1
|
Hagen AC, Tracy BL, Stephens JA. Altered neural recruitment despite dual task performance recovery in athletes with repeat concussion. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.19.24312271. [PMID: 39228732 PMCID: PMC11370505 DOI: 10.1101/2024.08.19.24312271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Sports-related concussions (SRCs) pose significant challenges to college-aged athletes, eliciting both immediate symptoms and subacute cognitive and motor function impairment. While most symptoms and impairments resolve within weeks, athletes with repeat SRCs may experience heightened risk for prolonged recovery trajectories, future musculoskeletal injuries, and long-term neurocognitive deficits. This includes impaired dual task performance and altered neurophysiology that could persist across the lifespan and elicit future pathophysiology and neurodegeneration. Thus, it is imperative to improve our understanding of neurophysiology after SRC. This study aimed to investigate the impact of repeat SRCs on dual task performance and associated neural recruitment using functional near-infrared spectroscopy (fNIRS). A total of 37 college-aged athletes (ages 18-24) participated in this cross-sectional observational study. Among these athletes, 20 had a history of two or more SRCs, while 17 had never sustained a SRC and served as controls. Participants completed the Neuroimaging-Compatible Dual Task Screen (NC-DTS) while fNIRS measured neural recruitment in the frontoparietal attention network and the primary motor and sensory cortices. Behavioral analysis revealed that athletes with repeat SRCs exhibited comparable single task and dual task performance to control athletes. Additionally, dual task effects (DTE), which capture performance declines in dual tasks versus single tasks, did not significantly differ between groups. Notably, the cohort of athletes with repeat SRC in this study had a longer time since their last SRC (mean = 1.75 years) than majority of previous SRC studies. Neuroimaging results indicated altered neural recruitment patterns in athletes with multiple repeat SRCs during both single and dual tasks. Specifically, athletes with repeat SRCs demonstrated increased prefrontal cortex (PFC) activation during single motor tasks compared to controls ( P < 0.001, d = 0.47). Conversely, during dual tasks, these same athletes exhibited reduced PFC activation ( P < 0.001, d = 0.29) and primary motor cortex (M1) activation ( P = 0.038, d = 0.16) compared to their single task activation. These findings emphasize the complex relationship between SRC history, dual task performance, and changes in neurophysiology. While athletes with repeat SRCs demonstrate recovery in behavioral dual task performance, persistent alterations in neural recruitment patterns suggest ongoing neurophysiological changes, possibly indicating compensatory neural strategies and inefficient neural resource allocation, even beyond symptom resolution and medical clearance. Understanding the compensatory neural recruitment strategies that support behavioral performance following repeat SRCs can inform return-to-play decisions, future musculoskeletal injury risk, and the long-term impact of SRCs on neurocognitive function.
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Petersell TL, Quammen DL, Crofts R, Morris AJ, Fino NF, Jensen CB, Hollien A, Pelo R, Roemmich BJ, Dibble LE, Fino PC. Instrumented Static and Reactive Balance in Collegiate Athletes: Normative Values and Minimal Detectable Change. J Athl Train 2024; 59:608-616. [PMID: 38014789 PMCID: PMC11220770 DOI: 10.4085/1062-6050-0403.23] [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: 11/29/2023]
Abstract
CONTEXT Wearable sensors are increasingly popular in concussion research because of their objective quantification of subtle balance deficits. However, normative data and minimal detectable change (MDC) values are necessary to serve as references for diagnostic use and tracking longitudinal recovery. OBJECTIVE To identify normative and MDC values for instrumented static- and reactive-balance tests, an instrumented static mediolateral (ML) root mean square (RMS) sway standing balance assessment and the instrumented, modified push and release (I-mP&R), respectively. DESIGN Cross-sectional study. SETTING Clinical setting. PATIENTS OR OTHER PARTICIPANTS Normative static ML RMS sway and I-mP&R data were collected on 377 (n = 184 female) healthy National Collegiate Athletic Association Division I athletes at the beginning of their competitive seasons. Test-retest data were collected in 36 healthy control athletes based on standard recovery timelines after concussion. MAIN OUTCOME MEASURE(S) Descriptive statistics, intraclass correlation coefficients (ICCs), and MDC values were calculated for primary outcomes of ML RMS sway in a static double-limb stance on firm ground and a foam block, and time to stability and latency from the I-mP&R in single- and dual-task conditions. RESULTS Normative outcomes across static ML RMS sway and I-mP&R were sensitive to sex and type of footwear. Mediolateral RMS sway demonstrated moderate reliability in the firm condition (ICC = 0.73; MDC = 2.7 cm/s2) but poor reliability in the foam condition (ICC = 0.43; MDC = 11.1 cm/s2). Single- and dual-task times to stability from the I-mP&R exhibited good reliability (ICC = 0.84 and 0.80, respectively; MDC = 0.25 and 0.29 seconds, respectively). Latency from the I-mP&R had poor to moderate reliability (ICC = 0.38 and 0.55; MDC = 107 and 105 milliseconds). CONCLUSIONS Sex-matched references should be used for instrumented static- and reactive-balance assessments. Footwear may explain variability in static ML RMS sway and time to stability of the I-mP&R. Moderate-to-good reliability suggests time to stability from the I-mP&R and ML RMS static sway on firm ground can be used for longitudinal assessments.
