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Yang S, Johnson PK, Hansen CR, Wilde EA, Cortez MM, Dibble LE, Fino PC, Raffegeau TE. Talking while Walking After Concussion: Acute effects of concussion on speech pauses and gait speed. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.06.24311478. [PMID: 39211856 PMCID: PMC11361251 DOI: 10.1101/2024.08.06.24311478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Background Deficits in dual-tasks (DT) are frequently observed post-concussion (i.e., mild Traumatic Brain Injury). However, traditional DT may not be relevant to daily life. Walking while talking elicits DT costs in healthy adults and is part of daily life. Objective We investigated the effect of concussion on walking with extemporaneous speech and explored relationships between DT and acute symptoms. Methods Participants with recent concussion (<14 days post-injury) and controls completed three tasks: single-task gait without speaking (ST G ), single-task speaking without walking (ST S ) and walking while speaking (DT). Silent pauses in speech audio reflected cognitive performance, and gait was quantified using inertial sensors. We used linear mixed models to compare groups and conditions and explored associations with self-reported symptoms. Results Both concussion (n=19) and control (n=18) groups exhibited longer speech pauses ( p < 0.001), slower walking speeds ( p < 0.001), and slower cadence ( p < 0.001) during the DT compared to ST conditions. There were no group differences or interactions for speech pauses ( p > 0.424). The concussion group walked slower ( p = 0.010) and slowed down more during DT than the control group (group*task p = 0.032). Vestibular symptoms strongly associated with ST speech pause duration ( ρ = 0.72), ST gait speed ( ρ = -0.75), and DT gait speed ( ρ = -0.78). Conclusions Extemporaneous speech is well-practiced, but challenging to complete while walking post-concussion. Strong associations between DT outcomes and vestibular-related symptoms suggest DT deficits vary with post-concussion symptomology. DT deficits may be deleterious to daily tasks post-concussion.
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Martini DN, Mancini M, Antonellis P, McDonnell P, Vitorio R, Stuart S, King LA. Prefrontal Cortex Activity During Gait in People With Persistent Symptoms After Concussion. Neurorehabil Neural Repair 2024:15459683241240423. [PMID: 38506532 DOI: 10.1177/15459683241240423] [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: 03/21/2024]
Abstract
BACKGROUND Concussions result in transient symptoms stemming from a cortical metabolic energy crisis. Though this metabolic energy crisis typically resolves in a month, symptoms can persist for years. The symptomatic period is associated with gait dysfunction, the cortical underpinnings of which are poorly understood. Quantifying prefrontal cortex (PFC) activity during gait may provide insight into post-concussion gait dysfunction. The purpose of this study was to explore the effects of persisting concussion symptoms on PFC activity during gait. We hypothesized that adults with persisting concussion symptoms would have greater PFC activity during gait than controls. Within the concussed group, we hypothesized that worse symptoms would relate to increased PFC activity during gait, and that increased PFC activity would relate to worse gait characteristics. METHODS The Neurobehavior Symptom Inventory (NSI) characterized concussion symptoms. Functional near-infrared spectroscopy quantified PFC activity (relative concentration changes of oxygenated hemoglobin [HbO2]) in 14 people with a concussion and 25 controls. Gait was assessed using six inertial sensors in the concussion group. RESULTS Average NSI total score was 26.4 (13.2). HbO2 was significantly higher (P = .007) for the concussed group (0.058 [0.108]) compared to the control group (-0.016 [0.057]). Within the concussion group, HbO2 correlated with NSI total symptom score (ρ = .62; P = .02), sagittal range of motion (r = .79; P = .001), and stride time variability (r = -.54; P = .046). CONCLUSION These data suggest PFC activity relates to symptom severity and some gait characteristics in people with persistent concussion symptoms. Identifying the neurophysiological underpinnings to gait deficits post-concussion expands our knowledge of motor behavior deficits in people with persistent concussion symptoms.
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Affiliation(s)
- Douglas N Martini
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | | | - Paul McDonnell
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Rodrigo Vitorio
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Samuel Stuart
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
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Chou TY, Huang YL, Leung W, Brown CN, Kaminski TW, Norcross MF. Does prior concussion lead to biomechanical alterations associated with lateral ankle sprain and anterior cruciate ligament injury? A systematic review and meta-analysis. Br J Sports Med 2023; 57:1509-1515. [PMID: 37648411 DOI: 10.1136/bjsports-2023-106980] [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] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To determine whether individuals with a prior concussion exhibit biomechanical alterations in balance, gait and jump-landing tasks with and without cognitive demands that are associated with risk of lateral ankle sprain (LAS) and anterior cruciate ligament (ACL) injury. DESIGN Systematic review and meta-analysis. DATA SOURCES Five electronic databases (Web of Science, Scopus, PubMed, SPORTDiscus and CiNAHL) were searched in April 2023. ELIGIBILITY CRITERIA Included studies involved (1) concussed participants, (2) outcome measures of spatiotemporal, kinematic or kinetic data and (3) a comparison or the data necessary to compare biomechanical variables between individuals with and without concussion history or before and after a concussion. RESULTS Twenty-seven studies were included involving 1544 participants (concussion group (n=757); non-concussion group (n=787)). Individuals with a recent concussion history (within 2 months) had decreased postural stability (g=0.34, 95% CI 0.20 to 0.49, p<0.001) and slower locomotion-related performance (g=0.26, 95% CI 0.11 to 0.41, p<0.001), both of which are associated with LAS injury risk. Furthermore, alterations in frontal plane kinetics (g=0.41, 95% CI 0.03 to 0.79, p=0.033) and sagittal plane kinematics (g=0.30, 95% CI 0.11 to 0.50, p=0.002) were observed in individuals approximately 2 years following concussion, both of which are associated with ACL injury risk. The moderator analyses indicated cognitive demands (ie, working memory, inhibitory control tasks) affected frontal plane kinematics (p=0.009), but not sagittal plane kinematics and locomotion-related performance, between the concussion and non-concussion groups. CONCLUSION Following a recent concussion, individuals display decreased postural stability and slower locomotion-related performance, both of which are associated with LAS injury risk. Moreover, individuals within 2 years following a concussion also adopt a more erect landing posture with greater knee internal adduction moment, both of which are associated with ACL injury risk. While adding cognitive demands to jump-landing tasks affected frontal plane kinematics during landing, the altered movement patterns in locomotion and sagittal plane kinematics postconcussion persisted regardless of additional cognitive demands. PROSPERO REGISTRATION NUMBER CRD42021248916.
