1
|
Oyekan AA, Eagle S, Trbovich AM, Shaw JD, Schneider M, Collins M, Lee JY, Kontos AP. Neck Symptoms and Associated Clinical Outcomes in Patients Following Concussion. J Head Trauma Rehabil 2023; 38:417-424. [PMID: 36854136 PMCID: PMC10619635 DOI: 10.1097/htr.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To examine the frequency and association of neck pain symptoms in patients with a concussion. STUDY SETTING AND PARTICIPANTS Three-hundred and thirty-one consecutively enrolled patients aged 9 to 68 years with a diagnosed concussion 1 to 384 days post-injury were enrolled at a concussion clinic from a single integrated healthcare system in Western Pennsylvania between 2019 and 2021. DESIGN Retrospective cohort analysis of prospectively collected concussion screening tool intake survey responses and clinical outcomes data. The primary outcome was self-reported neck pain or difficulty with neck movement on the Concussion Clinical Profiles Screening (CP Screen) tool, recovery time, and incidence of treatment referral. Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) composite scores, Vestibular/Ocular Motor Screening (VOMS) item scores, type and severity of neck symptoms, mechanism of injury, time from injury to clinic presentation, medical history, and concussion symptom profile were secondary outcomes. RESULTS Of the 306 consecutively enrolled eligible patients in the registry, 145 (47%) reported neck pain, 68 (22.2%) reported difficulty moving their neck, and 146 (47.7%) reported either symptom. A total of 47 (15.4%) participants reported more severe neck symptoms, and this group took longer to recover (40 ± 27 days) than those not reporting neck symptoms (30 ± 28 days; U = 8316, P < .001). Stepwise logistic regression predicting more severe neck symptoms was significant (Nagelkerke R2 = 0.174, χ 2 = 9.315, P = .316) with older age ( P = .019) and mechanism of injury including motor vehicle collisions (MVCs) ( P = .047) and falls ( P = .044) as risk factors. MVCs and falls were associated with over 4 times and 2 times greater risk, respectively, for reporting more severe neck symptoms. CONCLUSION Neck pain and stiffness symptoms are common in patients with a concussion following high-energy mechanisms of injury including MVCs or falls from height. These symptoms are associated with prolonged recovery. Providers should evaluate neck symptoms and consider targeted treatment strategies to limit their effects in patients with a concussion.
Collapse
Affiliation(s)
- Anthony A Oyekan
- Departments of Orthopaedic Surgery (Drs Oyekan, Trbovich, Shaw, Collins, Lee, and Kontos) and Physical Therapy (Dr Schneider), University of Pittsburgh, Pittsburgh, Pennsylvania; Pittsburgh Ortho Spine Research Group, University of Pittsburgh, Pittsburgh, Pennsylvania (Drs Oyekan, Shaw, and Lee); Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Eagle); and UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania (Drs Trbovich, Collins, and Kontos)
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Pashaei M, Babakhani F, Banihashemi K. Evaluation of surface electromyography of selected neck muscles during the whiplash mechanism in aware and unaware conditions due to safe punching in kickboxing. BMC Musculoskelet Disord 2023; 24:429. [PMID: 37254094 DOI: 10.1186/s12891-023-06563-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/20/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Kickboxing is considered as a combat sport in progress, in which injuries are frequent and significant, and close injury monitoring is highly recommended. Sports injuries to the head and neck are estimated to cause 70% deaths and 20% permanent disabilities although they are much less common than those to the limbs. Whiplash mechanism involves the rapid extension (opening) and flexion (bending) of neck. The purpose of the current study was to investigate the electromyographic activity of selected muscles in the whiplash mechanism in aware and unaware conditions of the safe punching in kickboxing so that we can design special exercises. METHOD In the present study, 24 male kickboxing athletes aged 18-40 years were selected based on a purposive sampling method. The surface electromyography (EMG) signals of muscles were recorded with and without awareness of safe punching by using a nine-channel wireless EMG device. Additionally, a nine-channel 3D inertial measurement unit (IMU, wireless,) was utilized to determine the acceleration, kinematics, and angular velocity of the subjects' head. The statistical dependent t-test was applied to compare the EMG activity of each muscle, as well as its participation ratio. RESULTS The results of statistical analysis represented a significant increase in the EMG activity of sternocleidomastoid (p = 0.001), upper trapezius (p = 0.001) and cervical erector spinae muscles (p = 0.001), as well as the neck extension and flexion angles between the athletes aware (open eyes) and unaware (closed eyes) of the safe punching. CONCLUSION In this study, the EMG activity of the sternocleidomastoid, upper trapezius, and cervical erector spine muscles in the aware condition was significantly different from the activity under unaware condition. In fact, the intended muscles exhibited significantly different behaviors in preventing extension and flexion in the two conditions.
Collapse
Affiliation(s)
- Mosa Pashaei
- Department of Sport Injuries and Corrective Exercises, Faculty of Physical education and sport science, Allameh Tabataba'i University, Tehran, Iran
| | - Farideh Babakhani
- Department of Sport Injuries and Corrective Exercises, Faculty of Physical education and sport science, Allameh Tabataba'i University, Tehran, Iran.
| | - Kambiz Banihashemi
- Department of Sport Injuries and Corrective Exercises, Faculty of Physical education and sport science, Allameh Tabataba'i University, Tehran, Iran
| |
Collapse
|
3
|
Carmo GP, Grigioni J, Fernandes FAO, Alves de Sousa RJ. Biomechanics of Traumatic Head and Neck Injuries on Women: A State-of-the-Art Review and Future Directions. BIOLOGY 2023; 12:biology12010083. [PMID: 36671775 PMCID: PMC9855362 DOI: 10.3390/biology12010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023]
Abstract
The biomechanics of traumatic injuries of the human body as a consequence of road crashes, falling, contact sports, and military environments have been studied for decades. In particular, traumatic brain injury (TBI), the so-called "silent epidemic", is the traumatic insult responsible for the greatest percentage of death and disability, justifying the relevance of this research topic. Despite its great importance, only recently have research groups started to seriously consider the sex differences regarding the morphology and physiology of women, which differs from men and may result in a specific outcome for a given traumatic event. This work aims to provide a summary of the contributions given in this field so far, from clinical reports to numerical models, covering not only the direct injuries from inertial loading scenarios but also the role sex plays in the conditions that precede an accident, and post-traumatic events, with an emphasis on neuroendocrine dysfunctions and chronic traumatic encephalopathy. A review on finite element head models and finite element neck models for the study of specific traumatic events is also performed, discussing whether sex was a factor in validating them. Based on the information collected, improvement perspectives and future directions are discussed.
Collapse
Affiliation(s)
- Gustavo P. Carmo
- Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Jeroen Grigioni
- Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Fábio A. O. Fernandes
- Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal
- LASI—Intelligent Systems Associate Laboratory, 4800-058 Guimaraes, Portugal
| | - Ricardo J. Alves de Sousa
- Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal
- LASI—Intelligent Systems Associate Laboratory, 4800-058 Guimaraes, Portugal
- Correspondence: ; Tel.: +351-234-370-200
| |
Collapse
|
4
|
Migotto BDJ, Gill S, Sem M, Macpherson AK, Hynes LM. Sex-related differences in sternocleidomastoid muscle morphology in healthy young adults: A cross-sectional magnetic resonance imaging measurement study. Musculoskelet Sci Pract 2022; 61:102590. [PMID: 35667320 DOI: 10.1016/j.msksp.2022.102590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Changes in sternocleidomastoid (SCM) muscle cross-sectional area (CSA) and volume may contribute to neck-related concussion symptoms and whiplash-associated disorders. Magnetic resonance imaging (MRI) data on healthy SCM morphology can provide information that may lead to targeted treatment protocols. OBJECTIVES To examine sex-related differences in MRI-based SCM CSA, SCM volume and neck area in healthy young adults, to analyze associations between measurements and participant variables and to assess inter-rater reliability for measurement quantification. DESIGN Cross-sectional study. METHODS 13 males and 14 females underwent MRI scans. Slices obtained from C3-C7 were analyzed by three raters. SCM CSA at C4, total SCM volume from C3-C7 and neck area at C4 were quantified. Measurements were calculated as absolute and normalized values by body mass. Multivariable regression was used to analyze associations between normalized measurement values and participant variables. Inter-rater reliability was determined using intraclass correlation coefficients (ICC). RESULTS Females had significantly lower normalized overall average SCM CSA (mean difference 1.3 mm2/kg (95% CI 0.4-2.2, p = 0.006) and total SCM volume (mean difference 140.8 mm3/kg (95% CI 66.1-215.5, p < 0.001) than males. Regression models indicated female sex was associated with lower normalized overall average SCM CSA (p = 0.004) and total SCM volume (p < 0.001). Inter-rater reliability was excellent for SCM CSA (ICC3,3 = 0.909), SCM volume (ICC3,3 = 0.910) and neck area (ICC3,3 = 0.995). CONCLUSIONS These results enhance our understanding of sex-related differences in SCM morphology and will inform future research and clinical practice related to cervical muscle injury.