Collapse
Affiliation(s)
| | | | | | - Amanda J. Morris
- Departments of Health & Kinesiology and
- Department of Kinesiology, California State University Sacramento
| | - Nora F. Fino
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City
| | | | | | - Ryan Pelo
- Physical Therapy and Athletic Training and
| | | | | | | |
Collapse
|
4
|
Hunzinger KJ, Walter AE, Rosenthal KA, Windham BG, Palta P, Juraschek SP, Hicks CW, Gottesman RF, Schneider ALC. Associations Between Prior Head Injury, Physical Functioning, and Frailty in the Atherosclerosis Risk in Communities Study. J Gerontol A Biol Sci Med Sci 2024; 79:glae032. [PMID: 38284926 PMCID: PMC10972581 DOI: 10.1093/gerona/glae032] [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: 10/05/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Older adults have the highest rates of head injury and are at the greatest risk for subsequent dysfunction, yet research on subsequent physical decline is limited. We sought to examine cross-sectional and prospective associations of head injury with physical functioning and frailty among older adults. METHODS A total of 5 598 Atherosclerosis Risk in Communities Study participants from Visit 5 (2011-13) underwent assessments of physical functioning (Short Physical Performance Battery [SPPB], comprised of gait speed, chair stands, and balance) and frailty (defined using established criteria) were followed through Visit 7 (2018-19). Head injury was self-reported or based on ICD-9 codes. Adjusted linear and multinomial logistic regression models were used to estimate associations. Prospective models incorporated inverse probability of attrition weights to account for death or attrition. RESULTS Participants were a mean age of 75 years, 58% were women, 22% were Black, and 27% had a prior head injury. Compared to individuals without head injury, individuals with head injury had worse physical functioning (SPPB total score, β-coefficient = -0.22, 95% CI: -0.35 to -0.09) and were more likely to be pre-frail (OR = 1.19, 95% CI: 1.04 to 1.35) or frail (OR = 1.40, 95% CI: 1.08 to 1.80) compared to robust. Prospectively, head injury was associated with a 0.02 m/s greater decline (95% CI: -0.04 to -0.01) in gait speed over a median of 5 years. Among baseline robust individuals (n = 1 847), head injury was associated with increased odds of becoming pre-frail (OR = 1.32, 95% CI: 1.04 to 1.67) or frail (OR = 1.92, 95% CI: 1.05 to 3.51) compared to robust. CONCLUSIONS Older adults with prior head injury had worse physical functioning and greater frailty at baseline and were more likely to become frail and walk slower over time, compared to individuals without head injury.
