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Antonellis P, Weightman MM, Fino PC, Chen S, Lester ME, Hoppes CW, Dibble LE, King LA. Relation Between Cognitive Assessment and Clinical Physical Performance Measures After Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2024; 105:868-875. [PMID: 37931890 DOI: 10.1016/j.apmr.2023.10.013] [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: 07/05/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To investigate the relation between cognitive and motor performance in individuals with mild traumatic brain injury (mTBI) and examine differences in both cognitive and motor performance between adults after mTBI and healthy controls. DESIGN Multi-center, cross-sectional study. SETTING Three institutional sites (Courage Kenny Research Center, Minneapolis, MN, Oregon Health & Science University, Portland, OR, and University of Utah, Salt Lake City, UT). PARTICIPANTS Data were collected from 110 participants (N=110), including those with mTBI and healthy controls, who completed cognitive and physical performance assessments. INTERVENTIONS Not applicable. OUTCOME MEASURES Cognitive assessments involved the Automated Neuropsychological Assessment Metrics to evaluate domains of attention, memory, reaction time, processing speed, and executive function. Physical performance was evaluated through clinical performance assessments, such as the 1-min walk test, the modified Illinois Agility Test, the Functional Gait Assessment Tool, the High-Level Mobility Assessment Tool, a complex turning course, and a 4-Item Hybrid Assessment of Mobility for mTBI. Participants also completed additional trials of the 1-min walk test, modified Illinois Agility Test, and complex turning course with a simultaneous cognitive task. RESULTS Individuals with mTBI performed worse on cognitive assessments, as well as several of the physical performance assessments compared with healthy controls. Complex tasks were more strongly related to cognitive assessments compared with simple walking tasks. CONCLUSIONS Combining complex motor tasks with cognitive demands may better demonstrate functional performance in individuals recovering from mTBI. By understanding the relation between cognitive and physical performance in individuals recovering from mTBI, clinicians may be able to improve clinical care and assist in return to activity decision-making.
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Affiliation(s)
| | | | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT
| | - Siting Chen
- School of Public Health, Oregon Health & Science University, Portland, OR
| | - Mark E Lester
- Department of Physical Therapy, University of Texas Rio Grande Valley, Harlingen, TX
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR
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Cecchini AS, McCulloch K, Harrison C, Favorov O, Davila M, Zhang W, Prim J, Krok CDRM. Expanding capabilities to evaluate readiness for return to duty after mTBI: The CAMP study protocol. PLoS One 2024; 19:e0270076. [PMID: 38285693 PMCID: PMC10824418 DOI: 10.1371/journal.pone.0270076] [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: 06/02/2022] [Accepted: 03/22/2023] [Indexed: 01/31/2024] Open
Abstract
Physical Therapists affiliated with Intrepid Spirit Centers evaluate and treat Active Duty Service Members (ADSM) who have duty-limiting post-concussion symptoms to improve the ability to perform challenging tasks associated with military service. The Complex Assessment of Military Performance (CAMP) is a test battery that more closely approximates the occupational demands of ADSM without specific adherence to a particular branch of service or military occupational specialty. Subtasks were developed with military collaborators to include high level skills that all service members must be able to perform such as reacting quickly, maintaining visual stability while moving and changing positions, and scanning for, noting, and/or remembering operationally relevant information under conditions of physical exertion. OBJECTIVE The purpose of this observational longitudinal study is to: 1- establish typical performance parameters for ADSM on the CAMP test battery 2- determine the element of the CAMP battery that demonstrate the greatest differences from standard performance and serve as predictors for successful return to duty and 3- develop clinician-facing feedback algorithms and displays and 4-develop materials for clinical dissemination. This ongoing multi-site study is currently funded through the CDMRP and has been approved by the Naval Medical Center Portsmouth IRB. METHODS ADSM undergoing post-concussion rehabilitation at the Intrepid Spirit Centers will be tested within one week of their initial Physical Therapy evaluation and after completing Physical Therapy. Control participants will include males, females, and ADSM from the Special Operations community. Participants will complete an intake form that includes questions about demographics, military service, deployment and concussion history, and profile and duty status. Other measures include those that explore concussion symptoms, sleep quality, post-traumatic stress, and perceptions of resilience. The CAMP includes three separate 10-15 minute tasks. Movement is recorded by wearable inertial sensors and heart rate variability is recorded with a POLAR10 monitor. The "Run-Roll" task requires rapid position changes, combat rolls and quick running forwards and backwards while carrying a simulated weapon. Visual stability before and after the task is also performed. The "Dual-Task Agility" task includes rapid running with and without a weighted vest and a working memory task. The "Patrol Exertion" task requires repeated stepping onto an exercise step while watching a virtual patrol video. Additional tasks include monitoring direction of travel, observing for signs of enemy presence, and reacting to multiple auditory signals embedded in the video. DISCUSSION Measures that evaluate relevant skills are vital to support safe return to duty for ADSM who may be exposed to imminent danger as part of training or mission demands. The CAMP is designed to be an ecologically valid and clinically feasible assessment that may be more sensitive to capturing subtle impairments that impact duty performance as test skills are integrated into dual and multi-tasks that reflect occupational demands. Assessment results may serve as a more robust indicator of readiness for full return to duty after concussion.
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Affiliation(s)
- Amy Seal Cecchini
- The Geneva Foundation, Womack Army Medical Center, Ft. Bragg, NC, United States of America
| | - Karen McCulloch
- Department of Human Movement Science, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Courtney Harrison
- Department of Human Movement Science, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Oleg Favorov
- Department of Biomedical Engineering, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Maria Davila
- Research Triangle Institue, Research Triangle Park, NC, United States of America
| | - Wanqing Zhang
- Department of Human Movement Science, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Julianna Prim
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - C. D. R. Michael Krok
- Womack Army Medical Center Intrepid Spirit Clinic, Ft. Bragg, NC, United States of America
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Sicard V, Ledoux AA, Tang K, Yeates KO, Brooks BL, Anderson P, Keightley M, Desire N, Beauchamp MH, Zemek R. The association between symptom burden and processing speed and executive functioning at 4 and 12 weeks following pediatric concussion. J Int Neuropsychol Soc 2024:1-13. [PMID: 38273645 DOI: 10.1017/s1355617724000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVES Symptoms and cognition are both utilized as indicators of recovery following pediatric concussion, yet their interrelationship is not well understood. This study aimed to investigate: 1) the association of post-concussion symptom burden and cognitive outcomes (processing speed and executive functioning [EF]) at 4 and 12 weeks after pediatric concussion, and 2) the moderating effect of sex on this association. METHODS This prospective, multicenter cohort study included participants aged 5.00-17.99 years with acute concussion presenting to four Emergency Departments of the Pediatric Emergency Research Canada network. Five processing speed and EF tasks and the Post-Concussion Symptom Inventory (PCSI; symptom burden, defined as the difference between post-injury and retrospective [pre-injury] scores) were administered at 4 and 12 weeks post-concussion. Generalized least squares models were conducted with task performances as dependent variables and PCSI and PCSI*sex interaction as the main predictors, with important pre-injury demographic and injury characteristics as covariates. RESULTS 311 children (65.0% males; median age = 11.92 [IQR = 9.14-14.21 years]) were included in the analysis. After adjusting for covariates, higher symptom burden was associated with lower Backward Digit Span (χ2 = 9.85, p = .043) and Verbal Fluency scores (χ2 = 10.48, p = .033) across time points; these associations were not moderated by sex, ps ≥ .20. Symptom burden was not associated with performance on the Coding, Continuous Performance Test, and Color-Word Interference scores, ps ≥ .17. CONCLUSIONS Higher symptom burden is associated with lower working memory and cognitive flexibility following pediatric concussion, yet these associations were not moderated by sex. Findings may inform concussion management by emphasizing the importance of multifaceted assessments of EF.
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Affiliation(s)
- Veronik Sicard
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Andrée-Anne Ledoux
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ken Tang
- Independent Statistical Consultant, Richmond, BC, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Brian L Brooks
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Peter Anderson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Mental Health Neuropsychology Program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Michelle Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, TorontoON, Canada
- Departments of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Naddley Desire
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Ste-Justine Hospital Research Center, Montreal, QC, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
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Barone V, van Dijk JP, Debeij-van Hall MH, van Putten MJ. A Potential Multimodal Test for Clinical Assessment of Visual Attention in Neurological Disorders. Clin EEG Neurosci 2023; 54:512-521. [PMID: 36189613 PMCID: PMC10411032 DOI: 10.1177/15500594221129962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/05/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022]
Abstract
Attention is an important aspect of human brain function and often affected in neurological disorders. Objective assessment of attention may assist in patient care, both for diagnostics and prognostication. We present a compact test using a combination of a choice reaction time task, eye-tracking and EEG for assessment of visual attention in the clinic. The system quantifies reaction time, parameters of eye movements (i.e. saccade metrics and fixations) and event related potentials (ERPs) in a single and fast (15 min) experimental design. We present pilot data from controls, patients with mild traumatic brain injury and epilepsy, to illustrate its potential use in assessing attention in neurological patients. Reaction times and eye metrics such as fixation duration, saccade duration and latency show significant differences (p < .05) between neurological patients and controls. Late ERP components (200-800 ms) can be detected in the central line channels for all subjects, but no significant group differences could be found in the peak latencies and mean amplitudes. Our system has potential to assess key features of visual attention in the clinic. Pilot data show significant differences in reaction times and eye metrics between controls and patients, illustrating its promising use for diagnostics and prognostication.
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Affiliation(s)
- Valentina Barone
- Clinical Neurophysiology (CNPH), TechMed Centre, University of Twente, Enschede, Netherlands
- Twente Medical System International B.V. (TMSi), Oldenzaal, Netherlands
| | - Johannes P. van Dijk
- Academic Center for Epileptology Kempenhaeghe, Heeze, Netherlands
- Eindhoven University of Technology, Eindhoven, Netherlands
| | | | - Michel J.A.M. van Putten
- Clinical Neurophysiology (CNPH), TechMed Centre, University of Twente, Enschede, Netherlands
- Department of Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, Netherlands
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Kim N, Jamison K, Jaywant A, Garetti J, Blunt E, RoyChoudhury A, Butler T, Dams-O'Connor K, Khedr S, Chen CC, Shetty T, Winchell R, Hill NJ, Schiff ND, Kuceyeski A, Shah SA. Comparisons of electrophysiological markers of impaired executive attention after traumatic brain injury and in healthy aging. Neuroimage 2023; 274:120126. [PMID: 37191655 PMCID: PMC10286242 DOI: 10.1016/j.neuroimage.2023.120126] [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: 01/04/2023] [Revised: 04/10/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
Executive attention impairments are a persistent and debilitating consequence of traumatic brain injury (TBI). To make headway towards treating and predicting outcomes following heterogeneous TBI, cognitive impairment specific pathophysiology first needs to be characterized. In a prospective observational study, we measured EEG during the attention network test aimed at detecting alerting, orienting, executive attention and processing speed. The sample (N = 110) of subjects aged 18-86 included those with and without traumatic brain injury: n = 27, complicated mild TBI; n = 5, moderate TBI; n = 10, severe TBI; n = 63, non-brain-injured controls. Subjects with TBI had impairments in processing speed and executive attention. Electrophysiological markers of executive attention processing in the midline frontal regions reveal that, as a group, those with TBI and elderly non-brain-injured controls have reduced responses. We also note that those with TBI and elderly controls have responses that are similar for both low and high-demand trials. In subjects with moderate-severe TBI, reductions in frontal cortical activation and performance profiles are both similar to that of controls who are ∼4 to 7 years older. Our specific observations of frontal response reductions in subjects with TBI and in older adults is consistent with the suggested role of the anterior forebrain mesocircuit as underlying cognitive impairments. Our results provide novel correlative data linking specific pathophysiological mechanisms underlying domain-specific cognitive deficits following TBI and with normal aging. Collectively, our findings provide biomarkers that may serve to track therapeutic interventions and guide development of targeted therapeutics following brain injuries.