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Affiliation(s)
- Tsung-Yeh Chou
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Yu-Lun Huang
- Department of Physical Education and Sport, National Taiwan Normal University, Taipei, Taiwan
| | - Willie Leung
- Department of Health Sciences and Human Performance, The University of Tampa, Tampa, Florida, USA
| | - Cathleen N Brown
- College of Health, Corvallis, Oregon State University, Corvallis, Oregon, USA
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Marc F Norcross
- College of Health, Corvallis, Oregon State University, Corvallis, Oregon, USA
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Grijalva C, Mullins VA, Michael BR, Hale D, Wu L, Toosizadeh N, Chilton FH, Laksari K. Neuroimaging, wearable sensors, and blood-based biomarkers reveal hyperacute changes in the brain after sub-concussive impacts. BRAIN MULTIPHYSICS 2023; 5:100086. [PMID: 38292249 PMCID: PMC10827333 DOI: 10.1016/j.brain.2023.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Impacts in mixed martial arts (MMA) have been studied mainly in regard to the long-term effects of concussions. However, repetitive sub-concussive head impacts at the hyperacute phase (minutes after impact), are not understood. The head experiences rapid acceleration similar to a concussion, but without clinical symptoms. We utilize portable neuroimaging technology - transcranial Doppler (TCD) ultrasound and functional near infrared spectroscopy (fNIRS) - to estimate the extent of pre- and post-differences following contact and non-contact sparring sessions in nine MMA athletes. In addition, the extent of changes in neurofilament light (NfL) protein biomarker concentrations, and neurocognitive/balance parameters were determined following impacts. Athletes were instrumented with sensor-based mouth guards to record head kinematics. TCD and fNIRS results demonstrated significantly increased blood flow velocity (p = 0.01) as well as prefrontal (p = 0.01) and motor cortex (p = 0.04) oxygenation, only following the contact sparring sessions. This increase after contact was correlated with the cumulative angular acceleration experienced during impacts (p = 0.01). In addition, the NfL biomarker demonstrated positive correlations with angular acceleration (p = 0.03), and maximum principal and fiber strain (p = 0.01). On average athletes experienced 23.9 ± 2.9 g peak linear acceleration, 10.29 ± 1.1 rad/s peak angular velocity, and 1,502.3 ± 532.3 rad/s2 angular acceleration. Balance parameters were significantly increased following contact sparring for medial-lateral (ML) center of mass (COM) sway, and ML ankle angle (p = 0.01), illustrating worsened balance. These combined results reveal significant changes in brain hemodynamics and neurophysiological parameters that occur immediately after sub-concussive impacts and suggest that the physical impact to the head plays an important role in these changes.
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Affiliation(s)
- Carissa Grijalva
- University of Arizona, Department of Biomedical Engineering, Tucson, AZ, United States
| | - Veronica A. Mullins
- University of Arizona, School of Nutritional Sciences and Wellness, Tucson, AZ, United States
| | - Bryce R. Michael
- University of Arizona, School of Nutritional Sciences and Wellness, Tucson, AZ, United States
| | - Dallin Hale
- University of Arizona, Department of Physiology, Tucson, AZ, United States
| | - Lyndia Wu
- Univerisity of British Columbia, Department of Mechanical Engineering, Vancouver, BC, Canada
| | - Nima Toosizadeh
- University of Arizona, Department of Biomedical Engineering, Tucson, AZ, United States
- University of Arizona, Department of Medicine, Arizona Center for Aging, Tucson, AZ, United States
| | - Floyd H. Chilton
- University of Arizona, School of Nutritional Sciences and Wellness, Tucson, AZ, United States
| | - Kaveh Laksari
- University of Arizona, Department of Biomedical Engineering, Tucson, AZ, United States
- University of Arizona, Department of Aerospace and Mechanical Engineering, Tucson, AZ, United States
- University of California Riverside, Department of Mechanical Engineering, Riverside, CA, United States
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Hume PA, Lewis GN, Brown SR, Rashid U, Theadom A, Taylor D. NZ-RugbyHealth Study: Current Postural Control Ability of Former Rugby Union and Non-contact Sport Players. Sports Med 2023; 53:2257-2266. [PMID: 37209367 DOI: 10.1007/s40279-023-01864-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Players in contact sports frequently experience mild traumatic brain (concussion) injuries (TBI). While there are known disruptions to balance following acute head trauma, it is uncertain if sport-related concussion injuries have a lasting impact on postural control. AIM To assess postural control in retired rugby players in comparison to retired non-contact sport players, and to evaluate any association with self-reported sport-related concussion history. METHODS Using a cross-sectional design, 75 players in the NZ-RugbyHealth study from three sports groups (44 ± 8 years; 24 elite rugby, 30 community rugby, 21 non-contact sport) took part in this study. The SMART EquiTest® Balance Master was used to assess participant's ability to make effective use of visual, vestibular and proprioceptive information using standardised tests. Postural sway was also quantified using centre of pressure (COP) path length. The relationship among sports group, sport-related concussion history and postural control was evaluated using mixed regression models while controlling for age and body mass index. RESULTS Limited significant differences in balance metrics were found between the sports groups. A statistically significant (p < 0.001) interaction indicated a relationship between COP path length and sport-related concussion history in the most challenging balance condition, such that path length increased as the number of previous sport-related concussions increased. CONCLUSION There was some evidence for a relationship between sport-related concussion recurrence in sports players and postural stability in challenging balance conditions. There was no evidence of impaired balance ability in retired rugby players compared with non-contact sport athletes.
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Affiliation(s)
- Patria A Hume
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
- Traumatic Brain Injury Network, Auckland University of Technology, Auckland, New Zealand.
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.
- Minderoo Tech & Policy Lab, The University of Western Australia, Perth, Australia.
| | - Gwyn N Lewis
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Scott R Brown
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
- Department of Kinesiology, Aquinas College, Grand Rapids, MI, USA
| | - Usman Rashid
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- Traumatic Brain Injury Network, Auckland University of Technology, Auckland, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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Grijalva C, Hale D, Wu L, Toosizadeh N, Laksari K. Hyper-acute effects of sub-concussive soccer headers on brain function and hemodynamics. Front Hum Neurosci 2023; 17:1191284. [PMID: 37780960 PMCID: PMC10538631 DOI: 10.3389/fnhum.2023.1191284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Sub-concussive head impacts in soccer are drawing increasing research attention regarding their acute and long-term effects as players may experience thousands of headers in a single season. During these impacts, the head experiences rapid acceleration similar to what occurs during a concussion, but without the clinical implications. The physical mechanism and response to repetitive impacts are not completely understood. The objective of this work was to examine the immediate functional outcomes of sub-concussive level impacts from soccer heading in a natural, non-laboratory environment. Methods Twenty university level soccer athletes were instrumented with sensor-mounted bite bars to record impacts from 10 consecutive soccer headers. Pre- and post-header measurements were collected to determine hyper-acute changes, i.e., within minutes after exposure. This included measuring blood flow velocity using transcranial Doppler (TCD) ultrasound, oxyhemoglobin concentration using functional near infrared spectroscopy imaging (fNIRS), and upper extremity dual-task (UEF) neurocognitive testing. Results On average, the athletes experienced 30.7 ± 8.9 g peak linear acceleration and 7.2 ± 3.1 rad/s peak angular velocity, respectively. Results from fNIRS measurements showed an increase in the brain oxygenation for the left prefrontal cortex (PC) (p = 0.002), and the left motor cortex (MC) (p = 0.007) following the soccer headers. Additional analysis of the fNIRS time series demonstrates increased sample entropy of the signal after the headers in the right PC (p = 0.02), right MC (p = 0.004), and left MC (p = 0.04). Discussion These combined results reveal some variations in brain oxygenation immediately detected after repetitive headers. Significant changes in balance and neurocognitive function were not observed in this study, indicating a mild level of head impacts. This is the first study to observe hemodynamic changes immediately after sub-concussive impacts using non-invasive portable imaging technology. In combination with head kinematic measurements, this information can give new insights and a framework for immediate monitoring of sub-concussive impacts on the head.