Collapse
Affiliation(s)
- Katherine J Hunzinger
- Department of Exercise Science, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexa E Walter
- Department of Neurology, University of Pennsylvania-Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kimberly A Rosenthal
- Department of Physical Medicine and Rehabilitation, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - B Gwen Windham
- Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Priya Palta
- Department of Neurology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Caitlin W Hicks
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland, USA
| | - Andrea L C Schneider
- Department of Neurology, University of Pennsylvania-Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania-Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
5
|
Echemendia RJ, Burma JS, Bruce JM, Davis GA, Giza CC, Guskiewicz KM, Naidu D, Black AM, Broglio S, Kemp S, Patricios JS, Putukian M, Zemek R, Arango-Lasprilla JC, Bailey CM, Brett BL, Didehbani N, Gioia G, Herring SA, Howell D, Master CL, Valovich McLeod TC, Meehan WP, Premji Z, Salmon D, van Ierssel J, Bhathela N, Makdissi M, Walton SR, Kissick J, Pardini J, Schneider KJ. Acute evaluation of sport-related concussion and implications for the Sport Concussion Assessment Tool (SCAT6) for adults, adolescents and children: a systematic review. Br J Sports Med 2023; 57:722-735. [PMID: 37316213 DOI: 10.1136/bjsports-2022-106661] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To systematically review the scientific literature regarding the acute assessment of sport-related concussion (SRC) and provide recommendations for improving the Sport Concussion Assessment Tool (SCAT6). DATA SOURCES Systematic searches of seven databases from 2001 to 2022 using key words and controlled vocabulary relevant to concussion, sports, SCAT, and acute evaluation. ELIGIBILITY CRITERIA (1) Original research articles, cohort studies, case-control studies, and case series with a sample of >10; (2) ≥80% SRC; and (3) studies using a screening tool/technology to assess SRC acutely (<7 days), and/or studies containing psychometric/normative data for common tools used to assess SRC. DATA EXTRACTION Separate reviews were conducted involving six subdomains: Cognition, Balance/Postural Stability, Oculomotor/Cervical/Vestibular, Emerging Technologies, and Neurological Examination/Autonomic Dysfunction. Paediatric/Child studies were included in each subdomain. Risk of Bias and study quality were rated by coauthors using a modified SIGN (Scottish Intercollegiate Guidelines Network) tool. RESULTS Out of 12 192 articles screened, 612 were included (189 normative data and 423 SRC assessment studies). Of these, 183 focused on cognition, 126 balance/postural stability, 76 oculomotor/cervical/vestibular, 142 emerging technologies, 13 neurological examination/autonomic dysfunction, and 23 paediatric/child SCAT. The SCAT discriminates between concussed and non-concussed athletes within 72 hours of injury with diminishing utility up to 7 days post injury. Ceiling effects were apparent on the 5-word list learning and concentration subtests. More challenging tests, including the 10-word list, were recommended. Test-retest data revealed limitations in temporal stability. Studies primarily originated in North America with scant data on children. CONCLUSION Support exists for using the SCAT within the acute phase of injury. Maximal utility occurs within the first 72 hours and then diminishes up to 7 days after injury. The SCAT has limited utility as a return to play tool beyond 7 days. Empirical data are limited in pre-adolescents, women, sport type, geographical and culturally diverse populations and para athletes. PROSPERO REGISTRATION NUMBER CRD42020154787.
Collapse
Affiliation(s)
- Ruben J Echemendia
- Concussion Care Clinic, University Orthopedics, State College, Pennsylvania, USA
- University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jared M Bruce
- Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dhiren Naidu
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Simon Kemp
- Sports Medicine, Rugby Football Union, London, UK
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | | | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Christopher M Bailey
- Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Benjamin L Brett
- Neurosurgery/ Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Gerry Gioia
- Depts of Pediatrics and Psychiatry & Behavioral Sciences, Children's National Health System, Washington, District of Columbia, USA
| | - Stanley A Herring
- Department of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - David Howell
- Orthopedics, Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Tamara C Valovich McLeod
- Department of Athletic Training and School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
| | - William P Meehan
- Sports Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
- Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | | | | | - Neil Bhathela
- UCLA Health Steve Tisch BrainSPORT Program, Los Angeles, California, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, School of Medicine, Richmond, Virginia, USA
| | - James Kissick
- Dept of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie Pardini
- Departments of Internal Medicine and Neurology, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
6
|
Putukian M, Purcell L, Schneider KJ, Black AM, Burma JS, Chandran A, Boltz A, Master CL, Register-Mihalik JK, Anderson V, Davis GA, Fremont P, Leddy JJ, Maddocks D, Premji Z, Ronksley PE, Herring S, Broglio S. Clinical recovery from concussion-return to school and sport: a systematic review and meta-analysis. Br J Sports Med 2023; 57:798-809. [PMID: 37316183 DOI: 10.1136/bjsports-2022-106682] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To define the time frames, measures used and modifying factors influencing recovery, return to school/learn (RTL) and return to sport (RTS) after sport-related concussion (SRC). DESIGN Systematic review and meta-analysis. DATA SOURCES 8 databases searched through 22 March 2022. ELIGIBILITY CRITERIA Studies with diagnosed/suspected SRC and interventions facilitating RTL/RTS or investigating the time and modifying factors for clinical recovery. Outcomes included days until symptom free, days until RTL and days until RTS. We documented study design, population, methodology and results. Risk of bias was evaluated using a modified Scottish Intercollegiate Guidelines Network tool. RESULTS 278 studies were included (80.6% cohort studies and 92.8% from North America). 7.9% were considered high-quality studies, while 23.0% were considered high risk of bias and inadmissible. The mean days until symptom free was 14.0 days (95% CI: 12.7, 15.4; I2=98.0%). The mean days until RTL was 8.3 (95% CI: 5.6, 11.1; I2=99.3%), with 93% of athletes having a full RTL by 10 days without new academic support. The mean days until RTS was 19.8 days (95% CI: 18.8, 20.7; I2=99.3%), with high heterogeneity between studies. Several measures define and track recovery, with initial symptom burden remaining the strongest predictor of longer days until RTS. Continuing to play and delayed access to healthcare providers were associated with longer recovery. Premorbid and postmorbid factors (eg, depression/anxiety, migraine history) may modify recovery time frames. Though point estimates suggest that female sex or younger age cohorts take longer to recover, the heterogeneity of study designs, outcomes and overlap in CIs with male sex or older age cohorts suggests that all have similar recovery patterns. CONCLUSION Most athletes have full RTL by 10 days but take twice as long for an RTS. PROSPERO REGISTRATION NUMBER CRD42020159928.
