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Singh A, Gong S, Vu A, Li S, Obenaus A. Social deficits mirror delayed cerebrovascular dysfunction after traumatic brain injury. Acta Neuropathol Commun 2024; 12:126. [PMID: 39107831 PMCID: PMC11304659 DOI: 10.1186/s40478-024-01840-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/28/2024] [Indexed: 08/10/2024] Open
Abstract
Traumatic brain injury (TBI) survivors face debilitating long-term psychosocial consequences, including social isolation and depression. TBI modifies neurovascular physiology and behavior but the chronic physiological implications of altered brain perfusion on social interactions are unknown. Adult C57/BL6 male mice received a moderate cortical TBI, and social behaviors were assessed at baseline, 3-, 7-, 14-, 30-, and 60-days post injury (dpi). Magnetic resonance imaging (MRI, 9.4T) using dynamic susceptibility contrast perfusion weighted MRI were acquired. At 60dpi mice underwent histological angioarchitectural mapping. Analysis utilized standardized protocols followed by cross-correlation metrics. Social behavior deficits at 60dpi emerged as reduced interactions with a familiar cage-mate (partner) that mirrored significant reductions in cerebral blood flow (CBF) at 60dpi. CBF perturbations were dynamic temporally and across brain regions including regions known to regulate social behavior such as hippocampus, hypothalamus, and rhinal cortex. Social isolation in TBI-mice emerged with a significant decline in preference to spend time with a cage mate. Cortical vascular density was also reduced corroborating the decline in brain perfusion and social interactions. Thus, the late emergence of social interaction deficits mirrored the reduced vascular density and CBF in regions known to be involved in social behaviors. Vascular morphology and function improved prior to the late decrements in social function and our correlations strongly implicate a linkage between vascular density, cerebral perfusion, and social interactions. Our study provides a clinically relevant timeline of alterations in social deficits alongside functional vascular recovery that can guide future therapeutics.
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Affiliation(s)
- Aditya Singh
- Department of Pediatrics, School of Medicine, University of California Irvine, Hewitt Hall Rm. 2066, Irvine, CA, 92697, USA
- Department of Neurology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA, 120 Walter P Martin Research Center, Torrance, California, 90502, USA
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, 90095, USA
| | - Steven Gong
- Department of Pediatrics, School of Medicine, University of California Irvine, Hewitt Hall Rm. 2066, Irvine, CA, 92697, USA
| | - Anh Vu
- Department of Pediatrics, School of Medicine, University of California Irvine, Hewitt Hall Rm. 2066, Irvine, CA, 92697, USA
| | - Scott Li
- Department of Pediatrics, School of Medicine, University of California Irvine, Hewitt Hall Rm. 2066, Irvine, CA, 92697, USA
| | - Andre Obenaus
- Department of Pediatrics, School of Medicine, University of California Irvine, Hewitt Hall Rm. 2066, Irvine, CA, 92697, USA.
- Division of Biomedical Sciences, 206 SOM Research Bldg, University of California Riverside, Riverside, CA, 92521, USA.
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Javra R, Burma JS, Johnson NE, Smirl JD. Feasibility of superimposed supine cycling and lower body negative pressure as an effective means of prolonging exercise tolerance in individuals experiencing persisting post-concussive symptoms: Preliminary results. Exp Physiol 2024. [PMID: 39102430 DOI: 10.1113/ep091677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 07/08/2024] [Indexed: 08/07/2024]
Abstract
To examine the feasibility, utility and safety of superimposed lower body negative pressure (LBNP) and tilt during supine cycling in individuals suffering from persisting post-concussive symptoms (PPCS). Eleven individuals aged 17-31 (6 females/5 males) participated in two randomized separate visits, 1 week apart. A ramp-incremental test was performed during both visits until volitional failure. Visits included no pressure (control) or LBNP at -40 Torr (experimental) with head-up tilt at 15 degrees (females) or 30 degrees (males). Transcranial Doppler ultrasound was utilized to quantify middle cerebral artery velocity (MCAv), while symptom reports were filled out before and 0, 10, and 60 min post-exertion. Ratings of exertion and overall condition followed similar trends for participants across both tests. The relative increase in MCAv was blunted during the experimental condition (8%) compared to control (24%), while a greater heart rate (17 beats/min) was achieved during the LBNP condition (P = 0.047). Symptom severity at the 0 and 10 min post-exertion time points displayed negligible-to-small effect sizes between conditions (Wilcoxon's r < 0.11). Symptom reporting was lower at the 60 min post-exertion time point with these displaying a moderate effect size (Wilcoxon's r = 0.31). The combination of LBNP and tilt during supine cycling did not change the participants' subjective interpretation of the exertional test but attenuated the hyperpnia-induced vasodilatory MCAv response, while also enabling participants to achieve a higher heart rate during exercise and reduced symptoms 1 h later. As this protocol is safe and feasible, further research is warranted in this area for developing PPCS treatment options. HIGHLIGHTS: What is the central question of this study? What are the feasibility, safety and utility of combining head-up tilt with lower body negative pressure during supine cycling for blunting the increase in cerebral blood velocity seen during moderate-intensity exercise in individuals experiencing persisting post-concussion symptoms? What is the main finding and its importance? Although no differences were found in symptoms between conditions within the first 10 min following exertion, symptom severity scores showed a clinically meaningful reduction 60 min following the experimental condition compared to the non-experimental control condition.
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Affiliation(s)
- Raelyn Javra
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Joel S Burma
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Nathan E Johnson
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
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Kennedy CM, Burma JS, Smirl JD. Sensor-Assisted Analysis of Autonomic and Cerebrovascular Dysregulation following Concussion in an Individual with a History of Ten Concussions: A Case Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:4404. [PMID: 39001186 PMCID: PMC11244393 DOI: 10.3390/s24134404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION Concussion is known to cause transient autonomic and cerebrovascular dysregulation that generally recovers; however, few studies have focused on individuals with an extensive concussion history. METHOD The case was a 26-year-old male with a history of 10 concussions, diagnosed for bipolar type II disorder, mild attention-deficit hyperactivity disorder, and a history of migraines/headaches. The case was medicated with Valproic Acid and Escitalopram. Sensor-based baseline data were collected within six months of his injury and on days 1-5, 10, and 14 post-injury. Symptom reporting, heart rate variability (HRV), neurovascular coupling (NVC), and dynamic cerebral autoregulation (dCA) assessments were completed using numerous biomedical devices (i.e., transcranial Doppler ultrasound, 3-lead electrocardiography, finger photoplethysmography). RESULTS Total symptom and symptom severity scores were higher for the first-week post-injury, with physical and emotional symptoms being the most impacted. The NVC response showed lowered activation in the first three days post-injury, while autonomic (HRV) and autoregulation (dCA) were impaired across all testing visits occurring in the first 14 days following his concussion. CONCLUSIONS Despite symptom resolution, the case demonstrated ongoing autonomic and autoregulatory dysfunction. Larger samples examining individuals with an extensive history of concussion are warranted to understand the chronic physiological changes that occur following cumulative concussions through biosensing devices.
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Affiliation(s)
- Courtney M Kennedy
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Joel S Burma
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
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Kagialis A, Simos N, Manolitsi K, Vakis A, Simos P, Papadaki E. Functional connectivity-hemodynamic (un)coupling changes in chronic mild brain injury are associated with mental health and neurocognitive indices: a resting state fMRI study. Neuroradiology 2024; 66:985-998. [PMID: 38605104 PMCID: PMC11133187 DOI: 10.1007/s00234-024-03352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE To examine hemodynamic and functional connectivity alterations and their association with neurocognitive and mental health indices in patients with chronic mild traumatic brain injury (mTBI). METHODS Resting-state functional MRI (rs-fMRI) and neuropsychological assessment of 37 patients with chronic mTBI were performed. Intrinsic connectivity contrast (ICC) and time-shift analysis (TSA) of the rs-fMRI data allowed the assessment of regional hemodynamic and functional connectivity disturbances and their coupling (or uncoupling). Thirty-nine healthy age- and gender-matched participants were also examined. RESULTS Patients with chronic mTBI displayed hypoconnectivity in bilateral hippocampi and parahippocampal gyri and increased connectivity in parietal areas (right angular gyrus and left superior parietal lobule (SPL)). Slower perfusion (hemodynamic lag) in the left anterior hippocampus was associated with higher self-reported symptoms of depression (r = - 0.53, p = .0006) and anxiety (r = - 0.484, p = .002), while faster perfusion (hemodynamic lead) in the left SPL was associated with lower semantic fluency (r = - 0.474, p = .002). Finally, functional coupling (high connectivity and hemodynamic lead) in the right anterior cingulate cortex (ACC)) was associated with lower performance on attention and visuomotor coordination (r = - 0.50, p = .001), while dysfunctional coupling (low connectivity and hemodynamic lag) in the left ventral posterior cingulate cortex (PCC) and right SPL was associated with lower scores on immediate passage memory (r = - 0.52, p = .001; r = - 0.53, p = .0006, respectively). Uncoupling in the right extrastriate visual cortex and posterior middle temporal gyrus was negatively associated with cognitive flexibility (r = - 0.50, p = .001). CONCLUSION Hemodynamic and functional connectivity differences, indicating neurovascular (un)coupling, may be linked to mental health and neurocognitive indices in patients with chronic mTBI.
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Affiliation(s)
- Antonios Kagialis
- Department of Psychiatry, School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, University Hospital of Heraklion, 71003, Crete, Greece
| | - Nicholas Simos
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
| | - Katina Manolitsi
- Department of Neurosurgery, School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece
| | - Antonios Vakis
- Department of Neurosurgery, School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece
| | - Panagiotis Simos
- Department of Psychiatry, School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
| | - Efrosini Papadaki
- Department of Radiology, School of Medicine, University of Crete, University Hospital of Heraklion, 71003, Crete, Greece.
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece.
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Wingerson MJ, Hunt DL, Wilson JC, Mannix RC, Meehan WP, Howell DR. Factors Associated with Symptom Resolution after Aerobic Exercise Intervention in Adolescent and Young Adults with Concussion. Med Sci Sports Exerc 2024; 56:783-789. [PMID: 38109187 PMCID: PMC11018463 DOI: 10.1249/mss.0000000000003358] [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: 12/19/2023]
Abstract
BACKGROUND Aerobic exercise facilitates postconcussion symptom resolution at the group level, but patient-level characteristics may affect the likelihood of treatment efficacy. PURPOSE This study aimed to investigate demographic and clinical characteristics, which differentiate postconcussion aerobic exercise treatment efficacy from nonefficacy in the intervention arm of a randomized clinical trial. METHODS Adolescent and young adult participants initiated a standardized aerobic exercise intervention within 14 d of concussion, consisting of self-selected exercise for 100 min·wk -1 at an individualized heart rate (80% of heart rate induced symptom exacerbation during graded exercise testing). Treatment efficacy was defined as symptom resolution within 28-d postconcussion. Treatment efficacy and nonefficacy groups were compared on demographics, clinical characteristics, intervention adherence, and persistent symptom risk using the Predicting Persistent Postconcussive Problems in Pediatrics (5P) clinical risk score. RESULTS A total of 27 participants (16.1 ± 2.3 yr old; range, 11-21 yr; 52% female) began the intervention, with a mean of 9.5 ± 3.7 d after concussion; half ( n = 13; 48%) demonstrated treatment efficacy (symptom resolution within 28 d postconcussion). Those whose symptoms resolved within 28 d had significantly lower preintervention postconcussion symptom inventory scores (21.2 ± 13.2 vs 41.4 ± 22.2; P < 0.01), greater adherence to the intervention (77% vs 36%; P = 0.05), and longer average exercise duration (median [interquartile range], 49.7 [36.8-68.6] vs 30.4 [20.7-34.7] min; P < 0.01) than those whose symptoms lasted more than 28 d. Groups were similar in age, sex, timing of intervention, and preintervention 5P risk score. CONCLUSIONS A standardized aerobic exercise intervention initiated within 14 d of concussion demonstrated efficacy for approximately half of participants, according to our definition of treatment efficacy. This multisite aerobic exercise intervention suggests that lower symptom severity, higher intervention adherence, and greater exercise duration are factors that increase the likelihood of symptoms resolving within 28 d of concussion.
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Affiliation(s)
- Mathew J. Wingerson
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, CO
- Children’s Hospital Colorado, Sports Medicine Center, Aurora, CO
| | - Danielle L. Hunt
- Boston Children’s Hospital, Micheli Center for Sports Injury Prevention, Boston, MA
| | - Julie C. Wilson
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, CO
- Children’s Hospital Colorado, Sports Medicine Center, Aurora, CO
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO
| | - Rebekah C. Mannix
- Boston Children’s Hospital, Micheli Center for Sports Injury Prevention, Boston, MA
| | - William P. Meehan
- Boston Children’s Hospital, Micheli Center for Sports Injury Prevention, Boston, MA
| | - David R. Howell
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, CO
- Children’s Hospital Colorado, Sports Medicine Center, Aurora, CO
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Kawata K, Rettke DJ, Thompson C, Mannix R, Bazarian JJ, Datta D. Effectiveness of biomedical interventions on the chronic stage of traumatic brain injury: a systematic review of randomized controlled trials. Front Neurol 2024; 15:1321239. [PMID: 38562423 PMCID: PMC10983769 DOI: 10.3389/fneur.2024.1321239] [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: 10/13/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Traumatic brain injury (TBI), in any form and severity, can pose risks for developing chronic symptoms that can profoundly hinder patients' work/academic, social, and personal lives. In the past 3 decades, a multitude of pharmacological, stimulation, and exercise-based interventions have been proposed to ameliorate symptoms, memory impairment, mental fatigue, and/or sleep disturbances. However, most research is preliminary, thus limited influence on clinical practice. This review aims to systematically appraise the evidence derived from randomized controlled trials (RCT) regarding the effectiveness of pharmacological, stimulation, and exercise-based interventions in treating chronic symptoms due to TBI. Our search results indicate that despite the largest volume of literature, pharmacological interventions, especially using neurostimulant medications to treat physical, cognitive, and mental fatigue, as well as daytime sleepiness, have yielded inconsistent results, such that some studies found improvements in fatigue (e.g., Modafinil, Armodafinil) while others failed to yield the improvements after the intervention. Conversely, brain stimulation techniques (e.g., transcranial magnetic stimulation, blue light therapy) and exercise interventions were effective in ameliorating mental health symptoms and cognition. However, given that most RCTs are equipped with small sample sizes, more high-quality, larger-scale RCTs is needed.
