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Massé I, Moquin L, Bouchard C, Gratton A, De Beaumont L. Uninterrupted in vivo cerebral microdialysis measures of the acute neurochemical response to a single or repeated concussion in a rat model combining force and rotation. Brain Res 2024; 1838:148998. [PMID: 38754802 DOI: 10.1016/j.brainres.2024.148998] [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: 01/22/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
Altered extracellular amino acid concentrations following concussion or mild traumatic brain injury can result in delayed neuronal damage through overactivation of NMDA glutamatergic receptors. However, the consequences of repeated concussions prior to complete recovery are not well understood. In this study, we utilized in vivo cerebral microdialysis and a weight-drop model to investigate the acute neurochemical response to single and repeated concussions in adult rats that were fully conscious. A microdialysis probe was inserted into the hippocampus and remained in place during impact. Primary outcomes included concentrations of glutamate, GABA, taurine, glycine, glutamine, and serine, while secondary outcomes were righting times and excitotoxic indices. Compared to sham injury, the first concussion resulted in significant increases in glutamate, GABA, taurine, and glycine levels, longer righting times, and higher excitotoxic indices. Following the second concussion, righting times were significantly longer, suggesting cumulative effects of repeated concussion while only partial increases were observed in glutamate and taurine levels. GABA and glycine levels, and excitotoxic indices were comparable to sham injury. These findings suggest that single and repeated concussions may induce acute increases in several amino acids, while repeated concussions could exacerbate neurological symptoms despite less pronounced neurochemical changes.
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Affiliation(s)
- Ian Massé
- Research Center, Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Ouest Blvd, Montreal, Quebec H4J 1C5, Canada.
| | - Luc Moquin
- Research Center, Douglas Institute, 6875 LaSalle Blvd, Montreal, Quebec H4H 1R3, Canada
| | - Caroline Bouchard
- Research Center, Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Ouest Blvd, Montreal, Quebec H4J 1C5, Canada
| | - Alain Gratton
- Research Center, Douglas Institute, 6875 LaSalle Blvd, Montreal, Quebec H4H 1R3, Canada
| | - Louis De Beaumont
- Research Center, Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Ouest Blvd, Montreal, Quebec H4J 1C5, Canada; Department of Surgery, Université de Montréal, 2900 Edouard-Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada
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Roberts M, Popovich M, Almeida A. The Evaluation and Management of Concussion to Optimize Safe Recovery. Prim Care 2024; 51:269-282. [PMID: 38692774 DOI: 10.1016/j.pop.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Concussion is a mild traumatic brain injury causing temporary neurologic dysfunction. Symptoms following concussion are variable and generally are expected to resolve within about 1 month, but some patients experience persistent and prolonged symptoms. An early return to safe, symptom-limited activity is now favored, using targeted rehabilitation and treatments. Accommodations may be needed to facilitate return-to-school and work following concussion. Athletes should not be cleared for a full return to sport until they have recovered from a concussion and completed a return-to-play progression, in addition to returning to work/school fully.
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Affiliation(s)
- Mark Roberts
- Department of Neurology, University of Michigan, 2901 Hubbard Road, Suite 2723, Ann Arbor, MI 48109, USA
| | - Michael Popovich
- Department of Neurology, University of Michigan, 2901 Hubbard Road, Suite 2723, Ann Arbor, MI 48109, USA.
| | - Andrea Almeida
- Department of Neurology, University of Michigan, 2901 Hubbard Road, Suite 2723, Ann Arbor, MI 48109, USA
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Corwin DJ, Myers SR, Arbogast KB, Lim MM, Elliott JE, Metzger KB, LeRoux P, Elkind J, Metheny H, Berg J, Pettijohn K, Master CL, Kirschen MP, Cohen AS. Head Injury Treatment With Healthy and Advanced Dietary Supplements: A Pilot Randomized Controlled Trial of the Tolerability, Safety, and Efficacy of Branched Chain Amino Acids in the Treatment of Concussion in Adolescents and Young Adults. J Neurotrauma 2024; 41:1299-1309. [PMID: 38468511 DOI: 10.1089/neu.2023.0433] [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: 03/13/2024] Open
Abstract
Concussion is a common injury in the adolescent and young adult populations. Although branched chain amino acid (BCAA) supplementation has shown improvements in neurocognitive and sleep function in pre-clinical animal models of mild-to-moderate traumatic brain injury (TBI), to date, no studies have been performed evaluating the efficacy of BCAAs in concussed adolescents and young adults. The goal of this pilot trial was to determine the efficacy, tolerability, and safety of varied doses of oral BCAA supplementation in a group of concussed adolescents and young adults. The study was conducted as a pilot, double-blind, randomized controlled trial of participants ages 11-34 presenting with concussion to outpatient clinics (sports medicine and primary care), urgent care, and emergency departments of a tertiary care pediatric children's hospital and an urban tertiary care adult hospital, between June 24, 2014 and December 5, 2020. Participants were randomized to one of five study arms (placebo and 15 g, 30 g, 45 g, and 54 g BCAA treatment daily) and followed for 21 days after enrollment. Outcome measures included daily computerized neurocognitive tests (processing speed, the a priori primary outcome; and attention, visual learning, and working memory), symptom score, physical and cognitive activity, sleep/wake alterations, treatment compliance, and adverse events. In total, 42 participants were randomized, 38 of whom provided analyzable data. We found no difference in our primary outcome of processing speed between the arms; however, there was a significant reduction in total symptom score (decrease of 4.4 points on a 0-54 scale for every 500 g of study drug consumed, p value for trend = 0.0036, [uncorrected]) and return to physical activity (increase of 0.503 points on a 0-5 scale for every 500 g of study drug consumed, p value for trend = 0.005 [uncorrected]). There were no serious adverse events. Eight of 38 participants reported a mild (not interfering with daily activity) or moderate (limitation of daily activity) adverse event; there were no differences in adverse events by arm, with only two reported mild adverse events (both gastrointestinal) in the highest (45 g and 54 g) BCAA arms. Although limited by slow enrollment, small sample size, and missing data, this study provides the first demonstration of efficacy, as well as safety and tolerability, of BCAAs in concussed adolescents and young adults; specifically, a dose-response effect in reducing concussion symptoms and a return to baseline physical activity in those treated with higher total doses of BCAAs. These findings provide important preliminary data to inform a larger trial of BCAA therapy to expedite concussion recovery.
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Affiliation(s)
- Daniel J Corwin
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sage R Myers
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kristy B Arbogast
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Miranda M Lim
- Oregon Alzheimer's Disease Research Center & Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
- Research Service and VA RR&D VISN20 Northwest Mental Illness Research Education and Clinical Center (MIRECC), VA Portland Health Care System, Portland, Oregon, USA
| | - Jonathan E Elliott
- Oregon Alzheimer's Disease Research Center & Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kristina B Metzger
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter LeRoux
- Department of Neurosurgery, University of Rochester Medical Center and Bassett Medical Center, Cooperstown, New York, USA
| | - Jaclynn Elkind
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hannah Metheny
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey Berg
- Department of Family Medicine, Suburban Community Hospital, East Norriton, Pennsylvania, USA
| | - Kevin Pettijohn
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christina L Master
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Matthew P Kirschen
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Akiva S Cohen
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Johnson GM, Wild JT, Burgess JK, McCracken K, Malekian S, Turner JA, King K, Kwon S, Carl RL, LaBella CR. Assessment of post-concussion emotional symptom load using PCSS and PROMIS instruments in pediatric patients. PHYSICIAN SPORTSMED 2024; 52:253-261. [PMID: 37483167 DOI: 10.1080/00913847.2023.2239159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/20/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVES The purpose of this study is to evaluate the utility of the Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depressive symptom domains in conjunction with the Post-Concussion Symptom Scale (PCSS)for identifying pediatric patients with emotional symptoms following a concussion, and to identify predictors of higher emotional symptom loads. METHODS We recruited English-speaking patients aged 8-17 years presenting to a tertiary-care concussion clinic from 2014 to 2018 (n = 458). Demographics and clinical data including PCSS, injury date, previous history of anxiety/depression, and Vestibular/Ocular-Motor Screen (VOMS) were collected from patients' electronic medical records. Participants completed surveys in the PROMISTM Pediatric Item Bank v1.1-Anxiety and Depressive Symptoms domains at their initial clinic visit. Multivariable linear regression identified predictors of higher emotional symptom loads. RESULTS Overall, 425 (92.8%) reported ≥1 emotional symptom on either PROMIS or PCSS. Predictors of higher emotional symptom loads were abnormal VOMS, female sex, history of anxiety or depression, and longer time since injury. CONCLUSION Our results suggest that adding PROMIS anxiety and depressive symptom surveys to pediatric concussion evaluations may identify more children with emotional symptoms, allowing clinicians to better direct post-concussion treatment and incorporate psychological support for patients if necessary. Future studies should examine whether earlier identification of emotional symptoms with these tools facilitates recovery and improves short- and/or long-term psychological outcomes in pediatric concussion.
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Affiliation(s)
- Gina M Johnson
- Division of Orthopedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jacob T Wild
- Division of Orthopedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jamie K Burgess
- Division of Orthopedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kristi McCracken
- Division of Orthopedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sina Malekian
- Division of Orthopedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jacqueline A Turner
- Division of Orthopedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kiana King
- Division of Orthopedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Soyang Kwon
- Division of Orthopedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Rebecca L Carl
- Division of Orthopedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Cynthia R LaBella
- Division of Orthopedic Surgery and Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Loo BKG, Fyffe A, Lam LTM, Browne G. The Effect of Impact Seizure on the Recovery of Children and Adolescents With Concussion: A Matched Case-Control Study. Clin J Sport Med 2024; 34:273-279. [PMID: 37706664 DOI: 10.1097/jsm.0000000000001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/09/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Management of sport-related and recreation-related concussions (SRCs) in children and adolescents is challenging as brain maturation affects prognosis. However, impact seizure was removed as a prognosis modifying factor in children and adolescents with SRCs in the 2017 consensus statement on concussion in sport, based mostly on adult literature. Therefore, this study evaluates the association of impact seizure on the recovery in children and adolescents with SRCs. DESIGN Retrospective matched case-control study. SETTING Tertiary pediatric sports medicine service, from January 1, 2015, to June 30, 2022. PATIENTS A cohort of 452 patients, aged 7 to 18 years, with new episode of SRC was seen. From this cohort, 396 patients were included in the analysis, including 22 with impact seizures. Controls were generated using the propensity score matching approach. Patients with moderate or severe traumatic brain injury or incomplete treatment were excluded. INDEPENDENT VARIABLE Impact seizure during SRC. MAIN OUTCOME MEASURES Primary outcome was recovery duration in number of days. RESULTS The median recovery duration was longer in the cases (73 days, interquartile range [IQR] = 38-143 days) as compared with controls (49.5 days, IQR = 30.5-93.5 days). There was no difference in patients with prolonged recovery (ie >28 days) between both groups (OR 1.6, 95% CI, 0.4-6.6, P = 0.505). CONCLUSIONS Impact seizures prolonged the recovery duration in children and adolescents with SRCs and therefore have a potential concussion modifying prognostic role. These findings could help provide evidence-based management principles for children and adolescents with SRCs in subsequent concussion consensus statements.
