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Sicard V, Ledoux AA, Tang K, Yeates KO, Brooks BL, Anderson P, Keightley M, Desire N, Beauchamp MH, Zemek R. The association between symptom burden and processing speed and executive functioning at 4 and 12 weeks following pediatric concussion. J Int Neuropsychol Soc 2024:1-13. [PMID: 38273645 DOI: 10.1017/s1355617724000043] [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: 01/27/2024]
Abstract
OBJECTIVES Symptoms and cognition are both utilized as indicators of recovery following pediatric concussion, yet their interrelationship is not well understood. This study aimed to investigate: 1) the association of post-concussion symptom burden and cognitive outcomes (processing speed and executive functioning [EF]) at 4 and 12 weeks after pediatric concussion, and 2) the moderating effect of sex on this association. METHODS This prospective, multicenter cohort study included participants aged 5.00-17.99 years with acute concussion presenting to four Emergency Departments of the Pediatric Emergency Research Canada network. Five processing speed and EF tasks and the Post-Concussion Symptom Inventory (PCSI; symptom burden, defined as the difference between post-injury and retrospective [pre-injury] scores) were administered at 4 and 12 weeks post-concussion. Generalized least squares models were conducted with task performances as dependent variables and PCSI and PCSI*sex interaction as the main predictors, with important pre-injury demographic and injury characteristics as covariates. RESULTS 311 children (65.0% males; median age = 11.92 [IQR = 9.14-14.21 years]) were included in the analysis. After adjusting for covariates, higher symptom burden was associated with lower Backward Digit Span (χ2 = 9.85, p = .043) and Verbal Fluency scores (χ2 = 10.48, p = .033) across time points; these associations were not moderated by sex, ps ≥ .20. Symptom burden was not associated with performance on the Coding, Continuous Performance Test, and Color-Word Interference scores, ps ≥ .17. CONCLUSIONS Higher symptom burden is associated with lower working memory and cognitive flexibility following pediatric concussion, yet these associations were not moderated by sex. Findings may inform concussion management by emphasizing the importance of multifaceted assessments of EF.
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Affiliation(s)
- Veronik Sicard
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Andrée-Anne Ledoux
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ken Tang
- Independent Statistical Consultant, Richmond, BC, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Brian L Brooks
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Peter Anderson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Mental Health Neuropsychology Program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Michelle Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, TorontoON, Canada
- Departments of Occupational Science and Occupational Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Naddley Desire
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, QC, Canada
- Ste-Justine Hospital Research Center, Montreal, QC, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
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Hou X, Zhang Y, Fei X, Zhou Q, Li J. Sports-Related Concussion Affects Cognitive Function in Adolescents: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:3604-3618. [PMID: 36799499 DOI: 10.1177/03635465221142855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Rates of sports-related concussion (SRC) are high in adolescents. Ambiguity exists regarding the effect of SRC on cognitive function in adolescents. PURPOSE To rigorously examine adolescents' cognitive function after SRC. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS Web of Science, Scopus, and PubMed were searched from database inception until September 2021. Studies were included if participants were adolescents aged 13 to 18 years, if the definition of SRC was fully consistent with the Berlin Consensus Statement on Concussion in Sport, if the study included a control group or in-group baseline test, and if the study reported cognitive outcomes (eg, visual memory, processing speed) that could be separately extracted. RESULTS A total of 47 studies were included in the systematic review, of which 31 were included in the meta-analysis, representing 8877 adolescents with SRC. Compared with individuals in the non-SRC group, individuals with SRC had worse performance in cognitive function and reported more symptoms not only in the acute phase but also in the prolonged phase (1-6 months after injury) (visual memory: d = -0.21, 95% CI, -0.37 to -0.05, P = .012; executive function: d = -0.56, 95% CI, -1.07 to -0.06, P = .028; and symptoms: d = 1.17, 95% CI, 0.13 to 2.22, P = .028). Lower scores in most of the outcomes of cognitive function were observed at <3 days and at 3 to 7 days, but higher scores for verbal memory (d = 0.10; 95% CI, 0.03 to 0.17; P = .008) and processing speed (d = 0.17; 95% CI, 0.10 to 0.24; P < .001) were observed at 7 to 14 days after SRC relative to baseline. The effects of SRC on cognitive function decreased over time (100% of the variance in reaction time, P < .001; 99.94% of the variance in verbal memory, P < .001; 99.88% of the variance in visual memory, P < .001; 39.84% of the variance in symptoms, P = .042) in control group studies. Study design, participant sex, measurement tools, and concussion history were found to be modulators of the relationship between cognitive function and SRC. CONCLUSION This study revealed that adolescent cognitive function is impaired by SRC even 1 to 6 months after injury. Results of this study point to the need for tools to measure cognitive function with multiple parallel versions that have demographically diversiform norms in adolescents. Effective prevention of SRC, appropriate treatment, and adequate evaluation of cognitive function before return to play are needed in adolescent SRC management. Moreover, caution is warranted when using the baseline-to-postconcussion paradigm in return-to-play decisions.
