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Reuter-Rice K, Fitterer AN, Duquette P, Yang Q, Palipana AK, Laskowitz D, Garrett ME, Fletcher M, Smith J, Makor L, Grant G, Ramsey K, Bloom OJ, Ashley-Koch AE. A study protocol for risk stratification in children with concussion (RSiCC): Theoretical framework, design, and methods. PLoS One 2024; 19:e0306399. [PMID: 39024215 PMCID: PMC11257289 DOI: 10.1371/journal.pone.0306399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 06/14/2024] [Indexed: 07/20/2024] Open
Abstract
Research shows that one in five children will experience a concussion by age 16. Compared to adults, children experience longer and more severe postconcussive symptoms (PCS), with severity and duration varying considerably among children and complicating management of these patients. Persistent PCS can result in increased school absenteeism, social isolation, and psychological distress. Although early PCS diagnosis and access to evidence-based interventions are strongly linked to positive health and academic outcomes, symptom severity and duration are not fully explained by acute post-injury symptoms. Prior research has focused on the role of neuroinflammation in mediating PCS and associated fatigue; however relationship between inflammatory biomarkers and PCS severity, has not examined longitudinally. To identify which children are at high risk for persistent PCS and poor health, academic, and social outcomes, research tracking PCS trajectories and describing school-based impacts across the entire first year postinjury is critically needed. This study will 1) define novel PCS trajectory typologies in a racially/ethnically diverse population of 500 children with concussion (11-17 years, near equal distribution by sex), 2) identify associations between these typologies and patterns of inflammatory biomarkers and genetic variants, 3) develop a risk stratification model to identify children at risk for persistent PCS; and 4) gain unique insights and describe PCS impact, including fatigue, on longer-term academic and social outcomes. We will be the first to use NIH's symptom science model and patient-reported outcomes to explore the patterns of fatigue and other physical, cognitive, psychological, emotional and academic responses to concussion in children over a full year. Our model will enable clinicians and educators to identify children most at risk for poor long-term health, social, and academic outcomes after concussion. This work is critical to meeting our long-term goal of developing personalized concussion symptom-management strategies to improve outcomes and reduce disparities in the health and quality of life of children.
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Affiliation(s)
- Karin Reuter-Rice
- Duke University School of Nursing, Durham, North Carolina, United States of America
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States of America
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Amanda N. Fitterer
- Duke University School of Nursing, Durham, North Carolina, United States of America
| | - Peter Duquette
- Department of Physical Medicine & Rehabilitation, Univeristy of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Qing Yang
- Duke University School of Nursing, Durham, North Carolina, United States of America
| | - Anushka K. Palipana
- Duke University School of Nursing, Durham, North Carolina, United States of America
| | - Daniel Laskowitz
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Melanie E. Garrett
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina, United States of America
| | - Margaret Fletcher
- Duke University School of Nursing, Durham, North Carolina, United States of America
| | - Julia Smith
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina, United States of America
| | - Lynn Makor
- Department of Public Instruction, State of North Carolina, Office of Exceptional Children, Raleigh, North Carolina, United States of America
| | - Gerald Grant
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Kristen Ramsey
- Duke University Health System, Carolina Family Practice and Sports Medicine, Carolina Sports Concussion Clinic, Cary, North Carolina, United States of America
| | - O. Josh Bloom
- Duke University Health System, Carolina Family Practice and Sports Medicine, Carolina Sports Concussion Clinic, Cary, North Carolina, United States of America
| | - Allison E. Ashley-Koch
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina, United States of America
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von Steinbuechel N, Krenz U, Bockhop F, Koerte IK, Timmermann D, Cunitz K, Zeldovich M, Andelic N, Rojczyk P, Bonfert MV, Berweck S, Kieslich M, Brockmann K, Roediger M, Lendt M, Buchheim A, Muehlan H, Holloway I, Olabarrieta-Landa L. A Multidimensional Approach to Assessing Factors Impacting Health-Related Quality of Life after Pediatric Traumatic Brain Injury. J Clin Med 2023; 12:3895. [PMID: 37373590 DOI: 10.3390/jcm12123895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
In the field of pediatric traumatic brain injury (TBI), relationships between pre-injury and injury-related characteristics and post-TBI outcomes (functional recovery, post-concussion depression, anxiety) and their impact on disease-specific health-related quality of life (HRQoL) are under-investigated. Here, a multidimensional conceptual model was tested using a structural equation model (SEM). The final SEM evaluates the associations between these four latent variables. We retrospectively investigated 152 children (8-12 years) and 148 adolescents (13-17 years) after TBI at the recruiting clinics or online. The final SEM displayed a fair goodness-of-fit (SRMR = 0.09, RMSEA = 0.08 with 90% CI [0.068, 0.085], GFI = 0.87, CFI = 0.83), explaining 39% of the variance across the four latent variables and 45% of the variance in HRQoL in particular. The relationships between pre-injury and post-injury outcomes and between post-injury outcomes and TBI-specific HRQoL were moderately strong. Especially, pre-injury characteristics (children's age, sensory, cognitive, or physical impairments, neurological and chronic diseases, and parental education) may aggravate post-injury outcomes, which in turn may influence TBI-specific HRQoL negatively. Thus, the SEM comprises potential risk factors for developing negative post-injury outcomes, impacting TBI-specific HRQoL. Our findings may assist healthcare providers and parents in the management, therapy, rehabilitation, and care of pediatric individuals after TBI.
