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Shumski EJ, Oh J, Schmidt JD, Lynall RC. Trunk and Lower Extremity Biomechanics in Female Athletes With and Without a Concussion History. J Athl Train 2024; 59:751-761. [PMID: 37681680 PMCID: PMC11277281 DOI: 10.4085/1062-6050-0259.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
CONTEXT Athletes with a history of concussion are at a greater risk for lower extremity musculoskeletal injury. Female athletes may be at an even greater risk than male athletes. Previous researchers on postconcussion landing biomechanics have focused on the lower extremities, but the trunk plays a crucial role as an injury risk factor. OBJECTIVE To compare lower extremity and trunk biomechanics during jump-landing and cutting maneuvers between female athletes with and those without a concussion history. DESIGN Cross-sectional study. SETTING Biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 26 athletes (mean ± SD age = 19.0 ± 1.3 years, height = 1.68 ± 0.07 m, mass = 64.02 ± 6.76 kg, body mass index = 22.58 ± 1.97 kg/m2; median [interquartile range] time since most recent concussion = 37.5 months [25.0 months, 65.8 months]) with a concussion history and 38 athletes (age = 19.0 ± 1.1 years, height = 1.71 ± 0.08 m, mass = 64.72 ± 9.45 kg, body mass index = 22.14 ± 1.80 kg/m2) without a concussion history. MAIN OUTCOME MEASURE(S) Peak kinetics (vertical ground reaction force, vertical loading rate, external knee-abduction moment, and external knee-flexion moment) and kinematics (trunk-flexion angle, trunk lateral-bending angle, ankle-dorsiflexion angle, knee-flexion angle, knee-abduction angle, and hip-flexion angle) were obtained during the eccentric portion of jump-landing and cutting tasks. Separate 2 (group) × 2 (limb) between- and within-factors analyses of covariance were used to compare outcomes between groups. We covaried for time since the most recent concussion and the limb that had a history of musculoskeletal injury. RESULTS Athletes with a concussion history displayed a greater peak knee-abduction angle in their nondominant limb than their dominant limb (P = .01, ηp2 = 0.107) and the nondominant limb of athletes without a concussion history (P = .02, ηp2 = 0.083) during jump landing. They also had less trunk lateral bending during cutting compared with athletes without a concussion history (P = .005, ηp2 = 0.126). CONCLUSIONS Our results indicated landing biomechanics are different between female athletes with and those without a concussion history. This finding may be due to impairments in neuromuscular control postconcussion that may ultimately increase the risk of subsequent lower extremity injury, although further research is warranted given the cross-sectional nature of our study.
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Affiliation(s)
| | - Jeonghoon Oh
- Center of Neuroregeneration, Houston Methodist Research Institute, TX
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Bennys K, Busto GU, Touchon J. Cumulative effects of subsequent concussions on the neural patterns of young rugby athletes: data from event-related potentials. Res Sports Med 2024; 32:609-620. [PMID: 36919531 DOI: 10.1080/15438627.2023.2189594] [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: 12/16/2021] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
Our study aimed at detecting a potential cumulative effect of subsequent concussions on the neural activation patterns of young rugby athletes with or without concussion history. Event-related brain potential (ERP) data from 24 rugby players, 22-year-old on average, were retrospectively examined. All underwent a Sport Concussion Assessment Tool (SCAT2) during preseason and an on-site ERP task (P300) following a recent concussion event (<48 hours). Sixteen players suffered at least one concussion in the previous 3 years and eight were without self-reported past concussion. While no differences were reported between groups regarding symptom appraisal on the SCAT2 assessment, ERP revealed significantly decreased P3b amplitude and a trend for increased P3b latency in players who experienced prior concussions. Our data thus support the cumulative effect of concussions on neuroelectric events in young rugby players, highlighting the importance of managing player's concussion load to reduce the risk of long-term injuries.
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Affiliation(s)
- Karim Bennys
- Memory Resources Research Center for Alzheimer's disease, Department of Neurology, University Hospital of Montpellier, Montpellier, France
- Neurophysiology Unit, Department of Neurology, University Hospital of Montpellier, Montpellier, France
| | - Germain U Busto
- Memory Resources Research Center for Alzheimer's disease, Department of Neurology, University Hospital of Montpellier, Montpellier, France
- Neurophysiology Unit, Department of Neurology, University Hospital of Montpellier, Montpellier, France
| | - Jacques Touchon
- Memory Resources Research Center for Alzheimer's disease, Department of Neurology, University Hospital of Montpellier, Montpellier, France
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Shumski EJ, Schmidt JD, Lynall RC. Cognition Uniquely Influences Dual-Task Tandem Gait Performance Among Athletes With a Concussion History. Sports Health 2024; 16:542-550. [PMID: 37377161 PMCID: PMC11195850 DOI: 10.1177/19417381231183413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND After a concussion, there are unique associations between static balance and landing with cognition. Previous research has explored these unique correlations, but the factor of time, dual-task, and different motor tasks leave gaps within the literature. The purpose of this study was to determine the associations between cognition and tandem gait performance. HYPOTHESIS We hypothesized that athletes with a concussion history would display stronger associations compared with athletes without a concussion history between cognition and tandem gait. STUDY DESIGN Cross-sectional. LEVEL OF EVIDENCE Level 3. METHODS A total of 126 athletes without (56.3% female; age, 18.8 ± 1.3 years; height, 176.7 ± 12.3 cm; mass, 74.8 ± 19.0 kg) and 42 athletes with (40.5% female; age, 18.8 ± 1.3 years; height, 179.3 ± 11.9 cm; mass, 81.0 ± 25.1 kg) concussion history participated. Cognitive performance was assessed with CNS Vital Signs. Tandem gait was performed on a 3-meter walkway. Dual-task tandem gait included a concurrent cognitive task of serial subtraction, reciting months backward, or spelling words backward. RESULTS Athletes with a concussion history exhibited a larger number of significant correlations compared with athletes without a concussion history for cognition and dual-task gait time (4 significant correlations: rho-range, -0.377 to 0.358 vs 2 significant correlations: rho, -0.233 to 0.179) and dual-task cost gait time (4 correlations: rho range, -0.344 to 0.392 vs 1 correlation: rho, -0.315). The time between concussion and testing did significantly moderate any associations (P = 0.11-0.63). Athletes with a concussion history displayed better dual-task cost response rate (P = 0.01). There were no other group differences for any cognitive (P = 0.13-0.97) or tandem gait (P = 0.20-0.92) outcomes. CONCLUSION Athletes with a concussion history display unique correlations between tandem gait and cognition. These correlations are unaffected by the time since concussion. CLINICAL RELEVANCE These unique correlations may represent shared neural resources between cognition and movement that are only present for athletes with a concussion history. Time does not influence these outcomes, indicating the moderating effect of concussion on the correlations persists long-term after the initial injury.
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Affiliation(s)
- Eric J. Shumski
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia
| | - Julianne D. Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia
| | - Robert C. Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia
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Pearce AJ, Kidgell DJ, Frazer AK, Rist B, Tallent J. Evidence of altered corticomotor inhibition in older adults with a history of repetitive neurotrauma. A transcranial magnetic stimulation study. J Neurol Sci 2023; 453:120777. [PMID: 37677860 DOI: 10.1016/j.jns.2023.120777] [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: 06/13/2023] [Revised: 07/26/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023]
Abstract
International concern continues regarding the association between the long-term neurophysiologic changes from repetitive neurotrauma associated with contact and collision sports. This study describes corticomotor changes in retired contact/collision sport athletes and controls, between the ages of 30 and 70 years. Retired athletes (n = 152; 49.1 ± 8.5 years) and controls (n = 72; 47.8 ± 9.5 years) were assessed using single and paired-pulse transcranial magnetic stimulation (TMS) for active motor threshold (aMT), motor evoked potential and cortical silent period duration (expressed as MEP:cSP ratio), and short- and long-interval intracortical inhibition (SICI and LICI). Motor threshold, MEP:cSP, SICI and LICI for both groups were correlated across age. Controls showed significant moderate correlations for MEP:cSP ratios at 130% (rho = 0.48, p < 0.001), 150% (rho = 0.49, p < 0.001) and 170% aMT (rho = 0.42; p < 0.001) and significant small negative correlation for SICI (rho = -0.27; p = 0.030), and moderate negative correlation for LICI (rho = -0.43; p < 0.001). Group-wise correlation analysis comparisons showed significant correlation differences between groups for 130% (p = 0.016) and 150% aMT (p = 0.009), specifically showing retired athletes were displaying increased corticomotor inhibition. While previous studies have focussed studies on older athletes (>50 years), this study is the first to characterize corticomotor differences between retired athletes and controls across the lifespan. These results, demonstrating pathophysiological differences in retired athletes across the lifespan, provide a foundation to utilise evoked potentials as a prodromal marker in supplementing neurological assessment for traumatic encephalopathy syndrome associated with contact/collision sport athletes that is currently lacking physiological biomarkers.
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Affiliation(s)
- Alan J Pearce
- College of Science, Health and Engineering, La Trobe University, Melbourne 3086, Australia.
| | - Dawson J Kidgell
- Faculty of Medicine Nursing and Health Science, Monash University, Melbourne 3800, Australia
| | - Ashlyn K Frazer
- Faculty of Medicine Nursing and Health Science, Monash University, Melbourne 3800, Australia
| | - Billymo Rist
- College of Science, Health and Engineering, La Trobe University, Melbourne 3086, Australia; Australian Football League Players Association, Melbourne 32067, Australia
| | - Jamie Tallent
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Essex CO4 3SQ, UK
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Weppner JL, Hillaker E, Boomgaardt J, Tan S, Holum P, Li F, Tu J, Sheppard M. Actigraphic and nursing sleep log measures in moderate-to-severe traumatic brain injury: Identifying discrepancies in total sleep time. PM R 2023; 15:1266-1272. [PMID: 36565443 DOI: 10.1002/pmrj.12934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/26/2022] [Accepted: 12/02/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Sleep disturbances are common in patients with traumatic brain injury (TBI). In an inpatient rehabilitation setting, clinicians often use information from sleep logs filled out by trained nurses to identify and treat sleep disturbances. However, there are limited data related to accuracy of sleep logs, and patient-reported sleep diaries are poor predictors of total sleep time, which raises concern about the accuracy of sleep logs filled out by a third party. OBJECTIVE To examine the reliability of sleep logs for participants with TBI by comparing total sleep time determined by sleep logs versus actigraphy. DESIGN Prospective, cross-sectional study. SETTING Free-standing, academic inpatient rehabilitation facility. PARTICIPANTS Thirty individuals (n = 30) participated in the study. Inclusion criteria were (1) diagnosis of moderate-to-severe TBI; (2) age ≥ 18 years at the time of TBI; and (3) participating in inpatient rehabilitation with no prior inpatient rehabilitation admissions. INTERVENTIONS Actigraph monitoring using ActiGraph GT9X Link devices was initiated within 72 hours of admission and continued for 7 consecutive days. Sleep logs were concurrently filled out by trained nurses. MAIN OUTCOME MEASURES Sleep parameter correspondence between actigraphy and sleep logs in moderate-to-severe TBI. RESULTS Only 51.4% of participants' sleep logs and actigraph total sleep time measurements were within 1 hour of each other, and only 23.8% were within 30 minutes. On average, sleep logs overestimated actigraphy-determined total sleep time by 60 minutes compared to actigraphic measurement. CONCLUSIONS For those with moderate-to-severe TBI undergoing inpatient rehabilitation, sleep logs are poor predictors of sleep time because they overestimate total sleep time compared to actigraphy. Therefore, clinicians should use caution when using sleep log data to make decisions regarding treatment for sleep disturbances in TBI.
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Affiliation(s)
- Justin L Weppner
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Department of Internal Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, Virginia, USA
| | - Emily Hillaker
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
| | - Jacob Boomgaardt
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen Tan
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
| | - Parker Holum
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Felix Li
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Justin Tu
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
| | - Michael Sheppard
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
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Hiskens MI, Li KM, Schneiders AG, Fenning AS. Repetitive mild traumatic brain injury-induced neurodegeneration and inflammation is attenuated by acetyl-L-carnitine in a preclinical model. Front Pharmacol 2023; 14:1254382. [PMID: 37745053 PMCID: PMC10514484 DOI: 10.3389/fphar.2023.1254382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/31/2023] [Indexed: 09/26/2023] Open
Abstract
Repetitive mild traumatic brain injuries (rmTBI) may contribute to the development of neurodegenerative diseases through secondary injury pathways. Acetyl-L-carnitine (ALC) shows neuroprotection through anti-inflammatory effects and via regulation of neuronal synaptic plasticity by counteracting post-trauma excitotoxicity. This study aimed to investigate mechanisms implicated in the etiology of neurodegeneration in rmTBI mice treated with ALC. Adult male C57BL/6J mice were allocated to sham, rmTBI or ALC + rmTBI groups. 15 rmTBIs were administered across 23 days using a modified weight drop model. Neurological testing and spatial learning and memory assessments via the Morris Water Maze (MWM) were undertaken at 48 h and 3 months. RT-PCR analysis of the cortex and hippocampus was undertaken for MAPT, GFAP, AIF1, GRIA, CCL11, TDP43, and TNF genes. Gene expression in the cortex showed elevated mRNA levels of MAPT, TNF, and GFAP in the rmTBI group that were reduced by ALC treatment. In the hippocampus, mRNA expression was elevated for GRIA1 in the rmTBI group but not the ALC + rmTBI treatment group. ALC treatment showed protective effects against the deficits displayed in neurological testing and MWM assessment observed in the rmTBI group. While brain structures display differential vulnerability to insult as evidenced by location specific postimpact disruption of key genes, this study shows correlative mRNA neurodegeneration and functional impairment that was ameliorated by ALC treatment in several key genes. ALC may mitigate damage inflicted in the various secondary neurodegenerative cascades and contribute to functional protection following rmTBI.