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Affiliation(s)
- Benny Kai Guo Loo
- Sport and Exercise Medicine Service, KK Women's and Children's Hospital, Singapore
| | - Andrew Fyffe
- Children's Hospital Institute of Sports Medicine, The Children's Hospital at Westmead, Sydney, Australia; and
| | | | - Gary Browne
- Children's Hospital Institute of Sports Medicine, The Children's Hospital at Westmead, Sydney, Australia; and
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Sgro M, Kodila ZN, Li C, Carmichael I, Warren S, Reichelt AC, Yamakawa GR, Mychasiuk R. Microbiome depletion prior to repeat mild TBI differentially alters social deficits and prefrontal cortex plasticity in adolescent and adult rats. iScience 2024; 27:109395. [PMID: 38510122 PMCID: PMC10952042 DOI: 10.1016/j.isci.2024.109395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/21/2023] [Accepted: 02/28/2024] [Indexed: 03/22/2024] Open
Abstract
Although aging, repeat mild traumatic brain injury (RmTBI), and microbiome modifications independently change social behavior, there has been no investigation into their cumulative effects on social behavior and neuroplasticity within the prefrontal cortex. Therefore, we examined how microbiome depletion prior to RmTBI affected social behavior and neuroplasticity in adolescent and adult rats. Play, temperament analysis, elevated plus maze, and the hot/cold plate assessed socio-emotional function. Analyses of perineuronal nets (PNNs) and parvalbumin (PV) interneurons was completed. Social-emotional deficits were more pronounced in adults, with microbiome depletion attenuating social behavior deficits associated with RmTBI in both age groups. Microbiome depletion increased branch length and PNN arborization within the PFC but decreased the overall number of PNNs. Adults and males were more vulnerable to RmTBI. Interestingly, microbiome depletion may have attenuated the changes to neuroplasticity and subsequent social deficits, suggesting that the microbiome is a viable, but age-specific, target for RmTBI therapeutics.
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Affiliation(s)
- Marissa Sgro
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Zoe N. Kodila
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Crystal Li
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Irena Carmichael
- Monash Micro Imaging, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Samantha Warren
- Monash Micro Imaging, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Amy C. Reichelt
- School of Biomedicine, University of Adelaide, Adelaide, SA 5005, Australia
| | - Glenn R. Yamakawa
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
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Ledoux AA, Sicard V, Bijelić V, Barrowman N, Borghese MM, Kuzik N, Tremblay MS, Yeates KO, Davis AL, Sangha G, Reed N, Zemek RL. Optimal Volume of Moderate-to-Vigorous Physical Activity Postconcussion in Children and Adolescents. JAMA Netw Open 2024; 7:e2356458. [PMID: 38363567 PMCID: PMC10873766 DOI: 10.1001/jamanetworkopen.2023.56458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/26/2023] [Indexed: 02/17/2024] Open
Abstract
Importance Determining the optimal volume of early moderate-to-vigorous-intensity physical activity (MVPA) after concussion and its association with subsequent symptom burden is important for early postinjury management recommendations. Objectives To investigate the association between cumulative MVPA (cMVPA) over 2 weeks and subsequent symptom burden at 1 week, 2 weeks, and 4 weeks postinjury in children and examine the association between cMVPA and odds of persisting symptoms after concussion (PSAC) at 2 weeks and 4 weeks postinjury. Design, Setting, and Participants This multicenter cohort study used data from a randomized clinical trial that was conducted from March 2017 to December 2019 at 3 Canadian pediatric emergency departments in participants aged 10.00 to 17.99 years with acute concussion of less than 48 hours. Data were analyzed from July 2022 to December 2023. Exposure cMVPA postinjury was measured with accelerometers worn on the waist for 24 hours per day for 13 days postinjury, with measurements deemed valid if participants had 4 or more days of accelerometer data and 3 or fewer consecutive days of missing data. cMVPA at 1 week and 2 weeks postinjury was defined as cMVPA for 7 days and 13 days postinjury, respectively. Multiple imputations were carried out on missing MVPA days. Main Outcomes and measures Self-reported postconcussion symptom burden at 1 week, 2 weeks, and 4 weeks postinjury using the Health and Behavior Inventory (HBI). PSAC was defined as reliable change on the HBI. A linear mixed-effect model was used for symptom burden at 1 week, 2 weeks, and 4 weeks postinjury with a time × cMVPA interaction. Logistic regressions assessed the association between cMVPA and PSAC. All models were adjusted for prognostically important variables. Results In this study, 267 of 456 children (119 [44.6%] female; median [IQR] age, 12.9 [11.5 to 14.4] years) were included in the analysis. Participants with greater cMVPA had significantly lower HBI scores at 1 week (75th percentile [258.5 minutes] vs 25th percentile [90.0 minutes]; difference, -5.45 [95% CI, -7.67 to -3.24]) and 2 weeks postinjury (75th percentile [565.0 minutes] vs 25th percentile [237.0 minutes]; difference, -2.85 [95% CI, -4.74 to -0.97]) but not at 4 weeks postinjury (75th percentile [565.0 minutes] vs 25th percentile [237.0 minutes]; difference, -1.24 [95% CI, -3.13 to 0.64]) (P = .20). Symptom burden was not lower beyond the 75th percentile for cMVPA at 1 week or 2 weeks postinjury (1 week, 259 minutes; 2 weeks, 565 minutes) of cMVPA. The odds ratio for the association between 75th and 25th percentile of cMVPA and PSAC was 0.48 (95% CI, 0.24 to 0.94) at 2 weeks. Conclusions and Relevance In children and adolescents with acute concussion, 259 minutes of cMVPA during the first week postinjury and 565 minutes of cMVPA during the second week postinjury were associated with lower symptom burden at 1 week and 2 weeks postinjury. At 2 weeks postinjury, higher cMVPA volume was associated with 48% reduced odds of PSAC compared with lower cMVPA volume.
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Affiliation(s)
- Andrée-Anne Ledoux
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Veronik Sicard
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Vid Bijelić
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Michael M. Borghese
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Nicholas Kuzik
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Mark S. Tremblay
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, Children’s Hospital of Eastern, Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Adrienne L. Davis
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gurinder Sangha
- Department of Pediatrics, Children’s Hospital London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Nick Reed
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Roger Leonard Zemek
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, Children’s Hospital of Eastern, Ontario, University of Ottawa, Ottawa, Ontario, Canada
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Philipson EB, Machamer J, Dikmen S, Temkin N. Traumatic Brain Injuries Impact on School One Month and One Year After Injury. Neurotrauma Rep 2023; 4:507-514. [PMID: 37771425 PMCID: PMC10523406 DOI: 10.1089/neur.2022.0069] [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: 09/30/2023] Open
Abstract
Traumatic brain injury (TBI) is a major cause of death and disability among the American population, but the impact TBIs have on the school experience of high school, and post-secondary students, is poorly understood. In this study, a cohort of 79 students, ages 15-22, with mild-to-severe TBIs, were retrospectively identified from the University of Washington Traumatic Brain Injury Database and Sample Repository. The Sickness Impact Profile (SIP) was used to determine the frequency at which schooling was impacted by a TBI and identify the most common self-reported issues students faced in their return to school. At 1 month post-injury, 70% of students either had not returned to school as a result of their TBI or had returned to school but experienced issues related to their TBI. The most-reported issues at 1 month were a difficulty keeping up with school work as a result of it taking longer to complete assignments, tiring easily, having to take frequent rests, and grades that were not as good as they used to be. At 1 year post-injury, the number of students whose TBIs were affecting their school situation dropped 20 percentage points to 49%. The most reported issues at 1 year were forgetting more quickly what was learned in class and having more difficulty understanding new concepts and material. These findings indicate that TBIs have a profound effect on a student's school experiences up to at least 1 year post-injury.
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Affiliation(s)
- Erik B. Philipson
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Joan Machamer
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
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Using Comic-Based Concussion Discharge Instructions to Address Caregiver Health Literacy in the Emergency Department. J Emerg Nurs 2023; 49:236-243. [PMID: 36604284 DOI: 10.1016/j.jen.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION This study compared the effectiveness of comic-based with text-based concussion discharge instructions on improving caregiver knowledge. This study also examined the role of social determinants of health on comprehension instructions. METHODS This was an observational study of the caregivers of pediatric concussion patients. Caregivers' health literacy and demographics related socioeconomic factors were obtained. After the patients' evaluation in the emergency department, caregivers were given printed comic-based concussion discharge instructions. Caregivers were contacted 3 days later and tested overall knowledge of discharge instructions' content. These survey results were compared with historical controls who received text-based instructions. RESULTS A total of 120 participants were recruited, and 86 participants completed follow-up procedures. When comparing the caregivers' recall ability with a comic-based vs traditional text-based instructions, caregivers with comic-based content were more likely to accurately recall overall discharge instructions (77.5% vs 44%, P < .001), particularly physical rest and activity restrictions (86.5% vs 63%, P < .001). Caregivers also were less likely to misidentify a red flag symptom (7.5% vs 19%, P < .04). Comic-based instructions did not increase recall of cognitive rest instructions or postconcussive symptoms. When examining demographic factors, caregivers who could not recall 3 postconcussive symptoms were more likely to be Hispanic or Black, less likely to be college educated, and more likely to have low health literacy. DISCUSSION Novel methods should be explored to adequately prepare caregivers for continuing postconcussive care at home. Discharge instructions must be tailored to address caregivers' baseline health literacy and how caregivers digest and retain information.
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10
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Mohammed FN, Master CL, Arbogast KB, McDonald CC, Sharma S, Kang B, Corwin DJ. Disparities in Adherence to Concussion Clinical Care Recommendations in a Pediatric Population. J Head Trauma Rehabil 2023; 38:147-155. [PMID: 36731016 PMCID: PMC9998329 DOI: 10.1097/htr.0000000000000823] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To characterize the relationship of sociodemographic factors to adherence to provider recommendations for pediatric concussion. SETTING Primary care (PC) practices within the Children's Hospital of Philadelphia network. PARTICIPANTS Patients aged 5 to 18 years old who presented to any PC site for concussion from September 26, 2019, to December 31, 2019. DESIGN Retrospective medical record review. MAIN MEASURES The primary outcome was adherence to follow-up recommendations as defined by (1) continued follow-up until provider clearance to return to full activity; (2) no more than 2 no-show visits; and (3) for those referred to specialty care (SC), attending at least 1 visit. We compared adherence by race/ethnicity, insurance, age, sex, injury mechanism, and repeat head injury using bivariate and multivariate analyses. A secondary outcome of referral to SC was compared by sociodemographic factors. RESULTS A total of 755 patients were included. Overall, 80.5% of the patients met adherence criteria. Following adjustment, non-Hispanic Black patients and publicly insured/self-pay patients were less likely to adhere to recommendations than non-Hispanic White patients (adjusted odds ratio [AOR] = 0.60; 95% CI, 0.37-1.00) and privately insured patients (AOR = 0.48; 95% CI, 0.30-0.75), respectively. When assessing differences in referral to SC, non-Hispanic Black patients and publicly insured/self-pay patients were more likely to receive a referral than their non-Hispanic White peers (OR = 1.56; 95% CI, 1.00-2.45) and privately insured patients (OR = 1.56; 95% CI, 1.05-2.32), respectively. CONCLUSION This study highlights disparities in adherence to concussion care recommendations, with non-Hispanic Black and publicly insured/self-pay patients less likely to adhere to follow-up recommendations than non-Hispanic White and privately insured patients, respectively. These disparities may impact recovery trajectories. Future studies should aim to identify specific individual- and system-level barriers preventing adherence to care in order to ultimately inform targeted interventions to achieve equity in care delivery and outcomes.
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Affiliation(s)
- Fairuz N Mohammed
- Center for Injury Research and Prevention (Mrs Mohammed, Drs Master, Arbogast, McDonald, and Corwin, and Mss Sharma and Kang), Sports Medicine and Performance Center (Dr Master), and Division of Emergency Medicine (Drs Arbogast and Corwin), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine (Drs Master, Arbogast, McDonald, and Corwin) and School of Nursing (Dr McDonald), University of Pennsylvania, Philadelphia
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11
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Mortazavi M, Lucini FA, Joffe D, Oakley DS. Electrophysiological trajectories of concussion recovery: From acute to prolonged stages in late teenagers. J Pediatr Rehabil Med 2023; 16:287-299. [PMID: 36710690 PMCID: PMC10894572 DOI: 10.3233/prm-210114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 10/17/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Numerous studies have reported electrophysiological differences between concussed and non-concussed groups, but few studies have systematically explored recovery trajectories from acute concussion to symptom recovery and the transition from acute concussion to prolonged phases. Questions remain about recovery prognosis and the extent to which symptom resolution coincides with injury resolution. This study therefore investigated the electrophysiological differences in recoveries between simple and complex concussion. METHODS Student athletes with acute concussion from a previous study (19(2) years old) were tracked from pre-injury baseline, 24-48 hours after concussion, and through in-season recovery. The electroencephalography (EEG) with P300 evoked response trajectories from this acute study were compared to an age-matched population of 71 patients (18(2) years old) with prolonged post-concussive symptoms (PPCS), 61 (SD 31) days after concussion. RESULTS Acute, return-to-play, and PPCS groups all experienced a significant deficit in P300 amplitude compared to the pre-injury baseline group. The PPCS group, however, had significantly different EEG spectral and coherence patterns from every other group. CONCLUSION These data suggest that while the evoked response potentials deficits of simple concussion may persist in more prolonged stages, there are certain EEG measures unique to PPCS. These metrics are readily accessible to clinicians and may provide useful parameters to help predict trajectories, characterize injury (phenotype), and track the course of injury.
