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Pyndiura KL, Di Battista AP, Richards D, Reed N, Lawrence DW, Hutchison MG. A Multimodal Exertional Test for concussion: a pilot study in healthy athletes. Front Neurol 2024; 15:1390016. [PMID: 38699052 PMCID: PMC11063232 DOI: 10.3389/fneur.2024.1390016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Exertional tests have become a promising tool to assist clinicians in the management of concussions, however require expensive equipment, extensive spaces, and specialized clinician expertise. As such, we developed a test with minimal resource requirements encompassing key elements of sport and physical activity. The purpose of this study was to pilot test the Multimodal Exertional Test (MET) protocol in a sample of healthy interuniversity athletes. Methods The MET comprises four stages, each featuring three distinct tasks. The test begins with engaging in squats, alternating reverse lunges, and hip hinges (Stage 1). The next stage progressively evolves into executing these tasks within specified time limits (Stage 2). Following this, the test advances to a stage that incorporates cognitive tasks (Stage 3), and the final stage demands greater levels of physical exertion, cognition, and multi-directional movements (Stage 4). Heart rate (HR) was obtained during each stage of the MET and participants' symptom severity scores were recorded following each task. Results Fourteen healthy interuniversity athletes (n = 8 female, n = 6 male) participated in the study. HR was obtained for 10 of the 14 athletes (females: n = 6, males: n = 4). Increases in average and maximum HR were identified between pre-MET and Stage 1, and between Stages 3 and 4. Consistent with the tasks in each stage, there were no increases in average and maximum HR observed between MET Stages 1 to 3. Female athletes exhibited higher average and maximum HRs compared to male athletes during all four stages. All 14 athletes reported minimal changes in symptom severity following each task. Conclusion Among healthy athletes, the MET elicits an increase in average and maximum HR throughout the protocol without symptom provocation. Female athletes exhibit higher HRs during all four stages in comparison to male athletes.
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Affiliation(s)
- Kyla L. Pyndiura
- Centre for Sport-Related Concussion Research, Innovation, and Knowledge, University of Toronto, Toronto, ON, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Alex P. Di Battista
- Centre for Sport-Related Concussion Research, Innovation, and Knowledge, University of Toronto, Toronto, ON, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Doug Richards
- Centre for Sport-Related Concussion Research, Innovation, and Knowledge, University of Toronto, Toronto, ON, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Nick Reed
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - David W. Lawrence
- Centre for Sport-Related Concussion Research, Innovation, and Knowledge, University of Toronto, Toronto, ON, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Michael G. Hutchison
- Centre for Sport-Related Concussion Research, Innovation, and Knowledge, University of Toronto, Toronto, ON, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, ON, Canada
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2
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Saalfield J, Piersol KL, Esopenko C, Bates ME, Weismiller SA, Brostrand K, Todaro SM, Conway FN, Wilde EA, Buckman JF. Digital neuropsychological test performance in a large sample of uninjured collegiate athletes. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:155-161. [PMID: 34822256 PMCID: PMC10199655 DOI: 10.1080/23279095.2021.2003365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Digital neuropsychological test batteries are popular in college athletics; however, well-validated digital tests that are short and portable are needed to expand the feasibility of performing cognitive testing quickly, reliably, and outside standard clinical settings. This study assessed performance on digital versions of Trail Making Test (dTMT) and a modified Symbol Digit Modalities Test (dSDMT) in uninjured collegiate athletes (n = 537; 47% female) using the C3Logix baseline assessment module. Time to complete (dTMT) and the number of correct responses (dSDMT) were computed, transformed into z scores, and compared to age-matched normative data from analogous paper-and-pencil tests. Overall sample performance was compared to normative sample performance using Cohen's d. Sample averages on the dTMT, Part A, and dSDMT were similar to published norms; 97 and 92% of z scores fell within 2 standard deviations of normative means, respectively. The sample averaged faster completion times on dTMT, Part B than published norms, although 98% of z scores were within 2 standard deviations of the normative means. Brief, digitized tests may be useful in populations and testing environments when longer cognitive test batteries are impractical. Future studies should assess the ability of these tests to detect clinically relevant changes following a suspected head injury.
