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Holcomb TD, Marks ME, Pritchard NS, Miller LE, Rowson S, Bullock GS, Urban JE, Stitzel JD. On-Field Evaluation of Mouthpiece-and-Helmet-Mounted Sensor Data from Head Kinematics in Football. Ann Biomed Eng 2024; 52:2655-2665. [PMID: 39058402 PMCID: PMC11402845 DOI: 10.1007/s10439-024-03583-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 07/04/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE Wearable sensors are used to measure head impact exposure in sports. The Head Impact Telemetry (HIT) System is a helmet-mounted system that has been commonly utilized to measure head impacts in American football. Advancements in sensor technology have fueled the development of alternative sensor methods such as instrumented mouthguards. The objective of this study was to compare peak magnitude measured from high school football athletes dually instrumented with the HIT System and a mouthpiece-based sensor system. METHODS Data was collected at all contact practices and competitions over a single season of spring football. Recorded events were observed and identified on video and paired using event timestamps. Paired events were further stratified by removing mouthpiece events with peak resultant linear acceleration below 10 g and events with contact to the facemask or body of athletes. RESULTS A total of 133 paired events were analyzed in the results. There was a median difference (mouthpiece subtracted from HIT System) in peak resultant linear and rotational acceleration for concurrently measured events of 7.3 g and 189 rad/s2. Greater magnitude events resulted in larger kinematic differences between sensors and a Bland Altman analysis found a mean bias of 8.8 g and 104 rad/s2, respectively. CONCLUSION If the mouthpiece-based sensor is considered close to truth, the results of this study are consistent with previous HIT System validation studies indicating low error on average but high scatter across individual events. Future researchers should be mindful of sensor limitations when comparing results collected using varying sensor technologies.
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Affiliation(s)
- Ty D Holcomb
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Madison E Marks
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - N Stewart Pritchard
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Logan E Miller
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Steve Rowson
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Garrett S Bullock
- Department of Orthopedic Surgery and Rehabilitation, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jillian E Urban
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA.
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA.
| | - Joel D Stitzel
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 Patterson Avenue, Suite 530, Winston-Salem, NC, 27101, USA
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
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de Souza NL, Bogner J, Corrigan JD, Rabinowitz AR, Walker WC, Kumar RG, Dams-O'Connor K. The Effects of Repetitive Head Impact Exposure on Mental Health Symptoms Following Traumatic Brain Injury. J Head Trauma Rehabil 2024; 39:E430-E441. [PMID: 38483265 PMCID: PMC11387145 DOI: 10.1097/htr.0000000000000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
OBJECTIVE This study aimed to characterize the types and timing of repetitive head impact (RHI) exposures in individuals with moderate to severe traumatic brain injury (TBI) and to examine the effects of RHI exposures on mental health outcomes. SETTING TBI Model Systems National Database. PARTICIPANTS 447 patients with moderate to severe TBI who reported RHI exposure between 2015 and 2022. DESIGN Secondary data analysis. MAIN MEASURES RHI exposures reported on the Ohio State University TBI Identification Method (OSU TBI-ID) were characterized by exposure category, duration, and timing relative to the index TBI. Mental health outcomes were evaluated at the 5-year follow-up assessment using the Patient Health Questionnaire-9 (PHQ-9) for depression symptoms and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms. RESULTS The majority of RHI exposures were sports-related (61.1%), followed by other causes (20.8%; including falls), repetitive violence/assault (18.8%), and military exposures (6.7%). Males predominantly reported sports and military exposures, while a larger proportion of females reported violence and falls. Sports exposures were most common before the index TBI, while exposures from falls and violence/abuse were most common after TBI. RHI exposures occurring after the index TBI were associated with higher levels of depression (β = 5.05; 95% CI, 1.59-8.50) and anxiety (β = 4.53; 95% CI, 1.02-8.05) symptoms than exposures before the index TBI. CONCLUSION The findings emphasize the need to consider RHI exposures and their interaction with TBI when assessing mental health outcomes. Understanding the prevalence and challenges associated with RHI post-TBI can inform targeted interventions and improve the well-being of individuals with TBI. Preventive measures and ongoing care should be implemented to address the risks posed by RHI, particularly in individuals with prior TBI, especially surrounding fall and violence/abuse prevention.
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Affiliation(s)
- Nicola L de Souza
- Author Affiliation : Departments of Rehabilitation and Human Performance (Drs de Souza, Kumar, and Dams-O'Connor) and Neurology (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York, New York; Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio (Drs Bogner and Corrigan); Department of Physical Medicine and Rehabilitation, Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Dr Rabinowitz); and Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia (Dr Walker)
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Krch D, Lequerica AH, Arango-Lasprilla JC, Corrigan JD. Neurobehavioral Symptoms in Spanish-Speaking Individuals With Subconcussive Injuries. J Head Trauma Rehabil 2024; 39:E399-E406. [PMID: 38456793 DOI: 10.1097/htr.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To examine whether exposure to high-risk events causing injury to the head or neck has an effect on neurobehavioral symptoms in the absence of an alteration of consciousness in Spanish-speakers. SETTING Web-based survey. PARTICIPANTS Seven hundred forty-eight individuals from Spain and Latin America, aged 18 to 65 years, with 10 years or more of education. Thirty-nine participants failed quality checks and were excluded. Seven hundred nine participants were included in the analyses. DESIGN Cross-sectional study. Subconcussive exposure was defined as endorsing exposure to one or more high-risk scenarios in the absence of any alteration of consciousness. Three injury groups were derived: No Head Injury, Subconcussive Exposure, and traumatic brain injury (TBI). The Subconcussive Exposure group was further divided into Single and Multiple Exposures. Two analyses were conducted: the effect of lifetime exposure to injury (No Head Injury, Subconcussive Exposure, TBI) on neurobehavioral symptoms; the effect of Subconcussive Exposure Frequency (No Head Injury, Single Exposure, Multiple Exposures) on neurobehavioral symptoms. MAIN MEASURES Spanish Ohio State University Traumatic Brain Injury Identification Method Self-Administered-Brief (OSU TBI-ID SAB); Neurobehavioral Symptom Inventory (NSI). RESULTS There was a significant effect for Injury group on the NSI partial eta-squared (η p2 = 0.053) and a significant effect of Exposure Frequency group on the NSI (η p2 = 0.40). Individuals with subconcussive exposures reported significantly more neurobehavioral symptoms than those with no history of head injury and significantly less symptoms than those with TBI. Individuals with multiple subconcussive exposures reported significantly more neurobehavioral symptoms than those with single and no exposure. CONCLUSION This research expands the utility of the OSU-TBI-ID SAB as a lifetime TBI history assessment tool to one capable of evaluating subconcussive exposure dosing effects in Spanish-speakers. Such an index may facilitate establishment of subconcussive exposure prevalence rates worldwide, leading to improved understanding of the chronic effects of high-risk exposures.
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Affiliation(s)
- Denise Krch
- Author Affiliations: Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, and Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey (Drs Krch and Lequerica); Department of Psychology, Virginia Commonwealth University, Richmond, Virginia (Dr Arango-Lasprilla); and Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio (Dr Corrigan)
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Kawas MI, Atcheson KM, Flood WC, Sheridan CA, Barcus RA, Flashman LA, McAllister TW, Lipford ME, Kim J, Urban JE, Davenport EM, Vaughan CG, Sai KKS, Stitzel JD, Maldjian JA, Whitlow CT. Cognitive and Salience Network Connectivity Changes following a Single Season of Repetitive Head Impact Exposure in High School Football. AJNR Am J Neuroradiol 2024; 45:1116-1123. [PMID: 39054293 PMCID: PMC11383397 DOI: 10.3174/ajnr.a8294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/18/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND PURPOSE During a season of high school football, adolescents with actively developing brains experience a considerable number of head impacts. Our aim was to determine whether repetitive head impacts in the absence of a clinically diagnosed concussion during a season of high school football produce changes in cognitive performance or functional connectivity of the salience network and its central hub, the dorsal anterior cingulate cortex. MATERIALS AND METHODS Football players were instrumented with the Head Impact Telemetry System during all practices and games, and the helmet sensor data were used to compute a risk-weighted exposure metric (RWEcp), accounting for the cumulative risk during the season. Participants underwent MRI and a cognitive battery (ImPACT) before and shortly after the football season. A control group of noncontact/limited-contact-sport athletes was formed from 2 cohorts: one from the same school and protocol and another from a separate, nearly identical study. RESULTS Sixty-three football players and 34 control athletes were included in the cognitive performance analysis. Preseason, the control group scored significantly higher on the ImPACT Visual Motor (P = .04) and Reaction Time composites (P = .006). These differences increased postseason (P = .003, P < .001, respectively). Additionally, the control group had significantly higher postseason scores on the Visual Memory composite (P = .001). Compared with controls, football players showed significantly less improvement in the Verbal (P = .04) and Visual Memory composites (P = .01). A significantly greater percentage of contact athletes had lower-than-expected scores on the Verbal Memory (27% versus 6%), Visual Motor (21% versus 3%), and Reaction Time composites (24% versus 6%). Among football players, a higher RWEcp was significantly associated with greater increments in ImPACT Reaction Time (P = .03) and Total Symptom Scores postseason (P = .006). Fifty-seven football players and 13 control athletes were included in the imaging analyses. Postseason, football players showed significant decreases in interhemispheric connectivity of the dorsal anterior cingulate cortex (P = .026) and within-network connectivity of the salience network (P = .018). These decreases in dorsal anterior cingulate cortex interhemispheric connectivity and within-network connectivity of the salience network were significantly correlated with deteriorating ImPACT Total Symptom (P = .03) and Verbal Memory scores (P = .04). CONCLUSIONS Head impact exposure during a single season of high school football is negatively associated with cognitive performance and brain network connectivity. Future studies should further characterize these short-term effects and examine their relationship with long-term sequelae.
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Affiliation(s)
- Mohammad I Kawas
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
- Department of Physiology (M.I.K.), Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Kyle M Atcheson
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - William C Flood
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Christopher A Sheridan
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Richard A Barcus
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Laura A Flashman
- Department of Neuropsychology (L.A.F.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Thomas W McAllister
- Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis, Indiana
| | - Megan E Lipford
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Jeongchul Kim
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Jillian E Urban
- Department of Biomedical Engineering (J.E.U., J.D.S.), Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Elizabeth M Davenport
- Department of Radiology (E.M.D., J.A.M), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher G Vaughan
- Division of Pediatric Neuropsychology (C.G.V.), Children's National Hospital, Washington, DC
| | - Kiran K Solingapuram Sai
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Joel D Stitzel
- Department of Biomedical Engineering (J.E.U., J.D.S.), Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joseph A Maldjian
- Department of Radiology (E.M.D., J.A.M), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher T Whitlow
- From the Department of Radiology (M.I.K., K.M.A., W.C.F., C.A.S., R.A.B., M.E.L., J.K., K.K.S.S., C.T.W.), Wake Forest School of Medicine/Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
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Garcia-Cordero I, Vasilevskaya A, Taghdiri F, Khodadadi M, Mikulis D, Tarazi A, Mushtaque A, Anssari N, Colella B, Green R, Rogaeva E, Sato C, Grinberg M, Moreno D, Hussain MW, Blennow K, Zetterberg H, Davis KD, Wennberg R, Tator C, Tartaglia MC. Functional connectivity changes in neurodegenerative biomarker-positive athletes with repeated concussions. J Neurol 2024; 271:4180-4190. [PMID: 38589629 DOI: 10.1007/s00415-024-12340-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/27/2024] [Accepted: 03/19/2024] [Indexed: 04/10/2024]
Abstract
Multimodal biomarkers may identify former contact sports athletes with repeated concussions and at risk for dementia. Our study aims to investigate whether biomarker evidence of neurodegeneration in former professional athletes with repetitive concussions (ExPro) is associated with worse cognition and mood/behavior, brain atrophy, and altered functional connectivity. Forty-one contact sports athletes with repeated concussions were divided into neurodegenerative biomarker-positive (n = 16) and biomarker-negative (n = 25) groups based on positivity of serum neurofilament light-chain. Six healthy controls (negative for biomarkers) with no history of concussions were also analyzed. We calculated cognitive and mood/behavior composite scores from neuropsychological assessments. Gray matter volume maps and functional connectivity of the default mode, salience, and frontoparietal networks were compared between groups using ANCOVAs, controlling for age, and total intracranial volume. The association between the connectivity networks and sports characteristics was analyzed by multiple regression analysis in all ExPro. Participants presented normal-range mean performance in executive function, memory, and mood/behavior tests. The ExPro groups did not differ in professional years played, age at first participation in contact sports, and number of concussions. There were no differences in gray matter volume between groups. The neurodegenerative biomarker-positive group had lower connectivity in the default mode network (DMN) compared to the healthy controls and the neurodegenerative biomarker-negative group. DMN disconnection was associated with increased number of concussions in all ExPro. Biomarkers of neurodegeneration may be useful to detect athletes that are still cognitively normal, but with functional connectivity alterations after concussions and at risk of dementia.
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Affiliation(s)
- Indira Garcia-Cordero
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Anna Vasilevskaya
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Foad Taghdiri
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Mozhgan Khodadadi
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - David Mikulis
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Apameh Tarazi
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Asma Mushtaque
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Neda Anssari
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
- Brain Vision and Concussion Clinic, Winnipeg, Canada
| | - Brenda Colella
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Robin Green
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Christine Sato
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Mark Grinberg
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Danielle Moreno
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Mohammed W Hussain
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
| | - Karen D Davis
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
- Krembil Brain Institute, University Health Network, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Richard Wennberg
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Charles Tator
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Maria C Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada.
- Canadian Concussion Centre, Toronto Western Hospital, University Health Network, Toronto, Canada.