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Affiliation(s)
- Keisuke Kawata
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
- Program in Neuroscience, The College of Arts and Sciences, Indiana University, Bloomington, IN, United States
| | - Devin J. Rettke
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Christopher Thompson
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Jeffrey J. Bazarian
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Dibyadyuti Datta
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
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Willingham TB, Stowell J, Collier G, Backus D. Leveraging Emerging Technologies to Expand Accessibility and Improve Precision in Rehabilitation and Exercise for People with Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:79. [PMID: 38248542 PMCID: PMC10815484 DOI: 10.3390/ijerph21010079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024]
Abstract
Physical rehabilitation and exercise training have emerged as promising solutions for improving health, restoring function, and preserving quality of life in populations that face disparate health challenges related to disability. Despite the immense potential for rehabilitation and exercise to help people with disabilities live longer, healthier, and more independent lives, people with disabilities can experience physical, psychosocial, environmental, and economic barriers that limit their ability to participate in rehabilitation, exercise, and other physical activities. Together, these barriers contribute to health inequities in people with disabilities, by disproportionately limiting their ability to participate in health-promoting physical activities, relative to people without disabilities. Therefore, there is great need for research and innovation focusing on the development of strategies to expand accessibility and promote participation in rehabilitation and exercise programs for people with disabilities. Here, we discuss how cutting-edge technologies related to telecommunications, wearables, virtual and augmented reality, artificial intelligence, and cloud computing are providing new opportunities to improve accessibility in rehabilitation and exercise for people with disabilities. In addition, we highlight new frontiers in digital health technology and emerging lines of scientific research that will shape the future of precision care strategies for people with disabilities.
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Affiliation(s)
- T. Bradley Willingham
- Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA 30309, USA (D.B.)
- Department of Physical Therapy, Georgia State University, Atlanta, GA 30302, USA
| | - Julie Stowell
- Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA 30309, USA (D.B.)
- Department of Physical Therapy, Georgia State University, Atlanta, GA 30302, USA
| | - George Collier
- Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA 30309, USA (D.B.)
| | - Deborah Backus
- Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA 30309, USA (D.B.)
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Whitehead B, Corbin D, Albowaidey A, Zhang N, Karelina K, Weil ZM. Mild traumatic brain injury induces pericyte detachment independent of stroke vulnerability. Neurosci Lett 2024; 818:137552. [PMID: 37949292 PMCID: PMC10913758 DOI: 10.1016/j.neulet.2023.137552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
Mild traumatic brain injury (mTBI) is an independent risk factor for ischemic stroke and can result in poorer outcomes- an effect presumed to involve the cerebral vasculature. Here we tested the hypothesis that mTBI-induced pericyte detachment from the cerebrovascular endothelium is responsible for worsened stroke outcomes. We performed a mild closed-head injury and/or treated C57/bl6 mice with imatinib mesylate, a tyrosine kinase inhibitor that induces pericyte detachment. The time course of pericyte detachment was assessed 7, 14, and 28 days post injury (DPI). To test the role of pericytes in TBI-induced exacerbation of ischemic stroke outcomes, we induced mTBI and/or treated mice with imatinib for one week prior to transient middle cerebral artery occlusion. We found that injury promoted pericyte detachment from the vasculature commensurate with the levels of detachment seen in imatinib-only treated animals, and that the detachment persisted for at least 14DPI, but recovered to sham levels by 28DPI. Further, mTBI, but not imatinib-induced pericyte detachment, increased infarct volume. Thus, we conclude that the transient detachment of pericytes caused by mTBI may not be sufficient to exacerbate subsequent ischemic stroke damage. These data have important implications for understanding cerebrovascular dysfunction following mTBI and potential mechanisms of increased risk for future ischemic strokes.
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Affiliation(s)
- Bailey Whitehead
- Department of Neuroscience and Rockefeller Neuroscience Institute, West Virginia University, 108 Biomedical Rd, Morgantown, WV, 26506, USA.
| | - Deborah Corbin
- Department of Neuroscience and Rockefeller Neuroscience Institute, West Virginia University, 108 Biomedical Rd, Morgantown, WV, 26506, USA
| | - Ali Albowaidey
- Department of Neuroscience and Rockefeller Neuroscience Institute, West Virginia University, 108 Biomedical Rd, Morgantown, WV, 26506, USA
| | - Ning Zhang
- Department of Neuroscience and Rockefeller Neuroscience Institute, West Virginia University, 108 Biomedical Rd, Morgantown, WV, 26506, USA
| | - Kate Karelina
- Department of Neuroscience and Rockefeller Neuroscience Institute, West Virginia University, 108 Biomedical Rd, Morgantown, WV, 26506, USA
| | - Zachary M Weil
- Department of Neuroscience and Rockefeller Neuroscience Institute, West Virginia University, 108 Biomedical Rd, Morgantown, WV, 26506, USA
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Miutz LN, Burma JS, Brassard P, Phillips AA, Emery CA, Smirl JD. Comparison of the Buffalo Concussion Treadmill Test With a Physiologically Informed Cycle Test: Calgary Concussion Cycle Test. Sports Health 2023:19417381231217744. [PMID: 38149331 DOI: 10.1177/19417381231217744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Sport-related concussions are a complex injury requiring multifaceted assessment, including physical exertion. Currently, concussion testing relies primarily on a treadmill-based protocol for assessing exertion-related symptoms in persons after concussion. This study compared a modified cycle protocol (Calgary Concussion Cycle Test [CCCT]) with the clinically adopted standard, the Buffalo Concussion Treadmill Test (BCTT), across multiple physiological parameters. HYPOTHESIS Treadmill and cycle matched workload protocols would produce similar results for cerebral blood velocity, mean arterial pressure (MAP), and end-tidal carbon dioxide partial pressure (PETCO2), but heart rate (HR) and oxygen consumption (VO2) would be higher on the treadmill than the cycle modality. STUDY DESIGN Crossover study design. LEVEL OF EVIDENCE Level 3. METHODS A total of 17 healthy adults (8 men, 9 women; age, 26 ± 3 years; body mass index, 23.8 ± 2.7 kg/m2) completed the BCTT and CCCT protocols, 7 days apart in a randomized order. During both exertional protocols, the physiological parameters measured were middle cerebral artery mean blood velocity (MCAv), MAP, PETCO2, VO2, and HR. Analysis of variance with effect size computations, coefficient of variation, and Bland-Altman plots with 95% limits of agreement were used to compare exercise tests. RESULTS The BCTT and CCCT produced comparable results for both male and female participants with no significant differences for average MCAv, MAP, and PETCO2 (all P > 0.05; all generalized eta squared [η2G] < 0.02 [negligible]; P value range, 0.29-0.99) between stages. When accounting for exercise stage and modality, VO2 (P < 0.01) and HR (P < 0.01) were higher on the treadmill compared with the cycle. Aside from the final few stages, all physiology measures displayed good-to-excellent agreeability/variability. CONCLUSION The CCCT was physiologically similar to the BCTT in terms of MCAv, PETCO2, and MAP; however, HR and VO2 differed between modalities. CLINICAL RELEVANCE Providing a cycle-based modality to exertional testing after injury mayincrease accessibility to determine symptom thresholds in the future.
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Affiliation(s)
- Lauren N Miutz
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Health and Sport Science, University of Dayton, Dayton, Ohio
| | - Joel S Burma
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, University Laval, Québec, Canada
- Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Aaron A Phillips
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Departments of Physiology and Pharmacology, Clinical Neurosciences, Cardiac Sciences, Biomedical Engineering, and Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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10
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Wright BM, Zhang C, Fisher RR, Karmarkar AM, Bjork JM, Pugh MJ, Hodges CB, Martindale SL, Wilde EA, Kenney K, McDonald SD, Scheibel RS, Newsome MR, Cook LJ, Walker WC. Relation of Aerobic Activity to Cognition and Well-being in Chronic Mild Traumatic Brain Injury: A LIMBIC-CENC Study. Mil Med 2023; 188:124-133. [PMID: 37948207 DOI: 10.1093/milmed/usad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/20/2023] [Accepted: 02/10/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Because chronic difficulties with cognition and well-being are common after mild traumatic brain injury (mTBI) and aerobic physical activity and exercise (PAE) is a potential treatment and mitigation strategy, we sought to determine their relationship in a large sample with remote mTBI. MATERIALS AND METHODS The Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study is a national multicenter observational study of combat-exposed service members and veterans. Study participants with positive mTBI histories (n = 1,087) were classified as "inactive" (23%), "insufficiently active" (46%), "active" (19%), or "highly active" (13%) based on the aerobic PAE level. The design was a cross-sectional analysis with multivariable regression. PAE was reported on the Behavioral Risk Factor Surveillance System. Preselected primary outcomes were seven well-validated cognitive performance tests of executive function, learning, and memory: The California Verbal Learning Test-Second Edition Long-Delay Free Recall and Total Recall, Brief Visuospatial Memory Test-Revised Total Recall, Trail-Making Test-Part B, and NIH Toolbox for the Assessment of Neurological Behavior and Function Cognition Battery Picture Sequence Memory, Flanker, and Dimensional Change Card Sort tests. Preselected secondary outcomes were standardized self-report questionnaires of cognitive functioning, life satisfaction, and well-being. RESULTS Across the aerobic activity groups, cognitive performance tests were not significantly different. Life satisfaction and overall health status scores were higher for those engaging in regular aerobic activity. Exploratory analyses also showed better working memory and verbal fluency with higher aerobic activity levels. CONCLUSIONS An association between the aerobic activity level and the preselected primary cognitive performance outcome was not demonstrated using this study sample and methods. However, higher aerobic activity levels were associated with better subjective well-being. This supports a clinical recommendation for regular aerobic exercise among persons with chronic or remote mTBI. Future longitudinal analyses of the exercise-cognition relationship in chronic mTBI populations are recommended.
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Affiliation(s)
- Brennan M Wright
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84108, USA
| | - Renae R Fisher
- Department of Rehabilitation Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA 19107, USA
| | - Amol M Karmarkar
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
- Sheltering Arms Institute, Richmond, VA 23233, USA
| | - James M Bjork
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
- Mental Health Service, Central Virginia VA Health Care System, Richmond, VA 23249, USA
| | - Mary Jo Pugh
- VA Salt Lake City IDEAS Center for Innovation and Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84312, USA
| | - Cooper B Hodges
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
- Research Service Line, Washington DC VA Medical Center, Washington, DC 20422, USA
| | - Sarah L Martindale
- Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC 28144, USA
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Elisabeth A Wilde
- George E. Wahlen VA Salt Lake City Healthcare System, Salt Lake City, UT 84148, USA
- Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kimbra Kenney
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Scott D McDonald
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
- Mental Health Service, Central Virginia VA Health Care System, Richmond, VA 23249, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Randall S Scheibel
- Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA
| | - Mary R Newsome
- Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA
| | - Lawrence J Cook
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA
| | - William C Walker
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
- PM&R Service, Richmond Veterans Affairs Medical Center, Richmond, VA 23249, USA
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11
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McPherson JI, Nazir MSZ, Willer BS, Leddy JJ, Haider MN. Does Physiologic Post-Concussion Disorder Cause Persistent Post-Traumatic Headache? Curr Pain Headache Rep 2023; 27:793-799. [PMID: 37831366 DOI: 10.1007/s11916-023-01176-5] [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: 09/27/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE OF REVIEW One system classifies patients with symptoms after concussion into physiologic, vestibulo-ocular, cervicogenic, and mood/cognition post-concussion disorders (PCD) based upon the preponderance of specific symptoms and physical impairments. This review discusses physiologic PCD and its potential relationship to the development of persistent post-traumatic headaches (PPTH). RECENT FINDINGS Headache is the most reported symptom after a concussion. Headaches in physiologic PCD are suspected to be due to abnormal cellular metabolism, subclinical neuroinflammation, and dysfunction of the autonomic nervous system (ANS). These abnormalities have been linked to the development of migraine-like and neuralgia-related PPTH. Physiologic PCD is a potential cause of PPTH after a concussion. Future research should focus on how to prevent PPTH in patients with physiologic PCD.
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Affiliation(s)
- Jacob I McPherson
- Department of Rehabilitation Science, School of Public Health and Health Professions, State University of New York at Buffalo, 534 Kimball Tower, Buffalo, NY, 14214, USA.
| | - Muhammad S Z Nazir
- Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, State University of New York at Buffalo, Buffalo, NY, 14214, USA
| | - Barry S Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14215, USA
| | - John J Leddy
- Department of Orthopedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14215, USA
| | - Mohammad N Haider
- Department of Orthopedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14215, USA
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12
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Mustafayev B, Mustafayeva A, Bakhtiyarov A, Nikatov K. Cross-spectral analysis of cerebral autoregulation after mild traumatic brain injury. Neurosurg Rev 2023; 46:263. [PMID: 37801134 DOI: 10.1007/s10143-023-02173-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/19/2023] [Accepted: 10/02/2023] [Indexed: 10/07/2023]
Abstract
Severe traumatic brain injury (TBI) disrupts cerebral autoregulation (CAR), which may increase the risk of secondary neuronal damage in victims with large fluctuations in blood pressure (BP). CAR is also impaired in mild TBI. Given that mild TBI accounts for up to 70% of cases, this issue needs to be addressed. Physiological and non-invasive methods are now required to study CAR without the sharp fluctuations in blood pressure that underlie CAR tests. The cross-spectral analysis of fluctuations between cerebral blood flow and blood pressure discussed in the article is truly non-invasive and physiological. Forty-eight victims with mild traumatic brain injury were studied. CAR was assessed using two methods. The cuff test was used as a control method to assess autoregulation (RoR). Non-invasive cross-spectral analysis with phase shift (PS) detection was performed. The RoR values were normal, but there were cases within the group with varying severity of symptoms of the acute period of mild TBI. For example, the RoR was significantly higher (p < 0.001) in 32 patients with regression of symptoms than in 16 with persistence of symptoms. Their RoR and PS indicated a violation of the CAR, which required correction of the treatment. It was found that in 1/3 of the patients with mild TBI, a different state of CAR required individual tactics. RoR and PS correlated well.
