1
|
Ludwig R, Rippee M, D'Silva L, Radel J, Eakman AM, Beltramo A, Drerup M, Siengsukon C. Cognitive Behavioral Therapy for Insomnia Improves Sleep Outcomes in Individuals With Concussion: A Preliminary Randomized Wait-List Control Study. J Head Trauma Rehabil 2024; 39:318-327. [PMID: 38466122 DOI: 10.1097/htr.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Cognitive behavioral therapy for insomnia (CBT-I) is the gold standard treatment for insomnia, but there is limited evidence on the treatment effect of CBT-I in individuals after a concussion. Therefore, the main purpose of this study was to evaluate the treatment effect of CBT-I on sleep outcomes and postconcussion symptoms. SETTING This study was conducted at an academic institution. The CBT-I sessions were conducted using a teleconferencing system (Zoom). PARTICIPANTS Participants were eligible to participate if they were at least 4 weeks post- concussion, aged 18 to 64 years, and scored 10 or more on the Insomnia Severity Index. A total of 40 people were enrolled; 32 participants were included in analyses. DESIGN This was a randomized controlled wait-list study. Participants were randomized into starting the CBT-I intervention immediately after the baseline assessment or into the wait-list group for 6 weeks before starting CBT-I. Assessments were performed at baseline, 6, 12, and 18 weeks. MAIN MEASURES The primary outcome was the Insomnia Severity Index. Secondary measures included the Pittsburg Sleep Quality Index, Post-Concussion Symptom Scale, and Beck Depression and Anxiety Inventories. Statistical analyses included a repeated-measures analysis of variance, t tests, and mixed linear regression modeling. RESULTS There was a group-by-time interaction for the sleep outcomes but not for the concussion or mood outcomes. Differences were seen between groups on sleep outcomes, symptom severity, and depression. The treatment effect was maintained following CBT-I for all outcomes. Improvement in sleep outcomes was predictive of improvement in postconcussion symptom severity and number of symptoms. CONCLUSIONS CBT-I reduces insomnia in individuals with concussions, and improved sleep was associated with lower postconcussion and mood symptoms. These effects were maintained 6 to 12 weeks following the intervention.
Collapse
Affiliation(s)
- Rebecca Ludwig
- Departments of Physical Therapy, Rehabilitation Science, and Athletic Training (Ms Ludwig and Drs D'Silva and Siengsukon), Neurology (Dr Rippee), Occupational Therapy and Therapeutic Science (Dr Radel), and Biostatistics and Data Science (Mr Beltramo), University of Kansas Medical Center, Kansas City; Department of Occupational Therapy, Colorado State University, Fort Collins (Dr Eakman); and Neurological Institute, Sleep Disorders Center, Cleveland Clinic, Cleveland, Ohio (Dr Drerup)
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Sgro M, Ray J, Foster E, Mychasiuk R. Making migraine easier to stomach: the role of the gut-brain-immune axis in headache disorders. Eur J Neurol 2023; 30:3605-3621. [PMID: 37329292 DOI: 10.1111/ene.15934] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND PURPOSE Headache disorders place a significant burden on the healthcare system, being the leading cause of disability in those under 50 years. Novel studies have interrogated the relationship between headache disorders and gastrointestinal dysfunction, suggesting a link between the gut-brain-immune (GBI) axis and headache pathogenesis. Although the exact mechanisms driving the complex relationship between the GBI axis and headache disorders remain unclear, there is a growing appreciation that a healthy and diverse microbiome is necessary for optimal brain health. METHODS A literature search was performed through multiple reputable databases in search of Q1 journals within the field of headache disorders and gut microbiome research and were critically and appropriately evaluated to investigate and explore the following; the role of the GBI axis in dietary triggers of headache disorders and the evidence indicating that diet can be used to alleviate headache severity and frequency. The relationship between the GBI axis and post-traumatic headache is then synthesized. Finally, the scarcity of literature regarding paediatric headache disorders and the role that the GBI axis plays in mediating the relationship between sex hormones and headache disorders are highlighted. CONCLUSIONS There is potential for novel therapeutic targets for headache disorders if understanding of the GBI axis in their aetiology, pathogenesis and recovery is increased.