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Affiliation(s)
- Carissa Grijalva
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, United States
| | - Dallin Hale
- Department of Physiology, University of Arizona, Tucson, AZ, United States
| | - Lyndia Wu
- Department of Mechanical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Nima Toosizadeh
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, United States
- Arizona Center for Aging, Department of Medicine, University of Arizona, Tucson, AZ, United States
| | - Kaveh Laksari
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, United States
- Department of Aerospace and Mechanical Engineering, University of Arizona, Tucson, AZ, United States
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Hunzinger KJ, Caccese JB, Mannix R, Meehan WP, Hafer JF, Swanik CB, Buckley TA. Effects of contact/collision sport history on gait in early- to mid-adulthood. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:398-405. [PMID: 36496131 DOI: 10.1016/j.jshs.2022.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/22/2022] [Accepted: 11/18/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND To determine the effect of contact/collision sport participation on measures of single-task (ST) and dual-task (DT) gait among early- to middle-aged adults. METHODS The study recruited 113 adults (34.88 ± 11.80 years, (mean ± SD); 53.0% female) representing 4 groups. Groups included (a) former non-contact/collision athletes and non-athletes who are not physically active (n = 28); (b) former non-contact/collision athletes who are physically active (n = 29); (c) former contact/collision sport athletes who participated in high-risk sports and are physically active (n = 29); and (d) former rugby players with prolonged repetitive head impact exposure history who are physically active (n = 27). Gait parameters were collected using inertial measurement units during ST and DT gait. DT cost was calculated for all gait parameters (double support, gait speed, and stride length). Groups were compared first using one-way analysis of covariance. Then a multiple regression was performed for participants in the high-risk sport athletes and repetitive head impact exposure athletes groups only to predict gait outcomes from contact/collision sport career duration. RESULTS There were no significant differences between groups on any ST, DT, or DT cost outcomes (p > 0.05). Contact/collision sport duration did not predict any ST, DT, or DT cost gait outcomes. CONCLUSION Years and history of contact/collision sport participation does not appear to negatively affect or predict neurobehavioral function in early- to mid-adulthood among physically active individuals.
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Affiliation(s)
- Katherine J Hunzinger
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - William P Meehan
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA 02115, USA; The Micheli Center for Sports Injury Prevention, Waltham, MA 02453, USA; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA 02453, USA; Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA 02453, USA
| | - Jocelyn F Hafer
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 02453, USA; Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE 02453, USA
| | - C Buz Swanik
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 02453, USA; Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE 02453, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 02453, USA; Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE 02453, USA.
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Magliato SN, Wingerson MJ, Seehusen CN, Smulligan KL, Simon SL, Wilson JC, Howell DR. Sleep Problems After Concussion Are Associated With Poor Balance and Persistent Postconcussion Symptoms. J Child Neurol 2023; 38:198-205. [PMID: 37122172 DOI: 10.1177/08830738231170721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We examined the association of self-reported sleep problems with clinical measures of postural stability, memory performance, symptom burden, and symptom duration following youth concussion. Patients 6-18 years of age presenting ≤21 days postconcussion underwent a clinical evaluation including modified Balance Error Scoring System, single- and dual-task tandem gait, immediate and delayed recall, and symptom severity. We calculated time from injury until symptom resolution and determined the proportion of patients who developed persistent postconcussion symptoms, defined as a symptom duration >28 days postconcussion. We grouped patients based on whether they reported sleep problems at their postconcussion clinical evaluation and compared symptom-based and functional outcomes between groups. Of the 207 patients included, n = 97 (14.3 ± 2.9 years; 49% female; initial visit 10.2 ± 5.8 days postconcussion) reported sleep problems postconcussion and n = 110 (14.3 ± 2.4 years; 46% female; initial visit 9.3 ± 5.4 days postinjury) did not. Those reporting sleep problems postconcussion had significantly more modified Balance Error Scoring System errors than those without (8.4 ± 5.5 vs 6.7 ± 4.7; P = .01), but similar tandem gait and memory performance. A significantly greater proportion of those who reported sleep problems postconcussion experienced persistent postconcussion symptoms than those who did not (53% vs 31%; P = .004). After adjusting for time from concussion to clinical visit and preconcussion sleep problems, postconcussion sleep problems were associated with a 2 times greater odds of developing persistent postconcussion symptoms (adjusted odds ratio = 2.02, 95% CI = 1.01, 4.06; P = .049). Identifying sleep problems early following concussion may allow clinicians to implement targeted treatment recommendations to improve sleep and provide an optimal recovery environment.
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Affiliation(s)
- Samantha N Magliato
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, CO, USA
| | - Mathew J Wingerson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, CO, USA
| | - Corrine N Seehusen
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, CO, USA
| | - Katherine L Smulligan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, CO, USA
| | - Stacey L Simon
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Pediatric Sleep Center, Children's Hospital of Colorado, Aurora, CO, USA
| | - Julie C Wilson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - David R Howell
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
- Sports Medicine Center, Children's Hospital of Colorado, Aurora, CO, USA
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Fino PC, Michielutti PG, Pelo R, Parrington L, Dibble LE, Hoppes CW, Lester ME, Weightman MM, King LA. A Hybrid Assessment of Clinical Mobility Test Items for Evaluating Individuals With Mild Traumatic Brain Injury. J Neurol Phys Ther 2023; 47:84-90. [PMID: 36538333 PMCID: PMC10033306 DOI: 10.1097/npt.0000000000000427] [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: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE The Functional Gait Assessment (FGA) and High Level Mobility Assessment Tool (HiMAT) are clinical batteries used to assess people with mild traumatic brain injury (mTBI). However, neither assessment was specifically developed for people with mTBI; the FGA was developed to evaluate vestibular deficits, and the HiMAT was developed for individuals with more severe TBI. To maximize the sensitivity and reduce the time burden of these assessments, the purpose of this study was to determine the combination of FGA and HiMAT items that best discriminates persons with persistent symptoms from mTBI from healthy controls. METHODS Fifty-three symptomatic civilians with persistent symptoms from mTBI (21% male, aged 31 (9.5) years, 328 [267] days since concussion) and 57 healthy adults (28% male, aged 32 (9.6) years) participated across 3 sites. The FGA and HiMAT were evaluated sequentially as part of a larger study. To determine the best combination of items, a lasso-based generalized linear model (glm) was fit to all data. RESULTS The area under the curve (AUC) for FGA and HiMAT total scores was 0.68 and 0.66, respectively. Lasso regression selected 4 items, including FGA Gait with Horizontal Head Turns and with Pivot Turn, and HiMAT Fast Forward and Backward Walk, and yielded an AUC (95% confidence interval) of 0.71 (0.61-0.79) using standard scoring. DISCUSSION AND CONCLUSIONS The results provide initial evidence supporting a reduced, 4-Item Hybrid Assessment of Mobility for mTBI (HAM-4-mTBI) for monitoring individuals with mTBI. Future work should validate the HAM-4-mTBI and investigate its utility for tracking progression throughout rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A409 ).
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Affiliation(s)
- Peter C Fino
- Departments of Health & Kinesiology (P.C.F.) and Physical Therapy & Athletic Training (R.P., L.E.D.), The University of Utah, Salt Lake City, Utah; Courage Kenny Research Center, Allina Health, Minneapolis, Minnesota (P.G.M., M.M.W.); Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia (L.P.); Department of Neurology, Oregon Health & Science University, Portland, Oregon (L.P., L.A.K.); Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, Texas (C.W.H., M.E.L.); and Department of Physical Therapy, Texas State University, Round Rock, Texas (M.E.L.)
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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.