Collapse
Affiliation(s)
- Ben D J Migotto
- Whiplash and Head Injury Prevention/Rehabilitation (WHIPR) Lab, York University, 4700, Keele Street, Toronto, ON, M3J 1P3, Canada; School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Sandeep Gill
- Whiplash and Head Injury Prevention/Rehabilitation (WHIPR) Lab, York University, 4700, Keele Street, Toronto, ON, M3J 1P3, Canada; School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Matthew Sem
- Whiplash and Head Injury Prevention/Rehabilitation (WHIPR) Lab, York University, 4700, Keele Street, Toronto, ON, M3J 1P3, Canada; School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Alison K Macpherson
- School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada; York University Sport Medicine Team, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Loriann M Hynes
- Whiplash and Head Injury Prevention/Rehabilitation (WHIPR) Lab, York University, 4700, Keele Street, Toronto, ON, M3J 1P3, Canada; School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada; York University Sport Medicine Team, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| |
Collapse
|
5
|
Papa L, Johnson B, Walter AE, Wilkes JR, Knollmann-Ritschel B, Bhomia M, Slobounov SM. Decreases in Dorsal Cervical Spinal Cord White Matter Tract Integrity Are Associated with Elevated Levels of Serum MicroRNA Biomarkers in NCAA Division I Collegiate Football Players. Neurotrauma Rep 2021; 2:476-487. [PMID: 34901943 PMCID: PMC8655801 DOI: 10.1089/neur.2021.0036] [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] [Indexed: 11/07/2022] Open
Abstract
This prospective, controlled, observational cohort study assessed the performance of a novel panel of serum microRNA (miRNA) biomarkers relative to findings on cervical spinal cord magnetic resonance imaging (MRI) in collegiate football players. There were 44 participants included in the study: 30 non-athlete control subjects and 14 male collegiate football athletes participating in a Division I Football Bowl Subdivision of the National Collegiate Athletic Association. Diffuse tensor MRI and blood samples were acquired within the week before the athletic season began and within the week after the last game of the season. All miRNAs were significantly higher in athletes regardless of their fractional anisotropy (FA) values (p < 0.001), even those considered to be in the “normal” range of FA for white and gray matter integrity in the cervical spinal cord. miRNA biomarkers were most significantly correlated with FA of the white matter (WM) tracts of the dorsal (posterior) spinal cord; particularly, the fasciculus gracilis, fasciculus cuneatus, lateral corticospinal tract, rubrospinal tract, lateral reticulospinal tract, spinal lemniscus, and spinothalamic and -reticular tracts. Areas under the curve for miRNA biomarkers predicting lower FA of WM dorsal (posterior) cervical spinal tracts, therefore lower white matter integrity (connectivity), were miR-505* = 0.75 (0.54–0.96), miR-30d = 0.74 (0.52–0.95), and miR-92a = 0.75 (0.53–0.98). Should these findings be replicated in a larger cohort of athletes, these markers could potentially serve as measures of neuroimaging abnormalities in athletes at risk for concussion and subconcussive injuries to the cervical spinal cord.
Collapse
Affiliation(s)
- Linda Papa
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Brian Johnson
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alexa E Walter
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James R Wilkes
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Manish Bhomia
- Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Semyon M Slobounov
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
| |
Collapse
|
6
|
Swenson AG, Pritchard NS, Miller LE, Urban JE, Stitzel JD. Characterization of head impact exposure in boys' youth ice hockey. Res Sports Med 2021:1-11. [PMID: 34689676 DOI: 10.1080/15438627.2021.1989433] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ice hockey has one of the highest concussion rates among youth sports. Sensor technology has been implemented in contact and collision sports to inform the frequency and severity of head impacts experienced on-ice. However, existing studies have utilized helmet-mounted sensors with limited accuracy. The objective of this study was to characterize head kinematics of contact events in a sample of youth boys' hockey players using a validated instrumented mouthpiece with improved accuracy. Head kinematics from 892 video-verified events were recorded from 18 athletes across 127 sessions. Median peak resultant linear acceleration, rotational velocity, and rotational acceleration of video-verified events were 7.4 g, 7.7 rad/s, and 576 rad/s2, respectively. Contact events occurred at a higher rate in games (2.48 per game) than practices (1.30 per practice). Scenarios involving head contact had higher peak kinematics than those without head contact. This study improves our understanding of head kinematics in boys' youth hockey.
Collapse
Affiliation(s)
- Abigail G Swenson
- Department of Neuroscience, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - N Stewart Pritchard
- Virginia Tech, Wake Forest University School of Biomedical Engineering and Sciences, Winston Salem, NC, USA
| | - Logan E Miller
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Jillian E Urban
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Joel D Stitzel
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston Salem, NC, USA
| |
Collapse
|
7
|
Carey L, Terry DP, McIntosh AS, Stanwell P, Iverson GL, Gardner AJ. Video Analysis and Verification of Direct Head Impacts Recorded by Wearable Sensors in Junior Rugby League Players. SPORTS MEDICINE - OPEN 2021; 7:66. [PMID: 34529180 PMCID: PMC8446122 DOI: 10.1186/s40798-021-00353-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Rugby league is a high-intensity collision sport that carries a risk of concussion. Youth athletes are considered to be more vulnerable and take longer to recover from concussion than adult athletes. PURPOSE To review head impact events in elite-level junior representative rugby league and to verify and describe characteristics of X-patchTM-recorded impacts via video analysis. STUDY DESIGN Observational case series. METHODS The X-patchTM was used on twenty-one adolescent players (thirteen forwards and eight backs) during a 2017 junior representative rugby league competition. Game-day footage, recorded by a trained videographer from a single camera, was synchronised with X-patchTM-recorded timestamped events. Impacts were double verified by video review. Impact rates, playing characteristics, and gameplay situations were described. RESULTS The X-patchTM-recorded 624 impacts ≥ 20g between game start and finish, of which 564 (90.4%) were verified on video. Upon video review, 413 (73.2%) of all verified impacts ≥ 20g where determined to be direct head impacts. Direct head impacts ≥ 20g occurred at a rate of 5.2 impacts per game hour; 7.6 for forwards and 3.0 for backs (range = 0-18.2). A defender's arm directly impacting the head of the ball carrier was the most common event, accounting for 21.3% (n = 120) of all impacts, and 46.7% of all "hit-up" impacts. There were no medically diagnosed concussions during the competition. CONCLUSION The majority (90.4%) of head impacts ≥ 20g recorded by the X-patchTM sensor were verified by video. Double verification of direct head impacts in addition to cross-verification of sensor-recorded impacts using a secondary source such as synchronised video review can be used to ensure accuracy and validation of data.