Collapse
Affiliation(s)
- Marissa Sgro
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jason Ray
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, Austin Health, Melbourne, Victoria, Australia
| | - Emma Foster
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Lima Santos JP, Jia-Richards M, Kontos AP, Collins MW, Versace A. Emotional Regulation and Adolescent Concussion: Overview and Role of Neuroimaging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6274. [PMID: 37444121 PMCID: PMC10341732 DOI: 10.3390/ijerph20136274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
Emotional dysregulation symptoms following a concussion are associated with an increased risk for emotional dysregulation disorders (e.g., depression and anxiety), especially in adolescents. However, predicting the emergence or worsening of emotional dysregulation symptoms after concussion and the extent to which this predates the onset of subsequent psychiatric morbidity after injury remains challenging. Although advanced neuroimaging techniques, such as functional magnetic resonance imaging and diffusion magnetic resonance imaging, have been used to detect and monitor concussion-related brain abnormalities in research settings, their clinical utility remains limited. In this narrative review, we have performed a comprehensive search of the available literature regarding emotional regulation, adolescent concussion, and advanced neuroimaging techniques in electronic databases (PubMed, Scopus, and Google Scholar). We highlight clinical evidence showing the heightened susceptibility of adolescents to experiencing emotional dysregulation symptoms following a concussion. Furthermore, we describe and provide empirical support for widely used magnetic resonance imaging modalities (i.e., functional and diffusion imaging), which are utilized to detect abnormalities in circuits responsible for emotional regulation. Additionally, we assess how these abnormalities relate to the emotional dysregulation symptoms often reported by adolescents post-injury. Yet, it remains to be determined if a progression of concussion-related abnormalities exists, especially in brain regions that undergo significant developmental changes during adolescence. We conclude that neuroimaging techniques hold potential as clinically useful tools for predicting and, ultimately, monitoring the treatment response to emotional dysregulation in adolescents following a concussion.
Collapse
Affiliation(s)
- João Paulo Lima Santos
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.J.-R.); (A.V.)
| | - Meilin Jia-Richards
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.J.-R.); (A.V.)
| | - Anthony P. Kontos
- Department of Orthopaedic Surgery, UPMC Sports Concussion Program, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.P.K.); (M.W.C.)
| | - Michael W. Collins
- Department of Orthopaedic Surgery, UPMC Sports Concussion Program, University of Pittsburgh, Pittsburgh, PA 15213, USA; (A.P.K.); (M.W.C.)
| | - Amelia Versace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (M.J.-R.); (A.V.)
| |
Collapse
|
4
|
Barela M, Wong A, Chamberlain R. Concussion and Psychological Effects: A Review of Recent Literature. Curr Sports Med Rep 2023; 22:24-28. [PMID: 36606633 DOI: 10.1249/jsr.0000000000001031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
ABSTRACT The aim of this article is to provide an up-to-date review of psychological changes in association with postconcussive athletes. In particular, this article focused on the symptomatology, risk factors, and treatment of psychiatric diagnoses in patients who suffered a sports-related concussion (SRC). After an extensive review of prior and current literature, there is significant evidence that demonstrates an association of changes in mood and behavior, including new or worsening symptoms of anxiety, depression, and difficulty with attention and concentration in those who are recovering from a concussion. The goal of care in these patients is to identify and treat these psychological symptoms early to have more favorable long-term outcomes. Primary treatment should focus on psychotherapy; however, other considerations may be warranted in certain cases, such as selective serotonin reuptake inhibitors for depression and tricyclic antidepressants and gabapentin for short-term cognitive symptom improvement.
Collapse
Affiliation(s)
- Matthew Barela
- University of New Mexico School of Medicine, Albuquerque, NM
| | - Allen Wong
- Department of Family & Community Medicine, University of New Mexico, Albuquerque, NM
| | - Rachel Chamberlain
- Department of Family & Community Medicine, University of New Mexico, Albuquerque, NM
| |
Collapse
|
5
|
A review of molecular and genetic factors for determining mild traumatic brain injury severity and recovery. BRAIN DISORDERS 2022. [DOI: 10.1016/j.dscb.2022.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
6
|
Ludwig R, Rippee M, D'Silva LJ, Radel J, Eakman AM, Morris J, Drerup M, Siengsukon C. Assessing Cognitive Behavioral Therapy for Insomnia to Improve Sleep Outcomes in Individuals With a Concussion: Protocol for a Delayed Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e38608. [PMID: 36149737 PMCID: PMC9547332 DOI: 10.2196/38608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sleep disturbances post concussion have been associated with more frequent and severe concussion symptoms and may contribute to poorer recovery. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for insomnia; however, it remains unclear if this treatment method is effective in improving sleep outcomes and reducing concomitant postconcussion symptoms. OBJECTIVE The hypotheses for this study are that (1) CBT-I will improve sleep outcomes and (2) CBT-I will improve concomitant postconcussion symptoms. METHODS In total, 40 individuals who are within ≥4 weeks of postconcussion injury and have insomnia symptoms will be enrolled in this randomized controlled trial. Participants will be randomized into either a group that starts a 6-week CBT-I program immediately after baseline or a waitlist control group that starts CBT-I following a 6-week waiting period. All participants will be reassessed 6, 12, and 18 weeks after baseline. Standardized assessments measuring sleep outcomes, postconcussion symptoms, and mood will be used. Linear regression and t tests will be used for statistical analyses. RESULTS Enrollment of 40 participants was completed July 2022, data collection will be completed in November 2022, and publication of main findings is anticipated in May 2023. It is anticipated that participants experience reduced insomnia symptoms and postconcussion symptoms following CBT-I and these improvements will be retained for at least 12 weeks. Additionally, we expect to observe a positive correlation between sleep and postconcussion symptom improvement. CONCLUSIONS Successful completion of this pilot study will allow for a better understanding of the treatment of insomnia and postconcussion symptoms in individuals following a concussion. TRIAL REGISTRATION ClinicalTrials.gov NCT04885205; https://clinicaltrials.gov/ct2/show/NCT04885205. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38608.