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Affiliation(s)
- Matthew I. Hiskens
- Mackay Institute of Research and Innovation, Mackay Hospital and Health Service, Mackay, QLD, Australia
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Katy M. Li
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Anthony G. Schneiders
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Andrew S. Fenning
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
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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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Hallock H, Mantwill M, Vajkoczy P, Wolfarth B, Reinsberger C, Lampit A, Finke C. Sport-Related Concussion: A Cognitive Perspective. Neurol Clin Pract 2023; 13:e200123. [PMID: 36891462 PMCID: PMC9987206 DOI: 10.1212/cpj.0000000000200123] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/03/2022] [Indexed: 02/25/2023]
Abstract
Purpose of Review The incidence of sport-related concussion (SRC) has been increasing in different sports and its impact on long-term cognitive function is increasingly recognized. In this study, we review the epidemiology, neuropathophysiology, clinical symptoms, and long-term consequences of SRC with a specific focus on cognition. Recent Findings Repeated concussions are associated with an increased risk of several neurologic diseases and long-term cognitive deficits. To improve cognitive outcomes in athletes with SRC, standardized guidelines for the assessment and management of SRC are vital. However, current concussion management guidelines lack procedures for rehabilitating acute and long-term cognitive symptoms. Summary Increased awareness for the management and rehabilitation of cognitive symptoms in SRC is needed in all clinical neurologists treating professional and amateur athletes. We propose cognitive training as a prehabilitation tool to alleviate the severity of cognitive symptoms and as a rehabilitative tool to improve cognitive recovery postinjury.
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Affiliation(s)
- Harry Hallock
- Berlin School of Mind and Brain (HH, MM, AL, CF), Humboldt-Universität zu Berlin; Departments of Neurology (HH, MM, AL, CF) and Neurosurgery (PV) and of Sports Medicine (BW), Charité Universitätsmedizin, Berlin; Institute of Sports Medicine (CR), University of Paderborn, Germany; and Department of Psychiatry (AL), University of Melbourne, Parkville, Australia
| | - Maron Mantwill
- Berlin School of Mind and Brain (HH, MM, AL, CF), Humboldt-Universität zu Berlin; Departments of Neurology (HH, MM, AL, CF) and Neurosurgery (PV) and of Sports Medicine (BW), Charité Universitätsmedizin, Berlin; Institute of Sports Medicine (CR), University of Paderborn, Germany; and Department of Psychiatry (AL), University of Melbourne, Parkville, Australia
| | - Peter Vajkoczy
- Berlin School of Mind and Brain (HH, MM, AL, CF), Humboldt-Universität zu Berlin; Departments of Neurology (HH, MM, AL, CF) and Neurosurgery (PV) and of Sports Medicine (BW), Charité Universitätsmedizin, Berlin; Institute of Sports Medicine (CR), University of Paderborn, Germany; and Department of Psychiatry (AL), University of Melbourne, Parkville, Australia
| | - Bernd Wolfarth
- Berlin School of Mind and Brain (HH, MM, AL, CF), Humboldt-Universität zu Berlin; Departments of Neurology (HH, MM, AL, CF) and Neurosurgery (PV) and of Sports Medicine (BW), Charité Universitätsmedizin, Berlin; Institute of Sports Medicine (CR), University of Paderborn, Germany; and Department of Psychiatry (AL), University of Melbourne, Parkville, Australia
| | - Claus Reinsberger
- Berlin School of Mind and Brain (HH, MM, AL, CF), Humboldt-Universität zu Berlin; Departments of Neurology (HH, MM, AL, CF) and Neurosurgery (PV) and of Sports Medicine (BW), Charité Universitätsmedizin, Berlin; Institute of Sports Medicine (CR), University of Paderborn, Germany; and Department of Psychiatry (AL), University of Melbourne, Parkville, Australia
| | - Amit Lampit
- Berlin School of Mind and Brain (HH, MM, AL, CF), Humboldt-Universität zu Berlin; Departments of Neurology (HH, MM, AL, CF) and Neurosurgery (PV) and of Sports Medicine (BW), Charité Universitätsmedizin, Berlin; Institute of Sports Medicine (CR), University of Paderborn, Germany; and Department of Psychiatry (AL), University of Melbourne, Parkville, Australia
| | - Carsten Finke
- Berlin School of Mind and Brain (HH, MM, AL, CF), Humboldt-Universität zu Berlin; Departments of Neurology (HH, MM, AL, CF) and Neurosurgery (PV) and of Sports Medicine (BW), Charité Universitätsmedizin, Berlin; Institute of Sports Medicine (CR), University of Paderborn, Germany; and Department of Psychiatry (AL), University of Melbourne, Parkville, Australia
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Lins BR, Anyaegbu CC, Hellewell SC, Papini M, McGonigle T, De Prato L, Shales M, Fitzgerald M. Cannabinoids in traumatic brain injury and related neuropathologies: preclinical and clinical research on endogenous, plant-derived, and synthetic compounds. J Neuroinflammation 2023; 20:77. [PMID: 36935484 PMCID: PMC10026409 DOI: 10.1186/s12974-023-02734-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 02/13/2023] [Indexed: 03/21/2023] Open
Abstract
Traumatic brain injury is common, and often results in debilitating consequences. Even mild traumatic brain injury leaves approximately 20% of patients with symptoms that persist for months. Despite great clinical need there are currently no approved pharmaceutical interventions that improve outcomes after traumatic brain injury. Increased understanding of the endocannabinoid system in health and disease has accompanied growing evidence for therapeutic benefits of Cannabis sativa. This has driven research of Cannabis' active chemical constituents (phytocannabinoids), alongside endogenous and synthetic counterparts, collectively known as cannabinoids. Also of therapeutic interest are other Cannabis constituents, such as terpenes. Cannabinoids interact with neurons, microglia, and astrocytes, and exert anti-inflammatory and neuroprotective effects which are highly desirable for the management of traumatic brain injury. In this review, we comprehensively appraised the relevant scientific literature, where major and minor phytocannabinoids, terpenes, synthetic cannabinoids, and endogenous cannabinoids were assessed in TBI, or other neurological conditions with pathology and symptomology relevant to TBI, as well as recent studies in preclinical TBI models and clinical TBI populations.
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Affiliation(s)
- Brittney R Lins
- Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Australia.
- Perron Institute for Neurological and Translational Science, Nedlands, 6009, Australia.
| | - Chidozie C Anyaegbu
- Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, 6009, Australia
| | - Sarah C Hellewell
- Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, 6009, Australia
| | - Melissa Papini
- Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, 6009, Australia
| | - Terence McGonigle
- Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Australia
| | - Luca De Prato
- MediCann Health Aust Pty Ltd, Osborne Park, 6017, Australia
| | - Matthew Shales
- MediCann Health Aust Pty Ltd, Osborne Park, 6017, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, 6009, Australia
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10
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Tapper A, Niechwiej-Szwedo E. Path Configuration Complexity Affects Spatial Memory Span on the eCorsi Task but Does Not Influence Performance of a Concurrent Auditory Discrimination Task. Vision (Basel) 2023; 7:vision7010024. [PMID: 36977304 PMCID: PMC10057422 DOI: 10.3390/vision7010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/26/2023] [Accepted: 03/04/2023] [Indexed: 03/30/2023] Open
Abstract
Visuospatial working memory is often assessed using the Corsi block-tapping task where set size is used to estimate capacity. It is well established that characteristics of the Corsi task path configuration such as length, crossings, and angles influence recall accuracy suggesting that more complex path configurations increase the load on working memory. However, the interaction between set size and path configuration is not well understood. Here we used a secondary auditory task to probe if set size and path configuration impose a similar type of load on the system. Nineteen participants (age = 25.3 ± 3.9 years) performed a computerized version of the Corsi test either alone (single) or simultaneously with an auditory tone discrimination task (dual). The eCorsi task involved a set of simple (no crosses, shorter lengths, larger angles) or complex (>2 crosses, longer lengths, smaller angles) paths at set sizes of five to eight blocks. Results showed significantly lower recall accuracy for the complex compared to the simple paths (63.32% vs. 86.38%, p < 0.001) at all set sizes, regardless of task condition (single, dual). Auditory performance (accuracy and response time) was significantly lower in the dual compared to single task (85.34% vs. 99.67%, p < 0.001), but performance was not affected by the complexity of the eCorsi path configuration. These findings suggest that set size and path complexity impose a different type of load on the working memory system and may rely on different resources.
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Affiliation(s)
- Anthony Tapper
- Department of Kinesiology and Health Science, Faculty of Health, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Ewa Niechwiej-Szwedo
- Department of Kinesiology and Health Science, Faculty of Health, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Corbin-Berrigan LA, Teel E, Vinet SA, P De Koninck B, Guay S, Beaulieu C, De Beaumont L. The Use of Electroencephalography as an Informative Tool in Assisting Early Clinical Management after Sport-Related Concussion: a Systematic Review. Neuropsychol Rev 2023; 33:144-159. [PMID: 32577950 DOI: 10.1007/s11065-020-09442-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 06/07/2020] [Indexed: 12/21/2022]
Abstract
Sport-related concussion (SRC) is managed primarily through serial clinical evaluations throughout recovery. However, studies suggest that clinical measures may not be suitable to detect subtle alterations in functioning and are limited by numerous internal and external factors. Electroencephalography (EEG) has been used for over eight decades to discern altered function following illnesses and injuries, including traumatic brain injury. This study evaluated the associations between EEG measures and clinical presentation within three-months following SRC. A systematic review of the literature was performed in Medline, Embase, PsycINFO, CINAHL and Web of Science databases following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines, yielding a total of 13 peer-reviewed articles. Most studies showed low to moderate bias and moderate to high quality. The majority of the existing literature on the impact of concussion within the first 3 months post-injury suggests that individuals with concussion show altered brain function, with EEG abnormalities outlasting clinical dysfunction. Of all EEG biomarkers evaluated, P300 shows the most promise and should be explored further. Despite the relatively high quality of included articles, significant limitations are still present within this body of literature, including potential conflicts of interest and proprietary algorithms, making it difficult to draw strong and meaningful conclusions on the use of EEG in the early stages of SRC. Therefore, further exploration of the relationship between EEG measures and acute clinical presentation is warranted to determine if EEG provides additional benefits over current clinical assessments and is a feasible tool in clinical settings.
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Affiliation(s)
- Laurie-Ann Corbin-Berrigan
- Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | | | | | - Béatrice P De Koninck
- Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Université de Montréal, Montréal, Quebec, Canada
| | - Samuel Guay
- Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Université de Montréal, Montréal, Quebec, Canada
| | | | - Louis De Beaumont
- Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Quebec, Canada. .,Université de Montréal, Montréal, Quebec, Canada.
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12
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Mental Fatigue Uniquely Influences Drop Landing Biomechanics for Individuals With a Concussion History. J Sport Rehabil 2023; 32:353-360. [PMID: 36716746 DOI: 10.1123/jsr.2022-0252] [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: 07/01/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 02/01/2023]
Abstract
CONTEXT Induced mental fatigue negatively impacts sport performance and neurocognition. However, it is unclear how induced mental fatigue influences landing biomechanics. The purpose of this study was to examine the influence of mental fatigue on drop landing biomechanics in individuals with and without a concussion history. DESIGN Crossover design. METHODS Forty-eight (24 per group) recreationally active individuals were matched on age (±3 y), sex, and body mass index (±1 kg/m2). All participants completed an experimental (30-min Stroop task) and control (30-min reading magazines) intervention on separate days separated by a minimum of 24 hours. Drop landings were performed before and after both interventions. Outcomes included peak vertical ground reaction force (vGRF), vertical loading rate (VLR), knee flexion angle, knee abduction angle, external knee flexion moment, external knee abduction moment, and initial ground contact knee flexion and knee abduction angles. Separate 2 (group) × 2 (intervention) between-within analyses of covariance compared drop landing outcomes. Each group's average pre-Stroop and premagazine outcomes were covariates. RESULTS There was a significant interaction for vGRF (P = .033, ηp2=.097) and VLR (P = .0497, ηp2=.083). The vGRF simple effects were not statistically significantly (P range = .052-.325). However, individuals with a concussion history displayed a medium effect size for greater vGRF post-Stroop compared with their own postmagazine vGRF (mean difference (95% confidence interval [95% CI] = 0.163 (-0.002 to 0.327) bodyweight (BW), p = .052, ηp2=.081. In contrast, the control group displayed a small effect size (mean difference [95% CI] = 0.095 [-0.069 to 0.259] BW, p = .251, ηp2=.029). Individuals with a concussion history displayed greater VLR post-Stroop compared with controls (mean difference [95% CI], 26.29 [6.19 to 46.40] BW/s, P = .012, ηp2=.134) and their own postmagazine values (mean difference [95% CI] = 32.61 [7.80 to 57.42] BW/s, p = .011, ηp2=.135). CONCLUSION Mental fatigue leads to greater VLR for individuals with a concussion history. Athletic competition and activities of daily living can increase mental fatigue. Training programs may seek to teach mental fatigue reducing strategies to athletes with a concussion history.