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McPherson AL, Anderson T, Finnoff JT, Adams WM. Head Kinematics and Injury Analysis in Elite Bobsleigh Athletes Throughout a World Cup Tour. J Athl Train 2024; 59:584-593. [PMID: 37648215 PMCID: PMC11220765 DOI: 10.4085/1062-6050-0014.23] [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: 09/01/2023]
Abstract
CONTEXT The neurocognitive health effects of repetitive head impacts have been examined in many sports. However, characterizations of head impacts for sliding-sport athletes are lacking. OBJECTIVE To describe head impact kinematics and injury epidemiology in elite athletes during the 2021-2022 Bobsleigh World Cup season. DESIGN Cross-sectional study. SETTING On-track training and competitions during the Bobsleigh World Cup season. PATIENTS OR OTHER PARTICIPANTS Twelve elite bobsleigh athletes (3 pilots [1 female], 9 push athletes [5 females]; age = 30 ± 5 years; female height and weight = 173 ± 8 cm and 75 ± 5 kg, respectively; male height and weight = 183 ± 5 cm and 101 ± 5 kg, respectively). MAIN OUTCOME MEASURE(S) Athletes wore an accelerometer-enabled mouthguard to quantify 6-degrees-of-freedom head impact kinematics. Isometric absolute and relative neck strength, number of head acceleration events (HAEs), workload (J), peak linear velocity (m·s-1), peak angular velocity (rad·s-1), peak linear acceleration (g), and peak angular acceleration (rad·s-2) were derived from mouthguard manufacturer algorithms. Linear mixed-effect models tested the effects of sex (male versus female), setting (training versus competition), and position (pilot versus push athlete) on the kinematic variables. RESULTS A total of 1900 HAEs were recorded over 48 training and 53 competition days. No differences were found between the number of HAEs per run per athlete by sex (incidence rate ratio [IRR] = 0.82, P = .741), setting (IRR = 0.94, P = .325), or position (IRR = 1.64, P = .463). No sex differences were observed for workload (mean ± SD: males = 3.3 ± 2.2 J, females = 3.1 ± 1.9 J; P = .646), peak linear velocity (males = 1.1 ± 0.3 m·s-1, females = 1.1 ± 0.3 m·s-1; P = .706), peak angular velocity (males = 4.2 ± 2.1 rad·s-1, females = 4.7 ± 2.5 rad·s-1; P = .220), peak linear acceleration (male = 12.4 ± 3.9g, females = 11.9 ± 3.5g; P = .772), or peak angular acceleration (males = 610 ± 353 rad·s-2, females = 680 ± 423 rad·s-2; P = .547). Also, no effects of setting or position on any kinematic variables were seen. Male athletes had greater peak neck strength than female athletes for all neck movements, aside from right-side flexion (P = .085), but no sex differences were noted in relative neck strength. CONCLUSIONS We provide a foundational understanding of the repetitive HAEs that occur in bobsleigh athletes. Future authors should determine the effects of repetitive head impacts on neurocognitive function and mental health.
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Affiliation(s)
- April L. McPherson
- Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs
| | - Travis Anderson
- Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs
| | - Jonathan T. Finnoff
- Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver
| | - William M. Adams
- Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs
- Department of Kinesiology, University of North Carolina-Greensboro
- School of Sport, Exercise and Health Sciences, Loughborough University, National Centre for Sport and Exercise Medicine (NCSEM), UK
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Robertson MK, McLoughlin J. The role of the physiotherapist in concussion. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2024; 80:2013. [PMID: 38725965 PMCID: PMC11079349 DOI: 10.4102/sajp.v80i1.2013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/31/2024] [Indexed: 05/12/2024] Open
Abstract
In the last decade, concussion research has exploded in multiple fields of scientific research. This has helped to clarify what causes, influences, and perpetuates human concussion, and displays the integral role physiotherapists play in concussion management. In this article we discuss the latest research relevant to the key role of physiotherapy in concussion management. A narrative review of the literature on concussion was conducted. The current review analyses how concussion has influenced physiotherapy in several categories: assessment, treatment, management, research rigour and building the profile of the profession. Scientific concussion research has largely converged in support of the role of physiotherapists utilising specific components including: (1) autonomic, (2) cervicogenic, (3) vestibulo-ocular and (4) psychological approaches to management. Latest research supports the critical role of physiotherapy in concussion care in the assessment, management, and prevention of concussion with scope for further interdisciplinary collaborations. Clinical implications Concussion is complex. A basic mental health, Vestibular Ocular Motor Screening (VOMS) and four key components relating to concussion management (autonomic, cervicogenic, vestibular oculomotor, and psychological approaches to management) should be included in the undergraduate and postgraduate curriculum. This will aid clinical physiotherapists to support their patients. A call to advance more intradisciplinary physiotherapy teamwork should be encouraged as valuable knowledge sharing is potentially lost within the framework of 'specialisation'. If needed, the skills of a greater interdisciplinary team are imperative to facilitate patient management and recovery from this multi-faceted injury.
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Affiliation(s)
| | - James McLoughlin
- College of Nursing and Health Sciences, Faculty of Physiotherapy, Flinders University, Adelaide, Australia
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Zuidema TR, Hou J, Kercher KA, Recht GO, Sweeney SH, Chenchaiah N, Cheng H, Steinfeldt JA, Kawata K. Cerebral Cortical Surface Structure and Neural Activation Pattern Among Adolescent Football Players. JAMA Netw Open 2024; 7:e2354235. [PMID: 38300622 PMCID: PMC10835513 DOI: 10.1001/jamanetworkopen.2023.54235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/08/2023] [Indexed: 02/02/2024] Open
Abstract
Importance Recurring exposure to head impacts in American football has garnered public and scientific attention, yet neurobiological associations in adolescent football players remain unclear. Objective To examine cortical structure and neurophysiological characteristics in adolescent football players. Design, Setting, and Participants This cohort study included adolescent football players and control athletes (swimming, cross country, and tennis) from 5 high school athletic programs, who were matched with age, sex (male), and school. Neuroimaging assessments were conducted May to July of the 2021 and 2022 seasons. Data were analyzed from February to November 2023. Exposure Playing tackle football or noncontact sports. Main Outcomes and Measures Structural magnetic resonance imaging (MRI) data were analyzed for cortical thickness, sulcal depth, and gyrification, and cortical surface-based resting state (RS)-functional MRI analyses examined the amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and RS-functional connectivity (RS-FC). Results Two-hundred seventy-five male participants (205 football players; mean [SD] age, 15.8 [1.2] years; 5 Asian [2.4%], 8 Black or African American [3.9%], and 189 White [92.2%]; 70 control participants; mean [SD] age 15.8 [1.2] years, 4 Asian [5.7], 1 Black or African American [1.4%], and 64 White [91.5%]) were included in this study. Relative to the control group, the football group showed significant cortical thinning, especially in fronto-occipital regions (eg, right precentral gyrus: t = -2.24; P = .01; left superior frontal gyrus: -2.42; P = .002). Elevated cortical thickness in football players was observed in the anterior and posterior cingulate cortex (eg, left posterior cingulate cortex: t = 2.28; P = .01; right caudal anterior cingulate cortex 3.01; P = .001). The football group had greater and deeper sulcal depth than the control groups in the cingulate cortex, precuneus, and precentral gyrus (eg, right inferior parietal lobule: t = 2.20; P = .004; right caudal anterior cingulate cortex: 4.30; P < .001). Significantly lower ALFF was detected in the frontal lobe and cingulate cortex of the football group (t = -3.66 to -4.92; P < .01), whereas elevated ALFF was observed in the occipital regions (calcarine and lingual gyrus, t = 3.20; P < .01). Similar to ALFF, football players exhibited lower ReHo in the precentral gyrus and medial aspects of the brain, such as precuneus, insula, and cingulum, whereas elevated ReHo was clustered in the occipitotemporal regions (t = 3.17; P < .001; to 4.32; P < .01). There was no group difference in RS-FC measures. Conclusions and Relevance In this study of adolescent athletes, there was evidence of discernible structural and physiological differences in the brains of adolescent football players compared with their noncontact controls. Many of the affected brain regions were associated with mental health well-being.
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Affiliation(s)
- Taylor R. Zuidema
- Department of Kinesiology, Indiana University School of Public Health, Bloomington
- Program in Neuroscience, The College of Arts and Sciences, Indiana University, Bloomington
| | - Jiancheng Hou
- Department of Kinesiology, Indiana University School of Public Health, Bloomington
- Research Center for Cross-Straits Cultural Development, Fujian Normal University, Fuzhou, Fujian, China
| | - Kyle A. Kercher
- Department of Kinesiology, Indiana University School of Public Health, Bloomington
| | - Grace O. Recht
- Department of Kinesiology, Indiana University School of Public Health, Bloomington
| | - Sage H. Sweeney
- Department of Kinesiology, Indiana University School of Public Health, Bloomington
| | - Nishant Chenchaiah
- Department of Kinesiology, Indiana University School of Public Health, Bloomington
| | - Hu Cheng
- Program in Neuroscience, The College of Arts and Sciences, Indiana University, Bloomington
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Indiana University, Bloomington
| | - Jesse A. Steinfeldt
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University School of Public Health, Bloomington
- Program in Neuroscience, The College of Arts and Sciences, Indiana University, Bloomington
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis
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9
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Fitzgerald B, Bari S, Vike N, Lee TA, Lycke RJ, Auger JD, Leverenz LJ, Nauman E, Goñi J, Talavage TM. Longitudinal changes in resting state fMRI brain self-similarity of asymptomatic high school American football athletes. Sci Rep 2024; 14:1747. [PMID: 38243048 PMCID: PMC10799081 DOI: 10.1038/s41598-024-51688-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024] Open
Abstract
American football has become the focus of numerous studies highlighting a growing concern that cumulative exposure to repetitive, sports-related head acceleration events (HAEs) may have negative consequences for brain health, even in the absence of a diagnosed concussion. In this longitudinal study, brain functional connectivity was analyzed in a cohort of high school American football athletes over a single play season and compared against participants in non-collision high school sports. Football athletes underwent four resting-state functional magnetic resonance imaging sessions: once before (pre-season), twice during (in-season), and once 34-80 days after the contact activities play season ended (post-season). For each imaging session, functional connectomes (FCs) were computed for each athlete and compared across sessions using a metric reflecting the (self) similarity between two FCs. HAEs were monitored during all practices and games throughout the season using head-mounted sensors. Relative to the pre-season scan session, football athletes exhibited decreased FC self-similarity at the later in-season session, with apparent recovery of self-similarity by the time of the post-season session. In addition, both within and post-season self-similarity was correlated with cumulative exposure to head acceleration events. These results suggest that repetitive exposure to HAEs produces alterations in functional brain connectivity and highlight the necessity of collision-free recovery periods for football athletes.
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Affiliation(s)
- Bradley Fitzgerald
- Elmore Family School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA.
| | - Sumra Bari
- Elmore Family School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA
- Department of Computer Science, University of Cincinnati, Cincinnati, OH, USA
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Nicole Vike
- Department of Computer Science, University of Cincinnati, Cincinnati, OH, USA
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- Department of Basic Medical Sciences, Purdue University, West Lafayette, IN, USA
| | - Taylor A Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Roy J Lycke
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, USA
| | - Joshua D Auger
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Larry J Leverenz
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Eric Nauman
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- Department of Basic Medical Sciences, Purdue University, West Lafayette, IN, USA
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Joaquín Goñi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
- Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, IN, USA
| | - Thomas M Talavage
- Elmore Family School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
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10
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Jones CMA, Kamintsky L, Parker E, Kureshi N, Audas L, Wilson L, Champagne AA, Boulanger MM, DiStefano V, Fenerty L, Bowen C, Beyea S, Atkinson C, Clarke DB, Friedman A. Blood-Brain Barrier Dysfunction and Exposure to Head Impacts in University Football Players. Clin J Sport Med 2024; 34:61-68. [PMID: 37285595 DOI: 10.1097/jsm.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/21/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the link between dysfunction of the blood-brain barrier (BBB) and exposure to head impacts in concussed football athletes. DESIGN This was a prospective, observational pilot study. SETTING Canadian university football. PARTICIPANTS The study population consisted of 60 university football players, aged 18 to 25. Athletes who sustained a clinically diagnosed concussion over the course of a single football season were invited to undergo an assessment of BBB leakage. INDEPENDENT VARIABLES Head impacts detected using impact-sensing helmets were the measured variables. MAIN OUTCOME MEASURES Clinical diagnosis of concussion and BBB leakage assessed using dynamic contrast-enhanced MRI (DCE-MRI) within 1 week of concussion were the outcome measures. RESULTS Eight athletes were diagnosed with a concussion throughout the season. These athletes sustained a significantly higher number of head impacts than nonconcussed athletes. Athletes playing in the defensive back position were significantly more likely to sustain a concussion than remain concussion free. Five of the concussed athletes underwent an assessment of BBB leakage. Logistic regression analysis indicated that region-specific BBB leakage in these 5 athletes was best predicted by impacts sustained in all games and practices leading up to the concussion-as opposed to the last preconcussion impact or the impacts sustained during the game when concussion occurred. CONCLUSIONS These preliminary findings raise the potential for the hypothesis that repeated exposure to head impacts may contribute to the development of BBB pathology. Further research is needed to validate this hypothesis and to test whether BBB pathology plays a role in the sequela of repeated head trauma.