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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
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11
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Morris A, Casucci T, McFarland MM, Cassidy B, Pelo R, Kreter N, Dibble LE, Fino PC. Reactive Balance Responses After Mild Traumatic Brain Injury: A Scoping Review. J Head Trauma Rehabil 2022; 37:311-317. [PMID: 35125435 PMCID: PMC9339587 DOI: 10.1097/htr.0000000000000761] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Balance testing after concussion or mild traumatic brain injury (mTBI) can be useful in determining acute and chronic neuromuscular deficits that are unapparent from symptom scores or cognitive testing alone. Current assessments of balance do not comprehensively evaluate all 3 classes of balance: maintaining a posture; voluntary movement; and reactive postural response. Despite the utility of reactive postural responses in predicting fall risk in other balance-impaired populations, the effect of mTBI on reactive postural responses remains unclear. This review sought to (1) examine the extent and range of available research on reactive postural responses in people post-mTBI and (2) determine whether reactive postural responses (balance recovery) are affected by mTBI. DESIGN Scoping review. METHODS Studies were identified using MEDLINE, EMBASE, CINAHL, Cochrane Library, Dissertations and Theses Global, PsycINFO, SportDiscus, and Web of Science. Inclusion criteria were injury classified as mTBI with no confounding central or peripheral nervous system dysfunction beyond those stemming from the mTBI, quantitative measure of reactive postural response, and a discrete, externally driven perturbation was used to test reactive postural response. RESULTS A total of 4747 publications were identified, and a total of 3 studies (5 publications) were included in the review. CONCLUSION The limited number of studies available on this topic highlights the lack of investigation on reactive postural responses after mTBI. This review provides a new direction for balance assessments after mTBI and recommends incorporating all 3 classes of postural control in future research.
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Affiliation(s)
- Amanda Morris
- Department of Health and Kinesiology, University of Utah, 250 S 1850 E,Salt Lake City, UT, USA
| | - Tallie Casucci
- J. Willard Marriot Library, University of Utah, 295 1500 E, Salt Lake City, UT, USA
| | - Mary M. McFarland
- Eccles Health Sciences Library, 10 N 1900 E, Salt Lake City, UT, USA
| | - Benjamin Cassidy
- Department of Health and Kinesiology, University of Utah, 250 S 1850 E,Salt Lake City, UT, USA
| | - Ryan Pelo
- Department of Physical Therapy and Athletic Training, University of Utah, 520 S Wakara Way, Salt Lake City, UT, USA
| | - Nicholas Kreter
- Department of Health and Kinesiology, University of Utah, 250 S 1850 E,Salt Lake City, UT, USA
| | - Leland E. Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, 520 S Wakara Way, Salt Lake City, UT, USA
| | - Peter C. Fino
- Department of Health and Kinesiology, University of Utah, 250 S 1850 E,Salt Lake City, UT, USA
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12
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Parrington L, King LA, Hoppes CW, Klaiman MJ, Michielutti P, Fino PC, Dibble LE, Lester ME, Weightman MM. Exploring Vestibular Ocular Motor Screening in Adults With Persistent Complaints After Mild Traumatic Brain Injury. J Head Trauma Rehabil 2022; 37:E346-E354. [PMID: 35067602 DOI: 10.1097/htr.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to (1) explore differences in vestibular ocular motor screening (VOMS) symptoms between healthy adults and adults with persistent symptoms after mild traumatic brain injury (mTBI), and (2) explore the relationships between VOMS symptoms and other measures (self-reported vestibular symptoms, clinical measures of balance and gait, and higher-level motor ability tasks). SETTING Research laboratory setting. PARTICIPANTS Fifty-three persons with persistent symptoms (>3 weeks) following mTBI and 57 healthy controls were recruited. Eligibility for participation included being 18 to 50 years of age and free of medical conditions that may affect balance, with the exception of recent mTBI for the mTBI group. DESIGN Cross-sectional. MAIN MEASURES The primary outcomes were the VOMS symptom scores and near point of convergence (NPC) distance. Secondary outcomes included the Dizziness Handicap Inventory (DHI) total and subdomain scores, sway area, Functional Gait Analysis total score, gait speed, and modified Illinois Agility Task completion time, and Revised High-Level Mobility Assessment Tool total score. RESULTS The mTBI group reported more VOMS symptoms ( z range, -7.28 to -7.89) and a further NPC ( t = -4.16) than healthy controls (all P s < .001). DHI self-reported symptoms (total and all subdomain scores) were strongly associated with the VOMS symptom scores (rho range, 0.53-0.68; all P s < .001). No significant relationships existed between VOMS symptoms and other measures. CONCLUSION Significant group differences support the relevance of the VOMS for mTBI in an age-diverse sample with persistent symptoms. Furthermore, strong association with DHI symptoms supports the ability of the VOMS to capture vestibular complaints in this population.
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Affiliation(s)
- Lucy Parrington
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Victoria, Australia (Dr Parrington); Department of Neurology, Oregon Health & Science University, Portland (Drs Parrington and King); Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, Texas (Drs Hoppes and Lester); Courage Kenny Research Center, Allina Health, Minneapolis, Minnesota (Mr Klaiman and Drs Michielutti and Weightman); Departments of Health and Kinesiology (Dr Fino) and Physical Therapy & Athletic Training (Dr Dibble), University of Utah, Salt Lake City; Department of Physical Therapy, Texas State University, Round Rock (Dr Lester)
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13
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D'Silva L, Chalise P, Rippee M, Devos H. Challenging the Vestibular System Affects Gait Speed and Cognitive Workload in Chronic Mild Traumatic Brain Injury and Healthy Adults. Front Neurol 2022; 13:819169. [PMID: 35812099 PMCID: PMC9259866 DOI: 10.3389/fneur.2022.819169] [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: 11/20/2021] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
People with persistent symptoms after mild traumatic brain injury (mTBI) report imbalance during walking with head movements. The purpose of this study was (1) to compare usual walk gait speed to walking with head turns (HT) between people with mTBI and controls, (2) to compare the cognitive workload from usual walk to HT walk between groups, and (3) to examine if gaze stability deficits and mTBI symptoms influence gait speed. Twenty-three individuals (mean age 55.7 ± 9.3 years) with persistent symptoms after mTBI (between 3 months to 2 years post-injury) were compared with 23 age and sex-matched controls. Participants walked a 12-inch wide, 60-foot walkway when looking ahead and when walking with HT to identify letters and their colors. Gait speed during usual walk and HT walk were calculated. Pupillary responses during both walks were converted to the Index of Cognitive Activity (ICA) as a measure of cognitive workload. Gaze stability was examined by the dynamic visual acuity (DVA) test in the yaw plane. The post-concussion symptom scale (PCSS) was used to collect symptom severity. Within group analysis showed that gait speed was lower during HT walk compared to usual walk in the people with mTBI (p < 0.001) as well as in controls (p < 0.001). ICA was higher with HT compared to usual walk in the mTBI group in the right eye (p = 0.01) and left eye (p = 0.001), and in controls in the right eye (p = 0.01) and left eye (p = 0.01). Participants in the mTBI group had slower usual (p < 0.001), and HT gait speed (p < 0.001) compared to controls. No differences were noted in ICA in the right or left eye during usual walk and HT walk between groups (p > 0.05). DVA loss in the yaw plane to the right and left was not different between groups (p > 0.05) and were not correlated with gait speed. PCSS scores were correlated with usual walk (r = −0.50, p < 0.001) and HT gait speed (r = −0.44, p = 0.002). Slower gait speed, poorer stability, and higher cognitive workload during walking with head turns may reduce community participation in people with mTBI and persistent symptoms.