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Mortazavi M, Lucini FA, Joffe D, Oakley DS. Electrophysiological trajectories of concussion recovery: From acute to prolonged stages in late teenagers. J Pediatr Rehabil Med 2023; 16:287-299. [PMID: 36710690 PMCID: PMC10894572 DOI: 10.3233/prm-210114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 10/17/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Numerous studies have reported electrophysiological differences between concussed and non-concussed groups, but few studies have systematically explored recovery trajectories from acute concussion to symptom recovery and the transition from acute concussion to prolonged phases. Questions remain about recovery prognosis and the extent to which symptom resolution coincides with injury resolution. This study therefore investigated the electrophysiological differences in recoveries between simple and complex concussion. METHODS Student athletes with acute concussion from a previous study (19(2) years old) were tracked from pre-injury baseline, 24-48 hours after concussion, and through in-season recovery. The electroencephalography (EEG) with P300 evoked response trajectories from this acute study were compared to an age-matched population of 71 patients (18(2) years old) with prolonged post-concussive symptoms (PPCS), 61 (SD 31) days after concussion. RESULTS Acute, return-to-play, and PPCS groups all experienced a significant deficit in P300 amplitude compared to the pre-injury baseline group. The PPCS group, however, had significantly different EEG spectral and coherence patterns from every other group. CONCLUSION These data suggest that while the evoked response potentials deficits of simple concussion may persist in more prolonged stages, there are certain EEG measures unique to PPCS. These metrics are readily accessible to clinicians and may provide useful parameters to help predict trajectories, characterize injury (phenotype), and track the course of injury.
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Affiliation(s)
- Mo Mortazavi
- SPARCC Sports Medicine, Rehabilitation, and Concussion Center, Tucson, AZ, USA
- Department of Pediatrics, Tucson Medical Center, Tucson, AZ, USA
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14
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Lindsey A, Guernon A, Stika M, Bender Pape T. The diagnostic intersection of cognitive-communication disorders and aphasia secondary to TBI. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:82-93. [PMID: 36068952 DOI: 10.1111/1460-6984.12770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND & AIMS The present retrospective study examines veterans and military personnel who have sustained a cognitive-communication deficit/disorder (CCD) and/or aphasia secondary to traumatic brain injury (TBI). The prevalence of each disorder secondary to TBI is identified and demographic factors are analysed to determine whether specific characteristics (age, gender, race and/or ethnicity) differentially influenced diagnosis (CCD or aphasia). METHODS & PROCEDURES A retrospective analysis examining the prevalence of CCD and aphasia among US service personnel with a complicated mild-to-severe TBI treated over a 4-year period (1 January 2016-31 December 2019) was conducted. Medical diagnoses and demographic factors were obtained from administrative data repositories and a logistic regression was performed to identify the relationship between demographic factors and diagnoses. OUTCOMES & RESULTS Analyses revealed that 8.8% of individuals studied had a secondary diagnosis of CCD (6.9%), aphasia (1.5%) or both (0.4%). This signifies 6863 cases of CCD, 1516 cases of aphasia and 396 cases of CCD and aphasia (dual diagnosis) per 100,000 individuals who have sustained a complicated mild-to-severe TBI. The proportion of cases observed with these diagnoses was consistent with the racial, gender and ethnic demographics of those diagnosed with TBI. Statistical modelling revealed that increased age is predictive of a diagnosis of aphasia relative to CCD. CONCLUSIONS & IMPLICATIONS Service personnel sustaining TBIs are at increased risk of communication impairments with deficits observed across all gender, racial and ethnic demographics. CCD is more commonly observed than aphasia, though clinicians should be cognisant of both when performing assessments. Age is a factor that can influence diagnosis. WHAT THIS PAPER ADDS What is already known on the subject Military personnel are at increased risk of communication disorders (CCDs) with TBI associated with multiple types of communication impairments including CCD, aphasia, dysarthria and apraxia of speech. What this paper adds to existing knowledge This paper examines CCD and aphasia occurring following TBI. The proportion of observed cases of CCD and aphasia secondary to TBI are calculated over a 4-year period and the prevalence of these disorders is provided. Additionally, statistical modelling is used to identify differences in the diagnosis of CCD relative to aphasia using the demographic factors of age, racial identity and ethnicity. What are the potential or actual clinical implications of this work? CCD is a frequently occurring issue following TBI, and the findings of this study demonstrate that it is a concern observed across gender, racial and ethnic lines. Advanced age is linked with the diagnosis of aphasia relative to CCD following TBI and should be a consideration during evaluation of patients who have sustained significant head trauma.
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Affiliation(s)
- André Lindsey
- Nevada State College, School of Education, Henderson, NV, USA
- Research Service, Edward Hines Jr., VA Hospital, Hines, IL, USA
| | - Ann Guernon
- Research Service, Edward Hines Jr., VA Hospital, Hines, IL, USA
- College of Nursing and Health Sciences, Speech-Language Pathology Program, Lewis University, Romeoville, IL, USA
| | - Monica Stika
- Spinal Cord Injury/Disorder Service, Edward Hines Jr., VA Hospital, Hines, IL, USA
| | - Theresa Bender Pape
- Research Service, Edward Hines Jr., VA Hospital, Hines, IL, USA
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Innovation for Complex Chronic Healthcare, Edward Hines Jr., VA Hospital, Hines, IL, USA
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15
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Younger DS. Mild traumatic brain injury and sports-related concussion. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:475-494. [PMID: 37620086 DOI: 10.1016/b978-0-323-98817-9.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Mild traumatic brain injury (mTBI) and concussion are equivalent terms for the sequela of injury to the head that disrupts brain functioning. Various forces may be causative from seemingly innocuous bumps to the head resulting from sports-related injuries to more severe blows to the head. However, the postconcussive motor, cognitive, emotional, and psychosocial sequelae can be just as devastating and long lasting, leading to loss of independent function and safe performance of activities. Taken together, they pose a significant challenge to recovery, requiring a multifaceted dynamic rehabilitative strategy. The current systems of health care pose challenges to suboptimal management of sports-related concussion (SRC) that goes beyond the acute injury, and into the school setting, failing to be identified by school staff, and inconsistencies in communicating medical information regarding school modifications, follow-up health services, or concussion-related educational services. Children who sustain SRC at different ages face different challenges. Young children face increased vulnerability due to SRC that coincides with periods of brain motor maturation and development.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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16
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Mitra B, Beck B, Dipnall JF, Ponsford J, Gabbe B, Cameron PA. Long-term outcomes of major trauma patients with concussion. Injury 2023; 54:75-81. [PMID: 35965130 DOI: 10.1016/j.injury.2022.07.048] [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] [Received: 12/14/2021] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Concussion may be sustained in the setting of injuries to multiple body regions and persistent effects of concussion may impact recovery. This project aimed to evaluate the association between concussion and 6-month and 12-month functional outcomes in survivors after major trauma. METHODS This was a registry-based cohort study that included adult patients with major trauma who presented to hospital between 01 Jan 2008 and 31 Dec 2017 and survived to hospital discharge. We excluded patients presenting with a Glasgow Coma Scale score <13 and those diagnosed with other intracranial injuries. Additionally, from the non-concussed group, patients with fractured skull and/or face were excluded, with the assumption that such patients may have had undiagnosed concussion. A good recovery was considered for Glasgow Outcome Scale-Extended (GOS-E) scores of 7 or 8. In addition, we assessed for patient reported anxiety and/or depression measured using the 3-level EuroQol 5 dimensions questionnaire. A modified mixed effects Poisson models with random intercepts for participant was used to assess the association between concussion and outcome. RESULTS There were 28,161 eligible patients and 12,822 met inclusion criteria. Concussion was diagnosed in 1860 patients (14.5%; 95%CI: 13.9-15.1). There was no association between concussion and good recovery at 12 months (aRR 1.05 (95%CI: 0.99-1.11). There was no association between concussion and anxiety and/or depression at 12 months (aRR 1.03; 95%CI: 0.99-1.07). CONCLUSIONS Concussion was sustained among 14.5% of included patients in the setting of major trauma but not associated with longer-term adverse outcomes using GOS-E. Concussed patients did not report differential rates of anxiety and/or depression.
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Affiliation(s)
- Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Emergency & Trauma Centre, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia; National Trauma Research Institute, The Alfred Hospital, Victoria, Australia.
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Joanna F Dipnall
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Victoria, Australia; Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Victoria, Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Emergency & Trauma Centre, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia; National Trauma Research Institute, The Alfred Hospital, Victoria, Australia
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17
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Pearce AJ, King D, Kidgell DJ, Frazer AK, Tommerdahl M, Suter CM. Assessment of Somatosensory and Motor Processing Time in Retired Athletes with a History of Repeated Head Trauma. J Funct Morphol Kinesiol 2022; 7:jfmk7040109. [PMID: 36547655 PMCID: PMC9782447 DOI: 10.3390/jfmk7040109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Measurement of the adverse outcomes of repeated head trauma in athletes is often achieved using tests where the comparator is ‘accuracy’. While it is expected that ex-athletes would perform worse than controls, previous studies have shown inconsistent results. Here we have attempted to address these inconsistencies from a different perspective by quantifying not only accuracy, but also motor response times. Age-matched control subjects who have never experienced head trauma (n = 20; 41.8 ± 14.4 years) where compared to two cohorts of retired contact sport athletes with a history of head trauma/concussions; one with self-reported concerns (n = 36; 45.4 ± 12.6 years), and another with no ongoing concerns (n = 19; 43.1 ± 13.5 years). Participants performed cognitive (Cogstate) and somatosensory (Cortical Metrics) testing with accuracy and motor times recorded. Transcranial magnetic stimulation (TMS) investigated corticospinal conduction and excitability. Results showed that there was little difference between groups in accuracy scores. Conversely, motor times in all but one test revealed that ex-athletes with self-reported concerns were significantly slower compared to other groups (p ranges 0.031 to <0.001). TMS latency showed significantly increased time (p = 0.008) in the group with ongoing concerns. These findings suggest that incorporating motor times is more informative than considering accuracy scores alone.
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Affiliation(s)
- Alan J. Pearce
- College of Science, Health and Engineering, La Trobe University, Melbourne 3016, Australia
- Correspondence:
| | - Doug King
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland 1142, New Zealand
- Wolfson Research Institute for Health and Wellbeing, Department of Sport and Exercise Sciences, Durham University, Durham DH1 3LE, UK
| | - Dawson J. Kidgell
- Faculty of Medicine Nursing and Health Science, Monash University, Melbourne 3800, Australia
| | - Ashlyn K. Frazer
- Faculty of Medicine Nursing and Health Science, Monash University, Melbourne 3800, Australia
| | - Mark Tommerdahl
- Cortical Metrics, Carrboro, NC 27510, USA
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC 27510, USA
| | - Catherine M. Suter
- Department of Neuropathology, Royal Prince Alfred Hospital, Sydney 2050, Australia
- Brain and Mind Centre, University Sydney, Camperdown 2050, Australia
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18
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Hogg JA, Riehm CD, Wilkerson GB, Tudini F, Peyer KL, Acocello SN, Carlson LM, Le T, Sessions R, Diekfuss JA, Myer GD. Changes in dual-task cognitive performance elicited by physical exertion vary with motor task. Front Sports Act Living 2022; 4:989799. [PMID: 36385777 PMCID: PMC9650128 DOI: 10.3389/fspor.2022.989799] [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: 07/08/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
Background Integrated movement and cognitive load paradigms are used to expose impairments associated with concussion and musculoskeletal injury. There is currently little information on the discriminatory nature of dual-task complexity and the relative influence of physical exertion on cognitive outcomes. Purpose Assess cognitive performance while under motor conditions of increasing complexity before and after a standardized exercise protocol. Methods 34 participants were recruited (17 male and 17 female; 24 ± 1.4 yrs). A modified Eriksen flanker test was used to assess cognitive performance under four conditions (seated, single-leg stance, walking, and lateral stepping) before and after a 20-min moderate-to vigorous intensity treadmill protocol. The flanker test consisted of 20 sets of 5-arrow configurations, appearing in random order. To complete the response to cognitive stimulus, participants held a smartphone horizontally and were instructed to respond as quickly and as accurately as possible by tilting the device in the direction corresponding to the orientation of the middle arrow. The metrics used for analysis included average reaction time (ms), inverse efficiency index (average reaction time penalized for incorrect responses), and conflict effect (the average time cost of responding to an incongruent repetition vs. a congruent repetition). Mixed effects (condition by time) RMANOVAs were conducted to examine the effects of motor task complexity and physical exertion on cognitive performance. Results There was a condition by time interaction for inverse efficiency index (p < 0.001), in which participants displayed higher cognitive efficiency for the pre-activity lateral stepping condition compared to the other three conditions (Cohen's d = 1.3–1.6). For reaction time and conflict effect, there were main effects for condition (p = 0.004 and 0.006, respectively), in which performance during lateral stepping was improved in relation to the seated condition (reaction time Cohen's d = 0.68; conflict effect Cohen's d = 0.64). Conclusion Participants tended to display better dual-task cognitive performance under more stimulating or complex motor tasks before physical exertion, likely associated with the inverted-U arousal-performance relationship. When using dual-task assessments, clinicians should be mindful of the accompanying motor task and baseline exertion levels and their potential to disrupt or optimize cognitive performance.