Collapse
Affiliation(s)
| | - Laura Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amanda Marie Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Joel S Burma
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Adrian Boltz
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Christina L Master
- Childrens Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Johna K Register-Mihalik
- Matthew Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Vicki Anderson
- Clinical Sciences Research, Murdoch Children's Research Institute & Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - John J Leddy
- UBMD Orthopaedics and Sports Medicine, SUNY Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - David Maddocks
- Perry Maddocks Trollope Lawyers, Melbourne, Victoria, Australia
| | - Zahra Premji
- Libraries and Cultural Resources, University of Victoria, Victoria, British Columbia, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stanley Herring
- Departments of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
7
|
Shumski EJ, Anderson MN, Oh J, Schmidt JD, Lynall RC. Computerized and functional reaction time in varsity-level female collegiate athletes with and without a concussion history. J Sci Med Sport 2023; 26:189-194. [PMID: 36906428 DOI: 10.1016/j.jsams.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES To 1) determine the association between computerized and functional reaction time, and 2) compare functional reaction times between female athletes with and without a concussion history. DESIGN Cross-sectional study. METHODS Twenty female college athletes with concussion history (age = 19.1 ± 1.5 years, height = 166.9 ± 6.7 cm, mass = 62.8 ± 6.9 kg, median total concussion = 1.0 [interquartile range = 1.0, 2.0]), and 28 female college athletes without concussion history (age = 19.1 ± 1.0 years, height = 172.7 ± 8.3 cm, mass = 65.4 ± 8.4 kg). Functional reaction time was assessed during jump landing and dominant and non-dominant limb cutting. Computerized assessments included simple, complex, Stroop, and composite reaction times. Partial correlations investigated the associations between functional and computerized reaction time assessments while covarying for time between computerized and functional reaction time assessments. Analysis of covariance compared functional and computerized reaction time, covarying for time since concussion. RESULTS There were no significant correlations between functional and computerized reaction time assessments (p-range = 0.318 to 0.999, partial correlation range = -0.149 to 0.072). Reaction time did not differ between groups during any functional (p-range = 0.057 to 0.920) or computerized (p-range = 0.605 to 0.860) reaction time assessments. CONCLUSIONS Post-concussion reaction time is commonly assessed via computerized measures, but our data suggest computerized reaction time assessments are not characterizing reaction time during sport-like movements in varsity-level female athletes. Future research should investigate confounding factors of functional reaction time.
Collapse
Affiliation(s)
- Eric J Shumski
- Department of Kinesiology, UGA Concussion and Biomechanics Research Laboratory and Biomechanics Laboratory, University of Georgia, United States of America.