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Affiliation(s)
- Xianyun Hou
- School of Psychology, Beijing Sport University, Beijing, China
| | - Yu Zhang
- School of Psychology, Beijing Sport University, Beijing, China
| | - Xueyin Fei
- Sport Science School, Beijing Sport University, Beijing, China
| | - Qian Zhou
- School of Psychology, Beijing Sport University, Beijing, China
| | - Jie Li
- Center for Cognition and Brain Disorders, the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China
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Using a Likelihood Heuristic to Summarize Conflicting Literature on Predictors of Clinical Outcome Following Sport-Related Concussion. Clin J Sport Med 2021; 31:e476-e483. [PMID: 32941376 DOI: 10.1097/jsm.0000000000000825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/29/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To introduce a new methodology for summarizing the results from systematic reviews-a likelihood heuristic-to the field of sport-related concussion. DATA SOURCES We applied the likelihood heuristic to the results of a systematic review published by Iverson et al (2017), containing 101 studies, on the predictors of worse clinical outcome following sport-related concussion. STUDY SELECTION We re-examined 5 individual prognostic factors that are of clinical interest and for which there is conflicting literature (female sex = 44 studies, prior concussion history = 41 studies, loss of consciousness = 31 studies, post-traumatic amnesia = 25 studies, and retrograde amnesia = 10 studies). DATA EXTRACTION For each prognostic factor, likelihood ratios were generated using the (1) number of significant and nonsignificant studies, (2) study power, (3) alpha level, and (4) prior probability that the alternative hypothesis was true. DATA SYNTHESIS Assuming each study had 80% power and an alpha level of 5%, observing the reported number of conflicting studies for female sex, prior concussion history, and retrograde amnesia is substantially more likely if each prognostic factor is associated with worse clinical outcome following sport-related concussion. For loss of consciousness, the observed number of conflicting studies is more likely if loss of consciousness is not associated with worse clinical outcome following sport-related concussion. A secondary analysis incorporating potentially more realistic study parameters of statistical power (45%) and alpha level (25%) generates weaker likelihood evidence that the observed numbers of studies for each prognostic factor are associated with worse clinical outcome following sport-related concussion than they are not. CONCLUSIONS Using a likelihood heuristic with 80% power and 5% alpha level, there is very strong likelihood evidence that female sex, prior concussion history, and retrograde amnesia are associated with worse clinical outcome following sport-related concussion. The strength of likelihood evidence that prognostic factors are associated with worse clinical outcome reduces when statistical power is lower and alpha level is inflated.