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Affiliation(s)
- Jennifer A. Hogg
- Department of Health and Human Performance, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
- *Correspondence: Jennifer A. Hogg
| | - Christopher D. Riehm
- Emory Sports Performance And Research Center, Flowery Branch, GA, United States
- Emory Sports Medicine Center, Atlanta, GA, United States
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, United States
| | - Gary B. Wilkerson
- Department of Health and Human Performance, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Frank Tudini
- Department of Physical Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Karissa L. Peyer
- Department of Health and Human Performance, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Shellie N. Acocello
- Department of Health and Human Performance, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Lynette M. Carlson
- Department of Health and Human Performance, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Tan Le
- Upstream Rehabilitation, Raymond, MS, United States
| | - Ross Sessions
- Cornerstone Rehabilitation, Southaven, MS, United States
| | - Jed A. Diekfuss
- Emory Sports Performance And Research Center, Flowery Branch, GA, United States
- Emory Sports Medicine Center, Atlanta, GA, United States
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, United States
| | - Gregory D. Myer
- Emory Sports Performance And Research Center, Flowery Branch, GA, United States
- Emory Sports Medicine Center, Atlanta, GA, United States
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, United States
- The Micheli Center for Sports Injury Prevention, Waltham, MA, United States
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19
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Tapper A, Staines WR, Niechwiej-Szwedo E. EEG reveals deficits in sensory gating and cognitive processing in asymptomatic adults with a history of concussion. Brain Inj 2022; 36:1266-1279. [PMID: 36071612 DOI: 10.1080/02699052.2022.2120210] [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: 12/14/2022]
Abstract
OBJECTIVE Individuals with a concussion history tend to perform worse on dual-tasks compared controls but the underlying neural mechanisms contributing to these deficits are not understood. This study used event-related potentials (ERPs) to investigate sensory gating and cognitive processing in athletes with and without a history of concussion while they performed a challenging dual-task. METHODS We recorded sensory (P50, N100) and cognitive (P300) ERPs in 30 athletes (18 no previous concussion; 12 history of concussion) while they simultaneously performed an auditory oddball task and a working memory task that progressively increased in difficulty. RESULTS The concussion group had reduced auditory performance as workload increased compared to the no-concussion group. Sensory gating and cognitive processing were reduced in the concussion group indicating problems with filtering relevant from irrelevant information and appropriately allocating resources. Sensory gating (N100) was positively correlated with cognitive processing (P300) at the hardest workload in the no-concussion group but negatively correlated in the concussion group. CONCLUSION Concussions result in long-term problems in behavioral performance, which may be due to poorer sensory gating that impacts cognitive processing. SIGNIFICANCE Problems effectively gating sensory information may influence the availability or allocation of attention at the cognitive stage in those with a concussion.
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Affiliation(s)
- Anthony Tapper
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
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20
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Cunningham J, O'Dowd A, Broglio SP, Newell FN, Kelly Á, Joyce O, Januszewski J, Wilson F. Multisensory perception is not influenced by previous concussion history in retired rugby union players. Brain Inj 2022; 36:1123-1132. [PMID: 35994241 DOI: 10.1080/02699052.2022.2109732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND To assess whether concussion history adversely affects multisensory integration, we compared susceptibility to the Sound-Induced Flash Illusion (SIFI) in retired professional rugby players compared to controls. METHODS Retired professional rugby players ((N = 58) and retired international rowers (N = 26) completed a self-report concussion history questionnaire and the SIFI task. Susceptibility to the SIFI (i.e., perceiving two flashes in response to one flash paired with two beeps) was assessed at three stimulus onset asynchronies (70 ms, 150 ms or 230 ms).Logistic mixed-effects regression modeling was implemented to evaluate how athlete grouping, previous concussion history and total number of years playing sport, impacted the susceptibility to the SIFI task. The statistical significance of a fixed effect of interest was determined by a likelihood ratio test. RESULTS Former rugby players had significantly more self-reported concussions than the rower group (p < 0.001). There was no impact of athlete grouping (i.e., retired professional rugby players and retired international rowers), years participation in elite sport or concussion history on performance in the SIFI. CONCLUSION A career in professional rugby, concussion history or number of years participating in professional rugby was not found to be predictive of performance on the SIFI task.
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Affiliation(s)
- Joice Cunningham
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Alan O'Dowd
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Fiona N Newell
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Áine Kelly
- Department of Physiology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Oisín Joyce
- Department of Physiology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Julia Januszewski
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Fiona Wilson
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Cortical inhibition in neurofibromatosis type 1 is modulated by lovastatin, as demonstrated by a randomized, triple-blind, placebo-controlled clinical trial. Sci Rep 2022; 12:13814. [PMID: 35970940 PMCID: PMC9378617 DOI: 10.1038/s41598-022-17873-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/02/2022] [Indexed: 11/24/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is associated with GABAergic dysfunction which has been suggested as the underlying cause of cognitive impairments. Previous intervention trials investigated the statins’ effects using cognitive outcome measures. However, available outcome measures have led to inconclusive results and there is a need to identify other options. Here, we aimed at investigating alternative outcome measures in a feasibility trial targeting cortical inhibition mechanisms known to be altered in NF1. We explored the neurochemical and physiological changes elicited by lovastatin, with magnetic resonance spectroscopy and transcranial magnetic stimulation (TMS). Fifteen NF1 adults participated in this randomized, triple-blind, placebo-controlled crossover trial (Clinicaltrials.gov NCT03826940) composed of one baseline and two reassessment visits after lovastatin/placebo intake (60 mg/day, 3-days). Motor cortex GABA+ and Glx concentrations were measured using HERMES and PRESS sequences, respectively. Cortical inhibition was investigated by paired-pulse, input–output curve, and cortical silent period (CSP) TMS protocols. CSP ratios were significantly increased by lovastatin (relative: p = 0.027; absolute: p = 0.034) but not by placebo. CSP durations showed a negative correlation with the LICI 50 ms amplitude ratio. Lovastatin was able to modulate cortical inhibition in NF1, as assessed by TMS CSP ratios. The link between this modulation of cortical inhibition and clinical improvements should be addressed by future large-scale studies.
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22
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Chauhan AV, Guralnik J, dosReis S, Sorkin JD, Badjatia N, Albrecht JS. Repetitive Traumatic Brain Injury Among Older Adults. J Head Trauma Rehabil 2022; 37:E242-E248. [PMID: 34320558 PMCID: PMC8789954 DOI: 10.1097/htr.0000000000000719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine the incidence of and assess risk factors for repetitive traumatic brain injury (TBI) among older adults in the United States. DESIGN Retrospective cohort study. SETTING Administrative claims data obtained from the Centers for Medicare & Medicaid Services' Chronic Conditions Data Warehouse. PARTICIPANTS Individuals 65 years or older and diagnosed with TBI between July 2008 and September 2012 drawn from a 5% random sample of US Medicare beneficiaries. MAIN MEASURES Repetitive TBI was identified as a second TBI occurring at least 90 days after the first occurrence of TBI following an 18-month TBI-free period. We identified factors associated with repetitive TBI using a log-binomial model. RESULTS A total of 38 064 older Medicare beneficiaries experienced a TBI. Of these, 4562 (12%) beneficiaries sustained at least one subsequent TBI over up to 5 years of follow-up. The unadjusted incidence rate of repetitive TBI was 3022 (95% CI, 2935-3111) per 100 000 person-years. Epilepsy was the strongest predictor of repetitive TBI (relative risk [RR] = 1.44; 95% CI, 1.25-1.56), followed by Alzheimer disease and related dementias (RR = 1.32; 95% CI 1.20-1.45), and depression (RR = 1.30; 95% CI, 1.21-1.38). CONCLUSIONS Injury prevention and fall-reduction interventions could be targeted to identify groups of older adults at an increased risk of repetitive head injury. Future work should focus on injury-reduction initiatives to reduce the risk of repetitive TBI as well as assessment of outcomes related to repetitive TBI.
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Affiliation(s)
- Aparna Vadlamani Chauhan
- Departments of Epidemiology and Public Health (Drs Chauhan, Guralnik, and Albrecht) and Neurology (Dr Badjatia), University of Maryland School of Medicine, Baltimore; Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore (Dr dosReis); Baltimore VA Geriatric Research, Education and Clinical Center (Dr Sorkin); and Department of Medicine, Division of Gerontology and Geriatrics, University of Maryland School of Medicine, Baltimore (Dr Sorkin)
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23
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Pauhl A, Yasen A, Christie A. Corticospinal Excitability and Inhibition Are Not Different between Concussed Males and Females. Brain Sci 2022; 12:brainsci12070824. [PMID: 35884631 PMCID: PMC9313179 DOI: 10.3390/brainsci12070824] [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: 04/13/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
It has been consistently demonstrated that females report greater numbers of concussions in sex-comparable sports and take longer to recover from concussive symptoms than males. However, it is unknown if the neurophysiological consequences of concussion may contribute to these sex differences in concussion symptoms and recovery. The purpose of this study was to examine potential sex-related differences in neurophysiology in healthy and concussed individuals. Twenty-one (nine F) concussed individuals (20.9 ± 4.1 years; CONC) and twenty-one age-, sex-, height-, weight-, and activity-matched controls (21.2 ± 4.2 years; CONT) participated in the study. The CONC group reported to the lab within 72 h, 1-week, and 2-weeks post-injury and the CONT group followed a similar measurement schedule. Using transcranial magnetic stimulation, motor evoked potential (MEP) amplitude and cortical silent period (CSP) duration were measured from the first dorsal interosseous muscle to assess corticospinal excitability and inhibition, respectively. There were no significant differences across time (p ≥ 0.13) or between the CONC and CONT group in MEP amplitude (p = 0.72) or CSP duration (p = 0.54). Overall, males (119.08 ± 29.91 ms) had significantly longer CSP durations compared with females (101.24 ± 33.43 ms), indicating greater corticospinal inhibition in males, regardless of injury status (p = 0.04). An important and novel finding of this study was the lack of differences in these neurophysiological measures between males and females following concussion. To our knowledge, this is the first study to document greater corticospinal inhibition in males compared with females.
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Affiliation(s)
- Alexandra Pauhl
- Faculty of Health Sciences, School of Kinesiology, Western University, London, ON N6A 2X2, Canada;
| | - Alia Yasen
- Department of Human Physiology, University of Oregon, Eugene, OR 97403, USA;
| | - Anita Christie
- Faculty of Health Sciences, School of Kinesiology, Western University, London, ON N6A 2X2, Canada;
- Correspondence: ; Tel.: +1-(519)-661-2111 (ext. 80984)
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24
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Towards defining biomarkers to evaluate concussions using virtual reality and a moving platform (BioVRSea). Sci Rep 2022; 12:8996. [PMID: 35637235 PMCID: PMC9151646 DOI: 10.1038/s41598-022-12822-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Current diagnosis of concussion relies on self-reported symptoms and medical records rather than objective biomarkers. This work uses a novel measurement setup called BioVRSea to quantify concussion status. The paradigm is based on brain and muscle signals (EEG, EMG), heart rate and center of pressure (CoP) measurements during a postural control task triggered by a moving platform and a virtual reality environment. Measurements were performed on 54 professional athletes who self-reported their history of concussion or non-concussion. Both groups completed a concussion symptom scale (SCAT5) before the measurement. We analyzed biosignals and CoP parameters before and after the platform movements, to compare the net response of individual postural control. The results showed that BioVRSea discriminated between the concussion and non-concussion groups. Particularly, EEG power spectral density in delta and theta bands showed significant changes in the concussion group and right soleus median frequency from the EMG signal differentiated concussed individuals with balance problems from the other groups. Anterior–posterior CoP frequency-based parameters discriminated concussed individuals with balance problems. Finally, we used machine learning to classify concussion and non-concussion, demonstrating that combining SCAT5 and BioVRSea parameters gives an accuracy up to 95.5%. This study is a step towards quantitative assessment of concussion.
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25
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Functional, but Minimal Microstructural Brain Changes Present in Aging Canadian Football League Players Years After Retirement. BRAIN DISORDERS 2022. [DOI: 10.1016/j.dscb.2022.100036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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26
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The Bidirectional Link Between Sleep Disturbances and Traumatic Brain Injury Symptoms: A Role for Glymphatic Dysfunction? Biol Psychiatry 2022; 91:478-487. [PMID: 34481662 PMCID: PMC8758801 DOI: 10.1016/j.biopsych.2021.06.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/14/2022]
Abstract
Mild traumatic brain injury (mTBI), often referred to as concussion, is a major cause of morbidity and mortality worldwide. Sleep disturbances are common after mTBI. Moreover, subjects who develop subjective sleep complaints after mTBI also report more severe somatic, mental health, and cognitive impairment and take longer to recover from mTBI sequelae. Despite many previous studies addressing the role of sleep in post-mTBI morbidity, the mechanisms linking sleep to recovery after mTBI remain poorly understood. The glymphatic system is a brainwide network that supports fluid movement through the cerebral parenchyma and the clearance of interstitial solutes and wastes from the brain. Notably, the glymphatic system is active primarily during sleep. Clearance of cellular byproducts related to somatic, mental health, and neurodegenerative processes (e.g., amyloid-β and tau, among others) depends in part on intact glymphatic function, which becomes impaired after mTBI. In this viewpoint, we review the current knowledge regarding the association between sleep disturbances and post-mTBI symptoms. We also discuss the role of glymphatic dysfunction as a potential link between mTBI, sleep disruption, and posttraumatic morbidity. We outline a model where glymphatic dysfunction and sleep disruption caused by mTBI may have an additive effect on waste clearance, leading to cerebral dysfunction and impaired recovery. Finally, we review the novel techniques being developed to examine glymphatic function in humans and explore potential interventions to alter glymphatic exchange that may offer a novel therapeutic approach to those experiencing poor sleep and prolonged symptoms after mTBI.