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Affiliation(s)
- Linda D'Silva
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
- *Correspondence: Linda D'Silva
| | - Prabhakar Chalise
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, MO, United States
| | - Michael Rippee
- Department of Neurology, University of Kansas Medical Center, Kansas City, MO, United States
| | - Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
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14
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Collision avoidance strategies between two athlete walkers: Understanding impaired avoidance behaviours in athletes with a previous concussion. Gait Posture 2022; 92:24-29. [PMID: 34801953 DOI: 10.1016/j.gaitpost.2021.11.003] [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: 07/01/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals who have sustained a concussion often display associated balance control deficits and visuomotor impairments despite being cleared by a physician to return to sport. Such visuomotor impairments can be highlighted in collision avoidance tasks that involves a mutual adaptation between two walkers. However, studies have yet to challenged athletes with a previous concussion during an everyday collision avoidance task, following return to sport. RESEARCH QUESTION Do athletes with a previous concussion display associated behavioural changes during a 90°-collision avoidance task with an approaching pedestrian? METHODS Thirteen athletes (ATH; 9 females, 23 ± 4years) and 13 athletes with a previous concussion (CONC; 9 females, 22 ± 3 years, concussion <6 months) walked at a comfortable walking speed along a 12.6 m pathway while avoiding another athlete on a 90º-collision course. Each participant randomly interacted with individuals from the same group 20 times and interacted with individuals from the opposite group 21 times. Minimum predicted distance (mpd) was used to examine collision avoidance behaviours between ATH and CONC groups. RESULTS The overall progression of mpd(t) did not differ between groups (p > .05). During the collision avoidance task, previously concussed athletes contributed less when passing second compared to their peers(p < .001). When two previously concussed athletes were on a collision course, there was a greater amount of variability resulting in inappropriate adaptive behaviours. SIGNIFICANCE Although successful at avoiding a collision with an approaching athlete, previously concussed athletes exhibit behavioural changes manifesting in riskier behaviours. The current findings suggest that previously concussed athletes possess behavioural changes even after being cleared to returned to sport, which may increase their risk of a subsequent injury when playing.
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15
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Potential Mechanisms of Acute Standing Balance Deficits After Concussions and Subconcussive Head Impacts: A Review. Ann Biomed Eng 2021; 49:2693-2715. [PMID: 34258718 DOI: 10.1007/s10439-021-02831-x] [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: 05/21/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023]
Abstract
Standing balance deficits are prevalent after concussions and have also been reported after subconcussive head impacts. However, the mechanisms underlying such deficits are not fully understood. The objective of this review is to consolidate evidence linking head impact biomechanics to standing balance deficits. Mechanical energy transferred to the head during impacts may deform neural and sensory components involved in the control of standing balance. From our review of acute balance-related changes, concussions frequently resulted in increased magnitude but reduced complexity of postural sway, while subconcussive studies showed inconsistent outcomes. Although vestibular and visual symptoms are common, potential injury to these sensors and their neural pathways are often neglected in biomechanics analyses. While current evidence implies a link between tissue deformations in deep brain regions including the brainstem and common post-concussion balance-related deficits, this link has not been adequately investigated. Key limitations in current studies include inadequate balance sampling duration, varying test time points, and lack of head impact biomechanics measurements. Future investigations should also employ targeted quantitative methods to probe the sensorimotor and neural components underlying balance control. A deeper understanding of the specific injury mechanisms will inform diagnosis and management of balance deficits after concussions and subconcussive head impact exposure.
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16
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Carrick FR, Pagnacco G, Azzolino SF, Hunfalvay M, Oggero E, Frizzell T, Smith CJ, Pawlowski G, Campbell NKJ, Fickling SD, Lakhani B, D'Arcy RCN. Brain Vital Signs in Elite Ice Hockey: Towards Characterizing Objective and Specific Neurophysiological Reference Values for Concussion Management. Front Neurosci 2021; 15:670563. [PMID: 34434084 PMCID: PMC8382572 DOI: 10.3389/fnins.2021.670563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Prior concussion studies have shown that objective neurophysiological measures are sensitive to detecting concussive and subconcussive impairments in youth ice-hockey. These studies monitored brain vital signs at rink-side using a within-subjects design to demonstrate significant changes from pre-season baseline scans. However, practical clinical implementation must overcome inherent challenges related to any dependence on a baseline. This requires establishing the start of normative reference data sets. Methods: The current study collected specific reference data for N = 58 elite, youth, male ice-hockey players and compared these with a general reference dataset from N = 135 of males and females across the lifespan. The elite hockey players were recruited to a select training camp through CAA Hockey, a management agency for players drafted to leagues such as the National Hockey League (NHL). The statistical analysis included a test-retest comparison to establish reliability, and a multivariate analysis of covariance to evaluate differences in brain vital signs between groups with age as a covariate. Findings: Test-retest assessments for brain vital signs evoked potentials showed moderate-to-good reliability (Cronbach’s Alpha > 0.7, Intraclass correlation coefficient > 0.5) in five out of six measures. The multivariate analysis of covariance showed no overall effect for group (p = 0.105), and a significant effect of age as a covariate was observed (p < 0.001). Adjusting for the effect of age, a significant difference was observed in the measure of N100 latency (p = 0.022) between elite hockey players and the heterogeneous control group. Interpretation: The findings support the concept that normative physiological data can be used in brain vital signs evaluation in athletes, and should additionally be stratified for age, skill level, and experience. These can be combined with general norms and/or individual baseline assessments where appropriate and/or possible. The current results allow for brain vital sign evaluation independent of baseline assessment, therefore enabling objective neurophysiological evaluation of concussion management and cognitive performance optimization in ice-hockey.
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Affiliation(s)
- Frederick R Carrick
- University of Central Florida College of Medicine, Orlando, FL, United States.,MGH Institute of Health Professions, Boston, MA, United States.,Centre for Mental Health Research, University of Cambridge, Cambridge, United Kingdom.,Centre for Mental Health Research in Association with University of Cambridge, Cambridge, United Kingdom
| | - Guido Pagnacco
- Centre for Mental Health Research in Association with University of Cambridge, Cambridge, United Kingdom.,Department of Electrical and Computer Engineering, University of Wyoming, Laramie, WY, United States
| | - Sergio F Azzolino
- Centre for Mental Health Research in Association with University of Cambridge, Cambridge, United Kingdom
| | - Melissa Hunfalvay
- Centre for Mental Health Research in Association with University of Cambridge, Cambridge, United Kingdom
| | - Elena Oggero
- Centre for Mental Health Research in Association with University of Cambridge, Cambridge, United Kingdom.,Department of Electrical and Computer Engineering, University of Wyoming, Laramie, WY, United States
| | - Tory Frizzell
- BrainNET, Health and Technology District, Vancouver, BC, Canada
| | | | - Gabriela Pawlowski
- BrainNET, Health and Technology District, Vancouver, BC, Canada.,Centre for Neurology Studies, HealthTech Connex, Vancouver, BC, Canada
| | - Natasha K J Campbell
- BrainNET, Health and Technology District, Vancouver, BC, Canada.,Centre for Neurology Studies, HealthTech Connex, Vancouver, BC, Canada
| | - Shaun D Fickling
- BrainNET, Health and Technology District, Vancouver, BC, Canada.,Centre for Neurology Studies, HealthTech Connex, Vancouver, BC, Canada
| | - Bimal Lakhani
- Centre for Neurology Studies, HealthTech Connex, Vancouver, BC, Canada
| | - Ryan C N D'Arcy
- BrainNET, Health and Technology District, Vancouver, BC, Canada.,Centre for Neurology Studies, HealthTech Connex, Vancouver, BC, Canada.,DM Centre for Brain Health, Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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17
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Reliability and Minimal Detectable Change for a Smartphone-Based Motor-Cognitive Assessment: Implications for Concussion Management. J Appl Biomech 2021; 37:380-387. [PMID: 34257159 DOI: 10.1123/jab.2020-0391] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 11/18/2022]
Abstract
Our purpose was to investigate the reliability and minimal detectable change characteristics of a smartphone-based assessment of single- and dual-task gait and cognitive performance. Uninjured adolescent athletes (n = 17; mean age = 16.6, SD = 1.3 y; 47% female) completed assessments initially and again 4 weeks later. The authors collected data via an automated smartphone-based application while participants completed a series of tasks under (1) single-task cognitive, (2) single-task gait, and (3) dual-task cognitive-gait conditions. The cognitive task was a series of continuous auditory Stroop cues. Average gait speed was consistent between testing sessions in single-task (0.98, SD = 0.21 vs 0.96, SD = 0.19 m/s; P = .60; r = .89) and dual-task (0.92, SD = 0.22 vs 0.89, SD = 0.22 m/s; P = .37; r = .88) conditions. Response accuracy was moderately consistent between assessments in single-task standing (82.3% accurate, SD = 17.9% vs 84.6% accurate, SD = 20.1%; P = .64; r = .52) and dual-task gait (89.4% accurate, SD = 15.9% vs 85.8% accurate, SD = 20.2%; P = .23; r = .81) conditions. Our results indicate automated motor-cognitive dual-task outcomes obtained within a smartphone-based assessment are consistent across a 1-month period. Further research is required to understand how this assessment performs in the setting of sport-related concussion. Given the relative reliability of values obtained, a smartphone-based evaluation may be considered for use to evaluate changes across time among adolescents, postconcussion.