Collapse
Affiliation(s)
- Lauchlan Carey
- Centre for Stroke and Brain Injury, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Douglas P Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- MassGeneral Hospital for Children™ Sports Concussion Program, Boston, Massachusetts, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Andrew S McIntosh
- School of Engineering and Australian Collaboration for Research into Injury in Sport and its Prevention, Edith Cowan University, Perth, Australia
| | - Peter Stanwell
- Centre for Stroke and Brain Injury, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- MassGeneral Hospital for Children™ Sports Concussion Program, Boston, Massachusetts, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Andrew J Gardner
- Centre for Stroke and Brain Injury, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia.
- Hunter New England Local Health District Sports Concussion Program, Waratah, NSW, Australia.
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, Callaghan, NSW, Australia.
- Hunter Medical Research Institute, New Lambtom Height, NSW, Australia.
| |
Collapse
|
8
|
Injury Reduction Programs for Reducing the Incidence of Sport-Related Head and Neck Injuries Including Concussion: A Systematic Review. Sports Med 2021; 51:2373-2388. [PMID: 34143411 DOI: 10.1007/s40279-021-01501-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sport-related head and neck injuries, including concussion, are a growing global public health concern with a need to explore injury risk reduction strategies such as neck exercises. OBJECTIVES To systematically review the literature to investigate: (1) the relationship between neck strength and sport-related head and neck injuries (including sport-related concussion (SRC); and (2) whether neck exercise programs can reduce the incidence of (a) sport-related head and neck injuries; and (b) SRC. METHODS Five databases (Ovid MEDLINE, CINAHL, EMBASE, SPORTDiscus, and Web of Science) and research lists of included studies were searched using a combination of medical subject headings and keywords to locate original studies which reported the association between incidence of head and/or neck injury and neck strength data, or included a neck exercise intervention either in isolation or as part of a more comprehensive exercise program. RESULTS From an initial search of 593 studies, six were included in this review. A narrative synthesis was performed due to the heterogeneity of the included studies. The results of two observational studies reported that higher neck strength, but not deep neck flexor endurance, is associated with a lower risk of sustaining a SRC. Four intervention studies demonstrated that injury reduction programs that included neck exercises can reduce the incidence of sport-related head and neck injuries including SRC. CONCLUSION Consideration should be given towards incorporating neck exercises into injury reduction exercise programs to reduce the incidence of sport-related head and neck injuries, including SRC. SYSTEMATIC REVIEW REGISTRATION PROSPERO (registration number: 194217).
Collapse
|
9
|
Gil C, Decq P. How similar are whiplash and mild traumatic brain injury? A systematic review. Neurochirurgie 2021; 67:238-243. [PMID: 33529694 DOI: 10.1016/j.neuchi.2021.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Mild traumatic brain injury (mTBI) and whiplash are two pathologies which appear in the follow-up of a cranio-cervical trauma. The objective of this study is to review their definitions, to discuss each entity. METHODS Whiplash and mTBI were defined. Then, a systematic literature review was carried out using the Pubmed database. Relevant studies after 1995 were selected, with 16 articles describing a link between whiplash and mTBI. 8 articles were analyzed after reading their abstracts. RESULTS Whiplash and mTBI have many similarities (symptoms, biomechanics, cognitive disorders, presence of diffuse axonal lesions on functional imaging) and some differences (in posture, more vestibular and balance disorders in whiplash). mTBIs result from linear accelerations between 60- 160g (gravity), studies on whiplash have shown that they can appear from 4.5g, which could explain biomechanically the frequent concomitant appearance. Cervical joint dysfunction can appear in persistent concussive syndrome, with upper cervical pain, less endurance of the cervical flexor muscles, and an increase in cervical stiffness leading to tension headache. This could explain neck pain in mTBI and headache in whiplash. An explanation to vestibular and cochlear disorders is given, and the two pathologies concomitantly could increase the symptoms. CONCLUSION To our knowledge, no studies define distinct boundaries between these two pathologies, which overlap on many points. An explanation is their concomitant onset, due to the biomechanics of the trauma and anatomical reasons. Larger-scale studies of rigorous scientific quality are needed to answer the question of the difference between whiplash and mTBI.
Collapse
Affiliation(s)
- C Gil
- Department of rheumatology and rehabilitation, hôpitaux nationaux de Saint-Maurice, 12/14, rue du Val-d'Osne, 94410 Saint-Maurice, France.
| | - P Decq
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of neurosurgery, Beaujon hospital, AP-HP, Clichy, France; Georges Charpak Human Biomecanics Institute, Arts et Métiers ParisTech, Paris, France
| |
Collapse
|
10
|
Li W, Chang C, Liang S, Bigler ED. Radiographic and neurobehavioral profile of sports-related concussion associated with scholastic wrestling: a case report. Neurocase 2020; 26:147-155. [PMID: 32412324 DOI: 10.1080/13554794.2020.1764977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Sports-related concussions (SRCs) are typically characterized by transient neurologic deficits due to physiologic and metabolic brain injury. However, following an SRC, subsequent insults may lead to severe and permanent injury in the affected brain cells. We present the case of a 15-year-old female scholastic wrestler who developed acute encephalopathy, macroscopic white matter injury on imaging, and chronic behavioral changes from inadequate neuro-recovery after a documented SRC. We also compare her case with established SRC data, demonstrating that wrestling-related concussions and repetitive head impacts can produce similar degrees of diffuse neuroinflammation, myelinated axonopathy, blood-brain barrier disruption, and post-concussive symptoms.
Collapse
Affiliation(s)
- Wentao Li
- Department of Neurology, University of California Davis , Sacramento, USA
| | - Celia Chang
- Department of Neurology, Division of Pediatric Neurology, University of California Davis , Sacramento, USA
| | - Shannon Liang
- Department of Neurology, Division of Pediatric Neurology, University of California Davis , Sacramento, USA
| | - Erin D Bigler
- Department of Neurology, University of California Davis , Sacramento, USA.,Department of Psychology and Neuroscience, Magnetic Resonance Imaging (MRI) Research Facility, Brigham Young University , Provo, USA.,Department of Neurology and Department of Psychiatry, University of Utah , Salt Lake City, USA
| |
Collapse
|
11
|
King JA, McCrea MA, Nelson LD. Frequency of Primary Neck Pain in Mild Traumatic Brain Injury/Concussion Patients. Arch Phys Med Rehabil 2020; 101:89-94. [PMID: 31493383 PMCID: PMC6930963 DOI: 10.1016/j.apmr.2019.08.471] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine (1) the frequency of neck pain overall and relative to other symptoms in patients presenting to a level I trauma center emergency department (ED) with mild traumatic brain injury (mTBI) and (2) the predictors of primary neck pain in this population. DESIGN Cohort study. SETTING Level I trauma center ED. PARTICIPANTS Patients presenting to the ED with symptoms of mTBI having been exposed to an event that could have caused mTBI (N=95). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Frequency of self-reported neck pain as measured by Sport Concussion Assessment Tool 3 (SCAT3) symptom questionnaire at <3, 8, 15, and 45 days post injury. Primary neck pain was defined in 2 ways: (1) neck pain rated as equal or greater in severity than all other SCAT3 symptoms and (2) neck pain worse than all other symptoms. RESULTS The frequency of any reported neck pain was 68.4%, 50.6%, 49%, and 41.9% within 72 hours and at 8, 15, and 45 days, respectively. Frequency of primary neck pain (equal or worse/worse definitions) was 35.8%/17.9%, 34.9%/14.5%, 37%/14.8%, and 39.2%/10.8% across the 4 follow-up assessments. Participants who sustained their injuries in motor vehicle collisions had a higher rate of primary neck pain than those with other mechanisms of injury. CONCLUSIONS A sizable percentage of patients who present to level I trauma center EDs with mTBI report neck pain, which is commonly rated as similar to or worse than other mTBI-related symptoms. Primary neck pain is more common after motor vehicle collisions than with other mechanisms of injury. These findings support consensus statements identifying cervical injury as an important potential concurrent diagnosis in patients with mTBI.