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4
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Caffey AL, Dalecki M. Evidence of residual cognitive deficits in young adults with a concussion history from adolescence. Brain Res 2021; 1768:147570. [PMID: 34216582 DOI: 10.1016/j.brainres.2021.147570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 05/17/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022]
Abstract
The present study investigated executive function and sustained attention of non-athlete, young adults (ages 18-23) with a history of concussion beyond ten months post incident. Cognitive functioning was examined in 24 non-athletic, college students with a concussion history (mean age 21 yrs.; mean time and range post-injury: 4 years, 10-90 months) and 24 non-athletic controls with no history (NH) of concussion. Computerized versions of two cognitive assessment techniques were utilized to examine executive functioning (Stroop) and sustained attention capacity (D2). Primary dependent variables were response time, error score, and sustained attention score. Relationships between dependent variables and concussion metrics were also analyzed. ANOVA's revealed a significantly higher error rate in concussion history (CH) participants when performing the Stroop task (p < 0.05), including a trend for greater errors in the incongruent task condition (p < 0.05). Group measures did not differ in the sustained attention test (all p > 0.05). Nevertheless, there was a significant relationship between D2 error rate and time since concussion (p < 0.01), showing that D2 error rate was greater for participants with more time since concussion sustainment. Our findings indicate the potential for prolonged cognitive dysfunction linked to decision-making, but not to processing speed, in young adult non-athletes with a CH averaging four years post-injury. These findings may provide evidence of residual cognitive deficits in young adults with a concussion history over time.
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Affiliation(s)
- Abigail L Caffey
- School of Kinesiology, Louisiana State University, Baton Rouge, USA
| | - Marc Dalecki
- School of Kinesiology, Louisiana State University, Baton Rouge, USA.
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5
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Xu X, Cowan M, Beraldo F, Schranz A, McCunn P, Geremia N, Brown Z, Patel M, Nygard KL, Khazaee R, Lu L, Liu X, Strong MJ, Dekaban GA, Menon R, Bartha R, Daley M, Mao H, Prado V, Prado MAM, Saksida L, Bussey T, Brown A. Repetitive mild traumatic brain injury in mice triggers a slowly developing cascade of long-term and persistent behavioral deficits and pathological changes. Acta Neuropathol Commun 2021; 9:60. [PMID: 33823944 PMCID: PMC8025516 DOI: 10.1186/s40478-021-01161-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/17/2021] [Indexed: 12/15/2022] Open
Abstract
We have previously reported long-term changes in the brains of non-concussed varsity rugby players using magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI) and functional magnetic imaging (fMRI). Others have reported cognitive deficits in contact sport athletes that have not met the diagnostic criteria for concussion. These results suggest that repetitive mild traumatic brain injuries (rmTBIs) that are not severe enough to meet the diagnostic threshold for concussion, produce long-term consequences. We sought to characterize the neuroimaging, cognitive, pathological and metabolomic changes in a mouse model of rmTBI. Using a closed-skull model of mTBI that when scaled to human leads to rotational and linear accelerations far below what has been reported for sports concussion athletes, we found that 5 daily mTBIs triggered two temporally distinct types of pathological changes. First, during the first days and weeks after injury, the rmTBI produced diffuse axonal injury, a transient inflammatory response and changes in diffusion tensor imaging (DTI) that resolved with time. Second, the rmTBI led to pathological changes that were evident months after the injury including: changes in magnetic resonance spectroscopy (MRS), altered levels of synaptic proteins, behavioural deficits in attention and spatial memory, accumulations of pathologically phosphorylated tau, altered blood metabolomic profiles and white matter ultrastructural abnormalities. These results indicate that exceedingly mild rmTBI, in mice, triggers processes with pathological consequences observable months after the initial injury.