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18
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Caccese JB, Santos FV, Yamaguchi FK, Buckley TA, Jeka JJ. Persistent Visual and Vestibular Impairments for Postural Control Following Concussion: A Cross-Sectional Study in University Students. Sports Med 2021; 51:2209-2220. [PMID: 33881749 DOI: 10.1007/s40279-021-01472-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine how concussion may impair sensory processing for control of upright stance. METHODS Participants were recruited from a single university into 3 groups: 13 participants (8 women, 21 ± 3 years) between 2 weeks and 6 months post-injury who initiated a return-to-play progression (under physician management) by the time of testing (recent concussion group), 12 participants (7 women, 21 ± 1 years) with a history of concussion (concussion history group, > 1 year post-injury), and 26 participants (8 women, 22 ± 3 years) with no concussion history (control group). We assessed sensory reweighting by simultaneously perturbing participants' visual, vestibular, and proprioceptive systems and computed center of mass gain relative to each modality. The visual stimulus was a sinusoidal translation of the visual scene at 0.2 Hz, the vestibular stimulus was ± 1 mA binaural monopolar galvanic vestibular stimulation (GVS) at 0.36 Hz, the proprioceptive stimulus was Achilles' tendon vibration at 0.28 Hz. RESULTS The recent concussion (95% confidence interval 0.078-0.115, p = 0.001) and the concussion history (95% confidence interval 0.056-0.094, p = 0.038) groups had higher gains to the vestibular stimulus than the control group (95% confidence interval 0.040-0.066). The recent concussion (95% confidence interval 0.795-1.159, p = 0.002) and the concussion history (95% confidence interval 0.633-1.012, p = 0.018) groups had higher gains to the visual stimulus than the control group (95% confidence interval 0.494-0.752). There were no group differences in gains to the proprioceptive stimulus or in sensory reweighting. CONCLUSION Following concussion, participants responded more strongly to visual and vestibular stimuli during upright stance, suggesting they may have abnormal dependence on visual and vestibular feedback. These findings may indicate an area for targeted rehabilitation interventions.
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Affiliation(s)
- Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, 453 W. 10th Avenue, Columbus, OH, 43210, USA.
| | | | - Felipe K Yamaguchi
- Department of Kinesiology & Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE, 19713, USA
| | - Thomas A Buckley
- Department of Kinesiology & Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE, 19713, USA
| | - John J Jeka
- Department of Kinesiology & Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, DE, 19713, USA
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19
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Park G, Suh JH, Han SJ. Transcranial direct current stimulation for balance and gait in repetitive mild traumatic brain injury in rats. BMC Neurosci 2021; 22:26. [PMID: 33865318 PMCID: PMC8052850 DOI: 10.1186/s12868-021-00633-4] [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: 02/16/2021] [Accepted: 04/06/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Balance impairment and lack of postural orientation are serious problems in patients with repetitive mild traumatic brain injury (mTBI). OBJECTIVE To investigate whether anodal transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) can improve balance control and gait in repetitive mTBI rat models. METHODS In this prospective animal study, 65 repetitive mTBI rats were randomly assigned to two groups: the tDCS group and the control group. To create repetitive mTBI model rats, we induced mTBI in the rats for 3 consecutive days. The tDCS group received one session of anodal tDCS over the M1 area 24 h after the third induced mTBI, while the control group did not receive tDCS treatment. Motor-evoked potential (MEP), foot-fault test, and rotarod test were evaluated before mTBI, before tDCS and after tDCS. The Mann-Whitney U test and Wilcoxon signed rank test were used to assess the effects of variables between the two groups. RESULTS Anodal tDCS over the M1 area significantly improved the amplitude of MEP in the tDCS group (p = 0.041). In addition, rotarod duration was significantly increased in the tDCS group (p = 0.001). The foot-fault ratio was slightly lower in the tDCS group, however, this was not statistically significant. CONCLUSION Anodal tDCS at the M1 area could significantly improve the amplitude of MEP and balance function in a repetitive mTBI rat model. We expect that anodal tDCS would have the potential to improve balance in patients with repetitive mTBI.
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Affiliation(s)
- Gahee Park
- Department of Rehabilitation Medicine, College of Medicine, Ewha Womans University, 1071 An-Yang-Cheon Ro, Yang-Cheon Gu, Seoul, 07985, Republic of Korea
| | - Jee Hyun Suh
- Department of Rehabilitation Medicine, College of Medicine, Ewha Womans University, 1071 An-Yang-Cheon Ro, Yang-Cheon Gu, Seoul, 07985, Republic of Korea. .,Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13590, Republic of Korea.
| | - Soo Jeong Han
- Department of Rehabilitation Medicine, College of Medicine, Ewha Womans University, 1071 An-Yang-Cheon Ro, Yang-Cheon Gu, Seoul, 07985, Republic of Korea
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20
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Abstract
PURPOSE OF REVIEW Sport-related concussion (SRC) is a significant public health problem. Understanding the behavioral and personal factors that influence risk and incidence of SRC is critically important for appropriate care and management. Sensation-seeking and impulsivity have been posited to be two such factors that may be significantly associated with SRC. We performed a focused review of recent evidence of the relationships between sensation-seeking and impulsivity in athletes with SRC. RECENT FINDINGS While the research is relatively limited, extant findings demonstrate a significant relationship between sensation-seeking and contact sport participation and risk of prior and future SRC. Impulsivity appears to be common among athletes competing in high contact sports and may contribute to neural and functional brain changes following SRC; however, causal relationships between impulsivity, contact sport participation, and SRC have not been demonstrated. Both sensation-seeking and impulsivity are significantly associated with SRC in collegiate athletes. Interventions designed to ameliorate high levels of these constructs may prove to be beneficial avenues to reducing SRC risk and improving patient care and outcomes.