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Affiliation(s)
- Casey M A Jones
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Lyna Kamintsky
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ellen Parker
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Nelofar Kureshi
- Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lorelei Audas
- Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada
| | | | | | | | - Vincent DiStefano
- School of Applied Child Psychology, McGill University, Montréal, QC, Canada
| | - Lynne Fenerty
- Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Chris Bowen
- Biomedical Translational Imaging Centre (BIOTIC), Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
- Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Steven Beyea
- Biomedical Translational Imaging Centre (BIOTIC), Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
- Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Christina Atkinson
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada; and
| | - David B Clarke
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Alon Friedman
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Departments of Cognitive and Brain Sciences, Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer Sheva, Israel
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11
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Nowak MK, Kronenberger WG, Rettke D, Ogbeide O, Klemsz LM, Quinn PD, Mickleborough TD, Newman SD, Kawata K. Neuro-ophthalmologic and blood biomarker responses in ADHD following subconcussive head impacts: a case-control trial. Front Psychiatry 2023; 14:1230463. [PMID: 38076682 PMCID: PMC10710155 DOI: 10.3389/fpsyt.2023.1230463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 11/09/2023] [Indexed: 02/12/2024] Open
Abstract
Introduction This clinical trial aimed to determine the influence of attention-deficit/hyperactivity disorder (ADHD) on neuro-ophthalmologic function and brain-derived blood biomarkers following acute subconcussive head impacts. Methods The present trial consisted of age- and sex-matched samples with a ratio of 1:1 between two groups with a total sample size of 60 adults (age ± SD; 20.0 ± 1.8 years). Soccer players diagnosed with and medicated daily for ADHD were assigned into an ADHD group (n = 30). Soccer players without ADHD were assigned into a non-ADHD group (n = 30). Participants performed 10 soccer headers with a soccer ball projected at a velocity of 25mph. King-Devick test (KDT), near point of convergence (NPC), and serum levels of NF-L, tau, GFAP, and UCH-L1 were assessed at baseline (pre-heading) and at 2 h and 24 h post-heading. Results There were no statistically significant group-by-time interactions in outcome measures. However, at baseline, the ADHD group exhibited lower neuro-ophthalmologic functions compared to the non-ADHD group (NPC: p = 0.019; KDT: p = 0.018), and persisted at 2 h-post (NPC: p = 0.007; KDT: p = 0.014) and 24 h-post heading (NPC: p = 0.001). NPC significantly worsened over time in both groups compared to baseline [ADHD: 2 h-post, 1.23 cm, 95%CI:(0.77, 1.69), p < 0.001; 24 h-post, 1.68 cm, 95%CI:(1.22, 2.13), p = 0.001; Non-ADHD: 2 h-post, 0.96 cm, 95%CI:(0.50, 1.42), p < 0.001; 24 h-post, 1.09 cm, 95%CI:(0.63, 1.55), p < 0.001]. Conversely, improvements in KDT time compared to baseline occurred at 2 h-post in the non-ADHD group [-1.32 s, 95%CI:(-2.55, -0.09), p = 0.04] and at 24 h-post in both groups [ADHD: -4.66 s, 95%CI:(-5.89, -3.43), p < 0.001; Non-ADHD: -3.46 s, 95%CI:(-4.69, -2.23), p < 0.001)]. There were no group-by-time interactions for GFAP as both groups exhibited increased levels at 2 h-post [ADHD: 7.75 pg./mL, 95%CI:(1.41, 14.10), p = 0.019; Non-ADHD: 7.91 pg./mL, 95%CI:(1.71, 14.14), p = 0.015)] that returned to baseline at 24 h-post. NF-L levels increased at 2 h-post heading in the ADHD group [0.45 pg./mL, 95%CI:(0.05, 0.86), p = 0.032], but no significant NF-L changes were observed in the non-ADHD group over time. Discussion Ten soccer headers elevated GFAP levels and NPC impairment in both groups. However, persisting group difference in NPC, blunted KDT performance, and increased NF-L levels in the ADHD group suggest that ADHD may reduce neuro-ophthalmologic function and heighten axonal response to soccer headers. Clinical trial registration ClinicalTrials.gov, identifier ID: (NCT04880304).
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Affiliation(s)
- Madeleine K. Nowak
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - William G. Kronenberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Devin Rettke
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Osamudiamen Ogbeide
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Lillian M. Klemsz
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Patrick D. Quinn
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
- Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN, United States
| | - Timothy D. Mickleborough
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Sharlene D. Newman
- Alabama Life Research Institute, University of Alabama, Tuscaloosa, AL, United States
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
- Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN, United States
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12
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Sattari S, Kenny R, Liu CC, Hajra SG, Dumont GA, Virji-Babul N. Blink-related EEG oscillations are neurophysiological indicators of subconcussive head impacts in female soccer players: a preliminary study. Front Hum Neurosci 2023; 17:1208498. [PMID: 37538402 PMCID: PMC10394644 DOI: 10.3389/fnhum.2023.1208498] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction Repetitive subconcussive head impacts can lead to subtle neural changes and functional consequences on brain health. However, the objective assessment of these changes remains limited. Resting state blink-related oscillations (BROs), recently discovered neurological responses following spontaneous blinking, are explored in this study to evaluate changes in BRO responses in subconcussive head impacts. Methods We collected 5-min resting-state electroencephalography (EEG) data from two cohorts of collegiate athletes who were engaged in contact sports (SC) or non-contact sports (HC). Video recordings of all on-field activities were conducted to determine the number of head impacts during games and practices in the SC group. Results In both groups, we were able to detect a BRO response. Following one season of games and practice, we found a strong association between the number of head impacts sustained by the SC group and increases in delta and beta spectral power post-blink. There was also a significant difference between the two groups in the morphology of BRO responses, including decreased peak-to-peak amplitude of response over left parietal channels and differences in spectral power in delta and alpha frequency range post-blink. Discussion Our preliminary results suggest that the BRO response may be a useful biomarker for detecting subtle neural changes resulting from repetitive head impacts. The clinical utility of this biomarker will need to be validated through further research with larger sample sizes, involving both male and female participants, using a longitudinal design.
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Affiliation(s)
- Sahar Sattari
- School of Biomedical Engineering, The University of British Columbia, Vancouver, BC, Canada
| | - Rebecca Kenny
- Department of Rehabilitation Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Careesa Chang Liu
- Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, FL, United States
| | - Sujoy Ghosh Hajra
- Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, FL, United States
| | - Guy A. Dumont
- School of Biomedical Engineering, The University of British Columbia, Vancouver, BC, Canada
- Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Naznin Virji-Babul
- Department of Rehabilitation Sciences, The University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada
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13
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Holcomb TD, Marks ME, Stewart Pritchard N, Miller L, Espeland MA, Miles CM, Moore JB, Foley KL, Stitzel JD, Urban JE. Characterization of Head Acceleration Exposure During Youth Football Practice Drills. J Appl Biomech 2023; 39:157-168. [PMID: 37105545 PMCID: PMC10809728 DOI: 10.1123/jab.2022-0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 02/08/2023] [Accepted: 03/04/2023] [Indexed: 04/29/2023]
Abstract
Many head acceleration events (HAEs) observed in youth football emanate from a practice environment. This study aimed to evaluate HAEs in youth football practice drills using a mouthpiece-based sensor, differentiating between inertial and direct HAEs. Head acceleration data were collected from athletes participating on 2 youth football teams (ages 11-13 y) using an instrumented mouthpiece-based sensor during all practice sessions in a single season. Video was recorded and analyzed to verify and assign HAEs to specific practice drill characteristics, including drill intensity, drill classification, and drill type. HAEs were quantified in terms of HAEs per athlete per minute and peak linear and rotational acceleration and rotational velocity. Mixed-effects models were used to evaluate the differences in kinematics, and generalized linear models were used to assess differences in HAE frequency between drill categories. A total of 3237 HAEs were verified and evaluated from 29 football athletes enrolled in this study. Head kinematics varied significantly between drill categorizations. HAEs collected at higher intensities resulted in significantly greater kinematics than lower-intensity drills. The results of this study add to the growing body of evidence informing evidence-based strategies to reduce head impact exposure and concussion risk in youth football practices.
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Affiliation(s)
- Ty D. Holcomb
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - Madison E. Marks
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - N. Stewart Pritchard
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - Logan Miller
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - Mark A. Espeland
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Christopher M. Miles
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Justin B. Moore
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kristie L. Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Joel D. Stitzel
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - Jillian E. Urban
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
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14
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Ryan D, Mirbagheri S, Yahyavi-Firouz-Abadi N. The Current State of Functional MR Imaging for Trauma Prognostication. Neuroimaging Clin N Am 2023; 33:299-313. [PMID: 36965947 DOI: 10.1016/j.nic.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
In this review, we discuss the basics of functional MRI (fMRI) techniques including task-based and resting state fMRI, and overview the major findings in patients with traumatic brain injury. We summarize the studies that have longitudinally evaluated the changes in brain connectivity and task-related activation in trauma patients during different phases of trauma. We discuss how these data may potentially be used for prognostication, treatment planning, or monitoring and management of trauma patients.
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Affiliation(s)
- Daniel Ryan
- Southern Illinois University School of Medicine, 401 East Carpenter Street, Springfield, IL, USA
| | - Saeedeh Mirbagheri
- University of Vermont Medical Center, 111 Colchester Avenue, Burlington, VT 05401, USA
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15
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Naskar A, Jayanty D, Head K, Khanna GL, Vatsalya V, Banerjee A. Diagnostic Prospectives with Tau Protein and Imaging Techniques to Detect Development of Chronic Traumatic Encephalopathy. JOURNAL OF BEHAVIORAL AND BRAIN SCIENCE 2023; 13:55-65. [PMID: 37275219 PMCID: PMC10239269 DOI: 10.4236/jbbs.2023.134005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Brain damage sustained from repeated blows in boxing, wrestling, and other combat sports has serious physical and mental health consequences. The degenerative brain disease, chronic traumatic encephalopathy (CTE), presents clinically with memory loss, aggression, difficulty in rational thinking and other cognitive problems. This spectrum, which mimics Alzheimer's disease, is diagnosed post-mortem through a brain biopsy in many professional athletes. However, little is known about the process of development and how to identify vulnerable individuals who may be on course for developing CTE. Boxing is a sport that has a severe toll on athletes' health, primarily on their brain health and function. This review addresses the concerns of brain injury, describes the pathologies that manifest in multiple scales, e.g., molecular and cognitive, and also proposes possible diagnostic and prognostic markers to characterize the early onset of CTE along with the aim to identify a starting point for future precautions and interventions.
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Affiliation(s)
- Amit Naskar
- Cognitive Brain Dynamics Lab, National Brain Research Centre, Manesar, India
| | - Danielle Jayanty
- Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Kimberly Head
- Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Gulshan L. Khanna
- Professor and Pro Vice Chancellor, Manav Rachna International Institute of Research and Studies, Faridabad, India
| | - Vatsalya Vatsalya
- Department of Medicine, University of Louisville, Louisville, KY, USA
- Robley Rex VA Medical Center, Louisville, KY, USA
- National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, USA
| | - Arpan Banerjee
- Cognitive Brain Dynamics Lab, National Brain Research Centre, Manesar, India
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16
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Ghiles CW, Clark MD, Kuzminski SJ, Fraser MA, Petrella JR, Guskiewicz KM. Changes in resting state networks in high school football athletes across a single season. Br J Radiol 2023; 96:20220359. [PMID: 36607807 PMCID: PMC10078860 DOI: 10.1259/bjr.20220359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The aim of this pilot cohort study was to examine changes in the organization of resting-state brain networks in high school football athletes and its relationship to exposure to on-field head impacts over the course of a single season. METHODS Seventeen male high school football players underwent functional magnetic resonance imaging and computerized neurocognitive testing (CNS Vital Signs) before the start of contact practices and again after the conclusion of the season. The players were equipped with helmet accelerometer systems (Head Impact Telemetry System) to record head impacts in practices and games. Graph theory analysis was applied to study intranetwork local efficiency and strength of connectivity within six anatomically defined brain networks. RESULTS We observed a significant decrease in the local efficiency (-24.9 ± 51.4%, r = 0.7, p < 0.01) and strength (-14.5 ± 26.8%, r = 0.5, p < 0.01) of functional connectivity within the frontal lobe resting-state network and strength within the parietal lobe resting-state network (-7.5 ± 17.3%, r = 0.1, p < 0.01), as well as a concomitant increase in the local efficiency (+55.0 +/- 59.8%, r = 0.5, p < 0.01) and strength (+47.4 +/- 47.3%, r = 0.5, p < 0.01) within the mediotemporal networks. These alterations in network organization were associated with changes in performance on verbal memory (p < 0.05) and executive function (p < 0.05). We did not observe a significant relationship between the frequency or cumulative magnitude of impacts sustained during the season and neurocognitive or imaging outcomes (p > 0.05). CONCLUSION Our findings suggest the efficiency and strength of resting-state networks are altered across a season of high school football, but the association of exposure levels to subconcussive impacts is unclear. ADVANCES IN KNOWLEDGE The efficiency of resting-state networks is dynamic in high school football athletes; such changes may be related to impacts sustained during the season, though further study is needed.
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Affiliation(s)
- Connor W Ghiles
- Wake Forest University School of Medicine, Winston-Salem, United States
| | - Michael D Clark
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, United States
| | | | - Melissa A Fraser
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, United States
| | | | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, United States
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17
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Gu C, He G, Lin C. REFINEMENT OF SALIVA MI-RNA BIOMARKERS FOR SPORT-RELATED CONCUSSION. REV BRAS MED ESPORTE 2022. [DOI: 10.1590/1517-8692202228052022_126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: The changes in brain structure caused by a sports-related concussion may initially be indistinguishable, however, the irreversible deleterious effects are noted in the long term. An early diagnosis may provide the patient with a better recovery chance and increased survival. For this purpose, this paper studies the feasibility of a diagnosis for concussion by microRNA (mi-RNA) biomarkers contained in the saliva of athletes. Objective: Verify whether salivary miRNAs could be considered good biomarkers for sports concussion. Methodology: Salivary mi-RNA levels were determined from 120 saliva samples of 120 players. There were 43 with a diagnosis of concussion and 77 without a diagnosis of concussion. Samples from players with a concussion were collected 30 minutes prior to activity, samples from individuals who did not engage in physical activity were also compared. Results: On the evaluation of 30 miRNA from individuals with a concussion between contact and non-contact sports there was high detection reliability(P<.05). Both miR-532-5p and miR-182-5p showed reduced amounts of physical activity. The miRNA-532-5p and miRNA-182-5p show significant results among 43 subjects from pre-exercise to post-exercise. The miRNA-4510 showed a significant result (p < 0.05) between contact and non-contact sport types. The amount of miRNA-4510 expanded in 20 individuals in the contact sport at post-exercise but remained normal in the non-contact sports group. Conclusion: The salivary miRNAs are reliable biomarkers for concussion. Evidence Level II; Therapeutic Studies – Investigating the results.