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Affiliation(s)
- Jessica Saalfield
- Department of Kinesiology and Health, Rutgers University–New Brunswick
| | - Kelsey L. Piersol
- Department of Kinesiology and Health, Rutgers University–New Brunswick
| | - Carrie Esopenko
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences
| | - Marsha E. Bates
- Department of Kinesiology and Health, Rutgers University–New Brunswick
- Center of Alcohol and Substance Use Studies, Rutgers University – New Brunswick
| | - Scott A. Weismiller
- Center of Alcohol and Substance Use Studies, Rutgers University – New Brunswick
| | - Kyle Brostrand
- Department of Athletics, Rutgers University–New Brunswick
| | - Sabrina M. Todaro
- Center of Alcohol and Substance Use Studies, Rutgers University – New Brunswick
| | - Fiona N. Conway
- Department of Kinesiology and Health, Rutgers University–New Brunswick
- Center of Alcohol and Substance Use Studies, Rutgers University – New Brunswick
| | - Elisabeth A. Wilde
- Department of Neurology, University of Utah School of Medicine and the George E. Wahlen Veterans Affairs Medical Center
| | - Jennifer F. Buckman
- Department of Kinesiology and Health, Rutgers University–New Brunswick
- Center of Alcohol and Substance Use Studies, Rutgers University – New Brunswick
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Wilmoth K, Brett BL, Emmert NA, Cook CM, Schaffert J, Caze T, Kotsonis T, Cusick M, Solomon G, Resch JE, Cullum CM, Nelson LD, McCrea M. Psychometric Properties of Computerized Cognitive Tools and Standard Neuropsychological Tests Used to Assess Sport Concussion: A Systematic Review. Neuropsychol Rev 2023; 33:675-692. [PMID: 36040610 DOI: 10.1007/s11065-022-09553-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/03/2022] [Indexed: 11/29/2022]
Abstract
Athletic programs are more frequently turning to computerized cognitive tools in order to increase efficiencies in concussion assessment. However, assessment using a traditional neuropsychological test battery may provide a more comprehensive and individualized evaluation. Our goal was to inform sport clinicians of the best practices for concussion assessment through a systematic literature review describing the psychometric properties of standard neuropsychological tests and computerized tools. We conducted our search in relevant databases including Ovid Medline, Web of Science, PsycINFO, and Scopus. Journal articles were included if they evaluated psychometric properties (e.g., reliability, sensitivity) of a cognitive assessment within pure athlete samples (up to 30 days post-injury). Searches yielded 4,758 unique results. Ultimately, 103 articles met inclusion criteria, all of which focused on adolescent or young adult participants. Test-retest reliability estimates ranged from .14 to .93 for computerized tools and .02 to .95 for standard neuropsychological tests, with strongest correlations on processing speed tasks for both modalities, although processing speed tasks were most susceptible to practice effects. Reliability was improved with a 2-factor model (processing speed and memory) and by aggregating multiple baseline exams, yet remained below acceptable limits for some studies. Sensitivity to decreased cognitive performance within 72 h of injury ranged from 45%-93% for computerized tools and 18%-80% for standard neuropsychological test batteries. The method for classifying cognitive decline (normative comparison, reliable change indices, regression-based methods) affected sensitivity estimates. Combining computerized tools and standard neuropsychological tests with the strongest psychometric performance provides the greatest value in clinical assessment. To this end, future studies should evaluate the efficacy of hybrid test batteries comprised of top-performing measures from both modalities.
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Affiliation(s)
- Kristin Wilmoth
- Departments of Psychiatry and Physical Medicine & Rehabilitation, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9055, USA.