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Affiliation(s)
- Nayoung Kim
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, United States
| | - Keith Jamison
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, United States
| | - Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, United States; Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY 10065, United States; NewYork-Presbyterian Hospital, New York, NY 10065, United States
| | - Jacob Garetti
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, United States
| | - Emily Blunt
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Arindam RoyChoudhury
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, United States
| | - Tracy Butler
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, United States
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Shahenda Khedr
- Department of Surgery, NewYork-Presbyterian Queens Hospital, Queens, NY 11355, United States
| | - Chun-Cheng Chen
- Department of Surgery, NewYork-Presbyterian Queens Hospital, Queens, NY 11355, United States; Department of Surgery, Weill Cornell Medicine, New York, NY 10065, United States
| | - Teena Shetty
- Department of Neurology, Hospital for Special Surgery, New York, NY, 10021 United States
| | - Robert Winchell
- Department of Surgery, Weill Cornell Medicine, New York, NY 10065, United States
| | - N Jeremy Hill
- National Center for Adaptive Neurotechnologies, Stratton VA Medical Center, Albany, NY 12208, United States; Electrical & Computer Engineering Department, State University of New York at Albany, NY 12226, United States
| | - Nicholas D Schiff
- Department of BMRI & Neurology, Weill Cornell Medicine, New York, NY 10065, United States
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, United States
| | - Sudhin A Shah
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, United States; Department of BMRI & Neurology, Weill Cornell Medicine, New York, NY 10065, United States.
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Jaywant A, Blunt E, Jamison K, Kim N, RoyChoudhury A, Schiff ND, Kuceyeski A, Dams-O'Connor K, Shah S. Association Between the Attention Network Test, Neuropsychological Measures, and Disability in Post-Acute Traumatic Brain Injury. Neurotrauma Rep 2023; 4:318-329. [PMID: 37771426 PMCID: PMC10523404 DOI: 10.1089/neur.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Cognitive impairment after traumatic brain injury (TBI) is persistent and disabling. Assessing cognitive function in a reliable and valid manner, using measures that are sensitive to the integrity of underlying neural substrates, is crucial in clinical research. The Attention Network Test (ANT) is one such assessment measure that has demonstrated associations with neural regions involved in attention; however, clinical utility of the ANT is limited because its relationship with neuropsychological measures of cognitive function (i.e., its construct validity) has not yet been established in TBI. We evaluated the association between the ANT and 1) a neuropsychological battery assessing executive function and memory and 2) global function assessed by the Glasgow Outcome Scale-Extended (GOSE). Forty-eight adults with complicated mild-severe TBI were evaluated ∼5 months post-injury. Using principal component analysis and multi-variate linear regression adjusted for age, gender, education, and cause of injury, we found that ANT reaction time and executive network scores predicted a principal component assessing processing speed and executive function. Conversely, the ANT did not predict a principal component assessing memory. The ANT was weakly associated with the GOSE. Among persons with TBI during the post-acute phase of recovery, the ANT has good construct validity as evidenced by its associations with neuropsychological measures of processing speed and executive function, but not memory. Given that ANT networks are known to relate to specific neuroanatomical regions, the ANT may be a useful outcome measure for evaluating novel therapeutics targeting attention and executive functions after TBI.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York, USA
- NewYork-Presbyterian Hospital, New York, New York, USA
| | - Emily Blunt
- Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Keith Jamison
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Nayoung Kim
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Arindam RoyChoudhury
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Nicholas D. Schiff
- Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
- Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
- Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
| | - Kristen Dams-O'Connor
- Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sudhin Shah
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
- Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
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Corrigan F, Wee IC, Collins-Praino LE. Chronic motor performance following different traumatic brain injury severity-A systematic review. Front Neurol 2023; 14:1180353. [PMID: 37288069 PMCID: PMC10243142 DOI: 10.3389/fneur.2023.1180353] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/05/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Traumatic brain injury (TBI) is now known to be a chronic disease, causing ongoing neurodegeneration and linked to increased risk of neurodegenerative motor diseases, such as Parkinson's disease and amyotrophic lateral sclerosis. While the presentation of motor deficits acutely following traumatic brain injury is well-documented, however, less is known about how these evolve in the long-term post-injury, or how the initial severity of injury affects these outcomes. The purpose of this review, therefore, was to examine objective assessment of chronic motor impairment across the spectrum of TBI in both preclinical and clinical models. Methods PubMed, Embase, Scopus, and PsycINFO databases were searched with a search strategy containing key search terms for TBI and motor function. Original research articles reporting chronic motor outcomes with a clearly defined TBI severity (mild, repeated mild, moderate, moderate-severe, and severe) in an adult population were included. Results A total of 97 studies met the inclusion criteria, incorporating 62 preclinical and 35 clinical studies. Motor domains examined included neuroscore, gait, fine-motor, balance, and locomotion for preclinical studies and neuroscore, fine-motor, posture, and gait for clinical studies. There was little consensus among the articles presented, with extensive differences both in assessment methodology of the tests and parameters reported. In general, an effect of severity was seen, with more severe injury leading to persistent motor deficits, although subtle fine motor deficits were also seen clinically following repeated injury. Only six clinical studies investigated motor outcomes beyond 10 years post-injury and two preclinical studies to 18-24 months post-injury, and, as such, the interaction between a previous TBI and aging on motor performance is yet to be comprehensively examined. Conclusion Further research is required to establish standardized motor assessment procedures to fully characterize chronic motor impairment across the spectrum of TBI with comprehensive outcomes and consistent protocols. Longitudinal studies investigating the same cohort over time are also a key for understanding the interaction between TBI and aging. This is particularly critical, given the risk of neurodegenerative motor disease development following TBI.
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Affiliation(s)
- Frances Corrigan
- Head Injury Lab, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
| | - Ing Chee Wee
- Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
| | - Lyndsey E. Collins-Praino
- Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
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Alnawmasi MM, Walz JA, Khuu SK. Deficits in visuospatial attentional cueing following mild traumatic brain injury. Neuropsychologia 2022; 177:108422. [PMID: 36370825 DOI: 10.1016/j.neuropsychologia.2022.108422] [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: 04/29/2022] [Revised: 08/31/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
Abstract
Visual attentional deficits are frequently reported in patients with mild traumatic brain injury (TBI). In the present study, the ability to orient visual attention (i.e., the use of endogenous and exogenous visual cues) was investigated using a modified Posner visual search task, in which the participant was required to search for a target shape (radial frequency patterns) amongst distractor shapes. Participants were required to determine whether a target radial frequency pattern was present or absent from an array of distractors. Attention to the target location was cued using central or peripheral cueing procedures to investigate endogenous or exogenous attention allocation. Predictability was not manipulated between central and peripheral cues. Search difficulty was varied by systematically changing the radial frequency difference between target and distractors (and thereby shape difference), and cues could be valid or invalid in that they correctly or incorrectly indicated the position of the target shape. Both target discriminability (i.e., identifying the presence or absence of the target) and reaction times were measured. Thirteen patients with chronic mild TBI and 21 age-, sex-, and IQ -matched healthy controls participated in the study. For control participants, both discrimination accuracy and reaction times improved with visual search efficiency, and they were sensitive to the type of cue, with performance worst for cue invalid conditions than valid conditions. However, the results for TBI patients were strikingly different; we find that discrimination accuracy slightly improved with visual search difficulty (compared to controls), but not reaction times, and TBI patients were largely insensitive to the type of visual cue, and did not show a selective deficit for central or peripheral cues, suggesting an impairment in both endogenous and exogenous visual attention. In conclusion, patients with mild TBI exhibit a poor ability to orient visual attention.
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Affiliation(s)
- Mohammed M Alnawmasi
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia; College of Applied Medical Science, Department of Optometry, Qassim University, Saudi Arabia.
| | - Jacinta A Walz
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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McCann R, Schussler E, Martinez J, Ramirez V. The Effect of Concussion History on Lower Extremity Injury Risk in College Athletes: A Systematic Review and Meta-Analysis. Int J Sports Phys Ther 2022; 17:753-765. [PMID: 35949388 PMCID: PMC9340842 DOI: 10.26603/001c.36810] [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: 10/18/2021] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Collegiate athletes who suffer a concussion may possess prolonged impairments even after clearance for return-to-participation, which may place them at an increased risk of lower extremity injury. Objective To conduct a systematic review and meta-analysis of studies examining risk of lower extremity musculoskeletal injury following a concussion in collegiate athletes. Methods A literature search was performed using the following databases: PubMed, CINAHL, SPORTDiscus. The following search terms were used to identify relevant articles, ["concussion" OR "brain injury" OR "mild traumatic brain injury" OR "mTBI"] AND ["lower extremity injury" OR "musculoskeletal injury"]. Articles were included if they were published between January 2000 and July 2021 and examined collegiate athletes' risk of sustaining a lower extremity musculoskeletal injury following a concussion. Methodological quality of included studies was performed with a modified Downs and Black Checklist. The primary outcome of interest was the risk of sustaining a lower extremity musculoskeletal injury following a concussion. A random effects meta-analysis was conducted in which a summative relative risk (RR) for sustaining a lower extremity injury in athletes with and without a history of concussion was calculated. Results Seven studies met the eligibility criteria to be included in the systematic review. There were 348 athletes in the concussion group and 482 control athletes in the included studies. Most of the studies were of good or excellent quality. Five of the seven studies were able to be included in the meta-analysis. College athletes who suffered a concussion possessed a 58% greater risk of sustaining a lower extremity musculoskeletal injury than those who did not have a history of a concussion (RR = 1.58[1.30, 1.93]). Conclusions Lower extremity injury risk is potentially increased in college athletes following a concussion compared to those without a history of a concussion. Further research is needed to investigate the mechanism behind this increased risk. Clinical assessments throughout the concussion return-to-play protocol may need to be improved in order to detect lingering impairments caused by concussions. Level of Evidence 1.
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Affiliation(s)
- Ryan McCann
- Rehabilitation Sciences, Old Dominion University
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Kang Y, Jamison K, Jaywant A, Dams-O’Connor K, Kim N, Karakatsanis NA, Butler T, Schiff ND, Kuceyeski A, Shah SA. Longitudinal alterations in gamma-aminobutyric acid (GABAA) receptor availability over ∼ 1 year following traumatic brain injury. Brain Commun 2022; 4:fcac159. [PMID: 35794871 PMCID: PMC9253887 DOI: 10.1093/braincomms/fcac159] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/24/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
Longitudinal alterations of gamma-aminobutyric acid (GABAA) receptor availability following traumatic brain injury have remained uncharacterized and may reflect changes in neuronal structure and function linked to cognitive recovery. We measured GABAA receptor availability using the tracer [11C]flumazenil in nine adults with traumatic brain injury (3–6 months after injury, subacute scan) and in 20 non-brain-injured individuals. A subset of subjects with traumatic brain injury (n = 7) were scanned at a second chronic time-point, 7–13 months after their first scan; controls (n = 9) were scanned for a second time, 5–11 months after the first scan. After accounting for atrophy in subjects with traumatic brain injury, we find broad decreases in GABAA receptor availability predominantly within the frontal lobes, striatum, and posterior-medial thalami; focal reductions were most pronounced in the right insula and anterior cingulate cortex (p < 0.05). Greater relative increase, compared to controls, in global GABAA receptor availability appeared between subacute and chronic scans. At chronic scan (>1 year post-injury), we find increased pallidal receptor availability compared to controls. Conversely, receptor availability remained depressed across the frontal cortices. Longitudinal improvement in executive attention correlated with increases in receptor availability across bilateral fronto-parietal cortical regions and the anterior-lateral aspects of the thalami. The specific observations of persistent bi-frontal lobe reductions and bilateral pallidal elevation are consistent with the anterior forebrain mesocircuit hypothesis for recovery of consciousness following a wide range of brain injuries; our results provide novel correlative data in support of specific cellular mechanisms underlying persistent cognitive deficits. Collectively, these measurements support the use of [11C]flumazenil to track recovery of large-scale network function following brain injuries and measure response to therapeutics.