Collapse
Affiliation(s)
- Rebecca Ludwig
- Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, United States
| | - Michael Rippee
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Linda J D'Silva
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jeff Radel
- Department of Occupational Therapy and Therapeutic Science, University of Kansas Medical Center, Kansas City, KS, United States
| | - Aaron M Eakman
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, United States
| | - Jill Morris
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Michelle Drerup
- Cleveland Clinic, Neurological Institute, Sleep Disorders Center, Cleveland, OH, United States
| | - Catherine Siengsukon
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, United States
| |
Collapse
|
7
|
Ellingson CJ, Singh J, Ellingson CA, Sirant LW, Krätzig GP, Dorsch KD, Piskorski J, Neary JP. Alterations in Baroreflex Sensitivity and Blood Pressure Variability Following Sport-Related Concussion. Life (Basel) 2022; 12:life12091400. [PMID: 36143435 PMCID: PMC9500648 DOI: 10.3390/life12091400] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/23/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
Current methods to diagnose concussions are subjective and difficult to confirm. A variety of physiological biomarkers have been reported, but with conflicting results. This study assessed heart rate variability (HRV), spontaneous baroreflex sensitivity (BRS), and systolic blood pressure variability (BPV) in concussed athletes. The assessment consisted of a 5-min seated rest followed by a 5-min (0.1 Hz) controlled breathing protocol. Thirty participants completed baseline assessments. The protocol was repeated during the post-injury acute phase (days one to five). Total (p = 0.02) and low-frequency (p = 0.009) BPV spectral power were significantly decreased during the acute phase of concussion. BRS down-sequence (p = 0.036) and up-sequence (p = 0.05) were significantly increased in the acute phase of concussion, with a trend towards an increased BRS pooled (p = 0.06). Significant decreases in HRV were also found. Acute concussion resulted in altered BRS and BPV dynamics compared to baseline. These findings highlight objective physiological parameters that could aid concussion diagnosis and return-to-play protocols.
Collapse
Affiliation(s)
- Chase J. Ellingson
- Faculty of Kinesiology & Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Jyotpal Singh
- Faculty of Kinesiology & Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Cody A. Ellingson
- Faculty of Kinesiology & Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Luke W. Sirant
- College of Medicine, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB R3T 2N2, Canada
| | - Gregory P. Krätzig
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Kim D. Dorsch
- Faculty of Kinesiology & Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Jaroslaw Piskorski
- Institute of Physics, University of Zielona Góra, Licealna 9, 65-417 Zielona Góra, Poland
| | - J. Patrick Neary
- Faculty of Kinesiology & Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
- Correspondence: ; Tel.: +1-306-585-4844
| |
Collapse
|
8
|
Beppi C, Penner M, Straumann D, Bögli SY. A non-invasive biomechanical model of mild TBI in larval zebrafish. PLoS One 2022; 17:e0268901. [PMID: 35622781 PMCID: PMC9140253 DOI: 10.1371/journal.pone.0268901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/05/2022] [Indexed: 11/18/2022] Open
Abstract
A mild traumatic brain injury is a neurological dysfunction caused by biomechanical forces transmitted to the brain in physical impacts. The current understanding of the neuropathological cascade resulting in the manifested clinical signs and symptoms is limited due to the absence of sensitive brain imaging methods. Zebrafish are established models for the reproduction and study of neurobiological pathologies. However, all available models mostly recreate moderate-to-severe focal injuries in adult zebrafish. The present work has induced a mild brain trauma in larval zebrafish through a non-invasive biomechanical approach. A custom-made apparatus with a commercially available motor was employed to expose larvae to rapidly decelerating linear movements. The neurophysiological changes following concussion were assessed through behavioural quantifications of startle reflex locomotor distance and habituation metrics. Here we show that the injury was followed, within five minutes, by a transient anxiety state and CNS dysfunction manifested by increased startle responsivity with impaired startle habituation, putatively mirroring the human clinical sign of hypersensitivity to noise. Within a day after the injury, chronic effects arose, as evidenced by an overall reduced responsivity to sensory stimulation (lower amplitude and distance travelled along successive stimuli), reflecting the human post-concussive symptomatology. This study represents a step forward towards the establishment of a parsimonious (simple, less ethically concerning, yet sensitive) animal model of mild TBI. Our behavioural findings mimic aspects of acute and chronic effects of human concussion, which warrant further study at molecular, cellular and circuit levels. While our model opens wide avenues for studying the underlying cellular and molecular pathomechanisms, it also enables high-throughput testing of therapeutic interventions to accelerate post-concussive recovery.