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Affiliation(s)
- Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Ugne Krenz
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Fabian Bockhop
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Inga K Koerte
- cBRAIN/Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital, Ludwig-Maximilian University, Nussbaumstrasse 5, 80336 Munich, Germany
| | - Dagmar Timmermann
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Katrin Cunitz
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Nada Andelic
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Department of Health and Society, University of Oslo, 0316 Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
| | - Philine Rojczyk
- cBRAIN/Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital, Ludwig-Maximilian University, Nussbaumstrasse 5, 80336 Munich, Germany
| | - Michaela Veronika Bonfert
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU University Hospital, Haydnstr. 5, 80336 Munich, Germany
| | - Steffen Berweck
- Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Klinik, Krankenhausstraße 20, 83569 Vogtareuth, Germany
| | - Matthias Kieslich
- Department of Paediatric Neurology, Hospital of Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Knut Brockmann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Maike Roediger
- Department of Pediatric Intensive Care Medicine and Neonatology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Michael Lendt
- Neuropediatrics, St. Mauritius Therapeutic Clinic, Strümper Straße 111, 40670 Meerbusch, Germany
| | - Anna Buchheim
- Institut für Psychologie, Universität Innsbruck, Innrain 52 f, 6020 Innsbruck, Austria
| | - Holger Muehlan
- Department of Health and Prevention, University of Greifswald, Robert-Blum-Str. 13, 17487 Greifswald, Germany
| | - Ivana Holloway
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Laiene Olabarrieta-Landa
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Campus de Arrosadía, 31006 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
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Hess CW, Howland J, Hackman H, Campbell JK, Vannoy S, Hayden L. Implementation of Concussion Management Policies in High Schools: The Critical Role of School Nurses. J Sch Nurs 2023:10598405231160249. [PMID: 36916285 DOI: 10.1177/10598405231160249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Evidence-based practices in concussion management (CM) have been codified into legislation. However, legislation is varied, and implementation is narrowly evaluated. School nurses hold a unique position to assess the implementation of health policies. The implementation of concussion management policies across Massachusetts high schools was evaluated by the school nurse. A cross-sectional survey was sent to school nurses (N = 304), and responses (n = 201; 68.1% response rate) were tallied whereby higher scores indicated more practices being implemented. One open-text question was included to encourage nurses to provide context regarding implementation in their school. Descriptive statistics and thematic analysis were used to assess current implementation and nursing perspectives. Findings indicate that the degree of implementation varies, and some nurses reported difficulty with mobilizing clinical uptake of concussion management practices in their schools. Further implementation research is needed, and school nurses are an important stakeholder to include when assessing the clinical uptake of concussion management policies in schools.
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Affiliation(s)
- Courtney W Hess
- Counseling & School Psychology, 14708University of Massachusetts Boston, Boston, MA, USA
| | - Jonathan Howland
- Emergency Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.,1836Boston Medical Center, Boston, MA, USA
| | - Holly Hackman
- Emergency Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.,1836Boston Medical Center, Boston, MA, USA
| | - Julia K Campbell
- Health Behavior, 2331University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Steven Vannoy
- Counseling & School Psychology, 14708University of Massachusetts Boston, Boston, MA, USA
| | - Laura Hayden
- Counseling & School Psychology, 14708University of Massachusetts Boston, Boston, MA, USA
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Snedaker KP, Lundine JP, Ciccia AH, Haider MN, O'Brien KH. Gaps in concussion management across school-aged children. Brain Inj 2022; 36:714-721. [PMID: 35130810 DOI: 10.1080/02699052.2022.2034954] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Examine how demographic and injury factors impact identification and management of concussion in students. METHODS Prospective observational cohort. Pre-K - 12th grade students within a large, urban school district reported to school with concussion during 2015-2019. Participants were grouped into Elementary/Middle School (E/MS) and High School (HS) and compared by sex, concussion history, injury setting and mechanism, time to medical evaluation and clearance, absences, and recommended accommodations. RESULTS 154 E/MS and 230 HS students reported to school with physician-diagnosed concussion. E/MS students experienced fewer concussions at school and from sports than HS. More E/MS males than females sustained concussions, while this difference was reversed for HS. Time-to-evaluation was longer for E/MS, specifically female E/MS students and those injured outside of school. E/MS males were cleared more quickly than females. In contrast, no differences were found between sexes for HS by injury setting, mechanism of injury, or management factors. CONCLUSION Differences observed in E/MS students by demographic and injury factors are not observed in HS students. Younger students, particularly females or those not injured in school or sports, may be at risk for delayed identification and prolonged time to clearance. Future research should further characterize concussion management in E/MS children.