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Affiliation(s)
- Mo Mortazavi
- SPARCC Sports Medicine, Rehabilitation, and Concussion Center, Tucson, AZ, USA
- Department of Pediatrics, Tucson Medical Center, Tucson, AZ, USA
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12
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D'Alonzo BA, Wiebe DJ, Master CL, Castellana MC, Willer BS, Leddy JJ. Relationship between anxiety and concussion symptoms among adolescents enrolled in a randomized controlled trial of aerobic exercise. NeuroRehabilitation 2023; 53:187-198. [PMID: 37638452 DOI: 10.3233/nre-220221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Affective symptoms, specifically, anxiety, are often overlooked after sport-related concussion (SRC), and may contribute to prolonged recovery. OBJECTIVE To examine the impact of anxiety during clinical recovery among adolescents (13-18y) enrolled in a randomized trial of aerobic exercise for SRC. METHODS Patients at three sites were randomized into aerobic exercise or stretching arms, and enrolled in the 4-week intervention. The relationship between PROMIS Anxiety score at initial visit and time to symptom resolution was evaluated with survival analysis. The relationship between weekly PROMIS Anxiety score and Post-concussion Symptom Inventory (PCSI) score was evaluated with Linear Mixed Models. Analyses adjusted for study arm and baseline covariates. RESULTS Among 54 adolescents (median age = 15.8y, initial visit PCSI score = 32, pre-injury PROMIS Anxiety score = 2), median time to symptom resolution was 10 days (25th-75th percentiles: 6-24) in the Low-PROMIS Anxiety group and 12 days (25th-75th percentiles: 5-21) in the High-PROMIS Anxiety group (p = 0.62). Each additional unit of PROMIS Anxiety score corresponded to a 1.52-unit higher PCSI total score (p < 0.01). Neither effect varied by aerobic exercise/stretching group. CONCLUSION Higher initial PROMIS Anxiety score was not significantly associated with delayed symptom resolution. However, over time, PROMIS Anxiety score was significantly associated with elevated PCSI score, regardless of exercise/stretching group.
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Affiliation(s)
- Bernadette A D'Alonzo
- Department of Biostatistics Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas J Wiebe
- Department of Biostatistics Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Christina L Master
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew C Castellana
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Barry S Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - John J Leddy
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
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13
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Younger DS. Mild traumatic brain injury and sports-related concussion. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:475-494. [PMID: 37620086 DOI: 10.1016/b978-0-323-98817-9.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Mild traumatic brain injury (mTBI) and concussion are equivalent terms for the sequela of injury to the head that disrupts brain functioning. Various forces may be causative from seemingly innocuous bumps to the head resulting from sports-related injuries to more severe blows to the head. However, the postconcussive motor, cognitive, emotional, and psychosocial sequelae can be just as devastating and long lasting, leading to loss of independent function and safe performance of activities. Taken together, they pose a significant challenge to recovery, requiring a multifaceted dynamic rehabilitative strategy. The current systems of health care pose challenges to suboptimal management of sports-related concussion (SRC) that goes beyond the acute injury, and into the school setting, failing to be identified by school staff, and inconsistencies in communicating medical information regarding school modifications, follow-up health services, or concussion-related educational services. Children who sustain SRC at different ages face different challenges. Young children face increased vulnerability due to SRC that coincides with periods of brain motor maturation and development.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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14
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Use of Traditional Mongolian Medicine in Children with Concussion. MEDICINES (BASEL, SWITZERLAND) 2022; 10:medicines10010005. [PMID: 36662489 PMCID: PMC9863045 DOI: 10.3390/medicines10010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
(1) Background: There is no specific treatment for concussion in modern medicine, and existing treatment is only limited to resting and restoring cognition. For centuries, Mongolians have used traditional Mongolian medicine (TMM) methods to treat a variety of diseases such as Baria zasal. In this study, we aimed to explore the treatment parents and guardians seek when their children have suffered a concussion. (2) Methods: In this study, we used an online questionnaire. The study participants (n = 400) were randomly selected parents and guardians. The definition of bariachi is an advanced practitioner of baria zasal, which covers most of the massage therapy techniques mentioned in this study. (3) Results: In total, 72% of the parents and guardians went to a bariachi when their children suffered a concussion, while only 10.3% chose western medical hospitals. When asked what they did after the initial treatment was not effective, 47.8% of the participants responded that they went to the bariachi. Based on the days of treatment result, 11.8% reported on the beneficial effects of the treatment appearing in one day, and 60.3% in 1−3 days, which shows that the participants suffered a healing effect of the baria zasal shortly after application to their children. In the regression analysis, visiting a Bariachi was independent of age, gender, or even religion. (4) Conclusions: Although Western medicine is highly developed in Mongolia, the baria zasal of TMM has not lost its appeal in treating concussion. This suggests that baria zasal could be a unique method of concussion treatment even today. This also suggests that the techniques of Baria zasal should be further studied, and as in modern medicine.
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15
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Cook NE, Gaudet CE, Zafonte R, Berkner PD, Iverson GL. Acute effects of concussion among adolescents with attention-deficit/hyperactivity disorder. Child Neuropsychol 2022:1-24. [PMID: 36510369 DOI: 10.1080/09297049.2022.2144815] [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: 12/15/2022]
Abstract
Adolescents with ADHD have a greater lifetime history of concussion and experience concussion-like symptoms in the absence of a concussion, complicating concussion assessment and management. It is well established that individuals who experience greater acute symptoms following concussion are at risk for slower recovery and persistent symptoms. We examined whether youth with ADHD experience worse acute effects, within the first 72 h following concussion, compared to youth without ADHD. We hypothesized that youth with ADHD would perform worse on neurocognitive testing and endorse more severe symptoms acutely following injury, but the magnitude of change from pre injury to post injury would be similar for both groups, and thus comparable to baseline group differences. The sample included 852 adolescents with pre-injury and post-injury ImPACT results (within 72 h); we also conducted supplementary case-control analyses on a subset of youth with and without ADHD matched on demographics and pre-injury health history. For both samples, there were significant interaction effects for the Verbal Memory and Visual Motor Speed composites (p < 0.01, η2=.01-.07, small-medium effect), such that youth with ADHD showed a greater magnitude of diminished cognitive functioning from pre-injury to post-injury testing. There were no significant differences in the magnitudes of changes from pre injury to post injury with regard to overall symptom reporting (i.e., total symptom severity scores, total number of symptoms endorsed); however, there were group differences in endorsement rates for several individual symptoms. Further research is needed to determine whether such differential acute effects are associated with recovery time in youth with ADHD.
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Affiliation(s)
- Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Sports Concussion Program, MassGeneral Hospital for Children, Waltham, MA, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Charles E Gaudet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Sports Concussion Program, MassGeneral Hospital for Children, Waltham, MA, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Paul D Berkner
- College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Sports Concussion Program, MassGeneral Hospital for Children, Waltham, MA, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA.,Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, USA
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16
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Examining the Relationship Between Mild Traumatic Brain Injuries and Development of Mental Illness Disorders in a Mid-Term Follow-up Period. Am J Phys Med Rehabil 2022; 101:1117-1121. [PMID: 35213394 DOI: 10.1097/phm.0000000000001985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The sequalae of mild concussions continue to emerge with increased awareness in sports-related injuries. This study aimed to quantify the number of patients who are affected by a mental illness within 3 yrs of a concussion and identify whether demographic differences exist that may influence a mental illness diagnosis. DESIGN Using a nationwide database, data were queried for a diagnosis of concussion, capturing patients aged 18-45 yrs with no previous mental illness, and then identified if these patients were diagnosed with a mental illness within 3 yrs of their concussion. The mental illnesses specifically chosen for this study included depression, anxiety, panic disorder, posttraumatic stress disorder, bipolar, and schizophrenia. RESULTS Within 3 yrs after a concussion, 48% of patients were later diagnosed with a mental illness. All of the mental illnesses this study chose to evaluate were present in a higher proportion of patients after a concussion than the general population. CONCLUSIONS The mechanism between concussions and mental illness remains unclear. A large proportion of patients who experience a concussion are later diagnosed with a mental illness within 3 yrs. Patients with a history of a previous concussion may benefit from screening for the development of a mental illness.
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Sgro M, Iacono G, Yamakawa GR, Kodila ZN, Marsland BJ, Mychasiuk R. Age matters: Microbiome depletion prior to repeat mild traumatic brain injury differentially alters microbial composition and function in adolescent and adult rats. PLoS One 2022; 17:e0278259. [PMID: 36449469 PMCID: PMC9710846 DOI: 10.1371/journal.pone.0278259] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/13/2022] [Indexed: 12/02/2022] Open
Abstract
Dysregulation of the gut microbiome has been shown to perpetuate neuroinflammation, alter intestinal permeability, and modify repetitive mild traumatic brain injury (RmTBI)-induced deficits. However, there have been no investigations regarding the comparative effects that the microbiome may have on RmTBI in adolescents and adults. Therefore, we examined the influence of microbiome depletion prior to RmTBI on microbial composition and metabolome, in adolescent and adult Sprague Dawley rats. Rats were randomly assigned to standard or antibiotic drinking water for 14 days, and to subsequent sham or RmTBIs. The gut microbiome composition and metabolome were analysed at baseline, 1 day after the first mTBI, and at euthanasia (11 days following the third mTBI). At euthanasia, intestinal samples were also collected to quantify tight junction protein (TJP1 and occludin) expression. Adolescents were significantly more susceptible to microbiome depletion via antibiotic administration which increased pro-inflammatory composition and metabolites. Furthermore, RmTBI induced a transient increase in 'beneficial bacteria' (Lachnospiraceae and Faecalibaculum) in only adolescents that may indicate compensatory action in response to the injury. Finally, microbiome depletion prior to RmTBI generated a microbiome composition and metabolome that exemplified a potentially chronic pathogenic and inflammatory state as demonstrated by increased Clostridium innocuum and Erysipelatoclostridium and reductions in Bacteroides and Clostridium Sensu Stricto. Results highlight that adolescents are more vulnerable to RmTBI compared to adults and dysbiosis prior to injury may exacerbate secondary inflammatory cascades.
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Affiliation(s)
- Marissa Sgro
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Giulia Iacono
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Glenn R. Yamakawa
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Zoe N. Kodila
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Benjamin J. Marsland
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- * E-mail:
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18
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Koh JO. What is a Repetitive Concussion in Sports? THE ASIAN JOURNAL OF KINESIOLOGY 2022. [DOI: 10.15758/ajk.2022.24.4.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Athletes are in a unique situation where they experience repeated concussions while participating in competitions. Although repeated exposure to a concussion has a high risk of negatively affecting athletes' performance and health after retirement, awareness of it is very low in athletes and sports associations. Therefore, the purpose of this review is to provide the basic information about the concussion problem that occurs repeatedly in sports and to establish the plan for the concussion reduction strategy.METHODS To provide the basic information related to a concussion problem in sports, the narrative review was applied.RESULTS The definition, symptoms and symptoms of a sports-related concussion, second impact syndrome, long-term sequelae from the concussion, the preventive effect of the helmet, and the guideline for the safe return to sports after concussion were discussed.CONCLUSIONS This study has reviewed the lack of awareness of concussions that occur repeatedly in the sports field and the problems related to the safety and health of the athletes. In order to reduce a concussion incidence and surrounding issues, the concussion reduction strategy has been proposed, and persistent interest is required from athletes, coaches, parents, and related sports organizations in relation to concussions.
