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Joseph CR, Lim JK, Grohol BN, Zivcevska M, Lencke J, Rich ED, Arrasmith CJ, Dorman IS, Clark BW, Love K, Ferry B, Rolfs ME. Identifying delay in glymphatic clearance of labeled protons post-acute head trauma utilizing 3D ASL MRI (arterial spin labeling): a pilot study. Sci Rep 2024; 14:6188. [PMID: 38485759 PMCID: PMC10940642 DOI: 10.1038/s41598-024-56236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
This study correlated mild traumatic brain injury (mTBI) cognitive changes with ASL-MRI glymphatic clearance rates (GCRs) and recovery with GCR improvement. mTBI disrupts the blood brain barrier (BBB), reducing capillary mean transit time and GCRs. mTBI is clinically diagnosed utilizing history/examination findings with no physiologic biomarkers. 3D TGSE (turbo-gradient spin-echo) pulsed arterial spin-labeling 3T MRI with 7 long inversion times (TIs) assessed the signal clearance of labeled protons 2800-4000 ms postlabeling in bifrontal, bitemporal, and biparietal regions within 7 days of mTBI and once clinically cleared to resume activities. The Sport Concussion Assessment Tool Version 5 (SKAT5) and Brief Oculomotor/Vestibular Assessment evaluated injured athletes' cognitive function prior to MRIs. The pilot study demonstrated significant GCRs improvement (95% CI - 0.06 to - 0.03 acute phase; to CI-recovery CI 0.0772 to - 0.0497; P < 0.001 in frontal lobes; and parietal lobes (95% CI - 0.0584 to - 0.0251 acute; CI - 0.0727 to - 0.0392 recovery; P = 0.024) in 9 mTBI athletes (8 female, 1 male). Six age/activity-matched controls (4 females, 2 males) were also compared. mTBI disrupts the BBB, reducing GCR measured using the 3D ASL MRI technique. ASL MRI is a potential noninvasive biomarker of mTBI and subsequent recovery.
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Affiliation(s)
- Charles R Joseph
- Liberty University College of Osteopathic Medicine, Lynchburg, USA.
| | - Jubin Kang Lim
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Bryce N Grohol
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Marija Zivcevska
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Joshua Lencke
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Ethan Dean Rich
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | | | | | | | - Kim Love
- K. R. Love Quantitative Consulting and Collaboration, Athens, USA
| | - Ben Ferry
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Mark E Rolfs
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
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Dunne LAM, Cole MH, Cormack SJ, Howell DR, Johnston RD. Validity and Reliability of Methods to Assess Movement Deficiencies Following Concussion: A COSMIN Systematic Review. SPORTS MEDICINE - OPEN 2023; 9:76. [PMID: 37578611 PMCID: PMC10425315 DOI: 10.1186/s40798-023-00625-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND There is an increased risk of subsequent concussion and musculoskeletal injury upon return to play following a sports-related concussion. Whilst there are numerous assessments available for clinicians for diagnosis and during return to play following concussion, many may lack the ability to detect these subclinical changes in function. Currently, there is no consensus or collated sources on the reliability, validity and feasibility of these assessments, which makes it difficult for clinicians and practitioners to select the most appropriate assessment for their needs. OBJECTIVES This systematic review aims to (1) consolidate the reliability and validity of motor function assessments across the time course of concussion management and (2) summarise their feasibility for clinicians and other end-users. METHODS A systematic search of five databases was conducted. Eligible studies were: (1) original research; (2) full-text English language; (3) peer-reviewed with level III evidence or higher; (4) assessed the validity of lower-limb motor assessments used to diagnose or determine readiness for athletes or military personnel who had sustained a concussion or; (5) assessed the test-retest reliability of lower-limb motor assessments used for concussion management amongst healthy athletes. Acceptable lower-limb motor assessments were dichotomised into instrumented and non-instrumented and then classified into static (stable around a fixed point), dynamic (movement around a fixed point), gait, and other categories. Each study was assessed using the COSMIN checklist to establish methodological and measurement quality. RESULTS A total of 1270 records were identified, with 637 duplicates removed. Titles and abstracts of 633 records were analysed, with 158 being retained for full-text review. A total of 67 records were included in this review; 37 records assessed reliability, and 35 records assessed the validity of lower-limb motor assessments. There were 42 different assessments included in the review, with 43% being non-instrumented, subjective assessments. Consistent evidence supported the use of instrumented assessments over non-instrumented, with gait-based assessments demonstrating sufficient reliability and validity compared to static or dynamic assessments. CONCLUSION These findings suggest that instrumented, gait-based assessments should be prioritised over static or dynamic balance assessments. The use of laboratory equipment (i.e. 3D motion capture, pressure sensitive walkways) on average exhibited sufficient reliability and validity, yet demonstrate poor feasibility. Further high-quality studies evaluating the reliability and validity of more readily available devices (i.e. inertial measurement units) are needed to fill the gap in current concussion management protocols. Practitioners can use this resource to understand the accuracy and precision of the assessments they have at their disposal to make informed decisions regarding the management of concussion. TRAIL REGISTRATION This systematic review was registered on PROSPERO (reg no. CRD42021256298).
