Likert) increased with sport intensity: non-contact 1.7, light contact 2.2, heavy contact 3.5 and combat 3.6. Twenty-nine of 59 parents had been given specific advice by the Craniofacial Team regarding athletic activity, 28 of which found useful. Three sport-related head injuries were reported, none of which required hospitalisation. CONCLUSION Little information exists regarding sports for children after craniosynostosis surgery. This study suggests that parental anxiety remains high, particularly for high impact/combat sports, and that parents would like more information from clinicians about the safety of post-operative sporting activities.
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Affiliation(s)
| | | | - Juling Ong
- Craniofacial Unit, Great Ormond Street Hospital, London, UK
- Great Ormond Street Institute of Child Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK
| | - N U Owase Jeelani
- Craniofacial Unit, Great Ormond Street Hospital, London, UK
- Great Ormond Street Institute of Child Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK
| | - David J Dunaway
- Craniofacial Unit, Great Ormond Street Hospital, London, UK
- Great Ormond Street Institute of Child Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK
| | - Greg James
- Craniofacial Unit, Great Ormond Street Hospital, London, UK.
- Great Ormond Street Institute of Child Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK.
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Russell JA, McIntyre L, Stewart L, Wang T. Concussions in Dancers and Other Performing Artists. Phys Med Rehabil Clin N Am 2020; 32:155-168. [PMID: 33198893 DOI: 10.1016/j.pmr.2020.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dancers and other performing artists are subject to head impacts that result in concussion-like symptoms. In spite of this, performing arts do not have access to the continual, focused emphasis on the diagnosis, management, and prevention of concussions that is commonplace in sports. Performing arts present a unique environment in which concussions occur and must be managed. This article outlines what is known about performing arts concussions, describes mechanisms of head impacts sustained by participants in dance and the related artforms of theater, circus, and film and television stunts, and offers concussion management guidelines for these artistic fields.
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Affiliation(s)
- Jeffrey A Russell
- Ohio University, College of Health Sciences and Professions, School of Applied Health Sciences and Wellness, Grover Center E182, Athens, OH 45701, USA.
| | - Lauren McIntyre
- Harkness Center for Dance Injuries at NYU Langone Health, 614 2nd Avenue, Floor 2, Suite G, New York, NY 10016, USA
| | - Lori Stewart
- Union of British Columbia Performers/ACTRA, 300 - 380 West 2nd Avenue, Vancouver, British Columbia V5Y 1C8, Canada
| | - Tina Wang
- Loma Linda School of Medicine, Loma Linda VA Hospital, 429 N Central Ave, Upland, CA 91786, USA
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