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19
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Schulze KJ, Robinson M, MacKenzie HM, Dickey JP. Association of Preexisting Mental Health Conditions With Increased Initial Symptom Count and Severity Score on SCAT5 When Assessing Concussion. Orthop J Sports Med 2022; 10:23259671221123581. [PMID: 36157090 PMCID: PMC9490471 DOI: 10.1177/23259671221123581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Mental health conditions, such as depression, anxiety, and learning disabilities, are associated with symptoms that can overlap with those seen in persons with concussion. While concussion screening tools such as the Sport Concussion Assessment Tool–5th Edition (SCAT5) quantify the number of symptoms and symptom severity, it is not known whether these outcomes differ among individuals with concurrent mental health conditions compared with those without them. Purpose: To determine whether, during initial concussion assessment, individuals with a self-reported mental health condition have a significantly different number of self-reported concussion symptoms or symptom severity compared with those without a self-reported mental health condition (controls). Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective chart review was performed on consecutive patients aged ≥13 years who underwent post-concussion assessment at the Fowler Kennedy Sport Medicine Clinic between May 2018 and March 2020 (N = 765). Most participants did not self-report a mental health condition (n = 606; 79.2%). Participants with a self-reported mental health condition (n = 159) were classified as having a learning disability (n = 14; 8.8%), anxiety (n = 62; 39.0%), depression (n = 20; 12.6%), or multiple conditions (≥2 conditions: n = 63; 39.6%). Each participant with a mental health condition was matched with 2 control participants (overall pool, n = 318) based on age, sex, student status, and sport-related risk. Mann-Whitney U tests were used to determine the statistical significance of differences between each subgroup and their matched controls for the self-reported number of concussion symptoms and symptom severity as measured using the SCAT5. Results: The anxiety and multiple-conditions subgroups had a significantly greater number of reported symptoms than their corresponding control subgroups (median, 17 vs 15 [P = .004] and 18 vs 14.5 [P < .001], respectively). Additionally, the SCAT5 symptom severity score was significantly greater in the anxiety and multiple-conditions subgroups than their corresponding controls (median, 49 vs 34.5 [P = .018] and 62 vs 32 [P < .001], respectively). Conclusion: During initial concussion assessment, both the number of concussion-related symptoms and the symptom severity were greater in study participants with anxiety and multiple mental health conditions than participants without these conditions.
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Affiliation(s)
| | - Michael Robinson
- Faculty of Health Science, Lawson Health Research Institute, Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada
| | - Heather M MacKenzie
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Parkwood Institute, St. Joseph's Health Care London, London, Ontario, Canada
| | - James P Dickey
- School of Kinesiology, Western University, London, Ontario, Canada
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20
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Chaychi S, Valera E, Tartaglia MC. Sex and gender differences in mild traumatic brain injury/concussion. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 164:349-375. [PMID: 36038209 DOI: 10.1016/bs.irn.2022.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The high incidence of concussions/mild traumatic brain injury and the significant number of people with persisting concussion symptoms as well as the concern for delayed, neurodegenerative effects of concussions makes them a major public health concern. There is much to learn on concussions with respect to pathophysiology as well as vulnerability and resiliency factors. The heterogeneity in outcome after a concussion warrants a more personalized approach to better understand the biological and psychosocial factors that may affect outcome. In this chapter we address biological sex and gender as they impact different aspects of concussion including incidence, risk factors and outcome. As well, this chapter will provide a more fulsome overview of intimate partner violence, an often-overlooked cause of concussion in women. Applying the sex and gender lens to concussion/mild traumatic brain injury is imperative for discovery of its pathophysiology and moving closer to treatments.
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Affiliation(s)
- Samaneh Chaychi
- Memory Clinic, Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Eve Valera
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States
| | - Maria Carmela Tartaglia
- Memory Clinic, Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Canadian Concussion Centre, Krembil Brain Institute, University Health Network, Toronto, ON, Canada; Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.
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21
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Fontana J, Cranmer GA, Ash E, Mazer JP, Denham BE. Parent-Child Communication regarding Sport-Related Concussion: An Application of the Theory of Planned Behavior. HEALTH COMMUNICATION 2022; 37:923-934. [PMID: 33487037 DOI: 10.1080/10410236.2021.1876326] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Extant research has discussed the importance of social climates surrounding sport-related concussion (SRC) reporting, especially the need to address parents/guardians' role in concussion management. This study explores parents/guardians' intentions toward SRC-related conversations with their children and their seeking of conversational resources via the Theory of Planned Behavior (TPB). Data collected from 292 parents/guardians of 1st-12th graders who play contact sports are examined via a structural equation model. The results indicate that parents/guardians' intention toward communicating with their child about SRC reporting was determined by their attitudes and subjective norms but that perceived behavioral control was not a significant predictor of intention. Furthermore, parents/guardians' intention toward having these conversations was predictive of whether they sought information to aid these conversations. This study answers calls to address parents/guardians' involvement in SRC management and provides preliminary information for persuading parents/guardians to have conversations with their children about SRC reporting.
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Affiliation(s)
| | | | - Erin Ash
- Department of Communication, Clemson University
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22
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Sheldrake E, Al-Hakeem H, Lam B, Goldstein BI, Wheeler AL, Burke M, Dunkley BT, Reed N, Scratch SE. Mental Health Outcomes Across the Lifespan in Individuals With Persistent Post-Concussion Symptoms: A Scoping Review. Front Neurol 2022; 13:850590. [PMID: 35481264 PMCID: PMC9035995 DOI: 10.3389/fneur.2022.850590] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objective:Concussion is a common yet heterogenous injury. Approximately 15–30% of cases present with persistent post-concussion symptoms (PPCS), continuing 4 weeks or more post-injury in children, youth, and adolescents, and 3 months or more in adults. There are known bidirectional links between PPCS and mental health outcomes. The focus of this scoping review is to explore the literature on mental health outcomes in individuals experiencing PPCS. Research objectives were to explore: (1) the mental health outcomes of individuals with PPCS and types of assessments used to identify mental health outcomes this group, and (2) how mental health outcomes compare in terms of similarities and differences among pediatric and adult populations with PPCS.MethodOvid MEDLINE; EMBASE; CINAHL, and PsycInfo databases were searched. After title and abstract screening of 11,920 studies, 481 articles were reviewed. Twenty-five papers met inclusion criteria. Results were organized by mental health outcomes of pediatric and adult populations, separately.ResultsThere was a significantly higher number of studies devoted to adult populations. Of the 25 studies, 19 (76%) focused on adults, while six (24%) focused on adolescents. In adult populations, studies focused on symptoms of: anxiety (n = 2), depression (n = 8), and anxiety and depression (n = 9). Two studies assessed other emotional outcomes (10.5%). Within pediatric populations, an equal number of studies explored symptoms of: anxiety (n = 2), depression (n = 2), and anxiety and depression (n = 2). No studies focused on other emotional outcomes. Studies ranged greatly in methods, design, and control group. Most studies reported higher psychiatric symptoms of anxiety and/or depression in those with PPCS compared to individuals with recovered concussion or healthy controls.DiscussionThis review contributes to the understanding of mental health outcomes in those experiencing PPCS. Mental health and PPCS requires greater attention in pediatric populations, and consider strategies for those experiencing PPCS and mental health impacts. Future studies should consider including a wider range of emotional outcomes in their design, not limited to anxiety and depression. Study results may lead to improvements and research in the identification, assessment, and management of PPCS and mental health.
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Affiliation(s)
- Elena Sheldrake
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- *Correspondence: Elena Sheldrake
| | - Hiba Al-Hakeem
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Brendan Lam
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Benjamin I. Goldstein
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Anne L. Wheeler
- Neuroscience and Mental Health Program, Hospital for Sick Children, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Matthew Burke
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Benjamin T. Dunkley
- Neuroscience and Mental Health Program, Hospital for Sick Children, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Shannon E. Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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23
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Miutz LN, Burma JS, Lapointe AP, Newel KT, Emery CA, Smirl JD. Physical Activity Following Sport-Related Concussion in Adolescents: A Systematic Review. J Appl Physiol (1985) 2022; 132:1250-1266. [PMID: 35323056 DOI: 10.1152/japplphysiol.00691.2021] [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: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the evidence related to how physical activity (PA) affects recovery following a sport-related concussion (SRC) in adolescents. DESIGN Systematic review Data Source: PUBMED, MEDLINE, and SPORTDiscus Eligibility criteria for selecting study:(1) original research article (e.g., randomized controlled trials (RCT), quasi-experimental designs, cohort, case-control studies), (2) 66% or greater of the sample has to have a SRC diagnosed by a clinician, (4) human research, (5) evaluate the effect of a SRC on PA in adolescents only (<18 years). Participants were seen within 1-2 weeks post-SRC for acute studies and 4 weeks post-SRC for studies focused on prolonged recoveries. RESULTS Twenty-two studies met the inclusion criteria (i.e., 8 regarding PA (PA-daily aerobic activity including light-moderate intensities), 8 evaluating active rehabilitation/exercise programs (20 minutes of daily aerobic exercise below symptom threshold), 6 examining a single bout of exertion). The methodological quality of the literature was assessed using the Downs and Black risk of bias (ROB) checklist. The ROB scores ranged from 7-24, with only two RCTs included. Studies demonstrated single bouts of exertion testing were safe and feasible. Daily PA or active rehabilitation/exercise programs led to a reduction in symptoms present and a decrease in number of days to medical clearance. CONCLUSION Following a brief period of rest (24-48 hours), individuals can gradually and safely return to PA below their physical symptom exacerbation thresholds. Further research is warranted to delineate how to optimize the timing, intensity, duration, and modality of PA impacts symptom resolution and physiological recovery following SRC.
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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
| | - 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
| | - Andrew P Lapointe
- 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
| | - Kailey T Newel
- Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, 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 David 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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24
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Corwin DJ, Root JM, Zonfrillo MR, Thomas DG. Concussion Referral and Practice Patterns by Pediatric Emergency Medicine Providers. Pediatr Emerg Care 2022; 38:e1133-e1138. [PMID: 34432741 DOI: 10.1097/pec.0000000000002523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Concussion is a commonly encountered diagnosis for pediatric emergency medicine (PEM) providers, yet little is known regarding referral patterns to specialists. Our goal was to assess PEM providers' referral patterns and current usage of standardized evaluation tools. METHODS This study was conducted as cross-sectional survey of PEM providers recruited from the American Academy of Pediatrics Section on Emergency Medicine Listserv. Surveys were distributed at 3 time points between December 1, 2020, and February 28, 2021, and included multiple choice, Likert scale, and free text questions. Descriptive statistics and bivariate analyses were used to describe the sample and compare responses between those with variable experience and confidence in concussion management. RESULTS In total, 162 of 491 Listserv members (33.0%) completed the survey. The factors most often reported to assist in referral decisions were history of severe (92.6%) or multiple (90.7%) prior concussions, prolonged symptom duration (89.5%), and severity of current symptoms (84.6%). Most providers reported having large experience (63.0%) and confidence (54.9%) in managing concussion. Standardized symptom scales (8.0%), vestibular (11.7%) and balance assessments (13.0%), and prognostic tools (6.8%) were infrequently used. Most (64.2%) providers felt specialty referral was important. More than 80% reported high likelihood to use an accurate risk stratification tool to facilitate referral. CONCLUSIONS Although most PEM providers reported significant experience and confidence in managing pediatric concussion, standardized assessment tools were infrequently used. Most were likely to use a risk stratification tool to assist in specialty referral. Future studies should assess the ability of targeted referral strategies to improve recovery for concussed youth.