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Affiliation(s)
- Cuifeng Gu
- Hebei University of Economics and Business, China
| | - Guojian He
- Hebei University of Economics and Business, China
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18
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Papa L, Walter AE, Wilkes JR, Clonts HS, Johnson B, Slobounov SM. Effect of Player Position on Serum Biomarkers during Participation in a Season of Collegiate Football. J Neurotrauma 2022; 39:1339-1348. [PMID: 35615873 PMCID: PMC9529311 DOI: 10.1089/neu.2022.0083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This prospective cohort study examined the relationship between a panel of four serum proteomic biomarkers (glial fibrillary acidic protein [GFAP], ubiquitin C-terminal hydrolase-L1 [UCH-L1], total Tau, and neurofilament light chain polypeptide [NF-L]) in 52 players from two different cohorts of male collegiate student football athletes from two different competitive seasons of Division I National Collegiate Athletic Association Football Bowl Subdivision. This study evaluated changes in biomarker concentrations (as indicators of brain injury) over the course of the playing season (pre- and post-season) and also assessed biomarker concentrations by player position using two different published classification systems. Player positions were divided into: 1) speed (quarterbacks, running backs, halfbacks, fullbacks, wide receivers, tight ends, defensive backs, safety, and linebackers) versus non-speed (offensive and defensive linemen), and 2) "Profile 1" (low frequency/high strain magnitudes positions including quarterbacks, wide receivers, and defensive backs), "Profile 2" (mid-range impact frequency and strain positions including linebackers, running backs, and tight ends), and "Profile 3" (high frequency/low strains positions including defensive and offensive linemen). There were significant increases in GFAP 39.3 to 45.6 pg/mL and NF-L 3.5 to 5.4 pg/mL over the course of the season (p < 0.001) despite only five players being diagnosed with concussion. UCH-L1 decreased significantly, and Tau was not significantly different. In both the pre- and post-season blood samples Tau and NF-L concentrations were significantly higher in speed versus non-speed positions. Concentrations of GFAP, Tau, and NF-L increased incrementally from "Profile 3," to "Profile 2" to "Profile 1" in the post-season. UCH-L1 did not. GFAP increased (by Profiles 3, 2, 1) from 42.4 to 49.6 to 78.2, respectively (p = 0.051). Tau increased from 0.37 to 0.61 to 0.67, respectively (p = 0.024). NF-L increased from 3.5 to 4.9 to 8.2, respectively (p < 0.001). Although GFAP and Tau showed similar patterns of elevations by profile in the pre-season samples they were not statistically significant. Only NF-L showed significant differences between profiles 2.7 to 3.1 to 4.2 in the pre-season (p = 0.042). GFAP, Tau, and NF-L concentrations were significantly associated with different playing positions with the highest concentrations in speed and "Profile 1" positions and the lowest concentrations were in non-speed and "Profile 3" positions. Blood-based biomarkers (GFAP, Tau, NF-L) provide an additional layer of injury quantification that could contribute to a better understanding of the risks of playing different positions.
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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
| | - Alexa E. Walter
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James R. Wilkes
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Hunter S. Clonts
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA
| | - Brian Johnson
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Semyon M. Slobounov
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
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19
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Wilson A, Stevens WD, Sergio L, Wojtowicz M. Altered Brain Functional Connectivity in Female Athletes Over the Course of a Season of Collision or Contact Sports. Neurotrauma Rep 2022; 3:377-387. [PMID: 36204391 PMCID: PMC9531888 DOI: 10.1089/neur.2022.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
University athletes are exposed to numerous impacts to the body and head, though the potential cumulative effects of such hits remain elusive. This study examined resting-state functional connectivity (rsFC) of brain networks in female varsity athletes over the course of a season. Nineteen female university athletes involved in collision (N = 12) and contact (N = 7) sports underwent functional magnetic resonance imaging scans at both pre- and post-season. A group-level independent component analysis (ICA) was used to investigate differences in rsFC over the course of a season and differences between contact and collision sport athletes. Decreased rsFC was observed over the course of the season between the default mode network (DMN) and regions in the frontal, parietal, and occipital lobe (p false discovery rate, ≤0.05) driven by differences in the contact group. There was also a main effect of group in the dorsal attention network (DAN) driven by differences between contact and collision groups at pre-season. Differences identified over the course of a season of play indicate largely decreased rsFC within the DMN, and level of contact was associated with differences in rsFC of the DAN. The association between exposure to repetitive head impacts (RHIs) and observed changes in network rsFC supplements the growing literature suggesting that even non-concussed athletes may be at risk for changes in brain functioning. However, the complexity of examining the direct effects of RHIs highlights the need to consider multiple factors, including mental health and sport-specific training and expertise, that may potentially be associated with neural changes.
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Affiliation(s)
- Alyssia Wilson
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - W. Dale Stevens
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Lauren Sergio
- School of Kinesiology, York University, Toronto, Ontario, Canada
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20
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Vinh To X, Soni N, Medeiros R, Alateeq K, Nasrallah FA. Traumatic brain injury alterations in the functional connectome are associated with neuroinflammation but not tau in a P30IL tauopathy mouse model. Brain Res 2022; 1789:147955. [PMID: 35636493 DOI: 10.1016/j.brainres.2022.147955] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/19/2022] [Accepted: 05/25/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Traumatic Brain Injury (TBI) is often associated with long-term cognitive deficits and altered brain networks which have been linked with accumulation of neurofibrillary tau tangles and neuroinflammation. In this work, we investigated the changes in the brain post-TBI in an Alzheimer's disease pR5 tauopathy model and evaluated the contribution of tauopathy and neuroinflammation to connectivity alterations using resting-state functional Magnetic Resonance Imaging (rs-fMRI). METHOD 26 P301L tau transgenic mice of 8-9 months of age (21-35 g) expressing the human tau isoform carrying the pathogenic P301L mutation were used for the study. Animals were assessed at day 1 and 7 post-injury/craniotomy and were randomly divided into four groups. All animals underwent an MRI scan on a 9.4 T Bruker system where rsfMRI was acquired. Following imaging, brains were stained with pSer (396 + 404), glial fibrillary acidic protein (GFAP), and ionised calcium-binding adaptor molecule-1 (Iba-1). Group-information-guided Independent Component Analysis (GIG-ICA) and region-of-interest (ROI)-based network connectivity approaches were applied. Principal Component Regression was applied to predict connectivity network strength from the corresponding ROIs. RESULTS TBI mice showed decreased functional connectivity in the dentate gyrus, thalamus, and other areas compared to sham animals at day 1 post-injury with the majority of changes resolving at day 7. Principal Component Regression showed only the contralateral CA1 network strength was correlated with the CA1's astrocyte and microglia cell density and the ipsilateral thalamus network strength was correlated with the ipsilateral thalamus' astrocyte and microglia cell density. CONCLUSION We present the first report on the temporal alterations in functional connectivity in a P30IL mouse model following TBI. Connectivity between key regions known to be affected in Alzheimer's disease were short-term and reversible following injury. Connectivity strength in CA1 and thalamus showed significant correlation with astrocyte and microglial cell density but not tau density.
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Affiliation(s)
- Xuan Vinh To
- The Queensland Brain Institute, The University of Queensland, St. Lucia, QLD, Australia
| | - Neha Soni
- The Queensland Brain Institute, The University of Queensland, St. Lucia, QLD, Australia
| | - Rodrigo Medeiros
- The Queensland Brain Institute, The University of Queensland, St. Lucia, QLD, Australia
| | - Khawlah Alateeq
- The Queensland Brain Institute, The University of Queensland, St. Lucia, QLD, Australia
| | - Fatima A Nasrallah
- The Queensland Brain Institute, The University of Queensland, St. Lucia, QLD, Australia; The University of California, Irvine, The United States of America.
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21
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DiFabio MS, Smith DR, Breedlove KM, Pohlig RT, Buckley TA, Johnson CL. Altered Brain Functional Connectivity in the Frontoparietal Network following an Ice Hockey Season. Eur J Sport Sci 2022; 23:684-692. [PMID: 35466861 DOI: 10.1080/17461391.2022.2069512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractSustaining sports-related head impacts has been reported to result in neurological changes that potentially lead to later-life neurological disease. Advanced neuroimaging techniques have been used to detect subtle neurological effects resulting from head impacts, even after a single competitive season. The current study used resting-state functional magnetic resonance imaging to assess changes in functional connectivity of the frontoparietal network, a brain network responsible for executive functioning, in collegiate club ice hockey players over one season. Each player was scanned before and after the season and wore accelerometers to measure head impacts at practices and home games throughout the season. We examined pre- to post-season differences in connectivity within the frontoparietal and default mode networks, as well as the relationship between the total number of head impacts sustained and changes in connectivity. We found a significant interaction between network region of interest and time point (p = 0.016), in which connectivity between the left and right posterior parietal cortex seed regions increased over the season (p < 0.01). Number of impacts had a significant effect on frontoparietal network connectivity, such that more impacts were related to greater connectivity differences over the season (p = 0.042). Overall, functional connectivity increased in ice hockey athletes over a season between regions involved in executive functioning, and sensory integration, in particular. Furthermore, those who sustained more impacts had the greatest changes in connectivity. Consistent with prior findings in resting-state sports-related head impact literature, these findings have been suggested to represent brain injury.
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Affiliation(s)
- Melissa S DiFabio
- Department of Biomedical Engineering, University of Delaware, Newark, DE.,Department of Child and Adolescent Psychiatry, Psychomatics, and Psychotherapy, Ludwig-Maximilans-Universität München - University of Munich, Munich, Germany
| | - Daniel R Smith
- Department of Biomedical Engineering, University of Delaware, Newark, DE
| | - Katherine M Breedlove
- Center for Clinical Spectroscopy, Brigham and Women's Hospital, Boston, MA.,Department of Radiology, Harvard Medical School, Boston, MA
| | - Ryan T Pohlig
- Biostatistics Core Facility, College of Health Sciences, University of Delaware, Newark, DE
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Curtis L Johnson
- Department of Biomedical Engineering, University of Delaware, Newark, DE
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22
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Kashyap P, Shenk TE, Svaldi DO, Lycke RJ, Lee TA, Tamer GG, Nauman EA, Talavage TM. Normalized Brain Tissue–Level Evaluation of Volumetric Changes of Youth Athletes Participating in Collision Sports. Neurotrauma Rep 2022; 3:57-69. [PMID: 35112108 PMCID: PMC8804236 DOI: 10.1089/neur.2021.0060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Observations of short-term changes in the neural health of youth athletes participating in collision sports (e.g., football and soccer) have highlighted a need to explore potential structural alterations in brain tissue volumes for these persons. Studies have shown biochemical, vascular, functional connectivity, and white matter diffusivity changes in the brain physiology of these athletes that are strongly correlated with repetitive head acceleration exposure. Here, research is presented that highlights regional anatomical volumetric measures that change longitudinally with accrued subconcussive trauma. A novel pipeline is introduced that provides simplified data analysis on standard-space template to quantify group-level longitudinal volumetric changes within these populations. For both sports, results highlight incremental relative regional volumetric changes in the subcortical cerebrospinal fluid that are strongly correlated with head exposure events greater than a 50-G threshold at the short-term post-season assessment. Moreover, longitudinal regional gray matter volumes are observed to decrease with time, only returning to baseline/pre-participation levels after sufficient (5–6 months) rest from collision-based exposure. These temporal structural volumetric alterations are significantly different from normal aging observed in sex- and age-matched controls participating in non-collision sports. Future work involves modeling repetitive head exposure thresholds with multi-modal image analysis and understanding the underlying physiological reason. A possible pathophysiological pathway is presented, highlighting the probable metabolic regulatory mechanisms. Continual participation in collision-based activities may represent a risk wherein recovery cannot occur. Even when present, the degree of the eventual recovery remains to be explored, but has strong implications for the well-being of collision-sport participants.
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Affiliation(s)
- Pratik Kashyap
- Department of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Trey E. Shenk
- Department of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Diana O. Svaldi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Roy J. Lycke
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Taylor A. Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Gregory G. Tamer
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Eric A. Nauman
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Thomas M. Talavage
- Department of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana, USA
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
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23
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Motanis H, Khorasani LN, Giza CC, Harris NG. Peering into the Brain through the Retrosplenial Cortex to Assess Cognitive Function of the Injured Brain. Neurotrauma Rep 2021; 2:564-580. [PMID: 34901949 PMCID: PMC8655812 DOI: 10.1089/neur.2021.0044] [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: 11/12/2022] Open
Abstract
The retrosplenial cortex (RSC) is a posterior cortical area that has been drawing increasing interest in recent years, with a growing number of studies studying its contribution to cognitive and sensory functions. From an anatomical perspective, it has been established that the RSC is extensively and often reciprocally connected with the hippocampus, neocortex, and many midbrain regions. Functionally, the RSC is an important hub of the default-mode network. This endowment, with vast anatomical and functional connections, positions the RSC to play an important role in episodic memory, spatial and contextual learning, sensory-cognitive activities, and multi-modal sensory information processing and integration. Additionally, RSC dysfunction has been reported in cases of cognitive decline, particularly in Alzheimer's disease and stroke. We review the literature to examine whether the RSC can act as a cortical marker of persistent cognitive dysfunction after traumatic brain injury (TBI). Because the RSC is easily accessible at the brain's surface using in vivo techniques, we argue that studying RSC network activity post-TBI can shed light into the mechanisms of less-accessible brain regions, such as the hippocampus. There is a fundamental gap in the TBI field about the microscale alterations occurring post-trauma, and by studying the RSC's neuronal activity at the cellular level we will be able to design better therapeutic tools. Understanding how neuronal activity and interactions produce normal and abnormal activity in the injured brain is crucial to understanding cognitive dysfunction. By using this approach, we expect to gain valuable insights to better understand brain disorders like TBI.
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Affiliation(s)
- Helen Motanis
- UCLA Brain Injury Research Center, Department of Neurosurgery, Geffen Medical School, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, California, USA
| | - Laila N. Khorasani
- UCLA Brain Injury Research Center, Department of Neurosurgery, Geffen Medical School, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, California, USA
| | - Christopher C. Giza
- UCLA Brain Injury Research Center, Department of Neurosurgery, Geffen Medical School, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, California, USA
| | - Neil G. Harris
- UCLA Brain Injury Research Center, Department of Neurosurgery, Geffen Medical School, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, California, USA
- Intellectual Development and Disabilities Research Center, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, California, USA
- *Address correspondence to: Neil G. Harris, PhD, Department of Neurosurgery, University of California at Los Angeles, Wasserman Building, 300 Stein Plaza, Room 551, Los Angeles, CA 90095, USA;
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24
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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.
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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
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25
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Lee TA, Lycke RJ, Lee PJ, Cudal CM, Torolski KJ, Bucherl SE, Leiva-Molano N, Auerbach PS, Talavage TM, Nauman EA. Distribution of Head Acceleration Events Varies by Position and Play Type in North American Football. Clin J Sport Med 2021; 31:e245-e250. [PMID: 32032162 DOI: 10.1097/jsm.0000000000000778] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The goal of this pilot study was to evaluate the number of head acceleration events (HAEs) based on position, play type, and starting stance. DESIGN Prospective cohort study. SETTING Postcollegiate skill development camp during practice sessions and 1 exhibition game. PARTICIPANTS Seventy-eight male adult North American football athletes. INDEPENDENT VARIABLES A position was assigned to each participant, and plays in the exhibition game were separated by play type for analysis. During the exhibition game, video data were used to determine the effects of the starting position ("up" in a 2-point stance or "down" in a 3- or 4-point stance) on the HAEs experienced by players on the offensive line. MAIN OUTCOME MEASURES Peak linear acceleration and number of HAEs greater than 20 g (g = 9.81 m/s2) were measured using an xPatch (X2 Biosystems, Seattle, WA). RESULTS Four hundred thirty-seven HAEs were recorded during practices and 272 recorded during the exhibition game; 98 and 52 HAEs, the greatest number of HAEs by position in the game, were experienced by the offensive and defensive linemen, respectively. Linebackers and tight ends experienced high percentages of HAEs above 60 g. Offensive line players in a down stance had a higher likelihood of sustaining a HAE than players in an up stance regardless of the type of play (run vs pass). CONCLUSIONS Changing the stance of players on the offensive line and reducing the number of full-contact practices will lower HAEs.