| | - Benjamin L Brett
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Natalie A Emmert
- Department of Neurology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Carolyn M Cook
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jeffrey Schaffert
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Todd Caze
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Kotsonis
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Margaret Cusick
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gary Solomon
- Player Health and Safety Department, National Football League and Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - C Munro Cullum
- Departments of Psychiatry, Neurology, and Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Lindsay D Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
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4
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Ross EA, Hines RB, Hoffmann M, Jay K, Antonucci MM. Multi-Modal Neurorehabilitation for Persisting Post-Concussion Symptoms. Neurotrauma Rep 2023; 4:297-306. [PMID: 37187507 PMCID: PMC10181800 DOI: 10.1089/neur.2022.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Treatment of the chronic sequela that persist after a mild traumatic brain injury has been challenging with limited efficacy. The aim of this work was to report outcomes obtained from persons who met the criteria of persisting post-concussive symptoms (PPCS), utilizing a novel combination of modalities in a structured neurorehabilitation program. This work was designed as a retrospective, pre-post chart review of objective and subjective measures collected from 62 outpatients with PPCS a mean of 2.2 years post-injury, before and after a multi-modal 5-day treatment protocol. The subjective outcome measure was the 27-item modified Graded Symptom Checklist (mGSC). Objective outcome measures were motor speed/reaction time, coordination, cognitive processing, visual acuity, and vestibular function. Interventions included non-invasive neuromodulation, neuromuscular re-education exercises, gaze stabilization exercises, orthoptic exercises, cognitive training, therapeutic exercises, and single/multi-axis rotation therapy. Pre-post differences in measures were analyzed using the Wilcoxon signed-rank test, with effect size determined by the rank-biserial correlation coefficient. Pre-post treatment comparisons for the subjective mGSC overall, combined symptom measures, individual components of the mGSC, and cluster scores significantly improved for all items. Moderate strength relationships were observed for the mGSC composite score, number of symptoms, average symptom score, feeling in a "fog," "don't feel right," irritability, and physical, cognitive, and affective cluster scores. Objective symptom assessment significantly improved for trail making, processing speed, reaction time, visual acuity, and Standardized Assessment of Concussion. Patients suffering from PPCS ∼2 years after injury may have significant benefits with some moderate effect sizes from an intensive, multi-modal neurorehabilitation program.
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Affiliation(s)
- Edward A. Ross
- Department of Medicine, University of Central Florida, Orlando, Florida, USA
- Address correspondence to: Edward A. Ross, MD, Department of Medicine, University of Central Florida, 6850 Lake Nona Boulevard, Orlando, FL 32832, USA
| | - Robert B. Hines
- Department of Population Health Sciences, University of Central Florida, Orlando, Florida, USA
| | - Michael Hoffmann
- Department of Medicine, University of Central Florida, Orlando, Florida, USA
- Neurology Section, Orlando VA Medical Center, Orlando, Florida, USA
| | - Kenneth Jay
- Department of Medicine, University of Central Florida, Orlando, Florida, USA
- Department of Neurology, Carrick Institute, Cape Canaveral, Florida, USA
- Department of Research, Cervello, A/S, Roskilde, Denmark
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Ten-Word List Performance in Healthy Athletes and Athletes at 3-to-5 Days Following Concussion. Clin J Sport Med 2022; 32:e354-e360. [PMID: 34029213 DOI: 10.1097/jsm.0000000000000941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/03/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Although the word recall component of the Sport Concussion Assessment Tool (SCAT) was updated from 5-to-10 words, its clinical utility across athletic populations remains unknown. The purpose of this study was to provide normative data on the SCAT-5 10-word test and examine its discriminative ability between healthy university level athletes and those with sport-related concussion (SRC). DESIGN Cross-sectional. SETTING University. PARTICIPANTS Three hundred sixty-three (363, M = 220, F = 153) healthy athletes and 49 (M = 30, F = 19) athletes following SRC. INDEPENDENT VARIABLE Healthy athletes measured preseason were compared with athletes following an SRC (median = 4.0 days postinjury). MAIN OUTCOME MEASURE Ten-word list performance from the SCAT-5. RESULTS There were no significant differences in either immediate ( P = 0.228, Cohen's D = 0.18) or delayed ( P = 0.908, Cohen's D = 0.02) recall tests between athletes with SRC and healthy athletes; the null findings extended to both the male and female subset comparisons. Among healthy athletes, females outperformed males on both immediate (mean difference = 1.0, P < 0.001) and delayed (mean difference = 0.5, P = 0.006) recall tasks. CONCLUSION Concussion does not seem to impact immediate or delayed recall of the 10-word list in the subacute period following injury. Practitioners should be mindful of sex differences and the time point of administration following injury.