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Affiliation(s)
- Daniel J Corwin
- From the Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jeremy M Root
- Emergency Medicine and Trauma Services, Children's National Medical Center, Washington, DC
| | - Mark R Zonfrillo
- Departments of Emergency Medicine and Pediatrics, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, RI
| | - Danny G Thomas
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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25
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Liu J, Judy Jin J, Eckner JT, Ji S, Hu J. Influence of Morphological Variation on Brain Impact Responses among Youth and Young Adults. J Biomech 2022; 135:111036. [DOI: 10.1016/j.jbiomech.2022.111036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/12/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
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26
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Berz K, Rhine T, Pomerantz WJ, Zhang Y, Loftus K, Lyons S, Logan K. An intervention to improve knowledge and increase comfort of concussion management among school medical staff. NURSE EDUCATION TODAY 2022; 109:105247. [PMID: 34968933 DOI: 10.1016/j.nedt.2021.105247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 11/03/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Concussion can negatively impact a child's ability to learn. School-based health professional staff have a unique opportunity to monitor students during recovery and mitigate the potential negative impact. Little is known about school health professional staff's knowledge and comfort with concussion diagnosis and management. OBJECTIVES We aimed to evaluate whether a tailored concussion education session could improve school health professional staff's knowledge about pediatric concussions. A secondary aim was to determine their knowledge retention and comfort with concussion management over the following year, including the impact of periodic follow-up education. We hypothesized that there would be sustained improvement in concussion knowledge and self-reported comfort in concussion management. STUDY DESIGN This study was a pre/post-intervention assessment with longitudinal follow-up. The study investigators provided a three-hour educational presentation about concussions in school-aged children. A survey on knowledge and management of pediatric concussions was administered immediately before and after this educational intervention. Knowledge retention and comfort with management was assessed at six months and at one year post-intervention. PARTICIPANTS AND SETTING Participants included Cincinnati Health Department school health professional staff in attendance at their Back to School in-service, prior to the start of the 2017-2018 school year. RESULTS Sixty school health professional staff from thirty-three schools completed the baseline knowledge survey, and forty completed all four assessments. Among the 40 participants with complete data, on average, the correct response rate (mean number correct, SD) was 82.3% (18.1/22, 11.0) pre-education, 91.8% (20.2/22, 10.3) immediate post-education, 86.4% (19.0/22, 10.8) 6-month follow-up, and 87.3% (19.2/22, 10.9) one-year follow-up. CONCLUSIONS A brief didactic educational intervention improved pediatric concussion knowledge and management skills among school health care providers. Periodic and in-person education is likely necessary to optimize knowledge retention.
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Affiliation(s)
- Kate Berz
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, United States of America; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, United States of America.
| | - Tara Rhine
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, United States of America
| | - Wendy J Pomerantz
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, United States of America
| | - Yin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, United States of America
| | - Kirsten Loftus
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, United States of America; Division of Pediatric Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, United States of America
| | - Stephanie Lyons
- Comprehensive Children's Injury Center, Division of Trauma Services, Cincinnati Children's Hospital Medical Center, United States of America
| | - Kelsey Logan
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, United States of America; Department of Internal Medicine, University of Cincinnati College of Medicine, United States of America
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27
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A Scoping Review of Concussion Guidelines in Amateur Sports in the United Kingdom. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031072. [PMID: 35162096 PMCID: PMC8834413 DOI: 10.3390/ijerph19031072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 12/02/2022]
Abstract
Objectives To investigate which United Kingdom (UK) amateur sporting organisations have published sports-related concussion (SRC) guidelines, their accessibility and the extent to which they follow the Berlin statement recommendations. This article is targeted at those involved with designing and implementing SRC guidelines in amateur sport. Design Scoping Review. Data Sources The SRC guidelines of 15 sporting organisations were accessed through public materials available from the official organisation website. Eligibility Criteria: To be included in this review, sports must enjoy broad participation by UK amateur athletes with a high risk of athletes sustaining an SRC. Results: 15 sporting organisations were included in this review with two, British Cycling and British Eventing, found not to have published SRC guidelines. There was found to be a large discrepancy between the extent to which the sport-specific guides followed the Berlin statement recommendations. Conclusions: The large discrepancy between the contents of the SRC guidelines may be putting the health of athletes at risk. We recommend the UK government publish standardised concussion guidelines based on the latest scientific research that must be used by all UK amateur sport groups.
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28
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OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1545-1554. [DOI: 10.1093/arclin/acac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
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29
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O'Neill JA, Rose SC, Davidson AM, Shiplett KM, Castillo A, McNally KA. Predictors of Treatment Response to Multidisciplinary Care for Persistent Symptoms after Pediatric Concussion. Dev Neurorehabil 2022; 25:38-44. [PMID: 33881383 DOI: 10.1080/17518423.2021.1917719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess which pediatric patients experiencing persistent post-concussive symptoms (PCS) benefit most from multidisciplinary treatment including specialists in Neurology, Neuropsychology, Physical Therapy, and Athletic Training, and to explore the effectiveness of this approach. METHODS A retrospective chart review of 56 adolescents 10-20 years old (M = 15.0 ± 2.1) receiving multidisciplinary care for PCS (>30 days) was conducted. RESULTS Systolic blood pressure and Body Mass Index predicted time to concussion resolution (p < .05), such that higher values were associated with slower resolution. PCS scores significantly decreased between participants' initial and final clinic visits, p < .01, and among the 25 participants for whom pre-intervention PCS scores were available, symptom severity scores significantly declined following multidisciplinary intervention compared to pre-referral values (p < .01). CONCLUSIONS Exploratory analyses reveal that multidisciplinary treatment is a promising approach for reducing symptoms among adolescents with PCS, and that those with greater levels of physical fitness may benefit most.
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Affiliation(s)
- Jilian A O'Neill
- Oakland Neuropsychology Center; Nationwide Children's Hospital Department of Pediatric Psychology and Neuropsychology; Ohio State University Department of Pediatrics, USA
| | - Sean C Rose
- Nationwide Children's Hospital Department of Neurology; Ohio State University Department of Pediatrics, USA
| | | | | | - Anthony Castillo
- Nationwide Children's Hospital Department of Pediatric Psychology and Neuropsychology, USA
| | - Kelly A McNally
- Nationwide Children's Hospital Department of Pediatric Psychology and Neuropsychology; Ohio State University Department of Pediatrics, USA
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30
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Cook NE, Teel E, Iverson GL, Friedman D, Grilli L, Gagnon I. Attention-Deficit/Hyperactivity Disorder and Outcome from Concussion: Examining Duration of Active Rehabilitation and Clinical Recovery. Phys Occup Ther Pediatr 2022; 42:645-662. [PMID: 35414341 DOI: 10.1080/01942638.2022.2061886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS The objective of this study was to compare recovery time and duration of active rehabilitation following concussion between adolescents with and without attention-deficit/hyperactivity disorder (ADHD). METHODS A retrospective cohort study was conducted among adolescents presenting to a specialty concussion clinic. One-quarter of the eligible episodes of care were selected. The final sample included 540 adolescents (ages 13-17 years, median age 15 years; 49.8% girls), of which 65 (12.0%) had a pre-injury diagnosis of ADHD. Days to recovery and days of active rehabilitation were examined. RESULTS ADHD was not associated with recovery time (ADHD: median = 49 days, IQR = 25-77; No ADHD: median = 47 days, IQR = 29-85) in univariate (Z = -0.45; p = 0.65) or multivariable analyses (Hazard Ratio: 1.17 (0.85-1.61); χ2(1) = 0.95; p = 0.33). The duration of active rehabilitation services received did not differ between youth with ADHD (median = 38.5 days, IQR = 27.5-54.5) and without ADHD (median = 37.5 days, IQR = 18.5-66) in univariate (Z = -0.19; p = 0.85) or multivariable analyses (Hazard Ratio: 1.04 (0.67-1.63); χ2(1) = 0.03; p = 0.85). CONCLUSIONS Our findings support accumulating evidence that ADHD, in and of itself, is not a risk factor for longer recovery or worse outcomes following pediatric concussion.
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Affiliation(s)
- Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Elizabeth Teel
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.,Spaulding Research Institute, Charlestown, Massachusetts, USA
| | - Deborah Friedman
- Montreal Children Hospital, McGill University Health Center, Montreal, Quebec, Canada.,Faculty of Medicine and Health Sciences, Department of Pediatrics and Pediatric Surgery, McGill University, Montreal, Quebec, Canada.,Health Canada, Canadian Hospitals Injury Reporting & Prevention Program, Montreal, Quebec, Canada
| | - Lisa Grilli
- Montreal Children Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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31
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Baiden P, Morgan MA, Logan MW. Sports- and Physical Activity-Related Concussions, Binge Drinking and Marijuana Use among Adolescents: The Mediating Role of Depression and Suicidal Ideation. Subst Use Misuse 2022; 57:504-515. [PMID: 34967277 DOI: 10.1080/10826084.2021.2019779] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although past studies have examined the adverse impact of sports- and physical activity-related concussions (SPACs) on health and mental health outcomes, there is a dearth of research investigating the association between SPACs and binge drinking and marijuana use. OBJECTIVE The objective of this study is to examine the cross-sectional association between SPACs and binge drinking and marijuana use among adolescents and whether symptoms of depression and suicidal ideation mediate this association. METHODS Data for this study came from the 2017 and 2019 National Youth Risk Behavior Survey. An analytic sample of 17,175 adolescents aged 14-18 years (50.2% male) was analyzed using binary logistic regression. RESULTS Of the 17,175 adolescents, 13.7% engaged in binge drinking and 19.3% used marijuana 30 days preceding the survey date. Approximately one in seven (14.1%) adolescents had SPACs during the past year. Upon controlling for the effects of other factors, adolescents who had SPACs had 1.74 times higher odds of engaging in binge drinking (AOR = 1.74, p<.001, 95% CI = 1.47-2.06) and 1.42 times higher odds of using marijuana (AOR = 1.42, p<.001, 95% CI = 1.24-1.62) than those who did not have SPACs. Symptoms of depression and suicidal ideation explained 12% of the association between SPACs and binge drinking, and 19% of the association between SPACs and marijuana use. CONCLUSIONS Understanding the association between SPACs and substance use and mental health could contribute to early identification of adolescents who may engage in substance use.
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Affiliation(s)
- Philip Baiden
- School of Social Work, The University of Texas at Arlington, Arlington, Texas, USA
| | - Mark A Morgan
- Department of Criminal Justice & Security Studies, University of Dayton, Dayton, Ohio, USA
| | - Matthew W Logan
- School of Criminal Justice & Criminology, Texas State University, San Marcos, Texas, USA
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32
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Mishra S, Singh VJ, Chawla PA, Chawla V. Neuroprotective Role of Nutritional Supplementation in Athletes. Curr Mol Pharmacol 2021; 15:129-142. [PMID: 34886789 DOI: 10.2174/1874467214666211209144721] [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: 01/30/2021] [Revised: 06/22/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Neurodegenerative disorders belong to different classes of progressive/chronic conditions that affect the peripheral/central nervous system. It has been shown through studies that athletes who play sports involving repeated head trauma and sub-concussive impacts are more likely to experience neurological impairments and neurodegenerative disorders in the long run. AIMS The aim of the current narrative review article is to provide a summary of various nutraceuticals that offer promise in the prevention or management of sports-related injuries, especially concussions and mild traumatic brain injuries. METHODS This article reviews the various potential nutraceutical agents and their possible mechanisms in providing a beneficial effect in the injury recovery process. A thorough survey of the literature was carried out in the relevant databases to identify studies published in recent years. In the present article, we have also highlighted the major neurological disorders along with the associated nutraceutical(s) therapy in the management of disorders. RESULTS The exact pathological mechanism behind neurodegenerative conditions is complex as well as idiopathic. However, mitochondrial dysfunction, oxidative stress as well as intracellular calcium overload are some common reasons responsible for the progression of these neurodegenerative disorders. Owing to the multifaceted effects of nutraceuticals (complementary medicine), these supplements have gained importance as neuroprotective. These diet-based approaches inhibit different pathways in a physiological manner without eliciting adverse effects. Food habits and lifestyle of an individual also affect neurodegeneration. CONCLUSION Studies have shown nutraceuticals (such as resveratrol, omega-3-fatty acids) to be efficacious in terms of their neuroprotection against several neurodegenerative disorders and to be used as supplements in the management of traumatic brain injuries. Protection prior to injuries is needed since concussions or sub-concussive impacts may trigger several pathophysiological responses or cascades that can lead to long-term complications associated with CNS. Thus, the use of nutraceuticals as prophylactic treatment for neurological interventions has been proposed.