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Affiliation(s)
- Taylor A Lee
- Department of Mechanical Engineering, Purdue University, West Lafayette, Indiana
| | - Roy J Lycke
- Department of Biomedical Engineering, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - Patrick J Lee
- Department of Mechanical Engineering, Purdue University, West Lafayette, Indiana
| | - Caroline M Cudal
- Department of Biomedical Engineering, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - Kelly J Torolski
- Department of Mechanical Engineering, Purdue University, West Lafayette, Indiana
| | - Sean E Bucherl
- Department of Biomedical Engineering, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - Nicolas Leiva-Molano
- Department of Biomedical Engineering, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - Paul S Auerbach
- Military/Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Thomas M Talavage
- Department of Biomedical Engineering, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
- Department of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana; and
| | - Eric A Nauman
- Department of Mechanical Engineering, Purdue University, West Lafayette, Indiana
- Department of Biomedical Engineering, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
- Department of Basic Medical Sciences, Purdue University, West Lafayette, Indiana
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26
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Harper MW, Lee J, Sherman KA, Uihlein MJ, Lee KKK. Wheelchair Athlete Concussion Baseline Data: A Pilot Retrospective Analysis. Am J Phys Med Rehabil 2021; 100:895-899. [PMID: 33105155 DOI: 10.1097/phm.0000000000001630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to investigate whether a disabled athlete's underlying disability and concussion history impact the score on baseline testing from a disability modified Graded Symptoms Checklist, Standardized Assessment of Concussion, and Wheelchair Error Scoring System. STUDY DESIGN This is a retrospective chart review of the 81 veteran wheelchair sports athletes who had baseline concussion evaluations. Demographic data including qualifying disability for the National Veterans Wheelchair Games, scores from the modified Graded Symptoms Checklist, Standardized Assessment of Concussion, and Wheelchair Error Scoring System were analyzed. RESULTS Forty-three percent of wheelchair athletes reported a history of a concussion. Individuals with a history of a concussion displayed more symptoms on the modified Graded Symptoms Checklist (38.8 vs. 24.71, P = 0.0378) as did those who had a qualifying disability in the brain disorder category (54.87 vs. amputees 24.07 and spinal cord disorders 24.9, P = 0.0015). There was no difference in Standardized Assessment of Concussion examination or Wheelchair Error Scoring System scores based on concussion history or qualifying disability. CONCLUSIONS Baseline symptom scores from a modified Graded Symptoms Checklist were higher in participants with a history of concussion, independent of their underlying disability, and higher if the athlete's disability was a brain disorder including multiple sclerosis and cerebral vascular accident. Scores on the Standardized Assessment of Concussion examination and Wheelchair Error Scoring System were not affected by the athlete's disability or concussion history. Baseline testing is integral for disabled athletes, especially those with underlying brain disorders and history of concussion.
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Affiliation(s)
- Michael W Harper
- From the Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Hub for Collaborative Medicine, Milwaukee, Wisconsin (MWH, KKKL); Case Western Reserve University, Milwaukee, Wisconsin (JL); Clement J. Zablocki Veterans Affairs Medical Center (ZVAMC), Milwaukee, Wisconsin (KAS); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (MJU); Department of Emergency Medicine, ZVAMC, Milwaukee, Wisconsin (MJU); and Spinal Cord Injury Division, ZVAMC, Milwaukee, Wisconsin (KKKL)
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27
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Williamson JR, Sturim D, Vian T, Lacirignola J, Shenk TE, Yuditskaya S, Rao HM, Talavage TM, Heaton KJ, Quatieri TF. Using Dynamics of Eye Movements, Speech Articulation and Brain Activity to Predict and Track mTBI Screening Outcomes. Front Neurol 2021; 12:665338. [PMID: 34295299 PMCID: PMC8289895 DOI: 10.3389/fneur.2021.665338] [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: 02/10/2021] [Accepted: 06/09/2021] [Indexed: 11/24/2022] Open
Abstract
Repeated subconcussive blows to the head during sports or other contact activities may have a cumulative and long lasting effect on cognitive functioning. Unobtrusive measurement and tracking of cognitive functioning is needed to enable preventative interventions for people at elevated risk of concussive injury. The focus of the present study is to investigate the potential for using passive measurements of fine motor movements (smooth pursuit eye tracking and read speech) and resting state brain activity (measured using fMRI) to complement existing diagnostic tools, such as the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), that are used for this purpose. Thirty-one high school American football and soccer athletes were tracked through the course of a sports season. Hypotheses were that (1) measures of complexity of fine motor coordination and of resting state brain activity are predictive of cognitive functioning measured by the ImPACT test, and (2) within-subject changes in these measures over the course of a sports season are predictive of changes in ImPACT scores. The first principal component of the six ImPACT composite scores was used as a latent factor that represents cognitive functioning. This latent factor was positively correlated with four of the ImPACT composites: verbal memory, visual memory, visual motor speed and reaction speed. Strong correlations, ranging between r = 0.26 and r = 0.49, were found between this latent factor and complexity features derived from each sensor modality. Based on a regression model, the complexity features were combined across sensor modalities and used to predict the latent factor on out-of-sample subjects. The predictions correlated with the true latent factor with r = 0.71. Within-subject changes over time were predicted with r = 0.34. These results indicate the potential to predict cognitive performance from passive monitoring of fine motor movements and brain activity, offering initial support for future application in detection of performance deficits associated with subconcussive events.
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Affiliation(s)
- James R Williamson
- Human Health and Performance Systems, MIT Lincoln Laboratory, Lexington, MA, United States
| | - Doug Sturim
- Human Health and Performance Systems, MIT Lincoln Laboratory, Lexington, MA, United States
| | - Trina Vian
- Counter-WMD Systems, MIT Lincoln Laboratory, Lexington, MA, United States
| | - Joseph Lacirignola
- Counter-WMD Systems, MIT Lincoln Laboratory, Lexington, MA, United States
| | - Trey E Shenk
- Advanced RF Techniques & Systems, MIT Lincoln Laboratory, Lexington, MA, United States
| | - Sophia Yuditskaya
- Human Health and Performance Systems, MIT Lincoln Laboratory, Lexington, MA, United States
| | - Hrishikesh M Rao
- Human Health and Performance Systems, MIT Lincoln Laboratory, Lexington, MA, United States
| | - Thomas M Talavage
- Electrical and Computer Engineering/Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Kristin J Heaton
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Thomas F Quatieri
- Human Health and Performance Systems, MIT Lincoln Laboratory, Lexington, MA, United States
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28
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Repeatability and Biofidelity of a Physical Surrogate Neck Model Fit to a Hybrid III Head. Ann Biomed Eng 2021; 49:2957-2972. [PMID: 33999296 DOI: 10.1007/s10439-021-02786-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/24/2021] [Indexed: 10/21/2022]
Abstract
In helmet impact testing, parameters including acceleration and velocity are measured using instrumented head-neck models that are meant to be mechanically realistic (i.e. biofidelic) stand-ins, or surrogates, for humans. Currently available models of the human neck are designed primarily for application in automotive crash testing, and their applicability in assessment of helmets is often questioned. The object of the present work is to document the mechanical design, repeatability, and biofidelity in low speed impact of a new neck model that we apply with a Hybrid III head. Focusing on Hybrid III head kinematics measured during impacts at 2 to 6 m/s, the co-efficient of variance of repeated measures of kinematics was generally less than 10%. Differences in kinematics between identical copies of the neck was less than 20% when tested with helmets, and less than 7% when the head was not helmeted. In parallel testing using a Hybrid III head-neck, the co-efficient of variance in repeated measures was less than 4% and the kinematics significantly differed from those measured using the new neck. CORAplus scores for the new neck were approximately 0.70 when compared against data for human subjects with passive neck muscles experiencing impact at 2 m/s.
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29
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Lee J, Anderson LJ, Migula D, Yuen KCJ, McPeak L, Garcia JM. Experience of a Pituitary Clinic for US Military Veterans With Traumatic Brain Injury. J Endocr Soc 2021; 5:bvab005. [PMID: 33655093 DOI: 10.1210/jendso/bvab005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Indexed: 01/02/2023] Open
Abstract
Context Traumatic brain injury (TBI) is considered the "signature" injury of veterans returning from wartime conflicts in Iraq and Afghanistan. While moderate/severe TBI is associated with pituitary dysfunction, this association has not been well established in the military setting and in mild TBI (mTBI). Screening for pituitary dysfunction resulting from TBI in veteran populations is inconsistent across Veterans Affairs (VA) institutions, and such dysfunction often goes unrecognized and untreated. Objective This work aims to report the experience of a pituitary clinic in screening for and diagnosis of pituitary dysfunction. Methods A retrospective analysis was conducted in a US tertiary care center of veterans referred to the VA Puget Sound Healthcare System pituitary clinic with a history of TBI at least 12 months prior. Main outcome measures included demographics, medical history, symptom burden, baseline hormonal evaluation, brain imaging, and provocative testing for adrenal insufficiency (AI) and adult-onset growth hormone deficiency (AGHD). Results Fatigue, cognitive/memory problems, insomnia, and posttraumatic stress disorder were reported in at least two-thirds of the 58 patients evaluated. Twenty-two (37.9%) were diagnosed with at least one pituitary hormone deficiency, including 13 (22.4%) AI, 12 (20.7%) AGHD, 2 (3.4%) secondary hypogonadism, and 5 (8.6%) hyperprolactinemia diagnoses; there were no cases of thyrotropin deficiency. Conclusion A high prevalence of chronic AI and AGHD was observed among veterans with TBI. Prospective, larger studies are needed to confirm these results and determine the effects of hormone replacement on long-term outcomes in this setting.
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Affiliation(s)
- Jonathan Lee
- Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, and Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lindsey J Anderson
- Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, and Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Dorota Migula
- Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, and Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kevin C J Yuen
- Barrow Pituitary Center, Barrow Neurological Institute and St. Joseph's Hospital and Medical Center, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, Arizona, USA
| | - Lisa McPeak
- Center for Polytrauma Care, Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Jose M Garcia
- Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, and Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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30
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Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Long-term changes in the small-world organization of brain networks after concussion. Sci Rep 2021; 11:6862. [PMID: 33767293 PMCID: PMC7994718 DOI: 10.1038/s41598-021-85811-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/04/2021] [Indexed: 11/09/2022] Open
Abstract
There is a growing body of literature using functional MRI to study the acute and long-term effects of concussion on functional brain networks. To date, studies have largely focused on changes in pairwise connectivity strength between brain regions. Less is known about how concussion affects whole-brain network topology, particularly the “small-world” organization which facilitates efficient communication at both local and global scales. The present study addressed this knowledge gap by measuring local and global efficiency of 26 concussed athletes at acute injury, return to play (RTP) and one year post-RTP, along with a cohort of 167 athletic controls. On average, concussed athletes showed no alterations in local efficiency but had elevated global efficiency at acute injury, which had resolved by RTP. Athletes with atypically long recovery, however, had reduced global efficiency at 1 year post-RTP, suggesting long-term functional abnormalities for this subgroup. Analyses of nodal efficiency further indicated that global network changes were driven by high-efficiency visual and sensorimotor regions and low-efficiency frontal and subcortical regions. This study provides evidence that concussion causes subtle acute and long-term changes in the small-world organization of the brain, with effects that are related to the clinical profile of recovery.
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Affiliation(s)
- N W Churchill
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada. .,Neuroscience Research Program, St. Michael's Hospital, Toronto, ON, Canada.
| | - M G Hutchison
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - S J Graham
- Physical Sciences Platform, Sunnybrook Research Institute, Sunnybrook Health Science Center, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - T A Schweizer
- Keenan Research Centre for Biomedical Science, 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), University of Toronto, Toronto, ON, Canada
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31
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DeSimone JC, Davenport EM, Urban J, Xi Y, Holcomb JM, Kelley ME, Whitlow CT, Powers AK, Stitzel JD, Maldjian JA. Mapping default mode connectivity alterations following a single season of subconcussive impact exposure in youth football. Hum Brain Mapp 2021; 42:2529-2545. [PMID: 33734521 PMCID: PMC8090779 DOI: 10.1002/hbm.25384] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/14/2022] Open
Abstract
Repetitive head impact (RHI) exposure in collision sports may contribute to adverse neurological outcomes in former players. In contrast to a concussion, or mild traumatic brain injury, “subconcussive” RHIs represent a more frequent and asymptomatic form of exposure. The neural network‐level signatures characterizing subconcussive RHIs in youth collision‐sport cohorts such as American Football are not known. Here, we used resting‐state functional MRI to examine default mode network (DMN) functional connectivity (FC) following a single football season in youth players (n = 50, ages 8–14) without concussion. Football players demonstrated reduced FC across widespread DMN regions compared with non‐collision sport controls at postseason but not preseason. In a subsample from the original cohort (n = 17), players revealed a negative change in FC between preseason and postseason and a positive and compensatory change in FC during the offseason across the majority of DMN regions. Lastly, significant FC changes, including between preseason and postseason and between in‐ and off‐season, were specific to players at the upper end of the head impact frequency distribution. These findings represent initial evidence of network‐level FC abnormalities following repetitive, non‐concussive RHIs in youth football. Furthermore, the number of subconcussive RHIs proved to be a key factor influencing DMN FC.