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Affiliation(s)
- Y Kang
- Department of Mathematics, Howard University , Washington, DC 20059 , USA
| | - K Jamison
- Department of Radiology, Weill Cornell Medicine , 407 E. 61 St., Rm 208, New York, NY 10065 , USA
| | - A Jaywant
- Department of Rehabilitation Medicine, Weill Cornell Medicine , New York, NY 10065 , USA
- Department of Psychiatry, Weill Cornell Medicine , New York, NY 10065 , USA
| | - K Dams-O’Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai , New York, NY 10029 , USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai , New York, NY 10029 , USA
| | - N Kim
- Department of Radiology, Weill Cornell Medicine , 407 E. 61 St., Rm 208, New York, NY 10065 , USA
| | - N A Karakatsanis
- Department of Radiology, Weill Cornell Medicine , 407 E. 61 St., Rm 208, New York, NY 10065 , USA
| | - T Butler
- Department of Radiology, Weill Cornell Medicine , 407 E. 61 St., Rm 208, New York, NY 10065 , USA
| | - N D Schiff
- Department of BMRI & Neurology, Weill Cornell Medicine , New York, NY 10065 , USA
| | - A Kuceyeski
- Department of Radiology, Weill Cornell Medicine , 407 E. 61 St., Rm 208, New York, NY 10065 , USA
| | - S A Shah
- Department of Radiology, Weill Cornell Medicine , 407 E. 61 St., Rm 208, New York, NY 10065 , USA
- Department of BMRI & Neurology, Weill Cornell Medicine , New York, NY 10065 , USA
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11
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Alnawmasi MM, Mani R, Khuu SK. Changes in the components of visual attention following traumatic brain injury: A systematic review and meta-analysis. PLoS One 2022; 17:e0268951. [PMID: 35679230 PMCID: PMC9182329 DOI: 10.1371/journal.pone.0268951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/11/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose We conducted a systematic review and meta-analysis to understand the impact of traumatic brain injury (TBI) on visual attention and whether different components and processes of visual attention (such as selective, sustained, divided, and covert orientation of visual attention) are affected following brain injury. Methods A literature search between January 1980 to May 2021 was conducted using Medline, Scopus, PubMed, and Google Scholar databases was undertaken for studies that assessed visual attention using different tasks that target specific or multiple components of visual attention. Three hundred twenty-nine potentially relevant articles were identified, and 20 studies met our inclusion criteria. Results A total of 123 effect sizes (ES) were estimated from 20 studies that included 519 patients with TBI and 530 normal participants. The overall combined ES was statistically significant and large (ES = 0.92), but with high heterogeneity (Q = 614.83, p < 0.0001, I2 = 80.32%). Subgroup analysis showed that the impact of TBI severity, with the ES for moderate-severe TBI significantly higher than mild TBI (t (112) = 3.11, p = 0.002). Additionally, the component of visual attention was differentially affected by TBI (F (2, 120) = 10.25, p<0.0001); the ES for selective attention (ES = 1.13) and covert orientation of visual attention (ES = 1.14) were large, whilst for sustained attention, the ES was medium at 0.43. A subgroup analysis comparing outcome measures showed that reaction time (ES = 1.12) was significantly more affected compared to performance accuracy (ES = 0.43), F (1, 96) = 25.98, p<0.0001). Conclusion Large and significant deficits in visual attention was found following TBI which can last for years after the initial injury. However, different components of visual attention were not affected to the same extent, with selective visual attention and orientation of visual attention most affected following TBI.
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Affiliation(s)
- Mohammed M. Alnawmasi
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
- Department of Optometry, College of Applied Medical Science, Qassim University, Buraydah, Saudi Arabia
- * E-mail:
| | - Revathy Mani
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Sieu K. Khuu
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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12
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Ratiu I, Fissel-Brannick S, Whiting M, Murnion L, Azuma T. The impact of mild traumatic brain injury on reading comprehension and eye movements: preliminary results. JOURNAL OF COMMUNICATION DISORDERS 2022; 96:106197. [PMID: 35151226 DOI: 10.1016/j.jcomdis.2022.106197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 12/21/2021] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Individuals who sustain a mild traumatic brain injury (mTBI) can suffer from executive function, working memory, and attention deficits, which can impact functional task performance, including reading comprehension. Individuals with mTBI commonly report reading difficulties, but such difficulties have been historically difficult to capture using behavioral measures. The current study examined reading performance in those with and without mTBI using eye-tracking measures, which may be more sensitive to reading impairment in mTBI. METHOD/RESULTS In Experiment 1, 26 participants with a history of mTBI and 26 healthy control participants completed working memory (WM) and reading comprehension tasks. We found no differences in behavioral measures but found that spontaneous eye-blinking frequency was lower during the reading task in the mTBI group. In Experiment 2, we explored the impact of auditory distraction (e.g., multi-talker babble) on reading and memory performance. Twenty-three new participants with a history of mTBI and 26 healthy control participants completed a short-term memory (STM) task, a WM task, and a reading comprehension task under two distraction conditions. As in Experiment 1, we found no differences on behavioral measures, but observed significant differences on spontaneous eye-blinking frequency between those with and without mTBI. Group differences in distraction effects were also observed and performance on the WM task predicted reading comprehension performance. CONCLUSIONS The lack of differences on behavioral measures between groups, but lower frequencies of spontaneous eye blinking in the mTBI group suggests that while these individuals successfully completed the reading comprehension task, they may require more cognitive resources to do so.
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Affiliation(s)
- Ileana Ratiu
- Midwestern University, USA; Arizona State University, USA.
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13
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Cao M, Luo Y, Wu Z, Wu K, Li X. Abnormal neurite density and orientation dispersion in frontal lobe link to elevated hyperactive/impulsive behaviors in young adults with traumatic brain injury. Brain Commun 2022; 4:fcac011. [PMID: 35187485 PMCID: PMC8853727 DOI: 10.1093/braincomms/fcac011] [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] [Received: 08/19/2021] [Revised: 12/02/2021] [Accepted: 01/27/2022] [Indexed: 11/15/2022] Open
Abstract
Traumatic brain injury is a major public health concern. A significant proportion of individuals experience post-traumatic brain injury behavioural impairments, especially in attention and inhibitory control domains. Traditional diffusion-weighted MRI techniques, such as diffusion tensor imaging, have provided tools to assess white matter structural disruptions reflecting the long-term brain tissue alterations associated with traumatic brain injury. The recently developed neurite orientation dispersion and density imaging is a more advanced diffusion MRI modality, which provides more refined characterization of brain tissue microstructures by assessing the neurite orientation dispersion and neurite density properties. In this study, neurite orientation dispersion and density imaging data from 44 young adults with chronic traumatic brain injury (who had no prior-injury diagnoses of any sub-presentation of attention deficits/hyperactivity disorder or experience of severe inattentive and/or hyperactive behaviours) and 45 group-matched normal controls were investigated, to assess the post-injury morphometrical and microstructural brain alterations and their relationships with the behavioural outcomes. Maps of fractional anisotropy, neurite orientation dispersion index and neurite density index were calculated. Vertex-wise and voxel-wise analyses were conducted for grey matter and white matter, respectively. Post hoc region-of-interest-based analyses were also performed. Compared to the controls, the group of traumatic brain injury showed significantly increased orientation dispersion index and significantly decreased neurite density index in various grey matter regions, as well as significantly decreased orientation dispersion index in several white matter regions. Brain–behavioural association analyses indicated that the reduced neurite density index of the left precentral gyrus and the reduced orientation dispersion index of the left superior longitudinal fasciculus were significantly associated with elevated hyperactive/impulsive symptoms in the patients with traumatic brain injury. These findings suggest that post-injury chronical neurite intracellular volume and angular distribution anomalies in the frontal lobe, practically the precentral area, can significantly contribute to the onset of hyperactive/impulsive behaviours in young adults with traumatic brain injury.
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Affiliation(s)
- Meng Cao
- Department of Biomedical Engineering, New Jersey Institute of Technology, NJ, USA
| | - Yuyang Luo
- Department of Biomedical Engineering, New Jersey Institute of Technology, NJ, USA
| | - Ziyan Wu
- Department of Electrical and Computer Engineering, New Jersey Institute of Technology, NJ, USA
| | - Kai Wu
- Department of Electrical and Computer Engineering, School of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Xiaobo Li
- Department of Biomedical Engineering, New Jersey Institute of Technology, NJ, USA
- Department of Electrical and Computer Engineering, New Jersey Institute of Technology, NJ, USA
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14
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Chen A, Zhang Z, Cao C, Lu J, Wu S, Ma S, Feng Y, Wang S, Xu G, Song J. Altered Attention Network in Paratroopers Exposed to Repetitive Subconcussion: Evidence Based on Behavioral and Event-Related Potential Results. J Neurotrauma 2021; 38:3306-3314. [PMID: 34549595 DOI: 10.1089/neu.2021.0253] [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: 10/20/2022] Open
Abstract
Cognitive impairment caused by repetitive subconcussion has received increasing attention in recent years. Although the dysfunction of attention has been confirmed by neuropsychological research using scales, there is no event-related potentials (ERPs) research. The Attention Network Test (ANT) has been widely used to evaluate the three separate components of attention processing (alerting, orienting, and executive control). Twenty-seven paratroopers exposed to repetitive subconcussion (subconcussion group) and 25 matched healthy control participants (HCs group) were enrolled, and all of them performed the ANT test while continuous scalp electroencephalography data were recorded. On the behavioral performance level, the subconcussion group showed a slower task response, with an especially significant slower reaction time in alerting. Concerning ERP results, reduction amplitudes of cue-N1 in the alerting network were observed, indicating that this group was less able to make efficient use of cues and maintain an alerting state for incoming information. For the orienting network, no difference in N1 amplitude was observed between the two groups. Moreover, there was a reduced P3 amplitude in the executive control network in the subconcussion group compared with the HCs group, suggesting a dysfunction of attentional resource allocation and inhibition control in the former group. This study is, to our knowledge, the first analysis of the altered attention network caused by repetitive subconcussion from the perspectives of behavioral and neuropsychology levels. These preliminary results revealed the possible damage of the alerting and executive control networks and provided a reference for further research on subconcussion cognitive impairment.
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Affiliation(s)
- Aobo Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China
| | - Zhihao Zhang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China
| | - Chenglong Cao
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China.,Department of Cognitive Neuroscience, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jinjiang Lu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China
| | - Shukai Wu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China
| | - Shenghui Ma
- Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China.,Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Yu Feng
- Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China.,Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Shuochen Wang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China
| | - Guozheng Xu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China
| | - Jian Song
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China
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15
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Walz JA, Mani R, Alnawmasi MM, Khuu SK. Visuospatial Attention Allocation as an Indicator of Cognitive Deficit in Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Front Hum Neurosci 2021; 15:675376. [PMID: 34354575 PMCID: PMC8329082 DOI: 10.3389/fnhum.2021.675376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/23/2021] [Indexed: 01/02/2023] Open
Abstract
Traumatic Brain Injury (TBI) is defined by changes in brain function resulting from external forces acting on the brain and is typically characterized by a host of physiological and functional changes such as cognitive deficits including attention problems. In the present study, we focused on the effect of TBI on the ability to allocate attention in vision (i.e., the use of endogenous and exogenous visual cues) by systematically reviewing previous literature on the topic. We conducted quantitative synthesis of 16 selected studies of visual attention following TBI, calculating 80 effect size estimates. The combined effect size was large (g = 0.79, p < 0.0001) with medium heterogeneity (I2 = 68.39%). Subgroup analyses revealed an increase in deficit with moderate-to-severe and severe TBI as compared to mild TBI [F(2, 76) = 24.14, p < 0.0001]. Task type was another key source of variability and subgroup analyses indicated that higher order attention processes were severely affected by TBI [F(2, 77) = 5.66, p = 0.0051). Meta-regression analyses revealed significant improvement in visual attention deficit with time [p(mild) = 0.031, p(moderate-to-severe) = 0.002, p(severe) < 0.0001]. Taken together, these results demonstrate that visual attention is affected by TBI and that regular assessment of visual attention, using a systematic attention allocation task, may provide a useful clinical measure of cognitive impairment and change after TBI.