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Affiliation(s)
| | - Jennifer P Lundine
- Department of Speech & Hearing Science, The Ohio State University, Columbus, Ohio, USA.,Division of Clinical Therapies & Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Angela H Ciccia
- Department of Psychological Sciences, Communication Sciences Program, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mohammad Nadir Haider
- Department of Orthopedics and Sports Medicine, State University of New York at Buffalo, Buffalo, New York, USA
| | - Katy H O'Brien
- Department of Communication Sciences and Special Education, University of Georgia, Athens, Georgia, USA
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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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6
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Haynes N, Goodwin T. Literature Review of Sex Differences in mTBI. Mil Med 2021; 188:e978-e984. [PMID: 34791408 DOI: 10.1093/milmed/usab472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) remains a significant source of morbidity worldwide and is of particular concern for the military. Scientific literature examining sex differences in TBI is highly contradictory with some reporting better outcomes in men, others reporting better outcomes in women, and others reporting mixed results or no difference. While the exact cause is currently debated, the existence of such differences has important implications for surveillance techniques, treatment options, and management of long-term consequences. As the number of women within the U.S. military ranks increases and with the opening of combat roles to women in 2013, increased awareness of probable sex differences regarding TBI responses will enable better standard of care. MATERIALS AND METHODS Using the PubMed database, a keyword search using gender, "sex factors", "sex dependent", "gender disparity", TBI, "traumatic brain injury", mTBI (mild TBI), and "cranial trauma" was used to identify articles of interest. Results were filtered for written in the last 5 years, English, and free full text. References of relevant articles were cross-checked for additional publications. Articles familiar to the authors were also included. RESULTS We review literature that includes analysis of age as an interaction in TBI, hypothesized mechanisms to explain variations in outcomes between men and women, and the need for inclusion of sex as a criterion in future studies. CONCLUSIONS Emerging studies underscore the complexity of interpreting sex differences in TBI. The long-held belief that women have a neuroprotective advantage compared to men based on higher levels of sex hormones is being re-evaluated. Past conclusions have relied extensively on clinical studies that include a disproportionate number of men or do not stratify results based on sex. While sex hormones may be neuroprotective, underlying mechanisms are far from clarified. Future TBI studies must include women and gonadal hormone levels should be measured to address potential variables. Given the significant number of TBIs within the military, an improved understanding of TBI pathophysiology and outcomes is important considerations for mission success and servicemember longevity.
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Affiliation(s)
- Nicole Haynes
- George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
| | - Tress Goodwin
- Division of Emergency Medicine, Children's National Health System, Washington, DC 20010, USA.,Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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7
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Merezhinskaya N, Mallia RK, Park D, Millian-Morell L, Barker FM. Photophobia Associated with Traumatic Brain Injury: A Systematic Review and Meta-analysis. Optom Vis Sci 2021; 98:891-900. [PMID: 34354013 DOI: 10.1097/opx.0000000000001757] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE This study reports the prevalence and relative risk of photophobia in patients with traumatic brain injury (TBI). OBJECTIVES This study aimed to conduct a systematic review and meta-analysis to determine the prevalence and relative risk of photophobia in patients with TBI. DATA SOURCES Three databases were used for literature search: PubMed, EMBASE, and Cochrane Library. STUDY APPRAISAL AND SYNTHESIS METHODS Publications reporting the prevalence of photophobia after TBI in patients of any age were included. A series of meta-regression analyses based on a generalized linear mixed model was performed to identify potential sources of heterogeneity in the prevalence estimates. RESULTS Seventy-five eligible publications were identified. The prevalence of photophobia was 30.46% (95% confidence interval [CI], 20.05 to 40.88%) at 1 week after the injury. Prevalence decreased to 19.34% (95% CI, 10.40 to 28.27%) between 1 week and 1 month after TBI and to 13.51% (95% CI, 5.77 to 21.24%) between 1 and 3 months after the injury. The rapid decrease in the prevalence of photophobia in the first 3 months after a TBI injury was significant (P < .001). Three months post-TBI, the prevalence of photophobia leveled off to a near plateau with nonsignificant variability, increasing between 3 and 6 months (17.68%; 95% CI, 9.05 to 26.32%) and decreasing between 6 and 12 months since TBI (14.85%; 95% CI, 6.80 to 22.90%). Subgroup analysis of 14 publications that contained control data showed that the estimated risk ratio for photophobia was significantly higher in the TBI than in the control group during the entire 12 months after TBI. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS This study demonstrates that photophobia is a frequent complaint after TBI, which largely resolves for many individuals within 3 months after the injury. For some patients, however, photophobia can last up to 12 months and possibly longer. Developing an objective quantitative methodology for measuring photophobia, validating a dedicated photophobia questionnaire, and having a specific photophobia International Classification of Diseases, Tenth Revision code would greatly improve data gathering and analysis.