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Affiliation(s)
- Laura A M Dunne
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia.
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia.
| | - Michael H Cole
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia
- Healthy Brain and Mind Research Centre, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Stuart J Cormack
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - 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
| | - Rich D Johnston
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- Carnegie Applied Rugby Research Centre, School of Sport, Leeds Beckett University, Leeds, UK
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3
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Lumetta K, Halama S, Fehr S, Apps J, Thomas D. Functional Assessment of Concussion Tool Application in a Pediatric Concussion Clinic. WMJ : OFFICIAL PUBLICATION OF THE STATE MEDICAL SOCIETY OF WISCONSIN 2023; 122:191-195. [PMID: 37494650 PMCID: PMC11346514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND Traditional concussion symptom scales do not assess function. We piloted a mobile app-based assessment that aims to measure the functional impact of symptoms. METHODS Patients with concussion completed the Functional Assessment of Concussion Tool and traditional symptom scales postinjury. RESULTS Linear regression assessed the predictive value of the Functional Assessment of Concussion Tool symptom number and function rating compared to scores on 2 traditional symptom scales across 4 symptom domains. The mobile app symptom number predicted scores on traditional symptom scales across domains. The rating score predicted traditional scale scores in 2 domains. The mobile health tool did not predict recovery. DISCUSSION This mobile health concussion symptom assessment may measure the functional impact of symptoms, though further study is needed.
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Affiliation(s)
| | - Sam Halama
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shayne Fehr
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Danny Thomas
- Medical College of Wisconsin, Milwaukee, Wisconsin,
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4
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Le RK, Ortega J, Chrisman SP, Kontos AP, Buckley TA, Kaminski TW, Meyer BP, Clugston JR, Goldman JT, McAllister T, McCrea M, Broglio SP, Schmidt JD. King-Devick Sensitivity and Specificity to Concussion in Collegiate Athletes. J Athl Train 2023; 58:97-105. [PMID: 34709396 PMCID: PMC10072097 DOI: 10.4085/1062-6050-0063.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The King-Devick (K-D) test is used to identify oculomotor impairment after concussion. However, the diagnostic accuracy of the K-D test over time has not been evaluated. OBJECTIVES To (1) examine the sensitivity and specificity of the K-D test at 0 to 6 hours postinjury, 24 to 48 hours postinjury, the beginning of a return-to-play (RTP) protocol (asymptomatic), unrestricted RTP, and 6 months postconcussion and (2) compare outcomes between athletes with and those without concussion across confounding factors (sex, age, sport contact level, academic year, learning disorder, attention-deficit/hyperactivity disorder, migraine history, concussion history, and test administration mode). DESIGN Retrospective, cross-sectional design. SETTING Multiple institutions in the Concussion Assessment, Research and Education Consortium. PATIENTS OR OTHER PARTICIPANTS A total of 320 athletes with a concussion (162 men, 158 women; age = 19.80 ± 1.41 years) were compared with 1239 total collegiate athletes without a concussion (646 men, 593 women; age = 20.31 ± 1.18 years). MAIN OUTCOME MEASURE(S) We calculated the K-D test time difference (in seconds) by subtracting the baseline from the most recent time. Receiver operator characteristic (ROC) curve and area under the curve (AUC) analyses were used to determine the diagnostic accuracy across time points. We identified cutoff scores and corresponding specificity at both the 80% and 70% sensitivity levels. We repeated ROC with AUC analyses using confounding factors. RESULTS The K-D test predicted positive results at the 0- to 6-hour (AUC = 0.724, P < .001), 24- to 48-hour (AUC = 0.701, P < .001), RTP (AUC = 0.640, P < .001), and 6-month postconcussion (AUC = 0.615, P < .001) tim points but not at the asymptomatic time point (AUC = 0.513, P = .497). The 0- to 6-hour and 24- to 48-hour time points yielded 80% sensitivity cutoff scores of -2.6 and -3.2 seconds (ie, faster), respectively, but 46% and 41% specificity, respectively. The K-D test had a better AUC when administered using an iPad (AUC = 0.800, 95% CI = 0.747, 0.854) compared with the spiral-bound card system (AUC = 0.646, 95% CI = 0.600, 0.692; P < .001). CONCLUSIONS The diagnostic accuracy of the K-D test was greatest at 0 to 6 hours and 24 to 48 hours postconcussion but declined across subsequent postconcussion time points. The AUCs did not differentiate between groups across confounding factors. Our negative cutoff scores indicated that practice effects contributed to improved performance, requiring athletes to outperform their baseline scores.
