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Ingram EO, Karr JE. The Sport Concussion Assessment Tool: A multidimensional symptom model for detecting elevated post-concussion symptoms. Clin Neuropsychol 2024:1-24. [PMID: 38369485 DOI: 10.1080/13854046.2024.2315735] [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: 06/18/2023] [Accepted: 12/20/2023] [Indexed: 02/20/2024]
Abstract
Objective: Investigate whether a four-factor model of post-concussion symptoms (i.e. cognitive, physical, affective, and sleep-arousal) aids in identifying student-athletes with persistent concerns not reflected by a total symptom score. Method: Collegiate student-athletes (N = 32,066) from the Concussion Assessment Research and Education consortium completed the Sport Concussion Assessment Tool, 3rd edition Symptom Evaluation at baseline and two post-injury follow-ups (i.e. beginning RTP and 6-month). Confirmatory factor analysis was used to compare a one- and four-factor model of post-concussion symptoms. Normative reference data were compared across stratifications (e.g. sex, prior concussions, and number of pre-existing conditions) using Mann-Whitney U tests, and elevation rates (i.e. ≥ 84th percentile) for subscales and the total score were recorded. Results: The four-factor model fit well before and after injury (CFIs > .95). Greater symptom severity on the subscale and total scores was associated with female sex (ps<.001, r range: .07 to .14) and more pre-existing conditions (ps<.001, η 2 range: .01 to .04), while having more prior concussions was only related to total symptom scores (ps<.001, η 2<.01). After a concussion, a sizeable portion of student-athletes (i.e., RTP = 11.8%; 6-month = 8.3%) had subscale elevations despite no total score elevation. Physical subscale elevations at RTP were the most common (i.e., 11.9%), driven by head and neck pain. Conclusion: After a sport-related concussion, a four-factor symptom model can be used to assess persistent symptoms in collegiate student-athletes. Identifying athletes with domain-specific elevations may help clinicians identify areas for further assessment and, in some cases, personalized rehabilitation plans.
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Affiliation(s)
- Eric O Ingram
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
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Durfee KJ, Elbin RJ, Trbovich AM, Womble MN, Mucha A, Stephenson K, Holland CL, Dollar CM, Sparto PJ, Collins MW, Kontos AP. A Common Data Element-Based Adjudication Process for mTBI Clinical Profiles: A Targeted Multidomain Clinical Trial Preliminary Study. Mil Med 2023; 188:354-362. [PMID: 37948273 DOI: 10.1093/milmed/usad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/07/2023] [Accepted: 05/01/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION The primary purpose of this study was to examine the prevalence and percent agreement of clinician-identified mild traumatic brain injury (mTBI) clinical profiles and cutoff scores for selected Federal Interagency Traumatic Brain Injury Research common data elements (CDEs). A secondary purpose was to investigate the predictive value of established CDE assessments in determining clinical profiles in adults with mTBI. MATERIALS AND METHODS Seventy-one (23 males; 48 females) participants (M = 29.00, SD = 7.60, range 18-48 years) within 1-5 months (M = 24.20, SD = 25.30, range 8-154 days) of mTBI completed a clinical interview/exam and a multidomain assessment conducted by a licensed clinician with specialized training in concussion, and this information was used to identify mTBI clinical profile(s). A researcher administered CDE assessments to all participants, and scores exceeding CDE cutoffs were used to identify an mTBI clinical profile. The clinician- and CDE-identified clinical profiles were submitted to a multidisciplinary team for adjudication. The prevalence and percent agreement between clinician- and CDE-identified clinical profiles was documented, and a series of logistic regressions with adjusted odds ratios were performed to identify which CDE assessments best predicted clinician-identified mTBI clinical profiles. RESULTS Migraine/headache, vestibular, and anxiety/mood mTBI clinical profiles exhibited the highest prevalence and overall percent agreement among CDE and clinician approaches. Participants exceeding cutoff scores for the Global Severity Index and Headache Impact Test-6 assessments were 3.90 and 8.81 times more likely to have anxiety/mood and migraine/headache profiles, respectively. The Vestibular/Ocular Motor Screening vestibular items and the Pittsburgh Sleep Quality Index total score were predictive of clinician-identified vestibular and sleep profiles, respectively. CONCLUSIONS The CDEs from migraine/headache, vestibular, and anxiety/mood domains, and to a lesser extent the sleep modifier, may be clinically useful for identifying patients with these profiles following mTBI. However, CDEs for cognitive and ocular may have more limited clinical value for identifying mTBI profiles.