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Schmid W, Fan Y, Chi T, Golanov E, Regnier-Golanov AS, Austerman RJ, Podell K, Cherukuri P, Bentley T, Steele CT, Schodrof S, Aazhang B, Britz GW. Review of wearable technologies and machine learning methodologies for systematic detection of mild traumatic brain injuries. J Neural Eng 2021; 18. [PMID: 34330120 DOI: 10.1088/1741-2552/ac1982] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/30/2021] [Indexed: 12/16/2022]
Abstract
Mild traumatic brain injuries (mTBIs) are the most common type of brain injury. Timely diagnosis of mTBI is crucial in making 'go/no-go' decision in order to prevent repeated injury, avoid strenuous activities which may prolong recovery, and assure capabilities of high-level performance of the subject. If undiagnosed, mTBI may lead to various short- and long-term abnormalities, which include, but are not limited to impaired cognitive function, fatigue, depression, irritability, and headaches. Existing screening and diagnostic tools to detect acute andearly-stagemTBIs have insufficient sensitivity and specificity. This results in uncertainty in clinical decision-making regarding diagnosis and returning to activity or requiring further medical treatment. Therefore, it is important to identify relevant physiological biomarkers that can be integrated into a mutually complementary set and provide a combination of data modalities for improved on-site diagnostic sensitivity of mTBI. In recent years, the processing power, signal fidelity, and the number of recording channels and modalities of wearable healthcare devices have improved tremendously and generated an enormous amount of data. During the same period, there have been incredible advances in machine learning tools and data processing methodologies. These achievements are enabling clinicians and engineers to develop and implement multiparametric high-precision diagnostic tools for mTBI. In this review, we first assess clinical challenges in the diagnosis of acute mTBI, and then consider recording modalities and hardware implementation of various sensing technologies used to assess physiological biomarkers that may be related to mTBI. Finally, we discuss the state of the art in machine learning-based detection of mTBI and consider how a more diverse list of quantitative physiological biomarker features may improve current data-driven approaches in providing mTBI patients timely diagnosis and treatment.
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Affiliation(s)
- William Schmid
- Department of Electrical and Computer Engineering and Neuroengineering Initiative (NEI), Rice University, Houston, TX 77005, United States of America
| | - Yingying Fan
- Department of Electrical and Computer Engineering and Neuroengineering Initiative (NEI), Rice University, Houston, TX 77005, United States of America
| | - Taiyun Chi
- Department of Electrical and Computer Engineering and Neuroengineering Initiative (NEI), Rice University, Houston, TX 77005, United States of America
| | - Eugene Golanov
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
| | | | - Ryan J Austerman
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
| | - Kenneth Podell
- Department of Neurology, Houston Methodist Hospital, Houston, TX 77030, United States of America
| | - Paul Cherukuri
- Institute of Biosciences and Bioengineering (IBB), Rice University, Houston, TX 77005, United States of America
| | - Timothy Bentley
- Office of Naval Research, Arlington, VA 22203, United States of America
| | - Christopher T Steele
- Military Operational Medicine Research Program, US Army Medical Research and Development Command, Fort Detrick, MD 21702, United States of America
| | - Sarah Schodrof
- Department of Athletics-Sports Medicine, Rice University, Houston, TX 77005, United States of America
| | - Behnaam Aazhang
- Department of Electrical and Computer Engineering and Neuroengineering Initiative (NEI), Rice University, Houston, TX 77005, United States of America
| | - Gavin W Britz
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
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7
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Linder SM, Lear A, Linder J, Lake A, Brier C, McGrath M, Cruickshank J, Figler R, Alberts JL. Symptom recovery and the relationship between post-injury symptom scores and neurocognitive performance in athletes with sport-related concussion. JOURNAL OF CONCUSSION 2021. [DOI: 10.1177/20597002211018063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction A multi-domain approach to concussion assessment has been recommended that includes self-reported symptom severity in addition to neurocognitive tests and measures of postural stability. The relationship between subjective self-reported symptoms and objective measures of cognitive function in the post-injury state is not well understood. The aims of the study were to determine symptom severity throughout the post-injury continuum of care and the association between symptom severity and performance on measures of neurocognitive function. Methods An observational cohort