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Affiliation(s)
| | - Justus Ortega
- Department of Kinesiology and Recreation Administration, Humboldt University, Arcata, CA
| | - Sara P. Chrisman
- Seattle Children's Research Institute and Department of Pediatrics, University of Washington
| | | | - Thomas A. Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
| | - Thomas W. Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
| | - Briana P. Meyer
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa
| | - James R. Clugston
- Department of Community Health and Family Medicine, University Athletic Association, University of Florida, Gainesville
- Department of Neurology, University Athletic Association, University of Florida, Gainesville
- Division of Sports Health, University Athletic Association, University of Florida, Gainesville
| | | | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa
| | - Steven P. Broglio
- Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor
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5
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Deschamps A, Giguère-Lemieux É, Fait P, Corbin-Berrigan LA. Test-retest reliability of the neurotracker compared to the impact test for the management of mild traumatic brain injuries during two consecutive university sport seasons. Brain Inj 2022; 36:977-984. [PMID: 35950219 DOI: 10.1080/02699052.2022.2109738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Neurocognitive assessment tools such as the Neurotracker and ImPACT have been proposed to optimize sports-related mild traumatic brain injury (mTBI) management. Baseline testing is recommended with such assessments to individualize monitoring of athletes' remission. While the ideal timeframe between baseline updates has been studied for the ImPACT, these data are missing for the Neurotracker. OBJECTIVE The current study aimed to compare the test-retest reliability of the ImPACT and Neurotracker for two consecutive seasons in university athletes participating in sports at risk for mTBI. METHODS At the start of two consecutive seasons, 30 athletes with no recent history of mTBI completed a baseline assessment including the Neurotracker and the ImPACT. The test-retest reliability of the results was analyzed by considering intra-class correlation (ICC), Becker's standardized mean difference (dB) and Bland-Altman' plot of each outcome. RESULTS The Neurotracker and the Visual Motor Speed composite score of the ImPAC were the only outcomes with significative ICCs and acceptable dB between the two seasons. Neurotracker was the only outcome with a significative bias (+0.179). CONCLUSION Our research suggests that the Neurotracker has an acceptable level of test-retest reliability after one year in comparison to the ImPACT.