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27
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Hogg JA, Avedesian JM, Diekfuss JA, Acocello SN, Shimmin RD, Kelley EA, Kostrub DA, Myer GD, Wilkerson GB. Sex Moderates the Relationship between Perceptual-Motor Function and Single-Leg Squatting Mechanics. J Sports Sci Med 2022; 21:104-111. [PMID: 35250339 PMCID: PMC8851119 DOI: 10.52082/jssm.2022.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
To examine the isolated and combined effects of sex and perceptual-motor function on single-leg squatting mechanics in males and females. We employed a cross-sectional design in a research laboratory. Fifty-eight females (22.2 ± 3.5 yrs, 1.60 ± .07 m, 64.1 ± 13.0 kg) and 35 males (23.5 ± 5.0 yrs, 1.80 ± .06m, 84.7 ± 15.3 kg) free from time-loss injury in the six months prior, vertigo, and vestibular conditions participated in this study. Independent variables were sex, perceptual-motor metrics (reaction time, efficiency index, conflict discrepancy), and interaction effects. Dependent variables were peak frontal plane angles of knee projection, ipsilateral trunk flexion, and contralateral pelvic drop during single-leg squatting. After accounting for the sex-specific variance and perceptual-motor function effects on frontal plane squatting kinematics, female sex amplified the associations of: higher reaction time, lower efficiency index, and higher conflict discrepancy with greater right ipsilateral peak trunk lean (R2 = .13; p = .05); higher reaction time, lower efficiency index, and higher conflict discrepancy with decreased right contralateral pelvic drop (R2 = .22; p < .001); higher reaction time and lower conflict discrepancy with greater right frontal plane knee projection angle (R2 = .12; p = .03); and higher reaction time with greater left frontal plane knee projection angle (R2 = .22; p < .001). Female sex amplified the relationship between perceptual-motor function and two-dimensional frontal plane squatting kinematics. Future work should determine the extent to which perceptual-motor improvements translate to safer movement strategies.
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Affiliation(s)
- Jennifer A Hogg
- Department of Health and Human Performance, The University of Tennessee Chattanooga, Chattanooga, TN, USA
| | | | - Jed A Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Shellie N Acocello
- Department of Health and Human Performance, The University of Tennessee Chattanooga, Chattanooga, TN, USA
| | | | | | | | - Gregory D Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Gary B Wilkerson
- Department of Health and Human Performance, The University of Tennessee Chattanooga, Chattanooga, TN, USA
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28
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Hume PA, Quarrie KL, Lewis GN, Theadom A. NZ-RugbyHealth Study: Self-reported Injury Experience and Current Health of Former Rugby Union and Non-contact Sport Players. Sports Med 2022; 52:1701-1713. [PMID: 35088235 PMCID: PMC9213390 DOI: 10.1007/s40279-021-01630-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/25/2022]
Abstract
Background There is limited research on associations between playing rugby union and player health post-retirement. Objective This study investigated differences in self-reported sport injury history and current self-reported health characteristics between former New Zealand rugby and non-contact sport players with a view to identifying issues to be further investigated with stronger epidemiological research designs. Methods Using a cross-sectional design, the NZ-RugbyHealth study surveyed 470 former rugby and non-contact sport players (43.8 ± 8.1 years; 127 elite rugby, 271 community rugby, 72 non-contact sport) recruited from October 2012 to April 2014. Demographic information, engagement in sport, sport injuries, medical conditions, mood, alcohol and substance use and ratings of current health status were obtained from a self-report 58-item general health e-questionnaire. We highlighted standardised differences in means of > 0.6 and differences in relative percentages of > 1.43 for variables between groups as representing at least moderate effect sizes, and of being worthy of follow-up studies. Results Higher percentages of the elite rugby player group had sustained injuries of a given body-site type (e.g. neck sprain/strain, thigh bruising, hamstring strain) combination than the non-contact sports players. Higher percentages of the rugby groups reported having sustained concussion (94% for elite, 82% for community, 26% for non-contact), injuries requiring hospitalisation (73%, 46%, 25%), injuries that stopped participation in sport permanently (28%, 28%, 11%) and sport-related surgery (72%, 46%, 32%) during their playing career. Both rugby groups had a higher prevalence of osteoarthritis (37%, 18%, 6%) than non-contact athletes and community rugby players had higher levels of hazardous alcohol consumption (38%, 40%, 25%) in retirement than non-contact athletes. There was little difference between rugby players and non-contact sports athletes in self-reported mood, substance use and current physical or psychological health ratings. Conclusions Former rugby player groups were at higher risk than the non-contact player group for most injuries during their playing careers, and in retirement had greater prevalence of osteoarthritis and hazardous alcohol consumption. The relative youth of the groups (43.8 years on average) means that health issues that typically do not emerge until later life may not have yet manifested. Supplementary Information The online version contains supplementary material available at 10.1007/s40279-021-01630-7.
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Affiliation(s)
- Patria A Hume
- Sport Performance Research Institute New Zealand, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand. .,Traumatic Brain Injury Network (TBIN), Auckland University of Technology, Auckland, New Zealand.
| | - Kenneth L Quarrie
- Sport Performance Research Institute New Zealand, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.,New Zealand Rugby, Wellington, New Zealand
| | - Gwyn N Lewis
- Health and Rehabilitation Research Institute (HRRI), Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- Traumatic Brain Injury Network (TBIN), Auckland University of Technology, Auckland, New Zealand
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29
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Wilde EA, Wanner I, Kenney K, Gill J, Stone JR, Disner S, Schnakers C, Meyer R, Prager EM, Haas M, Jeromin A. A Framework to Advance Biomarker Development in the Diagnosis, Outcome Prediction, and Treatment of Traumatic Brain Injury. J Neurotrauma 2022; 39:436-457. [PMID: 35057637 PMCID: PMC8978568 DOI: 10.1089/neu.2021.0099] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Elisabeth A. Wilde
- University of Utah, Neurology, 383 Colorow, Salt Lake City, Utah, United States, 84108
- VA Salt Lake City Health Care System, 20122, 500 Foothill Dr., Salt Lake City, Utah, United States, 84148-0002
| | - Ina Wanner
- UCLA, Semel Institute, NRB 260J, 635 Charles E. Young Drive South, Los Angeles, United States, 90095-7332, ,
| | - Kimbra Kenney
- Uniformed Services University of the Health Sciences, Neurology, Center for Neuroscience and Regenerative Medicine, 4301 Jones Bridge Road, Bethesda, Maryland, United States, 20814
| | - Jessica Gill
- National Institutes of Health, National Institute of Nursing Research, 1 cloister, Bethesda, Maryland, United States, 20892
| | - James R. Stone
- University of Virginia, Radiology and Medical Imaging, Box 801339, 480 Ray C. Hunt Dr. Rm. 185, Charlottesville, Virginia, United States, 22903, ,
| | - Seth Disner
- Minneapolis VA Health Care System, 20040, Minneapolis, Minnesota, United States
- University of Minnesota Medical School Twin Cities, 12269, 10Department of Psychiatry and Behavioral Sciences, Minneapolis, Minnesota, United States
| | - Caroline Schnakers
- Casa Colina Hospital and Centers for Healthcare, 6643, Pomona, California, United States
- Ronald Reagan UCLA Medical Center, 21767, Los Angeles, California, United States
| | - Restina Meyer
- Cohen Veterans Bioscience, 476204, New York, New York, United States
| | - Eric M Prager
- Cohen Veterans Bioscience, 476204, External Affairs, 535 8th Ave, New York, New York, United States, 10018
| | - Magali Haas
- Cohen Veterans Bioscience, 476204, 535 8th Avenue, 12th Floor, New York City, New York, United States, 10018,
| | - Andreas Jeromin
- Cohen Veterans Bioscience, 476204, Translational Sciences, Cambridge, Massachusetts, United States
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30
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Osman SM, Soliman HSM, Hamed FM, Marrez DA, El-Gazar AA, Alazzouni AS, Nasr T, Ibrahim HA. Neuroprotective Role of Microbial Biotransformed Metabolites of Sinapic Acid on Repetitive Traumatic Brain Injury in Rats. PHARMACOPHORE 2022. [DOI: 10.51847/1rj6v3egdu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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31
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Bernardino I, Dionísio A, Violante IR, Monteiro R, Castelo-Branco M. Motor Cortex Excitation/Inhibition Imbalance in Young Adults With Autism Spectrum Disorder: A MRS-TMS Approach. Front Psychiatry 2022; 13:860448. [PMID: 35492696 PMCID: PMC9046777 DOI: 10.3389/fpsyt.2022.860448] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/21/2022] [Indexed: 12/28/2022] Open
Abstract
Excitatory/inhibitory imbalance has been suggested as a neurobiological substrate of the cognitive symptomatology in Autism Spectrum Disorder (ASD). Studies using magnetic resonance spectroscopy (MRS) attempted to characterize GABA and Glutamate brain levels in ASD. However mixed findings have been reported. Here, we characterize both neurochemical and physiological aspects of GABA system in ASD by implementing a more comprehensive approach combining MRS and transcranial magnetic stimulation (TMS). A group of 16 young ASD adults and a group of 17 controls participated in this study. We employed one MRS session to assess motor cortex GABA+ and Glutamate+Glutamine (Glx) levels using MEGAPRESS and PRESS sequences, respectively. Additionally, a TMS experiment was implemented including paired-pulse (SICI, ICF and LICI), input-output curve and cortical silent period to probe cortical excitability. Our results showed a significantly increased Glx, with unchanged GABA+ levels in the ASD group compared with controls. Single TMS measures did not differ between groups, although exploratory within-group analysis showed impaired inhibition in SICI5ms, in ASD. Importantly, we observed a correlation between GABA levels and measures of the input-output TMS recruitment curve (slope and MEP amplitude) in the control group but not in ASD, as further demonstrated by direct between group comparisons. In this exploratory study, we found evidence of increased Glx levels which may contribute to ASD excitatory/inhibitory imbalance while highlighting the relevance of conducting further larger-scale studies to investigate the GABA system from complementary perspectives, using both MRS and TMS techniques.
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Affiliation(s)
- Inês Bernardino
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal.,Institute of Nuclear Sciences Applied to Health, University of Coimbra, Coimbra, Portugal
| | - Ana Dionísio
- Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal.,Institute of Nuclear Sciences Applied to Health, University of Coimbra, Coimbra, Portugal
| | - Inês R Violante
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Raquel Monteiro
- Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal.,Institute of Nuclear Sciences Applied to Health, University of Coimbra, Coimbra, Portugal
| | - Miguel Castelo-Branco
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal.,Institute of Nuclear Sciences Applied to Health, University of Coimbra, Coimbra, Portugal
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32
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Wilkerson GB, Bruce JR, Wilson AW, Huang N, Sartipi M, Acocello SN, Hogg JA, Mansouri M. Perceptual-Motor Efficiency and Concussion History Are Prospectively Associated With Injury Occurrences Among High School and Collegiate American Football Players. Orthop J Sports Med 2021; 9:23259671211051722. [PMID: 34722788 PMCID: PMC8552393 DOI: 10.1177/23259671211051722] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background: After a sport-related concussion (SRC), the risk for lower extremity injury is approximately 2 times greater, and the risk for another SRC may be as much as 3 to 5 times greater. Purpose: To assess the predictive validity of screening methods for identification of individual athletes who possess an elevated risk of SRC. Study Design: Case-control study; Level of evidence, 3. Methods: Metrics derived from a smartphone flanker test software application and self-ratings of both musculoskeletal function and overall wellness were acquired from American high school and college football players before study participation. Occurrences of core or lower extremity injury (CLEI) and SRC were documented for all practice sessions and games for 1 season. Receiver operating characteristic and logistic regression analyses were used to identify variables that provided the greatest predictive accuracy for CLEI or SRC occurrence. Results: Overall, there were 87 high school and 74 American college football players included in this study. At least 1 CLEI was sustained by 45% (39/87) of high school players and 55% (41/74) of college players. Predictors of CLEI included the flanker test conflict effect ≥69 milliseconds (odds ratio [OR], 2.12; 90% CI, 1.24-3.62) and a self-reported lifetime history of SRC (OR, 1.70; 90% CI, 0.90-3.23). Of players with neither risk factor, only 38% (29/77) sustained CLEI compared with 61% (51/84) of players with 1 or both of the risk factors (OR, 2.56; 90% CI, 1.50-4.36). SRC was sustained by 7 high school players and 3 college players. Predictors of SRC included the Overall Wellness Index score ≤78 (OR, 9.83; 90% CI, 3.17-30.50), number of postconcussion symptoms ≥4 (OR, 8.35; 90% CI, 2.71-25.72), the Sport Fitness Index score ≤78 (OR, 5.16; 90% CI, 1.70-15.65), history of SRC (OR, 4.03; 90% CI, 1.35-12.03), and the flanker test inverse efficiency ratio ≥1.7 (OR, 3.19; 90% CI, 1.08-9.47). Conclusion: Survey responses and smartphone flanker test metrics predicted greater injury incidence among individual football players classified as high-risk compared with that for players with a low-risk profile.
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Affiliation(s)
- Gary B Wilkerson
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, Tennessee, USA
| | - Jeremy R Bruce
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee, USA
| | - Andrew W Wilson
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, Tennessee, USA
| | - Neal Huang
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee, USA
| | - Mina Sartipi
- Center for Urban Informatics and Progress, University of Tennessee at Chattanooga, Chattanooga, Tennessee, USA
| | - Shellie N Acocello
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, Tennessee, USA
| | - Jennifer A Hogg
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, Tennessee, USA
| | - Misagh Mansouri
- Center for Urban Informatics and Progress, University of Tennessee at Chattanooga, Chattanooga, Tennessee, USA
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33
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Wilkerson GB, Nabhan DC, Perry TS. A Novel Approach to Assessment of Perceptual-Motor Efficiency and Training-Induced Improvement in the Performance Capabilities of Elite Athletes. Front Sports Act Living 2021; 3:729729. [PMID: 34661098 PMCID: PMC8517233 DOI: 10.3389/fspor.2021.729729] [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: 06/23/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Standard clinical assessments of mild traumatic brain injury are inadequate to detect subtle abnormalities that can be revealed by sophisticated diagnostic technology. An association has been observed between sport-related concussion (SRC) and subsequent musculoskeletal injury, but the underlying neurophysiological mechanism is not currently understood. A cohort of 16 elite athletes (10 male, 6 female), which included nine individuals who reported a history of SRC (5 male, 4 female) that occurred between 4 months and 8 years earlier, volunteered to participate in a 12-session program for assessment and training of perceptual-motor efficiency. Performance metrics derived from single- and dual-task whole-body lateral and diagonal reactive movements to virtual reality targets in left and right directions were analyzed separately and combined in various ways to create composite representations of global function. Intra-individual variability across performance domains demonstrated very good SRC history classification accuracy for the earliest 3-session phase of the program (Reaction Time Dispersion AUC = 0.841; Deceleration Dispersion AUC = 0.810; Reaction Time Discrepancy AUC = 0.825, Deceleration Discrepancy AUC = 0.794). Good earliest phase discrimination was also found for Composite Asymmetry between left and right movement directions (AUC = 0.778) and Excursion Average distance beyond the minimal body displacement necessary for virtual target deactivation (AUC = 0.730). Sensitivity derived from Youden's Index for the 6 global factors ranged from 67 to 89% and an identical specificity value of 86% for all of them. Median values demonstrated substantial improvement from the first 3-session phase to the last 3-session phase for Composite Asymmetry and Excursion Average. The results suggest that a Composite Asymmetry value ≥ 0.15 and an Excursion Average value ≥ 7 m, provide reasonable qualitative approximations for clinical identification of suboptimal perceptual-motor performance. Despite acknowledged study limitations, the findings support a hypothesized relationship between whole-body reactive agility performance and functional connectivity among brain networks subserving sensory perception, cognitive decision-making, and motor execution. A complex systems approach appears to perform better than traditional data analysis methods for detection of subtle perceptual-motor impairment, which has the potential to advance both clinical management of SRC and training for performance enhancement.