| | - Melissa N Anderson
- Department of Kinesiology and Applied Physiology, University of Delaware, United States of America
| | - Jeonghoon Oh
- Department of Neurosurgery, Center of Neuroregeneration, Houston Methodist Research Institute, United States of America
| | - Julianne D Schmidt
- Department of Kinesiology, UGA Concussion and Biomechanics Research Laboratory and Biomechanics Laboratory, University of Georgia, United States of America
| | - Robert C Lynall
- Department of Kinesiology, UGA Concussion and Biomechanics Research Laboratory and Biomechanics Laboratory, University of Georgia, United States of America
| |
Collapse
|
8
|
Campbell KR, Scanlan KT, Wilhelm JL, Brumbach BH, Pettigrew NC, Neilson A, Parrington L, King LA. Assessment of balance in people with mild traumatic brain injury using a balance systems model approach. Gait Posture 2023; 100:107-113. [PMID: 36516644 DOI: 10.1016/j.gaitpost.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/27/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Measuring persistent imbalance after mTBI is challenging and may include subjective symptom-reporting as well as clinical scales. Clinical assessments for quantifying balance following mTBI have focused on sensory orientation. It is theorized that balance control goes beyond sensory orientation and also includes subdomains of anticipatory postural adjustments, reactive postural control, and dynamic gait. The Mini Balance Evaluation Systems Test (Mini-BESTest) is a validated balance test that measures balance according to these subdomains for a more comprehensive assessment. The purpose of this study was to compare Mini-BESTest total and subdomain scores after subacute mTBI with healthy controls. METHODS Symptomatic mTBI (n = 90, 20 % male, age=36.0 ± 12.0, 46.3.4 ± 22.1 days since injury) and healthy control (n = 45, 20 % male, age=35.4 ± 12.5) participants completed the Mini-BESTest for balance. Mini-BESTest between-group differences were evaluated using Wilcoxon rank-sum tests. RESULTS The mTBI group (Median[minimum,maximum]) had a significantly worse Mini-BESTest total score than the healthy controls (24[18,28] vs 27[23-28], p < 0.001). The mTBI group performed significantly worse in 3 of the 4 subdomains compared to the healthy controls: reactive postural control: 5[2-6] vs 6[3-6], p = 0.003; sensory orientation: 6[5,6] vs 6[6], p = 0.005; dynamic gait: 8[5-10] vs 9[8-10], p < 0.001. There was no significance difference between groups in the anticipatory postural adjustments domain (5[3-6] vs 5[3-6], p = 0.12). CONCLUSIONS The Mini-BESTest identified deficits in people with subacute mTBI in the total score and 3 out of 4 subdomains, suggesting it may be helpful to use in the clinic to identify balance subdomain deficits in the subacute mTBI population. In combination with self-reported assessments, the mini-BESTest may identify balance domain deficits in the subacute mTBI population and help guide treatment for this population.
Collapse
Affiliation(s)
- Kody R Campbell
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, USA.
| | - Kathleen T Scanlan
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA
| | - Jennifer L Wilhelm
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, USA
| | - Barbara H Brumbach
- Biostatistics & Design Program, Oregon Health & Science University, Portland, USA
| | - Natalie C Pettigrew
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, USA; Department of Neurology, Center for Regenerative Medicine, Oregon Health & Science University, Portland, USA
| | - Akira Neilson
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA
| | - Lucy Parrington
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; Department of Dietetics, Human Nutrition and Sport, School of Sport and Exercise Science, La Trobe University, Melbourne, Australia
| | - Laurie A King
- Department of Neurology, Balance Disorders Laboratory, Oregon Health & Science University, Portland, USA; National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, USA
| |
Collapse
|
9
|
Reidy J, Mobbs R, Kim J, Brown E, Mobbs R. Clinical gait characteristics in the early post-concussion phase: A systematic review. J Clin Neurosci 2023; 107:184-191. [PMID: 36462967 DOI: 10.1016/j.jocn.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/29/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Understanding gait alterations immediately post-concussion can improve identification, management and prognosis of concussion. OBJECTIVE To identify and define gait characteristics immediately post-concussion. METHOD A review of electronic databases was conducted using terms gait alteration AND mTBI OR concussion. 172 reports were identified. After restricting to English and human studies, 158 remained. Reports were screened to include studies assessing quantifiable gait change post-concussion. 12 studies were included. DISCUSSION Multiple gait features are altered post-impact: stability, step length, walking speed and postural control. There is evidence that postural measures in gait initiation and termination may identify more subtle deficits. There is paucity of data evaluating the impact of concussion on gait function acutely and the authors identified no studies examining immediate changes. CONCLUSION Acutely post-concussion, various gait alterations are seen and correlate with degree of deficit and prognosis. Slowed gait, instability and postural control are several features. Dynamic gait and postural assessments identify more subtle gait alterations. Given the absence in literature, high quality prospective studies examining immediate gait alterations post-concussion would contribute to improved assessment, management and prognostication. Given difficulty in participant recruitment, technological and standardised gait assessments should be used to assess force of impact and immediate gait alteration.