study was conducted on 1257 high school and collegiate athletes (67% male and 33% female) who had sustained a concussion. Student-athletes were included in the study if they had a healthy baseline assessment and at least one follow-up injury assessment utilizing the Cleveland Clinic Concussion Application (C3 App). Symptom severity was assessed during the acute (0–7 days post-injury), subacute (8–20 days post-injury), and post-concussive (≥21 days post-injury) phases. Neurocognitive performance was assessed using the following measures: Simple Reaction Time (SRT), Choice Reaction Time (CRT), Processing Speed Test (PST), Trail Making Test A (TMT-A), and Trail Making Test B (TMT-B). To determine the relationship between symptom severity and neurocognitive test performance, athletes were stratified into two groups for comparison: symptom score ≤7 or >7, utilizing the 27-item graded symptom checklist within the C3 App. Neurocognitive performance was analyzed with separate linear mixed effect models for each module to compare within-phase differences. Significance for each module at each phase was tested at P < .05 and adjusted for multiple comparisons. Results Median symptom severity during the acute post-injury phase was 10 declining to 2 during the subacute and post-concussive phases. Performance on each of the C3 App modules (SRT, CRT, PST, Trails A, and Trails B) were significantly better in athletes reporting a symptom score of ≤7 compared to those reporting a symptom score >7 at each of the post-injury phases (P < 0.05 on all comparisons). Conclusions Symptomatic athletes performed worse on all measures of neurocognitive function, regardless of time from injury. While symptoms alone should not be used to determine recovery, our data indicate that symptom severity may aide in deciding when to initiate post-injury neurocognitive testing to determine readiness for treatment progression.
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Affiliation(s)
- Susan M Linder
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Concussion Center, Cleveland Clinic, Cleveland, OH, USA
| | - Aaron Lear
- Cleveland Clinic Akron General Sport Medicine, Akron, OH, USA
| | - Joseph Linder
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Adam Lake
- Cleveland Clinic Concussion Center, Cleveland Clinic, Cleveland, OH, USA
| | - Corey Brier
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Morgan McGrath
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Jason Cruickshank
- Cleveland Clinic Concussion Center, Cleveland Clinic, Cleveland, OH, USA
| | - Richard Figler
- Cleveland Clinic Concussion Center, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Sports Health, Cleveland Clinic, Cleveland, OH, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Concussion Center, Cleveland Clinic, Cleveland, OH, USA
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8
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Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Insular Connectivity Is Associated With Self-Appraisal of Cognitive Function After a Concussion. Front Neurol 2021; 12:653442. [PMID: 34093401 PMCID: PMC8175663 DOI: 10.3389/fneur.2021.653442] [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: 01/15/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Concussion is associated with acute cognitive impairments, with declines in processing speed and reaction time being common. In the clinical setting, these issues are identified via symptom assessments and neurocognitive test (NCT) batteries. Practice guidelines recommend integrating both symptoms and NCTs into clinical decision-making, but correlations between these measures are often poor. This suggests that many patients experience difficulties in the self-appraisal of cognitive issues. It is presently unclear what neural mechanisms give rise to appraisal mismatch after a concussion. One promising target is the insula, which regulates aspects of cognition, particularly interoception and self-monitoring. The present study tested the hypothesis that appraisal mismatch is due to altered functional connectivity of the insula to frontal and midline structures, with hypo-connectivity leading to under-reporting of cognitive issues and hyper-connectivity leading to over-reporting. Data were collected from 59 acutely concussed individuals and 136 normative controls, including symptom assessments, NCTs and magnetic resonance imaging (MRI) data. Analysis of resting-state functional MRI supported the hypothesis, identifying insular networks that were associated with appraisal mismatch in concussed athletes that included frontal, sensorimotor, and cingulate connections. Subsequent analysis of diffusion tensor imaging also determined that symptom over-reporting was associated with reduced fractional anisotropy and increased mean diffusivity of posterior white matter. These findings provide new insights into the mechanisms of cognitive appraisal mismatch after a concussion. They are of particular interest given the central role of symptom assessments in the diagnosis and clinical management of concussion.