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Affiliation(s)
- Supriya Mishra
- Department of Pharmacology, SRM College of Pharmacy, Delhi-NCR. India
| | - Vikram Jeet Singh
- Department of Pharmaceutical Chemistry and Analysis, ISF College of Pharmacy, Moga-142001, Punjab. India
| | - Pooja A Chawla
- Department of Pharmaceutical Chemistry and Analysis, ISF College of Pharmacy, Moga-142001, Punjab. India
| | - Viney Chawla
- Department of Pharmaceutics, University Institute of Pharmaceutical Sciences and Research, Baba Farid University of Health Sciences, Faridkot-151203, Punjab. India
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Wu L, Chan ST, Edmiston WJ, Jin G, Levy ES, Kwong KK, Mannix R, Meehan WP, Chifamba FF, Lipton JO, Whalen MJ, Chen YCI. Persistent CO 2 reactivity deficits are associated with neurological dysfunction up to one year after repetitive mild closed head injury in adolescent mice. J Cereb Blood Flow Metab 2021; 41:3260-3272. [PMID: 34229511 PMCID: PMC8669283 DOI: 10.1177/0271678x211021771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cerebrovascular reactivity (CVR) deficits in adolescents with concussion may persist after resolution of neurological symptoms. Whether or not CVR deficits predict long term neurological function is unknown. We used adolescent mice closed head injury (CHI) models (54 g, 107 cm or 117 cm drop height), followed by blood oxygenation level dependent (BOLD)-functional MRI with CO2 challenge to assess CVR and brain connectivity. At one week, 3HD 107 cm mice showed delayed BOLD responses (p = 0.0074), normal striatal connectivity, and an impaired respiratory rate response to CO2 challenge (p = 0.0061 in ΔRmax). The 107 cm group developed rotarod deficits at 6 months (p = 0.02) and altered post-CO2 brain connectivity (3-fold increase in striatum to motor cortex correlation coefficient) by one year, but resolved their CVR and respiratory rate impairments, and did not develop cognitive or circadian activity deficits. In contrast, the 117 cm group had persistent CVR (delay time: p = 0.016; washout time: p = 0.039) and circadian activity deficits (free-running period: 23.7 hr in sham vs 23.9 hr in 3HD; amplitude: 0.15 in sham vs 0.2 in 3HD; peak activity: 18 in sham vs 21 in 3HD) at one year. Persistent CVR deficits after concussion may portend long-term neurological dysfunction. Further studies are warranted to determine the utility of CVR to predict chronic neurological outcome after mild traumatic brain injury.
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Affiliation(s)
- Limin Wu
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Suk-Tak Chan
- Department of Radiology, A. Martino's Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - William J Edmiston
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gina Jin
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily S Levy
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kenneth K Kwong
- Department of Radiology, A. Martino's Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Rebekah Mannix
- Department of Emergency Medicine, Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA
| | - William P Meehan
- Department of Emergency Medicine, Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA.,Department of Orthopedics, Division of Sports Medicine, Boston, MA, USA
| | - Fortunate F Chifamba
- Department of Neurology, Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA
| | - Jonathan O Lipton
- Department of Neurology, Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Michael J Whalen
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yin-Ching I Chen
- Department of Radiology, A. Martino's Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
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McQuivey KS, Moore ML, Pollock JR, Hassebrock JD, Patel KA, Chhabra A. Top-100 Most-Cited Sports-Related Concussion Articles Focus on Symptomatology, Epidemiology, and Demographics. Arthrosc Sports Med Rehabil 2021; 3:e1585-e1597. [PMID: 34977610 PMCID: PMC8689224 DOI: 10.1016/j.asmr.2021.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/30/2021] [Indexed: 11/06/2022] Open
Abstract
Purpose To analyze the top-100 cited articles on sports-related concussions together with a bibliometric analysis to determine citations by year, level of evidence, study design, and several other factors related to the top referenced articles in sports concussions. Methods The Clarivate Analytics Web of Knowledge database was used to gather data using Boolean queries to capture all possible iterations of sports-related concussion research. Articles were organized in descending order based on the number of citations and included or excluded based on relevance to concussion. Collected information included author name, publication year, country of origin, journal name, article type, study focus, and the level of evidence. Results The top-100 articles were cited 31,197 times with an average of 312.0 citations per publication. More than one half were published in 2006 or later (52). Cohort studies and descriptive articles were the most prevalent study types (22 each). Studies with Level V evidence were the most common (33). The most common areas of study were symptomatology (short term, long term) with 17 articles, followed by epidemiology/demographics with 16 articles. The least common area of study was concussion prevention (2 articles), followed by management/treatment, diagnostics (labs, imaging) with 4 articles each. Conclusions We identified the most influential studies in sports-related concussion based on number of citations and citation density. A majority of these articles were published in the United States after 2006 and are most commonly cohort studies (Level IV evidence) and descriptive articles (Level V evidence). Current research focuses most heavily on the symptomatology and epidemiology/demographics of sports concussion. Clinical Relevance This study serves to identify the most influential articles in sports-related concussion and identify research topics with general deficiencies within the field of sports-related concussion research.
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Affiliation(s)
| | - M Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A
| | | | | | - Karan A Patel
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix
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35
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Youth Concussion Management Practices Among Athletic Trainers: A Vignette-Based Survey. J Sport Rehabil 2021; 31:69-76. [PMID: 34564069 DOI: 10.1123/jsr.2021-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Recovery protocols for treatment of sports concussion have received widespread adoption across the country. While stages of recovery and treatment are relatively clearly defined, there remains variability in implementation of specific recommendations, particularly regarding activities that constitute rest during stages calling for limitations on activity participation. Specific recommendations being employed by practitioners have not been previously assessed. In an aim to document current concussion management practices in the field, athletic trainers were surveyed regarding how activities that may constitute rest are utilized and defined. DESIGN The study was based on a cross-sectional vignette-based survey. METHODS The sample used was a geographically representative convenience sample of United States-based high school athletic trainers. E-mails were sent to 2146 potential survey respondents yielding a final sample of 226 athletic trainers. Data were gathered for questions concerning recommendations for follow-up care and rest based on provided vignettes, factors considered when developing recommendations, and differences in recommendations associated with varying symptom presentations. The percentage of practitioners that would utilize each potential recommendation was used to characterize results. RESULTS Participants demonstrated consensus on the importance of physical and cognitive rest as well as school accommodations (all greater than 97% endorsement). Greater variability was present for recommendations regarding pain medication for headache, repeating baseline cognitive testing, and engaging in subsymptom threshold activities. Recommendations for attending but not participating in games and practice yielded conflicting information. CONCLUSIONS Responses indicated general consensus regarding factors considered when making recommendations. There was also consensus regarding general recommendations for activity limitation following recovery with almost all participants strongly recommending cognitive and physical rest, in accordance with consensus guidelines. However, substantial differences were found for specific activities that should be limited or encouraged following youth concussion. Further research concerning the relationship between community and social interaction and clinical outcomes after concussion is warranted.
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Hill B, Mugayar LRF, da Fonseca MA. Oral Health Implications of Risky Behaviors in Adolescence. Dent Clin North Am 2021; 65:669-687. [PMID: 34503660 DOI: 10.1016/j.cden.2021.06.008] [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: 11/16/2022]
Abstract
Adolescence is a time for new discoveries, which may lead teens to engage in impulsive behaviors. Although social media and the Internet have brought great benefits to the world, they can also have a negative influence on adolescents, facilitating their engagement in risky behaviors. Positive parenting and healthy friendships in adolescence have a protective effect against sensation-seeking behaviors. Dental practitioners also have a significant role in steering young patients toward healthy behaviors. They play an essential role in the early recognition, initiation of appropriate interventions, and referrals for treatment of youth at risk.
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Affiliation(s)
- Brittaney Hill
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois Chicago, 801 South Paulina Street, Suite 250 (MC-850), Chicago, IL 60612, USA
| | - Leda R F Mugayar
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois Chicago, 801 South Paulina Street, Suite 250 (MC-850), Chicago, IL 60612, USA
| | - Marcio A da Fonseca
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois Chicago, 801 South Paulina Street, Suite 250 (MC-850), Chicago, IL 60612, USA.
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Zynda AJ, Worrall HM, Sabatino MJ, Ellis HB, Chung JS, Cullum CM, Miller SM. Continued play following adolescent sport-related concussion: Prospective data from the North Texas Concussion Registry (ConTex). APPLIED NEUROPSYCHOLOGY-CHILD 2021; 11:740-751. [PMID: 34392774 DOI: 10.1080/21622965.2021.1957677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Our study aims were to identify the frequency of continued play following sport-related concussion (SRC), defined as continuing athletic activity on the same day following a suspected SRC, characteristics associated with continued play, and whether continued play was associated with worse outcomes. A prospective study of participants ages 13-18 years diagnosed with SRC at a pediatric sports medicine clinic over a 4-year period was conducted. A comparison was performed between athletes who reported continued play following SRC (PLAY) and those who did not (NO PLAY). Of 441 participants, 231 (52.4%) were in the PLAY group. The PLAY group recalled less severe balance problems from the day of injury (p = 0.02), but reported greater symptoms of trouble falling asleep, concentrating, and remembering at their initial clinic visit (p < 0.05). There was no difference in recovery time between groups. Greater symptom severity score at the initial clinic visit and longer time to presentation were associated with prolonged recovery in both groups (p < 0.01). In conclusion, more than half of the athletes in this sample continued to play on the same day following SRC. Our results indicate the need for a heightened focus on education and additional efforts to reduce continued play following SRC in adolescents.
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Affiliation(s)
- Aaron J Zynda
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Hannah M Worrall
- Department of Sports Medicine, Scottish Rite for Children, Frisco, TX, USA
| | - Meagan J Sabatino
- Department of Sports Medicine, Scottish Rite for Children, Frisco, TX, USA
| | - Henry B Ellis
- Department of Sports Medicine, Scottish Rite for Children, Frisco, TX, USA.,Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Jane S Chung
- Department of Sports Medicine, Scottish Rite for Children, Frisco, TX, USA.,Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA.,Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA.,Department of Neurology, University of Texas Southwestern, Dallas, TX, USA.,Department of Neurosurgery, University of Texas Southwestern, Dallas, TX, USA
| | - Shane M Miller
- Department of Sports Medicine, Scottish Rite for Children, Frisco, TX, USA.,Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA.,Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA
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Keenan HT, Clark AE, Holubkov R, Ewing-Cobbs L. Changing Healthcare and School Needs in the First Year After Traumatic Brain Injury. J Head Trauma Rehabil 2021; 35:E67-E77. [PMID: 31246877 PMCID: PMC6930363 DOI: 10.1097/htr.0000000000000499] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine children's unmet and unrecognized healthcare and school needs following traumatic brain injury (TBI). SETTING Two pediatric trauma centers. PARTICIPANTS Children with all severity of TBI aged 4 to 15 years. DESIGN Prospective cohort. MAIN MEASURES Caregivers provided child health and school service use 3 and 12 months postinjury. Unmet and unrecognized needs were categorized compared with norms on standardized physical, cognitive, socioemotional health, or academic competence measures in conjunction with caregiver report of needs and services. Modified Poisson models examined child and family predictors of unmet and unrecognized needs. RESULTS Of 322 children, 28% had unmet or unrecognized healthcare or school needs at 3 months, decreasing to 24% at 12 months. Unmet healthcare needs changed from primarily physical (79%) at 3 months to cognitive (47%) and/or socioemotional needs (68%) at 12 months. At 3 months, low social capital, preexisting psychological diagnoses, and 6 to 11 years of age predicted higher healthcare needs and severe TBI predicted higher school needs. Twelve months postinjury, prior inpatient rehabilitation, low income, and preexisting psychological diagnoses were associated with higher healthcare needs; family function was important for school and healthcare needs. CONCLUSIONS Targeted interventions to provide family supports may increase children's access to services.