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6
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Urban K, Schudlo L, Keightley M, Alain S, Reed N, Chau T. Altered Brain Activation in Youth following Concussion: Using a Dual-task Paradigm. Dev Neurorehabil 2021; 24:187-198. [PMID: 33012188 DOI: 10.1080/17518423.2020.1825539] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A concussion is known as a functional injury affecting brain communication, integration, and processing. There is a need to objectively measure how concussions disrupt brain activation while completing ecologically relevant tasks.The objective of this study was to compare brain activation patterns between concussion and comparison groups (non-concussed youth) during a cognitive-motor single and dual-task paradigm utilizing functional near-infrared spectroscopy (fNIRS) in regions of the frontal-parietal attention network and compared to task performance.Youth with concussion generally exhibited hyperactivation and recruitment of additional brain regions in the dorsal lateral prefrontal (DLPFC), superior (SPC) and inferior parietal cortices (IPC), which are associated with processing, information integration, and response selection. Additionally, hyper- or hypo-activation patterns were associated with slower processing speed on the cognitive task. Our findings corroborate the growing literature suggesting that neural recovery may be delayed compared to the restoration of behavioral performance post-concussion.Concussion, near-infrared spectroscopy, dual-task paradigm, cognitive, motor, brain activation.
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Affiliation(s)
- Karolina Urban
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Science Institute, University of Toronto, Toronto, Canada
| | - Larissa Schudlo
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.,Electrical, Computer and Biomedical Engineering Department, Ryerson University, Toronto, Canada
| | | | - Sam Alain
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Nick Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Science Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Tom Chau
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
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7
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Avedesian JM, Covassin T, Dufek JS. Landing Biomechanics in Adolescent Athletes With and Without a History of Sports-Related Concussion. J Appl Biomech 2020; 36:313-318. [PMID: 32736340 DOI: 10.1123/jab.2020-0034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/07/2020] [Accepted: 05/13/2020] [Indexed: 11/18/2022]
Abstract
Recent evidence suggests previously concussed athletes are at greater risk for lower-extremity (LE) injuries than are controls. However, little is known regarding the influence of sports-related concussion (SRC) on landing biomechanics that may provide a mechanistic rationale for LE injury risk. The purpose of this investigation was to examine LE drop-landing biomechanics in adolescent athletes with and without a previous SRC history. Participants included 10 adolescent athletes with an SRC history and 11 controls from multiple sports. Three-dimensional kinematic and kinetic data associated with LE injury risk were analyzed across 5 trials for 30- and 60-cm landing heights. Multivariate analyses indicated group differences in landing patterns from the 30- (P = .041) and 60-cm (P = .015) landing heights. Follow-up analyses indicated that concussed adolescent athletes demonstrated significantly less ankle dorsiflexion and knee flexion versus controls when performing drop landings. Our findings suggest that previously concussed adolescent athletes complete drop-landing maneuvers with ankle and knee joint kinematic patterns that suggest greater risk for LE injury. While limitations such as sport variety and explicit LE injury history are present, the results of this study provide a possible biomechanical rationale for the association between SRC and LE injury risk.
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8
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Oldham JR, Howell DR, Bryk KN, Lanois CJ, Koerte IK, Meehan WP, Buckley TA. No differences in tandem gait performance between male and female athletes acutely post-concussion. J Sci Med Sport 2020; 23:814-819. [PMID: 32336568 DOI: 10.1016/j.jsams.2020.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/27/2020] [Accepted: 04/03/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To test whether 1) concussed athletes demonstrate slower tandem gait times compared to controls and 2) concussed female athletes display greater post-injury deficits than males. DESIGN Prospective longitudinal METHOD: Fifty concussed collegiate student-athletes (32% female, age=20.18±1.27 years) completed tandem gait tests during pre-season (Time 1) and acutely (<72hours) post-concussion (Time 2), and twenty-five controls (52% female, age=21.08±2.22 years) completed tandem gait at two time points, 1.96±0.46 days apart. Participants completed four single-task (ST) and dual-task (DT) trials. During DT trials, they simultaneously completed a cognitive assessment. The best ST and DT times were recorded, along with cognitive accuracy, and the change score between the two assessments was calculated. A positive change in tandem gait time was indicative of worsening performance. A 2×2 (group*sex) ANOVA was used to examine change between pre-injury and post-injury tests for ST/DT tandem gait time and DT cognitive accuracy. RESULTS The change in tandem gait time from Time 1 to Time 2 was significantly higher for the concussion group relative to controls during both ST (Concussion: 1.36±2.6 seconds, Controls: -1.16±0.8 seconds, p<0.001) and DT (Concussion: 1.70±3.8 seconds, Controls: -0.94±1.7 seconds, p=0.002) tandem gait. There were no interactions or main effects of sex for tandem gait time or cognitive accuracy. CONCLUSIONS There were no sex-specific differences in the change in tandem gait performance among concussed collegiate athletes or controls. However, all concussed participants, regardless of sex, performed significantly worse on tandem gait than male and female controls, who both improved between testing time points.