Collapse
Affiliation(s)
- Carolina Beppi
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
- * E-mail:
| | - Marco Penner
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Dominik Straumann
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Stefan Yu Bögli
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| |
Collapse
|
9
|
Jacob D, Unnsteinsdóttir Kristensen IS, Aubonnet R, Recenti M, Donisi L, Ricciardi C, Svansson HÁR, Agnarsdóttir S, Colacino A, Jónsdóttir MK, Kristjánsdóttir H, Sigurjónsdóttir HÁ, Cesarelli M, Eggertsdóttir Claessen LÓ, Hassan M, Petersen H, Gargiulo P. Towards defining biomarkers to evaluate concussions using virtual reality and a moving platform (BioVRSea). Sci Rep 2022; 12:8996. [PMID: 35637235 PMCID: PMC9151646 DOI: 10.1038/s41598-022-12822-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Current diagnosis of concussion relies on self-reported symptoms and medical records rather than objective biomarkers. This work uses a novel measurement setup called BioVRSea to quantify concussion status. The paradigm is based on brain and muscle signals (EEG, EMG), heart rate and center of pressure (CoP) measurements during a postural control task triggered by a moving platform and a virtual reality environment. Measurements were performed on 54 professional athletes who self-reported their history of concussion or non-concussion. Both groups completed a concussion symptom scale (SCAT5) before the measurement. We analyzed biosignals and CoP parameters before and after the platform movements, to compare the net response of individual postural control. The results showed that BioVRSea discriminated between the concussion and non-concussion groups. Particularly, EEG power spectral density in delta and theta bands showed significant changes in the concussion group and right soleus median frequency from the EMG signal differentiated concussed individuals with balance problems from the other groups. Anterior-posterior CoP frequency-based parameters discriminated concussed individuals with balance problems. Finally, we used machine learning to classify concussion and non-concussion, demonstrating that combining SCAT5 and BioVRSea parameters gives an accuracy up to 95.5%. This study is a step towards quantitative assessment of concussion.
Collapse
Affiliation(s)
- Deborah Jacob
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | | | - Romain Aubonnet
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - Marco Recenti
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - Leandro Donisi
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
- Department of Chemical, Materials and Production Engineering, University of Naples Federico II, Naples, Italy
| | - Carlo Ricciardi
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
| | - Halldór Á R Svansson
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - Sólveig Agnarsdóttir
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - Andrea Colacino
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
- Department of Computer Engineering, Electrical and Applied Mathematics, University of Salerno, Salerno, Italy
| | - María K Jónsdóttir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
- Landspitali National University Hospital of Iceland, Reykjavik, Iceland
| | - Hafrún Kristjánsdóttir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
- Physical Activity, Physical Education, Sport and Health (PAPESH) Research Centre, Sports Science Department, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
| | - Helga Á Sigurjónsdóttir
- Landspitali National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Mario Cesarelli
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
- Department of Information Technology and Electrical Engineering, University of Naples, Naples, Italy
| | - Lára Ósk Eggertsdóttir Claessen
- Landspitali National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Mahmoud Hassan
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
- MINDig, 35000, Rennes, France
| | - Hannes Petersen
- Department of Anatomy, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Akureyri Hospital, Akureyri, Iceland
| | - Paolo Gargiulo
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland.
- Department of Science, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland.
| |
Collapse
|
10
|
Bui LA, Yeboah D, Steinmeister L, Azizi S, Hier DB, Wunsch DC, Olbricht GR, Obafemi-Ajayi T. Heterogeneity in Blood Biomarker Trajectories After Mild TBI Revealed by Unsupervised Learning. IEEE/ACM TRANSACTIONS ON COMPUTATIONAL BIOLOGY AND BIOINFORMATICS 2022; 19:1365-1378. [PMID: 34166200 DOI: 10.1109/tcbb.2021.3091972] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Concussions, also known as mild traumatic brain injury (mTBI), are a growing health challenge. Approximately four million concussions are diagnosed annually in the United States. Concussion is a heterogeneous disorder in causation, symptoms, and outcome making precision medicine approaches to this disorder important. Persistent disabling symptoms sometimes delay recovery in a difficult to predict subset of mTBI patients. Despite abundant data, clinicians need better tools to assess and predict recovery. Data-driven decision support holds promise for accurate clinical prediction tools for mTBI due to its ability to identify hidden correlations in complex datasets. We apply a Locality-Sensitive Hashing model enhanced by varied statistical methods to cluster blood biomarker level trajectories acquired over multiple time points. Additional features derived from demographics, injury context, neurocognitive assessment, and postural stability assessment are extracted using an autoencoder to augment the model. The data, obtained from FITBIR, consisted of 301 concussed subjects (athletes and cadets). Clustering identified 11 different biomarker trajectories. Two of the trajectories (rising GFAP and rising NF-L) were associated with a greater risk of loss of consciousness or post-traumatic amnesia at onset. The ability to cluster blood biomarker trajectories enhances the possibilities for precision medicine approaches to mTBI.