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Affiliation(s)
- Natalya Merezhinskaya
- Department of Defense/Veterans Affairs Vision Center of Excellence, Bethesda, Maryland
| | - Rita K Mallia
- Department of Defense/Veterans Affairs Vision Center of Excellence, Bethesda, Maryland
| | - DoHwan Park
- University of Maryland, Baltimore County, Maryland
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Clinical Outcomes of Pediatric Acute Sport- and Non-Sport-Related Concussions. Can J Neurol Sci 2021; 49:263-269. [PMID: 33902784 DOI: 10.1017/cjn.2021.82] [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: 11/06/2022]
Abstract
OBJECTIVES The objectives were to examine clinical characteristics, length of recovery, and the prevalence of delayed physician-documented recovery, compare clinical outcomes among those with sport-related concussion (SRC) and non-sport-related concussion (nSRC), and identify risk factors for delayed recovery. METHODS Included patients (8-18 years) were assessed ≤14 days post-injury at a multidisciplinary concussion program and diagnosed with an acute SRC or nSRC. Physician-documented clinical recovery was defined as returning to pre-injury symptom status, attending full-time school without symptoms, completing Return-to-Sport strategy as needed, and normal physical examination. Delayed physician-documented recovery was defined as >28 days post-injury. RESULTS Four hundred and fifteen patients were included (77.8% SRC). There was no difference in loss of consciousness (SRC: 9.9% vs nSRC: 13.0%, p = 0.39) or post-traumatic amnesia (SRC: 24.1% vs SRC: 31.5%, p = 0.15) at the time of injury or any differences in median Post-Concussion Symptom Scale scores (SRC: 20 vs nSRC: 23, p = 0.15) at initial assessment. Among those with complete clinical follow-up, the median physician-documented clinical recovery was 20 days (SRC: 19 vs nSRC: 23; p = 0.37). There was no difference in the proportion of patients who developed delayed physician-documented recovery (SRC: 27.7% vs nSRC: 36.1%; p = 0.19). Higher initial symptom score increased the risk of delayed physician-documented recovery (IRR: 1.39; 95% CI: 1.29, 1.49). Greater material deprivation and social deprivation were associated with an increased risk of delayed physician-documented recovery. CONCLUSIONS Most pediatric concussion patients who undergo early medical assessment and complete follow-up appear to make a complete clinical recovery within 4 weeks, regardless of mechanism.
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Li L, Chopp M, Ding G, Davoodi-Bojd E, Zhang L, Li Q, Zhang Y, Xiong Y, Jiang Q. MRI detection of impairment of glymphatic function in rat after mild traumatic brain injury. Brain Res 2020; 1747:147062. [PMID: 32818526 PMCID: PMC9419050 DOI: 10.1016/j.brainres.2020.147062] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/02/2020] [Accepted: 08/14/2020] [Indexed: 12/19/2022]
Abstract
We investigated the effect of mild traumatic brain injury (mTBI) on the glymphatic pathway using contrast-enhanced magnetic resonance imaging (CE-MRI) and quantified with kinetic parameters obtained from an advanced two-compartment model. mTBI was induced in male Wistar rats using a closed head impact. Animals with and without mTBI (n = 7/group) underwent the identical MRI protocol 10-weeks post-injury, including T2-weighted imaging and 3D T1-weighted imaging with intra-cisterna magna injection of contrast agent (Gd-DTPA). The parameters of infusion rate, clearance rate and clearance time constant, characterizing the kinetic features of glymphatic tracer transport in a living brain, were quantified in multiple brain tissue regions. In the majority of examined regions, our quantification demonstrated significantly reduced infusion and clearance rates, and significantly increased clearance time constant in the mTBI animals compared to the healthy controls. These data indicate that mTBI induces chronic changes in influx and efflux of contrast agent and glymphatic pathway dysfunction. While the reduced efficiency of glymphatic function after mTBI was apparent in brain, regional evaluation revealed heterogeneous glymphatic effects of the mTBI in different anatomical regions. The suppression of glymphatic function, rather than the presence of focal lesions, indicates a persistent injury of the brain after mTBI. Thus, dynamic CE-MRI in conjunction with advanced kinetic analysis may offer a useful methodology for an objective assessment and confirmatory diagnosis of mTBI.