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Affiliation(s)
- Jessie R Oldham
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA.
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA; Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kelsey N Bryk
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA; Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, USA
| | - Corey J Lanois
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
| | - Inga K Koerte
- Department of Child and Adolescent Psychiatry, Psychomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA; Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, USA
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9
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Gupte R, Brooks W, Vukas R, Pierce J, Harris J. Sex Differences in Traumatic Brain Injury: What We Know and What We Should Know. J Neurotrauma 2019; 36:3063-3091. [PMID: 30794028 PMCID: PMC6818488 DOI: 10.1089/neu.2018.6171] [Citation(s) in RCA: 250] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There is growing recognition of the problem of male bias in neuroscience research, including in the field of traumatic brain injury (TBI) where fewer women than men are recruited to clinical trials and male rodents have predominantly been used as an experimental injury model. Despite TBI being a leading cause of mortality and disability worldwide, sex differences in pathophysiology and recovery are poorly understood, limiting clinical care and successful drug development. Given growing interest in sex as a biological variable affecting injury outcomes and treatment efficacy, there is a clear need to summarize sex differences in TBI. This scoping review presents an overview of current knowledge of sex differences in TBI and a comparison of human and animal studies. We found that overall, human studies report worse outcomes in women than men, whereas animal studies report better outcomes in females than males. However, closer examination shows that multiple factors including injury severity, sample size, and experimental injury model may differentially interact with sex to affect TBI outcomes. Additionally, we explore how sex differences in mitochondrial structure and function might contribute to possible sex differences in TBI outcomes. We propose recommendations for future investigations of sex differences in TBI, which we hope will lead to improved patient management, prognosis, and translation of therapies from bench to bedside.
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Affiliation(s)
- Raeesa Gupte
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas
| | - William Brooks
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
- Hoglund Brain Center, University of Kansas Medical Center, Kansas City, Kansas
- The University of Kansas Clinical and Translational Sciences Institute, University of Kansas Medical Center, Kansas City, Kansas
| | - Rachel Vukas
- School of Medicine, Dykes Library of Health Sciences, University of Kansas Medical Center, Kansas City, Kansas
| | - Janet Pierce
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Janna Harris
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas
- Hoglund Brain Center, University of Kansas Medical Center, Kansas City, Kansas
- Address correspondence to: Janna Harris, PhD, Hoglund Brain Imaging Center, MS 1052, 3901 Rainbow Boulevard, Kansas City, KS 66160
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Zuckerman SL, Brett BL, Jeckell AS, Yengo-Kahn AM, Solomon GS. Prognostic Factors in Pediatric Sport-Related Concussion. Curr Neurol Neurosci Rep 2018; 18:104. [PMID: 30397831 DOI: 10.1007/s11910-018-0909-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Sport-related concussion (SRC) and mild traumatic brain injury (mTBI) have been thrust into the national spotlight, with youth athletes bearing the burden of this public health problem. The current review aims to provide a practical summary of pediatric SRC, including key terminology, return to play/school, and risk factors for post-concussion syndrome (PCS). RECENT FINDINGS While the majority of youth athletes recover within 2 to 4 weeks, approximately 10% of athletes experience a protracted recovery with symptoms lasting months, impacting social, scholastic, and sporting activities. In the pediatric population, the strongest predictors of PCS are initial symptom burden and prior concussion, with mixed results behind the factors of gender, headaches, and learning disability. The role of psychiatric, family history, sports, and socioeconomic factors remain in their infancy.