Collapse
Affiliation(s)
- Jeffrey A King
- Medical College of Wisconsin Department of Neurosurgery, Milwaukee, Wisconsin, United States.
| | - Michael A McCrea
- Medical College of Wisconsin Department of Neurosurgery, Milwaukee, Wisconsin, United States
| | - Lindsay D Nelson
- Medical College of Wisconsin Department of Neurosurgery, Milwaukee, Wisconsin, United States
| |
Collapse
|
12
|
Can the Neck Contribute to Persistent Symptoms Post Concussion? A Prospective Descriptive Case Series. J Orthop Sports Phys Ther 2019; 49:845-854. [PMID: 31154952 DOI: 10.2519/jospt.2019.8547] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Persistent symptoms post concussion can arise from a range of sources, including the neck. There is little description of neck assessment findings in people with persistent symptoms post concussion. OBJECTIVES To assess people with persistent symptoms following a concussion and determine whether the neck has also been injured, and to evaluate the potential of the neck to contribute to their symptoms. METHODS A consecutive series of participants (n = 20) referred for neck assessment were prospectively recruited by 2 providers of a multidisciplinary concussion service for people with persistent symptoms. Data were collected at initial assessment and on completion of neck treatment, which included standard questionnaires (Rivermead Post Concussion Symptoms Questionnaire, Neck Disability Index, Dizziness Handicap Inventory); patient-reported measures of headache, dizziness, and neck pain; physical examination findings; and details of comorbidities. RESULTS Participants were evaluated at a mean of 7.5 weeks post concussion (median, 5 weeks). On neck assessment, 90% were considered by the clinician to have a neck problem contributing to their current symptoms. Multiple findings were consistent with this view, including moderate-to-severe Neck Disability Index scores (mean ± SD, 33.4 ± 9.5 points), frequent neck pain (85%), frequent moderate-to-severe pain on occiput-C4 segmental assessment (85%), a positive flexion-rotation test (45%), and muscle tenderness (50%-55%). CONCLUSION Multiple findings were indicative of concurrent neck injury, particularly involving the upper cervical spine. These neck-related findings are important to recognize, as they have the potential to contribute to persistent symptoms post concussion and may respond to neck treatment. This study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616001183471). J Orthop Sports Phys Ther 2019;49(11):845-854. Epub 1 Jun 2019. doi:10.2519/jospt.2019.8547.
Collapse
|
13
|
Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment. J Orthop Sports Phys Ther 2019; 49:799-810. [PMID: 31610760 DOI: 10.2519/jospt.2019.8926] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The risk factors of concussion may be categorized as intrinsic (internal factors specific to the individual) or extrinsic (external factors related to the environment or sport). Identifying these factors is part of an individualized, patient-centered approach to prevention, assessment, and management of concussion. In most cases, the symptoms of concussion resolve in the initial few days following the injury, and a strategy involving a gradual return to sport and school is recommended. When symptoms persist for longer than 7 to 10 days, a multifaceted interdisciplinary assessment to guide treatment is recommended. This article applies the dynamic, recursive model of sport injury to sport-related concussion and summarizes the process of individualized assessment and management following concussion in athletes of all ages, with a focus on physical rehabilitation. J Orthop Sports Phys Ther 2019;49(11):799-810. doi:10.2519/jospt.2019.8926.
Collapse
|
14
|
Concussion in Combination With Whiplash-Associated Disorder May Be Missed in Primary Care: Key Recommendations for Assessment and Management. J Orthop Sports Phys Ther 2019; 49:819-828. [PMID: 31610758 DOI: 10.2519/jospt.2019.8946] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Whiplash and concussion may have similar presenting symptoms, biomechanical mechanisms, and neurophysiological sequelae, but neither enjoys a gold standard diagnostic test. Guidelines for whiplash and concussion are developed and implemented separately. This disparate process may contribute to misdiagnosis, delay appropriate primary care management, and impair patient outcomes. In our clinical commentary, we present 3 cases where signs and symptoms consistent with whiplash were identified in primary care. Symptoms in all cases included neck pain, headache, dizziness, and concentration deficits, raising suspicion of coexisting postconcussion syndrome. All cases were referred for specialist physical therapy. Characteristics consistent with poor recovery in both whiplash and postconcussion syndrome were confirmed, and multidisciplinary management, drawing from both whiplash and concussion guidelines, was implemented. All patients reported improvement in activities of daily living after tailored management addressing both neck and head injury-related factors, suggesting that these conditions were not mutually exclusive. Self-reported outcomes included reductions in neck disability and postconcussion symptoms of between 20% and 40%. It may be appropriate for whiplash and concussion guidelines to be amalgamated, enhanced, and mutually recognized on a patient-by-patient basis. Primary health care professionals might consider minimum screening to identify postconcussion syndrome in patients following motor vehicle collision by administering questionnaires and assessing cranial nerve function, balance, and cognition. Management should then incorporate principles from both whiplash and concussion guidelines and harmonize with available imaging guidelines for suspected spine and head trauma. J Orthop Sports Phys Ther 2019;49(11):819-828. doi:10.2519/jospt.2019.8946.
Collapse
|
15
|
Baker M, Quesnele J, Baldisera T, Kenrick-Rochon S, Laurence M, Grenier S. Exploring the role of cervical spine endurance as a predictor of concussion risk and recovery following sports related concussion. Musculoskelet Sci Pract 2019; 42:193-197. [PMID: 31047873 DOI: 10.1016/j.msksp.2019.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 04/05/2019] [Accepted: 04/09/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Concussions have become a significant public health concern with rising incidence rates. Concussions have been shown to occur concurrently with neck injuries, such as whiplash-associated-disorder, therefore, understanding the role of the neck in concussions is important. OBJECTIVES To determine if there is a relationship between cervical muscle endurance and either concussion incidence, or concussion recovery in university athletes. Specifically, the primary aim was to investigate a relationship between pre-season deep neck flexor endurance test (DNFET) time in those who sustained an in-season injury versus those who did not. The secondary aim is to determine correlation in DNFET times and concussion recovery. DESIGN Longitudinal observational study. METHODS Pre-season DNFET was performed on university athletes. In the event of a concussion, cervical endurance and neuromuscular adaptation was re-assessed with the DNFET. Rehabilitative exercises were prescribed, as required, and DNFET was measured at subsequent treatments. RESULTS There was no significant difference between pre-season DNFET times and concussion incidence (p = 0.55). However, there was a moderate correlation between DNFET times and concussion recovery (R = 0.47, p = 0.001) whereby DNFET times improved predictively throughout rehabilitation. CONCLUSIONS While no statistically significant relationship was found between DNFET and concussion incidence, a significant clinical relationship was present with recovery. The validity of the DNFET test as a means for assessing risk or measuring recovery requires additional research.
Collapse
Affiliation(s)
- Matthew Baker
- School of Human Kinetics, Laurentian University, Sudbury, ON, Canada
| | | | - Tara Baldisera
- Northern Ontario School of Medicine, Sudbury, ON, Canada
| | | | - Michelle Laurence
- School of Human Kinetics, Laurentian University, Sudbury, ON, Canada
| | - Sylvain Grenier
- School of Human Kinetics, Laurentian University, Sudbury, ON, Canada.
| |
Collapse
|
16
|
Schneider KJ. Concussion - Part I: The need for a multifaceted assessment. Musculoskelet Sci Pract 2019; 42:140-150. [PMID: 31133539 DOI: 10.1016/j.msksp.2019.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Concussion is among the most commonly occurring sport and recreation injuries in today's society. An understanding of the heterogenous nature of concussion will assist in directing a multifaceted and comprehensive interdisciplinary assessment following injury. PURPOSE The purpose of this masterclass article is to summarize the current state of the evidence in the area of concussion, describe typical symptom presentations and assessment techniques that may assist in directing appropriate management following concussion. IMPLICATIONS A comprehensive assessment including a thoughtful differential diagnosis will assist the clinician to direct care appropriately and efficiently in individuals who have suffered a concussion.