Collapse
|
11
|
Smeha N, Kalkat R, Sergio LE, Hynes LM. Sex-related differences in visuomotor skill recovery following concussion in working-aged adults. BMC Sports Sci Med Rehabil 2022; 14:72. [PMID: 35443693 PMCID: PMC9022305 DOI: 10.1186/s13102-022-00466-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The ability to perform visually-guided motor tasks requires the transformation of visual information into programmed motor outputs. When the guiding visual information does not align spatially with the motor output, the brain processes rules to integrate somatosensory information into an appropriate motor response. Performance on such rule-based, "cognitive-motor integration" tasks is affected in concussion. Here, we investigate the relationship between visuomotor skill performance, concussion history, and sex during the course of a post-concussion management program. METHODS Fifteen acutely concussed working-aged adults, 11 adults with a history of concussion, and 17 healthy controls all completed a recovery program over the course of 4 weeks. Prior to, mid-way, and following the program, all participants were tested on their visuomotor skills. RESULTS We observed an overall change in visuomotor behaviour in all groups, as participants completed the tasks faster and more accurately. Specifically, we observed significant visuomotor skill improvement between the first and final sessions in participants with a concussion history compared to no-concussion-history controls. Notably, we observed a stronger recovery of these skills in females. CONCLUSIONS Our findings indicate that (1) concussion impairs visuomotor skill performance, (2) the performance of complex, rule-based tasks showed improvement over the course of a recovery program, and (3) stronger recovery in females suggests sex-related differences in the brain networks controlling skilled performance, and the effect of injury on these networks.
Collapse
Affiliation(s)
- Nicole Smeha
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.,Centre for Vision Research, York University, Toronto, Canada
| | - Ravneet Kalkat
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Lauren E Sergio
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada. .,York University Sport Medicine Team, York University, Toronto, Canada. .,Centre for Vision Research, York University, Toronto, Canada.
| | - Loriann M Hynes
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.,York University Sport Medicine Team, York University, Toronto, Canada
| |
Collapse
|
12
|
Diaz-Pacheco V, Vargas-Medrano J, Tran E, Nicolas M, Price D, Patel R, Tonarelli S, Gadad BS. Prognosis and Diagnostic Biomarkers of Mild Traumatic Brain Injury: Current Status and Future Prospects. J Alzheimers Dis 2022; 86:943-959. [PMID: 35147534 DOI: 10.3233/jad-215158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Mild traumatic brain injury (mTBI) is the most prevalent type of TBI (80-90%). It is characterized by a loss consciousness for less than 30 minutes, post-traumatic amnesia for less than 24 hours, and Glasgow Coma Score of 13-15. Accurately diagnosing mTBIs can be a challenge because the majority of these injuries do not show noticeable or visible changes on neuroimaging studies. Appropriate determination of mTBI is tremendously important because it might lead in some cases to post-concussion syndrome, cognitive impairments including attention, memory, and speed of information processing problems. The scientists have studied different methods to improve mTBI diagnosis and enhanced approaches that would accurately determine the severity of the trauma. The present review focuses on discussing the role of biomarkers as potential key factors in diagnosing mTBI. The present review focuses on 1) protein based peripheral and CNS markers, 2) genetic biomarkers, 3) imaging biomarkers, 4) neurophysiological biomarkers, and 5) the studies and clinical trials in mTBI. Each section provides information and characteristics on different biomarkers for mTBI.