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Affiliation(s)
- Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North T-4224, Nashville, TN, 37212, USA.
| | - Benjamin L Brett
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aaron S Jeckell
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North T-4224, Nashville, TN, 37212, USA
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North T-4224, Nashville, TN, 37212, USA.,Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA
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11
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Taranto E, Fishman M, Garvey K, Perlman M, Benjamin HJ, Ross LF. Public Attitudes and Knowledge About Youth Sports Participation and Concussion Risk in an Urban Area. J Natl Med Assoc 2018; 110:635-643. [PMID: 30376961 DOI: 10.1016/j.jnma.2018.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 06/13/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Every year, millions of children in the United States participate in youth full-contact sports, which carry concussion risks-the long-term sequelae of which are not well understood. We examined the attitudes and knowledge of adults in Chicago about youth sports participation, concussion risk, and whether physicians should counsel against youth participation in full-contact sports. METHODS An anonymous paper survey featuring 13 attitudinal, 13 demographic, and 9 knowledge questions was distributed to a convenience sample of adults ≥18 years in hospital waiting areas and four Chicago parks. Participants were asked to hypothetically consider themselves the parent of a 10-year-old child regarding attitudes towards full-contact sports participation. RESULTS Between June 13 and July 27, 2016, 1091 partial or complete valid surveys were collected. Almost half (46%) of respondents would not allow a hypothetical 10-year-old son to play tackle football. The majority (74%) of respondents agreed that it was appropriate for physicians to counsel against youth participation in full-contact sports. Respondents obtained information about concussions from, on average, 2-3 sources, although only 34% received information from physicians. Respondents demonstrated a high concussion knowledge level (average: 6.75 of 9 questions). However, only 39% of respondents correctly answered that the following statement was false: "After a mild concussion, there are usually visible changes on medical imaging". CONCLUSIONS Overall, respondents are well-informed about concussions. They are divided about the participation of youth in full-contact sports and are amenable to physician counseling against youth participation in full-contact sports.
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Affiliation(s)
- Eleanor Taranto
- Pritzker School of Medicine, University of Chicago 924 E 57th St., Chicago, IL, 60637, USA
| | - Michael Fishman
- Pritzker School of Medicine, University of Chicago 924 E 57th St., Chicago, IL, 60637, USA
| | - Katherine Garvey
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | - Meryl Perlman
- Massachusetts General Hospital for Children, Department of Pediatric Gastroenterology & Nutrition, 55 Fruit Street, 6B, Boston, MA, 02114, USA
| | - Holly J Benjamin
- Department of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA; Department of Pediatrics, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Lainie Friedman Ross
- Department of Pediatrics, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA; MacLean Center for Clinical Medical Ethics, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
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12
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The long-term outcomes of sport-related concussion in pediatric populations. Int J Psychophysiol 2018; 132:14-24. [DOI: 10.1016/j.ijpsycho.2018.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/08/2018] [Accepted: 04/04/2018] [Indexed: 12/14/2022]
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Josman N, Meyer S. Conceptualisation and use of executive functions in paediatrics: A scoping review of occupational therapy literature. Aust Occup Ther J 2018; 66:77-90. [DOI: 10.1111/1440-1630.12525] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Naomi Josman
- Department of Occupational Therapy; Faculty of Social Welfare & Health Sciences; University of Haifa; Haifa Israel
| | - Sonya Meyer
- Laboratory of Complex Human Activity and Participation (CHAP); Department Occupational Therapy; Faculty of Social Welfare & Health Sciences; University of Haifa; Haifa Israel