Collapse
Affiliation(s)
- Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, University of Calgary, KNB3300D 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
| |
Collapse
|
17
|
Sutton M, Chan V, Escobar M, Mollayeva T, Hu Z, Colantonio A. Neck Injury Comorbidity in Concussion-Related Emergency Department Visits: A Population-Based Study of Sex Differences Across the Life Span. J Womens Health (Larchmt) 2018; 28:473-482. [PMID: 30592685 PMCID: PMC6482894 DOI: 10.1089/jwh.2018.7282] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: The cervical spine region can be especially vulnerable to concurrent injury in concussion, with research suggesting that females may be at greater risk due to their weaker and anatomically distinct necks. The main objective of our research was to study sex differences in the rate of neck injury comorbidity across the life span among patients with a concussion diagnosis in the emergency department (ED) setting, by cause of injury (motor vehicle collisions [MVC] and sports). Materials and Methods: All patients with a first concussion-related ED visit between fiscal years 2002/2003 and 2011/2012 (inclusive) in Ontario were identified in population-based health administrative data using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA) codes. Age-dependent odds ratios of comorbid neck injury for sex were estimated using polynomial multivariable logistic regression models, adjusting for sociodemographic characteristics. Results: Females with a concussion had significantly higher odds of sustaining a comorbid neck injury between the ages of 5–49 years for all concussion-related ED visits, 15–49 years for MVC-related concussion ED visits, and 10–39 years for sports-related concussion ED visits, holding all other covariates in the model constant. Conclusions: These results support the consideration of increased screening for comorbid neck injuries, particularly for females, to allow for early intervention. Furthermore, the increased risk of comorbid neck injury in females with a concussion-related ED visit was age-dependent, with the interaction between sex and age following a nonlinear trend. As such, future studies on concussions should consider linear and nonlinear sex and age interactions.
Collapse
Affiliation(s)
- Mitchell Sutton
- Toronto Rehabilitation Institute–University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Vincy Chan
- Toronto Rehabilitation Institute–University Health Network, Toronto, Canada
| | - Michael Escobar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tatyana Mollayeva
- Toronto Rehabilitation Institute–University Health Network, Toronto, Canada
- Department of Occupational Sciences and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Zheng Hu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Angela Colantonio
- Toronto Rehabilitation Institute–University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Occupational Sciences and Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Institute for Clinical and Evaluative Sciences, Toronto, Canada
- Address correspondence to: Angela Colantonio, PhD, Rehabilitation Sciences Building, University of Toronto, 500 University Avenue, Suite 160, Toronto, ON M5G 1V7, Canada
| |
Collapse
|
18
|
|
19
|
Reneker JC, Cheruvu VK, Yang J, James MA, Cook CE. Physical examination of dizziness in athletes after a concussion: A descriptive study. Musculoskelet Sci Pract 2018; 34:8-13. [PMID: 29197811 DOI: 10.1016/j.msksp.2017.11.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/10/2017] [Accepted: 11/22/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Dizziness is commonly reported after concussion. With the forces experienced at the time of the injury, several anatomical locations may have been altered, causing dizziness. OBJECTIVE Describe an objective examination and the types of impairment/dysfunction implicated by the results of clinical examination tests in subjects with dizziness after a concussion. DESIGN Cross-Sectional. METHODS Athletes between ages 10-23 were enrolled with a diagnosis of concussion. An examination was completed to identify areas potentially contributing to dizziness, including tests of oculomotor control, the vestibular system, neuromotor control, and musculoskeletal components of the cervical spine. Descriptive analyses were completed to define the anatomical areas/types of dysfunction identified by positive findings of the examination tests. RESULTS All (n = 41; 100%) subjects had examination findings consistent with central dysfunction. Of these, 36 (97.8%) had oculomotor control deficits; 29 (70.7%) demonstrated motion sensitivity; and 6 (15%) had central vestibular deficits. Nineteen (46.3%) had peripheral dysfunction, including 18 (43.9%) with unilateral hypofunction, and 2 (4.9%) with Benign Paroxysmal Positional Vertigo. Thirty-four (82.9%) had cervical dysfunction, with 11 (26.8%) presenting with cervicogenic dizziness, and 31 (75.6%) with altered neuromotor control. CONCLUSIONS Functional injury to centrally-mediated pathways, specifically oculomotor control, and afferent and efferent pathways in the cervical spine are commonly identified through clinical examination tests in individuals with a complaint of dizziness post-concussion. According to results presented here, a high majority (90%) of the participants demonstrated dizziness that appeared to be multifactorial in nature and was not attributable to one main type of dysfunction. The common pathways between the systems make it difficult to isolate only one anatomical area as a contributor to dizziness.
Collapse
Affiliation(s)
- Jennifer C Reneker
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, United States; Department of Physical Therapy, School of Health Related Professions, University of Mississippi Medical Center, Jackson, MS, United States; Department of Neurosurgery, School of Medicine, University of Mississippi Medical Center, Jackson, MS, United States.
| | - Vinay K Cheruvu
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, United States
| | - Jingzhen Yang
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Dept. of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Mark A James
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, United States
| | - Chad E Cook
- Division of Physical Therapy, Department of Orthopaedics, Duke University, Durham, NC, United States
| |
Collapse
|
20
|
Anthropometrics and maturity status: A preliminary study of youth football head impact biomechanics. Int J Psychophysiol 2017; 132:87-92. [PMID: 28986327 DOI: 10.1016/j.ijpsycho.2017.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 11/21/2022]
Abstract
CONTEXT There is a paucity of head impact biomechanics research focusing on youth athletes. Little is known about how youth subconcussive head impact tolerances are related to physical size and maturation. OBJECTIVE To examine the effects of age, anthropometric and maturational status variability on head impact biomechanics. DESIGN Cross-sectional. SETTING Outdoor youth football facilities in South Carolina. PARTICIPANTS Thirty-four male recreational youth football players, 8 to 13yrs. INTERVENTIONS Categorized by CDC standards, independent variables were: age, height, mass, BMI, and estimated peak height velocity (PHV). Participants wore a designated head impact sensor (xPatch) on their mastoid process during practices and games. MAIN OUTCOME MEASURES Linear acceleration (g) and rotational acceleration (rad/s2). RESULTS Boys in the older age category had a greater linear (F=17.72; P<0.001) and rotational acceleration (F=10.74; P<0.001) than those in the younger category. Post-PHV boys had higher linear (F=9.09, P=0.002) and rotational (F=5.57, P=0.018) accelerations than those who were pre-PHV. Rotational, but not linear acceleration differed by height category with lowest impacts found for the tallest category, whereas both linear and rotational accelerations by mass differences favored average and heavy categories. BMI overweight boys, had the greatest linear (F=5.25; P=0.011) and rotational acceleration (F=4.13; P=0.260) means. CONCLUSION Post-PHV boys who were older, taller and had longer legs, but who were not heavier, had higher impacts perhaps due to the type of impacts sustained. Taller boys' heads are above their peers possibly encouraging hits in the torso region resulting in lower impact accelerations. Obese boys did not have sequential results compared to boys in the other BMI categories probably due to league rules, player position, and lack of momentum produced.