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Affiliation(s)
- Baglan Mustafayev
- Department of Neurosurgery and Neuropathology, National Centre for Neurosurgery, Astana, Republic of Kazakhstan.
| | - Alina Mustafayeva
- Department of Neurorehabilitation, National Centre for Neurosurgery, Astana, Republic of Kazakhstan
| | - Askar Bakhtiyarov
- Department of Neurosurgery, Shymkent Regional Clinical Hospital, Shymkent, Republic of Kazakhstan
| | - Kuanysh Nikatov
- Department of Neurosurgery, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
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13
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Bharadwaj VN, Sahbaie P, Shi X, Irvine KA, Yeomans DC, Clark JD. Effect of Voluntary Exercise on Endogenous Pain Control Systems and Post-traumatic Headache in Mice. THE JOURNAL OF PAIN 2023; 24:1859-1874. [PMID: 37271350 DOI: 10.1016/j.jpain.2023.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
Traumatic brain injury (TBI) can cause acute and chronic pain along with motor, cognitive, and emotional problems. Although the mechanisms are poorly understood, previous studies suggest disruptions in endogenous pain modulation may be involved. Voluntary exercise after a TBI has been shown to reduce some consequences of injury including cognitive impairment. We hypothesized, therefore, that voluntary exercise could augment endogenous pain control systems in a rodent model of TBI. For these studies, we used a closed-head impact procedure in male mice modeling mild TBI. We investigated the effect of voluntary exercise on TBI-induced hindpaw nociceptive sensitization, diffuse noxious inhibitory control failure, and periorbital sensitization after bright light stress, a model of post-traumatic headache. Furthermore, we investigated the effects of exercise on memory, circulating markers of brain injury, neuroinflammation, and spinal cord gene expression. We observed that exercise significantly reduced TBI-induced hindpaw allodynia and periorbital allodynia in the first week following TBI. We also showed that exercise improved the deficits associated with diffuse noxious inhibitory control and reduced bright light stress-induced allodynia up to 2 months after TBI. In addition, exercise preserved memory and reduced TBI-induced increases in spinal BDNF, CXCL1, CXCL2, and prodynorphin expression, all genes previously linked to TBI-induced nociceptive sensitization. Taken together, our observations suggest that voluntary exercise may reduce pain after TBI by reducing TBI-induced changes in nociceptive signaling and preserving endogenous pain control systems. PERSPECTIVE: This article evaluates the effects of exercise on pain-related behaviors in a preclinical model of traumatic brain injury (TBI). The findings show that exercise reduces nociceptive sensitization, loss of diffuse noxious inhibitory control, memory deficits, and spinal nociception-related gene expression after TBI. Exercise may reduce or prevent pain after TBI.
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Affiliation(s)
- Vimala N Bharadwaj
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, California.
| | - Peyman Sahbaie
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, California; Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Xiaoyou Shi
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, California; Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Karen-Amanda Irvine
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, California; Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - David C Yeomans
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, California
| | - J David Clark
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, California; Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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14
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Neely LM, Smulligan KL, Wingerson MJ, Seehusen CN, Simon SL, Wilson JC, Howell DR. The association between sleep and physical activity with persisting postconcussion symptoms among adolescent athletes. PM R 2023; 15:1122-1129. [PMID: 36580488 PMCID: PMC10875599 DOI: 10.1002/pmrj.12939] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/09/2022] [Accepted: 12/11/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Both sleep duration and physical activity following concussion may influence subsequent recovery. Objective measurement of sleep and physical activity behavior via wearable technology may provide insights into their association with concussion recovery. OBJECTIVE To determine whether sleep behavior (eg, duration, timing) and/or physical activity (steps/day, or exercise frequency, duration, intensity) in the first month after adolescent sports-related concussion are associated with developing persisting postconcussion symptoms (PPCS). DESIGN Case-control. SETTING Outpatient sports medicine clinic. PARTICIPANTS The study prospectively enrolled adolescent athletes who sustained a concussion (N = 49, age = 14.8 ± 1.8 years; 51% female) who were evaluated within 14 days of concussion (mean = 6.7 ± 2.7 days) and followed uvia sleep/physical activity monitoring for the subsequent 2 weeks. MAIN OUTCOME MEASURES Participants wore a monitor to track sleep (sleep time, wake time, and time spent awake in bed at night) and physical activity (average steps/day, exercise frequency, exercise duration) behavior for 2 weeks after initial assessment. Participants were followed until symptom resolution, and the main outcome of interest was development of PPCS (symptom duration >28 days). A multivariable logistic regression model was used to examine associations between physical activity and sleep behavior with PPCS. RESULTS Of the 49 participants, 47% (n = 23, mean symptom resolution = 57 ± 23 days post injury) developed PPCS and 53% (n = 26, mean symptom resolution = 15 ± 7 days post injury) did not. Univariable analysis showed that the PPCS group took fewer steps/day (7526 ± 2975 vs. 9803 ± 3786 steps/day; p = .02), exercised less frequently (2.5 ± 2.2 vs. 4.4 ± 2.1 days/week; p = .005), and spent more time in bed awake (1.2 ± 0.3 vs. 0.8 ± 0.3 h/night; p = .03) than the no PPCS group. Multivariable results indicated the odds of developing PPCS significantly increased with fewer exercise session/week (adjusted odds ratio = 1.96, 95% confidence interval = 1.09, 3.51, p = .024). CONCLUSIONS More exercise sessions that were longer than 15 minutes during concussion recovery was associated with a lower risk of developing PPCS, whereas sleep and other physical activity measures were not. Further studies regarding exercise duration and intensity are needed. Clinicians may consider advising patients to optimize sleep and physical activity during concussion recovery.
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Affiliation(s)
- Linda M Neely
- Modern Human Anatomy Program, University of Colorado School of Medicine, 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
| | - 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
- University of New England School of Osteopathic Medicine, Biddeford, ME, 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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15
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Thorne J, Hellewell S, Cowen G, Fitzgerald M. Neuroimaging to enhance understanding of cardiovascular autonomic changes associated with mild traumatic brain injury: a scoping review. Brain Inj 2023; 37:1187-1204. [PMID: 37203154 DOI: 10.1080/02699052.2023.2211352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/19/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Cardiovascular changes, such as altered heart rate and blood pressure, have been identified in some individuals following mild traumatic brain injury (mTBI) and may be related to disturbances of the autonomic nervous system and cerebral blood flow. METHODS We conducted a scoping review according to PRISMA-ScR guidelines across six databases (Medline, CINAHL, Web of Science, PsychInfo, SportDiscus and Google Scholar) to explore literature examining both cardiovascular parameters and neuroimaging modalities following mTBI, with the aim of better understanding the pathophysiological basis of cardiovascular autonomic changes associated with mTBI. RESULTS Twenty-nine studies were included and two main research approaches emerged from data synthesis. Firstly, more than half the studies used transcranial Doppler ultrasound and found evidence of cerebral blood flow impairments that persisted beyond symptom resolution. Secondly, studies utilizing advanced MRI identified microstructural injury within brain regions responsible for cardiac autonomic function, providing preliminary evidence that cardiovascular autonomic changes are a consequence of injury to these areas. CONCLUSION Neuroimaging modalities hold considerable potential to aid understanding of the complex relationship between cardiovascular changes and brain pathophysiology associated with mTBI. However, it is difficult to draw definitive conclusions from the available data due to variability in study methodology and terminology.
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Affiliation(s)
- Jacinta Thorne
- School of Allied Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Sarah Hellewell
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
| | - Gill Cowen
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Melinda Fitzgerald
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
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16
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Burma JS, Seok J, Johnston NE, Smirl JD. Cerebral blood velocity during concurrent supine cycling, lower body negative pressure, and head-up tilt challenges: implications for concussion rehabilitation. Physiol Meas 2023; 44:084002. [PMID: 37531960 DOI: 10.1088/1361-6579/acecd4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/02/2023] [Indexed: 08/04/2023]
Abstract
Introduction. The effect of concurrent head-up tilt and lower body negative pressure (LBNP) have been examined on middle cerebral artery velocity (MCAv) at rest; however, it is unknown the superimposed effect these factors have on blunting the elevation in cerebral blood velocity associated with moderate-intensity exercise.Methods. 23 healthy adults (11 females / 12 males, 20-33 years) completed three visits. The first consisted of a maximal ramp supine cycling test to identify the wattage associated with individualized maximal MCAv. Subsequent visits included randomized no LBNP (control) or LBNP at -40 Torr (experimental) with successively increasing head-up tilt stages of 0, 15, 30, and 45 degrees during the pre-described individualized wattage. Transcranial Doppler ultrasound was utilized to quantify MCAv. Two-factorial repeated measures analysis of variance with effect sizes were used to determine differences between days and tilt stages.Results. Between-day baseline values for MCAv, heart rate, and blood pressure displayed low variability with <5% variation. With no LBNP, MCAv was above baseline on average for all participants; however, 15 degrees and 30 degrees tilt with concurrent -40 Torr LBNP was sufficient to return MCAv to 100% of baseline values in females and males, respectively. Body-weight did not impact the association between tilt and pressure (R2range: 0.01-0.12).Conclusion. Combined LBNP and tilt were sufficient to reduce the increase in MCAv associated with moderate-intensity exercise. This exercise modality shows utility to enable individuals with a concussion to obtain the positive physiological adaptions associated with exercise while minimizing symptom exacerbation due to the notion of the Monro-Kellie doctrine.
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Affiliation(s)
- Joel S Burma
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
| | - Jina Seok
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | - Nathan E Johnston
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
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17
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Wang Y, Bartels HM, Nelson LD. A Systematic Review of ASL Perfusion MRI in Mild TBI. Neuropsychol Rev 2023; 33:160-191. [PMID: 32808244 PMCID: PMC7889778 DOI: 10.1007/s11065-020-09451-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 08/06/2020] [Indexed: 01/06/2023]
Abstract
Mild traumatic brain injury (mTBI) is a major public health concern. Cerebrovascular alterations play a significant role in the evolution of injury sequelae and in the process of post-traumatic brain repair. Arterial spin labeling (ASL) is an advanced perfusion magnetic resonance imaging technique that permits noninvasive quantification of cerebral blood flow (CBF). This is the first systematic review of ASL research findings in patients with mTBI. Our approach followed the American Academy of Neurology (AAN) and PRISMA guidelines. We searched Ovid/MEDLINE, Web of Science, Scopus, and the Cochrane Index for relevant articles published as of February 20, 2020. Full-text results were combined into Rayyan software for further evaluation. Data extraction, including risk of bias ratings, was performed using American Academy of Neurology's four-tiered classification scheme. Twenty-three articles met inclusion criteria comprising data on up to 566 mTBI patients and 654 control subjects. Of the 23 studies, 18 reported some type of regional CBF abnormality in mTBI patients at rest or during a cognitive task, with more findings of decreased than increased CBF. The evidence supports the conclusion that mTBI likely causes ASL-derived CBF anomalies. However, synthesis of findings was challenging due to substantial methodological variations across studies and few studies with low risk of bias. Thus, larger-scale prospective cohort studies are needed to more definitively chart the course of CBF changes in humans after mTBI and to understand how individual difference factors contribute to post-injury CBF changes.
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Affiliation(s)
- Yang Wang
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Hannah M Bartels
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
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18
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Smulligan KL, Wingerson MJ, Little CC, Wilson JC, Howell DR. Early physical activity after concussion is associated with sleep quality but not dizziness among adolescent athletes. J Sci Med Sport 2023; 26:183-188. [PMID: 36804710 PMCID: PMC10106390 DOI: 10.1016/j.jsams.2023.02.001] [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: 11/30/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVES To assess the association between early physical activity and post-concussion sleep quality, dizziness, and postural stability among adolescents with concussion compared to uninjured controls. DESIGN Cross-sectional. METHODS Adolescents ages 13-18 years assessed within 14 days post-concussion and uninjured controls. Those with concussion reported if they participated in physical activity between the concussion and assessment. Participants completed the Dizziness Handicap Inventory, Pittsburgh Sleep Quality Index, and single/dual-task tandem gait. RESULTS We enrolled 34 participants with concussion (early physical activity: n = 10, age = 15.8 ± 1.6 years, 70% female; no physical activity: n = 24, age = 16.0 ± 1.3 years, 50% female) and 21 uninjured controls (age = 16.0 ± 1.8 years, 48% female). Compared to controls, the no physical activity group reported worse sleep quality (Pittsburgh Sleep Quality Index: 3.8 ± 2.7 vs 8.0 ± 4.9 points, p = 0.002) and single-task tandem gait time (13.7 ± 3.4 vs 21.2 ± 8.1 s, p = 0.0006), while the early physical activity group did not (Pittsburgh Sleep Quality Index: 3.8 ± 2.7 vs 5.8 ± 3.2 points, p = 0.38; single-task tandem gait: 13.7 ± 3.4 vs 19.0 ± 5.7 s, p = 0.08). Compared to controls, early/no physical activity groups reported worse dizziness (Dizziness Handicap Inventory: 2.0 ± 3.4 vs 22.9 ± 23.8 vs 27.4 ± 19.2 points, p < 0.0001). There were no significant between-group differences for dual-task tandem gait (24.1 ± 8.0 vs 24.8 ± 6.2 vs 26.6 ± 7.3 s, p = 0.57). CONCLUSIONS The no physical activity group reported worse sleep quality and slower single-task tandem gait than controls, while both groups reported similar sleep quality and tandem gait. Early physical activity may promote sleep quality and postural stability, or early physical activity may be a function of improved sleep and postural stability after concussion.
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Affiliation(s)
| | - Mathew J Wingerson
- Department of Orthopedics, University of Colorado School of Medicine, USA; Sports Medicine Center, Children's Hospital of Colorado, USA
| | - Casey C Little
- Sports Medicine Center, Children's Hospital of Colorado, USA
| | - Julie C Wilson
- Department of Orthopedics, University of Colorado School of Medicine, USA; Sports Medicine Center, Children's Hospital of Colorado, USA; Department of Pediatrics, University of Colorado School of Medicine, USA
| | - David R Howell
- Department of Orthopedics, University of Colorado School of Medicine, USA; Sports Medicine Center, Children's Hospital of Colorado, USA.