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Affiliation(s)
- Jesse C. DeSimone
- Advanced Neuroscience Imaging Research (ANSIR) LaboratoryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Elizabeth M. Davenport
- Advanced Neuroscience Imaging Research (ANSIR) LaboratoryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Jillian Urban
- Department of Biomedical EngineeringWake Forest School of MedicineWinston SalemNorth CarolinaUSA
- Virginia Tech – Wake Forest School of Biomedical EngineeringWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Yin Xi
- Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - James M. Holcomb
- Advanced Neuroscience Imaging Research (ANSIR) LaboratoryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Mireille E. Kelley
- Department of Biomedical EngineeringWake Forest School of MedicineWinston SalemNorth CarolinaUSA
- Virginia Tech – Wake Forest School of Biomedical EngineeringWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Christopher T. Whitlow
- Virginia Tech – Wake Forest School of Biomedical EngineeringWake Forest School of MedicineWinston SalemNorth CarolinaUSA
- Department of Radiology – NeuroradiologyWake Forest School of MedicineWinston SalemNorth CarolinaUSA
- Clinical and Translational Sciences InstituteWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Alexander K. Powers
- Department of NeurosurgeryWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Joel D. Stitzel
- Department of Biomedical EngineeringWake Forest School of MedicineWinston SalemNorth CarolinaUSA
- Virginia Tech – Wake Forest School of Biomedical EngineeringWake Forest School of MedicineWinston SalemNorth CarolinaUSA
- Clinical and Translational Sciences InstituteWake Forest School of MedicineWinston SalemNorth CarolinaUSA
- Childress Institute for Pediatric TraumaWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Joseph A. Maldjian
- Advanced Neuroscience Imaging Research (ANSIR) LaboratoryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
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32
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Moyron RB, Vallejos PA, Fuller RN, Dean N, Wall NR. Neuroimaging and advanced research techniques may lead to improved outcomes in military members suffering from traumatic brain injury. Trauma Surg Acute Care Open 2021; 6:e000608. [PMID: 33490604 PMCID: PMC7797256 DOI: 10.1136/tsaco-2020-000608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 12/17/2022] Open
Abstract
Recent military conflicts in Iraq and Afghanistan have resulted in the significant increase in blast-related traumatic brain injury (TBI), leading to increased Department of Defense interest in its potential long-term effects ranging from the mildest head injuries termed subconcussive trauma to the most debilitating termed chronic traumatic encephalopathy (CTE). Most patients with mild TBI will recover quickly while others report persistent symptoms called postconcussive syndrome. Repeated concussive and subconcussive head injuries result in neurodegenerative conditions that may hinder the injured for years. Fundamental questions about the nature of these injuries and recovery remain unanswered. Clinically, patients with CTE present with either affective changes or cognitive impairment. Genetically, there have been no clear risk factors identified. The discovery that microglia of the cerebral cortex discharged small extracellular vesicles in the injured and adjacent regions to a TBI may soon shed light on the immediate impact injury mechanisms. The combination of neuroimaging and advanced research techniques may, one day, fill critical knowledge gaps and lead to significant TBI research and treatment advancements.
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Affiliation(s)
- Ron B Moyron
- Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA
| | - Paul A Vallejos
- Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA
| | - Ryan N Fuller
- Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA
| | - Natasha Dean
- Department of Biology, La Sierra University, Riverside, California, USA
| | - Nathan R Wall
- Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA
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33
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Gallagher VT, Murthy P, Stocks J, Vesci B, Colegrove D, Mjaanes J, Chen Y, Breiter H, LaBella C, Herrold AA, Reilly JL. Differential Change in Oculomotor Performance among Female Collegiate Soccer Players versus Non-Contact Athletes from Pre- to Post-Season. Neurotrauma Rep 2020; 1:169-180. [PMID: 33274345 PMCID: PMC7703496 DOI: 10.1089/neur.2020.0051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Sensitive and reliable tools are needed to evaluate potential behavioral and cognitive changes following head impact exposure in contact and collision sport participation. We evaluated change in oculomotor testing performance among female, varsity, collegiate athletes following variable exposure to head impacts across a season. Female, collegiate, contact sport (soccer, CONT) and non-contact sport (NON-CONT) athletes were assessed pre-season and post-season. Soccer athletes were grouped according to total season game headers into low dose (≤40 headers; CONT-Low Dose) or high dose (>40 headers; CONT-High Dose) groups. Performance on pro-saccade (reflexive visual response), anti-saccade (executive inhibition), and memory-guided saccade (MGS, spatial working memory) computer-based laboratory tasks were assessed. Primary saccade measures included latency/reaction time, inhibition error rate (anti-saccade only), and spatial accuracy (MGS only). NON-CONT (n = 20), CONT-Low Dose (n = 17), and CONT-High Dose (n = 7) groups significantly differed on pre-season versus post-season latency on tasks with executive functioning demands (anti-saccade and MGS, p ≤ 0.001). Specifically, NON-CONT and CONT-Low Dose demonstrated shorter (i.e., faster) anti-saccade (1.84% and 2.68%, respectively) and MGS (5.74% and 2.76%, respectively) latencies from pre-season to post-season, whereas CONT-High Dose showed 1.40% average longer anti-saccade, and 0.74% shorter MGS, latencies. NON-CONT and CONT-Low Dose demonstrated reduced (i.e., improved) inhibition error rate on the anti-saccade task at post-season versus pre-season, whereas CONT-High Dose demonstrated relative stability (p = 0.021). The results of this study suggest differential exposure to subconcussive head impacts in collegiate female athletes is associated with differential change in reaction time and inhibitory control performances on executive saccadic oculomotor testing.
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Affiliation(s)
- Virginia T Gallagher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Prianka Murthy
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane Stocks
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brian Vesci
- Department of Sports Medicine, Northwestern University, Evanston, Illinois, USA
| | - Danielle Colegrove
- Department of Sports Medicine, Northwestern University, Evanston, Illinois, USA
| | - Jeffrey Mjaanes
- Department of Sports Medicine, Northwestern University, Evanston, Illinois, USA
| | - Yufen Chen
- Center for Translational Imaging, Northwestern University, Chicago, Illinois, USA
| | - Hans Breiter
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cynthia LaBella
- Division of Orthopedics and Sports Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Amy A Herrold
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - James L Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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34
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Johnson B, Dodd A, Mayer AR, Hallett M, Slobounov S. Are there any differential responses to concussive injury in civilian versus athletic populations: a neuroimaging study. Brain Imaging Behav 2020; 14:110-117. [PMID: 30361946 DOI: 10.1007/s11682-018-9982-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Accurate identification and classification of patients suffering from mild traumatic brain injury (mTBI) is a significant challenge faced by clinicians and researchers. To examine if there are different pathophysiological responses to concussive injury in different populations, evaluated here comparing collegiate athletes versus age-matched non-athletes. Resting-state fMRI data were acquired in the acute phase of concussion from 30 collegiate athletes and from 30 injury and age matched non-athletes. Resting-state functional connectivity measures revealed group differences with reduced connectivity in the anterior cingulate cortex (p < .05) and posterior cingulate cortex (p < 0.05) hubs of the Default Mode Network in the athletes. Given the known positive effects of exercise on brain functional reserves and neural efficiency concept, we expected less pronounced effect of concussion in athletic population. In contrast, there were significant decreases in functional connectivity in athletes that could be a result of previous repetitive subconcussive impacts and history of concussion.
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Affiliation(s)
- Brian Johnson
- Department of Kinesiology, The Pennsylvania State University, 276, Recreation Building, University Park, PA, 16802, USA
| | - Andrew Dodd
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Andrew R Mayer
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA.,Departments of Neurology and Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Mark Hallett
- National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD, 20892, USA
| | - Semyon Slobounov
- Department of Kinesiology, The Pennsylvania State University, 276, Recreation Building, University Park, PA, 16802, USA. .,Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA.
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35
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Lee T, Lycke R, Auger J, Music J, Dziekan M, Newman S, Talavage T, Leverenz L, Nauman E. Head acceleration event metrics in youth contact sports more dependent on sport than level of play. Proc Inst Mech Eng H 2020; 235:208-221. [PMID: 33183139 DOI: 10.1177/0954411920970812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goal of the study was to evaluate how repetitive head traumas sustained by athletes in contact sports depend on sport and level of play. A total of 16 middle school football players, 107 high school football players, and 65 high school female soccer players participated. Players were separated into levels of play: middle school (MS), freshman (FR), junior varsity (JV), junior varsity-varsity (JV-V), and varsity (V). xPatch sensors were used to measure peak translational and angular accelerations (PTA and PAA, respectively) for each head acceleration event (HAE) during practice and game sessions. Data were analyzed using a custom MATLAB program to compare metrics that have been correlated with functional neurological changes: session metrics (median HAEs per contact session), season metrics (total HAEs, cumulative PTA/PAA), and regressions (cumulative PTA/PAA versus total HAEs, total HAEs versus median HAEs per contact session). Football players had greater session (p<.001) and season (p<.001) metrics than soccer players, but soccer players had a significantly greater player average PAA per HAE than football players (p<.001). Middle school football players had similar session and season metrics to high school level athletes. In conclusion, sport has a greater influence on HAE characteristics than level of play.
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Affiliation(s)
- Taylor Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Roy Lycke
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Joshua Auger
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Jacob Music
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Michael Dziekan
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Sharlene Newman
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Thomas Talavage
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.,Department of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA
| | - Larry Leverenz
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Eric Nauman
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA.,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.,Department of Basic Medical Sciences, Purdue University, West Lafayette, IN, USA
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36
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Cassoudesalle H, Petit A, Chanraud S, Petit H, Badaut J, Sibon I, Dehail P. Changes in resting-state functional brain connectivity associated with head impacts over one men's semi-professional soccer season. J Neurosci Res 2020; 99:446-454. [PMID: 33089563 DOI: 10.1002/jnr.24742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 11/05/2022]
Abstract
Soccer, as a contact sport, exposes players to repetitive head impacts, especially through heading the ball. The question of a long-term brain cumulative effect remains. Our objective was to determine whether exposure to head impacts over one soccer season was associated with changes in functional brain connectivity at rest, using magnetic resonance imaging (MRI). In this prospective cohort study, 10 semi-professional men soccer players, aged 18-25 years, and 20 age-matched men athletes without a concussion history and who do not practice any contact sport were recruited in Bordeaux (France). Exposure to head impacts per soccer player during competitive games over one season was measured using video analysis. Resting-state functional magnetic resonance imaging data were acquired for both groups at two times, before and after the season. With a seed-based analysis, resting-state networks that have been intimately associated with aspects of cognitive functioning were investigated. The results showed a mean head impacts of 42 (±33) per soccer player over the season, mainly intentional head-to-ball impacts and no concussion. No head impact was found among the other athletes. The number of head impacts between the two MRI acquisitions before and after the season was associated with increased connectivity within the default mode network and the cortico-cerebellar network. In conclusion, our findings suggest that the brain functioning changes over one soccer season in association with exposure to repetitive head impacts.
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Affiliation(s)
- Hélène Cassoudesalle
- Physical and Rehabilitation Medicine Department, University Hospital of Bordeaux, Bordeaux, France.,"Handicap, Activity, Cognition & Health" Team, INSERM, BPH, U1219, University of Bordeaux, Bordeaux, France
| | - Adrien Petit
- Physical and Rehabilitation Medicine Department, University Hospital of Bordeaux, Bordeaux, France
| | - Sandra Chanraud
- Neuroimaging and Human Cognition Group, UMR-CNRS 5287 - INCIA, Bordeaux, France
| | - Hervé Petit
- "Handicap, Activity, Cognition & Health" Team, INSERM, BPH, U1219, University of Bordeaux, Bordeaux, France
| | - Jérôme Badaut
- Brain Molecular Imaging Group, UMR-CNRS 5287 - INCIA, Bordeaux, France
| | - Igor Sibon
- Neuroimaging and Human Cognition Group, UMR-CNRS 5287 - INCIA, Bordeaux, France
| | - Patrick Dehail
- Physical and Rehabilitation Medicine Department, University Hospital of Bordeaux, Bordeaux, France.,"Handicap, Activity, Cognition & Health" Team, INSERM, BPH, U1219, University of Bordeaux, Bordeaux, France
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LoBue C, Munro C, Schaffert J, Didehbani N, Hart J, Batjer H, Cullum CM. Traumatic Brain Injury and Risk of Long-Term Brain Changes, Accumulation of Pathological Markers, and Developing Dementia: A Review. J Alzheimers Dis 2020; 70:629-654. [PMID: 31282414 DOI: 10.3233/jad-190028] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Traumatic brain injuries (TBI) have received widespread media attention in recent years as being a risk factor for the development of dementia and chronic traumatic encephalopathy (CTE). This has sparked fears about the potential long-term effects of TBI of any severity on cognitive aging, leading to a public health concern. This article reviews the evidence surrounding TBI as a risk factor for the later development of changes in brain structure and function, and an increased risk of neurodegenerative disorders. A number of studies have shown evidence of long-term brain changes and accumulation of pathological biomarkers (e.g., amyloid and tau proteins) related to a history of moderate-to-severe TBI, and research has also demonstrated that individuals with moderate-to-severe injuries have an increased risk of dementia. While milder injuries have been found to be associated with an increased risk for dementia in some recent studies, reports on long-term brain changes have been mixed and often are complicated by factors related to injury exposure (i.e., number of injuries) and severity/complications, psychiatric conditions, and opioid use disorder. CTE, although often described as a neurodegenerative disorder, remains a neuropathological condition that is poorly understood. Future research is needed to clarify the significance of CTE pathology and determine whether that can explain any clinical symptoms. Overall, it is clear that most individuals who sustain a TBI (particularly milder injuries) do not experience worse outcomes with aging, as the incidence for dementia is found to be less than 7% across the literature.
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Affiliation(s)
- Christian LoBue
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Catherine Munro
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey Schaffert
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nyaz Didehbani
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John Hart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hunt Batjer
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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38
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Monroe DC, Blumenfeld RS, Keator DB, Solodkin A, Small SL. One season of head-to-ball impact exposure alters functional connectivity in a central autonomic network. Neuroimage 2020; 223:117306. [PMID: 32861790 PMCID: PMC7822072 DOI: 10.1016/j.neuroimage.2020.117306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/26/2020] [Accepted: 08/22/2020] [Indexed: 11/30/2022] Open
Abstract
Repetitive head impacts represent a risk factor for neurological impairment in team-sport athletes. In the absence of symptoms, a physiological basis for acute injury has not been elucidated. A basic brain function that is disrupted after mild traumatic brain injury is the regulation of homeostasis, instantiated by activity across a specific set of brain regions that comprise a central autonomic network. We sought to relate head-to-ball impact exposure to changes in functional connectivity in a core set of central autonomic regions and then to determine the relation between changes in brain and changes in behavior, specifically cognitive control. Thirteen collegiate men's soccer players and eleven control athletes (golf, cross-country) underwent resting-state fMRI and behavioral testing before and after the season, and a core group of cortical, subcortical, and brainstem regions was selected to represent the central autonomic network. Head-to-ball impacts were recorded for each soccer player. Cognitive control was assessed using a Dot Probe Expectancy task. We observed that head-to-ball impact exposure was associated with diffuse increases in functional connectivity across a core CAN subnetwork. Increased functional connectivity between the left insula and left medial orbitofrontal cortex was associated with diminished proactive cognitive control after the season in those sustaining the greatest number of head-to-ball impacts. These findings encourage measures of autonomic physiology to monitor brain health in contact and collision sport athletes.