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Affiliation(s)
- Jacinta A Walz
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
| | - Revathy Mani
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
| | - Mohammed M Alnawmasi
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
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16
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McGowan AL, Bretzin AC, Anderson M, Pontifex MB, Covassin T. Paired cognitive flexibility task with symptom factors improves detection of sports-related concussion in high school and collegiate athletes. J Neurol Sci 2021; 428:117575. [PMID: 34304023 DOI: 10.1016/j.jns.2021.117575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/24/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022]
Abstract
Determining the sensitivity and specificity of short neurocognitive assessments to objectively detect concussion will help clinicians more confidently integrate such tools in clinical management decisions. This study quantified the sensitivity and specificity of a computerized cognitive flexibility task isolating shifts of visuospatial attention in combination with clinical symptoms acutely (< 72 h) following concussion. A total of 100 athletes (53 concussed; 47 non-injured control; 42% female) completed computerized neurocognitive testing and clinical symptom reports (Sport Concussion Assessment Tool 3rd edition: SCAT3). Separate discriminant function analyses were performed for individual, combination, and stepwise inclusion of neurocognitive and clinical symptomology assessments. Findings revealed the combination of neurocognitive outcomes (i.e., mean reaction time, response accuracy, and response accuracy cost) with clinical symptom factor scores exhibited the greatest sensitivity (95.7%) and specificity (88.7%) as well as the highest positive predictive value (95.9%) and negative predictive value (88%) relative to other approaches. Further, a stepwise approach predicting concussion status using the discriminant functions improved detection of concussion (98.2% sensitivity, 95.7% specificity, 96.4% positive predictive value, and 97.8% negative predictive value) when clinical symptom factors failed to indicate the presence of a concussion. Incorporating a cognitive flexibility task involving shifts of visuospatial attention combined with clinical symptom factor scores may improve clinical decision-making as this approach exceeds the sensitivity and specificity of widely popular neurocognitive test batteries and takes less than 10 min to administer.
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Affiliation(s)
- Amanda L McGowan
- Addiction, Health, and Adolescence Lab, Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Abigail C Bretzin
- Penn Injury Science Center, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Morgan Anderson
- Department of Kinesiology, Michigan State University, East Lansing, MI, United States of America
| | - Matthew B Pontifex
- Department of Kinesiology, Michigan State University, East Lansing, MI, United States of America
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, MI, United States of America
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17
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Psycho-affective health, cognition, and neurophysiological functioning following sports-related concussion in symptomatic and asymptomatic athletes, and control athletes. Sci Rep 2021; 11:13838. [PMID: 34226626 PMCID: PMC8257649 DOI: 10.1038/s41598-021-93218-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/31/2021] [Indexed: 11/08/2022] Open
Abstract
Little is known about the neuropsychiatric and neurophysiological differences that characterize abnormal recovery following a concussion. The present study aimed to investigate the psycho-affective, cognitive, and neurophysiological profiles of symptomatic, slow-to-recover, concussed athletes, asymptomatic concussed athletes, and control athletes. Seventy-eight athletes (26 symptomatic, 26 asymptomatic, 26 control) completed the Beck Depression Inventory-II, Profile of Mood States, and 2-Back task. Additionally, event-related brain potentials were recorded during an experimental three-stimulus visual Oddball paradigm. Compared to asymptomatic and control groups, the symptomatic group reported greater depression symptoms and negatively altered mood states. Symptomatic athletes also exhibited poorer cognitive performance on the 2-Back task, indicated by more errors and slower reaction time. ERP analyses indicated prolonged P3b latency for both symptomatic and asymptomatic groups, but symptomatic athletes also exhibited reduced P3b amplitude compared to both asymptomatic and control groups. For the asymptomatic group, correlations were observed between time since last concussion and functioning, but no relations were observed within the symptomatic group for any measure. The current findings provide valuable information regarding the psycho-affective, cognitive, and neurophysiological profiles of athletes with and without persistent symptoms following a concussion and highlight the need to assess and treat symptomatic, slow-to-recover athletes from a multidimensional and integrative perspective.
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18
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Validating a Short Conners CPT 3 as a Screener: Predicting Self-reported CDC Concussion Symptoms in Children, Adolescents, and Adults. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2021. [DOI: 10.1007/s40817-021-00107-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Lin X, Zhang X, Liu Q, Zhao P, Zhang H, Wang H, Yi Z. Theory of mind in adults with traumatic brain injury: A meta-analysis. Neurosci Biobehav Rev 2020; 121:106-118. [PMID: 33359093 DOI: 10.1016/j.neubiorev.2020.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/27/2020] [Accepted: 12/08/2020] [Indexed: 01/11/2023]
Abstract
Studies of abnormal theory of mind (ToM) performance in adult patients with traumatic brain injury (TBI) have reported inconsistent results. Therefore, we conducted a meta-analysis to characterize ToM performance in adult patients with TBI. Random-effects models were employed to estimate the overall effect size and the differential effect sizes across different ToM aspects. Based on a sample of 28 studies (1031 patients and 865 healthy controls), the meta-analytic findings revealed that ToM was significantly impaired in adult patients with TBI compared to healthy controls (g = -1.13). Besides, patients with TBI showed significant impairments in individual ToM tasks, as well as for different stimulus modes and contents involved in these ToM tasks. A meta-regression indicated a positive association between ToM performance and Glasgow Coma Scale score. The results of the current meta-analysis suggest that the performance in ToM tasks may be a good predictor of functional outcomes in adults with TBI, which is important for the identification of targets for cognitive interventions and the development of useful training intervention programs.
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Affiliation(s)
- XiaoGuang Lin
- Department of Neurology, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, PR China
| | - XueLing Zhang
- Department of Neurology, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, PR China
| | - QinQin Liu
- Department of Neurology, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, PR China
| | - PanWen Zhao
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - Hui Zhang
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - HongSheng Wang
- Department of Neurosurgery, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China.
| | - ZhongQuan Yi
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China.
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20
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Hershaw J, Hill-Pearson CA, Arango JI, Souvignier AR, Pazdan RM. Changes in attentional processing following neurofeedback in patients with persistent post-concussive symptoms: a pilot study. Brain Inj 2020; 34:1723-1731. [PMID: 33196305 DOI: 10.1080/02699052.2020.1812720] [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: 10/23/2022]
Abstract
OBJECTIVE Persistent post-concussive symptoms (PPCS) often include attention deficits, particularly orienting and executive attention. Research in other clinical populations has demonstrated that neurofeedback therapy (NFT) is effective at improving orienting and executive attention, although its effects on attentional networks in patients with PPCS are unknown. METHOD In this single-group pilot study, we examined attention-related event-related potentials (ERPs) - N1 and P3 - and cognitive outcomes following Live Z-score training (LZT), a variant of NFT. RESULTS No changes in early selective attention, as indexed by N1 amplitude, were observed; however, P3 amplitude, which indexes neural resource allocation, increased following LZT and returned to baseline by 3 months. Cognitive performance improved following treatment, which was sustained at 3 months. The magnitude of change in P3 and ANT performance did not differ between orienting or executive attention, suggesting LZT improved general attentional processing efficiency. CONCLUSION Our results suggest that LZT may positively affect attention globally, but does not target specific attention networks. These pilot data warrant the initiation of a clinical trial evaluating the effectiveness of LZT for treating attention deficits in patients with PPCS.
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Affiliation(s)
- Jamie Hershaw
- Defense and Veterans Brain Injury Center , Fort Carson, CO, USA.,General Dynamics Information Technology , Falls Church, VA, USA
| | - Candace A Hill-Pearson
- Defense and Veterans Brain Injury Center , Fort Carson, CO, USA.,General Dynamics Information Technology , Falls Church, VA, USA
| | - Jorge I Arango
- Defense and Veterans Brain Injury Center , Fort Carson, CO, USA.,General Dynamics Information Technology , Falls Church, VA, USA
| | - Alicia R Souvignier
- Defense and Veterans Brain Injury Center , Fort Carson, CO, USA.,Warrior Recovery Center, Evans Army Community Hospital , Fort Carson, CO, USA
| | - Renee M Pazdan
- Defense and Veterans Brain Injury Center , Fort Carson, CO, USA.,Warrior Recovery Center, Evans Army Community Hospital , Fort Carson, CO, USA
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21
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Yamakawa G, Brady R, Sun M, McDonald S, Shultz S, Mychasiuk R. The interaction of the circadian and immune system: Desynchrony as a pathological outcome to traumatic brain injury. Neurobiol Sleep Circadian Rhythms 2020; 9:100058. [PMID: 33364525 PMCID: PMC7752723 DOI: 10.1016/j.nbscr.2020.100058] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 12/16/2022] Open
Abstract
Traumatic brain injury (TBI) is a complex and costly worldwide phenomenon that can lead to many negative health outcomes including disrupted circadian function. There is a bidirectional relationship between the immune system and the circadian system, with mammalian coordination of physiological activities being controlled by the primary circadian pacemaker in the suprachiasmatic nucleus (SCN) of the hypothalamus. The SCN receives light information from the external environment and in turn synchronizes rhythms throughout the brain and body. The SCN is capable of endogenous self-sustained oscillatory activity through an intricate clock gene negative feedback loop. Following TBI, the response of the immune system can become prolonged and pathophysiological. This detrimental response not only occurs in the brain, but also within the periphery, where a leaky blood brain barrier can permit further infiltration of immune and inflammatory factors. The prolonged and pathological immune response that follows TBI can have deleterious effects on clock gene cycling and circadian function not only in the SCN, but also in other rhythmic areas throughout the body. This could bring about a state of circadian desynchrony where different rhythmic structures are no longer working together to promote optimal physiological function. There are many parallels between the negative symptomology associated with circadian desynchrony and TBI. This review discusses the significant contributions of an immune-disrupted circadian system on the negative symptomology following TBI. The implications of TBI symptomology as a disorder of circadian desynchrony are discussed.
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Affiliation(s)
- G.R. Yamakawa
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - R.D. Brady
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - M. Sun
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - S.J. McDonald
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Melbourne, Australia
| | - S.R. Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - R. Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
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22
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Sicard V, Simard A, Moore RD, Ellemberg D. Practice effect associated with the serial administration of the switch task and its implications in the assessment of sports-related concussion. J Clin Exp Neuropsychol 2020; 42:965-973. [DOI: 10.1080/13803395.2020.1828836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Veronik Sicard
- School of Kinesiology and Exercise Science, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche en neuropsychologie et cognition, Université de Montréal, Montreal, Quebec, Canada
| | - Alexe Simard
- School of Kinesiology and Exercise Science, Université de Montréal, Montreal, Quebec, Canada
| | - Robert Davis Moore
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Dave Ellemberg
- School of Kinesiology and Exercise Science, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche en neuropsychologie et cognition, Université de Montréal, Montreal, Quebec, Canada
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23
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Robinson-Freeman KE, Collins KL, Garber B, Terblanche R, Risling M, Vermetten E, Besemann M, Mistlin A, Tsao JW. A Decade of mTBI Experience: What Have We Learned? A Summary of Proceedings From a NATO Lecture Series on Military mTBI. Front Neurol 2020; 11:836. [PMID: 32982907 PMCID: PMC7477387 DOI: 10.3389/fneur.2020.00836] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 07/06/2020] [Indexed: 12/20/2022] Open
Abstract
Mild traumatic brain injury (mTBI, also known as a concussion) as a consequence of battlefield blast exposure or blunt force trauma has been of increasing concern to militaries during recent conflicts. This concern is due to the frequency of exposure to improvised explosive devices for forces engaged in operations both in Iraq and Afghanistan coupled with the recognition that mTBI may go unreported or undetected. Blasts can lead to mTBI through a variety of mechanisms. Debate continues as to whether exposure to a primary blast wave alone is sufficient to create brain injury in humans, and if so, exactly how this occurs with an intact skull. Resources dedicated to research in this area have also varied substantially among contributing NATO countries. Most of the research has been conducted in the US, focused on addressing uncertainties in management practices. Development of objective diagnostic tests should be a top priority to facilitate both diagnosis and prognosis, thereby improving management. It is expected that blast exposure and blunt force trauma to the head will continue to be a potential source of injury during future conflicts. An improved understanding of the effects of blast exposure will better enable military medical providers to manage mTBI cases and develop optimal protective measures. Without the immediate pressures that come with a high operational tempo, the time is right to look back at lessons learned, make full use of available data, and modify mitigation strategies with both available evidence and new evidence as it comes to light. Toward that end, leveraging our cooperation with the civilian medical community is critical because the military experience over the past 10 years has led to a renewed interest in many similar issues pertaining to mTBI in the civilian world. Such cross-fertilization of knowledge will undoubtedly benefit all. This paper highlights similarities and differences in approach to mTBI patient care in NATO and partner countries and provides a summary of and lessons learned from a NATO lecture series on the topic of mTBI, demonstrating utility of having patients present their experiences to a medical audience, linking practical clinical care to policy approaches.