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Affiliation(s)
- Heather T Keenan
- Division of Critical Care, Department of Pediatrics, The University of Utah, Salt Lake City (Drs Keenan and Holubkov and Ms Clark); and Department of Pediatrics and Children's Learning Institute, University of Texas McGovern Medical School, Houston (Dr Ewing-Cobbs)
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Contributions of PCSS, BESS, Tandem Gait, and Romberg Test for Identifying Balance Deficits in Pediatric Concussions. J Head Trauma Rehabil 2021; 37:E129-E134. [PMID: 34145162 DOI: 10.1097/htr.0000000000000702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Balance deficits are common after concussions in pediatric patients. This study evaluates 3 clinical tools for identifying postconcussion balance deficits in a pediatric population: (1) Post-Concussion Symptom Scale (PCSS); (2) Balance Error Scoring System (BESS); and (3) physical examination measures of balance: tandem gait (TG) and Romberg test. SETTING Data were collected in a tertiary care outpatient pediatric sports medicine clinic. PARTICIPANTS English-speaking patients aged 8 to 17 years who presented to a tertiary care hospital-based pediatric sports medicine clinic and diagnosed with concussion between August 2014 and February 2018 were invited to participate. A total of 614 patients were screened and/or approached during the inclusion period and 500 were enrolled. Of those enrolled, 423 patients had complete data collected and analyzed. DESIGN This is a cross-sectional, observational data set from a longitudinal, prospective study. MAIN MEASURES Data extracted from patients' electronic medical records included physical examination, PCSS, and BESS scores from their initial visit. Descriptive statistics were calculated for the outcome measures. A logistic regression was performed to evaluate significant contributors to abnormal BESS score (≥25). RESULTS There were 423 patients (56.7% female; 14.7 ± 2.01 years old) included in the study. Overall, we identified 336 patients (79.4%) with balance difficulties. Of the 336 with balance difficulties, 284 (84.5%) reported "balance problems" and/or "dizziness" on PCSS, 153 (45.5%) had abnormal BESS scores (≥25), and 100 (29.8%) had an abnormality on either TG or Romberg test. CONCLUSION Balance difficulties were identified in close to 80% of children with concussions. Using PCSS and BESS along with physical examination measures, TG and Romberg test, identified more patients with balance deficits than using TG and Romberg test alone.
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Optimizing Order of Administration for Concussion Baseline Assessment Among NCAA Student-Athletes and Military Cadets. Sports Med 2021; 52:165-176. [PMID: 34129221 DOI: 10.1007/s40279-021-01493-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Concussion pre-injury (i.e., baseline) assessments serve as a benchmark comparison point in the event an individual sustains a concussion and allows clinicians to compare to post-injury measures. However, baseline assessments must reflect the individual's true and most optimized performance to serve as a useful comparison. Mental fatigue and motivation throughout baseline testing may alter individual assessment performance, indicating an order of administration (OoA) may play an influential role in assessment outcomes. OBJECTIVE To examine the influence concussion baseline battery OoA has on symptom, postural stability, cognitive screening, and computerized neurocognitive test outcomes. METHODS We employed a retrospective observational cohort study to examine healthy collegiate student-athletes and military cadets (n = 2898, 19.0 ± 1.4 years, 66.1% male, 75.6% white, 54.4% Division-I) baseline assessment performance on the Sport Concussion Assessment Tool (SCAT; total symptom number and severity), Balance Error Scoring System (BESS; total error scores), Standardized Assessment of Concussion (SAC; total score), and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) domain scores (verbal and visual memory, visual-motor speed, reaction time). Assessments were binned to beginning, middle, or end tertiles based upon OoA. We used one-way ANOVAs with Tukey post-hoc t tests, 95% confidence intervals (CI), and Cohen's d effect sizes for significant models (α = 0.05). RESULTS SCAT total symptom number (mean difference = 2.23; 95% CI 1.76-2.70; d = 0.49, p < 0.001) and severity (mean difference = 5.58; 95% CI 4.42-6.74; d = 0.50; p < 0.001) were lower when completed at the end of baseline testing compared to the middle. Total BESS errors were 1.06 lower when completed at the middle relative to the end (95% CI 0.43-1.69; d = 0.17; p = 0.001). Total SAC scores were better at the beginning relative to middle (mean difference = 0.58; 95% CI 0.25-0.90; d = 0.33; p < 0.001) and end (mean difference = 0.44; 95% CI 0.16-0.73; d = 0.24; p = 0.001). Verbal memory, visual memory, and reaction time performance were highest at the beginning (p ≤ 0.002), while visual-motor speed performance was highest at the middle (p = 0.001). CONCLUSION Completing baseline assessments in the order of (1) ImPACT, (2) SAC, (3) BESS, and (4) SCAT symptom checklist may improve performance across assessments collectively. Clinicians and researchers should consider completing baseline assessments in this order when possible to potentially aid in optimizing concussion baseline assessment performance and maximize post-concussion comparisons.
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Blood Biomarkers of Sports-Related Concussion in Pediatric Athletes. Clin J Sport Med 2021; 31:250-256. [PMID: 30839351 DOI: 10.1097/jsm.0000000000000735] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/10/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine changes in blood biomarkers, serum neurofilament light (Nf-L), and plasma tau, as well as the relationship between blood biomarkers and symptom reports, in athletes with a sports-related concussion. DESIGN Prospective cohort study. SETTING Private community-based concussion clinic. PARTICIPANTS Athletes aged 13 to 18 years old with a diagnosed sports-related concussion presenting to a concussion clinic within 7 days of injury and noninjured athletes with no history of concussion aged 13 to 23 years old. ASSESSMENT AND MAIN OUTCOME MEASURES Injured athletes provided a blood sample at the initial clinical evaluation and again at least 6 months after injury. Noninjured athletes provided a single blood sample. All participants completed symptom reports during each visit. Statistical comparisons of biomarker concentrations and symptom reports were conducted. RESULTS The mean rank for tau was significantly lower for concussed athletes compared with nonconcussed athletes. In contrast, the mean rank of Nf-L was higher for concussed athletes than for nonconcussed athletes, although the difference was nonsignificant. Plasma tau was significantly lower postinjury compared with 6 months after injury, whereas serum Nf-L was significantly higher postinjury. There was a weak but significant inverse relationship observed between tau and the number of symptoms reported, but no relationship was observed between Nf-L and the number of symptoms reported. CONCLUSIONS These data indicate that in the days following a sports-related concussion, the blood biomarkers tau and Nf-L display contrasting patterns of change but may not be related to self-reported symptom scores.
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Beebe KE, Reynolds E, Driver S. One size fits none: neurobiologic-specific modifications for the assessment, diagnosis, and treatment of sport-related concussion (SRC). Brain Inj 2021; 35:505-510. [PMID: 33822673 DOI: 10.1080/02699052.2020.1837957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PRIMARY OBJECTIVE - To discuss how the underlying neuroanatomy and neurobiology of five sport-related concussion (SRC) clinical profiles impacts assessment and treatment. RESEARCH DESIGN - Narrative review. METHODS AND PROCEDURES - Based on the current literature and clinical experience, arguments against the traditional SRC protocol and for a clinical profiles-based SRC protocol are made. MAIN OUTCOMES AND RESULTS - While the clinical profiles-based SRC protocol is widely used and accepted, there has been little published regarding the link to the underlying neuropathology. Our narrative review describes the five SRC clinical profiles: vestibular, ocular, mood, post-traumatic migraine, and cognitive/fatigue. For these profiles, the underlying neuroanatomy and neurobiology is outlined, as well as how that anatomy and biology impact the profiles' etiology, assessment, and treatment. The cervical and sleep modifiers are also briefly covered. CONCLUSIONS - Utilizing this model, clinicians are able to provide an individualized assessment, conceptualization, and treatment plan for SRC, leading to improved outcomes and clinical experiences for athletes.
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Affiliation(s)
- Kelzie E Beebe
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Erin Reynolds
- Director, Baylor Scott & White Sports Concussion Program, Frisco, Texas, USA
| | - Simon Driver
- Research Center Director, Baylor Scott & White Research Institute, Frisco, Texas, USA
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Lugo GJ, Beletanga M, Goldstein L, Rana M, Jonas R, Torres AR. Assessment and Treatment of Concussion in the Pediatric Population. Semin Neurol 2021; 41:132-146. [PMID: 33657625 DOI: 10.1055/s-0041-1725135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Traumatic brain injury (TBI) is common in children. The evaluation and management of children with TBI is based on the research performed in adults. There is a relative paucity of research in the literature involving children and many of the practice recommendations for this age are based on expert opinion in the absence of good research studies in both sports and non-sports-related injuries. The pediatric population is heterogeneous and the approach might be specific for infants, preschoolers, school age children, and adolescents. Children may also suffer from neurodevelopmental disabilities, making their evaluation even more challenging. Adult neurologists are often asked to see children due to increasing demands. This review will focus on specific issues related to TBI in children that might be useful to adult neurologists. Science, however, is evolving rapidly and physicians should make sure to remain up to date to offer evidence-based services to their patients.
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Affiliation(s)
- Giancarlo J Lugo
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Maria Beletanga
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Laura Goldstein
- Division of Child Psychiatry, Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
| | - Mandeep Rana
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Rinat Jonas
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Alcy R Torres
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Pediatric Brain Injury Program, Boston University School of Medicine, Boston, Massachusetts
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Patel RD, LaBella CR. Contributions of PCSS, CISS, and VOMS for Identifying Vestibular/Ocular Motor Deficits in Pediatric Concussions. Sports Health 2021; 13:565-572. [PMID: 33618579 DOI: 10.1177/1941738121994116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Vestibular/ocular motor dysfunction can occur in pediatric concussions, which can impair reading, learning, and participation in athletics. This study evaluated 3 clinical tools for identifying postconcussion vestibular/ocular motor dysfunction: (1) Post-Concussion Symptom Scale (PCSS), (2) Convergence Insufficiency Symptom Survey (CISS), and (3) Vestibular/Ocular Motor Screening (VOMS). HYPOTHESIS Evaluating vestibular/ocular motor dysfunction with multiple clinical tools will capture more symptomatic patients than any 1 tool alone. STUDY DESIGN Cross-sectional data from a prospective cohort study. LEVEL OF EVIDENCE Level 4. METHODS Patients were between 8 and 17 years old and seen in a tertiary care pediatric sports medicine clinic between August 2014 and February 2018. Data were collected from initial visit and included VOMS, PCSS, and CISS. Descriptive statistics, Pearson's correlations, and logistic regressions were used to describe relationships between clinical tools. RESULTS Of the 156 patients (55.1% female; 14.35 ± 2.26 years old) included, this study identified 129 (82.7%) with vestibular/ocular motor dysfunction. Of these 129, 65 (50.4%) reported "visual problems" on PCSS, 93 (72.1%) had abnormal CISS, and 99 (76.7%) had abnormal VOMS. Together, VOMS and CISS identified 64 (49.6%) patients without reported "visual problems" on PCSS. Higher total PCSS scores predicted abnormal CISS (odds ratio [OR], = 1.11; 95% CI, 1.07-1.17) and abnormal VOMS (OR, 1.03; 95% CI, 1.01-1.06). "Visual problems" on PCSS did not predict abnormal CISS or VOMS. CONCLUSIONS Vestibular/ocular motor dysfunction were identified in nearly 83% of study subjects when PCSS, CISS, and VOMS are used together. CLINICAL RELEVANCE These results suggest adding CISS and VOMS to the clinical evaluation of concussions can help clinicians identify post-concussion vestibular/ocular motor dysfunction.