Collapse
Affiliation(s)
- Valeria Diaz-Pacheco
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA.,Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Javier Vargas-Medrano
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA.,Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Eric Tran
- Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Meza Nicolas
- Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Diamond Price
- The Chicago School of Professional Psychology, Irvine, CA, USA
| | - Richa Patel
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Silvina Tonarelli
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Bharathi S Gadad
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, USA.,Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, USA
| |
Collapse
|
13
|
Phybrata Sensors and Machine Learning for Enhanced Neurophysiological Diagnosis and Treatment. SENSORS 2021; 21:s21217417. [PMID: 34770729 PMCID: PMC8587627 DOI: 10.3390/s21217417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 11/29/2022]
Abstract
Concussion injuries remain a significant public health challenge. A significant unmet clinical need remains for tools that allow related physiological impairments and longer-term health risks to be identified earlier, better quantified, and more easily monitored over time. We address this challenge by combining a head-mounted wearable inertial motion unit (IMU)-based physiological vibration acceleration (“phybrata”) sensor and several candidate machine learning (ML) models. The performance of this solution is assessed for both binary classification of concussion patients and multiclass predictions of specific concussion-related neurophysiological impairments. Results are compared with previously reported approaches to ML-based concussion diagnostics. Using phybrata data from a previously reported concussion study population, four different machine learning models (Support Vector Machine, Random Forest Classifier, Extreme Gradient Boost, and Convolutional Neural Network) are first investigated for binary classification of the test population as healthy vs. concussion (Use Case 1). Results are compared for two different data preprocessing pipelines, Time-Series Averaging (TSA) and Non-Time-Series Feature Extraction (NTS). Next, the three best-performing NTS models are compared in terms of their multiclass prediction performance for specific concussion-related impairments: vestibular, neurological, both (Use Case 2). For Use Case 1, the NTS model approach outperformed the TSA approach, with the two best algorithms achieving an F1 score of 0.94. For Use Case 2, the NTS Random Forest model achieved the best performance in the testing set, with an F1 score of 0.90, and identified a wider range of relevant phybrata signal features that contributed to impairment classification compared with manual feature inspection and statistical data analysis. The overall classification performance achieved in the present work exceeds previously reported approaches to ML-based concussion diagnostics using other data sources and ML models. This study also demonstrates the first combination of a wearable IMU-based sensor and ML model that enables both binary classification of concussion patients and multiclass predictions of specific concussion-related neurophysiological impairments.
Collapse
|
14
|
King C, Coughlan E. Blowing the Whistle on Concussion Knowledge and Education in Youth Sport Referees. Open Access J Sports Med 2021; 12:109-117. [PMID: 34377036 PMCID: PMC8349549 DOI: 10.2147/oajsm.s324191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/27/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To gain an understanding of referee concussion knowledge, what sporting organizations were doing to prepare their referees to recognize concussions in youth sport, and what role referees could play in overall concussion safety. Materials and Methods A total of 134 referees participated in the study across four provincial sporting organizations (rugby, soccer, ice hockey, and football). Participants completed a concussion knowledge questionnaire that explored knowledge about concussion education, recognition, management, preparedness, and the role of the referee in overall concussion management. Results Overall, the sample was found to be moderately knowledgeable about concussions. Referees that received previous formal concussion education had statistically significant higher average scores when compared to those without formalized concussion education (P=0.001). However, only 24% of respondents reported receiving any formal education from their sporting body or referee organization. About 85% felt that referees could play an important role in concussion recognition in youth sport, but only 41% felt they were adequately equipped with the knowledge and skills to recognize these injuries. Conclusion The findings from this study suggest that national, provincial, and individual sporting organizations should ensure that all stakeholders (including referees) are formally educated about concussions to encourage a safety-first environment for youth athletes. Educational sessions should focus on the general aspects of SRC while also focusing on the specific role of the referee in concussion recognition.
Collapse
Affiliation(s)
- Colin King
- School of Kinesiology, Acadia University, Wolfville, NS, Canada
| | - Erin Coughlan
- School of Kinesiology, Acadia University, Wolfville, NS, Canada
| |
Collapse
|
15
|
Ludwig R, Nelson E, Vaduvathiriyan P, Rippee MA, Siengsukon C. Sleep quality in the chronic stage of concussion is associated with poorer recovery: A systematic review. JOURNAL OF CONCUSSION 2021. [DOI: 10.1177/20597002211020881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Recovery from a concussion varies based on a multitude of factors. One such factor is sleep disturbances. In our prior review, it was observed that in the acute phase, sleep disturbances are predictive of poor outcomes following a concussion. The literature gap remains on how sleep in the chronic phase of recovery affects outcomes. Objective To examine the association between sleep quality during the chronic stage of concussion and post-concussion outcomes. Literature Survey: Literature searches were performed during 1 July to 1 August 2019 in selected databases along with searching grey literature. Out of the 733 results, 702 references were reviewed after duplicate removal. Methods Three reviewers independently reviewed and consented on abstracts meeting eligibility criteria ( n = 35). The full-text articles were assessed independently by two reviewers. Consensus was achieved, leaving four articles. Relevant data from each study was extracted using a standard data-extraction table. Quality appraisal was conducted to assess potential bias and the quality of articles. Results One study included children (18–60 months) and three studies included adolescents and/or adults (ranging 12–35 years). The association between sleep and cognition (two studies), physical activity (one study), and emotion symptoms (one study) was examined. Sleep quality was associated with decreased cognition and emotional symptoms, but not with meeting physical activity guidelines six months post-concussion injury. Conclusions The heterogeneity in age of participants and outcomes across studies and limited number of included studies made interpretations difficult. Future studies may consider if addressing sleep quality following concussion will improve outcomes.