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Haider MN, Leddy JJ, Pavlesen S, Kluczynski M, Baker JG, Miecznikowski JC, Willer BS. A systematic review of criteria used to define recovery from sport-related concussion in youth athletes. Br J Sports Med 2018; 52:1179-1190. [PMID: 28735282 PMCID: PMC5818323 DOI: 10.1136/bjsports-2016-096551] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The Concussion in Sport Group guidelines recommend a multifaceted approach to help clinicians make return to sport decisions. The purpose of this study was to identify the most common multifaceted measures used to define clinical recovery from sport-related concussion in young athletes (high school and/or college level) and to summarise existing knowledge of criteria used to make return to sport decisions. DESIGN Systematic review. DATA SOURCES The PubMed (MEDLINE), SPORTDiscus and Embase electronic databases were searched from 1 January 2000 to 1 March 2017 by three independent reviewers. ELIGIBILITY CRITERIA Inclusion criteria: elementary, high school and college age groups, and a specific definition of clinical recovery that required two or more measures. EXCLUSION CRITERIA review articles, articles using the same sample population, case studies, non-English language and those that used one measure only or did not specify the recovery measures used. STUDY QUALITY Study quality was assessed using the Downs and Black Criteria. RESULTS Of 2023 publications, 43 met inclusion criteria. Included articles reported the following measures of recovery: somatic symptom resolution or return to baseline (100%), cognitive recovery or return to baseline (86%), no exacerbation of symptoms on physical exertion (49%), normalisation of balance (30%), normal special physical examination (12%), successful return to school (5%), no exacerbation of symptoms with cognitive exertion (2%) and normalisation of cerebral blood flow (2%). Follow-up to validate the return to sport decision was reported in eight (19%) articles. Most studies were case-control or cohort (level of evidence 4) and had significant risk of bias. CONCLUSION All studies of sport-related concussion use symptom reports to define recovery. A minority of studies used multiple measures of outcome or had clearly defined recovery criteria, the most common being a combination of a self-reported symptom checklist and a computerised neurocognitive test. Future studies ideally should define recovery a priori using objective physiological measures in addition to symptom reports.
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Affiliation(s)
- Mohammad N Haider
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Department of Psychiatry
| | - John J Leddy
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, UBMB Department of Orthopaedics and Sports Medicine
| | - Sonja Pavlesen
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, UBMB Department of Orthopaedics and Sports Medicine
| | - Melissa Kluczynski
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, UBMB Department of Orthopaedics and Sports Medicine
| | - John G Baker
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, UBMB Department of Orthopaedics and Sports Medicine
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Department of Nuclear Medicine
| | | | - Barry S Willer
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Department of Psychiatry
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Howell DR, Brilliant A, Berkstresser B, Wang F, Fraser J, Meehan WP. The Association between Dual-Task Gait after Concussion and Prolonged Symptom Duration. J Neurotrauma 2017; 34:3288-3294. [DOI: 10.1089/neu.2017.5191] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David R. Howell
- Sports Medicine Center, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts
| | - Anna Brilliant
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts
| | | | - Francis Wang
- Harvard University Health Service, Cambridge, Massachusetts
| | - Joana Fraser
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts
| | - William P. Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts
- Departments of Pediatrics and Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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16
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Iverson GL, Gardner AJ, Terry DP, Ponsford JL, Sills AK, Broshek DK, Solomon GS. Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med 2017; 51:941-948. [PMID: 28566342 PMCID: PMC5466929 DOI: 10.1136/bjsports-2017-097729] [Citation(s) in RCA: 574] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE A systematic review of factors that might be associated with, or influence, clinical recovery from sport-related concussion. Clinical recovery was defined functionally as a return to normal activities, including school and sports, following injury. DESIGN Systematic review. DATA SOURCES PubMed, PsycINFO, MEDLINE, CINAHL, Cochrane Library, EMBASE, SPORTDiscus, Scopus and Web of Science. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies published by June of 2016 that addressed clinical recovery from concussion. RESULTS A total of 7617 articles were identified using the search strategy, and 101 articles were included. There are major methodological differences across the studies. Many different clinical outcomes were measured, such as symptoms, cognition, balance, return to school and return to sports, although symptom outcomes were the most frequently measured. The most consistent predictor of slower recovery from concussion is the severity of a person's acute and subacute symptoms. The development of subacute problems with headaches or depression is likely a risk factor for persistent symptoms lasting greater than a month. Those with a preinjury history of mental health problems appear to be at greater risk for having persistent symptoms. Those with attention deficit hyperactivity disorder (ADHD) or learning disabilities do not appear to be at substantially greater risk. There is some evidence that the teenage years, particularly high school, might be the most vulnerable time period for having persistent symptoms-with greater risk for girls than boys. CONCLUSION The literature on clinical recovery from sport-related concussion has grown dramatically, is mostly mixed, but some factors have emerged as being related to outcome.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA
- Sport Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - Andrew J Gardner
- Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Douglas P Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA
- Sport Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - Jennie L Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Allen K Sills
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Donna K Broshek
- Department of Psychiatry & Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Gary S Solomon
- Departments of Neurological Surgery, Orthopaedic Surgery & Rehabilitation, and Psychiatry & Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Howell DR, Stracciolini A, Geminiani E, Meehan WP. Dual-task gait differences in female and male adolescents following sport-related concussion. Gait Posture 2017; 54:284-289. [PMID: 28384609 DOI: 10.1016/j.gaitpost.2017.03.034] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/27/2017] [Accepted: 03/30/2017] [Indexed: 02/02/2023]
Abstract
Concussion may affect females and males differentially. Identification of gender-related differences after concussion, therefore, may help clinicians with individualized evaluations. We examined potential differences in dual-task gait between females and males after concussion. Thirty-five participants diagnosed with a concussion (49% female, mean age=15.0±2.1 years, 7.5±3.0 days post-injury) and 51 controls (51% female, mean age=14.4±2.1 years) completed a symptom inventory and single/dual-task gait assessment. The primary outcome variable, the dual-task cost, was calculated as the percent change between single-task and dual-task conditions to account for individual differences in spatio-temporal gait variables. No significant differences in symptom severity measured by the post-concussion symptom scale were observed between females (32.0±18.0) and males (27.8±18.2). Compared with males, adolescent females walked with significantly decreased cadence dual-task costs after concussion (-19.7%±10.0% vs. -11.3%±9.2%, p=0.007) when adjusted for age, height, and prior concussion history. No significant differences were found between female and male control groups on other dual-task cost gait measures. Females and males with concussion also walked with significantly shorter stride lengths than controls during single-task (females: 1.13±0.11m vs. 1.26±0.11m, p=0.001; males: 1.14±0.14m vs. 1.22±0.15m, p=0.04) and dual-task gait (females: 0.99±0.10m vs. 1.10±0.11m, p=0.001; males: 1.00±0.13m vs. 1.08±0.14m, p=0.04). Females demonstrated a significantly greater amount of cadence change between single-task and dual-task gait than males after a sport-related concussion. Thus, differential alterations may exist during gait among those with a concussion; gender may be one prominent factor affecting dual-task gait.
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Affiliation(s)
- David R Howell
- The Micheli Center for Sports Injury Prevention, Waltham, MA, United States; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA, United States; Brain Injury Center, Boston Children's Hospital, Boston, MA, United States.
| | - Andrea Stracciolini
- The Micheli Center for Sports Injury Prevention, Waltham, MA, United States; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Ellen Geminiani
- The Micheli Center for Sports Injury Prevention, Waltham, MA, United States; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, United States; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA, United States; Brain Injury Center, Boston Children's Hospital, Boston, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States; Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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