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19
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Guerrette MC, McKerral M. Predictors of Social Participation Outcome after Traumatic Brain Injury Differ According to Rehabilitation Pathways. J Neurotrauma 2023; 40:523-535. [PMID: 35974662 DOI: 10.1089/neu.2022.0232] [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: 11/13/2022] Open
Abstract
Social participation (SP) is one of many objectives in the rehabilitation of patients with traumatic brain injury (TBI). Studies on predictors of SP specific to post-acute universally accessible specialized rehabilitation pathways following TBI are scarce. Our objectives were to: 1) characterize SP, as well as a set of pre-injury, injury-related, and post-injury variables in individuals participating in inpatient-outpatient or outpatient rehabilitation pathways within a universally accessible and organized trauma continuum of care; and 2) examine the ability of pre-injury, injury-related, and post-injury variables in predicting SP outcome after TBI according to rehabilitation path. Participants (N = 372) were adults admitted to an inpatient-outpatient rehabilitation pathway or an outpatient rehabilitation pathway after sustaining a TBI between 2016 and 2020, and for whom Mayo-Portland Adaptability Intentory-4 (MPAI-4) outcomes were prospectively obtained at the start and end of rehabilitation. Additional data was collected from medical files. For both rehabilitation pathways, predicted SP outcome was MPAI-4 Participation score at discharge from outpatient rehabilitation. Multiple regression models investigated the predictive value of each variable for SP outcome, separately for each care pathway. Main findings show that for the inpatient-outpatient sample, three variables (education years, MPAI-4 Ability and Adjustment scores at rehabilitation intake) significantly predicted SP outcome, with the regression model accounting for 49% of the variance. For the outpatient sample, five variables (pre-morbid hypertension and mental health diagnosis, total indirect rehabilitation hours received, MPAI-4 Abilities and Adjustment scores at rehabilitation intake) significantly predicted SP outcome, with the regression model accounting for 47% of the variance. In conclusion, different pre-morbid and post-injury variables are involved in predicting SP, depending on the rehabilitation path followed. The predictive value of those variables could help clinicians identify patients more likely of showing poorer SP at discharge and who may require additional or different interventions.
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Affiliation(s)
- Marie-Claude Guerrette
- Department of Psychology, Université de Montréal, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal-IURDPM, Montreal, Quebec, Canada
| | - Michelle McKerral
- Department of Psychology, Université de Montréal, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal-IURDPM, Montreal, Quebec, Canada
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20
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Burma JS, Rattana S, Johnson NE, Smirl JD. Do mean values tell the full story? Cardiac cycle and biological sex comparisons in temporally derived neurovascular coupling metrics. J Appl Physiol (1985) 2023; 134:426-443. [PMID: 36603050 DOI: 10.1152/japplphysiol.00170.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Previous reports have noted cerebrovascular regulation differs across the cardiac cycle, with greater regulation occurring within systole. However, this methodological notion has not been meticulously scrutinized during temporally deduced neurovascular coupling (NVC) metrics with additional respect to biological sex. Analyses of 111 healthy individuals (40 females/71 males) were performed where participants engaged in the "Where's Waldo?" paradigm. All NVC parameters were quantified in the posterior and middle cerebral arteries at 310 unique timepoints. Several individuals completed repeat testing which enabled for between-day (3 timepoints) and within-day (7 timepoints) reliability comparisons in 17 and 11 individuals, respectively. One-way analysis of variance compared NVC metrics between diastole, mean, and systole values, as well as differences between biological sexes. Greater absolute cerebral blood velocity (CBv; baseline and peak) and total activation (area under the curve) were noted within systole for both posterior cerebral artery (PCA; P < 0.001) and middle cerebral artery (MCA; P < 0.001) values; however, the relative percent increase in CBv was greater within diastole (P < 0.001). Females had an elevated diastolic and mean CBv and a greater diastolic cerebrovascular conductance (P < 0.050). No sex differences were present for systolic CBv measures and within parameters quantifying the NVC response (area under the curve/relative CBv increase) across the cardiac cycle (P > 0.072). Future investigations seeking to differentiate cerebral regulatory mechanisms between clinical populations may benefit by performing their analyses across the cardiac cycle, as certain pathogenesis may affect one aspect of the cardiac cycle independently. Minimal differences were noted between females and males for metrics characterizing the NVC response across the cardiac cycle.NEW & NOTEWORTHY Neurovascular coupling (NVC) studies commonly assess the mean cerebral hemodynamic response with little consideration for diastole, systole, and biological sex. Greater total activation expressed as the area under the curve was seen within systole compared with mean and diastole. Resting cerebral blood velocity sex differences were more prevalent during diastole when the cerebrovasculature was pressure-passive. Future studies should assess the NVC response across the cardiac cycle as it may help delineate the underlying pathophysiology of various clinical populations.
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Affiliation(s)
- Joel S Burma
- Faculty of Kinesiology, Cerebrovascular Concussion Lab, University of Calgary, Calgary, Alberta, Canada.,Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada.,Faculty of Kinesiology, Human Performance Laboratory, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
| | - Selina Rattana
- Faculty of Kinesiology, Cerebrovascular Concussion Lab, University of Calgary, Calgary, Alberta, Canada
| | - Nathan E Johnson
- Faculty of Kinesiology, Cerebrovascular Concussion Lab, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan D Smirl
- Faculty of Kinesiology, Cerebrovascular Concussion Lab, University of Calgary, Calgary, Alberta, Canada.,Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada.,Faculty of Kinesiology, Human Performance Laboratory, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada
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21
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Thomas DG, Erpenbach H, Hickey RW, Waltzman D, Haarbauer-Krupa J, Nelson LD, Patterson CG, McCrea MA, Collins MW, Kontos AP. Implementation of active injury management (AIM) in youth with acute concussion: A randomized controlled trial. Contemp Clin Trials 2022; 123:106965. [PMID: 36252936 PMCID: PMC10924688 DOI: 10.1016/j.cct.2022.106965] [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: 06/08/2022] [Revised: 09/10/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Nearly 2 million youth seek acute medical care following concussion in the U.S. each year. Current standard of care recommends rest for the first 48 h after a concussion. However, research suggests that prolonged rest may lengthen recovery time especially for patients with certain risk profiles. Research indicates that physical activity and behavioral management interventions (sleep, stress management) may enhance recovery. To date, there is limited empirical evidence to inform acute (<72 h) concussion recommendations for physical activity and behavioral management in adolescents. OBJECTIVE To determine the effectiveness of physical activity and behavioral management for acute concussion in adolescents and young adults, and to evaluate the role of patient characteristics on treatment response. METHODS This multicenter prospective randomized controlled trial will determine which combination of physical activity and behavioral management is most effective for patients 11-24 years old who present to the emergency department or concussion clinic within 72 h of injury. Participants are randomized into: 1) rest, 2) physical activity, 3) mobile health application (mHealth) behavioral management, or 4) physical activity and mHealth app conditions. Assessments at enrollment, 3-5 days, 14 days, 1 month, and 2 months include: concussion symptoms, balance, vestibular-ocular and cognitive assessments, quality of life, and recovery time. Somatic symptoms and other risk factors are evaluated at enrollment. Compliance with treatment and symptoms are assessed daily using actigraph and daily self-report. The primary study outcome is symptoms at 14 days. CONCLUSION Prescribed physical activity and behavioral management may improve outcomes in youth following acute concussion.
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Affiliation(s)
- D G Thomas
- Medical College of Wisconsin, Department of Pediatrics, United States of America.
| | - H Erpenbach
- Medical College of Wisconsin, Department of Pediatrics, United States of America
| | - R W Hickey
- University of Pittsburgh, Department of Pediatrics, United States of America
| | - D Waltzman
- Centers for Disease Control and Prevention, United States of America
| | - J Haarbauer-Krupa
- Centers for Disease Control and Prevention, United States of America
| | - L D Nelson
- Medical College of Wisconsin, Department of Neurosurgery, United States of America
| | - C G Patterson
- University of Pittsburgh, Department of Physical Therapy, United States of America
| | - M A McCrea
- Medical College of Wisconsin, Department of Neurosurgery, United States of America
| | - M W Collins
- University of Pittsburgh, Department of Orthopedic Surgery, United States of America
| | - A P Kontos
- University of Pittsburgh, Department of Orthopedic Surgery, United States of America
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22
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Sirant LW, Singh J, Martin S, Gaul CA, Stuart-Hill L, Candow DG, Mang C, Neary JP. Long-term effects of multiple concussions on prefrontal cortex oxygenation during neurovascular coupling activation in retired male contact sport athletes. Curr Res Physiol 2022; 5:421-428. [DOI: 10.1016/j.crphys.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022] Open
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23
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Vuu S, Barr CJ, Killington M, Jill G, van den Berg ME. Physical exercise for people with mild traumatic brain injury: A systematic review of randomized controlled trials. NeuroRehabilitation 2022; 51:185-200. [DOI: 10.3233/nre-220044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Recent research recommends physical exercise rather than rest following a mild traumatic brain injury (mTBI). OBJECTIVE: To determine the effect of physical exercise on persistent symptoms in people with mTBI. METHODS: A search of randomized controlled trials was conducted in CINAHL, Cochrane Library, EMBASE, MEDLINE, SportDiscus and Web of Science, from 2010 to January 2021. Studies were included if they described the effects of a physical exercise intervention in people with mTBI on persistent symptoms. Study quality, intervention reporting, and confidence in review findings were assessed with the CASP, TIDieR and GRADE respectively. RESULTS: 11 eligible studies were identified for inclusion. Study interventions broadly comprised of two categories of physical exercise, i.e., aerobic (n = 8) and vestibular (n = 3). A meta-analysis (n = 3) revealed the aerobic exercise group improvement was significantly larger compared to the usual care group –0.39 (95% CI: –0.73 to –0.05, p = 0.03). Only three studies using vestibular exercise reported on persistent symptoms and yielded mixed results. CONCLUSIONS: This study demonstrated that the use of aerobic exercise is supported by mixed quality evidence and moderate certainty of evidence, yet there is limited evidence for the use of vestibular exercise for improving persistent symptoms in people with mTBI.
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Affiliation(s)
- Sally Vuu
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Christopher J. Barr
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Maggie Killington
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Garner Jill
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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24
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Xiong F, Li T, Pan Y, Liu Y, Zhang J, Bai L. Arterial spin labeling magnetic resonance evaluates changes of cerebral blood flow in patients with mild traumatic brain injury. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:1016-1024. [PMID: 36097769 PMCID: PMC10950119 DOI: 10.11817/j.issn.1672-7347.2022.210754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The patients with mild traumatic brain injury (mTBI) accounts for more than 80% of the patients with brain injury. Most patients with mTBI have no abnormalities in CT examination. Therefore, most patients choose to self-care and recover rather than seeking medical treatment. In fact, mTBI may result in persistent cognitive decline and neurobehavioral dysfunction. In addition, changes occurred in neurochemistry, metabolism, and cells after injury may cause changes in cerebral blood flow (CBF), which is one of the causes of secondary injury and slow brain repair. This study aims to evaluate the changes of CBF with the progression of the disease in patients with mTBI based on arterial spin labeling (ASL) magnetic resonance imaging technology. METHODS In the outpatient or emergency department of the Second Affiliated Hospital of Wenzhou Medical University, 43 mTBI patients were collected as an mTBI group, and 43 normal subjects with age, gender, and education level matching served as a control group. They all received clinical neuropsychology and cognitive function evaluation and magnetic resonance imaging. In the mTBI group, 22 subjects were followed up at acute phase, 1 month, 3 months, and 12 months. Based on the control group, the abnormal regions of CBF in the whole brain of mTBI patients were analyzed. The abnormal regions were taken as the regions of interest (ROI). The correlation of the values of the CBF in ROIs with clinical indications, cognitive function, and the changes of CBF in ROI at each time point during the follow-up were analyzed. RESULTS Compared with the control group, the CBF in the bilateral dorsolateral superior frontal gyrus and auxiliary motor areas in the cortical region, as well as the right putamen, caudate nucleus, globus pallidus, and parahippocampus in the subcutaneous regions in the acute phase of the mTBI group were significantly increased (all P<0.01, TFCE-FWE correction). The analysis results of correlation of CBF with neuropsychology and cognitive domain showed that in the mTBI group, whole brain (r=0.528, P<0.001), right caudate nucleus (r=0.512, P<0.001), putamen (r=0.486, P<0.001), and globus pallidus (r=0.426, P=0.006) values of the were positively correlated with Backward Digit Span Test (BDST) score (reflectting working memory ability), and the right globus pallidus CBF was negatively correlated with the Post-Traumatic Stress Disorder Cheeklist-CivilianVersion (PCL-C) score (r=-0.402, P=0.010). Moreover, the follow-up study showed that abnormal CBF in these areas had not been restored. The correlation of CBF was negatively correlated with PCL-C and BDST at 1 months, 3 months, and 12 months (all P>0.05). CONCLUSIONS The elevated CBF value is one of the stress characteristics of brain injury in the mTBI patients at the acute phase. There is abnormal elevation of CBF values in multiple cortex or subcortical areas. Multi-time point studies show that there is no obvious change of CBF in abnormal areas, suggesting that potential clinical treatment is urgently needed for the mTBI patients.
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Affiliation(s)
- Feng Xiong
- Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University; Key Laboratory of Biomedical Information Engineering Ministry of Education, Xi'an 710049.
| | - Tianhui Li
- Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University; Key Laboratory of Biomedical Information Engineering Ministry of Education, Xi'an 710049
| | - Yizhen Pan
- Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University; Key Laboratory of Biomedical Information Engineering Ministry of Education, Xi'an 710049
| | - Yuling Liu
- Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University; Key Laboratory of Biomedical Information Engineering Ministry of Education, Xi'an 710049
| | - Jie Zhang
- Department of Radiation Medicine, Military Preventive Medicine School, Air Force Medical University, Xi'an 710032, China.
| | - Lijun Bai
- Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University; Key Laboratory of Biomedical Information Engineering Ministry of Education, Xi'an 710049.