Collapse
|
21
|
Rosene JM, Raksnis B, Silva B, Woefel T, Visich PS, Dompier TP, Kerr ZY. Comparison of Concussion Rates Between NCAA Division I and Division III Men's and Women's Ice Hockey Players. Am J Sports Med 2017. [PMID: 28622025 DOI: 10.1177/0363546517710005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Examinations related to divisional differences in the incidence of sports-related concussions (SRC) in collegiate ice hockey are limited. PURPOSE To compare the epidemiologic patterns of concussion in National Collegiate Athletic Association (NCAA) ice hockey by sex and division. STUDY DESIGN Descriptive epidemiology study. METHODS A convenience sample of men's and women's ice hockey teams in Divisions I and III provided SRC data via the NCAA Injury Surveillance Program during the 2009-2010 to 2014-2015 academic years. Concussion counts, rates, and distributions were examined by factors including injury activity and position. Injury rate ratios (IRRs) and injury proportion ratios (IPRs) with 95% confidence intervals (CIs) were used to compare concussion rates and distributions, respectively. RESULTS Overall, 415 concussions were reported for men's and women's ice hockey combined. The highest concussion rate was found in Division I men (0.83 per 1000 athlete-exposures [AEs]), followed by Division III women (0.78/1000 AEs), Division I women (0.65/1000 AEs), and Division III men (0.64/1000 AEs). However, the only significant IRR was that the concussion rate was higher in Division I men than Division III men (IRR = 1.29; 95% CI, 1.02-1.65). The proportion of concussions from checking was higher in men than women (28.5% vs 9.4%; IPR = 3.02; 95% CI, 1.63-5.59); however, this proportion was higher in Division I women than Division III women (18.4% vs 1.8%; IPR = 10.47; 95% CI, 1.37-79.75). The proportion of concussions sustained by goalkeepers was higher in women than men (14.2% vs 2.9%; IPR = 4.86; 95% CI, 2.19-10.77), with findings consistent within each division. CONCLUSION Concussion rates did not vary by sex but differed by division among men. Checking-related concussions were less common in women than men overall but more common in Division I women than Division III women. Findings highlight the need to better understand the reasons underlying divisional differences within men's and women's ice hockey and the need to develop concussion prevention strategies specific to each athlete population.
Collapse
Affiliation(s)
- John M Rosene
- University of New England, Department of Exercise and Sport Performance, Biddeford, Maine, USA
| | - Bryan Raksnis
- University of New England, Department of Exercise and Sport Performance, Biddeford, Maine, USA
| | - Brie Silva
- University of New England, Department of Exercise and Sport Performance, Biddeford, Maine, USA
| | - Tyler Woefel
- University of New England, Department of Exercise and Sport Performance, Biddeford, Maine, USA
| | - Paul S Visich
- University of New England, Department of Exercise and Sport Performance, Biddeford, Maine, USA
| | - Thomas P Dompier
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
22
|
Hides JA, Franettovich Smith MM, Mendis MD, Smith NA, Cooper AJ, Treleaven J, Leung F, Gardner AJ, McCrory P, Low Choy NL. A prospective investigation of changes in the sensorimotor system following sports concussion. An exploratory study. Musculoskelet Sci Pract 2017; 29:7-19. [PMID: 28259770 DOI: 10.1016/j.msksp.2017.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 02/10/2017] [Accepted: 02/16/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sports concussion is a risk for players involved in high impact, collision sports. Post-concussion, the majority of symptoms subside within 7-10 days, but can persist in 10-20% of athletes. Understanding the effects of sports concussion on sensorimotor systems could inform physiotherapy treatment. OBJECTIVE To explore changes in sensorimotor function in the acute phase following sports concussion. DESIGN Prospective cohort study. METHODS Fifty-four players from elite rugby union and league teams were assessed at the start of the playing season. Players who sustained a concussion were assessed three to five days later. Measures included assessments of balance (sway velocity), vestibular system function (vestibular ocular reflex gain; right-left asymmetry), cervical proprioception (joint position error) and trunk muscle size and function. RESULTS During the playing season, 14 post-concussion assessments were performed within 3-5 days of injury. Significantly decreased sway velocity and increased size/contraction of trunk muscles, were identified. Whilst not significant overall, large inter-individual variation of test results for cervical proprioception and the vestibular system was observed. LIMITATIONS The number of players who sustained a concussion was not large, but numbers were comparable with other studies in this field. There was missing baseline data for vestibular and cervical proprioception testing for some players. CONCLUSIONS Preliminary findings post-concussion suggest an altered balance strategy and trunk muscle control with splinting/over-holding requiring consideration as part of the development of appropriate physiotherapy management strategies.
Collapse
Affiliation(s)
- Julie A Hides
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia.
| | - Melinda M Franettovich Smith
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia
| | - M Dilani Mendis
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia; Physiotherapy Department, Mater Health Services, South Brisbane, 4101, Australia
| | - Nigel A Smith
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia
| | - Andrew J Cooper
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia
| | - Julia Treleaven
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, 4072, Australia
| | - Felix Leung
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia
| | - Andrew J Gardner
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2310, Australia; Hunter New England Local Health District Sports Concussion Program, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia
| | - Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Nancy L Low Choy
- School of Physiotherapy, Australian Catholic University, Brisbane, QLD, 4014, Australia
| |
Collapse
|
23
|
Kennedy E, Quinn D, Tumilty S, Chapple CM. Clinical characteristics and outcomes of treatment of the cervical spine in patients with persistent post-concussion symptoms: A retrospective analysis. Musculoskelet Sci Pract 2017; 29:91-98. [PMID: 28347935 DOI: 10.1016/j.msksp.2017.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/02/2017] [Accepted: 03/06/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Concussion is typically defined as a mild brain injury, and yet the brain is unlikely to be the only source of persistent post-concussion symptoms. Concurrent injury to the cervical spine in particular is acknowledged as a potential source of common persistent symptoms such as headache, dizziness and neck pain. OBJECTIVES To describe the cervical spine findings and outcomes of treatment in a series of patients with persistent post-concussion symptoms, and describe the clinical characteristics of a cervicogenic component when it is present. DESIGN Retrospective chart review of a consecutive series of patients with concussion referred to a physiotherapist for cervical spine assessment. METHOD Patient charts for all patients over a calendar year referred by a concussion service provider to a physiotherapist for cervical spine assessment were de-identified and transferred to the research team. Clinical data were independently extracted by two research assistants and analysed using descriptive statistics. RESULTS/FINDINGS Data were analysed from 46 patient charts. Those with a cervicogenic component (n = 32) were distinguished from those without a cervicogenic component (n = 14) by physical examination findings, particularly pain on manual segmental examination. Physiotherapy treatment of the cervicogenic component (n = 21) achieved improvements in function (mean increase of 3.8 in the patient-specific functional scale), and pain (mean decrease of 4.6 in the numeric pain-rating scale). CONCLUSIONS The clinical characteristics described give preliminary support to the idea that the cervical spine may contribute to persistent post-concussion symptoms, and highlight the value of physiotherapy assessment and treatment of the cervical spine following a concussive injury.