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Affiliation(s)
- Lian Li
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA.
| | - Michael Chopp
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA; Department of Physics, Oakland University, Rochester, MI 48309, USA.
| | - Guangliang Ding
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA.
| | | | - Li Zhang
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA.
| | - Qingjiang Li
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA.
| | - Yanlu Zhang
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI 48208, USA.
| | - Ye Xiong
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI 48208, USA.
| | - Quan Jiang
- Department of Neurology, Henry Ford Health System, Detroit, MI 48202, USA.
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10
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Newton A, Yang J, Shi J, Sullivan L, Huang L, Singichetti B, Zhu M, Felix AS. Sports and non-sports-related concussions among Medicaid-insured children: health care utilization before and after Ohio's concussion law. Inj Epidemiol 2020; 7:55. [PMID: 33131503 PMCID: PMC7604964 DOI: 10.1186/s40621-020-00283-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/11/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To evaluate patterns of health care utilization for sports-related concussions (SRCs) and non-sports-related concussions (NSRCs) among Medicaid-insured children before and after the enactment of Ohio’s concussion law in April 2013. Methods We analyzed claim data from the Partners For Kids (PFK) Ohio Medicaid database. Concussion diagnoses were identified between April 1, 2008 and June 30, 2017. We compared frequency of concussions by age and sex across the law period. We evaluated type of health care utilization before and after law enactment using multinomial logistic regression. Results Over the 9 year study period, 6157 concussions were included, most of which (70.4%) were NSRCs. The proportion of SRCs increased with age. Among children younger than 5 years old, the majority (96.1%) of concussions were NSRCs. During the post-law period, greater odds of primary care visits than emergency department (ED) visits were observed for both SRCs (OR = 1.53; 95% CI 1.34, 1.75) and NSRCs (OR = 1.73; 95% CI 1.58, 1.90) compared to the pre-law period. Conclusions We observed higher proportions of health care utilization for NSRCs than SRCs in Medicaid insured children and a shift in health care utilization from the ED to primary care in the post-law period. SRCs and NSRCs are likely to have different patterns of health care utilization before and after the enactment of Ohio’s concussion law. Our results demonstrate that Ohio’s youth concussion law had a quantifiable impact on health care utilization.
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Affiliation(s)
- Alison Newton
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive - RBIII, Columbus, OH, 43205, USA.,College of Public Health, Department of Epidemiology, Ohio State University, Columbus, OH, USA
| | - Jingzhen Yang
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive - RBIII, Columbus, OH, 43205, USA. .,College of Public Health, Department of Epidemiology, Ohio State University, Columbus, OH, USA.
| | - Junxin Shi
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH, USA
| | - Lindsay Sullivan
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive - RBIII, Columbus, OH, 43205, USA
| | - Lihong Huang
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive - RBIII, Columbus, OH, 43205, USA
| | - Bhavna Singichetti
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive - RBIII, Columbus, OH, 43205, USA
| | - Motao Zhu
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive - RBIII, Columbus, OH, 43205, USA.,College of Public Health, Department of Epidemiology, Ohio State University, Columbus, OH, USA
| | - Ashley S Felix
- College of Public Health, Department of Epidemiology, Ohio State University, Columbus, OH, USA
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11
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Koerte IK, Schultz V, Sydnor VJ, Howell DR, Guenette JP, Dennis E, Kochsiek J, Kaufmann D, Sollmann N, Mondello S, Shenton ME, Lin AP. Sex-Related Differences in the Effects of Sports-Related Concussion: A Review. J Neuroimaging 2020; 30:387-409. [PMID: 32533752 PMCID: PMC8221087 DOI: 10.1111/jon.12726] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/30/2020] [Indexed: 01/11/2023] Open
Abstract
Sports-related concussion is a serious health challenge, and females are at higher risk of sustaining a sports-related concussion compared to males. Although there are many studies that investigate outcomes following concussion, females remain an understudied population, despite representing a large proportion of the organized sports community. In this review, we provide a summary of studies that investigate sex-related differences in outcome following sports-related concussion. Moreover, we provide an introduction to the methods used to study sex-related differences after sports-related concussion, including common clinical and cognitive measures, neuroimaging techniques, as well as biomarkers. A literature search inclusive of articles published to March 2020 was performed using PubMed. The studies were reviewed and discussed with regard to the methods used. Findings from these studies remain mixed with regard to the effect of sex on clinical symptoms, concussion-related alterations in brain structure and function, and recovery trajectories. Nonetheless, there is initial evidence to suggest that sex-related differences following concussion are important to consider in efforts to develop objective biomarkers for the diagnosis and prognosis of concussion. Additional studies on this topic are, however, clearly needed to improve our understanding of sex-related differences following concussion, as well as to understand their neurobiological underpinnings. Such studies will help pave the way toward more personalized clinical management and treatment of sports-related concussion.