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Affiliation(s)
- Gary B Wilkerson
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Dustin C Nabhan
- Oslo Sports Trauma Research Center, Norwegian School of Sport Science, Oslo, Norway
| | - Tyler S Perry
- Orthopedics and Sports Medicine, Emory Healthcare, Atlanta, GA, United States
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34
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Leaston J, Qiao J, Harding IC, Kulkarni P, Gharagouzloo C, Ebong E, Ferris CF. Quantitative Imaging of Blood-Brain Barrier Permeability Following Repetitive Mild Head Impacts. Front Neurol 2021; 12:729464. [PMID: 34659094 PMCID: PMC8515019 DOI: 10.3389/fneur.2021.729464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/24/2021] [Indexed: 12/28/2022] Open
Abstract
This was an exploratory study designed to evaluate the feasibility of a recently established imaging modality, quantitative ultrashort time-to-echo contrast enhanced (QUTE-CE), to follow the early pathology and vulnerability of the blood brain barrier in response to single and repetitive mild head impacts. A closed-head, momentum exchange model was used to produce three consecutive mild head impacts aimed at the forebrain separated by 24 h each. Animals were measured at baseline and within 1 h of impact. Anatomical images were collected to assess the extent of structural damage. QUTE-CE biomarkers for BBB permeability were calculated on 420,000 voxels in the brain and were registered to a bilateral 3D brain atlas providing site-specific information on 118 anatomical regions. Blood brain barrier permeability was confirmed by extravasation of labeled dextran. All head impacts occurred in the absence of any structural brain damage. A single mild head impact had measurable effects on blood brain barrier permeability and was more significant after the second and third impacts. Affected regions included the prefrontal ctx, basal ganglia, hippocampus, amygdala, and brainstem. Our findings support the concerns raised by the healthcare community regarding mild head injuries in participants in organized contact sports and military personnel in basic training and combat.
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Affiliation(s)
| | - Ju Qiao
- Center for Translational Neuroimaging, Northeastern University, Boston, MA, United States
| | - Ian C. Harding
- Department of Bioengineering, Northeastern University, Boston, MA, United States
| | | | - Codi Gharagouzloo
- Imaginostics, Inc., Cambridge, MA, United States
- Center for Translational Neuroimaging, Northeastern University, Boston, MA, United States
| | - Eno Ebong
- Department of Chemical Engineering, Northeastern University, Boston, MA, United States
| | - Craig F. Ferris
- Center for Translational Neuroimaging, Northeastern University, Boston, MA, United States
- Departments of Psychology and Pharmaceutical Sciences, Northeastern University, Boston, MA, United States
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Drop Landing Biomechanics in Individuals With and Without a Concussion History. J Appl Biomech 2021; 37:450-457. [PMID: 34504042 DOI: 10.1123/jab.2021-0097] [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: 03/18/2021] [Revised: 06/21/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022]
Abstract
Research has identified an increased risk of lower extremity injury postconcussion, which may be due to aberrant biomechanics during dynamic tasks. The purpose of this study was to compare the drop landing biomechanics between individuals with and without a concussion history. Twenty-five individuals with and 25 without a concussion history were matched on age (±3 y), sex, and body mass index (±1 kg/m2). Three-dimensional landing biomechanics were recorded to obtain dependent variables (peak vertical ground reaction force, loading rate, knee flexion angle and external moment, knee abduction angle and external moment, and knee flexion and abduction angle at ground contact). A 1-way multivariate analysis of variance compared outcomes between groups. There was no difference in drop landing biomechanics between individuals with and without a concussion history (F10,39 = 0.460, P = .877, Wilk Λ= .918). There was an effect of time since concussion on knee flexion characteristics. Time since most recent concussion explained a significant amount of variation in both peak (ΔR2 = .177, β = -0.305, ΔP = .046) and initial ground contact (ΔR2 = .292, β = -0.204, ΔP = .008) knee flexion angle after covarying for sex and body mass index. Therefore, time since concussion should be considered when evaluating biomechanical patterns.
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Banks RE, Beal DS, Hunter EJ. Sports Related Concussion Impacts Speech Rate and Muscle Physiology. Brain Inj 2021; 35:1275-1283. [PMID: 34499576 PMCID: PMC8610105 DOI: 10.1080/02699052.2021.1972150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Establish objective and subjective speech rate and muscle function differences between athletes with and without sports related concussion (SRC) histories and provide potential motor speech evaluation in SRC. METHODS Over 1,110 speech samples were obtained from 30, 19-22 year-old athletes who had sustained an SRC within the past 2 years and 30 pair-wise matched control athletes with no history of SRC. Speech rate was measured via average time per syllable, average unvoiced time per syllable, and expert perceptual judgment. Speech muscle function was measured via surface electromyography over the obicularis oris, masseter, and segmental triangle. Group differences were assessed using MANOVA, bootstrapping and predictive ROC analyses. RESULTS Athletes with SRC had slower speech rates during DDK tasks than controls as evidenced by longer average time per syllable longer average unvoiced time per syllable and expert judgment of slowed rate. Rate measures were predictive of concussion history. Further, athletes with SRC required more speech muscle activation than controls to complete DDK tasks. CONCLUSION Clear evidence of slowed speech and increased muscle activation during the completion of DDK tasks in athletes with SRC histories relative to controls. Future work should examine speech rate in acute concussion.
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Affiliation(s)
- Russell E Banks
- Michigan State University, Department of Communicative Sciences and Disorders, East Lansing, MI, USA
- Massachusetts General Hospital, Institute of Health Professions, Boston, MA, USA
| | - Deryk S Beal
- Massachusetts General Hospital, Institute of Health Professions, Boston, MA, USA
- Department of Speech Language Pathology, Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eric J Hunter
- Michigan State University, Department of Communicative Sciences and Disorders, East Lansing, MI, USA
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Hellewell SC, Welton T, Pearce AJ, Maller JJ, Grieve SM. Diffusion MRI as a complementary assessment to cognition, emotion, and motor dysfunction after sports-related concussion: a systematic review and critical appraisal of the literature. Brain Imaging Behav 2021; 15:1685-1704. [PMID: 32720180 DOI: 10.1007/s11682-020-00336-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Sports-related concussion (SRC) is a complex and heterogeneous injury with psychological, cognitive and functional consequences. Advances in diffusion magnetic resonance imaging (dMRI) allow sensitive measurement of white matter pathology post-SRC and may provide insight into injury and recovery. We systematically reviewed and meta-analyzed the literature examining dMRI alongside cognitive, emotional or motor assessments to determine relationships between these analyses. Sixteen studies examining young athletes (n = 6) or retired professionals (n = 10) met the inclusion criteria, with 12 emotional, 10 cognitive and four motor assessments. Studies had heterogeneous methodology, moderate quality and modest sample sizes. Fractional anisotropy (FA) was the most frequent dMRI metric, with SRC-induced changes described most commonly in the frontal lobe and least in the cerebellum and brainstem. There is an emerging complementary role for dMRI as part of a comprehensive assessment battery for SRC. However, larger-scale studies with broader subject populations (specifically, in females and in the 30-45 year age range) are needed to corroborate findings and determine the true diagnostic utility of dMRI post-SRC.
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Affiliation(s)
- Sarah C Hellewell
- Imaging and Phenotyping Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Thomas Welton
- Imaging and Phenotyping Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Alan J Pearce
- School of Allied Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Jerome J Maller
- Imaging and Phenotyping Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia.,General Electric Healthcare, Richmond, VIC, 3181, Australia
| | - Stuart M Grieve
- Imaging and Phenotyping Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia. .,Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2006, Australia.
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Markovic SJ, Fitzgerald M, Peiffer JJ, Scott BR, Rainey-Smith SR, Sohrabi HR, Brown BM. The impact of exercise, sleep, and diet on neurocognitive recovery from mild traumatic brain injury in older adults: A narrative review. Ageing Res Rev 2021; 68:101322. [PMID: 33737117 DOI: 10.1016/j.arr.2021.101322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/06/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023]
Abstract
Mild traumatic brain injury (mTBI) accounts for a large majority of traumatic brain injuries sustained globally each year. Older adults, who are already susceptible to age-related declines to neurocognitive health, appear to be at an increased risk of both sustaining an mTBI and experiencing slower or impaired recovery. There is also growing evidence that mTBI is a potential risk factor for accelerated cognitive decline and neurodegeneration. Lifestyle-based interventions are gaining prominence as a cost-effective means of maintaining cognition and brain health with age. Consequently, inter-individual variations in exercise, sleep, and dietary patterns could influence the trajectory of post-mTBI neurocognitive recovery, particularly in older adults. This review synthesises the current animal and human literature centred on the mechanisms through which lifestyle-related habits and behaviours could influence acute and longer-term neurocognitive functioning following mTBI. Numerous neuroprotective processes which are impacted by lifestyle factors have been established in animal models of TBI. However, the literature is characterised by a lack of translation to human samples and limited appraisal of the interaction between ageing and brain injury. Further research is needed to better establish the therapeutic utility of applying lifestyle-based modifications to improve post-mTBI neurocognitive outcomes in older adults.
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Affiliation(s)
- Shaun J Markovic
- Discipline of Exercise Science, College of Science, Health, Engineering and Education, Murdoch University, 90 South St, Murdoch, Western Australia, Australia; Australian Alzheimer's Research Foundation, Sarich Neuroscience Research Institute Building, 8 Verdun St, Nedlands, Western Australia, Australia.
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Sarich Neuroscience Research Institute Building, 8 Verdun St, Nedlands, Western Australia, Australia; Perron Institute for Neurological and Translational Science, Sarich Neuroscience Research Institute Building, 8 Verdun St, Nedlands, Western Australia, Australia; School of Biological Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, Australia
| | - Jeremiah J Peiffer
- Discipline of Exercise Science, College of Science, Health, Engineering and Education, Murdoch University, 90 South St, Murdoch, Western Australia, Australia; Centre for Healthy Ageing, Murdoch University, 90 South St, Murdoch, Western Australia, Australia; Murdoch Applied Sports Science Laboratory, Murdoch University, 90 South St, Murdoch, Western Australia, Australia
| | - Brendan R Scott
- Discipline of Exercise Science, College of Science, Health, Engineering and Education, Murdoch University, 90 South St, Murdoch, Western Australia, Australia; Centre for Healthy Ageing, Murdoch University, 90 South St, Murdoch, Western Australia, Australia; Murdoch Applied Sports Science Laboratory, Murdoch University, 90 South St, Murdoch, Western Australia, Australia
| | - Stephanie R Rainey-Smith
- Australian Alzheimer's Research Foundation, Sarich Neuroscience Research Institute Building, 8 Verdun St, Nedlands, Western Australia, Australia; Centre for Healthy Ageing, Murdoch University, 90 South St, Murdoch, Western Australia, Australia; School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dr, Joondalup, Western Australia, Australia; School of Psychological Science, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, Australia
| | - Hamid R Sohrabi
- Australian Alzheimer's Research Foundation, Sarich Neuroscience Research Institute Building, 8 Verdun St, Nedlands, Western Australia, Australia; Centre for Healthy Ageing, Murdoch University, 90 South St, Murdoch, Western Australia, Australia; School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dr, Joondalup, Western Australia, Australia; Department of Biomedical Sciences, Macquarie University, Balaclava Rd, Macquarie Park, New South Wales, Australia
| | - Belinda M Brown
- Discipline of Exercise Science, College of Science, Health, Engineering and Education, Murdoch University, 90 South St, Murdoch, Western Australia, Australia; Australian Alzheimer's Research Foundation, Sarich Neuroscience Research Institute Building, 8 Verdun St, Nedlands, Western Australia, Australia; Centre for Healthy Ageing, Murdoch University, 90 South St, Murdoch, Western Australia, Australia
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Rudroff T, Workman CD. Transcranial Direct Current Stimulation as a Treatment Tool for Mild Traumatic Brain Injury. Brain Sci 2021; 11:brainsci11060806. [PMID: 34207004 PMCID: PMC8235194 DOI: 10.3390/brainsci11060806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/12/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022] Open
Abstract
Mild traumatic brain injury (mTBI) has been defined as a transient (<24 h) condition of confusion and/or loss of consciousness for less than 30 min after brain injury and can result in short- and long-term motor and cognitive impairments. Recent studies have documented the therapeutic potential of non-invasive neuromodulation techniques for the enhancement of cognitive and motor function in mTBI. Alongside repetitive transcranial magnetic stimulation (rTMS), the main technique used for this purpose is transcranial direct current stimulation (tDCS). The focus of this review was to provide a detailed, comprehensive (i.e., both cognitive and motor impairment) overview of the literature regarding therapeutic tDCS paradigms after mTBI. A publication search of the PubMed, Scopus, CINAHL, and PsycINFO databases was performed to identify records that applied tDCS in mTBI. The publication search yielded 14,422 records from all of the databases, however, only three met the inclusion criteria and were included in the final review. Based on the review, there is limited evidence of tDCS improving cognitive and motor performance. Surprisingly, there were only three studies that used tDCS in mTBI, which highlights an urgent need for more research to provide additional insights into ideal therapeutic brain targets and optimized stimulation parameters.