Collapse
Affiliation(s)
- Ewan Kennedy
- School of Physiotherapy, 325 Great King Street, University of Otago, Dunedin, 9054, New Zealand.
| | - Dusty Quinn
- Back in Motion Ltd, 27-29 Albany Street, Dunedin, 9016, New Zealand
| | - Steve Tumilty
- School of Physiotherapy, 325 Great King Street, University of Otago, Dunedin, 9054, New Zealand
| | - Cathy M Chapple
- School of Physiotherapy, 325 Great King Street, University of Otago, Dunedin, 9054, New Zealand
| |
Collapse
|
24
|
Matuszak JM, McVige J, McPherson J, Willer B, Leddy J. A Practical Concussion Physical Examination Toolbox. Sports Health 2017; 8:260-269. [PMID: 27022058 PMCID: PMC4981071 DOI: 10.1177/1941738116641394] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT With heightened awareness of concussion, there is a need to assess and manage the concussed patient in a consistent manner. Unfortunately, concussion physical examination has not been standardized or supported by evidence. Important questions remain about the physical examination. EVIDENCE ACQUISITION Review of ClinicalKey, Cochrane, MEDLINE, and PubMed prior to July 2015 was performed using search terms, including concussion, mTBI, physical examination, mental status, cranial nerves, reflexes, cervical, vestibular, and oculomotor. The references of the pertinent articles were reviewed for other relevant sources. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 3. RESULTS The pertinent physical examination elements for concussion include evaluation of cranial nerves, manual muscle testing, and deep tendon reflexes; inspecting the head and neck for trauma or tenderness and cervical range of motion; Spurling maneuver; a static or dynamic balance assessment; screening ocular examination; and a mental status examination that includes orientation, immediate and delayed recall, concentration, mood, affect, insight, and judgment. Other examination elements to consider, based on signs, symptoms, or clinical suspicion, include testing of upper motor neurons, cervical strength and proprioception, coordination, pupillary reactivity, and visual acuity; examination of the jaw, temporomandibular joint, and thoracic spine; fundoscopic evaluation; orthostatic vital signs; assessment of dynamic visual acuity; and screening for depression, anxiety, substance abuse disorders, and preinjury psychiatric difficulties. CONCLUSION Various elements of the physical examination, such as screening ocular examination, cervical musculoskeletal examination, static and/or dynamic balance assessment, and mental status examination, appear to have utility for evaluating concussion; however, data on validity are lacking.
Collapse
Affiliation(s)
| | | | | | - Barry Willer
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York
| | - John Leddy
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York
| |
Collapse
|
25
|
Whiplash Injury or Concussion? A Possible Biomechanical Explanation for Concussion Symptoms in Some Individuals Following a Rear-End Collision. J Orthop Sports Phys Ther 2016; 46:874-885. [PMID: 27690834 DOI: 10.2519/jospt.2016.7049] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Finite element modeling of experimental data. Background The clinical presentations of whiplash injury and concussion have considerable overlap. Both diagnoses are generally based on presenting signs and symptoms, and a history of neck or head trauma. With incomplete knowledge of the trauma, differentiating between whiplash injury and concussion can be clinically challenging. Objectives To estimate the brain strains that develop during rear-end car crashes, evaluate how these strains vary with different head kinematic parameters, and compare these strains to those generated during potentially concussive football helmet impacts. Methods Head kinematic data were analyzed from 2 prior studies, one that focused on head restraint impacts in rear-end crash tests and another that focused on football helmet impacts. These data were used as inputs to a finite element model of the human brain. Brain strains were calculated and compared to different peak kinematic parameters and between the 2 impact conditions. Results Brain strains correlated best with the head's angular velocity change for both impact conditions. The 4 crashes with head angular velocity changes greater than 30 rad/s (greater than 1719°/s) generated the highest brain stains. One crash, in which the head wrapped onto the top of the head restraint, generated brain strains similar to a 9.3-m/s rear football helmet impact, a level previously associated with concussion. Conclusion This work provides new insight into a potential biomechanical link between whiplash injury and concussion, and advances our understanding of how head restraint interaction during a rear-end crash may cause an injury more typically associated with sports-related head impacts. J Orthop Sports Phys Ther 2016;46(10):874-885. doi:10.2519/jospt.2016.7049.
Collapse
|
26
|
Rowson S, Bland ML, Campolettano ET, Press JN, Rowson B, Smith JA, Sproule DW, Tyson AM, Duma SM. Biomechanical Perspectives on Concussion in Sport. Sports Med Arthrosc Rev 2016; 24:100-7. [PMID: 27482775 PMCID: PMC4975525 DOI: 10.1097/jsa.0000000000000121] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Concussions can occur in any sport. Often, clinical and biomechanical research efforts are disconnected. This review paper analyzes current concussion issues in sports from a biomechanical perspective and is geared toward Sports Med professionals. Overarching themes of this review include the biomechanics of the brain during head impact, role of protective equipment, potential population-based differences in concussion tolerance, potential intervention strategies to reduce the incidence of injury, and common biomechanical misconceptions.
Collapse
Affiliation(s)
- Steven Rowson
- Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Gilchrist I, Moglo K, Storr M, Pelland L. Effects of head flexion posture on the multidirectional static force capacity of the neck. Clin Biomech (Bristol, Avon) 2016; 37:44-52. [PMID: 27289496 DOI: 10.1016/j.clinbiomech.2016.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/05/2016] [Accepted: 05/31/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neck muscle force protects vertebral alignment and resists potentially injurious loading of osteoligamentous structures during head impacts. As the majority of neck muscles generate moments about all three planes of motion, it is not clear how the force capacity of the neck might be modulated by direction of force application and head posture. The aim of our study was to measure the multidirectional moment-generating capacity of the neck and to evaluate effects of 20° of head flexion, a common head position in contact sports, on the measured capacity. METHODS We conducted a cross-sectional study, with 25 males, 20-30years old, performing maximum voluntary contractions, with ballistic intent, along eight directions, set at 45° intervals in the horizontal plane of the head. Three-dimensional moments at C3 and T1 were calculated using equations of static equilibrium. The variable of interest was the impulse of force generated from 0-50ms. Effects of direction of force application and head posture, neutral and 20° flexion, were evaluated by two-way analysis of variance and linear regression. FINDINGS Impulse of force was lower along diagonal planes, at 45° from the mid-sagittal plane, compared to orthogonal planes (P<0.001). Compared to neutral posture, head flexion produced a 55.2% decrease in impulse capacity at C3 and 45.9% at T1. INTERPRETATION The risk of injury with head impact would intrinsically be higher along diagonal planes and with a 20° head down position due to a lower moment generating capacity of the neck in the first 50ms of force application.
Collapse
Affiliation(s)
- Ian Gilchrist
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada; Human Mobility Research Centre, Queen's University, Kingston, Ontario, Canada
| | - Kodjo Moglo
- Royal Military College, Kingston, Ontario, Canada
| | - Michael Storr
- Kingston General Hospital, Department of Pediatrics, Kingston, Ontario, Canada
| | - Lucie Pelland
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada; Human Mobility Research Centre, Queen's University, Kingston, Ontario, Canada.
| |
Collapse
|
28
|
Morin M, Langevin P, Fait P. Cervical Spine Involvement in Mild Traumatic Brain Injury: A Review. JOURNAL OF SPORTS MEDICINE (HINDAWI PUBLISHING CORPORATION) 2016; 2016:1590161. [PMID: 27529079 PMCID: PMC4977400 DOI: 10.1155/2016/1590161] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/30/2016] [Accepted: 06/19/2016] [Indexed: 06/06/2023]
Abstract
Background. There is a lack of scientific evidence in the literature on the involvement of the cervical spine in mTBI; however, its involvement is clinically accepted. Objective. This paper reviews evidence for the involvement of the cervical spine in mTBI symptoms, the mechanisms of injury, and the efficacy of therapy for cervical spine with concussion-related symptoms. Methods. A keyword search was conducted on PubMed, ICL, SportDiscus, PEDro, CINAHL, and Cochrane Library databases for articles published since 1990. The reference lists of articles meeting the criteria (original data articles, literature reviews, and clinical guidelines) were also searched in the same databases. Results. 4,854 records were screened and 43 articles were retained. Those articles were used to describe different subjects such as mTBI's signs and symptoms, mechanisms of injury, and treatments of the cervical spine. Conclusions. The hypothesis of cervical spine involvement in post-mTBI symptoms and in PCS (postconcussion syndrome) is supported by increasing evidence and is widely accepted clinically. For the management and treatment of mTBIs, few articles were available in the literature, and relevant studies showed interesting results about manual therapy and exercises as efficient tools for health care practitioners.