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Affiliation(s)
| | - Kassondra L Collins
- Department of Physical Therapy, University of Saskatchewan, Saskatoon, SK, Canada
| | - Bryan Garber
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, ON, Canada
| | - Ronel Terblanche
- Centre for Mental and Cognitive Health, DMRC Headey Court, Epsom, United Kingdom
| | - Marten Risling
- Department of Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Eric Vermetten
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Markus Besemann
- Physical Medicine and Rehabilitation, Canadian Forces Health Services Group, Ottawa, ON, Canada
| | - Alan Mistlin
- Centre for Mental and Cognitive Health, DMRC Headey Court, Epsom, United Kingdom
| | - Jack W Tsao
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States.,Le Bonheur Children's Hospital, Children's Foundation Research Institute, Memphis, TN, United States
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24
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Oculomotor, Vestibular, and Reaction Time Effects of Sports-Related Concussion: Video-Oculography in Assessing Sports-Related Concussion. J Head Trauma Rehabil 2020; 34:176-188. [PMID: 30234848 PMCID: PMC6553977 DOI: 10.1097/htr.0000000000000437] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective: The purpose of the study was to test the ability of oculomotor, vestibular, and reaction time (OVRT) metrics to serve as a concussion assessment or diagnostic tool for general clinical use. Setting and Participants: Patients with concussion were high school-aged athletes clinically diagnosed in a hospital setting with a sports-related concussion (n = 50). Control subjects were previously recruited male and female high school student athletes from 3 local high schools (n = 170). Design: Video-oculography was used to acquire eye movement metrics during OVRT tasks, combined with other measures. Measures were compared between groups, and a subset was incorporated into linear regression models that could serve as indicators of concussion. Measures: The OVRT test battery included multiple metrics of saccades, smooth pursuit tracking, nystagmoid movements, vestibular function, and reaction time latencies. Results: Some OVRT metrics were significantly different between groups. Linear regression models distinguished control subjects from concussion subjects with high accuracy. Metrics included changes in smooth pursuit tracking, increased reaction time and reduced saccade velocity in a complex motor task, and decreased optokinetic nystagmus (OKN) gain. In addition, optokinetic gain was reduced and more variable in subjects assessed 22 or more days after injury. Conclusion: These results indicate that OVRT tests can be used as a reliable adjunctive tool in the assessment of concussion and that OKN results appear to be associated with a prolonged expression of concussion symptoms.
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Adams MS, Niechwiej-Szwedo E, McIlroy WE, Staines WR. A History of Concussion Affects Relevancy-Based Modulation of Cortical Responses to Tactile Stimuli. Front Integr Neurosci 2020; 14:33. [PMID: 32719591 PMCID: PMC7350857 DOI: 10.3389/fnint.2020.00033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/28/2020] [Indexed: 11/13/2022] Open
Abstract
Modulating cortical excitability based on a stimulus’ relevance to the task at hand is a component of sensory gating, and serves to protect higher cortical centers from being overwhelmed with irrelevant information (McIlroy et al., 2003; Kumar et al., 2005; Wasaka et al., 2005). This study examined relevancy-based modulation of cortical excitability, and corresponding behavioral responses, in the face of distracting stimuli in participants with and without a history of concussion (mean age 22 ± 3 SD years; most recent concussion 39.1 ± 30 SD months). Participants were required to make a scaled motor response to the amplitudes of visual and tactile stimuli presented individually or concurrently. Task relevance was manipulated, and stimuli were occasionally presented with irrelevant distractors. Electroencephalography (EEG) and task accuracy data were collected from participants with and without a history of concussion. The somatosensory-evoked N70 event-related potential (ERP) was significantly modulated by task relevance in the control group but not in those with a history of concussion, and there was a significantly greater cost to task accuracy in the concussion history group when relevant stimuli were presented with an irrelevant distractor. This study demonstrated that relevancy-based modulation of electrophysiological responses and behavioral correlates of sensory gating differ in people with and without a history of concussion, even after patients were symptom-free and considered recovered from their injuries.
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Affiliation(s)
- Meaghan S Adams
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | | | - William E McIlroy
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - William R Staines
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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26
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Aminihajibashi S, Hagen T, Laeng B, Espeseth T. Pupillary and behavioral markers of alerting and orienting: An individual difference approach. Brain Cogn 2020; 143:105597. [PMID: 32673900 DOI: 10.1016/j.bandc.2020.105597] [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: 10/31/2019] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 02/07/2023]
Abstract
Measuring task-evoked pupillary (TEP) responses as an index of phasic activity in the locus coeruleus (LC), we examined two competing hypotheses regarding the alerting and orienting mechanisms of attention. According to a dual mechanism account (Fernandez-Duque & Posner, 1997), two separate noradrenergic and cholinergic mechanisms modulate, respectively, the alerting and orienting effects. However, Corbetta and colleagues (2008) proposed that LC phasic activity may also be involved in orienting effect through its functional relationship with the ventral attentional network. We recruited seventy-five healthy Norwegian participants to perform a Posner cueing task. Both behavioral and pupillary responses revealed the alerting effect. Also, both behavioral and pupillary responses indicated that cued attention is affected by age. Behavioral responses also revealed orienting effect However, we found no TEP differences between valid, invalid, and neutral conditions, suggesting that TEP effects were driven by the alerting effect of cue presentation. Moreover, both behavioral and pupillary estimates of alertness and orienting were uncorrelated. Finally, individual differences in general cognitive abilities did not appear to affect the orienting and alerting mechanisms. This pattern of results is consistent with the dual mechanism account of attention. However, the LC involvement in the (re)orienting attention may be driven by state-specific factors.
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Affiliation(s)
| | - Thomas Hagen
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Bruno Laeng
- Department of Psychology, University of Oslo, Oslo, Norway; RITMO Centre for Interdisciplinary Studies in Rhythm, Time and Motion, University of Oslo, Oslo, Norway
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27
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Electrophysiological Markers of Visuospatial Attention Recovery after Mild Traumatic Brain Injury. Brain Sci 2019; 9:brainsci9120343. [PMID: 31783501 PMCID: PMC6956036 DOI: 10.3390/brainsci9120343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 11/17/2022] Open
Abstract
Objective: Attentional problems are amongst the most commonly reported complaints following mild traumatic brain injury (mTBI), including difficulties orienting and disengaging attention, sustaining it over time, and dividing attentional resources across multiple simultaneous demands. The objective of this study was to track, using a single novel electrophysiological task, various components associated with the deployment of visuospatial selective attention. Methods: A paradigm was designed to evoke earlier visual evoked potentials (VEPs), as well as attention-related and visuocognitive ERPs. Data from 36 individuals with mTBI (19 subacute, 17 chronic) and 22 uninjured controls are presented. Postconcussion symptoms (PCS), anxiety (BAI), depression (BDI-II) and visual attention (TEA Map Search, DKEFS Trail Making Test) were also assessed. Results: Earlier VEPs (P1, N1), as well as processes related to visuospatial orientation (N2pc) and encoding in visual short-term memory (SPCN), appear comparable in mTBI and control participants. However, there appears to be a disruption in the spatiotemporal dynamics of attention (N2pc-Ptc, P2) in subacute mTBI, which recovers within six months. This is also reflected in altered neuropsychological performance (information processing speed, attentional shifting). Furthermore, orientation of attention (P3a) and working memory processes (P3b) are also affected and remain as such in the chronic post-mTBI period, in co-occurrence with persisting postconcussion symptomatology. Conclusions: This study adds original findings indicating that such a sensitive and rigorous ERP task implemented at diagnostic and follow-up levels could allow for the identification of subtle but complex brain activation and connectivity deficits that can occur following mTBI.
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Lucente G, Valls-Sole J, Murillo N, Rothwell J, Coll J, Davalos A, Kumru H. Noninvasive Brain Stimulation and Noninvasive Peripheral Stimulation for Neglect Syndrome Following Acquired Brain Injury. Neuromodulation 2019; 23:312-323. [PMID: 31725939 DOI: 10.1111/ner.13062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/10/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Hemispatial neglect is a frequent condition usually following nondominant hemispheric brain injury. It strongly affects rehabilitation strategies and everyday life activities. It is associated with behavioral and cognitive disability with a strong impact on patient's life. METHODS We reviewed the published literature on the use of noninvasive brain stimulation, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), and of noninvasive peripheral muscle stimulation, as therapeutic strategies for rehabilitation of neglect after acquired brain injury, such as in stroke or in traumatic injuries. The studies were grouped as controlled or uncontrolled studies in each stimulation techniques. RESULTS Thirty-four studies were identified and 16 on rTMS, 10 on tDCS, and 8 on vibration. All studies were conducted in adult patients who suffered a stroke, except for one that was conducted in a patient suffering traumatic acquired brain injury and another that was conducted in a patient with brain tumor. In spite of significant variability in treatment protocols, patients' features and assessment of neglect, improvement was reported in almost all studies with no side-effects. CONCLUSIONS Noninvasive brain stimulation and neuromuscular vibration are promising therapeutic neuromodulatory approaches for neglect. Further randomized-controlled studies are needed to corroborate their effectiveness as separate and combined techniques.
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Affiliation(s)
- Giuseppe Lucente
- Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain.,Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Department of Neurosciences, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.,Medicine Department, Universitat Autonoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Josep Valls-Sole
- EMG Department, Hospital Clinic, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Narda Murillo
- Medicine Department, Universitat Autonoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.,Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, 08916, Badalona, Spain
| | - John Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, University College London, London, UK
| | - Jaume Coll
- Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain.,Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Department of Neurosciences, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.,Medicine Department, Universitat Autonoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Antoni Davalos
- Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain.,Medicine Department, Universitat Autonoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Hatice Kumru
- Medicine Department, Universitat Autonoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Spain.,Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, 08916, Badalona, Spain
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29
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McGowan AL, Bretzin AC, Savage JL, Petit KM, Covassin T, Pontifex MB. Acute and protracted disruptions to inhibitory control following sports-related concussion. Neuropsychologia 2019; 131:223-232. [DOI: 10.1016/j.neuropsychologia.2019.05.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 05/13/2019] [Accepted: 05/27/2019] [Indexed: 11/26/2022]
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Green SL, Keightley ML, Lobaugh NJ, Dawson DR, Mihailidis A. Exploring changes in processing speed and intraindividual variability in youth following sports-related concussion. JOURNAL OF CONCUSSION 2019. [DOI: 10.1177/2059700219839588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Concussion represents a growing concern in sports participation for adults and youth alike. Studies exploring the neurocognitive sequelae of concussion, such as speed of processing typically compare mean reaction time scores to a control group. Intraindividual variability measures the consistency of reaction times between trials and has been previously explored in adults post-concussion. Some adult studies show increased variability following injury. Developmentally youth show higher intraindividual variability than adults, which may put them at higher risk of increased intraindividual variability change post-concussion. Exploring intraindividual variability may provide additional insight into fluctuating performance reported following injury. Despite preliminary findings of slowed reaction time in youth, a pre-/post-concussion comparison of intraindividual variability of reaction time has not been explored. Objective To describe and compare pre- and post-concussion measures of processing speed and intraindividual variability in youth. Methods A pre-/post-concussion design was used to compare mean reaction time and the coefficient of variation before and after sports-related concussion in 18 youth athletes aged 10–14 years using verbal and nonverbal working memory tasks. Pre-/post-concussion reaction time and coefficient of variation were compared using t-tests. Results The coefficient of variation for nonverbal working memory was significantly higher following concussion, but no changes in average reaction time were found. Conclusions Preliminary findings suggest that average response times are unchanged following concussion, but the fluctuation across response times is more variable during a nonverbal working memory task in youth. Increased variability in speed of reaction times could have implications for safe return to sports and reduced academic performance.