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Affiliation(s)
- Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA;
- Department of Neurology, University of Iowa Health Clinics, Iowa City, IA 52242, USA
- Correspondence: ; Tel.: +1-319-467-0363
| | - Craig D. Workman
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA;
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Hiskens MI, Vella RK, Schneiders AG, Fenning AS. Minocycline improves cognition and molecular measures of inflammation and neurodegeneration following repetitive mTBI. Brain Inj 2021; 35:831-841. [PMID: 33818227 DOI: 10.1080/02699052.2021.1909139] [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: 11/26/2020] [Revised: 02/01/2021] [Accepted: 03/15/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare the neuroprotective effects of minocycline treatment in a murine model of mTBI on measures of spatial learning and memory, neuroinflammation, excitotoxicity, and neurodegeneration. DESIGN Adult male C57BL/6 J mice were randomly assigned into vehicle control, vehicle with repetitive mTBI, minocycline without mTBI, or minocycline with repetitive mTBI groups. METHODS A validated mouse model of repetitive impact-induced rotational acceleration was used to deliver 15 mTBIs across 23 days. Cognition was assessed via Morris water maze (MWM) testing, and mRNA analysis investigated MAPT, GFAP, AIF1, GRIA1, TARDBP, TNF, and NEFL genes. Assessment was undertaken 48 h and 3 months following final mTBI. RESULTS In the chronic phase of recovery, MWM testing revealed impairment in the vehicle mTBI group compared to unimpacted controls (p < .01) that was not present in the minocycline mTBI group, indicating chronic neuroprotection. mRNA analysis revealed AIF1 elevation in the acute cortex (p < .01) and chronic hippocampus (p < .01) of the vehicle mTBI group, with minocycline treatment leading to improved markers of microglial activation and inflammation in the chronic stage of recovery. CONCLUSIONS These data suggest that minocycline treatment alleviated some mTBI pathophysiology and clinical features at chronic time-points.
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Affiliation(s)
- Matthew I Hiskens
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton 4701, Australia
| | - Rebecca K Vella
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton 4701, Australia
| | - Anthony G Schneiders
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton 4701, Australia
| | - Andrew S Fenning
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton 4701, Australia
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Repetitive mild traumatic brain injury affects inflammation and excitotoxic mRNA expression at acute and chronic time-points. PLoS One 2021; 16:e0251315. [PMID: 33961674 PMCID: PMC8104440 DOI: 10.1371/journal.pone.0251315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/24/2021] [Indexed: 12/30/2022] Open
Abstract
The cumulative effect of mild traumatic brain injuries (mTBI) can result in chronic neurological damage, however the molecular mechanisms underpinning this detriment require further investigation. A closed head weight drop model that replicates the biomechanics and head acceleration forces of human mTBI was used to provide an exploration of the acute and chronic outcomes following single and repeated impacts. Adult male C57BL/6J mice were randomly assigned into one of four impact groups (control; one, five and 15 impacts) which were delivered over 23 days. Outcomes were assessed 48 hours and 3 months following the final mTBI. Hippocampal spatial learning and memory assessment revealed impaired performance in the 15-impact group compared with control in the acute phase that persisted at chronic measurement. mRNA analyses were performed on brain tissue samples of the cortex and hippocampus using quantitative RT-PCR. Eight genes were assessed, namely MAPT, GFAP, AIF1, GRIA1, CCL11, TARDBP, TNF, and NEFL, with expression changes observed based on location and follow-up duration. The cortex and hippocampus showed vulnerability to insult, displaying upregulation of key excitotoxicity and inflammation genes. Serum samples showed no difference between groups for proteins phosphorylated tau and GFAP. These data suggest that the cumulative effect of the impacts was sufficient to induce mTBI pathophysiology and clinical features. The genes investigated in this study provide opportunity for further investigation of mTBI-related neuropathology and may provide targets in the development of therapies that help mitigate the effects of mTBI.
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42
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Gimbel SI, Ettenhofer ML, Cordero E, Roy M, Chan L. Brain bases of recovery following cognitive rehabilitation for traumatic brain injury: a preliminary study. Brain Imaging Behav 2021; 15:410-420. [PMID: 32328915 DOI: 10.1007/s11682-020-00269-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many patients with traumatic brain injury (TBI) have persistent cognitive deficits, including decreased attention and working memory. This preliminary study examined fMRI data from a clinical trial implementing a 4-week virtual reality driving intervention to assess how sustained training can improve deficits related to traumatic brain injury. Previously-reported behavioral findings showed improvements in working memory and processing speed in those who received the intervention; this report explores the brain bases of these effects by comparing neural activity related to working memory (n-back task) and resting state connectivity before and after the intervention. In the baseline visit (n = 24), working memory activity was prominent in bilateral DLPFC and prefrontal cortex, anterior insula, medial superior frontal gyrus, left thalamus, bilateral supramarginal / angular gyrus, precuneus, and left posterior middle temporal gyrus. Following intervention, participants showed less global activation on the n-back task, with regions of activity only in the bilateral middle frontal cortex, posterior middle frontal gyrus, and supramarginal gyrus. Activity related to working memory load was reduced for the group that went through the intervention (n = 7) compared to the waitlist control group (n = 4). These results suggest that successful cognitive rehabilitation of working memory in TBI may be associated with increased efficiency of brain networks, evidenced by reduced activation of brain activity during cognitive processing. These results highlight the importance of examining brain activity related to cognitive rehabilitation of attention and working memory after brain injury.
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Affiliation(s)
- Sarah I Gimbel
- Naval Medical Center San Diego, 34730 Bob Wilson Drive, San Diego, CA, 92134, USA
- Henry M. Jackson Foundation, 6720A Rockledge Drive, Bethesda, MD, 20817, USA
- Defense and Veterans Brain Injury Center, 7700 Arlington Blvd Suite 5101, Falls Church, VA, 22041, USA
| | - Mark L Ettenhofer
- Naval Medical Center San Diego, 34730 Bob Wilson Drive, San Diego, CA, 92134, USA.
- Defense and Veterans Brain Injury Center, 7700 Arlington Blvd Suite 5101, Falls Church, VA, 22041, USA.
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
- Center for Neuroscience and Regenerative Medicine, 12725 Twinbrook Parkway, Rockville, MD, 20852, USA.
| | - Evelyn Cordero
- Naval Medical Center San Diego, 34730 Bob Wilson Drive, San Diego, CA, 92134, USA
- Henry M. Jackson Foundation, 6720A Rockledge Drive, Bethesda, MD, 20817, USA
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Michael Roy
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
- Center for Neuroscience and Regenerative Medicine, 12725 Twinbrook Parkway, Rockville, MD, 20852, USA
| | - Leighton Chan
- Center for Neuroscience and Regenerative Medicine, 12725 Twinbrook Parkway, Rockville, MD, 20852, USA
- National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
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43
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Esopenko C, Meyer J, Wilde EA, Marshall AD, Tate DF, Lin AP, Koerte IK, Werner KB, Dennis EL, Ware AL, de Souza NL, Menefee DS, Dams-O'Connor K, Stein DJ, Bigler ED, Shenton ME, Chiou KS, Postmus JL, Monahan K, Eagan-Johnson B, van Donkelaar P, Merkley TL, Velez C, Hodges CB, Lindsey HM, Johnson P, Irimia A, Spruiell M, Bennett ER, Bridwell A, Zieman G, Hillary FG. A global collaboration to study intimate partner violence-related head trauma: The ENIGMA consortium IPV working group. Brain Imaging Behav 2021; 15:475-503. [PMID: 33405096 PMCID: PMC8785101 DOI: 10.1007/s11682-020-00417-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
Intimate partner violence includes psychological aggression, physical violence, sexual violence, and stalking from a current or former intimate partner. Past research suggests that exposure to intimate partner violence can impact cognitive and psychological functioning, as well as neurological outcomes. These seem to be compounded in those who suffer a brain injury as a result of trauma to the head, neck or body due to physical and/or sexual violence. However, our understanding of the neurobehavioral and neurobiological effects of head trauma in this population is limited due to factors including difficulty in accessing/recruiting participants, heterogeneity of samples, and premorbid and comorbid factors that impact outcomes. Thus, the goal of the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium Intimate Partner Violence Working Group is to develop a global collaboration that includes researchers, clinicians, and other key community stakeholders. Participation in the working group can include collecting harmonized data, providing data for meta- and mega-analysis across sites, or stakeholder insight on key clinical research questions, promoting safety, participant recruitment and referral to support services. Further, to facilitate the mega-analysis of data across sites within the working group, we provide suggestions for behavioral surveys, cognitive tests, neuroimaging parameters, and genetics that could be used by investigators in the early stages of study design. We anticipate that the harmonization of measures across sites within the working group prior to data collection could increase the statistical power in characterizing how intimate partner violence-related head trauma impacts long-term physical, cognitive, and psychological health.
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Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, 07107, USA.
- Department of Health Informatics, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, 07107, USA.
| | - Jessica Meyer
- Department of Psychiatry, Summa Health System, Akron, OH, 44304, USA
| | - Elisabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Amy D Marshall
- Department of Psychology, Pennsylvania State University, University Park, PA, 16802, USA
| | - David F Tate
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Alexander P Lin
- Department of Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Inga K Koerte
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, 80336, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Kimberly B Werner
- College of Nursing, University of Missouri, St. Louis, MO, 63121, USA
| | - Emily L Dennis
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Ashley L Ware
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- Department of Psychology, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Nicola L de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers, The State University of New Jersey, Newark, NJ, 07103, USA
| | | | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, 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
| | - Dan J Stein
- Department of Psychiatry and Neuroscience Institute, South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, 7501, South Africa
| | - Erin D Bigler
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
| | - Martha E Shenton
- College of Nursing, University of Missouri, St. Louis, MO, 63121, USA
- Departments of Psychiatry and Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Veterans Affairs, Boston Healthcare System, Boston, MA, 02130, USA
| | - Kathy S Chiou
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
| | - Judy L Postmus
- School of Social Work, University of Maryland, Baltimore, USA
| | - Kathleen Monahan
- School of Social Welfare, Stony Brook University, Stony Brook, NY, 11794-8231, USA
| | | | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - Tricia L Merkley
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Carmen Velez
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Cooper B Hodges
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
| | - Hannah M Lindsey
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
| | - Paula Johnson
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
- Neuroscience Center, Brigham Young University, Provo, UT, 84602, USA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, 90089, USA
- Denney Research Center Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, 90089, USA
| | - Matthew Spruiell
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Esther R Bennett
- Rutgers University School of Social Work, New Brunswick, NJ, 08901, USA
| | - Ashley Bridwell
- Barrow Concussion and Brain Injury Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Glynnis Zieman
- Barrow Concussion and Brain Injury Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Frank G Hillary
- Department of Psychology, Pennsylvania State University, University Park, PA, 16802, USA
- Social Life and Engineering Sciences Imaging Center, University Park, PA, 16802, USA
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Celecoxib in a Preclinical Model of Repetitive Mild Traumatic Brain Injury: Hippocampal Learning Deficits Persist with Inflammatory and Excitotoxic Neuroprotection. TRAUMA CARE 2021. [DOI: 10.3390/traumacare1010003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Repetitive mild traumatic brain injuries (mTBIs) contribute to inflammation-induced neurodegeneration. Cycloxygenase (COX) enzymes produce inflammatory cytokines that influence the microglia response to neurotrauma. Celecoxib is a selective COX-2 inhibitor that is prescribed in some conditions of mTBI to alleviate symptoms of concussion, and has shown benefits in neurodegenerative conditions. We investigated molecular pathways of neuroinflammation in response to celecoxib treatment in a mouse model of repetetive mTBI. Fifteen mTBIs were delivered over 23 days in adult male C57BL/6J mice in one of four groups (control, celecoxib without impact, celecoxib with impact, and vehicle with impact). Cognitive function was assessed at 48 h and three months following the final mTBI. Morris Water Maze testing revealed impaired hippocampal spatial learning performance in the celecoxib treatment with the impact group compared to the vehicle with impact control in the acute phase, with celecoxib treatment providing no improvement compared with the control at chronic testing; mRNA analysis of the cerebral cortex and hippocampus revealed expression change, indicating significant improvement in microglial activation, inflammation, excitotoxicity, and neurodegeneration at chronic measurement. These data suggest that, in the acute phase following injury, celecoxib protected against neuroinflammation, but exacerbated clinical cognitive disturbance. Moreover, while there was evidence of neuroprotective alleviation of mTBI pathophysiology at chronic measurement, there remained no change in clinical features.