Collapse
Affiliation(s)
- Rebecca Ludwig
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Eryen Nelson
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Michael A Rippee
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Catherine Siengsukon
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
16
|
Caswell SV, Kelshaw PM, Lincoln AE, Herman DC, Hepburn LH, Vincent HK, Dunn RE, Cortes N. The Effects of Headgear in High School Girls' Lacrosse. Orthop J Sports Med 2021; 8:2325967120969685. [PMID: 33447621 PMCID: PMC7780324 DOI: 10.1177/2325967120969685] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Girls’ lacrosse headgear that met the ASTM International performance standard (ASTM F3137) became available in 2017. However, the effects of headgear use on impact forces during game play are unknown. Purpose: To evaluate potential differences in rates, magnitudes, and game-play characteristics associated with verified impacts among players with and without headgear during competition. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 49 female high school participants (mean age, 16.2 ± 1.2 years; mean height, 1.66 ± 0.05 m; mean weight, 61.2 ± 6.4 kg) volunteered for this study, which took place during the 2016 (no headgear; 18 games) and 2017 (headgear; 15 games) seasons. Wearable sensors synchronized with video verification were used. Descriptive statistics, impact rates, and chi-square analyses described impacts and game-play characteristics among players with and without headgear. Differences in mean peak linear acceleration (PLA) and peak rotational velocity (PRV) between the no headgear and headgear conditions were evaluated using a linear generalized estimating equation regression model to control for repeated within-player measurements. Results: Overall, 649 sensor-instrumented player-games were recorded. A total of 204 impacts ≥20g recorded by the wearable sensors were verified with video analysis (102 no headgear; 102 headgear). Most impacts were imparted to the player’s body (n = 152; 74.5%) rather than to the player’s head (n = 52; 25.5%). Impact rates per player-game did not vary between the no headgear and headgear conditions (0.30 vs 0.34, respectively; impact rate ratio, 0.88 [95% CI, 0.37-2.08]). There was no association between impact frequency by mechanism or penalties administered between the no headgear and headgear conditions for overall or direct head impacts. The generalized estimating equation model estimated a significant reduction in mean impact magnitudes overall (PLA: –7.9g [95% CI, –13.3 to –2.5]; PRV: –212 deg/s [95% CI, –359 to –64]) with headgear relative to no headgear. No game-related concussions were reported during this study. Conclusion: Lacrosse headgear use was associated with a reduction in the magnitude of overall impacts but not a significant change in the rate of impacts, how they occur, or how penalties were administered for impacts sustained during competition. Further research is needed with a larger sample and different levels of play to evaluate the consequences of headgear use in girls’ lacrosse.
Collapse
Affiliation(s)
- Shane V Caswell
- Sports Medicine Assessment Research and Testing (SMART) Laboratory, School of Kinesiology, George Mason University, Fairfax, Virginia, USA
| | - Patricia M Kelshaw
- Sports Medicine Assessment Research and Testing (SMART) Laboratory, School of Kinesiology, George Mason University, Fairfax, Virginia, USA.,Department of Kinesiology, College of Health and Human Services, University of New Hampshire, Durham, New Hampshire, USA
| | - Andrew E Lincoln
- MedStar Sports Medicine Research Center, MedStar Health, Baltimore, Maryland, USA.,Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Daniel C Herman
- Divisions of Physical Medicine & Rehabilitation, Sports Medicine, and Research, Department of Orthopaedics and Rehabilitation, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Lisa H Hepburn
- MedStar Sports Medicine Research Center, MedStar Health, Baltimore, Maryland, USA
| | - Heather K Vincent
- Human Performance Laboratory and Sports Performance Center, University of Florida, Gainesville, Florida, USA
| | - Reginald E Dunn
- MedStar Sports Medicine Research Center, MedStar Health, Baltimore, Maryland, USA
| | - Nelson Cortes
- Sports Medicine Assessment Research and Testing (SMART) Laboratory, School of Kinesiology, George Mason University, Fairfax, Virginia, USA
| |
Collapse
|
17
|
Di Battista AP, Churchill N, Rhind SG, Richards D, Hutchison MG. The relationship between symptom burden and systemic inflammation differs between male and female athletes following concussion. BMC Immunol 2020; 21:11. [PMID: 32164571 PMCID: PMC7068899 DOI: 10.1186/s12865-020-0339-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/26/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Inflammation appears to be an important component of concussion pathophysiology. However, its relationship to symptom burden is unclear. Therefore, the purpose of this study was to evaluate the relationship between symptoms and inflammatory biomarkers measured in the blood of male and female athletes following a sport-related concussion (SRC). RESULTS Forty athletes (n = 20 male, n = 20 female) from nine interuniversity sport teams at a single institution provided blood samples within one week of an SRC. Twenty inflammatory biomarkers were quantitated by immunoassay. The Sport Concussion Assessment Tool version 5 (SCAT-5) was used to evaluate symptoms. Partial least squares (PLS) analyses were used to evaluate the relationship(s) between biomarkers and symptoms. In males, a positive correlation between interferon (IFN)-γ and symptom severity was observed following SRC. The relationship between IFN-γ and symptoms was significant among all symptom clusters, with cognitive symptoms displaying the largest effect. In females, a significant negative relationship was observed between symptom severity and cytokines IFN-γ, tumor necrosis factor (TNF)-α, and myeloperoxidase (MPO); a positive relationship was observed between symptom severity and MCP-4. Inflammatory mediators were significantly associated with all symptom clusters in females; the somatic symptom cluster displayed the largest effect. CONCLUSION These results provide supportive evidence of a divergent relationship between inflammation and symptom burden in male and female athletes following SRC. Future investigations should be cognizant of the potentially sex-specific pathophysiology underlying symptom presentation.