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Affiliation(s)
- Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Vivian Schultz
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Valerie J Sydnor
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO.,Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO
| | - Jeffrey P Guenette
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Emily Dennis
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Neurology, University of Utah, Salt Lake City, UT
| | - Janna Kochsiek
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - David Kaufmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Radiology, Charité Universitätsmedizin, Berlin, Germany
| | - Nico Sollmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.,Oasi Research Institute-IRCCS, Troina, Italy
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,VA Boston Healthcare System, Boston, MA
| | - Alexander P Lin
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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12
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Campbell J, Howland J, Hess C, Nelson K, Stern RA, Torres A, Olshaker J. Disparities in baseline neurocognitive testing for student concussion management in Massachusetts high schools. BMJ Open Sport Exerc Med 2020; 6:e000752. [PMID: 32537243 PMCID: PMC7264696 DOI: 10.1136/bmjsem-2020-000752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2020] [Indexed: 01/21/2023] Open
Abstract
PURPOSE There is evidence of socioeconomic disparities with respect to the implementation of student-sports concussion laws nationally. The purpose of this study was to examine school sociodemographic characteristics associated with the provision of computerised baseline neurocognitive testing (BNT) in Massachusetts (MA) high schools, and to assess whether the scope of testing is associated with the economic status of student populations in MA. METHODS A cross-sectional secondary analysis of surveys conducted with MA athletic directors (n=270) was employed to investigate school characteristics associated with the provision of BNT. Correlation and regression analyses were used to assess whether the scope of testing is associated with the economic status of student populations in MA. RESULTS The scope of BNT was independently associated with the economic disadvantage rate (EDR) of the student population (β=-0.02, p=0.01); whether or not the school employs an athletic trainer (AT) (β=0.43, p=0.03); and school size (β=-0.54, p=0.03). In a multivariable regression model, EDR was significantly associated with the scope of baseline testing, while controlling for AT and size (β=-0.01, p=0.03, adj-R2=0.1135). CONCLUSION Among public high schools in MA, disparities in the provision of BNT for students are associated with the economic characteristics of the student body. Schools that have a greater proportion of low-income students are less likely to provide comprehensive BNT. The clinical implications of not receiving BNT prior to concussion may include diminished quality of postconcussive care, which can have short-term and long-term social, health-related and educational impacts.
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Affiliation(s)
- Julia Campbell
- Department of Emergency Medicine, Boston University Medical Center, Boston, Massachusetts, USA
- Injury Prevention Center, Boston Medical Center, Boston, Massachusetts, USA
| | - Jonathan Howland
- Department of Emergency Medicine, Boston University Medical Center, Boston, Massachusetts, USA
- Injury Prevention Center, Boston Medical Center, Boston, Massachusetts, USA
| | - Courtney Hess
- Department of Counseling & School Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Kerrie Nelson
- Injury Prevention Center, Boston Medical Center, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Robert A Stern
- Injury Prevention Center, Boston Medical Center, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Alcy Torres
- Department of Emergency Medicine, Boston University Medical Center, Boston, Massachusetts, USA
- Injury Prevention Center, Boston Medical Center, Boston, Massachusetts, USA
| | - Jonathan Olshaker
- Department of Emergency Medicine, Boston University Medical Center, Boston, Massachusetts, USA
- Injury Prevention Center, Boston Medical Center, Boston, Massachusetts, USA
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13
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Aggarwal SS, Ott SD, Padhye NS, Schulz PE. Sex, race, ADHD, and prior concussions as predictors of concussion recovery in adolescents. Brain Inj 2020; 34:809-817. [DOI: 10.1080/02699052.2020.1740942] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Seema S. Aggarwal
- Center for Nursing Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Summer D. Ott
- Department of Orthopedics, McGovern Medical School of UTHealth, the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nikhil S. Padhye
- Center for Nursing Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Paul E. Schulz
- Department of Neurology, McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, Texas, USA
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14
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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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15
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Hurtubise JM, Hughes CE, Sergio LE, Macpherson AK. Comparison of baseline and postconcussion SCAT3 scores and symptoms in varsity athletes: an investigation into differences by sex and history of concussion. BMJ Open Sport Exerc Med 2018; 4:e000312. [PMID: 29629181 PMCID: PMC5884362 DOI: 10.1136/bmjsem-2017-000312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To investigate the use of the Sport Concussion Assessment Tool 3 (SCAT3) as an assessment tool in the varsity population, as well as the effects of sex and concussion history on both baseline and postconcussion scores. METHODS A comparison between baseline and postconcussion SCAT3 scores of varsity level athletes was conducted through retrospective chart review. Differences in both baseline and postconcussion scores were further analysed by sex and history of concussion. RESULTS The only clinically significant change on the SCAT3 elicited by a concussion was that of self-reported symptoms. There were no clinically significant differences based on sex or history of concussion. CONCLUSION The SCAT3 in its entirety may not be useful in this population. Additional research on sociocultural and sport aspects that may be affecting symptom reporting in this population is needed.