Collapse
Affiliation(s)
- Michael Morin
- Department of Human Kinetics, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada G9A 5H7
- Research Group on Neuromusculoskeletal Dysfunctions (GRAN), UQTR, Trois-Rivières, QC, Canada G9A 5H7
| | - Pierre Langevin
- Cortex Médecine et Réadaptation Concussion Clinic, Quebec City, QC, Canada G1W 0C5
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC, Canada G1V 0A6
| | - Philippe Fait
- Department of Human Kinetics, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada G9A 5H7
- Research Group on Neuromusculoskeletal Dysfunctions (GRAN), UQTR, Trois-Rivières, QC, Canada G9A 5H7
- Cortex Médecine et Réadaptation Concussion Clinic, Quebec City, QC, Canada G1W 0C5
- Research Center in Neuropsychology and Cognition (CERNEC), Montreal, QC, Canada H3C 3J7
| |
Collapse
|
29
|
Olson HM, Tunning MJ, Boesch RJ. Chiropractic Management of Musculoskeletal Symptoms in a 14-Year-Old Hockey Player With Postconcussion Symptoms: A Case Report. J Chiropr Med 2016; 15:208-13. [PMID: 27660598 DOI: 10.1016/j.jcm.2016.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The purpose of this study is to describe the chiropractic management of a student athlete with postconcussion syndrome. CLINICAL FEATURES A 14-year-old male hockey player presented to a chiropractic clinic with postconcussion symptoms 13 days after his initial injury. He experienced an occipital headache with a pain rating of 8/10, upset stomach, blurry vision, nausea, dizziness, balance problems, a "foggy feeling," difficulty with concentration, difficulty with memory, fatigue, confusion, drowsiness, and irritability. Prior to seeing the doctor of chiropractic, the patient was monitored by a medical doctor, and the care he had been receiving was in accordance with current concussion guidelines. At the time of presentation to the chiropractic clinic, he had failed to progress toward return to play, and his computerized neurocognitive testing scores had not improved. INTERVENTION AND OUTCOME Chiropractic manipulative therapy, myofascial release, instrument-assisted soft tissue technique, and therapeutic exercises were provided over 5 treatments spanning a 20-day period. The patient followed up each treatment with ImPACT testing. At the conclusion of the treatments, the patient's computerized neurocognitive testing scores had improved, and the patient was returned to play. CONCLUSION This case demonstrates the improvement of postconcussion syndrome in a 14-year-old male hockey player under chiropractic management.
Collapse
|
30
|
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]
|
31
|
Abstract
While much is known regarding the pathophysiology surrounding concussion injuries in the acute phase, there is little evidence to support many of the theorized etiologies to post-concussion syndrome (PCS); the chronic phase of concussion occurring in ∼ 10-15% of concussed patients. This paper reviews the existing literature surrounding the numerous proposed theories of PCS and introduces another potential, and very treatable, cause of this chronic condition; cervical spine dysfunction due to concomitant whiplash-type injury. We also discuss a short case-series of five patients with diagnosed PCS having very favorable outcomes following various treatment and rehabilitative techniques aimed at restoring cervical spine function.
Collapse
Affiliation(s)
- Cameron M Marshall
- a 1 Department of Graduate Studies, Canadian Memorial Chiropractic College , 6100 Leslie Street, Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
32
|
Brain or strain? Symptoms alone do not distinguish physiologic concussion from cervical/vestibular injury. Clin J Sport Med 2015; 25:237-42. [PMID: 25051194 DOI: 10.1097/jsm.0000000000000128] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare symptoms in patients with physiologic postconcussion disorder (PCD) versus cervicogenic/vestibular PCD. We hypothesized that most symptoms would not be equivalent. In particular, we hypothesized that cognitive symptoms would be more often associated with physiologic PCD. DESIGN Retrospective review of symptom reports from patients who completed a 22-item symptom questionnaire. SETTING University-based concussion clinic. PATIENTS Convenience sample of 128 patients who had symptoms after head injury for more than 3 weeks and who had provocative treadmill exercise testing. INDEPENDENT VARIABLES Subjects were classified as either physiologic PCD (abnormal treadmill performance and a normal cervical/vestibular physical examination) or cervicogenic/vestibular PCD (CGV, normal treadmill performance, and an abnormal cervical/vestibular physical examination). MAIN OUTCOME MEASURES Self-reported symptoms. Univariate and multivariate methods, including t tests, tests of equivalence, a logistic regression model, k-nearest neighbor analysis, multidimensional scaling, and principle components analysis were used to see whether symptoms could distinguish PCD from CGV. RESULTS None of the statistical methods used to analyze self-reported symptoms was able to adequately distinguish patients with PCD from patients with CGV. CONCLUSIONS Symptoms after head injury, including cognitive symptoms, have traditionally been ascribed to brain injury, but they do not reliably discriminate between physiologic PCD and cervicogenic/vestibular PCD. Clinicians should consider specific testing of exercise tolerance and perform a physical examination of the cervical spine and the vestibular/ocular systems to determine the etiology of postconcussion symptoms. CLINICAL RELEVANCE Symptoms after head injury, including cognitive symptoms, do not discriminate between concussion and cervical/vestibular injury.
Collapse
|
33
|
Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, Barlow K, Boyd L, Kang J, Emery CA. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. Br J Sports Med 2014; 48:1294-8. [DOI: 10.1136/bjsports-2013-093267] [Citation(s) in RCA: 222] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
34
|
Tator CH. Concussions and their consequences: current diagnosis, management and prevention. CMAJ 2013; 185:975-9. [PMID: 23877672 DOI: 10.1503/cmaj.120039] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Charles H Tator
- The Division of Neurosurgery, University of Toronto, Toronto, Ont.
| |
Collapse
|
35
|
Wennberg RA, Cohen HB, Walker SR. Neurologic Injuries in Hockey. Phys Med Rehabil Clin N Am 2009; 20:215-26, x. [DOI: 10.1016/j.pmr.2008.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
36
|
Hynes LM, Dickey JP. The rate of change of acceleration: implications to head kinematics during rear-end impacts. ACCIDENT; ANALYSIS AND PREVENTION 2008; 40:1063-1068. [PMID: 18460374 DOI: 10.1016/j.aap.2007.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 11/26/2007] [Accepted: 11/29/2007] [Indexed: 05/26/2023]
Abstract
Whiplash is a mechanism of injury commonly associated with rear-impact vehicle collisions. To date, research has focused primarily on changes in velocity and acceleration as key factors for determining injuries due to whiplash mechanisms, but other characteristics of the acceleration pulse may be important. This study assessed whether the head acceleration response to whiplash-like perturbation profiles were affected by a change in the rate of the applied acceleration, or jerk. Twenty-one subjects were exposed to different low-velocity rear-impact whiplash-like perturbations using a precisely controlled robotic platform. The perturbations were divided into two groupings of peak acceleration (approximately 10 (high) and 5.7 (low) m/s2) and three groupings of jerk (approximately 260, 310, and 360 m/s3). These six profiles were repeated twice. Results demonstrated that the jerk magnitude significantly affected forehead acceleration in the vertical and horizontal directions. Increasing the magnitude of the platform acceleration also differentially affected the horizontal and vertical forehead accelerations. This indicates that the level of jerk influences the resulting head kinematics and should be considered when designing or interpreting experiments that are attempting to predict injury from whiplash-like perturbations.
Collapse
Affiliation(s)
- Loriann M Hynes
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada N1G 2W1
| | | |
Collapse
|
37
|
Abstract
Ice hockey is a fast contact sport played on an ice surface enclosed by rigid boards. There is an intrinsic risk for injury in hockey, with many injuries potentially affecting the nervous system. This article provides an overview of neurologic injuries occurring in hockey as reported in the scientific literature. Among all injuries, a small but real risk for catastrophic cervical spinal cord injury and a high incidence of concussion emerge as the two most important neurologic issues.
Collapse
|
38
|
Static and dynamic postural control adaptations induced by playing ice hockey. SPORT SCIENCES FOR HEALTH 2008. [DOI: 10.1007/s11332-008-0045-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|