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Affiliation(s)
- Spencer W Liebel
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA.
| | - Katherine A M Edwards
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
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21
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Van Deventer KA, Seehusen CN, Walker GA, Wilson JC, Howell DR. The diagnostic and prognostic utility of the dual-task tandem gait test for pediatric concussion. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:131-137. [PMID: 32795624 PMCID: PMC7987555 DOI: 10.1016/j.jshs.2020.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND The tandem gait test has gained interest recently for assessment of concussion recovery. The purpose of our study was to determine the prognostic and diagnostic use of the single- and dual-task tandem gait test, alongside other clinical measures, within 10 days of pediatric concussion. METHODS We assessed 126 patients post-concussion (6.3 ± 2.3 days post-injury, mean ± SD) at a pediatric sports medicine clinic and compared them to 58 healthy controls (age: 15.6 ± 1.3 years; 43% female). We also compared the 31 patients with concussion who developed persistent post-concussion symptoms (PPCS) (age = 14.9 ± 2.0 years; 48% female) to the 81 patients with concussion who did not develop PPCS following the initial assessment (age: 14.1 ± 3.0 years; 41% female). All subjects completed a test battery, and concussion patients were monitored until they experienced concussion-symptom resolution. The test battery included tandem gait (single-task, dual-task (performing tandem gait while concurrently completing a cognitive test) conditions), modified Balance Error Scoring System (mBESS), and concussion symptom assessment (Health and Behavior Inventory). We defined PPCS as symptom resolution time > 28 days post-concussion for the concussion group. Measurement outcomes included tandem gait time (single- and dual-task), dual-task cognitive accuracy, mBESS errors (single/double/tandem stances), and symptom severity. RESULTS The concussion group completed the single-task (mean difference = 9.1 s, 95% confidential interval (95%CI): 6.1-12.1) and dual-task (mean difference = 12.7 s, 95%CI: 8.7-16.8) tandem gait test more slowly than the control group. Compared to those who recovered within 28 days of concussion, the PPCS group had slower dual-task tandem gait test times (mean difference = 7.9 s, 95%CI: 2.0-13.9), made more tandem-stance mBESS errors (mean difference = 1.3 errors, 95%CI: 0.2-2.3), and reported more severe symptoms (mean difference = 26.6 Health and Behavior Inventory rating, 95%CI: 21.1-32.6). CONCLUSION Worse dual-task tandem gait test time and mBESS tandem stance performance predicted PPCS in pediatric patients evaluated within 10 days of concussion. Tandem gait assessments may provide valuable information augmenting common clinical practices for concussion management.
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Affiliation(s)
| | - Corrine N Seehusen
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO 80045, USA
| | - Gregory A Walker
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO 80045, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Julie C Wilson
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO 80045, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO 80045, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO 80045, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
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22
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Sada YH, Poursina O, Zhou H, Workeneh BT, Maddali SV, Najafi B. Harnessing digital health to objectively assess cancer-related fatigue: The impact of fatigue on mobility performance. PLoS One 2021; 16:e0246101. [PMID: 33636720 PMCID: PMC7910036 DOI: 10.1371/journal.pone.0246101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/11/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Cancer-related fatigue (CRF) is highly prevalent among cancer survivors, which may have long-term effects on physical activity and quality of life. CRF is assessed by self-report or clinical observation, which may limit timely diagnosis and management. In this study, we examined the effect of CRF on mobility performance measured by a wearable pendant sensor. Methods This is a secondary analysis of a clinical trial evaluating the benefit of exercise in cancer survivors with chemotherapy-induced peripheral neuropathy (CIPN). CRF status was classified based on a Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) score ≤ 33. Among 28 patients (age = 65.7±9.8 years old, BMI = 26.9±4.1kg/m2, sex = 32.9%female) with database variables of interest, twenty-one subjects (75.9%) were classified as non-CRF. Mobility performance, including behavior (sedentary, light, and moderate to vigorous activity (MtV)), postures (sitting, standing, lying, and walking), and locomotion (e.g., steps, postural transitions) were measured using a validated pendant-sensor over 24-hours. Baseline psychosocial, Functional Assessment of Cancer Therapy–General (FACT-G), Falls Efficacy Scale–International (FES-I), and motor-capacity assessments including gait (habitual speed, fast speed, and dual-task speed) and static balance were also performed. Results Both groups had similar baseline clinical and psychosocial characteristics, except for body-mass index (BMI), FACT-G, FACIT-F, and FES-I (p<0.050). The groups did not differ on motor-capacity. However, the majority of mobility performance parameters were different between groups with large to very large effect size, Cohen’s d ranging from 0.91 to 1.59. Among assessed mobility performance, the largest effect sizes were observed for sedentary-behavior (d = 1.59, p = 0.006), light-activity (d = 1.48, p = 0.009), and duration of sitting+lying (d = 1.46, p = 0.016). The largest correlations between mobility performance and FACIT-F were observed for sitting+lying (rho = -0.67, p<0.001) and the number of steps per day (rho = 0.60, p = 0.001). Conclusion The results of this study suggest that sensor-based mobility performance monitoring could be considered as a potential digital biomarker for CRF assessment. Future studies warrant evaluating utilization of mobility performance to track changes in CRF over time, response to CRF-related interventions, and earlier detection of CRF.
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Affiliation(s)
- Yvonne H. Sada
- Department of Medicine, Section of Hematology and Oncology, Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, United States of America
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
| | - Olia Poursina
- Michael E. DeBakey Department of Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Baylor College of Medicine, Houston, Texas, United States of America
| | - He Zhou
- Michael E. DeBakey Department of Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Baylor College of Medicine, Houston, Texas, United States of America
| | - Biruh T. Workeneh
- Department of Nephrology, Division of Internal Medicine, MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Sandhya V. Maddali
- Michael E. DeBakey Department of Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Baylor College of Medicine, Houston, Texas, United States of America
| | - Bijan Najafi
- Michael E. DeBakey Department of Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail:
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23
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Sensitivity and Specificity of Computer-Based Neurocognitive Tests in Sport-Related Concussion: Findings from the NCAA-DoD CARE Consortium. Sports Med 2020; 51:351-365. [PMID: 33315231 DOI: 10.1007/s40279-020-01393-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND To optimally care for concussed individuals, a multi-dimensional approach is critical and a key component of this assessment in the athletic environment is computer-based neurocognitive testing. However, there continues to be concerns about the reliability and validity of these testing tools. The purpose of this study was to determine the sensitivity and specificity of three common computer-based neurocognitive tests (Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT], CNS Vital Signs, and CogState Computerized Assessment Tool [CCAT]), to provide guidance on their clinical utility. METHODS This study analyzed assessments from a cohort of collegiate athletes and non-varsity cadets from the NCAA-DoD CARE Consortium. The data were collected from 2014-2018. Study participants were divided into two testing groups [concussed, n = 1414 (baseline/24-48 h) and healthy, n = 8305 (baseline/baseline)]. For each test type, change scores were calculated for the components of interest. Then, the Normative Change method, which used normative data published in a similar cohort, and the Reliable Change Index (RCI) method were used to determine if the change scores were significant. RESULTS Using the Normative Change method, ImPACT performed best with an 87.5%-confidence interval and 1 number of components failed (NCF; sensitivity = 0.583, specificity = 0.625, F1 = 0.308). CNS Vital Signs performed best with a 90%-confidence interval and 1 NCF (sensitivity = 0.587, specificity = 0.532, F1 = 0.314). CCAT performed best when using a 75%-confidence interval and 2 NCF (sensitivity = 0.513, specificity = 0.715, F1 = 0.290). When using the RCI method, ImPACT performed best with an 87.5%-confidence interval and 1 NCF (sensitivity = 0.626, specificity = 0.559, F1 = 0.297). CONCLUSION When considering all three computer-based neurocognitive tests, the overall low sensitivity and specificity results provide additional evidence for the use of a multi-dimensional assessment for concussion diagnosis, including symptom evaluation, postural control assessment, neuropsychological status, and other functional assessments.