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Affiliation(s)
- Stephanie L Green
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Michelle L Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehab and Rehabilitation Sciences Institute and Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Nancy J Lobaugh
- Research Imaging Centre, Centre for Addiction and Mental Health and Division of Neurology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Deirdre R Dawson
- Rotman Research Institute, Baycrest and Rehabilitation Sciences Institute and Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Alex Mihailidis
- Toronto Rehab Institute, University Health Network and Occupational Science and Occupational Therapy and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
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31
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Chow BH, Stevenson AM, Burke JF, Adelman EE. The effect of concussion on batting performance of major league baseball players. Open Access J Sports Med 2019; 10:41-48. [PMID: 30881155 PMCID: PMC6419592 DOI: 10.2147/oajsm.s192338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Previous investigations into concussions' effects on Major League Baseball (MLB) players suggested that concussion negatively impacts traditional measures of batting performance. This study examined whether post-concussion batting performance, as measured by traditional, plate discipline, and batted ball statistics, in MLB players was worse than other post-injury performance. Subjects and methods MLB players with concussion from 2008 to 2014 were identified. Concussion was defined by placement on the disabled list or missing games due to concussion, post-concussive syndrome, or head trauma. Injuries causing players to be put on the disabled list were matched by age, position, and injury duration to serve as controls. Mixed effects models were used to estimate concussion's influence after adjusting for potential confounders. The primary study outcome measurements were: traditional (eg, average), plate discipline (eg, swing-at-strike rate), and batted ball (eg, ground ball percentage) statistics. Results There were 85 concussed players and 212 controls included in the analyses. There was no significant difference in performance between concussed players and controls. However, concussed players started at a lower level of performance pre-event than the controls, striking out a 9.2% rate vs 8.2% (P=0.042) with an isolated power of 0.075 vs 0.082 (P=0.035). For concussed players, traditional batting statistics decreased before plate discipline metrics. Conclusion MLB players' performance was lower after return from concussion, but no more than after return from other injuries. The decreased performance prior to concussion suggests that concussion-related performance declines may not be due exclusively to concussion and perhaps point to risk factors predisposing to concussion.
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Affiliation(s)
- Bryan H Chow
- Department of Anesthesiology, Duke University, Durham, NC, USA
| | | | - James F Burke
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Department of Veterans Affairs, Ann Arbor VA Healthcare System, Ann Arbor, MI, USA
| | - Eric E Adelman
- Department of Neurology, University of Wisconsin, Madison, WI, USA,
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Niu X, Bai L, Sun Y, Wang S, Cao J, Sun C, Wang Z, Xu H, Gan S, Fan G, Huang W, Gu C, Yin B, Bai G, Xu X, Zhang M. Disruption of periaqueductal grey-default mode network functional connectivity predicts persistent post-traumatic headache in mild traumatic brain injury. J Neurol Neurosurg Psychiatry 2019; 90:326-332. [PMID: 30554137 DOI: 10.1136/jnnp-2018-318886] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/01/2018] [Accepted: 11/13/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Post-traumatic headache (PTH) is one of the most frequent and persistent physical symptoms following mild traumatic brain injury (mTBI) and develop in more than 50% of this population. This study aimed to investigate the periaqueductal grey (PAG)-seeded functional connectivity (FC) in patients with mTBI with acute post-traumatic headache (APTH) and further examine whether the FC can be used as a neural biomarker to identify patients developing chronic pain 3 months postinjury. METHODS 70 patients with mTBI underwent neuropsychological measurements and MRI scans within 7 days postinjury and 56 (80%) of patients were followed up at 3 months. 46 healthy controls completed the same protocol on recruitment to the study. PAG-seeded resting-state FC analysis was measured in 54 patients with mTBI with APTH, in comparison with 46 healthy volunteers. RESULTS The mTBI+APTH group presented significantly reduced PAG-seeded FC within the default mode network (DMN), compared with healthy volunteers group. The connectivity strength can also predict patients' complaints on the impact of headache on their lives. Crucially, the initial FC strength between the PAG-right precuneus as well as the PAG-right inferior parietal lobule became the important predictor to identify patients with mTBI developing persistent PTH 3 months postinjury. CONCLUSIONS Patients with mTBI+APTH exhibited significant PAG-related FC differences mainly within the DMN. These regions extended beyond traditional pain processing areas and may reflect the diminished top-down attention regulation of pain perception through antinociceptive descending modulation network. The disrupted PAG-DMN FC may be used as an early imaging biomarker to identify patients at risk of developing persistent PTH.
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Affiliation(s)
- Xuan Niu
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lijun Bai
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Yingxiang Sun
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shan Wang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Jieli Cao
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Chuanzhu Sun
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Zhuonan Wang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hui Xu
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Shuoqiu Gan
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Geng Fan
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Wenmin Huang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Chenghui Gu
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Xi'an, China
| | - Bo Yin
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Xi'an, China
| | - Guanghui Bai
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Xi'an, China
| | - Xiaoling Xu
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ming Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Sensitivity of the Cogstate Test Battery for Detecting Prolonged Cognitive Alterations Stemming From Sport-Related Concussions. Clin J Sport Med 2019; 29:62-68. [PMID: 29023272 DOI: 10.1097/jsm.0000000000000492] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if the Cogstate test battery contains the requisite sensitivity to detect prolonged cognitive alterations. METHODS One hundred twenty collegiate athletes (71 with a history of concussion; 49 controls) completed the Cogstate test battery, to which we added a 2-back condition. In addition to the Cogstate clinical (transformed variables), we analyzed the raw data. RESULTS The clinical variables failed to reveal any group differences. Further, although the raw data failed to reveal group differences for tasks measuring lower-level cognition, group differences were observed for accuracy on the 1- and 2-back tasks, which require multiple aspects of higher cognition. The overall classification accuracy was higher using the raw data than the clinical variables. The combined sensitivity of the 1- and 2-back task was moderate and specificity was high. CONCLUSIONS These results suggest that using the raw scores over clinical variables increases the sensitivity of the test battery. Moreover, these results add another piece of evidence suggesting that concussive injuries are associated with subtle long-term alterations in aspects of higher cognition. Importantly, these deficits would have gone unobserved if we had relied solely on automated clinical variables. The current results further our scientific understanding of concussion and may be used to advance clinical practices.
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34
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Howell DR, Lynall RC, Buckley TA, Herman DC. Neuromuscular Control Deficits and the Risk of Subsequent Injury after a Concussion: A Scoping Review. Sports Med 2018; 48:1097-1115. [PMID: 29453743 DOI: 10.1007/s40279-018-0871-y] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
An emerging area of research has identified that an increased risk of musculoskeletal injury may exist upon returning to sports after a sport-related concussion. The mechanisms underlying this recently discovered phenomenon, however, remain unknown. One theorized reason for this increased injury risk includes residual neuromuscular control deficits that remain impaired despite clinical recovery. Thus, the objectives of this review were: (1) to summarize the literature examining the relationship between concussion and risk of subsequent injury and (2) to summarize the literature for one mechanism with a theorized association with this increased injury risk, i.e., neuromuscular control deficits observed during gait after concussion under dual-task conditions. Two separate reviews were conducted consistent with both specified objectives. Studies published before 9 December, 2016 were identified using PubMed, Web of Science, and Academic Search Premier (EBSCOhost). Inclusion for the objective 1 search included dependent variables of quantitative measurements of musculoskeletal injury after concussion. Inclusion criteria for the objective 2 search included dependent variables pertaining to gait, dynamic balance control, and dual-task function. A total of 32 studies were included in the two reviews (objective 1 n = 10, objective 2 n = 22). According to a variety of study designs, athletes appear to have an increased risk of sustaining a musculoskeletal injury following a concussion. Furthermore, dual-task neuromuscular control deficits may continue to exist after patients report resolution of concussion symptoms, or perform normally on other clinical concussion tests. Therefore, musculoskeletal injury risk appears to increase following a concussion and persistent motor system and attentional deficits also seem to exist after a concussion. While not yet experimentally tested, these motor system and attentional deficits may contribute to the risk of sustaining a musculoskeletal injury upon returning to full athletic participation.
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Affiliation(s)
- David R Howell
- Department of Orthopedics, Sports Medicine Center, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Avenue B060, Aurora, CO, 80045, USA. .,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.
| | - Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.,Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, USA
| | - Daniel C Herman
- Divisions of Physical Medicine and Rehabilitation, Sports Medicine, and Research, Department of Orthopaedics and Rehabilitation, Orthopaedics and Sports Medicine Institute, University of Florida, Gainesville, FL, USA
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Jeong E, Ryu H, Shin JH, Kwon GH, Jo G, Lee JY. High Oxygen Exchange to Music Indicates Auditory Distractibility in Acquired Brain Injury: An fNIRS Study with a Vector-Based Phase Analysis. Sci Rep 2018; 8:16737. [PMID: 30425287 PMCID: PMC6233191 DOI: 10.1038/s41598-018-35172-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/31/2018] [Indexed: 01/30/2023] Open
Abstract
Attention deficits due to auditory distractibility are pervasive among patients with acquired brain injury (ABI). It remains unclear, however, whether attention deficits following ABI specific to auditory modality are associated with altered haemodynamic responses. Here, we examined cerebral haemodynamic changes using functional near-infrared spectroscopy combined with a topological vector-based analysis method. A total of thirty-seven participants (22 healthy adults, 15 patients with ABI) performed a melodic contour identification task (CIT) that simulates auditory distractibility. Findings demonstrated that the melodic CIT was able to detect auditory distractibility in patients with ABI. The rate-corrected score showed that the ABI group performed significantly worse than the non-ABI group in both CIT1 (target contour identification against environmental sounds) and CIT2 (target contour identification against target-like distraction). Phase-associated response intensity during the CITs was greater in the ABI group than in the non-ABI group. Moreover, there existed a significant interaction effect in the left dorsolateral prefrontal cortex (DLPFC) during CIT1 and CIT2. These findings indicated that stronger hemodynamic responses involving oxygen exchange in the left DLPFC can serve as a biomarker for evaluating and monitoring auditory distractibility, which could potentially lead to the discovery of the underlying mechanism that causes auditory attention deficits in patients with ABI.
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Affiliation(s)
- Eunju Jeong
- Department of Arts and Technology, Hanyang University, Seoul, 04763, Republic of Korea.
- Division of Industrial Information Studies, Hanyang University, Seoul, 04763, Republic of Korea.
| | - Hokyoung Ryu
- Department of Arts and Technology, Hanyang University, Seoul, 04763, Republic of Korea
- Graduate School of Technology and Innovation Management, Hanyang University, Seoul, 04763, Republic of Korea
| | - Joon-Ho Shin
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, 01022, Republic of Korea
| | - Gyu Hyun Kwon
- Department of Arts and Technology, Hanyang University, Seoul, 04763, Republic of Korea
- Graduate School of Technology and Innovation Management, Hanyang University, Seoul, 04763, Republic of Korea
| | - Geonsang Jo
- Department of Arts and Technology, Hanyang University, Seoul, 04763, Republic of Korea
| | - Ji-Yeong Lee
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, 01022, Republic of Korea
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Barlow SE, Medrano P, Seichepine DR, Ross RS. Investigation of the changes in oscillatory power during task switching after mild traumatic brain injury. Eur J Neurosci 2018; 48:3498-3513. [PMID: 30383314 DOI: 10.1111/ejn.14231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/15/2018] [Accepted: 10/23/2018] [Indexed: 11/27/2022]
Abstract
Mild traumatic brain injury (mTBI) can cause persistent cognitive changes. These cognitive changes may be due to changes in neural communication. Task-switching is a cognitive control operation that may be susceptible to mTBI and is associated with oscillations in theta (4-7 Hz), alpha (8-13 Hz), and beta (14-30 Hz) ranges. This study aimed to investigate oscillatory power in response to cues indicating a task-switch after mTBI. Electroencephalogram and behavioral data were collected from 21 participants with a history of two or more concussions (mTBI) and 21 age- and gender-matched controls as they performed a task-switching paradigm. Participants differentiated whether visual stimuli were red or green, or circles or squares, depending on a cue. The cue changed every few trials with the first trial after a rule change being termed a switch trial. The mTBI group showed significantly less overall accuracy during the task. Over a posterior parietal region, the mTBI group showed more theta desynchronization than the control group from ~300 to ~600 ms post-cue during switch trials and from ~300 to 400 ms during maintain trials, along with less alpha and beta desynchronization than the control group from ~2,000 to ~2,200 ms post-cue. In a right parietal region, the mTBI group showed less alpha and beta desynchronization from ~525 to ~775 ms post-cue. However, there was no condition × group interaction in the behavior or oscillatory results. These oscillatory differences suggest a change in neural communication is present after mTBI that may relate to global changes in task performance.