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25
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Smulligan KL, Wingerson MJ, Seehusen CN, Wilson JC, Howell DR. Postconcussion Dizziness Severity Predicts Daily Step Count during Recovery among Adolescent Athletes. Med Sci Sports Exerc 2022; 54:905-911. [PMID: 35081096 DOI: 10.1249/mss.0000000000002877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Physical activity (PA) after concussion is an important aspect of appropriate clinical management. However, symptoms or functional deficits may reduce patient propensity toward PA, thereby negatively affecting recovery. Our purpose was to examine whether postconcussion dizziness, total symptom severity, or postural stability predicts PA level in the 2 wk after initial evaluation. METHODS We evaluated adolescent athletes within 14 d of concussion on assessments of symptoms, dizziness, and postural stability. Athletes were provided an activity monitor to track PA for 2 wk after the evaluation. Our primary outcome was step count (mean steps per day). Potential predictor variables included sex, Post-Concussion Symptom Inventory (PCSI) total symptom severity, individual PCSI ratings of dizziness and balance impairment, and postural stability assessments (single- and dual-task tandem gait, modified Balance Error Scoring System). To examine predictors of PA, we calculated correlation coefficients between steps per day and each potential predictor and included significantly correlated variables in a multivariable regression model. RESULTS Participants were ages 12-18 yr (n = 35, 15.2 ± 1.7 yr, 49% female) and initially evaluated 7.3 ± 3.0 d after concussion. Upon univariable evaluation, PCSI dizziness rating (Pearson R = -0.49, P = 0.003) and sex (mean difference, 2449 steps per day; P = 0.05) were associated with steps per day. Within the multivariable regression analysis, PCSI dizziness rating (β = -1035; 95% confidence interval, -191 to -1880; P = 0.018), but not sex, predicted average steps per day in the 2 wk after initial evaluation. CONCLUSIONS Self-reported dizziness, but not overall symptom severity or postural stability, assessed within 14 d of concussion predicted daily step count in the subsequent 2 wk. Given the importance of PA for concussion recovery, treating acute postconcussion dizziness can potentially reduce a barrier to PA and improve recovery trajectories.
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26
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Liu M, He E, Fu X, Gong S, Han Y, Deng F. Cerebral blood flow self-regulation in depression. J Affect Disord 2022; 302:324-331. [PMID: 35032508 DOI: 10.1016/j.jad.2022.01.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/21/2021] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Depression is a common neuropsychiatric disease with a high prevalence rate. Sleep problems, memory decline, dizziness and headaches are the most common neurological symptoms in depressed patients. Abnormality of cerebral blood flow (CBF) has been observed in depressive patients, but those patients did not have intracranial structural damage. Both of those phenomena might be related to cerebral blood flow self-regulation (CBFSR: cerebral blood flow self-regulation). CBFSR can maintain CBF relatively stable in response to changes in neurological and metabolic factors. Therefore, this review aimed to discuss CBFSR in depression. METHODS We searched for keywords such as "depression", "cerebral blood flow", "cerebral autoregulation", "cerebrovascular reactivity" and the words related to depression. We analyzed whether there is a change in the CBFSR in depression, further explored whether there is a relationship between the pathogenesis of depression and the CBFSR, and discussed the possible mechanism of impaired CBFSR in patients with depression. RESULTS Discovered by the literature review, CBFSR is significantly impaired in depressed patients. The level of circulating markers of endothelial dysfunction, nitric oxide, inflammatory cytokines, glucocorticoid and monoamine neurotransmitters is mostly abnormal in depression, which affected the CBFSR to varying degrees. LIMITATIONS Limitations include the small number of direct studies about depression and CBFSR mechanisms. CONCLUSION CBFSR is impaired in depression. The underlying mechanisms include endothelial dysfunction, overactivation of microglia and changes of cytokines, hyperactivation of the HPA axis, increased oxidative stress, monoamine neurotransmitter disorders, etc. These deepened our understanding of the clinical symptoms of depressed patients.
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Affiliation(s)
- Min Liu
- Department of Neurology, The First Hospital of Jilin University, No.1, Xinmin Street, Changchun, China
| | - Enling He
- Department of Neurology, The First Hospital of Jilin University, No.1, Xinmin Street, Changchun, China
| | - Xiyao Fu
- Department of Neurology, The First Hospital of Jilin University, No.1, Xinmin Street, Changchun, China
| | - Sizhu Gong
- Department of Neurology, The First Hospital of Jilin University, No.1, Xinmin Street, Changchun, China
| | - Yue Han
- Department of Neurology, The First Hospital of Jilin University, No.1, Xinmin Street, Changchun, China
| | - Fang Deng
- Department of Neurology, The First Hospital of Jilin University, No.1, Xinmin Street, Changchun, China.
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27
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Fyffe A, Carron MA, Orr R, Cassimatis M, Browne G. Greater symptom burden results in reduced exercise tolerance in adolescents following concussion. Brain Inj 2022; 36:368-374. [PMID: 35196195 DOI: 10.1080/02699052.2022.2034964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVES To explore the relationship between symptoms and exercise tolerance in adolescents following concussion. METHODS A retrospective analysis of 417 adolescents who attended a concussion service between January 2015 and April 2021 was performed, with 149 meeting eligibility criteria for inclusion. Post-Concussion Symptom Scale (PCSS) and graded exercise tolerance time (min) were assessed at initial and follow-up visits. Spearman's correlation was used to examine the relationship between PCSS scores and exercise time. RESULTS Adolescents (n = 149, 13.9 ± 1.7 years, 66.4% male) presented at 28.6 ± 19.7 days post-injury. Statistically significant correlations were identified between initial (r = -0.36, p < .001) and follow-up (r = -0.41, p < .001) PCSS scores and exercise time among all participants. Initial PCSS and initial exercise time were inversely correlated for males (r = -0.24, p = .018) and females (r = -0.22, p = .127). Follow-up PCSS and follow-up exercise time were inversely correlated for males (r = -0.30, p = .003) and females (r = -0.35, p = .014). CONCLUSION There is a statistically significant relationship between higher PCSS and poorer exercise time and both factors should be considered together to provide the most accurate assessment, particularly in females.
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Affiliation(s)
- Andrew Fyffe
- Children's Hospital Institute of Sports Medicine, Sydney Children's Hospital Network, Children's Hospital Institute of Sports Medicine, the Royal Alexandra Hospital for Children, Children's Hospital Westmead, Sydney Australia.,Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Michael A Carron
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Rhonda Orr
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,The Children's Hospital at Westmead Clinical School Sydney Medical School, the University of Sydney, Australia
| | - Maree Cassimatis
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gary Browne
- Children's Hospital Institute of Sports Medicine, Sydney Children's Hospital Network, Children's Hospital Institute of Sports Medicine, the Royal Alexandra Hospital for Children, Children's Hospital Westmead, Sydney Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, the University of Sydney, Australia
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28
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Quinn DK, Story-Remer J, Brandt E, Fratzke V, Rieger R, Wilson JK, Gill D, Mertens N, Hunter M, Upston J, Jones TR, Richardson JD, Myers O, Arciniegas DB, Campbell R, Clark VP, Yeo RA, Shuttleworth CW, Mayer AR. Transcranial direct current stimulation modulates working memory and prefrontal-insula connectivity after mild-moderate traumatic brain injury. Front Hum Neurosci 2022; 16:1026639. [PMID: 36310843 PMCID: PMC9608772 DOI: 10.3389/fnhum.2022.1026639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Persistent posttraumatic symptoms (PPS) may manifest after a mild-moderate traumatic brain injury (mmTBI) even when standard brain imaging appears normal. Transcranial direct current stimulation (tDCS) represents a promising treatment that may ameliorate pathophysiological processes contributing to PPS. Objective/Hypothesis: We hypothesized that in a mmTBI population, active tDCS combined with training would result in greater improvement in executive functions and post-TBI cognitive symptoms and increased resting state connectivity of the stimulated region, i.e., left dorsolateral prefrontal cortex (DLPFC) compared to control tDCS. Methods: Thirty-four subjects with mmTBI underwent baseline assessments of demographics, symptoms, and cognitive function as well as resting state functional magnetic resonance imaging (rsfMRI) in a subset of patients (n = 24). Primary outcome measures included NIH EXAMINER composite scores, and the Neurobehavioral Symptom Inventory (NSI). All participants received 10 daily sessions of 30 min of executive function training coupled with active or control tDCS (2 mA, anode F3, cathode right deltoid). Imaging and assessments were re-obtained after the final training session, and assessments were repeated after 1 month. Mixed-models linear regression and repeated measures analyses of variance were calculated for main effects and interactions. Results: Both active and control groups demonstrated improvements in executive function (EXAMINER composite: p < 0.001) and posttraumatic symptoms (NSI cognitive: p = 0.01) from baseline to 1 month. Active anodal tDCS was associated with greater improvements in working memory reaction time compared to control (p = 0.007). Reaction time improvement correlated significantly with the degree of connectivity change between the right DLPFC and the left anterior insula (p = 0.02). Conclusion: Anodal tDCS improved reaction time on an online working memory task in a mmTBI population, and decreased connectivity between executive network and salience network nodes. These findings generate important hypotheses for the mechanism of recovery from PPS after mild-moderate TBI.
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Affiliation(s)
- Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Jacqueline Story-Remer
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Emma Brandt
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Violet Fratzke
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Rebecca Rieger
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - John Kevin Wilson
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Darbi Gill
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Nickolas Mertens
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States.,Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Michael Hunter
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Joel Upston
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Thomas R Jones
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Jessica D Richardson
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Orrin Myers
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, United States
| | - David B Arciniegas
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Richard Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States.,Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States
| | - Vincent P Clark
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States.,Mind Research Network, Albuquerque, NM, United States
| | - Ronald A Yeo
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States.,Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - C William Shuttleworth
- Center for Brain Recovery and Repair, University of New Mexico, Albuquerque, NM, United States.,Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
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Haider MN, Nowak A, Sandhur M, Leddy JJ. Sport-Related Concussion and Exercise Intolerance. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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30
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Zhang Y, Huang Z, Xia H, Xiong J, Ma X, Liu C. The benefits of exercise for outcome improvement following traumatic brain injury: Evidence, pitfalls and future perspectives. Exp Neurol 2021; 349:113958. [PMID: 34951984 DOI: 10.1016/j.expneurol.2021.113958] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/04/2021] [Accepted: 12/15/2021] [Indexed: 12/15/2022]
Abstract
Traumatic brain injury (TBI), also known as a silent epidemic, is currently a substantial public health problem worldwide. Given the increased energy demands following brain injury, relevant guidelines tend to recommend absolute physical and cognitive rest for patients post-TBI. Nevertheless, recent evidence suggests that strict rest does not provide additional benefits to patients' recovery. By contrast, as a cost-effective non-pharmacological therapy, exercise has shown promise for enhancing functional outcomes after injury. This article summarizes the most recent evidence supporting the beneficial effects of exercise on TBI outcomes, focusing on the efficacy of exercise for cognitive recovery after injury and its potential mechanisms. Available evidence demonstrates the potential of exercise in improving cognitive impairment, mood disorders, and post-concussion syndrome following TBI. However, the clinical application for exercise rehabilitation in TBI remains challenging, particularly due to the inadequacy of the existing clinical evaluation system. Also, a better understanding of the underlying mechanisms whereby exercise promotes its most beneficial effects post-TBI will aid in the development of new clinical strategies to best benefit of these patients.
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Affiliation(s)
- Yulan Zhang
- Cognitive & Sports Neuroscience Laboratory, National Demonstration Center for Experimental Sports Science Education, College of Physical Education and Sports Science, South China Normal University, Guangzhou, Guangdong 510006, China; Laboratory of Laser Sports Medicine, College of Physical Education and Sports Science, South China Normal University, Guangzhou, Guangdong 510006, China
| | - Zhihai Huang
- Cognitive & Sports Neuroscience Laboratory, National Demonstration Center for Experimental Sports Science Education, College of Physical Education and Sports Science, South China Normal University, Guangzhou, Guangdong 510006, China
| | - Honglin Xia
- Laboratory of Regenerative Medicine in Sports Science, College of Physical Education and Sports Science, South China Normal University, Guangzhou, Guangdong 510006, China
| | - Jing Xiong
- Cognitive & Sports Neuroscience Laboratory, National Demonstration Center for Experimental Sports Science Education, College of Physical Education and Sports Science, South China Normal University, Guangzhou, Guangdong 510006, China; Laboratory of Laser Sports Medicine, College of Physical Education and Sports Science, South China Normal University, Guangzhou, Guangdong 510006, China
| | - Xu Ma
- Cognitive & Sports Neuroscience Laboratory, National Demonstration Center for Experimental Sports Science Education, College of Physical Education and Sports Science, South China Normal University, Guangzhou, Guangdong 510006, China; Laboratory of Laser Sports Medicine, College of Physical Education and Sports Science, South China Normal University, Guangzhou, Guangdong 510006, China
| | - Chengyi Liu
- Laboratory of Laser Sports Medicine, College of Physical Education and Sports Science, South China Normal University, Guangzhou, Guangdong 510006, China.
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31
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Worley ML, Reed EL, J Kueck P, Dirr J, Klaes N, Schlader ZJ, D Johnson B. Hot head-out water immersion does not acutely alter dynamic cerebral autoregulation or cerebrovascular reactivity to hypercapnia. Temperature (Austin) 2021; 8:381-401. [PMID: 34901320 DOI: 10.1080/23328940.2021.1894067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Recurring hot head-out water immersion (HOWI) enhances peripheral vascular function and cerebral blood velocity during non-immersion conditions. However, it is unknown if an acute bout of hot HOWI alters cerebrovascular function. Using two experimental studies, we tested the hypotheses that dynamic cerebral autoregulation (dCA) and cerebrovascular reactivity (CVR) are improved during an acute bout of hot (HOT; 39 °C) vs. thermoneutral (TN; 35 °C) HOWI. Eighteen healthy participants (eight females) completed the dCA study, and 14 participants (6 females) completed the CVR study. Both studies consisted of two randomized (TNdCA vs. HOTdCA; TNCVR vs. HOTCVR) 45minute HOWI visits. Middle cerebral artery blood velocity (MCAvmean) was continuously recorded. dCA was assessed using a respiratory impedance device and analyzed via transfer gain and phase in the low-frequency band. CVR was assessed using stepped hypercapnia. Assessments were completed PRE and 30 minutes into HOWI. Values are reported as a change (Δ) from PRE (mean ± SD). There were no differences at PRE for either study. ΔMCAvmean was greater in TNdCA (TNdCA: 4 ± 4 vs. HOTdCA: -3 ± 5 cm/s; P < 0.01) and TNCVR (TNCVR: 5 ± 4 vs. HOTCVR: -1 ± 6 cm/s; P < 0.01) during HOWI. ΔGain was greater in HOTdCA during HOWI (TNdCA: -0.09 ± 0.15 vs. HOTdCA: 0.10 ± 0.17 cm/s/mmHg; P = 0.04). ΔPhase (P > 0.84) and ΔCVR (P > 0.94) were not different between conditions. These data indicate that hot and thermoneutral water immersion do not acutely alter cerebrovascular function in healthy, young adults.