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Affiliation(s)
- Nathan W Churchill
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada.,Neuroscience Research Program, St. Michael's Hospital, Toronto, ON, Canada
| | - Michael G Hutchison
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Physical Sciences Platform, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Tom A Schweizer
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada.,Neuroscience Research Program, St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Medicine (Neurosurgery), University of Toronto, Toronto, ON, Canada.,The Institute of Biomaterials and Biomedical Engineering (IBBME) at the University of Toronto, Toronto, ON, Canada
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9
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Porfido T, de Souza NL, Brown AM, Buckman JF, Fanning BD, Parrott JS, Esopenko C. The relation between neck strength and psychological distress: preliminary evidence from collegiate soccer athletes. Concussion 2021; 6:CNC91. [PMID: 34084557 PMCID: PMC8162191 DOI: 10.2217/cnc-2020-0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/21/2021] [Indexed: 11/21/2022] Open
Abstract
AIM To examine whether neck strength and symmetry are associated with psychological function in athletes with exposure to repetitive head impacts. METHODS Collegiate soccer (n = 29) and limited/noncontact (n = 63) athletes without a history of concussion completed the Brief Symptom Inventory 18 and assessments of isometric neck strength. Neck strength symmetry was calculated as the difference in strength between opposing muscle groups. RESULTS The results demonstrated that lower neck strength was associated with more symptoms of anxiety, whereas asymmetry in neck strength was associated with more symptoms of somatization and depression in soccer athletes only. CONCLUSION These preliminary results suggest that greater neck strength/symmetry is related to better psychological function in athletes who have higher exposure to repetitive head impacts.
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Affiliation(s)
- Tara Porfido
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Nicola L de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Allison M Brown
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Jennifer F Buckman
- Department of Kinesiology & Health, Rutgers–New Brunswick, Piscataway, NJ, USA
| | - Brian D Fanning
- Department of Intercollegiate Athletics & Recreation, Rutgers–Newark, Newark, NJ, USA
| | - James S Parrott
- Department of Interdisciplinary Studies, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Carrie Esopenko
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
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10
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Miyashita TL, Cote C, Terrone D, Diakogeorgiou E. Detecting changes in postural sway. J Biomech 2020; 107:109868. [DOI: 10.1016/j.jbiomech.2020.109868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/12/2020] [Accepted: 05/24/2020] [Indexed: 01/14/2023]
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11
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Reliability, Validity and Utility of Inertial Sensor Systems for Postural Control Assessment in Sport Science and Medicine Applications: A Systematic Review. Sports Med 2020; 49:783-818. [PMID: 30903440 DOI: 10.1007/s40279-019-01095-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Recent advances in mobile sensing and computing technology have provided a means to objectively and unobtrusively quantify postural control. This has resulted in the rapid development and evaluation of a series of wearable inertial sensor-based assessments. However, the validity, reliability and clinical utility of such systems is not fully understood. OBJECTIVES This systematic review aims to synthesise and evaluate studies that have investigated the ability of wearable inertial sensor systems to validly and reliably quantify postural control performance in sports science and medicine applications. METHODS A systematic search strategy utilising the PRISMA guidelines was employed to identify eligible articles through ScienceDirect, Embase and PubMed databases. In total, 47 articles met the inclusion criteria and were evaluated and qualitatively synthesised under two main headings: measurement validity and measurement reliability. Furthermore, studies that investigated the utility of these systems in clinical populations were summarised and discussed. RESULTS After duplicate removal, 4374 articles were identified with the search strategy, with 47 papers included in the final review. In total, 28 studies investigated validity in healthy populations, and 15 studies investigated validity in clinical populations; 13 investigated the measurement reliability of these sensor-based systems. CONCLUSIONS The application of wearable inertial sensors for sports science and medicine postural control applications is an evolving field. To date, research has primarily focused on evaluating the validity and reliability of a heterogeneous set of assessment protocols, in a laboratory environment. While researchers have begun to investigate their utility in clinical use cases such as concussion and musculoskeletal injury, most studies have leveraged small sample sizes, are of low quality and use a variety of descriptive variables, assessment protocols and sensor-mounting locations. Future research should evaluate the clinical utility of these systems in large high-quality prospective cohort studies to establish the role they may play in injury risk identification, diagnosis and management. This systematic review was registered with the International Prospective Register of Systematic Reviews on 10 August 2018 (PROSPERO registration: CRD42018106363): https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=106363 .