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24
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Pryhoda MK, Shelburne KB, Gorgens K, Ledreux A, Granholm AC, Davidson BS. Centre of pressure velocity shows impairments in NCAA Division I athletes six months post-concussion during standing balance. J Sports Sci 2020; 38:2677-2687. [PMID: 32715955 DOI: 10.1080/02640414.2020.1795561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
Sport-related concussion return to play (RTP) decisions are largely based on the resolution of self-reported symptoms and neurocognitive function. Some evaluators also incorporate balance; however, an objective approach to balance that can detect effects beyond the acute condition is warranted. The purpose of this study is to examine linear measures of biomechanical balance up to 6 months post-concussion, and to present preliminary diagnostic thresholds useful for RTP. Each concussed athlete participated in instrumented standing balance tasks at 4 timepoints post-concussion. The measures from concussed athletes were compared to the sport-matched non-concussed athlete group at each timepoint. Centre of pressure (COP) mediolateral (ML) velocity in double-leg stance on a hard surface discriminated well between non-concussed and concussed athletes. COP anterior-posterior (AP) velocity in tandem stance on foam showed sensitivity to concussion. Sixty per cent of athletes at 6 months post-concussion did not recover to within the proposed COP ML velocity threshold in double-leg stance on a hard surface. Seventy-one per cent of athletes at 6 months post-concussion did not recover to within the COP AP velocity threshold in tandem stance on foam. This lack of recovery potentially indicates vestibular and motor control impairments long past the typical period of RTP.
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Affiliation(s)
- Moira K Pryhoda
- Human Dynamics Laboratory, Department of Mechanical and Materials Engineering, University of Denver , Denver, CO, USA
| | - Kevin B Shelburne
- Human Dynamics Laboratory, Department of Mechanical and Materials Engineering, University of Denver , Denver, CO, USA
| | - Kim Gorgens
- Graduate School of Professional Psychology, University of Denver , Denver, CO, USA
| | - Aurélie Ledreux
- Knoebel Institute for Healthy Aging, University of Denver , Denver, CO, USA
| | | | - Bradley S Davidson
- Human Dynamics Laboratory, Department of Mechanical and Materials Engineering, University of Denver , Denver, CO, USA
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25
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Liebel SW, Van Pelt KL, Garcia GGP, Czerniak LL, McCrea MA, McAllister TW, Broglio SP. The Relationship between Sport-Related Concussion and Sensation-Seeking. Int J Mol Sci 2020; 21:ijms21239097. [PMID: 33265913 PMCID: PMC7729784 DOI: 10.3390/ijms21239097] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 11/16/2022] Open
Abstract
Sensation-seeking, or the need for novel and exciting experiences, is thought to play a role in sport-related concussion (SRC), yet much remains unknown regarding these relationships and, more importantly, how sensation-seeking influences SRC risk. The current study assessed sensation-seeking, sport contact level, and SRC history and incidence in a large sample of NCAA collegiate athletes. Data included a full study sample of 22,374 baseline evaluations and a sub-sample of 2037 incident SRC. Independent samples t-test, analysis of covariance, and hierarchical logistic regression were constructed to address study hypotheses. Results showed that (1) among participants without SRC, sensation-seeking scores were higher in athletes playing contact sports compared to those playing limited- or non-contact sports (p < 0.001, R2 = 0.007, η2p = 0.003); (2) in the full study sample, a one-point increase in sensation-seeking scores resulted in a 21% greater risk of prior SRC (OR = 1.212; 95% CI: 1.154-1.272), and in the incident SRC sub-sample, a 28% greater risk of prior SRC (OR = 1.278; 95% CI: 1.104-1.480); (3) a one-point increase in sensation-seeking scores resulted in a 12% greater risk of incident SRC among the full study sample; and (4) sensation-seeking did not vary as a function of incident SRC (p = 0.281, η2p = 0.000). Our findings demonstrate the potential usefulness of considering sensation-seeking in SRC management.
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Affiliation(s)
- Spencer W. Liebel
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI 48109, USA;
- Correspondence:
| | - Kathryn L. Van Pelt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40504, USA;
| | - Gian-Gabriel P. Garcia
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (G.-G.P.G.); (L.L.C.)
| | - Lauren L. Czerniak
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (G.-G.P.G.); (L.L.C.)
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI 53226, USA;
| | - Thomas W. McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Steven P. Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI 48109, USA;
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Mang CS, Whitten TA, Cosh MS, Dukelow SP, Benson BW. Assessment of Postural Stability During an Upper Extremity Rapid, Bimanual Motor Task After Sport-Related Concussion. J Athl Train 2020; 55:1160-1173. [PMID: 33064821 DOI: 10.4085/1062-6050-378-19] [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: 11/09/2022]
Abstract
CONTEXT Sport-related concussion (SRC) often presents with multidimensional and subtle neurologic deficits that are difficult to detect with standard clinical tests. New assessment approaches that efficiently quantify deficits across multiple neurologic domains are needed. OBJECTIVE To quantify impairments in postural movements during an assessment of rapid, bimanual motor ability in athletes within 10 days of experiencing an SRC and evaluate relationships between impairments in upper extremity and postural performance. DESIGN Cohort study. SETTING Sports medicine clinic. PATIENTS OR OTHER PARTICIPANTS Initial baseline assessments were completed for 711 athletes. Seventy-five athletes (age = 15.8 ± 3.3 years at baseline) sustained SRCs and were reassessed within 10 days. Seventy-eight athletes (age = 15.5 ± 2.0 years) completed 2 assessments in a healthy state. MAIN OUTCOME MEASURE(S) Athletes stood on force plates and performed a rapid, bimanual motor task, termed the object-hit task, delivered using a Kinesiological Instrument for Normal and Altered Reaching Movements endpoint robot. Measures of postural stability that quantified center-of-pressure movements and measures of upper extremity performance were used to characterize task performance. RESULTS Performance changes across assessments were converted to reliable change indices. We observed a difference in reliable change indices values between athletes with SRC and healthy control athletes on the combined postural measures (P = .01). Using measures to evaluate the change in postural movements from the early, easier portion of the task to the later, more difficult portion, we identified the highest levels of impairment (19%-25% of the sample impaired). We also noted a difference between individuals with concussion and healthy individuals on the combined upper extremity measures (P = .003), but these impairments were largely unrelated to those identified in the postural movements. CONCLUSIONS Measurement of postural movements during the object-hit task revealed impairments in postural stability that were not related to impairments in upper extremity performance. The findings demonstrated the benefits of using assessments that simultaneously evaluate multiple domains of neurologic function (eg, upper extremity and postural control) after SRC.
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Affiliation(s)
- Cameron S Mang
- Faculty of Kinesiology and Health Studies, University of Regina, SK, Canada
| | - Tara A Whitten
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Madeline S Cosh
- Benson Concussion Institute, Group23 Sports Medicine Clinic, Calgary, AB, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Brian W Benson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada
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