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Affiliation(s)
- Kori J Durfee
- Office for Sport Concussion Research, University of Arkansas, Fayetteville, AR 72701, USA
| | - R J Elbin
- Office for Sport Concussion Research, University of Arkansas, Fayetteville, AR 72701, USA
| | - Alicia M Trbovich
- Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, Pittsburgh, PA 15260, USA
| | - Melissa N Womble
- Inova Sports Medicine Concussion Program, Fairfax, VA 22031, USA
| | - Anne Mucha
- UPMC Rehabilitation Institute, Pittsburgh, PA 15203, USA
| | - Katie Stephenson
- College of Osteopathic Medicine, University of New England, Biddeford, ME 04005, USA
| | - Cyndi L Holland
- Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, Pittsburgh, PA 15260, USA
| | | | - Patrick J Sparto
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Michael W Collins
- Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, Pittsburgh, PA 15260, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Anthony P Kontos
- Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, Pittsburgh, PA 15260, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15260, USA
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McPherson JI, Nazir MSZ, Willer BS, Leddy JJ, Haider MN. Does Physiologic Post-Concussion Disorder Cause Persistent Post-Traumatic Headache? Curr Pain Headache Rep 2023; 27:793-799. [PMID: 37831366 DOI: 10.1007/s11916-023-01176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE OF REVIEW One system classifies patients with symptoms after concussion into physiologic, vestibulo-ocular, cervicogenic, and mood/cognition post-concussion disorders (PCD) based upon the preponderance of specific symptoms and physical impairments. This review discusses physiologic PCD and its potential relationship to the development of persistent post-traumatic headaches (PPTH). RECENT FINDINGS Headache is the most reported symptom after a concussion. Headaches in physiologic PCD are suspected to be due to abnormal cellular metabolism, subclinical neuroinflammation, and dysfunction of the autonomic nervous system (ANS). These abnormalities have been linked to the development of migraine-like and neuralgia-related PPTH. Physiologic PCD is a potential cause of PPTH after a concussion. Future research should focus on how to prevent PPTH in patients with physiologic PCD.
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Affiliation(s)
- Jacob I McPherson
- Department of Rehabilitation Science, School of Public Health and Health Professions, State University of New York at Buffalo, 534 Kimball Tower, Buffalo, NY, 14214, USA.
| | - Muhammad S Z Nazir
- Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, State University of New York at Buffalo, Buffalo, NY, 14214, USA
| | - Barry S Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14215, USA
| | - John J Leddy
- Department of Orthopedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14215, USA
| | - Mohammad N Haider
- Department of Orthopedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14215, USA
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Rydzik Ł, Ambroży T, Pałka T, Wąsacz W, Spieszny M, Perliński J, Król P, Kopańska M. Preliminary Development of a Brainwave Model for K1 Kickboxers Using Quantitative Electroencephalography (QEEG) with Open Eyes. Int J Mol Sci 2023; 24:ijms24108882. [PMID: 37240227 DOI: 10.3390/ijms24108882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
K1 kickboxing fighting is characterised by high injury rates due to the low restrictions of fighting rules. In recent years, much attention has been paid to research on changes in brain function among athletes, including those in combat sports. One of the tools that are likely to help diagnose and assess brain function is quantitative electroencephalography (QEEG). Therefore, the aim of the present study was an attempt to develop a brainwave model using quantitative electroencephalography in competitive K1 kickboxers. A total of thirty-six male individuals were purposefully selected and then comparatively divided into two groups. The first group consisted of specialised K1 kickboxing athletes exhibiting a high level of sports performance (experimental group, n = 18, mean age: 29.83 ± 3.43), while the second group comprised healthy individuals not training competitively (control group, n = 18, mean age: 26.72 ± 1.77). Body composition assessment was performed in all participants before the main measurement process. Measurements were taken for