Collapse
Affiliation(s)
- Joseph Reidy
- Department of Neurosurgery, Prince of Wales Hospital, Randwick, NSW, Australia; University of New South Wales, Randwick, NSW, Australia.
| | - Ralph Mobbs
- Department of Neurosurgery, Prince of Wales Hospital, Randwick, NSW, Australia; University of New South Wales, Randwick, NSW, Australia; NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Jake Kim
- University of New South Wales, Randwick, NSW, Australia; NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Eamon Brown
- Macquarie Medical School, Macquarie University, NSW, Australia
| | - Rowena Mobbs
- Department of Neurology, Macquarie University Hospital, Macquarie University, NSW, Australia
| |
Collapse
|
10
|
Fraser MA, Kuo M, Boeckmann AM, Kilchrist LM. Evidence to Eliminate Double-Leg Conditions From the Modified Balance Error Scoring System and Balance Error Scoring System. Clin J Sport Med 2022; 32:e521-e526. [PMID: 35316822 DOI: 10.1097/jsm.0000000000001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/29/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of our study was to assess the differences between the Balance Error Scoring System (BESS), modified BESS (mBESS), and both measures with the double-leg (DL) stances removed [BESS-revised (BESS-R) and mBESS-revised (mBESS-R)] among healthy and concussed collegiate student-athletes. DESIGN Retrospective, repeated-measures cohort study. SETTING Clinical. PATIENTS OR OTHER PARTICIPANTS Healthy and concussed collegiate athletes (baseline n = 622, postinjury n = 41) from 12 National Collegiate Athletic Association Division I sports cheer and dance at a single university. INTERVENTION OR INDEPENDENT VARIABLES Balance Error Scoring System, mBESS, BESS-R, and mBESS-R test versions from baseline and postinjury testing. MAIN OUTCOME MEASURES The mBESS and BESS and their revised versions with DL stances removed (mBESS-R and BESS-R) scores were compared at baseline. Baseline and postinjury scores for all 4 BESS variations and the 6 BESS conditions were compared for those who sustained a concussion. RESULTS The BESS and BESS-R were statistically different at baseline for the entire sample (99.6% confidence interval 0.32, 0.38, P > 0.0001). None of the other comparisons were significantly different ( P > 0.004). CONCLUSION Although our results do suggest statistically significant differences between the BESS and BESS-R test versions, they do not represent clinically meaningful differences. The greatest mean difference between all test versions was <1 error; therefore, these BESS versions may not be specific enough to identify balance deficits at baseline or postinjury. Elimination of the time intensive DL measures in the revised BESS variations may be a more clinically practical alternative.
Collapse
Affiliation(s)
- Melissa A Fraser
- Department of Health and Human Performance, Texas State University, San Marcos, Texas
| | | | | | | |
Collapse
|
11
|
Utility of a Postural Stability/Perceptual Inhibition Dual Task for Identifying Concussion in Adolescents. J Sport Rehabil 2021; 30:1191-1196. [PMID: 34525453 DOI: 10.1123/jsr.2021-0084] [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] [Received: 03/09/2021] [Revised: 05/24/2021] [Accepted: 06/16/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Research in the area of dual-task paradigms to assess sport-related concussion (SRC) status is growing, but additional assessment of this paradigm in adolescents is warranted. DESIGN This case-control study compared 49 adolescent athletes aged 12-20 years with diagnosed SRC to 49 age- and sex-matched controls on visual-spatial discrimination and perceptual inhibition (PIT) reaction time tasks performed while balancing on floor/foam pad conditions. METHODS The SRC group completed measures at a single time point between 1 and 10 days postinjury. Primary outcomes were dual-task reaction time, accuracy, and sway. General linear models evaluated differences between groups (P < .05). Logistic regression identified predictors of concussion from outcomes. Area under the curve evaluated discriminative ability of identifying SRC. RESULTS Results supported significantly higher anterior-posterior (AP) sway values in concussed participants for visual-spatial discrimination and PIT when balancing on the floor (P = .03) and foam pad (P = .03), as well as mediolateral sway values on the floor during visual-spatial discrimination (P = .01). Logistic regression analysis (R2 = .15; P = .001) of all dual-task outcomes identified AP postural sway during the PIT foam dual task as the only significant predictor of concussed status (ß = -2.4; P = .004). Total symptoms (area under the curve = 0.87; P < .001) and AP postural sway on foam (area under the curve = 0.70; P = .001) differentiated concussed from controls. CONCLUSION The AP postural sway on foam during a postural stability/PIT dual task can identify concussion in adolescents between 1 and 10 days from injury.
Collapse
|