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Pearce AJ, Kidgell DJ, Tommerdahl MA, Frazer AK, Rist B, Mobbs R, Batchelor J, Buckland ME. Chronic Neurophysiological Effects of Repeated Head Trauma in Retired Australian Male Sport Athletes. Front Neurol 2021; 12:633320. [PMID: 33767661 PMCID: PMC7985524 DOI: 10.3389/fneur.2021.633320] [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: 11/29/2020] [Accepted: 02/17/2021] [Indexed: 12/16/2022] Open
Abstract
Aim: This study investigated the somatosensory and corticomotor physiology of retired contact sport athletes with a history of repeated concussion/subconcussion head trauma. Methods: Retired male athletes with a history of playing contact sports and repeated head trauma (n = 122) were divided into two groups: those who expressed concerns regarding their mental and cognitive health (“symptomatic”: n = 83), and those who did not express any ongoing concerns (“asymptomatic”: n = 39). Both groups were compared to age-matched male controls (n = 50) with no history of concussions or participation in contact sports, an absence of self-reported cognitive, or mood impairments. Transcranial magnetic stimulation (TMS) and vibrotactile stimulation were used to assess corticomotor and somatosensory pathways respectively. TMS and vibrotactile stimulation were correlated to self-reported responses using the Fatigue and Related Symptom Survey. Linear regression was used to associate concussion history with TMS, somatosensory variables. Results: Significant differences were found in symptom survey scores between all groups (p < 0.001). TMS showed significant differences between the “symptomatic” and control groups for intracortical inhibition and paired pulse TMS measures. Somatosensory measures showed significant differences for reaction time (p < 0.01) and reaction time variability (p < 0.01) between the “symptomatic” group to the “asymptomatic” and control groups. For other somatosensory measures, the “symptomatic” measures showed differences to the “control” group. Correlations showed significant associations between severity of symptom reporting with TMS and somatosensory measure, and regression revealed the number of concussions reported was shown to have significant relationships to increased intracortical inhibition and poorer somatosensory performance. Conclusion: This study shows that retired contact sport athletes expressing chronic symptoms showed significant pathophysiology compared to those with no ongoing concerns and non-concussed controls. Further, there is a linear dose-response relationship between number of reported concussions and abnormal neurophysiology. Neurophysiological assessments such as TMS and somatosensory measures represent useful and objective biomarkers to assess cortical impairments and progression of neuropsychological impairment in individuals with a history of repeated head trauma.
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Affiliation(s)
- Alan J Pearce
- College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Dawson J Kidgell
- Department of Physiotherapy, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, VIC, Australia
| | - Mark A Tommerdahl
- Department of Biomedical Engineering, University of North Carolina, Chappell Hill, NC, United States.,Cortical Metrics, Carrboro, NC, United States
| | - Ashlyn K Frazer
- Department of Physiotherapy, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, VIC, Australia
| | - Billymo Rist
- College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Rowena Mobbs
- Department of Neurology, Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia
| | | | - Michael E Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Brain and Mind Centre, University Sydney, Camperdown, NSW, Australia
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Upper-Extremity Perceptual-Motor Training Improves Whole-Body Reactive Agility Among Elite Athletes With History of Sport-Related Concussion. J Sport Rehabil 2021; 30:844-849. [PMID: 33418536 DOI: 10.1123/jsr.2020-0337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/25/2020] [Accepted: 10/18/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Sport-related concussion (SRC) elevates risk for subsequent injury, which may relate to impaired perceptual-motor processes that are potentially modifiable. OBJECTIVE To assess a possible upper-extremity (UE) training effect on whole-body (WB) reactive agility performance among elite athletes with history of SRC (HxSRC) and without such history of SRC. DESIGN Cohort study. SETTING Residential training center. PARTICIPANTS Elite athletes (12 males and 8 females), including 10 HxSRC and 10 without such history of SRC. INTERVENTION One-minute training sessions completed 2 to 3 times per week over a 3-week period involved verbal identification of center arrow direction for 10 incongruent and 10 congruent flanker test trials with simultaneous reaching responses to deactivate illuminated buttons. MAIN OUTCOME MEASURES Pretraining and posttraining assessments of UE and WB reactive responses included flanker test conflict effect (incongruent minus congruent reaction time) and WB lateral average asymmetry derived from reaction time, speed, acceleration, and deceleration in opposite directions. Discrimination was assessed by receiver operating characteristic analysis, and training effect was assessed by repeated-measures analysis of variance. RESULTS Pretraining discrimination between HxSRC and without such history of SRC was greatest for conflict effect ≥80 milliseconds and WB lateral average asymmetry ≥18%. Each athlete completed 6 training sessions, which improved UE mean reaction time from 767 to 646 milliseconds (P < .001) and reduced mean conflict effect from 96 to 53 milliseconds (P = .039). A significant group × trial interaction was evident for WB lateral average asymmetry (P = .004), which was reduced from 24.3% to 12.5% among those with HxSRC. CONCLUSIONS Suboptimal perceptual-motor performance may represent a subtle long-term effect of concussion that is modifiable through UE training, which appears to improve WB reactive capabilities.
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47
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Biese KM, Stamm JM, Wichman DM, Hetzel SJ, Post EG, Bell DR. Association of lower extremity injuries and injury mechanism with previous concussion history in adolescent athletes. Phys Ther Sport 2021; 48:76-82. [PMID: 33387901 DOI: 10.1016/j.ptsp.2020.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Determine the association between concussion and subsequent contact, non-contact, and overuse lower extremity (LE) injuries in a cohort of adolescent athletes. Secondarily, to identify this association between males and females. STUDY DESIGN Cross-sectional. SETTING Summer athletic events with participants ages 12-18. MAIN OUTCOME Anonymous survey included sport-related injuries (injury month/year) and participants classified injuries as a contact, non-contact, overuse injury, or concussion. Multivariable logistic regression analyses were used to examine associations between a concussion event and a subsequent LE injury while controlling for age and any previous LE injury. RESULTS A concussion was reported in 219 athletes (Female = 96, 44%) and were matched with 219 non-concussed athletes (438 total participants). Concussion was not association with a specific injury mechanism but was significant for any subsequent LE injury (OR = 1.58 95%CI = [1.03-2.41]; p < 0.05). Concussed females were more likely to report any subsequent LE injury compared to non-concussed female athletes (2.49[1.31, 4.74]; p < 0.01). This relationship was not observed between concussed and non-concussed males (1.11[0.62-1.99]; p > 0.5). CONCLUSION A history of concussion was associated with any subsequent LE injury, but not associated with a specific mechanism of injury. The association with concussion and a subsequent LE injury was different between males and females.
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Affiliation(s)
- Kevin M Biese
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA.
| | - Julie M Stamm
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniel M Wichman
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Scott J Hetzel
- Department of Biostatistics and Medical Information, University of Wisconsin-Madison, Madison, WI, USA
| | - Eric G Post
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN, USA
| | - David R Bell
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
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48
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Ye S, Ko B, Phi HQ, Sun K, Eagleman DM, Flores B, Katz Y, Huang B, Ghomi RH. Detection of mild traumatic brain injury in pediatric populations using BrainCheck, a tablet-based cognitive testing software: a preliminary study. EXPLORATION OF MEDICINE 2020. [DOI: 10.37349/emed.2020.00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aim: Despite its high frequency of occurrence, mild traumatic brain injury (mTBI), or concussion, is difficult to recognize and diagnose, particularly in pediatric populations. Conventional methods to diagnose mTBI primarily rely on clinical questionnaires and sometimes include neuroimaging or pencil and paper neuropsychological testing. However, these methods are time consuming, require administration/interpretation from health professionals, and lack adequate test sensitivity and specificity. This study explores the use of BrainCheck Sport, a computerized neurocognitive test that is available on iPad, iPhone, or computer desktop, for mTBI assessment. The BrainCheck Sport Battery consists of 6 gamified traditional neurocognitive tests that assess areas of cognition vulnerable to mTBI such as attention, processing speed, executing functioning, and coordination.
Methods: We administered BrainCheck Sport to 10 participants diagnosed with mTBI at the emergency department of Children’s hospital or local high school within 96 hours of injury, and 115 normal controls at a local high school. Statistical analysis included Mann-Whitney U test, chi-square tests, and Hochberg tests to examine differences between the mTBI group and control group on each assessment in the battery. Significant metrics from these assessments were used to build a logistic regression model that distinguishes mTBI from control participants.
Results: BrainCheck Sport was able to detect significant differences in Coordination, Stroop, Immediate/Delayed Recognition between normal controls and mTBI patients. Receiver operating characteristic (ROC) analysis of our logistic regression model found a sensitivity of 84% and specificity of 81%, with an area under the curve of 0.884.
Conclusions: BrainCheck Sport has potential in distinguishing mTBI from control participants, by providing a shorter, gamified test battery to assess cognitive function after brain injury, while also providing a method for tracking recovery with the opportunity to do so remotely from a patient’s home.
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Affiliation(s)
- Siao Ye
- Department of Biosciences, Rice University, Houston, TX 77005, USA
| | - Brian Ko
- University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Huy Q. Phi
- College of Arts and Sciences, University of Washington, Seattle, WA 98195, USA
| | - Kevin Sun
- BrainCheck, Inc, Houston, TX 77021, USA
| | - David M. Eagleman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Yael Katz
- BrainCheck, Inc, Houston, TX 77021, USA
| | - Bin Huang
- BrainCheck, Inc, Houston, TX 77021, USA
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Wilkerson GB, Acocello SN, Davis MB, Ramos JM, Rucker AJ, Hogg JA. Wellness Survey Responses and Smartphone App Response Efficiency: Associations With Remote History of Sport-Related Concussion. Percept Mot Skills 2020; 128:714-730. [PMID: 33357092 DOI: 10.1177/0031512520983680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Recent research findings have strongly suggested that sport-related concussion (SRC) increases risk for subsequent injury of any type, as well as a potential for long-term adverse effects on neurological and psychological well-being. The primary purpose of this study was to explore the reliability and discriminatory power of clinical testing procedures for detecting persisting effects of SRC. We used a cross-sectional study design to assess both self-reported symptoms commonly associated with post-concussion syndrome, and the effects of mental or physical activity on metrics derived from a smartphone app designed to test perceptual-motor responses. Among 30 physically active college students, 15 participants reported a SRC occurrence prior to testing (M time-since-injury = 4.0 years, SD = 3.1, range = 5 months to 11 years). We found good test-retest reliability for key metrics derived from the smartphone app (ICC ≥ .70); and the internal consistency for the Overall Wellness Index (OWI) for 10 categories of 82 post-concussion symptoms was ideal (Cronbach's α ≥ .80). Moderate intensity treadmill running demonstrated the strongest differential effect on perceptual-motor responses between participants with a history of SRC (HxSRC) and those with no such history (No SRC), which was best represented by the speed-accuracy trade-off quantified by the inverse efficiency index (IEI: group X trial interaction p = .055). Self-reported OWI symptoms ≥4 and post-physical activity IEI ≥ 568 ms provided the strongest discrimination between HxSRC and NoSRC participants (≥1 versus 0: OR = 9.75). Our findings suggest that persisting effects from a remote SRC occurrence can be detected by easily administered screening procedures that have the potential to identify individual athletes who might derive benefit from interventions to restore their optimal function and well-being.
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Affiliation(s)
- Gary B Wilkerson
- Graduate Athletic Training Program, University of Tennessee at Chattanooga, Chattanooga, United States
| | - Shellie N Acocello
- Graduate Athletic Training Program, University of Tennessee at Chattanooga, Chattanooga, United States
| | - Meredith B Davis
- Graduate Athletic Training Program, University of Tennessee at Chattanooga, Chattanooga, United States
| | - Justin M Ramos
- Graduate Athletic Training Program, University of Tennessee at Chattanooga, Chattanooga, United States
| | - Abigail J Rucker
- Graduate Athletic Training Program, University of Tennessee at Chattanooga, Chattanooga, United States
| | - Jennifer A Hogg
- Graduate Athletic Training Program, University of Tennessee at Chattanooga, Chattanooga, United States
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50
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Concussion Is Associated With Increased Odds of Acute Lower-Extremity Musculoskeletal Injury Among National Basketball Association Players. Arthrosc Sports Med Rehabil 2020; 3:e219-e225. [PMID: 33615268 PMCID: PMC7879202 DOI: 10.1016/j.asmr.2020.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/13/2020] [Indexed: 01/20/2023] Open
Abstract
Purpose To determine the odds of sustaining an acute lower-extremity (LE) musculoskeletal injury during the 90-day period after return-to-play (RTP) from concussion in National Basketball Association (NBA) athletes. Methods Concussion data for NBA players were collected from the 1999-2000 to 2017-2018 seasons, from publicly available sources. Age, position, injury, time to RTP, and demographic factors were collected. The 90-day period after each case of concussion was reviewed for acute noncontact LE musculoskeletal injury. Control athletes without a documented history of concussion were matched to concussed athletes by age, body mass index, position, and experience. Conditional logistic regression with a calculated odds ratio and a 95% confidence interval were used to assess the association between concussion and subsequent risk of LE injury. Results In total, 189 concussions were documented in 153 athletes. Of these, 140 cases were the first recorded instance of concussion in players with publicly available data. Thirty-six (25.7%) athletes sustained a LE injury within 90 days of concussion; 26 (20.2%) were non–season-ending and included in RTP analysis. The odds of sustaining an acute LE musculoskeletal injury within the 90-day period after concussion was 4.69 times greater in concussed players compared with controls (95% confidence interval 1.96-11.23, P < .001). There was no significant difference in games (4.2 ± 5.0 vs 4.7 ± 4.7 games, P = .566) or days (18.5 ± 39.1 days vs 10.9 ± 10.6 days, P = .912) missed between concussed players with LE injury and nonconcussed controls. The most common LE injuries in concussed athletes were ligament sprains/tears (65%). Conclusions Concussed NBA athletes have increased odds for sustaining an acute LE musculoskeletal injury within 90 days of RTP compared with nonconcussed controls. The most common injuries were ligament strains or tears. Changes in neuromotor control and proprioception following a concussion should be evaluated in high-level basketball players returning to sport. Level of Evidence Level III, Case-Control Study.
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