kickboxers during the de-training period, after the sports competition phase. Quantitative electroencephalography of Delta, Theta, Alpha, sensimotor rhytm (SMR), Beta1 and Beta2 waves was performed using electrodes placed on nine measurement points (frontal: FzF3F4, central: CzC3C4, and parietal: PzP3P4) with open eyes. In the course of the analyses, it was found that the level of brain activity among the study population significantly differentiated the K1 formula competitors compared with the reference standards and the control group in selected measurement areas. For kickboxers, all results of the Delta amplitude activity in the area of the frontal lobe were significantly above the normative values for this wave. The highest value was recorded for the average value of the F3 electrode (left frontal lobe), exceeding the norm by 95.65%, for F4 by 74.45% and Fz by 50.6%, respectively. In addition, the Alpha wave standard value for the F4 electrode was exceeded by 14.6%. Normative values were found for the remaining wave amplitudes. Statistically significant differentiation of results, with a strong effect (d = 1.52-8.41), was shown for the activity of Delta waves of the frontal area and the central part of the parietal area (Fz,F3,F4,Cz-p < 0.001), Theta for the frontal area as well as the central and left parietal lobes (Fz,F3,F4-p < 0.001, Cz-p = 0.001, C3-p = 0.018; d = 1.05-3.18), Alpha for the frontal, parietal and occipital areas (for: Fz,F3-p < 0.001, F4-p = 0.036, Cz-p < 0.001, C3-p = 0.001, C4-p = 0.025, Pz-p = 0.010, P3-p < 0.001, P4-p = 0.038; d = 0.90-1.66), SMR for the central parietal and left occipital lobes (Cz-p = 0.043; d = 0.69, P3-p < 0.001; d = 1.62), Beta for the frontal area, occipital and central lobes and left parietal segment (Fz,F3-p < 0.001, F4-p = 0.008, Cz, C3, Pz, P3,P4-p < 0.001; d = 1.27-2.85) and Beta 2 for all measurement areas (Fz, F3, F4, Cz, C3, C4, Pz, P3, P4-p < 0.001; d = 1.90-3.35) among the study groups. Significantly higher results were shown in the kickboxer group compared to the control. In addition to problems with concentration or over-stimulation of neural structures, high Delta waves, with elevated Alpha, Theta and Beta 2 waves, can cause disorders in the limbic system and problems in the cerebral cortex.
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Affiliation(s)
- Łukasz Rydzik
- Institute of Sports Sciences, University of Physical Education, 31-571 Kraków, Poland
| | - Tadeusz Ambroży
- Institute of Sports Sciences, University of Physical Education, 31-571 Kraków, Poland
| | - Tomasz Pałka
- Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, University of Physical Education, 31-571 Kraków, Poland
| | - Wojciech Wąsacz
- Institute of Sports Sciences, University of Physical Education, 31-571 Kraków, Poland
| | - Michał Spieszny
- Institute of Sports Sciences, University of Physical Education, 31-571 Kraków, Poland
| | - Jacek Perliński
- Faculty of Medical Sciences, Academy of Applied Medical and Social Sciences in Elblag, 82-300 Elblag, Poland
| | - Paweł Król
- Institute of Physical Culture Studies, College of Medical Sciences, University of Rzeszow, 35-959 Rzeszów, Poland
| | - Marta Kopańska
- Department of Pathophysiology, Institute of Medical Sciences, Medical College of Rzeszów University, 35-959 Rzeszów, Poland
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Concussion in the Athletic Training Room: a Team Physician Narrative. Curr Pain Headache Rep 2021; 25:24. [PMID: 33738547 DOI: 10.1007/s11916-021-00937-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF THE REVIEW Concussion evaluation and management has changed significantly. Understanding proper recognition, evaluation, and management allows for improved provision of care to patients. This paper will approach this topic from a sideline to training room management versus the traditional clinic evaluation RECENT FINDINGS: Research is continuing to refine and examine tools to assist in proper concussion evaluation. Concussion recovery protocols are becoming more conservative as patients are taking longer to recover than previously thought. Treatment of concussion is becoming more sophisticated and patient involved. Concussion research has increased dramatically over the last 30 years changing our approach to diagnosis and treatment. The area of concussion will continue to evolve as research continues to look at effective tools and markers for diagnosis and effective treatment protocols become substantiated through research.