Collapse
Affiliation(s)
- Alex P Di Battista
- Faculty of Kinesiology & Physical Education, University of Toronto, 55 Harbord St., Toronto, ON, M5S 2W6, Canada.
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada.
| | - Nathan Churchill
- Neuroscience Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada
| | - Shawn G Rhind
- Faculty of Kinesiology & Physical Education, University of Toronto, 55 Harbord St., Toronto, ON, M5S 2W6, Canada
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Doug Richards
- Faculty of Kinesiology & Physical Education, University of Toronto, 55 Harbord St., Toronto, ON, M5S 2W6, Canada
- David L. MacIntosh Sport Medicine Clinic, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
| | - Michael G Hutchison
- Faculty of Kinesiology & Physical Education, University of Toronto, 55 Harbord St., Toronto, ON, M5S 2W6, Canada
- David L. MacIntosh Sport Medicine Clinic, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada
| |
Collapse
|
18
|
Stuart S, Parrington L, Martini D, Peterka R, Chesnutt J, King L. The Measurement of Eye Movements in Mild Traumatic Brain Injury: A Structured Review of an Emerging Area. Front Sports Act Living 2020; 2:5. [PMID: 33345000 PMCID: PMC7739790 DOI: 10.3389/fspor.2020.00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/08/2020] [Indexed: 11/13/2022] Open
Abstract
Mild traumatic brain injury (mTBI), or concussion, occurs following a direct or indirect force to the head that causes a change in brain function. Many neurological signs and symptoms of mTBI can be subtle and transient, and some can persist beyond the usual recovery timeframe, such as balance, cognitive or sensory disturbance that may pre-dispose to further injury in the future. There is currently no accepted definition or diagnostic criteria for mTBI and therefore no single assessment has been developed or accepted as being able to identify those with an mTBI. Eye-movement assessment may be useful, as specific eye-movements and their metrics can be attributed to specific brain regions or functions, and eye-movement involves a multitude of brain regions. Recently, research has focused on quantitative eye-movement assessments using eye-tracking technology for diagnosis and monitoring symptoms of an mTBI. However, the approaches taken to objectively measure eye-movements varies with respect to instrumentation, protocols and recognition of factors that may influence results, such as cognitive function or basic visual function. This review aimed to examine previous work that has measured eye-movements within those with mTBI to inform the development of robust or standardized testing protocols. Medline/PubMed, CINAHL, PsychInfo and Scopus databases were searched. Twenty-two articles met inclusion/exclusion criteria and were reviewed, which examined saccades, smooth pursuits, fixations and nystagmus in mTBI compared to controls. Current methodologies for data collection, analysis and interpretation from eye-tracking technology in individuals following an mTBI are discussed. In brief, a wide range of eye-movement instruments and outcome measures were reported, but validity and reliability of devices and metrics were insufficiently reported across studies. Interpretation of outcomes was complicated by poor study reporting of demographics, mTBI-related features (e.g., time since injury), and few studies considered the influence that cognitive or visual functions may have on eye-movements. The reviewed evidence suggests that eye-movements are impaired in mTBI, but future research is required to accurately and robustly establish findings. Standardization and reporting of eye-movement instruments, data collection procedures, processing algorithms and analysis methods are required. Recommendations also include comprehensive reporting of demographics, mTBI-related features, and confounding variables.
Collapse
Affiliation(s)
- Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Lucy Parrington
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Douglas Martini
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Robert Peterka
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
- National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - James Chesnutt
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States
- Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, United States
| | - Laurie King
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
| |
Collapse
|