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Affiliation(s)
- Stephanie E Barlow
- Psychology Department, University of New Hampshire, Durham, New Hampshire.,Neuroscience and Behavior Program, University of New Hampshire, Durham, New Hampshire
| | - Paolo Medrano
- Psychology Department, University of New Hampshire, Durham, New Hampshire
| | - Daniel R Seichepine
- Neuropsychology Program, University of New Hampshire at Manchester, Manchester, New Hampshire
| | - Robert S Ross
- Psychology Department, University of New Hampshire, Durham, New Hampshire.,Neuroscience and Behavior Program, University of New Hampshire, Durham, New Hampshire
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Lesiakowski P, Lubiński W, Zwierko T. Evoked potentials in diagnosis of visual dysfunction in amateur boxers. PHYSICIAN SPORTSMED 2018; 46:449-459. [PMID: 29973091 DOI: 10.1080/00913847.2018.1496763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Injuries with varying degrees of temporary or permanent visual dysfunction are common in boxing. This study presents clinical diagnostic information regarding the functional integrity of the visual system in elite amateur boxers. The objective of this study was to assess the presence of normal or abnormal pattern visual evoked potentials (VEP). VEP in boxers were analyzed in relation to the nonathletic group and years of boxing activity. METHODS Clinical examination involved 31 boxers (21 male and 10 female) and 31 controls homogeneous in terms of age and gender. Pattern-reversal VEP elicited by checkerboard stimuli with large (LC) and small checks (SC) under monocular condition were applied. The latency and amplitude of N75, P100 and N135 components of the VEP waveform were analyzed. Absolute values and interocular differences of P100 latency and N75-P100 amplitude were used in determining VEP abnormalities. RESULTS Individual analysis showed prolonged P100 latency in both eyes in one male boxer. Interocular P100 latency differences beyond 8 ms were observed in three male boxers. The N75-P100 amplitude of four boxers exceeded the normal range in both eyes for the LC stimulation and one boxer for the SC stimulation. Interocular N75-P100 amplitude differences beyond the normal range in two cases for both the LC and the SC stimulation were confirmed. There was a positive correlation between years of boxing activity and N75 latency in SC (R = 0.480, p < 0.05) and N75-P100 amplitude in LC (R = -0.370, p < 0.05). CONCLUSION Long-term boxing training may cause impairments in neural conductivity in the visual pathway. VEP seem to be a valuable tool in the neurophysiological diagnosis of visual function in contact sports. They can be recommended as a systematical examination for boxers during training processes for the indication and reduction in the incidence of vision-threatening injuries.
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Affiliation(s)
- Piotr Lesiakowski
- a Department of Physical Education and Sport , Pomeranian Medical University , Szczecin , Poland
| | - Wojciech Lubiński
- b Department of Ophthalmology , Pomeranian Medical University , Szczecin , Poland
| | - Teresa Zwierko
- c Department of Physical Culture and Health Promotion, Laboratory of Kinesiology in Functional and Structural Human Research Center , University of Szczecin , Szczecin , Poland
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Merritt VC, Clark AL, Crocker LD, Sorg SF, Werhane ML, Bondi MW, Schiehser DM, Delano-Wood L. Repetitive mild traumatic brain injury in military veterans is associated with increased neuropsychological intra-individual variability. Neuropsychologia 2018; 119:340-348. [DOI: 10.1016/j.neuropsychologia.2018.08.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/24/2018] [Accepted: 08/29/2018] [Indexed: 11/26/2022]
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Long-term cognitive outcomes in male and female athletes following sport-related concussions. Int J Psychophysiol 2018; 132:3-8. [DOI: 10.1016/j.ijpsycho.2018.03.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 11/24/2022]
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Brokaw EB, Fine MS, Kindschi KE, Santago Ii AC, Lum PS, Higgins M. Cross-sectional evaluation of visuomotor tracking performance following subconcussive head impacts. Technol Health Care 2018; 26:109-118. [PMID: 29125529 DOI: 10.3233/thc-171079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Repeated mild traumatic brain injury (mTBI) has been associated with increased risk of degenerative neurological disorders. While the effects of mTBI and repeated injury are known, studies have only recently started examining repeated subconcussive impacts, impacts that do not result in a clinically diagnosed mTBI. In these studies, repeated subconcussive impacts have been connected to cognitive performance and brain imaging changes. OBJECTIVE Recent research suggests that performance on a visuomotor tracking (VMT) task may help improve the identification of mTBI. The goal of this study was to investigate if VMT performance is sensitive to the cumulative effect of repeated subconcussive head impacts in collegiate men's lacrosse players. METHODS A cross-sectional, prospective study was completed with eleven collegiate men's lacrosse players. Participants wore helmet-mounted sensors and completed VMT and reaction time assessments. The relationship between cumulative impact metrics and VMT metrics were investigated. RESULTS In this study, VMT performance correlated with repeated subconcussive head impacts; individuals approached clinically diagnosed mTBI-like performance as the cumulative rotational velocity they experienced increased. CONCLUSION This suggests that repeated subconcussive impacts can result in measurable impairments and indicates that visuomotor tracking performance may be a useful tool for monitoring the effects of repeated subconcussive impacts.
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Affiliation(s)
- E B Brokaw
- Emerging Technologies Department, The MITRE Corporation, McLean, VA, USA
| | - M S Fine
- Emerging Technologies Department, The MITRE Corporation, McLean, VA, USA
| | - K E Kindschi
- Department of Sports Medicine, The MedStar Health Union Memorial Hospital, Baltimore, MD, USA
| | - A C Santago Ii
- Emerging Technologies Department, The MITRE Corporation, McLean, VA, USA
| | - P S Lum
- Center for Applied Biomechanics and Rehabilitation Research, The MedStar Health National Rehabilitation Hospital, Washington, DC, USA.,Department of Biomedical Engineering, The Catholic University of America, Washington, DC, USA
| | - M Higgins
- Kinesiology Department, Towson University, Towson, MD, USA
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Fueger C, Huddleston WE. Effects of concussions on visually guided motor actions: A literature review. J Clin Exp Neuropsychol 2018; 40:1074-1080. [PMID: 29690820 DOI: 10.1080/13803395.2018.1458823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Athletes must be able to successfully navigate the soccer pitch or hockey rink to win the game, requiring maximal cognitive resources to successfully compete. Concussions potentially deplete these resources, and the long-term impact of concussions on an individual's goal-directed visually guided behavior continues to elude the scientific community. While the acute effects on cognition and the motor system have been elucidated elsewhere, long-term effects on performance have been less clear. Additionally, most investigations into long-term postinjury motor behaviors have focused on balance and gait, with little focus on functional upper extremity movements. These arm movements require both cognitive and motor functions to successfully complete the task, such as visually guided reaching, and have received little attention. This review examines the current state of the literature to date on the long-term effects of concussions on cognitive and motor deficits affecting visuomotor behavior.
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Affiliation(s)
- Christopher Fueger
- a Department of Kinesiology, Integrative Health Care and Performance , University of Wisconsin-Milwaukee , Milwaukee , WI , USA
| | - Wendy E Huddleston
- a Department of Kinesiology, Integrative Health Care and Performance , University of Wisconsin-Milwaukee , Milwaukee , WI , USA
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Wilkerson GB, Grooms DR, Acocello SN. Neuromechanical Considerations for Postconcussion Musculoskeletal Injury Risk Management. Curr Sports Med Rep 2018; 16:419-427. [PMID: 29135640 DOI: 10.1249/jsr.0000000000000430] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Recent epidemiological studies have documented increased susceptibility to musculoskeletal injury after sport-related concussion, which raises questions about the adequacy of current clinical practices to ensure safe return to sport. A growing body of evidence derived from advanced neuroimaging and neurological assessment methods strongly suggests that mild traumatic brain injury has long-lasting adverse effects that persist beyond resolution of clinical symptoms. Plausible interrelationships among postconcussion changes in brain structure and function support the rationale for specific methods of clinical assessment and training to target the interaction of cognitive and motor function for reduction of musculoskeletal injury risk after concussion. The findings of preliminary clinical studies are presented to support suggested strategies for reduction of postconcussion musculoskeletal injury risk, and to identify novel approaches that we consider worthy areas for further research.
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Affiliation(s)
- Gary B Wilkerson
- 1Division of Athletic Training, School of Applied Health Sciences and Wellness, and Ohio Musculoskeletal and Neurological Institute, University of Tennessee at Chattanooga, Chattanooga, TN; and 2Graduate Athletic Training Program, Department of Health and Human Performance, Ohio University, Athens, OH
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Howell DR, Kirkwood MW, Provance A, Iverson GL, Meehan WP. Using concurrent gait and cognitive assessments to identify impairments after concussion: a narrative review. Concussion 2018; 3:CNC54. [PMID: 30202596 PMCID: PMC6094155 DOI: 10.2217/cnc-2017-0014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 12/21/2017] [Indexed: 02/05/2023] Open
Abstract
Understanding how a concussion affects an individual is oftentimes difficult for clinicians due to the varying symptom profiles reported by the patient and the multifaceted and heterogeneous nature of the injury. Accordingly, the interpretation of postconcussion performance can be challenging, because many different testing paradigms have been reported as potentially useful in the literature. Among the types of tests clinicians use to understand how concussion affects an individual, both gait and neurocognitive evaluations have demonstrated utility. Our purpose is to describe how combined gait and cognitive (i.e., dual task), as well as single-task gait and computerized neurocognitive examinations can assist clinical decision-making.
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Affiliation(s)
- David R Howell
- The Micheli Center for Sports Injury Prevention, Waltham, MA 02453, USA
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA 02115, USA
- Brain Injury Center, Boston Children's Hospital, Boston, MA 02115, USA
- Sports Medicine Center, Children's Hospital Colorado & University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Michael W Kirkwood
- Department of Physical Medicine & Rehabilitation, University of Colorado, Aurora, CO 80045, USA
- Rehabilitation Medicine, Children's Hospital Colorado, Aurora, CO 80045, USA
| | - Aaron Provance
- Sports Medicine Center, Children's Hospital Colorado & University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Grant L Iverson
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02129, USA
- MassGeneral Hospital for Children Sport Concussion Program, Boston, MA 02114, USA
- Home Base, A Red Sox Foundation & Massachusetts General Hospital Program, Boston, MA 02129, USA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA 02453, USA
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA 02115, USA
- Brain Injury Center, Boston Children's Hospital, Boston, MA 02115, USA
- Department of Pediatrics & Orthopaedic Surgery, Harvard Medical School, Boston, MA 02115, USA
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Howell DR, Osternig LR, Chou LS. Detection of Acute and Long-Term Effects of Concussion: Dual-Task Gait Balance Control Versus Computerized Neurocognitive Test. Arch Phys Med Rehabil 2018; 99:1318-1324. [PMID: 29457997 DOI: 10.1016/j.apmr.2018.01.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the acute (within 72h of injury) and long-term (2mo postinjury) independent associations between objective dual-task gait balance and neurocognitive measurements among adolescents and young adults with a concussion and matched controls. DESIGN Longitudinal case-control. SETTING Motion analysis laboratory. PARTICIPANTS A total of 95 participants completed the study: 51 who sustained a concussion (mean age, 17.5±3.3y; 71% men) and 44 controls (mean age, 17.7±2.9y; 72% men). Participants who sustained a concussion underwent a dual-task gait analysis and computerized neurocognitive testing within 72 hours of injury and again 2 months later. Uninjured controls also completed the same test protocol in similar time increments. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We compared dual-task gait balance control and computerized neurocognitive test performance between groups using independent samples t tests. Multivariable binary logistic regression models were then constructed for each testing time to determine the association between group membership (concussion vs control), dual-task gait balance control, and neurocognitive function. RESULTS Medial-lateral center-of-mass displacement during dual-task gait was independently associated with group membership at the initial test (adjusted odds ratio [aOR], 2.432; 95% confidence interval [CI], 1.269-4.661) and 2-month follow-up test (aOR, 1.817; 95% CI, 1.014-3.256) tests. Visual memory composite scores were significantly associated with group membership at the initial hour postinjury time point (aOR, .953; 95% CI, .833-.998). However, the combination of computerized neurocognitive test variables did not predict dual-task gait balance control for participants with concussion, and no single neurocognitive variable was associated with dual-task gait balance control at either testing time. CONCLUSIONS Dual-task assessments concurrently evaluating gait and cognitive performance may allow for the detection of persistent deficits beyond those detected by computerized neurocognitive deficits alone.