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Abstract
After traumatic brain injury (TBI), a host of symptoms of varying severity and associated functional impairment may occur. One of the most commonly encountered and challenging to treat are the post-traumatic cephalalgias. Post-traumatic cephalalgia (PTC) or headache is often conceptualized as a single entity as currently classified using the ICHD-3. Yet, the terminology applicable to the major primary, non-traumatic, headache disorders such as migraine, tension headache, and cervicogenic headache are often used to specify the specific type of headache the patients experiences seemingly disparate from the unitary definition of post-traumatic headache adopted by ICHD-3. More complex post-traumatic presentations attributable to brain injury as well as other headache conditions are important to consider as well as other causes such as medication overuse headache and medication induced headache. Treatment of any post-traumatic cephalalgia must be optimized by understanding that there may be more than one headache pain generator, that comorbid traumatic problems may contribute to the pain presentation and that pre-existing conditions could impact both symptom complaint, clinical presentation and recovery. Any treatment for PTC must harmonize with ongoing medical and psychosocial aspects of recovery.
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Affiliation(s)
- Brigid Dwyer
- Department of Neurology, Boston University, Boston, Massachusetts, USA
| | - Nathan Zasler
- Concussion Care Centre of Virginia Ltd. and Tree of Life Services, Inc., Richmond, Virginia, USA.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
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Conder A, Conder R, Friesen C. Neurorehabilitation of Persistent Sport-Related Post-Concussion Syndrome. NeuroRehabilitation 2020; 46:167-180. [PMID: 32083597 DOI: 10.3233/nre-192966] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Persistent Sport-Related Post-Concussion Syndrome is often diagnosed with any type of prolonged PCS symptoms. However, there are not specific diagnostic criteria for PPCS such that misdiagnosis often occurs. Further, the signs and symptoms of PCS overlap with other common illnesses such as depression, anxiety, migraines, ADHD and others. Misdiagnosis may lead to less than efficacious treatment, resulting in prolonged symptoms. OBJECTIVE This article will review relevant evidence-based literature on PCS, pointing out the lack of a systemic diagnostic framework. It will also provide evidence that highlights the multiple conflicting findings in the literature. This article will posit the BioPsychoSocial framework as the best diagnostic framework for understanding the impact of concussions on the person and to generate individualized and personal interventions. METHODS A narrative review of sport concussion-related articles was conducted, after extensive searches of relevant and non-relevant literature by each author, as well as articles recommended by colleagues. Articles varied from American Academy of Neurology Class I to IV for evaluation and critique. Class IV articles were reviewed, as there is much public misconception regarding sport and other concussion treatment that needed identification and discussion. RESULTS Articles reviewed varied by quality of research design and methodology. Multiple symptoms, recovery patterns and rehabilitation treatment approaches are purported in the sport-related concussion literature. Current consensus data as well as the mixed and contradictory findings were explored. CONCLUSIONS Persistent Sport-Related Post-Concussion Syndrome is a topic of great interest to both professionals and the general public. There is much misunderstanding about the etiology, causation, diagnostic formulations, symptom presentation, prolonging factors and treatment involved in this syndrome. This article posits an individualized multi-system diagnostic formulation, examining all relevant factors, as generating the best interventions for neurorehabilitation of Persistent Sport-Related Post-Concussion Syndrome.
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Affiliation(s)
- Alanna Conder
- Carolina Neuropsychological Service, Raleigh, NC, USA
| | - Robert Conder
- Carolina Neuropsychological Service, Raleigh, NC, USA
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Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment. J Orthop Sports Phys Ther 2019; 49:799-810. [PMID: 31610760 DOI: 10.2519/jospt.2019.8926] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The risk factors of concussion may be categorized as intrinsic (internal factors specific to the individual) or extrinsic (external factors related to the environment or sport). Identifying these factors is part of an individualized, patient-centered approach to prevention, assessment, and management of concussion. In most cases, the symptoms of concussion resolve in the initial few days following the injury, and a strategy involving a gradual return to sport and school is recommended. When symptoms persist for longer than 7 to 10 days, a multifaceted interdisciplinary assessment to guide treatment is recommended. This article applies the dynamic, recursive model of sport injury to sport-related concussion and summarizes the process of individualized assessment and management following concussion in athletes of all ages, with a focus on physical rehabilitation. J Orthop Sports Phys Ther 2019;49(11):799-810. doi:10.2519/jospt.2019.8926.