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Affiliation(s)
- Morgan L Worley
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, United States
| | - Emma L Reed
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, United States
| | - Paul J Kueck
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, United States
| | - Jacqueline Dirr
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, United States
| | - Nathan Klaes
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, United States
| | - Zachary J Schlader
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, United States.,Department of Kinesiology, School of Public Health, Indiana University, Bloomington, United States
| | - Blair D Johnson
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, United States.,Department of Kinesiology, School of Public Health, Indiana University, Bloomington, United States
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32
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Howell DR, Hunt DL, Aaron SE, Hamner JW, Meehan WP, Tan CO. Association of Hemodynamic and Cerebrovascular Responses to Exercise With Symptom Severity in Adolescents and Young Adults With Concussion. Neurology 2021; 97:e2204-e2212. [PMID: 34635563 DOI: 10.1212/wnl.0000000000012929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/24/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Aerobic exercise has become a useful method to assist with post-concussion management. Exercise can exacerbate concussion symptoms even when symptoms are not apparent at rest. Few studies have examined the reasons for symptom exacerbation during exercise following a concussion. We had two primary objectives. 1) To delineate cardiopulmonary and cerebrovascular responses to exercise in adolescents and young adults with a concussion and healthy controls. 2) To determine the association between cerebrovascular responses and symptom burden. METHODS We recruited participants with a recent concussion from a sport concussion clinic between 9/1/2018-2/22/2020. They were included if their concussion occurred <3 weeks before initial testing and if they were symptomatic at rest. Participants were excluded if they sustained a concussion in the past year (excluding index injury), reported history of neurological disorders, or were using medications/devices that may alter neurological function. Participants completed a progressive, symptom-limited, sub-maximal exercise protocol on a stationary bike. We assessed heart rate, blood pressure, fraction of end tidal CO2 (FETCO2) and middle cerebral artery blood flow velocity (CBF) and cerebrovascular function (vasoreactivity and autoregulation) at seated rest and during exercise. RESULTS We conducted 107 exercise tests (40 concussed, 37 healthy participants initially; 30 concussed at follow-up). Concussed participants were tested initially (mean=17.6±2.2 [SD] years old; 55% female; mean=12.5±4.7 days post-concussion) and again 8 weeks later (mean=73.3±9.5 days post-concussion). Control participants (mean=18.3±2.4 years; 62% female) were tested once. FETCO2 increased throughout the exercise protocol as heart rate increased, reached a plateau, and declined at higher exercise intensities. CO2 explained >25% of the variation in resting CBF (R2>0.25; p<0.01) in most (73% individuals). Within the concussion group, resting symptom severity and the heart rate at which FETCO2 reached a plateau explained ∼two-thirds of variation in exercise-induced symptom exacerbation (R 2 =0.65; FETCO2 β=-1.210±0.517[S.E.], p<0.05). There was a moderate, statistically significant relationship between cerebrovascular responses to CO2 at rest (cerebral vasoreactivity) and cerebrovascular responses to exercise-induced changes in FETCO2 (R2=0.13, p=0.01). DISCUSSION The arterial CO2 response and symptom exacerbation relationship during post-concussion aerobic exercise may be mediated by increased sensitivity of cerebral vasculature to exercise-related increase in CO2.
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Affiliation(s)
- David R Howell
- Sports Medicine Center, Childrens Hospital Colorado, Aurora, CO, USA .,Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Danielle L Hunt
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,Division of Sports Medicine, Boston Childrens Hospital, Boston, MA, USA
| | - Stacey E Aaron
- Cerebrovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, USA.,Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Jason W Hamner
- Cerebrovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, USA.,Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,Division of Sports Medicine, Boston Childrens Hospital, Boston, MA, USA.,Departments of Orthopedic Surgery and Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Can Ozan Tan
- Cerebrovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, USA.,Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, USA.,Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA
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Ozturk ED, Iaccarino MA, Hamner JW, Aaron SE, Hunt DL, Meehan WP, Howell DR, Tan CO. Executive dysfunction after multiple concussions is not related to cerebrovascular dysfunction. Physiol Meas 2021; 42. [PMID: 34450608 DOI: 10.1088/1361-6579/ac2207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/27/2021] [Indexed: 11/11/2022]
Abstract
Objective.We investigated the relation between prior concussion history and working memory (WM), self-reported cognitive symptom burden, and cerebrovascular function in adolescents and young adults (14-21 years old).Approach.We recruited 59 participants, 34 clinically diagnosed with a sports-related concussion and 25 controls. Concussed subjects were studied at baseline (within 28 days of their injury) and eight weeks after, while control subjects only had one assessment. We assessed WM (n-back task up to four-back), and neurovascular coupling (cerebrovascular responses at middle cerebral artery duringn-back tasks) using a transcranial Doppler ultrasonograph.Main results.There was no significant difference in WM between controls and concussed participants (p = 0.402). However, WM capacity was lower in those who had sustained ≥3 concussions (7.1% with WM capacity of four) compared to those with their first ever concussion (33.3%) and controls (28.0%, overallp = 0.025). At the sub-acute point (n = 24), self-reported cognitive symptom burden was mostly resolved in all but two participants. Despite the resolution of symptoms, WM performance was not different eight weeks post injury (p = 0.706). Neurovascular coupling was not different between controls and concussed participants regardless of prior concussion history.Significance. Up to 20% of concussed individuals experience covert sequelae lasting beyond the resolution of self-reported overt symptoms. How a prior history of concussion impacts the potential for sequelae is not well established, and the underlying mechanisms are unknown. Despite no alterations in neurovascular coupling, a history of prior concussion was associated with significant deficits in WM capacity, and lasted beyond self-reported cognitive symptom resolution.
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Affiliation(s)
- Erin D Ozturk
- Cerebrovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, United States of America
| | - Mary Alexis Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States of America.,Spaulding Rehabilitation Hospital, Boston, MA, United States of America.,Massachusetts General Hospital for Children Sports Concussion Program, Boston, MA, United States of America
| | - Jason W Hamner
- Cerebrovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, United States of America
| | - Stacey E Aaron
- Cerebrovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, United States of America.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States of America
| | - Danielle L Hunt
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States of America.,The Micheli Center for Sports Injury Prevention, Waltham, MA, United States of America
| | - William P Meehan
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States of America.,The Micheli Center for Sports Injury Prevention, Waltham, MA, United States of America.,Departments of Orthopedic Surgery and Pediatrics, Harvard Medical School, Boston, MA, United States of America
| | - David R Howell
- The Micheli Center for Sports Injury Prevention, Waltham, MA, United States of America.,Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, United States of America.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Can Ozan Tan
- Cerebrovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, United States of America.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States of America.,Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, United States of America
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34
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Barlow KM, Iyer K, Yan T, Scurfield A, Carlson H, Wang Y. Cerebral Blood Flow Predicts Recovery in Children with Persistent Post-Concussion Symptoms after Mild Traumatic Brain Injury. J Neurotrauma 2021; 38:2275-2283. [PMID: 33430707 PMCID: PMC9009764 DOI: 10.1089/neu.2020.7566] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Persistent post-concussion symptoms (PPCS) following pediatric mild traumatic brain injury (mTBI) are associated with differential changes in cerebral blood flow (CBF). Given its potential as a therapeutic target, we examined CBF changes during recovery in children with PPCS. We hypothesized that CBF would decrease and that such decreases would mirror clinical recovery. In a prospective cohort study, 61 children and adolescents (mean age 14 [standard deviation = 2.6] years; 41% male) with PPCS were imaged with three-dimensional (3D) pseudo-continuous arterial spin-labelled (pCASL) magnetic resonance imaging (MRI) at 4-6 and 8-10 weeks post-injury. Exclusion criteria included any significant past medical history and/or previous concussion within the past 3 months. Twenty-three participants had clinically recovered at the time of the second scan. We found that relative and mean absolute CBF were higher in participants with poor recovery, 44.0 (95% confidence interval [CI]: 43.32, 44.67) than in those with good recovery, 42.19 (95% CI: 41.77, 42.60) mL/min/100 g gray tissue and decreased over time (β = -1.75; p < 0.001). The decrease was greater in those with good recovery (β = 2.29; p < 0.001) and predicted outcome in 77% of children with PPCS (odds ratio [OR] 0.54, 95% CI: 0.36, 0.80; p = 0.002). Future studies are warranted to validate the utility of CBF as a useful predictive biomarker of outcome in PPCS.
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Affiliation(s)
- Karen M. Barlow
- Children's Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kartik Iyer
- Children's Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Tingting Yan
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alex Scurfield
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Helen Carlson
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Yang Wang
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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35
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Convertino VA, Cardin S, Cap AP, Crowder AT, Stackle ME, Talley MJ, Lurie KG. Saving the brain after mild-to-moderate traumatic injury: A report on new insights of the physiology underlying adequate maintenance of cerebral perfusion. J Trauma Acute Care Surg 2021; 91:S33-S39. [PMID: 34039933 DOI: 10.1097/ta.0000000000003286] [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: 11/25/2022]
Abstract
ABSTRACT Traumatic brain injury (TBI) is associated with increased morbidity and mortality in civilian trauma and battlefield settings. It has been classified across a continuum of dysfunctions, with as much as 80% to 90% of cases diagnosed as mild to moderate in combat casualties. In this report, a framework is presented that focuses on the potential benefits for acute noninvasive treatment of reduced cerebral perfusion associated with mild TBI by harnessing the natural transfer of negative intrathoracic pressure during inspiration. This process is known as intrathoracic pressure regulation (IPR) therapy, which can be applied by having a patient breath against a small inspiratory resistance created by an impedance threshold device. Intrathoracic pressure regulation therapy leverages two fundamental principles for improving blood flow to the brain: (1) greater negative intrathoracic pressure enhances venous return, cardiac output, and arterial blood pressure; and (2) lowering of intracranial pressure provides less resistance to cerebral blood flow. These two effects work together to produce a greater pressure gradient that results in an improvement in cerebral perfusion pressure. In this way, IPR therapy has the potential to counter hypotension and hypoxia, potentially significant contributing factors to secondary brain injury, particularly in conditions of multiple injuries that include severe hemorrhage. By implementing IPR therapy in patients with mild-to-moderate TBI, a potential exists to provide early neuroprotection at the point of injury and a bridge to more definitive care, particularly in settings of prolonged delays in evacuation such as those anticipated in future multidomain operations. LEVEL OF EVIDENCE Report.
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Affiliation(s)
- Victor A Convertino
- From the US Army Institute of Surgical Research (V.A.C., A.P.C., A.T.C., M.E.S.); Naval Medical Research Unit-San Antonio (S.C.), Joint Base San Antonio-Fort Sam Houston, Texas; US Army Medical Research and Development Command (M.J.T.), Fort Detrick, Maryland; and Department of Emergency Medicine (K.G.L.), University of Minnesota, Minneapolis, Minnesota
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36
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Huang Z, Zhang Y, Zhou R, Yang L, Pan H. Lactate as Potential Mediators for Exercise-Induced Positive Effects on Neuroplasticity and Cerebrovascular Plasticity. Front Physiol 2021; 12:656455. [PMID: 34290615 PMCID: PMC8287254 DOI: 10.3389/fphys.2021.656455] [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: 01/20/2021] [Accepted: 06/09/2021] [Indexed: 01/22/2023] Open
Abstract
The accumulated evidence from animal and human studies supports that exercise is beneficial to physical health. Exercise can upregulate various neurotrophic factors, activate neuroplasticity, and play a positive role in improving and enhancing cerebrovascular function. Due to its economy, convenience, and ability to prevent or ameliorate various aging-related diseases, exercise, a healthy lifestyle, is increasingly popularized by people. However, the mechanism by which exercise performs this function and how it is transmitted from muscles to the brain remains incompletely understood. Here, we review the beneficial effects of exercise with different intensities on the brain with a focus on the positive effects of lactate on neuroplasticity and cerebrovascular plasticity. Based on these recent studies, we propose that lactate, a waste previously misunderstood as a by-product of glycolysis in the past, may be a key signal molecule that regulates the beneficial adaptation of the brain caused by exercise. Importantly, we speculate that a central protective mechanism may underlie the cognitive benefits induced by exercise.
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Affiliation(s)
- Zhihai Huang
- Cognitive and Sports Neuroscience Laboratory, National Demonstration Center for Experimental Sports Science Education, College of Physical Education and Sports Science, South China Normal University, Guangzhou, China
| | - Yulan Zhang
- Cognitive and Sports Neuroscience Laboratory, National Demonstration Center for Experimental Sports Science Education, College of Physical Education and Sports Science, South China Normal University, Guangzhou, China
| | - Ruixue Zhou
- Cognitive and Sports Neuroscience Laboratory, National Demonstration Center for Experimental Sports Science Education, College of Physical Education and Sports Science, South China Normal University, Guangzhou, China
| | - Luodan Yang
- Cognitive and Sports Neuroscience Laboratory, National Demonstration Center for Experimental Sports Science Education, College of Physical Education and Sports Science, South China Normal University, Guangzhou, China
| | - Hongying Pan
- Cognitive and Sports Neuroscience Laboratory, National Demonstration Center for Experimental Sports Science Education, College of Physical Education and Sports Science, South China Normal University, Guangzhou, China
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37
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Markovic SJ, Fitzgerald M, Peiffer JJ, Scott BR, Rainey-Smith SR, Sohrabi HR, Brown BM. The impact of exercise, sleep, and diet on neurocognitive recovery from mild traumatic brain injury in older adults: A narrative review. Ageing Res Rev 2021; 68:101322. [PMID: 33737117 DOI: 10.1016/j.arr.2021.101322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/06/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023]
Abstract
Mild traumatic brain injury (mTBI) accounts for a large majority of traumatic brain injuries sustained globally each year. Older adults, who are already susceptible to age-related declines to neurocognitive health, appear to be at an increased risk of both sustaining an mTBI and experiencing slower or impaired recovery. There is also growing evidence that mTBI is a potential risk factor for accelerated cognitive decline and neurodegeneration. Lifestyle-based interventions are gaining prominence as a cost-effective means of maintaining cognition and brain health with age. Consequently, inter-individual variations in exercise, sleep, and dietary patterns could influence the trajectory of post-mTBI neurocognitive recovery, particularly in older adults. This review synthesises the current animal and human literature centred on the mechanisms through which lifestyle-related habits and behaviours could influence acute and longer-term neurocognitive functioning following mTBI. Numerous neuroprotective processes which are impacted by lifestyle factors have been established in animal models of TBI. However, the literature is characterised by a lack of translation to human samples and limited appraisal of the interaction between ageing and brain injury. Further research is needed to better establish the therapeutic utility of applying lifestyle-based modifications to improve post-mTBI neurocognitive outcomes in older adults.