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Affiliation(s)
- Johanna M Hurtubise
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- York University Sport Medicine Team, York University, Toronto, Ontario, Canada
| | - Cindy E Hughes
- York University Sport Medicine Team, York University, Toronto, Ontario, Canada
- Department of Sport and Recreation, York University, Toronto, Ontario, Canada
| | - Lauren E Sergio
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- York University Sport Medicine Team, York University, Toronto, Ontario, Canada
- Centre for Vision Research, York University, Toronto, Ontario, Canada
| | - Alison K Macpherson
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- York University Sport Medicine Team, York University, Toronto, Ontario, Canada
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16
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Howell DR, Kirkwood MW, Provance A, Iverson GL, Meehan WP. Using concurrent gait and cognitive assessments to identify impairments after concussion: a narrative review. Concussion 2018; 3:CNC54. [PMID: 30202596 PMCID: PMC6094155 DOI: 10.2217/cnc-2017-0014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 12/21/2017] [Indexed: 02/05/2023] Open
Abstract
Understanding how a concussion affects an individual is oftentimes difficult for clinicians due to the varying symptom profiles reported by the patient and the multifaceted and heterogeneous nature of the injury. Accordingly, the interpretation of postconcussion performance can be challenging, because many different testing paradigms have been reported as potentially useful in the literature. Among the types of tests clinicians use to understand how concussion affects an individual, both gait and neurocognitive evaluations have demonstrated utility. Our purpose is to describe how combined gait and cognitive (i.e., dual task), as well as single-task gait and computerized neurocognitive examinations can assist clinical decision-making.
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Affiliation(s)
- David R Howell
- The Micheli Center for Sports Injury Prevention, Waltham, MA 02453, USA
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA 02115, USA
- Brain Injury Center, Boston Children's Hospital, Boston, MA 02115, USA
- Sports Medicine Center, Children's Hospital Colorado & University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Michael W Kirkwood
- Department of Physical Medicine & Rehabilitation, University of Colorado, Aurora, CO 80045, USA
- Rehabilitation Medicine, Children's Hospital Colorado, Aurora, CO 80045, USA
| | - Aaron Provance
- Sports Medicine Center, Children's Hospital Colorado & University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Grant L Iverson
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02129, USA
- MassGeneral Hospital for Children Sport Concussion Program, Boston, MA 02114, USA
- Home Base, A Red Sox Foundation & Massachusetts General Hospital Program, Boston, MA 02129, USA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA 02453, USA
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA 02115, USA
- Brain Injury Center, Boston Children's Hospital, Boston, MA 02115, USA
- Department of Pediatrics & Orthopaedic Surgery, Harvard Medical School, Boston, MA 02115, USA
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17
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Gorbet DJ, Sergio LE. Move faster, think later: Women who play action video games have quicker visually-guided responses with later onset visuomotor-related brain activity. PLoS One 2018; 13:e0189110. [PMID: 29364891 PMCID: PMC5783344 DOI: 10.1371/journal.pone.0189110] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/20/2017] [Indexed: 11/18/2022] Open
Abstract
A history of action video game (AVG) playing is associated with improvements in several visuospatial and attention-related skills and these improvements may be transferable to unrelated tasks. These facts make video games a potential medium for skill-training and rehabilitation. However, examinations of the neural correlates underlying these observations are almost non-existent in the visuomotor system. Further, the vast majority of studies on the effects of a history of AVG play have been done using almost exclusively male participants. Therefore, to begin to fill these gaps in the literature, we present findings from two experiments. In the first, we use functional MRI to examine brain activity in experienced, female AVG players during visually-guided reaching. In the second, we examine the kinematics of visually-guided reaching in this population. Imaging data demonstrate that relative to women who do not play, AVG players have less motor-related preparatory activity in the cuneus, middle occipital gyrus, and cerebellum. This decrease is correlated with estimates of time spent playing. Further, these correlations are strongest during the performance of a visuomotor mapping that spatially dissociates eye and arm movements. However, further examinations of the full time-course of visuomotor-related activity in the AVG players revealed that the decreased activity during motor preparation likely results from a later onset of activity in AVG players, which occurs closer to beginning motor execution relative to the non-playing group. Further, the data presented here suggest that this later onset of preparatory activity represents greater neural efficiency that is associated with faster visually-guided responses.