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Schneider KJ. Concussion part II: Rehabilitation - The need for a multifaceted approach. Musculoskelet Sci Pract 2019; 42:151-161. [PMID: 30745095 DOI: 10.1016/j.msksp.2019.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 12/09/2018] [Accepted: 01/15/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION While most individuals recover in the initial days to weeks following a concussion, in up to 30% of cases symptoms and functional limitations may persist beyond the initial four weeks. There is emerging evidence that multifaceted physiotherapy techniques for individuals who have ongoing symptoms following concussion may be of benefit. PURPOSE The purpose of this masterclass article is to summarize the evidence for rehabilitation, describe treatment techniques and multifaceted interventions following concussion. IMPLICATIONS Concussion is a heterogenous injury and multiple types of rehabilitation may be required to address ongoing alterations in function. A greater understanding of evidence based rehabilitative techniques will enable the clinician to direct treatment and facilitate recovery for individuals who have ongoing symptoms following concussion.
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Affiliation(s)
- Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, KNB3300D 2500 University Drive NW, University of Calgary, Calgary, Alberta, T2N 1N4, Canada.
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10
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Schneider KJ. Concussion - Part I: The need for a multifaceted assessment. Musculoskelet Sci Pract 2019; 42:140-150. [PMID: 31133539 DOI: 10.1016/j.msksp.2019.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Concussion is among the most commonly occurring sport and recreation injuries in today's society. An understanding of the heterogenous nature of concussion will assist in directing a multifaceted and comprehensive interdisciplinary assessment following injury. PURPOSE The purpose of this masterclass article is to summarize the current state of the evidence in the area of concussion, describe typical symptom presentations and assessment techniques that may assist in directing appropriate management following concussion. IMPLICATIONS A comprehensive assessment including a thoughtful differential diagnosis will assist the clinician to direct care appropriately and efficiently in individuals who have suffered a concussion.
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Affiliation(s)
- Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, University of Calgary, KNB3300D 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
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Purkayastha S, Stokes M, Bell KR. Autonomic nervous system dysfunction in mild traumatic brain injury: a review of related pathophysiology and symptoms. Brain Inj 2019; 33:1129-1136. [DOI: 10.1080/02699052.2019.1631488] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Sushmita Purkayastha
- Department of Applied Physiology and Wellness, Simmons School of Education and Human Development, Southern Methodist University, Dallas, TX, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mathew Stokes
- Department of Pediatrics/Division of Pediatric Neurology & Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kathleen R Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Begasse de Dhaem O, Barr WB, Balcer LJ, Galetta SL, Minen MT. Post-traumatic headache: the use of the sport concussion assessment tool (SCAT-3) as a predictor of post-concussion recovery. J Headache Pain 2017; 18:60. [PMID: 28560540 PMCID: PMC5449412 DOI: 10.1186/s10194-017-0767-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 05/15/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Given that post-traumatic headache is one of the most prevalent and long-lasting post-concussion sequelae, causes significant morbidity, and might be associated with slower neurocognitive recovery, we sought to evaluate the use of concussion screening scores in a concussion clinic population to assess for post-traumatic headache. METHODS This is a retrospective cross-sectional study of 254 concussion patients from the New York University (NYU) Concussion Registry. Data on the headache characteristics, concussion mechanism, concussion screening scores were collected and analyzed. RESULTS 72% of the patients had post-traumatic headache. About half (56.3%) were women. The mean age was 35 (SD 16.2). 90 (35%) patients suffered from sport-related concussions (SRC). Daily post-traumatic headache patients had higher Sport Concussion Assessment Tool (SCAT)-3 symptom severity scores than the non-daily post-traumatic headache and the headache-free patients (50.2 [SD 28.2] vs. 33.1 [SD 27.5] vs. 21.6 SD23], p < 0.001). Patients with SRC had lower headache intensity (4.47 [SD 2.5] vs. 6.24 [SD 2.28], p < 0.001) and SCAT symptom severity scores (33.9 [SD 27.4] vs. 51.4 [SD 27.7], p < 0.001) than the other patients, but there were no differences in post-traumatic headache prevalence, frequency, and Standardized Assessment of Concussion (SAC) scores. CONCLUSION The presence and frequency of post-traumatic headache are associated with the SCAT-3 symptom severity score, which is the most important predictor for post-concussion recovery. The SCAT-3 symptom severity score might be a useful tool to help characterize patients' post-traumatic headache.