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Affiliation(s)
- Shaun J Markovic
- Discipline of Exercise Science, College of Science, Health, Engineering and Education, Murdoch University, 90 South St, Murdoch, Western Australia, Australia; Australian Alzheimer's Research Foundation, Sarich Neuroscience Research Institute Building, 8 Verdun St, Nedlands, Western Australia, Australia.
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Sarich Neuroscience Research Institute Building, 8 Verdun St, Nedlands, Western Australia, Australia; Perron Institute for Neurological and Translational Science, Sarich Neuroscience Research Institute Building, 8 Verdun St, Nedlands, Western Australia, Australia; School of Biological Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, Australia
| | - Jeremiah J Peiffer
- Discipline of Exercise Science, College of Science, Health, Engineering and Education, Murdoch University, 90 South St, Murdoch, Western Australia, Australia; Centre for Healthy Ageing, Murdoch University, 90 South St, Murdoch, Western Australia, Australia; Murdoch Applied Sports Science Laboratory, Murdoch University, 90 South St, Murdoch, Western Australia, Australia
| | - Brendan R Scott
- Discipline of Exercise Science, College of Science, Health, Engineering and Education, Murdoch University, 90 South St, Murdoch, Western Australia, Australia; Centre for Healthy Ageing, Murdoch University, 90 South St, Murdoch, Western Australia, Australia; Murdoch Applied Sports Science Laboratory, Murdoch University, 90 South St, Murdoch, Western Australia, Australia
| | - Stephanie R Rainey-Smith
- Australian Alzheimer's Research Foundation, Sarich Neuroscience Research Institute Building, 8 Verdun St, Nedlands, Western Australia, Australia; Centre for Healthy Ageing, Murdoch University, 90 South St, Murdoch, Western Australia, Australia; School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dr, Joondalup, Western Australia, Australia; School of Psychological Science, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, Australia
| | - Hamid R Sohrabi
- Australian Alzheimer's Research Foundation, Sarich Neuroscience Research Institute Building, 8 Verdun St, Nedlands, Western Australia, Australia; Centre for Healthy Ageing, Murdoch University, 90 South St, Murdoch, Western Australia, Australia; School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dr, Joondalup, Western Australia, Australia; Department of Biomedical Sciences, Macquarie University, Balaclava Rd, Macquarie Park, New South Wales, Australia
| | - Belinda M Brown
- Discipline of Exercise Science, College of Science, Health, Engineering and Education, Murdoch University, 90 South St, Murdoch, Western Australia, Australia; Australian Alzheimer's Research Foundation, Sarich Neuroscience Research Institute Building, 8 Verdun St, Nedlands, Western Australia, Australia; Centre for Healthy Ageing, Murdoch University, 90 South St, Murdoch, Western Australia, Australia
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38
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Howell DR, Hunt D, Aaron SE, Meehan WP, Tan CO. Influence of Aerobic Exercise Volume on Postconcussion Symptoms. Am J Sports Med 2021; 49:1912-1920. [PMID: 33856860 PMCID: PMC9231419 DOI: 10.1177/03635465211005761] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Aerobic exercise has emerged as a useful treatment to improve outcomes among individuals who experience a concussion. However, compliance with exercise recommendations and the effect of exercise volume on symptom recovery require further investigation. PURPOSE To examine (1) if an 8-week aerobic exercise prescription, provided within 2 weeks of concussion, affects symptom severity or exercise volume; (2) whether prescription adherence, rather than randomized group assignment, reflects the actual effect of aerobic exercise in postconcussion recovery; and (3) the optimal volume of exercise associated with symptom resolution after 1 month of study. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Individuals randomized to an exercise intervention (n = 17; mean age, 17.2 ± 2.0 years; 41% female; initially tested a mean of 11.3 ± 2.8 days after injury) or standard of care (n = 20; mean age, 16.8 ± 2.2 years; 50% female; initially tested a mean of 10.7 ± 3.2 days after injury) completed an aerobic exercise test within 14 days of injury. They returned for assessments 1 month and 2 months after the initial visit. The aerobic exercise group was instructed to exercise 5 d/wk, 20 min/d (100 min/wk), at a target heart rate based on an exercise test at the initial visit. Participants reported their exercise volume each week over the 8-week study period and reported symptoms at each study visit (initial, 1 month, 2 months). Because of low compliance in both groups, there was no difference in the volume of exercise between the 2 groups. RESULTS There were no significant symptom severity differences between the intervention and standard-of-care groups at the initial (median Post-Concussion Symptom Inventory, 15 [interquartile range = 10, 42] vs 20 [11, 35.5]; P = .26), 1-month (4 [0, 28] vs 5.5 [0.5, 21.5]; P = .96), or 2-month (6.5 [0, 27.5] vs 0 [0, 4]; P = .11) study visits. Exercise volume was similar between groups (median, 115 [54, 225] vs 88 [28, 230] min/wk for exercise intervention vs standard of care; P = .52). Regardless of group, those who exercised <100 min/wk reported significantly higher symptom severity at the 1-month evaluation compared with those who exercised ≥100 min/wk (median, 1.5 [0, 7.5] vs 12 [4, 28]; P = .03). Exercising ≥160 min/wk successfully discriminated between those with and those without symptoms 1 month after study commencement (classification accuracy, 81%; sensitivity, 90%; specificity, 78%). CONCLUSION Greater exercise volume was associated with lower symptom burden after 1 month of study, and an exercise volume >160 min/wk in the first month of the study was the threshold associated with symptom resolution after the first month of the study. Because our observation on the association between exercise volume and symptom level is a retrospective and secondary outcome, it is possible that participants who were feeling better were more likely to exercise more, rather than the exercise itself driving the reduction in symptom severity.
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Affiliation(s)
- David R. Howell
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO, USA,Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA,Corresponding author: David R. Howell, PhD, ATC, Sports Medicine Center, Children’s Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Avenue, B060 Aurora, CO, USA 80045,
| | - Danielle Hunt
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA,Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Stacey E. Aaron
- Cerebrovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - William P. Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA,Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA,Departments of Orthopedic Surgery and Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Can Ozan Tan
- Cerebrovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, USA,Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA, USA,Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA
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Portanova J, Buchanan D, Moore M, Thompson H. Factors Associated with the Development of Persistent Pain after mTBI. Pain Manag Nurs 2021; 22:592-598. [PMID: 34011466 DOI: 10.1016/j.pmn.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Persistent pain after mild traumatic brain injury (mTBI) is widely experienced, yet little is known about who is at risk for experiencing persistent pain after their injury. AIMS The purpose of this study was to 1) determine if there are factors associated with later experiencing persistent pain after mTBI and 2) examine if there are symptom patterns associated with the experience of persistent pain. DESIGN Secondary analysis was conducted using de-identified data from an NIH-funded longitudinal study.SettingsParticipants were enrolled in the emergency department. PARTICIPANTS Participants were aged 21 to 92 and all had experienced mTBI. METHODS We examined baseline characteristics, symptoms, and injury related variables associated with the endorsement of persistent pain among those with mTBI (N = 183) from baseline to 6 months post-injury. In order to identify a persistent pain phenotype, exploratory factor analysis was used to determine which symptoms co-occur with persistent pain. RESULTS Persistent pain was found in 78% of those with mTBI. Those with lower overall health status at day 7 and at 1-month following injury had greater odds of developing persistent pain. Those with higher levels of general health status and physical function health status at day 7 and 1 month, and those with higher levels of overall health related status at 1 month had significantly lesser odds of persistent pain at 6 months. Factor analysis revealed that persistent pain and co-occurring symptoms (anxiety, depression, dizziness, nausea and vomiting, sleep disturbance, poor memory, poor concentration, longer to think and light sensitivity) loaded on one factor, indicating that these symptoms are associated. CONCLUSIONS Those at increased risk for persistent pain should be screened beginning early in the recovery trajectory to reduce their risk of developing persistent pain. Identification of a phenotype offers potential for recognition of symptoms that cluster with persistent pain, improving the ability to treat patients more holistically, and develop interventions to support recovery from injury.
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Affiliation(s)
- Jaclyn Portanova
- University of Washington, Seattle, Washington; Department of Veteran Affairs; Linfield University; Yale University.
| | | | - Megan Moore
- University of Washington, Seattle, Washington
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Aaron SE, Hamner JW, Ozturk ED, Hunt DL, Iaccarino MA, Meehan WP, Howell DR, Tan CO. Cerebrovascular Neuroprotection after Acute Concussion in Adolescents. Ann Neurol 2021; 90:43-51. [PMID: 33855730 DOI: 10.1002/ana.26082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/23/2021] [Accepted: 04/11/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess acute cerebrovascular function in concussed adolescents (14-21 years of age), whether it is related to resting cerebral hemodynamics, and whether it recovers chronically. METHODS Cerebral vasoreactivity and autoregulation, based on middle cerebral artery blood flow velocity, was assessed in 28 concussed participants (≤14 days of injury) and 29 matched controls. The participants in the concussion group returned for an 8-week follow-up assessment. Over the course of those 8-weeks, participants recorded aerobic exercise frequency and duration. RESULTS Between groups, demographic, clinical, and hemodynamic variables were not significantly different. Vasoreactivity was significantly higher in the concussed group (p = 0.02). Within the concussed group, 60% of the variability in resting cerebral blood flow velocity was explained by vasoreactivity and two components of autoregulation - falling slope and effectiveness of autoregulation (adjusted R2 = 0.60, p < 0.001). Moreover, lower mean arterial pressure, lower responses to increases in arterial pressure, and lower vasoreactivity were significantly associated with larger symptom burden (adjusted R2 = 0.72, p < 0.01). By the 8-week timepoint, symptom burden, but not vasoreactivity, improved in all but four concussed participants (p < 0.01). 8-week change in vasoreactivity was positively associated with aerobic exercise volume (adjusted R2 = 0.19, p = 0.02). INTERPRETATION Concussion resulted in changes in cerebrovascular regulatory mechanisms, which in turn explained the variability in resting cerebral blood flow velocity and acute symptom burden. Furthermore, these alterations persisted chronically despite symptom resolution, but was positively modified by aerobic exercise volume. These findings provide a mechanistic framework for further investigation into underlying cerebrovascular related symptomatology. ANN NEUROL 2021;90:43-51.
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Affiliation(s)
- Stacey E Aaron
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA.,Spaulding Rehabilitation Hospital, Boston, MA.,Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS
| | | | | | | | - Mary Alexis Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA.,Sports Concussion Program, MassGeneral for Children, Boston, MA.,Massachusetts General Hospital, Boston, MA
| | | | - David R Howell
- Boston Children's Hospital, Boston, MA.,University of Colorado School of Medicine, Aurora, CO.,Children's Hospital Colorado, Aurora, CO
| | - Can Ozan Tan
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA.,Spaulding Rehabilitation Hospital, Boston, MA.,Massachusetts General Hospital, Boston, MA
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Wilber CG, Leddy JJ, Bezherano I, Bromley L, Edwards AE, Willer BS, Haider MN. Rehabilitation of Concussion and Persistent Postconcussive Symptoms. Semin Neurol 2021; 41:124-131. [PMID: 33663005 DOI: 10.1055/s-0041-1725134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Concussion and persistent postconcussive symptoms (PPCS) are encountered by clinicians in sports medicine, pediatrics, neurology, physiatry, emergency medicine, and primary care. Clinical management may require a multidisciplinary approach. This article presents a structured method for the diagnosis of concussion and PPCS in the outpatient setting, which includes a history, physical examination, and additional tests as clinically indicated to help identify underlying symptom generators. Treatment for concussion and PPCS should be individualized, based on predominant signs and symptoms, and can include subsymptom threshold aerobic exercise, cervical physical therapy, vestibulo-ocular rehabilitation, behavioral and cognitive psychotherapy, and some symptom-specific pharmacological therapies.
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Affiliation(s)
- Charles G Wilber
- Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, UBMD, State University of New York at Buffalo, Buffalo, New York
| | - John J Leddy
- Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, UBMD, State University of New York at Buffalo, Buffalo, New York
| | - Itai Bezherano
- Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, UBMD, State University of New York at Buffalo, Buffalo, New York
| | - Lacey Bromley
- Department of Physical Therapy, School of Health Professions, D'Youville College, Buffalo, New York.,Bennett Rehabilitation Institute, Buffalo, New York
| | - Amanda E Edwards
- UB Counseling Services, Department of Athletics, State University of New York at Buffalo, Buffalo, New York
| | - Barry S Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Mohammad N Haider
- Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, UBMD, State University of New York at Buffalo, Buffalo, New York.,PhD Program in Biomedical Science, Program of Neuroscience, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
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Tu T, Yin S, Pang J, Zhang X, Zhang L, Zhang Y, Xie Y, Guo K, Chen L, Peng J, Jiang Y. Irisin Contributes to Neuroprotection by Promoting Mitochondrial Biogenesis After Experimental Subarachnoid Hemorrhage. Front Aging Neurosci 2021; 13:640215. [PMID: 33613273 PMCID: PMC7886674 DOI: 10.3389/fnagi.2021.640215] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/12/2021] [Indexed: 12/17/2022] Open
Abstract
Subarachnoid hemorrhage (SAH) is a devastating form of stroke, which poses a series of intractable challenges to clinical practice. Imbalance of mitochondrial homeostasis has been thought to be the crucial pathomechanism in early brain injury (EBI) cascade after SAH. Irisin, a protein related to metabolism and mitochondrial homeostasis, has been reported to play pivotal roles in post-stroke neuroprotection. However, whether this myokine can exert neuroprotection effects after SAH remains unknown. In the present study, we explored the protective effects of irisin and the underlying mechanisms related to mitochondrial biogenesis in a SAH animal model. Endovascular perforation was used to induce SAH, and recombinant irisin was administered intracerebroventricularly. Neurobehavioral assessments, TdT-UTP nick end labeling (TUNEL) staining, dihydroethidium (DHE) staining, immunofluorescence, western blot, and transmission electron microscopy (TEM) were performed for post-SAH assessments. We demonstrated that irisin treatment improved neurobehavioral scores, reduced neuronal apoptosis, and alleviated oxidative stress in EBI after SAH. More importantly, the administration of exogenous irisin conserved the mitochondrial morphology and promoted mitochondrial biogenesis. The protective effects of irisin were partially reversed by the mitochondrial uncoupling protein-2 (UCP-2) inhibitor. Taken together, irisin may have neuroprotective effects against SAH via improving the mitochondrial biogenesis, at least in part, through UCP-2 related targets.