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Affiliation(s)
- Derek C Monroe
- Department of Neurology, University of California, Room 150 Med Surge I, Irvine, CA 92697-4275, United States.
| | - Robert S Blumenfeld
- Department of Neurology, University of California, Room 150 Med Surge I, Irvine, CA 92697-4275, United States; Department of Psychology, California State Polytechnic University, 3801 West Temple Avenue, Pomona, CA 91768, United States
| | - David B Keator
- Department of Psychiatry and Human Behavior, University of California, 163 Irvine Hall, Irvine, CA 92697- 3960, United States
| | - Ana Solodkin
- Department of Anatomy and Neurobiology, University of California-Irvine, B240 Medical Science, Irvine, CA 92697-4275, United States; School of Behavioral and Brain Sciences, University of Texas at Dallas, 800 W Campbell Rd, GR 41, Richardson, TX 75080, United States
| | - Steven L Small
- Department of Neurology, University of California, Room 150 Med Surge I, Irvine, CA 92697-4275, United States; School of Behavioral and Brain Sciences, University of Texas at Dallas, 800 W Campbell Rd, GR 41, Richardson, TX 75080, United States
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Dudley J, Yuan W, Diekfuss J, Barber Foss KD, DiCesare CA, Altaye M, Logan K, Leach JL, Myer GD. Altered Functional and Structural Connectomes in Female High School Soccer Athletes After a Season of Head Impact Exposure and the Effect of a Novel Collar. Brain Connect 2020; 10:292-301. [DOI: 10.1089/brain.2019.0729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Jonathan Dudley
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jed Diekfuss
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kim D. Barber Foss
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher A. DiCesare
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mekibib Altaye
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kelsey Logan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James L. Leach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati Ohio, USA
| | - Gregory D. Myer
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
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40
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Nauman EA, Talavage TM, Auerbach PS. Mitigating the Consequences of Subconcussive Head Injuries. Annu Rev Biomed Eng 2020; 22:387-407. [PMID: 32348156 DOI: 10.1146/annurev-bioeng-091219-053447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Subconcussive head injury represents a pathophysiology that spans the expertise of both clinical neurology and biomechanical engineering. From both viewpoints, the terms injury and damage, presented without qualifiers, are synonymously taken to mean a tissue alteration that may be recoverable. For clinicians, concussion is evolving from a purely clinical diagnosis to one that requires objective measurement, to be achieved by biomedical engineers. Subconcussive injury is defined as subclinical pathophysiology in which underlying cellular- or tissue-level damage (here, to the brain) is not severe enough to present readily observable symptoms. Our concern is not whether an individual has a (clinically diagnosed) concussion, but rather, how much accumulative damage an individual can tolerate before they will experience long-term deficit(s) in neurological health. This concern leads us to look for the history of damage-inducing events, while evaluating multiple approaches for avoiding injury through reduction or prevention of the associated mechanically induced damage.
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Affiliation(s)
- Eric A Nauman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana 47907, USA; .,School of Mechanical Engineering, Purdue University, West Lafayette, Indiana 47907, USA.,Department of Basic Medical Sciences, Purdue University, West Lafayette, Indiana 47907, USA
| | - Thomas M Talavage
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana 47907, USA; .,School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana 47907, USA
| | - Paul S Auerbach
- Department of Emergency Medicine, Stanford University, Palo Alto, California 94304, USA
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41
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Monroe DC, Cecchi NJ, Gerges P, Phreaner J, Hicks JW, Small SL. A Dose Relationship Between Brain Functional Connectivity and Cumulative Head Impact Exposure in Collegiate Water Polo Players. Front Neurol 2020; 11:218. [PMID: 32300329 PMCID: PMC7145392 DOI: 10.3389/fneur.2020.00218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/09/2020] [Indexed: 12/13/2022] Open
Abstract
A growing body of evidence suggests that chronic, sport-related head impact exposure can impair brain functional integration and brain structure and function. Evidence of a robust inverse relationship between the frequency and magnitude of repeated head impacts and disturbed brain network function is needed to strengthen an argument for causality. In pursuing such a relationship, we used cap-worn inertial sensors to measure the frequency and magnitude of head impacts sustained by eighteen intercollegiate water polo athletes monitored over a single season of play. Participants were evaluated before and after the season using computerized cognitive tests of inhibitory control and resting electroencephalography. Greater head impact exposure was associated with increased phase synchrony [r(16) > 0.626, p < 0.03 corrected], global efficiency [r(16) > 0.601, p < 0.04 corrected], and mean clustering coefficient [r(16) > 0.625, p < 0.03 corrected] in the functional networks formed by slow-wave (delta, theta) oscillations. Head impact exposure was not associated with changes in performance on the inhibitory control tasks. However, those with the greatest impact exposure showed an association between changes in resting-state connectivity and a dissociation between performance on the tasks after the season [r(16) = 0.481, p = 0.043] that could also be attributed to increased slow-wave synchrony [F(4, 135) = 113.546, p < 0.001]. Collectively, our results suggest that athletes sustaining the greatest head impact exposure exhibited changes in whole-brain functional connectivity that were associated with altered information processing and inhibitory control.
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Affiliation(s)
- Derek C Monroe
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Nicholas J Cecchi
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Paul Gerges
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Jenna Phreaner
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - James W Hicks
- Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine, CA, United States
| | - Steven L Small
- Department of Neurology, University of California, Irvine, Irvine, CA, United States.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, United States
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42
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Lust CAC, Mountjoy M, Robinson LE, Oliver JM, Ma DWL. Sports-related concussions and subconcussive impacts in athletes: incidence, diagnosis, and the emerging role of EPA and DHA. Appl Physiol Nutr Metab 2020; 45:886-892. [PMID: 32119565 DOI: 10.1139/apnm-2019-0555] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Sports-related concussions (SRC) are traumatic brain injuries induced as the result of a biomechanical force to the body that temporarily impair neurological functions. Not all traumatic impacts reach the threshold necessary to produce concussive symptoms; however, the culmination of these events is known as a subconcussive impact (SCI). Athletes who have been diagnosed with a SRC or those who accumulate multiple SCI have exhibited structural damage to the brain, impairments to learning and memory, and an increase in depressive symptoms. This area is rapidly evolving, and current clinical definitions of injury, diagnosis, and treatment of SRC and SCI are reviewed. In tandem, there is also growing research examining the role of nutrition in brain injuries, focusing primarily on n-3 polyunsaturated fatty acids (PUFA). The potential role of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in reducing inflammation and promoting recovery following brain injury are also reviewed. Overall, advancements in the evaluation of SRC and SCI coupled with n-3 PUFA supplementation show promise in the management of brain injuries, leading to better long-term health outcomes for athletes. Novelty SRC have garnered widespread attention due to the growing body of reported prevalence in youth and professional sports. Current definitions and protocol(s) for diagnosing SRC and SCI have improved, but still require further evaluation. n-3, EPA and DHA, reduce inflammation and promote recovery following brain injuries in experimental models.
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Affiliation(s)
- Cody A C Lust
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Margo Mountjoy
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Lindsay E Robinson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Jonathan M Oliver
- Athletics, United States Military Academy, West Point, NY 10996, USA
| | - David W L Ma
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
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43
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Xia G, Hu Z, Zhou F, Duan W, Wang M, Gong H, He Y, Guan Y. Functional Connectivity Density with Frequency-Dependent Changes in Patients with Diffuse Axonal Injury: A Resting-State Functional Magnetic Resonance Imaging Study. Neuropsychiatr Dis Treat 2020; 16:2733-2742. [PMID: 33209028 PMCID: PMC7669505 DOI: 10.2147/ndt.s267023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/19/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE We explored changes in spontaneous brain connectivity in patients with diffuse axonal injury (DAI), assessed via functional connectivity density (FCD) tests using different frequency bands. PATIENTS AND METHODS In all, 23 patients with DAI (17 males and 6 females) and 23 healthy controls (HCs; 17 males and 6 females) were included. Functional magnetic resonance imaging scans were performed when the participants were in a resting state and the FCD levels in three frequency bands (slow-4: 0.027-0.073 Hz, slow-5: 0.01-0.027 Hz, and typical: 0.01-0.08 Hz) were measured. In addition, Pearson's correlation coefficient was used to explore the relationship between clinical indices and brain regions with abnormal FCD values. RESULTS Compared to HCs, DAI patients had significantly greater FCD values in the right extranuclear/limbic lobe/cingulate gyrus and left limbic lobe/hippocampus/parahippocampal gyrus, and significantly lower FCD values in the left precuneus/posterior cingulate gyrus, in the slow-4 band. In the slow-5 band, the DAI patients had higher FCD values in the left inferior temporal gyrus/superior temporal gyrus, left parahippocampal gyrus/limbic lobe, left extranuclear/cingulate gyrus, and right medial frontal gyrus, and lower values in the right inferior frontal gyrus, right inferior parietal lobule, and left cingulate gyrus/limbic lobe. Moreover, compared to HCs, the values in the typical band were higher in the right extranuclear/limbic lobe/hippocampus/parahippocampal gyrus, but were significantly lower in the right precuneus/posterior cingulate gyrus and right inferior parietal lobule/supramarginal gyrus. The abnormal FCD values of these brain regions were linearly correlated with different clinical scale scores. CONCLUSION DAI patients had abnormal FCD values in various brain regions, indicating disruption to the brain functional network. Moreover, the values were frequency dependent. Our results provide new evidence for the pathogenesis of functional impairment and may explain the neuropathological or compensatory mechanism of the disease.
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Affiliation(s)
- Guojin Xia
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Jiangxi, People's Republic of China
| | - Zhenzhen Hu
- Department of Thoracic Oncology, Jiangxi Cancer Hospital, Jiangxi, People's Republic of China
| | - Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Jiangxi, People's Republic of China
| | - Wenfeng Duan
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Jiangxi, People's Republic of China
| | - Min Wang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Jiangxi, People's Republic of China
| | - Honghan Gong
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Jiangxi, People's Republic of China
| | - Yulin He
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China.,Jiangxi Province Medical Imaging Research Institute, Jiangxi, People's Republic of China
| | - Yanxing Guan
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China
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Cutting to the Pathophysiology Chase: Translating Cutting-Edge Neuroscience to Rehabilitation Practice in Sports-Related Concussion Management. J Orthop Sports Phys Ther 2019; 49:811-818. [PMID: 31154951 DOI: 10.2519/jospt.2019.8884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mild traumatic brain injury, or concussion, is a common sports injury. Concussion involves physical injury to brain tissue and vascular and axonal damage that manifests as transient and often nonspecific clinical symptoms. Concussion diagnosis is challenging, and the relationship between brain injury and clinical symptoms is unclear. The purpose of this commentary was to translate cutting-edge neuroscience to rehabilitation practice. We (1) highlight potential biomarkers that may improve our understanding of concussion and its recovery, (2) explain why researchers must address the paucity of concussion research in female athletes, and (3) present female-specific factors that should be accounted for in future studies. Integrating objective, quantitative measures of concussion pathophysiology with concussion history, genetics, and genomics will help caregivers identify concussed athletes, tailor recovery protocols, and protect athletes from potential long-term effects of cumulative head impact. J Orthop Sports Phys Ther 2019;49(11):811-818. Epub 1 Jun 2019. doi:10.2519/jospt.2019.8884.
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Eckner JT, Wang J, Nelson LD, Bancroft R, Pohorence M, He X, Broglio SP, Giza CC, Guskiewicz KM, Kutcher JS, McCrea M. Effect of Routine Sport Participation on Short-Term Clinical Neurological Outcomes: A Comparison of Non-Contact, Contact, and Collision Sport Athletes. Sports Med 2019; 50:1027-1038. [PMID: 31637659 DOI: 10.1007/s40279-019-01200-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To compare pre-season to post-season changes on a battery of clinical neurological outcome measures between non-contact, contact, and collision sport athletes over multiple seasons of play. METHODS 244 high school and collegiate athletes participating in multiple non-contact, contact, and collision sports completed standardized annual pre-season and post-season assessments over 1-4 years. Pre/post-season changes in 10 outcome measures assessing concussion symptoms, neurocognitive performance, and balance were compared between the groups using linear mixed models. RESULTS Small, but statistically significant overall pre/post-season change differences were present between the groups for Axon computerized neurocognitive test processing speed, attention, and working memory speed scores (Axon-PS, Axon-Att, Axon-WMS), as well as Balance Error Scoring System (BESS) total score. Small seasonal declines not exceeding reliable-change thresholds were observed in the collision sport group relative to the contact and non-contact groups for Axon-PS and Axon-Att scores. The collision and contact sport groups demonstrated less pre-/post-season improvement than the non-contact sport group for Axon-WMA and BESS, with less BESS improvement also observed in the collision sport group relative to the contact sport group. Overall, longitudinal performance on all 10 outcome measures remained stable in all 3 groups over 4 years. CONCLUSION Our findings do not necessarily support the notion that participation in sports associated with exposure to repetitive head impacts has clinically meaningful cumulative effects over the course of a season, nor over four consecutive seasons in high school and collegiate athletes.