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Affiliation(s)
- Olivia Begasse de Dhaem
- Department of Internal Medicine, New York University Langone Medical Center, New York, NY, USA.,Department of Neurology, Columbia University - New York Presbyterian Hospital, New York, NY, USA
| | - William B Barr
- Department of Neurology, New York University Langone Medical Center, 240 East 38th Street, New York, NY, USA
| | - Laura J Balcer
- Department of Neurology, New York University Langone Medical Center, 240 East 38th Street, New York, NY, USA
| | - Steven L Galetta
- Department of Neurology, New York University Langone Medical Center, 240 East 38th Street, New York, NY, USA
| | - Mia T Minen
- Department of Neurology, New York University Langone Medical Center, 240 East 38th Street, New York, NY, USA.
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American pediatric surgical association journal of pediatric surgery lecture. J Pediatr Surg 2017; 52:16-21. [PMID: 27836360 DOI: 10.1016/j.jpedsurg.2016.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/20/2016] [Indexed: 12/16/2022]
Abstract
Every year in the United States, 1.6 to 3.8 million concussions occur secondary to injuries sustained during sports and recreational activities. Major advances have been made in terms of identifying specific clinical profiles following concussion. Nevertheless, there are continued misunderstandings regarding this injury and variable clinical management strategies being employed that may result in protracted recovery periods for youth athletes. Therefore, it is essential that individualized treatment plans target the particular clinical profile(s) present following concussion. Further progress related to management of this injury depends on medical professionals working as part of multidisciplinary teams to provide appropriate education, accurate information, and treatments based on the identified clinical profiles. It is also important for medical professionals of all disciplines to stay vigilant toward future research and practice guidelines given the evolving nature of this injury.
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Junn C, Bell KR, Shenouda C, Hoffman JM. Symptoms of Concussion and Comorbid Disorders. Curr Pain Headache Rep 2015; 19:46. [DOI: 10.1007/s11916-015-0519-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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16
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Gardner RC, Possin KL, Hess CP, Huang EJ, Grinberg LT, Nolan AL, Cohn-Sheehy BI, Ghosh PM, Lanata S, Merrilees J, Kramer JH, Berger MS, Miller BL, Yaffe K, Rabinovici GD. Evaluating and treating neurobehavioral symptoms in professional American football players: Lessons from a case series. Neurol Clin Pract 2015; 5:285-295. [PMID: 26336629 PMCID: PMC4549717 DOI: 10.1212/cpj.0000000000000157] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In the aftermath of multiple high-profile cases of chronic traumatic encephalopathy (CTE) in professional American football players, physicians in clinical practice are likely to face an increasing number of retired football players seeking evaluation for chronic neurobehavioral symptoms. Guidelines for the evaluation and treatment of these patients are sparse. Clinical criteria for a diagnosis of CTE are under development. The contribution of CTE vs other neuropathologies to neurobehavioral symptoms in these players remains unclear. Here we describe the experience of our academic memory clinic in evaluating and treating a series of 14 self-referred symptomatic players. Our aim is to raise awareness in the neurology community regarding the different clinical phenotypes, idiosyncratic but potentially treatable symptoms, and the spectrum of underlying neuropathologies in these players.
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Affiliation(s)
- Raquel C Gardner
- Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA
| | - Katherine L Possin
- Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA
| | - Christopher P Hess
- Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA
| | - Eric J Huang
- Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA
| | - Lea T Grinberg
- Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA
| | - Amber L Nolan
- Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA
| | - Brendan I Cohn-Sheehy
- Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA
| | - Pia M Ghosh
- Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA
| | - Serggio Lanata
- Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA
| | - Jennifer Merrilees
- Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA
| | - Joel H Kramer
- Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA
| | - Mitchel S Berger
- Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA
| | - Bruce L Miller
- Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA
| | - Kristine Yaffe
- Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA
| | - Gil D Rabinovici
- Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA
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