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Affiliation(s)
- Tianqi Tu
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Shigang Yin
- Luzhou Key Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jinwei Pang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Sichuan Clinical Research Center for Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xianhui Zhang
- Sichuan Clinical Research Center for Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lifang Zhang
- Sichuan Clinical Research Center for Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yuxuan Zhang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yuke Xie
- Luzhou Key Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Kecheng Guo
- Luzhou Key Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ligang Chen
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Sichuan Clinical Research Center for Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jianhua Peng
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Luzhou Key Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Sichuan Clinical Research Center for Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yong Jiang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Luzhou Key Laboratory of Neurological Diseases and Brain Function, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Sichuan Clinical Research Center for Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Post-concussion symptoms in sports-related mild traumatic brain injury compared to non-sports-related mild traumatic brain injury. CAN J EMERG MED 2021; 23:223-231. [PMID: 33512694 DOI: 10.1007/s43678-020-00060-0] [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: 06/03/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To compare post-concussion symptoms in patients who sustained a sports-related mild traumatic brain injury (TBI) to those with non-sports-related mild TBI at 7 and 90 days post-injury. METHODS This prospective multicentre cohort study took place in seven Canadian Emergency Departments (ED). Non-hospitalized patients aged ≥ 14 years with a documented mild TBI that occurred ≤ 24 h of ED visit and a Glasgow Coma Scale score ≥ 13 were included. Main outcome measure was the presence of ≥ 3 symptoms on the Rivermead Post-concussion Questionnaire at 90 days post-injury. Secondary outcomes were the prevalence of (1) individual Rivermead Post-concussion Questionnaire symptom, (2) total Rivermead Post-concussion Questionnaire score ≥ 21 and (3) return to normal daily activities. Adjusted risk ratios (RR) were calculated. RESULTS 1727 patients were included, 363 (21.0%) sustained a sports-related mild TBI. Similar proportions of patients with ≥ 3 symptoms, a Rivermead Post-concussion Questionnaire score ≥ 21 and those who returned to their normal daily activities were observed at 7 and 90 days post-injury. Sports-related mild TBI patients were at higher risk of poor concentration [RR: 1.3 (95% CI 1.05-1.54)] and non-return to sports activities [RR: 2.2 (95% CI 1.69-2.94)] at 7 days post-injury. At 90 days, sports-relate -mild TBI patients reported less fatigue [RR: 0.7 (95% CI 0.51-0.98)] and feeling of dizziness [RR: 0.6 (95% CI 0.35-0.99)]. CONCLUSION Patients who sustained sports-related mild TBI could be at lower risk of experiencing symptoms such as fatigue and dizziness 90 days post-injury. Clinicians should be mindful that non-sports-related mild TBI patients may experience more post-concussion symptoms and that the level of physical activity may influence the patient's rehabilitation.
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Wu YN, Stark C, Gravel J, White M, Avery J, Enis T, Cantu RC. Effects of Interval-Training Exercise on People Who Have Had Persistent Post-Concussive Symptoms for Less Than One Year: A Pilot Study. J Neurotrauma 2020; 38:573-581. [PMID: 33096965 DOI: 10.1089/neu.2019.6915] [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: 11/12/2022] Open
Abstract
This study is to examine the effects of a 12-session moderate intensity-interval-training program with blood flow restriction (BFR) and body cooling (BC) on people who have had persistent post-concussive symptoms (PPCS) for <1 year. A single-blind randomized controlled trial of interval-training exercise with BFR and BC was conducted. Twenty-five adults with PPCS were assigned to the experimental group (n = 14) or the control group (n = 11). Both groups rode a recumbent elliptical machine for 21 min at moderate intensity (65% predicted maximum heart rate) twice a week for 6 weeks, but only the experimental group received BFR and BC while riding. The variances of overall PPCS scale scores and their sub-domain scores for individuals during the 6-week intervention and 6-week follow-up period were calculated. During the intervention, the fluctuation of overall symptom severity, severity in the cognitive domain and severity in the mood domain were significantly less in the experimental group (p = 0.03; p = 0.02; p = 0.02). During the follow-up period, the number of symptoms remained more stable in the experimental group (p = 0.02), and a trend toward less fluctuation of symptom severity (p = 0.05) was also observed. The reduced number of symptoms in the cognitive and sleep domains remained more stable in the experimental group following the intervention (p = 0.007; p = 0.02). The severity of mood and sleep symptoms also remained more stable during the follow-up period in the experimental group (p = 0.04). More stable recovery was found in individuals who exercised using BFR and BC than in those who underwent exercise without BFR and BC. Moderate intensity-interval-training exercise with BFR and BC alleviated post-concussive symptoms in people who have had PPCS <1 year.
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Affiliation(s)
- Yi-Ning Wu
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Caroline Stark
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Jessica Gravel
- Dr. Robert C. Cantu Concussion Center, Emerson Hospital, Concord, Massachusetts, USA
| | - Matthew White
- Dr. Robert C. Cantu Concussion Center, Emerson Hospital, Concord, Massachusetts, USA
| | - Josh Avery
- Dr. Robert C. Cantu Concussion Center, Emerson Hospital, Concord, Massachusetts, USA
| | - Terrie Enis
- Dr. Robert C. Cantu Concussion Center, Emerson Hospital, Concord, Massachusetts, USA
| | - Robert C Cantu
- Dr. Robert C. Cantu Concussion Center, Emerson Hospital, Concord, Massachusetts, USA
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Abstract
This article provides a summary of clinical assessment methods and nonpharmacologic rehabilitation techniques used for concussed patients. It describes concussion-relevant physical examination methods to identify underlying symptom generators. This approach allows practitioners to prescribe targeted rehabilitation therapies to treat postconcussion symptoms. Evidence-based rehabilitation approaches include cervical rehabilitation, vestibulo-ocular rehabilitation, and sub-symptom threshold aerobic exercise.
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Abstract
After a concussion, a series of complex, overlapping, and disruptive events occur within the brain, leading to symptoms and behavioral dysfunction. These events include ionic shifts, damaged neuronal architecture, higher concentrations of inflammatory chemicals, increased excitatory neurotransmitter release, and cerebral blood flow disruptions, leading to a neuronal crisis. This review summarizes the translational aspects of the pathophysiologic cascade of postconcussion events, focusing on the role of excitatory neurotransmitters and ionic fluxes, and their role in neuronal disruption. We review the relationship between physiologic disruption and behavioral alterations, and proposed treatments aimed to restore the balance of disrupted processes.
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Affiliation(s)
- David R Howell
- Sports Medicine Center, Children's Hospital Colorado, 13123 East 16th Avenue, B060, Aurora, CO 80045, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Julia Southard
- Sports Medicine Center, Children's Hospital Colorado, 13123 East 16th Avenue, B060, Aurora, CO 80045, USA; Department of Psychology and Neuroscience, Regis University, 3333 Regis Boulevard, Denver, CO 80221, USA
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Tu T, Peng J, Jiang Y. FNDC5/Irisin: A New Protagonist in Acute Brain Injury. Stem Cells Dev 2020; 29:533-543. [PMID: 31914844 DOI: 10.1089/scd.2019.0232] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Tianqi Tu
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jianhua Peng
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Neurosurgical Clinical Research Center of Sichuan Province, Luzhou, China
- Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yong Jiang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Neurosurgical Clinical Research Center of Sichuan Province, Luzhou, China
- Laboratory of Neurological Diseases and Brain Functions, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Baker JG, Willer BS, Dwyer MG, Leddy JJ. A preliminary investigation of cognitive intolerance and neuroimaging among adolescents returning to school after concussion. Brain Inj 2020; 34:818-827. [PMID: 32324445 DOI: 10.1080/02699052.2020.1749932] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PRIMARY OBJECTIVE To introduce the concept of cognitive intolerance. A test is proposed to measure this concept and pilot data are presented to support this measure and future research to develop this concept into a construct. Research design: Three-group comparison to protect larger study blinding. Methods and procedures: Two groups of student athletes (n = 13, n = 13) between 13 and 17 (mean 15.1 ± 1.1 years; 58% male) who sustained a sport-related concussion within 10 days and one group (n = 13) of age-matched healthy controls were recruited for a comparison of correlations between self and observer ratings of cognitive difficulties and DTI fractional anisotropy (FA) using tract-based spatial statistics (TBSS) analysis at two time points. Main outcomes and results: Significant negative only associations (higher cognitive difficulty and lower FA) with DTI FA were found in white matter tracts. These included the anterior corpus callosum, frontal-parietal longitudinal fasciculi, and cortical-subcortical pathways at only the second time point. Several working memory networks would likely involve connections using the above-identified white matter tracts. Conclusions: Cognitive intolerance can be defined as symptom exacerbation from prolonged cognitive activity. Cognitive intolerance could be measured by the n-back working memory task and time to symptom exacerbation.
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Affiliation(s)
- John G Baker
- Departments of UBMD Orthopedics and Sports Medicine and Nuclear Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, New York, USA
| | - Barry S Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, New York, USA
| | - Michael G Dwyer
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, New York, USA
| | - John J Leddy
- Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, New York, USA
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Wilson JC, Kirkwood MW, Potter MN, Wilson PE, Provance AJ, Howell DR. Early physical activity and clinical outcomes following pediatric sport-related concussion. J Clin Transl Res 2020; 5:161-168. [PMID: 33029564 PMCID: PMC7534529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/17/2020] [Accepted: 03/16/2020] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The objective of the study was to evaluate the clinical outcomes among patients who did and did not report engaging in early physical activity (PA) following sport-related concussion. METHODS We evaluated pediatric patients seen within 21 days of concussion. The independent variable was early PA engagement (since the injury and before initial clinical evaluation). Dependent variables included demographics, injury details, medical history, Health and Behavior Inventory (HBI) score, and balance, vestibular, and oculomotor function tests. RESULTS We examined data from 575 pediatric patients: Sixty-nine (12%) reported engaging in early PA (mean age=14.3±2.4 years; 30% female). The no PA group (mean age=14.5±2.4 years; 35% female) had significantly longer symptom resolution times than the early PA group (median= 16 [interquartile range (IQR)=8-24] vs. 10.5 [IQR=4-17] days; p=0.02). When controlling for pre-existing headache history and time from injury-evaluation time, the early PA group demonstrated lower odds of reporting current headache (adjusted odds ratio=0.14; 95% CI=0.07, 0.26), and reported lower symptom frequency ratings than the no PA group (b=-5.58, 95% CI=-8.94, -2.22). CONCLUSIONS Patients who did not engage in early PA had longer symptom duration, greater odds of post-injury headache, and greater symptoms at initial clinical evaluation. We cannot determine if patients engaged in early PA due to the lower symptom burden and higher functioning at the time of assessment, or if early PA positively affected outcomes. However, as early PA was associated with better post-injury outcomes, clinicians may consider supervised and structured early PA programs as a method to improve clinical outcomes following concussion. RELEVANCE FOR PATIENTS Children and adolescents who were engaged in PA after concussion presented to a clinic with less severe symptoms and had symptoms that resolved sooner compared to those who did not engage in early PA after concussion.
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Affiliation(s)
- Julie C. Wilson
- 1Sports Medicine Center, Children’s Hospital Colorado, Aurora, Colorado, United States,2Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, United States,3Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Michael W. Kirkwood
- 4Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, United States,5Rehabilitation Medicine, Children’s Hospital Colorado, Aurora, Colorado, United States
| | - Morgan N. Potter
- 6Department of Physical Therapy, University of Delaware, Newark, Delaware, United States
| | - Pamela E. Wilson
- 4Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, United States,5Rehabilitation Medicine, Children’s Hospital Colorado, Aurora, Colorado, United States
| | - Aaron J. Provance
- 1Sports Medicine Center, Children’s Hospital Colorado, Aurora, Colorado, United States,2Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - David R. Howell
- 1Sports Medicine Center, Children’s Hospital Colorado, Aurora, Colorado, United States,2Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, United States,
Corresponding author: David R. Howell, PhD, ATC ATC. Sports Medicine Center, Children’s Hospital Colorado Department of Orthopedics, University of Colorado School of Medicine, 13123 E. 16th Avenue, B060 Aurora, Colorado - 80045, United States Phone: 720-777-1502
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Wright AD, Smirl JD, Bryk K, Jakovac M, van Donkelaar P. A Prospective Transcranial Doppler Ultrasound-Based Evaluation of the Effects of Repetitive Subconcussive Head Trauma on Neurovascular Coupling Dynamics. Clin J Sport Med 2020; 30 Suppl 1:S53-S60. [PMID: 32132478 DOI: 10.1097/jsm.0000000000000578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effects of repetitive subconcussive head trauma on neurovascular coupling (NVC) responses. DESIGN Prospective cohort study collected between September 2013 and December 2016. SETTING University laboratory. PARTICIPANTS One hundred seventy-nine elite, junior-level (age, 19.6 ± 1.5 years) contact sport (ice hockey, American football) athletes recruited for preseason testing. Fifty-two nonconcussed athletes returned for postseason testing. Fifteen noncontact sport athletes (age, 20.4 ± 2.2 years) also completed preseason and postseason testing. EXPOSURE(S) Subconcussive sport-related head trauma. MAIN OUTCOME MEASURES Dynamics of NVC were estimated during cycles of 20 seconds eyes closed and 40 seconds eyes open to a visual stimulus (reading) by measuring cerebral blood flow (CBF) velocity in the posterior (PCA) and middle (MCA) cerebral arteries via transcranial Doppler ultrasound. RESULTS Both athlete groups demonstrated no significant differences in PCA or MCA NVC dynamics between preseason and postseason, despite exposure to a median of 353.5 (range, 295.0-587.3) head impacts (>2g) over the course of the season for contact sport athletes. CONCLUSIONS Within the context of growing concern over detrimental effects of repetitive subconcussive trauma, the current results encouragingly suggest that the dynamics of NVC responses are not affected by 1 season of participation in junior-level ice hockey or American football. This is an important finding because it indicates an appropriate postseason CBF response to elevated metabolic demand with increases in neural activity.
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Affiliation(s)
- Alexander D Wright
- MD/PhD Program, University of British Columbia, Vancouver, BC, Canada
- Southern Medical Program, Reichwald Health Sciences Centre, University of British Columbia Okanagan, Kelowna, BC, Canada
- Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada; and
| | - Jonathan D Smirl
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada; and
| | - Kelsey Bryk
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada; and
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE
| | - Michael Jakovac
- Southern Medical Program, Reichwald Health Sciences Centre, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada; and
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