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Affiliation(s)
- Diana J. Gorbet
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- Centre for Vision Research, York University, Toronto, Ontario, Canada
- * E-mail:
| | - Lauren E. Sergio
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- Centre for Vision Research, York University, Toronto, Ontario, Canada
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18
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Dobney DM, Miller MB, Tufts E. Non-pharmacological rehabilitation interventions for concussion in children: a scoping review. Disabil Rehabil 2017; 41:727-739. [PMID: 29157025 DOI: 10.1080/09638288.2017.1400595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To summarise the extent, nature, and quality of current scholarly literature related to non-pharmacological, rehabilitation interventions following concussion, or mild traumatic brain injury in children. METHODS An electronic search was conducted from 1987 to 24 October 2017. Studies were included if they met the following criteria: (1) full text, peer reviewed, and written in English, (2) original research, (3) diagnosed concussion or mild traumatic brain injury, (4) described the evaluation of an intervention, (5) the outcome was a concussion impairment, and (6) the mean/median age was under 19. Quality assessment using the Down's and Black criteria was conducted. RESULTS Twenty-six studies published between 2001 and 2017 were identified. Interventions included rest, active rehabilitation, exercise, vestibular, oculomotor, cervicospinal therapy, education, early intervention, telephone counselling, mobile health application, Web-based Self-Management program, multimodal physical therapy, cognitive behavioural therapy, transcranial direct current stimulation, and acupuncture. The quality assessments ranged from poor to good. CONCLUSIONS The literature describing interventions following concussion in children is scarce. While both positive and negative results were obtained, there were methodological concerns in most studies limiting the ability to draw conclusions. Interventions incorporating aerobic exercise show promise as a concussion management strategy. Implications for rehabilitation Few studies have examined rehabilitation interventions for youth following concussion. Research ranging from rest to exercise highlights the uncertainty of the field. Low quality research limits the generalizability of results. The use of physical activity appears to be an emerging area of interest. Individualised, aerobic exercise should be used as part of clinical management.
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Affiliation(s)
- Danielle M Dobney
- a School of Physical and Occupational Therapy, Faculty of Medicine , McGill University , Montreal , Canada
| | - Matthew B Miller
- b Department of Exercise Science, Faculty of Arts and Science , Concordia University , Montreal , Canada
| | - Emily Tufts
- c Centennial College Libraries , Toronto , Canada
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19
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Risen SR, Reesman J, Yenokyan G, Slomine BS, Suskauer SJ. The Course of Concussion Recovery in Children 6-12 Years of Age: Experience From an Interdisciplinary Rehabilitation Clinic. PM R 2017; 9:874-883. [PMID: 28082178 PMCID: PMC5502002 DOI: 10.1016/j.pmrj.2016.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 12/16/2016] [Accepted: 12/23/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Current concussion evidence is derived largely from teenagers and adults. Concussion in younger children occurs within the context of neuromaturation, with differing age-based pathophysiological responses to injury. Therefore, our current understanding of concussion in older children and adults is unlikely to directly apply to younger children. OBJECTIVE To describe patient variables, clinical course, and factors associated with time to discharge from concussion care in children 6-12 years of age with concussion treated in an interdisciplinary rehabilitation-based concussion clinic. DESIGN Retrospective chart review. SETTING Interdisciplinary concussion clinic at an academically affiliated rehabilitation center. PATIENTS Children aged 6-12 years (n = 105; mean 10.8 years of age, 70% male) seen within 60 days of concussive injury. MAIN OUTCOME MEASUREMENTS Descriptive statistics explored demographic, injury, and clinical features. The primary outcome measure, time to discharge from concussion care, was estimated with survival-analysis methods based on the date of discharge from the clinic. Multivariate models were used to examine factors associated with longer time to discharge. RESULTS Median time to discharge was 34 days postinjury (range 5-192 days); 75% of children were discharged within 60 days of injury. A minority reported persisting symptoms at discharge. Younger age and increased symptom burden at initial evaluation predicted longer time to discharge. CONCLUSIONS Although children 6-12 years old treated in a specialty concussion clinic show variability in time to discharge from concussion care, most were discharged within 2 months after injury. Risk factors for prolonged recovery, such as younger age and greater symptom burden at initial visit, can be used when counseling families and planning interventions. There may be varying contributions, including psychosocial stressors, to ongoing symptoms in children who experience persisting symptoms after other concussion-related concerns have resolved. Future work focused on the subset of children who report persisting symptoms will be useful for developing an evidence base related to their care. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Sarah R Risen
- Kennedy Krieger Institute and Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; current affiliation: Pediatric Neurology and Developmental Medicine, Baylor College of Medicine and Texas Children's Hospital(∗)
| | - Jennifer Reesman
- Kennedy Krieger Institute and Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD(†)
| | - Gayane Yenokyan
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD(‡)
| | - Beth S Slomine
- Kennedy Krieger Institute, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD(§)
| | - Stacy J Suskauer
- Kennedy Krieger Institute, 707 N Broadway, Baltimore, MD 21230; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD(¶).
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