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Affiliation(s)
- David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO; The Micheli Center for Sports Injury Prevention, Waltham, MA
| | - Louis R Osternig
- Department of Human Physiology, University of Oregon, Eugene, OR
| | - Li-Shan Chou
- Department of Human Physiology, University of Oregon, Eugene, OR.
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Abstract
Study Design Systematic review. Background When assessed in isolation, balance and neurocognitive testing may not be sufficiently responsive to capture changes that occur with concussion. Normal daily activities require simultaneous cognitive and physical demands. Therefore, a dual-task assessment paradigm should be considered to identify performance deficits. Objectives To evaluate the literature and to identify dual-task testing protocols associated with changes in gait after concussion. Methods A systematic review of articles of individuals with concussion who underwent dual-task testing with a combination of motor and cognitive tasks was conducted. The AMED, CINAHL, Embase, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science databases and gray literature were searched from inception to January 29, 2017. Title and abstract, full-text, and quality review and data abstraction were performed by 2 independent reviewers. Results Twenty-four articles met the inclusion criteria. Eleven articles reported decreased gait velocity and increased medial-lateral displacement for individuals with concussion during dual-task conditions. Overall, included articles were of poor to moderate methodological quality. Fifteen articles used the same participants and data sets, creating a threat to validity and limiting the ability to make conclusions. Conclusion A deterioration in gait performance during dual-task testing is present among people with concussion. Specific recommendations for the use of a dual-task protocol to assess individuals with suspected concussion injury in a clinical setting have yet to be determined. J Orthop Sports Phys Ther 2018;48(2):87-103. Epub 7 Nov 2017. doi:10.2519/jospt.2018.7432.
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Petley L, Bardouille T, Chiasson D, Froese P, Patterson S, Newman A, Omisade A, Beyea S. Attentional dysfunction and recovery in concussion: effects on the P300m and contingent magnetic variation. Brain Inj 2018; 32:464-473. [DOI: 10.1080/02699052.2018.1429022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Lauren Petley
- Biomedical Translational Imaging Centre (BIOTIC), IWK Health Centre, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Tim Bardouille
- Biomedical Translational Imaging Centre (BIOTIC), IWK Health Centre, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Darrell Chiasson
- Nova Scotia Health Authority, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Patrick Froese
- Nova Scotia Health Authority, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | - Aaron Newman
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Antonina Omisade
- Nova Scotia Health Authority, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Steven Beyea
- Biomedical Translational Imaging Centre (BIOTIC), IWK Health Centre, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
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Shah-Basak PP, Urbain C, Wong S, da Costa L, Pang EW, Dunkley BT, Taylor MJ. Concussion Alters the Functional Brain Processes of Visual Attention and Working Memory. J Neurotrauma 2017; 35:267-277. [PMID: 29020848 DOI: 10.1089/neu.2017.5117] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Millions of North Americans sustain a concussion or a mild traumatic brain injury annually, and are at risk of cognitive, emotional, and physical sequelae. Although functional MRI (fMRI) studies have provided an initial framework for examining functional deficits induced by concussion, particularly working memory and attention, the temporal dynamics underlying these deficits are not well understood. We used magnetoencephalography (MEG), a modality with millisecond temporal resolution, in conjunction with a 1-back visual working memory (VWM) paradigm using scenes from everyday life to characterize spatiotemporal functional differences at specific VWM stages, in adults had had or had not had a recent concussion. MEG source-level differences between groups were determined by whole-brain analyses during encoding and recognition phases. Despite comparable behavioral performance, abnormal hypo- and hyperactivation patterns were found in brain areas involving frontoparietal, ventral occipitotemporal, temporal, and subcortical areas in concussed patients. These patterns and their timing varied as a function of VWM stagewise processing, linked to early attentional control, visuoperceptual scene processing, and VWM maintenance and retrieval processes. Parietal hypoactivation, starting at 60 ms during encoding, was correlated with symptom severity, possibly linked to impaired top-down attentional processing. Hyperactivation in the scene-selective occipitotemporal areas, the medial temporal complex, specifically the right hippocampus and orbitofrontal areas during encoding and/or recognition, lead us to posit inefficient but compensatory visuoperceptual, relational, and retrieval processing. Although injuries sustained after the concussion were considered "mild," these data suggest that they can have prolonged effects on early attentional and VWM processes.
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Affiliation(s)
- Priyanka P Shah-Basak
- 1 Diagnostic Imaging, The Hospital for Sick Children , Toronto, Ontario, Canada
- 2 Rotman Research Institute , Baycrest Centre, Toronto, Ontario, Canada
| | - Charline Urbain
- 1 Diagnostic Imaging, The Hospital for Sick Children , Toronto, Ontario, Canada
- 3 Laboratoire de Cartographie Fonctionnelle du Cerveau, Erasme Hospital , ULB Bruxelles, Belgium
| | - Simeon Wong
- 1 Diagnostic Imaging, The Hospital for Sick Children , Toronto, Ontario, Canada
| | - Leodante da Costa
- 4 Department of Surgery, Division of Neurosurgery, Sunnybrook Hospital, University of Toronto , Toronto, Ontario, Canada
| | - Elizabeth W Pang
- 5 Division of Neurology, The Hospital for Sick Children , Toronto, Ontario, Canada
- 6 Program in Neuroscience and Mental Health, SickKids Research Institute , Toronto, Ontario, Canada
| | - Benjamin T Dunkley
- 1 Diagnostic Imaging, The Hospital for Sick Children , Toronto, Ontario, Canada
- 6 Program in Neuroscience and Mental Health, SickKids Research Institute , Toronto, Ontario, Canada
- 7 Department of Medical Imaging, Sunnybrook Hospital, University of Toronto , Toronto, Ontario, Canada
| | - Margot J Taylor
- 1 Diagnostic Imaging, The Hospital for Sick Children , Toronto, Ontario, Canada
- 7 Department of Medical Imaging, Sunnybrook Hospital, University of Toronto , Toronto, Ontario, Canada
- 8 Department of Psychology, Sunnybrook Hospital, University of Toronto , Toronto, Ontario, Canada
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Yasen AL, Howell DR, Chou LS, Pazzaglia AM, Christie AD. Cortical and Physical Function after Mild Traumatic Brain Injury. Med Sci Sports Exerc 2017; 49:1066-1071. [PMID: 28509819 DOI: 10.1249/mss.0000000000001217] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of this study was to prospectively examine the association between intracortical inhibition and functional recovery after mild traumatic brain injury (mTBI). METHODS Twenty individuals with mTBI and 20 matched control participants were assessed using transcranial magnetic stimulation, the Attentional Network Test, and gait analysis. Hierarchical linear modeling was used to longitudinally examine potential differences between groups and relationships in the pattern of recovery in cortical silent period (CSP) duration, cognitive reaction time, and single- and dual-task walking speeds across five testing time points. Individuals with mTBI were assessed within 72 h of injury, and again at 1 wk, 2 wk, 1 month, and 2 months postinjury. After initial testing, control participants followed a similar timeline. RESULTS At the 72-h time point, the group with mTBI had longer reaction time (b = -91.76, P = 0.01), similar single-task walking speed (b = 0.055, P = 0.10), and slower dual-task walking speed (b = 0.10, P = 0.012) compared with control participants. The CSP duration also tended to be longer in individuals with mTBI than controls at the 72-h time point (b = -16.34, P = 0.062). The change is CSP duration over time was not significantly associated with the change in reaction time (b = -0.19, P = 0.47), single-task walking speed (b = 0.0001, P = 0.53), or dual-task walking speed (b < 0.001, P = 0.68). CONCLUSION Although cognitive and motor functions were significantly impaired in the mTBI group acutely after injury, levels of intracortical inhibition were not associated with recovery in either functional domain.
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Affiliation(s)
- Alia L Yasen
- 1Department of Human Physiology, University of Oregon, Eugene, OR; 2Division of Sports Medicine, Department of Orthopedics, Children's Hospital Boston, Boston, MA; 3The Micheli Center for Sports Injury Prevention, Waltham, MA; and 4Education Development Center, Inc., Waltham, MA
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49
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Hazan E, Zhang J, Brenkel M, Shulman K, Feinstein A. Getting clocked: screening for TBI-related cognitive impairment with the clock drawing test. Brain Inj 2017; 31:1501-1506. [DOI: 10.1080/02699052.2017.1376763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Elias Hazan
- Department of Psychiatry, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jia Zhang
- Department of Psychiatry, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Megan Brenkel
- Department of Psychiatry, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Kenneth Shulman
- Department of Psychiatry, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Anthony Feinstein
- Department of Psychiatry, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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50
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Ng LJ, Volman V, Gibbons MM, Phohomsiri P, Cui J, Swenson DJ, Stuhmiller JH. A Mechanistic End-to-End Concussion Model That Translates Head Kinematics to Neurologic Injury. Front Neurol 2017; 8:269. [PMID: 28663736 PMCID: PMC5471336 DOI: 10.3389/fneur.2017.00269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 05/26/2017] [Indexed: 11/13/2022] Open
Abstract
Past concussion studies have focused on understanding the injury processes occurring on discrete length scales (e.g., tissue-level stresses and strains, cell-level stresses and strains, or injury-induced cellular pathology). A comprehensive approach that connects all length scales and relates measurable macroscopic parameters to neurological outcomes is the first step toward rationally unraveling the complexity of this multi-scale system, for better guidance of future research. This paper describes the development of the first quantitative end-to-end (E2E) multi-scale model that links gross head motion to neurological injury by integrating fundamental elements of tissue and cellular mechanical response with axonal dysfunction. The model quantifies axonal stretch (i.e., tension) injury in the corpus callosum, with axonal functionality parameterized in terms of axonal signaling. An internal injury correlate is obtained by calculating a neurological injury measure (the average reduction in the axonal signal amplitude) over the corpus callosum. By using a neurologically based quantity rather than externally measured head kinematics, the E2E model is able to unify concussion data across a range of exposure conditions and species with greater sensitivity and specificity than correlates based on external measures. In addition, this model quantitatively links injury of the corpus callosum to observed specific neurobehavioral outcomes that reflect clinical measures of mild traumatic brain injury. This comprehensive modeling framework provides a basis for the systematic improvement and expansion of this mechanistic-based understanding, including widening the range of neurological injury estimation, improving concussion risk correlates, guiding the design of protective equipment, and setting safety standards.
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Affiliation(s)
- Laurel J Ng
- Simulation Engineering and Testing, L-3 Applied Technologies, Inc., San Diego, CA, United States
| | - Vladislav Volman
- Simulation Engineering and Testing, L-3 Applied Technologies, Inc., San Diego, CA, United States
| | - Melissa M Gibbons
- Simulation Engineering and Testing, L-3 Applied Technologies, Inc., San Diego, CA, United States
| | - Pi Phohomsiri
- Simulation Engineering and Testing, L-3 Applied Technologies, Inc., San Diego, CA, United States
| | - Jianxia Cui
- Simulation Engineering and Testing, L-3 Applied Technologies, Inc., San Diego, CA, United States
| | - Darrell J Swenson
- Cardiac Rhythm and Heart Failure Numerical Modeling, Medtronic, Mounds View, MN, United States
| | - James H Stuhmiller
- Simulation Engineering and Testing, L-3 Applied Technologies, Inc., San Diego, CA, United States
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