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Iaccarino MA, Zafonte RD, Roy ED, Wojtowicz M. Case 27-2019: A 16-Year-Old Girl with Head Trauma during a Sailboat Race. N Engl J Med 2019; 381:863-871. [PMID: 31461598 DOI: 10.1056/nejmcpc1900590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Mary A Iaccarino
- From the Departments of Physical Medicine and Rehabilitation (M.A.I., R.D.Z.) and Physical Therapy (E.D.R.), Massachusetts General Hospital, the Departments of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital (M.A.I., R.D.Z.), the Departments of Physical Medicine and Rehabilitation, Brigham and Women's Hospital (M.A.I., R.D.Z.), and the Departments of Physical Medicine and Rehabilitation, Harvard Medical School (M.A.I., R.D.Z.) - all in Boston; and the Department of Psychology, York University, Toronto (M.W.)
| | - Ross D Zafonte
- From the Departments of Physical Medicine and Rehabilitation (M.A.I., R.D.Z.) and Physical Therapy (E.D.R.), Massachusetts General Hospital, the Departments of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital (M.A.I., R.D.Z.), the Departments of Physical Medicine and Rehabilitation, Brigham and Women's Hospital (M.A.I., R.D.Z.), and the Departments of Physical Medicine and Rehabilitation, Harvard Medical School (M.A.I., R.D.Z.) - all in Boston; and the Department of Psychology, York University, Toronto (M.W.)
| | - Emily D Roy
- From the Departments of Physical Medicine and Rehabilitation (M.A.I., R.D.Z.) and Physical Therapy (E.D.R.), Massachusetts General Hospital, the Departments of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital (M.A.I., R.D.Z.), the Departments of Physical Medicine and Rehabilitation, Brigham and Women's Hospital (M.A.I., R.D.Z.), and the Departments of Physical Medicine and Rehabilitation, Harvard Medical School (M.A.I., R.D.Z.) - all in Boston; and the Department of Psychology, York University, Toronto (M.W.)
| | - Magdalena Wojtowicz
- From the Departments of Physical Medicine and Rehabilitation (M.A.I., R.D.Z.) and Physical Therapy (E.D.R.), Massachusetts General Hospital, the Departments of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital (M.A.I., R.D.Z.), the Departments of Physical Medicine and Rehabilitation, Brigham and Women's Hospital (M.A.I., R.D.Z.), and the Departments of Physical Medicine and Rehabilitation, Harvard Medical School (M.A.I., R.D.Z.) - all in Boston; and the Department of Psychology, York University, Toronto (M.W.)
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Makwana B, Xu XM. C3Logix assessment of neuropsychological performance in athletes and nonathletes. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 27:490-496. [PMID: 30793975 DOI: 10.1080/23279095.2019.1570927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Physical activity (PA) has been shown to enhance physical health, mental health, and cognitive functioning. Adult and older adult research shows that PA positively influences neuropsychological performance and protects against cognitive decline. This study investigated neuropsychological performance in uninjured athletes and nonathletes using an iPad-based neuropsychological battery called C3Logix. Since literature suggests that PA enhances cognitive functioning, athletes may perform better on neurocognitive measures than nonathletes due to athletes' assumed higher level of PA. We hypothesized that collegiate athletes would outperform nonathletes on all cognitive tasks. Ninety-five athletes and 92 nonathletes completed the neurocognitive assessments and results showed that athletes outperformed nonathletes on reaction time tasks, but not in other cognitive domains. The implications of this study included extending the work of previous research using C3Logix and added to our understanding of a possible difference in reaction time between healthy collegiate athletes and nonathletes.
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Affiliation(s)
- Bindal Makwana
- Department of Psychology, Idaho State University, Pocatello, Idaho, USA
| | - Xiaomeng Mona Xu
- Department of Psychology, Idaho State University, Pocatello, Idaho, USA
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