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Affiliation(s)
- Rishi D Patel
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Cynthia R LaBella
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Division of Orthopaedic Surgery and Sports Medicine, Lurie Children's Hospital, Chicago, Illinois
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Howland J, Hackman H, Torres A, Campbell J, Olshaker J. It is time to rewrite state youth sports concussion laws. BMJ Open Sport Exerc Med 2021; 7:e000959. [PMID: 33456786 PMCID: PMC7789433 DOI: 10.1136/bmjsem-2020-000959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Between 2009 and 2014, all 50 states and the District of Columbia passed legislation to improve the recognition and management of youth concussed in sports. These laws can include requirements for concussion training for school athletic personnel, concussion education for children and their parents, return-to-play (RTP) procedures, and medical clearance to for RTP. Concussion can impact academic learning and performance in children and adolescents. Postconcussion academic accommodations during recovery can be an important component of secondary prevention for mitigating the sequalae of head injury. Few state youth concussion laws, however, include provision of postconcussion return-to-learn (RTL) accommodations and most of those that do address RTL apply to student athletes only. Concussions may occur in youth who are not participating in organised sports (eg, falls, traffic crashes) and thus may not be subjected to RTL accommodations, even if the state mandates such procedures for athletes. Low income and students of colour may be more likely to have non-sports concussions than their more affluent and white peers, thus potentially creating demographic disparities in the benefits of RTL procedures. State youth sports concussion laws should be revised so that they include RTL provisions that apply to all students, athletes and non-athletes alike.
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Affiliation(s)
- Jonathan Howland
- Department of Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Injury Prevention Center, Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Holly Hackman
- Department of Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Injury Prevention Center, Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Alcy Torres
- Department of Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Injury Prevention Center, Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Julia Campbell
- Department of Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Injury Prevention Center, Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Jonathan Olshaker
- Department of Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Injury Prevention Center, Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts, USA
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Macartney G, Woodfield M, Terekhov I, Vassilyadi M, Goulet K. Anxiety, depression, and symptom experience in concussed children and youth. J SPEC PEDIATR NURS 2021; 26:e12310. [PMID: 32965082 DOI: 10.1111/jspn.12310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/18/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe and explore the relationship between baseline anxiety, depression and symptom experience in children and youth assessed at a concussion clinic. DESIGN AND METHODS A retrospective chart review of concussed children and youth referred to a pediatric teaching hospital concussion clinic over a 15-month period was completed. Kutcher Adolescent Depression Scale (KAD-6), General Anxiety Disorder Scale (GAD-7), and the Post-Concussion Symptom Inventory (PCSI) scores were extracted. RESULTS A total of 155 patients were included. The most common symptoms (PCSI) at baseline were headache, fatigue, and feelings of head pressure. Symptoms were rated as mild to moderate in intensity. Overall, mean depression and anxiety scores were low. The mean anxiety scores, as measured by the GAD-7 (n = 108), was 7.4 (range, 0-24). The mean depression score, as measured by the KAD-6 (n = 94), was 4.7 (range, 0-18). A statistically significant, moderate positive correlation between PCSI scores with KAD-6 scores for male (r = .64, p < .001) and female (r = .61, p < .001) participants was identified. Similarly, a statistically significant, moderate positive correlation between PCSI scores with GAD-7 scores for male (r = .68, p < .001) and female (r = .60, p < .001) participants was identified. PRACTICE IMPLICATIONS Concussed children may experience a wide array of symptoms, including emotional challenges such as anxiety and depression. Feelings of anxiety and depression may contribute to overall post concussive symptoms in concussed children. The electronic health record can be leveraged to provide important patient data. Clinicians should systematically assess symptoms at each visit in concussed children and youth so that appropriate interventions can be implemented and monitored.
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Affiliation(s)
- Gail Macartney
- Faculty of Nursing, The University of Prince Edward Island, Charlottetown, Canada
| | | | - Ivan Terekhov
- The Children's Hospital of Eastern Ontario, Ottawa, Canada
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Ye S, Ko B, Phi HQ, Sun K, Eagleman DM, Flores B, Katz Y, Huang B, Ghomi RH. Detection of mild traumatic brain injury in pediatric populations using BrainCheck, a tablet-based cognitive testing software: a preliminary study. EXPLORATION OF MEDICINE 2020. [DOI: 10.37349/emed.2020.00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aim: Despite its high frequency of occurrence, mild traumatic brain injury (mTBI), or concussion, is difficult to recognize and diagnose, particularly in pediatric populations. Conventional methods to diagnose mTBI primarily rely on clinical questionnaires and sometimes include neuroimaging or pencil and paper neuropsychological testing. However, these methods are time consuming, require administration/interpretation from health professionals, and lack adequate test sensitivity and specificity. This study explores the use of BrainCheck Sport, a computerized neurocognitive test that is available on iPad, iPhone, or computer desktop, for mTBI assessment. The BrainCheck Sport Battery consists of 6 gamified traditional neurocognitive tests that assess areas of cognition vulnerable to mTBI such as attention, processing speed, executing functioning, and coordination.
Methods: We administered BrainCheck Sport to 10 participants diagnosed with mTBI at the emergency department of Children’s hospital or local high school within 96 hours of injury, and 115 normal controls at a local high school. Statistical analysis included Mann-Whitney U test, chi-square tests, and Hochberg tests to examine differences between the mTBI group and control group on each assessment in the battery. Significant metrics from these assessments were used to build a logistic regression model that distinguishes mTBI from control participants.
Results: BrainCheck Sport was able to detect significant differences in Coordination, Stroop, Immediate/Delayed Recognition between normal controls and mTBI patients. Receiver operating characteristic (ROC) analysis of our logistic regression model found a sensitivity of 84% and specificity of 81%, with an area under the curve of 0.884.
Conclusions: BrainCheck Sport has potential in distinguishing mTBI from control participants, by providing a shorter, gamified test battery to assess cognitive function after brain injury, while also providing a method for tracking recovery with the opportunity to do so remotely from a patient’s home.
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Affiliation(s)
- Siao Ye
- Department of Biosciences, Rice University, Houston, TX 77005, USA
| | - Brian Ko
- University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Huy Q. Phi
- College of Arts and Sciences, University of Washington, Seattle, WA 98195, USA
| | - Kevin Sun
- BrainCheck, Inc, Houston, TX 77021, USA
| | - David M. Eagleman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Yael Katz
- BrainCheck, Inc, Houston, TX 77021, USA
| | - Bin Huang
- BrainCheck, Inc, Houston, TX 77021, USA
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Chase D, Slicer K, Schatz P. Relationship between Standalone Performance Validity Test Failure and Emotionality among Youth/student Athletes Experiencing Prolonged Recovery following Sports-related Concussion. Dev Neuropsychol 2020; 45:435-445. [PMID: 33269627 DOI: 10.1080/87565641.2020.1852239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study documented the rate of Performance Validity Testing (PVT) failure in 81 youth athletes, aged 10-21 years, experiencing prolonged recovery following sports-related concussion, and the relationship between PVT and emotional symptoms. Neuropsychological assessments were conducted across three test sessions with a stand-alone PVT at each session. Results showed that 48% (39/81) of individuals failed at least one PVT, with an overall PVT failure rate of 26% (64/243). Those failing at least one PVT scored significantly higher on anxiety but not depression or somatization. Results illustrate the importance of including measures of emotional and behavioral functioning in testing following SRC.
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Affiliation(s)
| | - Kayley Slicer
- Department of Psychology, Saint Joseph's University , Philadelphia, PA, USA
| | - Philip Schatz
- Department of Psychology, Saint Joseph's University , Philadelphia, PA, USA
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Hardesty K, Walston Z, Walston L, Yake D, Marr T. Treatment of non-sports related concussion in adolescents following an irritability algorithmic approach: a case series. Physiother Theory Pract 2020; 38:1570-1578. [PMID: 33267702 DOI: 10.1080/09593985.2020.1855683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Concussion management evidence supports the efficacy of gradual active rehabilitation for return to sport in adolescents, however there is paucity of evidence for non-sports-related concussion management.Purpose: The purpose of this case series is to describe the feasibility and practicality of an irritability-based step-by-step model to guide rehabilitation.Case Descriptions: Three adolescent patients diagnosed with concussion during a non-sports related event are described. Each adolescent was classified as high, moderate, or low irritability level based on symptom exacerbation with Vestibular/Ocular-Motor Screening (VOMS), physical exertion based on age-predicted maximum heart rate, and cervicogenic factors. Each Patient's intervention was progressed following the proposed irritability-based algorithm.Outcomes: Patients were assessed using the Brain Injury Functional Status Patient-Reported Outcome Measure, VOMS testing, and a Numeric Pain Rating Scale. Concluding each plan of care, all patients met or exceeded the minimal clinically important difference for age, gender, and risk-adjusted predicted measure on all outcome assessments. All patients returned to school and age-appropriate activities without symptom exacerbation.Conclusion: An irritability-based algorithm model for non-sports-related concussion management may be a practical and feasible treatment approach for adolescents.
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Affiliation(s)
- Kelly Hardesty
- Department of Physical Therapy, PT Solutions Physical Therapy, Kennesaw, GA, USA.,PT Solutions Physical Therapy, Atlanta, GA, USA
| | - Zachary Walston
- Department of Physical Therapy, PT Solutions Physical Therapy, Kennesaw, GA, USA
| | | | - Dale Yake
- Department of Physical Therapy, PT Solutions Physical Therapy, Kennesaw, GA, USA
| | - Tye Marr
- PT Solutions Physical Therapy, Atlanta, GA, USA
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Root JM, Sady MD, Gai J, Vaughan CG, Madati PJ. Effect of Cognitive and Physical Rest on Persistent Postconcussive Symptoms following a Pediatric Head Injury. J Pediatr 2020; 227:184-190.e4. [PMID: 32702425 DOI: 10.1016/j.jpeds.2020.07.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the effect of cognitive and physical rest on persistent postconcussive symptoms in a pediatric population. STUDY DESIGN A prospective cohort study of 5- to 18-year-olds diagnosed with an acute concussion in a tertiary care pediatric emergency department was conducted from December 2016 to May 2019. Participants (n = 119) were followed over 1 month to track days off from school and sports and the development of persistent postconcussive symptoms (residual concussion symptoms beyond 1 month). Participants were dichotomized into minimal (≤2) and moderate (>2) rest, based on days off from school and sports after a concussion. Univariate and multivariable logistic regression analyses were completed to examine associations with persistent postconcussive symptoms. RESULTS Of the participants in our study, 24% had persistent postconcussive symptoms. Adolescent age, history of prolonged concussion recovery, and headache at presentation were associated with higher odds of persistent postconcussive symptoms in univariate analyses. In a multivariable logistic regression model, only adolescent age was associated with increased odds of persistent postconcussive symptoms. Compared with the minimal cognitive rest group, moderate cognitive rest did not decrease the odds of persistent postconcussive symptoms (aOR, 1.15; 95% CI, 0.44-2.99). Compared with the minimal physical rest group, moderate physical rest also did not decrease the odds of persistent postconcussive symptoms (aOR, 3.17; 95% CI, 0.35-28.78). CONCLUSIONS Emerging evidence supports early return to light activity for recovery of acute pediatric concussion. Our study adds to this management approach as we did not find that rest from school and sports resulted in a decreased odds of persistent postconcussive symptoms.
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Affiliation(s)
- Jeremy M Root
- Division of Emergency Medicine, Children's National Health System, Washington, DC.
| | - Maegan D Sady
- Division of Pediatric Neuropsychology, Children's National Health System, Washington, DC
| | - Jiaxiang Gai
- Biostatistics and Study Methodology Division, Clinical and Translational Science Institute at Children's National (CTSI-CN), Washington, DC
| | - Christopher G Vaughan
- Division of Pediatric Neuropsychology, Children's National Health System, Washington, DC
| | - Ponda J Madati
- Division of Emergency Medicine, Children's National Health System, Washington, DC
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