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Affiliation(s)
- James T Eckner
- Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower Parkway, Ann Arbor, MI, 48108, USA.
| | | | | | | | | | - Xuming He
- Statistics, University of Michigan, Ann Arbor, USA
| | | | | | - Kevin M Guskiewicz
- Exercise and Sport Science, University of North Carolina, Chapel Hill, USA
| | - Jeffrey S Kutcher
- Neurology, University of Michigan, Ann Arbor, USA.,The Sports Neurology Clinic, Brighton, USA
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, USA
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Meier TB, Giraldo-Chica M, España LY, Mayer AR, Harezlak J, Nencka AS, Wang Y, Koch KM, Wu YC, Saykin AJ, Giza CC, Goldman J, DiFiori JP, Guskiewicz KM, Mihalik JP, Brooks A, Broglio SP, McAllister T, McCrea MA. Resting-State fMRI Metrics in Acute Sport-Related Concussion and Their Association with Clinical Recovery: A Study from the NCAA-DOD CARE Consortium. J Neurotrauma 2019; 37:152-162. [PMID: 31407610 DOI: 10.1089/neu.2019.6471] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
There has been a recent call for longitudinal cohort studies to track the physiological recovery of sport-related concussion (SRC) and its relationship with clinical recovery. Resting-state functional magnetic resonance imaging (rs-fMRI) has shown potential for detecting subtle changes in brain function after SRC. We investigated the effects of SRC on rs-fMRI metrics assessing local connectivity (regional homogeneity; REHO), global connectivity (average nodal strength), and the relative amplitude of slow oscillations of rs-fMRI (fractional amplitude of low-frequency fluctuations; fALFF). Athletes diagnosed with SRC (n = 92) completed visits with neuroimaging at 24-48 h post-injury (24 h), after clearance to begin the return-to-play (RTP) progression (asymptomatic), and 7 days following unrestricted RTP (post-RTP). Non-injured athletes (n = 82) completed visits yoked to the schedule of matched injured athletes and served as controls. Concussed athletes had elevated symptoms, worse neurocognitive performance, greater balance deficits, and elevated psychological symptoms at the 24-h visit relative to controls. These deficits were largely recovered by the asymptomatic visit. Concussed athletes still reported elevated psychological symptoms at the asymptomatic visit relative to controls. Concussed athletes also had elevated REHO in the right middle and superior frontal gyri at the 24-h visit that returned to normal levels by the asymptomatic visit. Additionally, REHO in these regions at 24 h predicted psychological symptoms at the asymptomatic visit in concussed athletes. Current results suggest that SRC is associated with an acute alteration in local connectivity that follows a similar time course as clinical recovery. Our results do not indicate strong evidence that concussion-related alterations in rs-fMRI persist beyond clinical recovery.
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Affiliation(s)
- Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Lezlie Y España
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Neurology and Psychiatry Departments, University of New Mexico School of Medicine, Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, Indiana
| | - Andrew S Nencka
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yang Wang
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kevin M Koch
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yu-Chien Wu
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Christopher C Giza
- Departments of Pediatrics and Neurosurgery, University of California Los Angeles, Los Angeles, California
| | - Joshua Goldman
- Departments of Family Medicine and Orthopaedic Surgery, University of California Los Angeles, Los Angeles, California.,Center for Sports Medicine, Orthopaedic Institute for Children, Los Angeles, California
| | - John P DiFiori
- Hospital for Special Surgery, Primary Sports Medicine Service, New York, New York
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina
| | - Jason P Mihalik
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina
| | - Alison Brooks
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Steven P Broglio
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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47
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Jang I, Chun IY, Brosch JR, Bari S, Zou Y, Cummiskey BR, Lee TA, Lycke RJ, Poole VN, Shenk TE, Svaldi DO, Tamer GG, Dydak U, Leverenz LJ, Nauman EA, Talavage TM. Every hit matters: White matter diffusivity changes in high school football athletes are correlated with repetitive head acceleration event exposure. NEUROIMAGE-CLINICAL 2019; 24:101930. [PMID: 31630026 PMCID: PMC6807364 DOI: 10.1016/j.nicl.2019.101930] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 06/29/2019] [Accepted: 07/09/2019] [Indexed: 11/29/2022]
Abstract
Recent evidence of short-term alterations in brain physiology associated with repeated exposure to moderate intensity subconcussive head acceleration events (HAEs), prompts the question whether these alterations represent an underlying neural injury. A retrospective analysis combining counts of experienced HAEs and longitudinal diffusion-weighted imaging explored whether greater exposure to incident mechanical forces was associated with traditional diffusion-based measures of neural injury—reduced fractional anisotropy (FA) and increased mean diffusivity (MD). Brains of high school athletes (N = 61) participating in American football exhibited greater spatial extents (or volumes) experiencing substantial changes (increases and decreases) in both FA and MD than brains of peers who do not participate in collision-based sports (N = 15). Further, the spatial extents of the football athlete brain exhibiting traditional diffusion-based markers of neural injury were found to be significantly correlated with the cumulative exposure to HAEs having peak translational acceleration exceeding 20 g. This finding demonstrates that subconcussive HAEs induce low-level neurotrauma, with prolonged exposure producing greater accumulation of neural damage. The duration and extent of recovery associated with periods in which athletes do not experience subconcussive HAEs now represents a priority for future study, such that appropriate participation and training schedules may be developed to minimize the risk of long-term neurological dysfunction. Brain volumes evidencing injury are larger in football athletes than controls. Spatial extent of decreased FA correlates with head acceleration event exposure. Spatial extent of increased MD correlates with head acceleration event exposure.
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Affiliation(s)
- Ikbeom Jang
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America.
| | - Il Yong Chun
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Jared R Brosch
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Sumra Bari
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Yukai Zou
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America; College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States of America
| | - Brian R Cummiskey
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Taylor A Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Roy J Lycke
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Victoria N Poole
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Trey E Shenk
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Diana O Svaldi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Gregory G Tamer
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Ulrike Dydak
- School of Health Sciences, Purdue University, West Lafayette, IN, United States of America
| | - Larry J Leverenz
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States of America
| | - Eric A Nauman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America; School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America; Department of Basic Medical Sciences, Purdue University, West Lafayette, IN, United States of America
| | - Thomas M Talavage
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
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48
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Zonner SW, Ejima K, Bevilacqua ZW, Huibregtse ME, Charleston C, Fulgar C, Kawata K. Association of Increased Serum S100B Levels With High School Football Subconcussive Head Impacts. Front Neurol 2019; 10:327. [PMID: 31024425 PMCID: PMC6459945 DOI: 10.3389/fneur.2019.00327] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/15/2019] [Indexed: 12/14/2022] Open
Abstract
Astrocyte-enriched marker, S100B, shows promise for gauging the severity of acute brain trauma, and understanding subconcussive effects will advance its utility in tracking real-time acute brain damage. The aim of the study was to investigate whether serum S100B elevations were associated with frequency and magnitude of subconcussive head impacts in adolescents. This prospective cohort study of 17 high-school football players consisted of the following 12 time points: pre-season baseline, 5 in-season pre-post games, and post-season. A sensor-installed mouthguard recorded the number of head impacts, peak linear (PLA) and peak rotational (PRA) head accelerations from every practice and game. During the 5 games, players wore chest-strap heart-rate monitors to estimate players' excess post-exercise oxygen consumption (EPOC), accounting for physical exertion effects. At each time point, blood samples were obtained and assessed for S100B and creatine kinase levels to account for astrocyte damage/activation and muscle damage, respectively. Using k-means clustering on the impact data, players were categorized into high- or low-impact group. Two players withdrew during the first month of the study. A total of 156 blood samples from 15 players were assessed for S100B and creatine kinase levels and included in the analysis. A median value of 596 head impacts from 15 players were recorded during all practices and games in a season. S100B levels were significantly elevated in all post-game measures compared with the respective pre-game values (median-increase, 0.022 μg/L; interquartile-range, 0.011–0.043 μg/L, p < 0.05 for all games). Greater acute S100B increases were significantly associated with greater impact frequency, sum of PLA and PRA, with negligible contributions from physical exertion and muscle damage effects. The high-impact group exhibited greater increases in serum S100B levels at post-games than the low-impact group (high vs. low, 0.043 ± 0.035 μg/L vs. 0.019 ± 0.017 μg/L, p = 0.002). The degree of acute S100B increases was correlated with subconcussive head impact exposure, suggesting that acute astrocyte damage may be induced in an impact-dependent manner. Acute changes in serum S100B levels may become a useful tool in monitoring real-time brain damage in sports.
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Affiliation(s)
- Steven W Zonner
- Department of Sports Medicine, Washington Township Medical Foundation, Fremont, CA, United States
| | - Keisuke Ejima
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Zachary W Bevilacqua
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Megan E Huibregtse
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Carmen Charleston
- Division of Washington Sports Medicine, Irvington High School, Fremont, CA, United States
| | - Ciara Fulgar
- Center for Health and the Environment, University of California, Davis, Davis, CA, United States
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, United States.,Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN, United States
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49
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Walter A, Herrold AA, Gallagher VT, Lee R, Scaramuzzo M, Bream T, Seidenberg PH, Vandenbergh D, O'Connor K, Talavage TM, Nauman EA, Slobounov SM, Breiter HC. KIAA0319 Genotype Predicts the Number of Past Concussions in a Division I Football Team: A Pilot Study. J Neurotrauma 2019; 36:1115-1124. [DOI: 10.1089/neu.2017.5622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Alexa Walter
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
- Concussion Neuroimaging Consortium, Florida State University, Florida; Harvard University, Massachusetts; Michigan State University, Michigan; Northwestern University, Illinois; Ohio State University, Ohio; Purdue University, Indiana; The Pennsylvania State University, Pennsylvania; University of Central Florida, Florida; University of Nebraska, Nebraska
| | - Amy A. Herrold
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Edward Hines Jr., VA Hospital, Hines, Illinois
- Concussion Neuroimaging Consortium, Florida State University, Florida; Harvard University, Massachusetts; Michigan State University, Michigan; Northwestern University, Illinois; Ohio State University, Ohio; Purdue University, Indiana; The Pennsylvania State University, Pennsylvania; University of Central Florida, Florida; University of Nebraska, Nebraska
| | - Virginia T. Gallagher
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Concussion Neuroimaging Consortium, Florida State University, Florida; Harvard University, Massachusetts; Michigan State University, Michigan; Northwestern University, Illinois; Ohio State University, Ohio; Purdue University, Indiana; The Pennsylvania State University, Pennsylvania; University of Central Florida, Florida; University of Nebraska, Nebraska
| | - Rosa Lee
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Concussion Neuroimaging Consortium, Florida State University, Florida; Harvard University, Massachusetts; Michigan State University, Michigan; Northwestern University, Illinois; Ohio State University, Ohio; Purdue University, Indiana; The Pennsylvania State University, Pennsylvania; University of Central Florida, Florida; University of Nebraska, Nebraska
| | - Madeleine Scaramuzzo
- Athletic Department, The Pennsylvania State University, University Park, Pennsylvania
| | - Tim Bream
- Athletic Department, The Pennsylvania State University, University Park, Pennsylvania
| | - Peter H. Seidenberg
- Athletic Department, The Pennsylvania State University, University Park, Pennsylvania
| | - David Vandenbergh
- Department of Biobehavioral Health, Molecular and Cellular Biosciences Program and Institute for the Neurosciences, The Pennsylvania State University, University Park, Pennsylvania
| | - Kailyn O'Connor
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Thomas M. Talavage
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana
- Concussion Neuroimaging Consortium, Florida State University, Florida; Harvard University, Massachusetts; Michigan State University, Michigan; Northwestern University, Illinois; Ohio State University, Ohio; Purdue University, Indiana; The Pennsylvania State University, Pennsylvania; University of Central Florida, Florida; University of Nebraska, Nebraska
| | - Eric A. Nauman
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana
- Concussion Neuroimaging Consortium, Florida State University, Florida; Harvard University, Massachusetts; Michigan State University, Michigan; Northwestern University, Illinois; Ohio State University, Ohio; Purdue University, Indiana; The Pennsylvania State University, Pennsylvania; University of Central Florida, Florida; University of Nebraska, Nebraska
| | - Semyon M. Slobounov
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
- Concussion Neuroimaging Consortium, Florida State University, Florida; Harvard University, Massachusetts; Michigan State University, Michigan; Northwestern University, Illinois; Ohio State University, Ohio; Purdue University, Indiana; The Pennsylvania State University, Pennsylvania; University of Central Florida, Florida; University of Nebraska, Nebraska
| | - Hans C. Breiter
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Concussion Neuroimaging Consortium, Florida State University, Florida; Harvard University, Massachusetts; Michigan State University, Michigan; Northwestern University, Illinois; Ohio State University, Ohio; Purdue University, Indiana; The Pennsylvania State University, Pennsylvania; University of Central Florida, Florida; University of Nebraska, Nebraska
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50
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Champagne AA, Coverdale NS, Nashed JY, Fernandez-Ruiz J, Cook DJ. Resting CMRO 2 fluctuations show persistent network hyper-connectivity following exposure to sub-concussive collisions. Neuroimage Clin 2019; 22:101753. [PMID: 30884366 PMCID: PMC6424143 DOI: 10.1016/j.nicl.2019.101753] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 02/20/2019] [Accepted: 03/09/2019] [Indexed: 12/20/2022]
Abstract
Exposure to head impacts may alter brain connectivity within cortical hubs such as the default-mode network (DMN). However, studies have yet to consider the confounding effects of altered resting cerebral blood flow (CBF0) and cerebrovascular reactivity (CVR) on changes in connectivity following sub-concussive impacts. Here, 23 Canadian collegiate football players were followed during a season using calibrated resting-state MRI and helmet accelerometers to examine the interplay between the neural and vascular factors that determine functional connectivity (FC). Connectivity-based analyses using blood oxygen level dependent (BOLD) and cerebral metabolic rate of oxygen consumption (CMRO2) mapping were used to study the DMN longitudinally. Network-specific decreases in CBF0 were observed one month following the season, while impaired CVR was documented at both mid-season and one month following the season, compared to pre-season baseline. Alterations in CBF0 and BOLD-based CVR throughout the season suggest that neurophysiological markers may show different susceptibility timelines following head impacts. DMN connectivity was increased throughout the season, independent of changes in cerebrovascular physiology, suggesting that alterations in FC following sub-concussive impacts are robust and independent of changes in brain hemodynamics. No significant correlations between impact kinematics and DMN connectivity changes were documented in this study. Altogether, these findings create a strong paradigm for future studies to examine the underlying neural and vascular mechanisms associated with increases in network connectivity following repeated exposure to sub-concussive collisions, in an effort to improve management of head impacts in contact sports.
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Affiliation(s)
- Allen A Champagne
- Centre for Neuroscience Studies, Room 260, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Nicole S Coverdale
- Centre for Neuroscience Studies, Room 260, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Joseph Y Nashed
- Centre for Neuroscience Studies, Room 260, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Juan Fernandez-Ruiz
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Av. Universidad 3000, Coyoacán, Ciudad de México 04510, México.
| | - Douglas J Cook
- Centre for Neuroscience Studies, Room 260, Queen's University, Kingston, ON K7L 3N6, Canada; Department of Surgery, Queen's University, Room 232, 18 Stuart St, Kingston, ON K7L 3N6, Canada.
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