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Affiliation(s)
- Alexandre Deschamps
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Quebec, Canada.,Groupe de recherche sur les affections neuromusculosquelettiques, Trois-Rivières, Québec, Canada
| | - Élizabeth Giguère-Lemieux
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Quebec, Canada
| | - Philippe Fait
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Quebec, Canada.,Groupe de recherche sur les affections neuromusculosquelettiques, Trois-Rivières, Québec, Canada.,Centre de Recherche en Neuropsychologie et Cognition, Montréal, Québec, Canada.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, Canada
| | - Laurie-Ann Corbin-Berrigan
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Quebec, Canada.,Groupe de recherche sur les affections neuromusculosquelettiques, Trois-Rivières, Québec, Canada
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6
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Ray T, Fleming D, Le D, Faherty M, Killelea C, Bytomski J, Ray T, Lemak L, Martinez C, Bergeron MF, Sell T. Effect of Concussion on Reaction Time and Neurocognitive Factors: Implications for Subsequent Lower Extremity Injury. Int J Sports Phys Ther 2022; 17:816-822. [PMID: 35949376 PMCID: PMC9340841 DOI: 10.26603/001c.36648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 05/04/2022] [Indexed: 12/03/2022] Open
Abstract
Background Recent evidence has demonstrated that athletes are at greater risk for a lower extremity injury following a return-to-sport (RTS) after sport-related concussion (SRC). The reason for this is not completely clear, but it has been hypothesized that persistent deficits in neurocognitive factors may be a contributing factor. Hypothesis/Purpose This study assessed simple reaction time, processing speed, attention, and concentration in a group of athletes, post-concussion upon clearance for RTS for potential deficits that may result in slower reaction time, processing speed, attention, and concentration. The researchers hypothesized that the concussion group would demonstrate worse scores on both assessments compared to a sex-, age-, and sport-matched cohort. Study Design Case-controlled study. Methods Twelve participants who had suffered a SRC and eight healthy individuals who were matched to the concussed group by age, sex, and sport were evaluated. Those with a concussion had been cleared for RTS by a licensed healthcare provider. Each participant underwent neurocognitive tests that included a simple reaction time test (SRT) and the King-Devick Test (K-D). Independent t-tests were performed to compare the groups with significance set a priori at p<0.05. Results There was a significant difference (p =0.024) between groups for SRT with the concussed group demonstrating a better SRT than the control group. There were no significant differences (p =0.939) between the groups for the K-D. Conclusion With no significant differences between groups in the K-D assessment and, surprisingly, the concussed group having a better SRT compared to the healthy group, our hypothesis was not supported. Clinical Relevance These specific measures, compounded with extensive post-concussion time lapse until RTS clearance, may have limited capacity in revealing potential persistent deficits in relevant neurocognitive characteristics. Level of Evidence Level of Evidence 3.
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Affiliation(s)
- Tyler Ray
- Duke Doctor of Physical Therapy Program
| | | | - Daniel Le
- Michael W. Krzyzewski Human Performance Lab, Department of Orthopedic Surgery, Duke University Medical Center
| | | | | | | | | | | | | | - Michael F Bergeron
- WTA Performance Health and Sport Sciences & Medicine, WTA Women's Tennis Association
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7
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Beitchman JA, Burg BA, Sabb DM, Hosseini AH, Lifshitz J. The pentagram of concussion: an observational analysis that describes five overt indicators of head trauma. BMC Sports Sci Med Rehabil 2022; 14:39. [PMID: 35292090 PMCID: PMC8922760 DOI: 10.1186/s13102-022-00430-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022]
Abstract
Background Multifarious clinical presentations of traumatic brain injury (TBI) makes detection difficult. Acceptance of the Fencing Response as an indicator of moderate TBI with localization to the brainstem expanded interest towards other possible indicators. Methods We hypothesized that an individual experiencing traumatic forces to the head resulting in concussion could display additional brainstem-mediated responses. Using YouTube™, videos were systematically evaluated for mechanical forces imposed on the head with a subsequent, observable behavior. Searches identified 9.9 million non-unique videos in which 0.01% were viewed and 79 met inclusion criteria. Videos of head injuries occurred during athletic activity (57%), assaults (38%), automobile accidents (4%) and impact by an inanimate object (1%). Results Individuals with acute head injury were identified as adults (70%; n = 55), teens (29%; n = 23), and children (1.2%; n = 1). Those identified as males made up majority of injured persons (n = 77♂, 2♀). Individuals in the videos were observed to demonstrate the Fencing Response (47%; n = 37), seizing (44%; n = 35), snoring (24%; n = 19), crying (7.6%; n = 6), and vomiting (3.8%; n = 3). Conclusion Each response, which together comprise the “Pentagram of Concussion”, indicates the presence of traumatic forces to the head that present with one or more pentagram signs that would localize dysfunction to the brainstem. Clinical consideration of these responses helps to immediately identify patients at high risk for a brain injury with brainstem involvement that may have otherwise been mistaken for a different diagnosis.
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Affiliation(s)
- Joshua A Beitchman
- BARROW Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA.,Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.,Joe R. and Theresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,UT Southwestern Medical Center, Children's Medical Center Dallas, Dallas, TX, 75235, USA
| | - Brendan A Burg
- BARROW Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA.,Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.,University of Southern California, Los Angeles, CA, 90089, USA
| | - Dylan M Sabb
- Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.,Family and Community Medicine, Davis Hospital, University of California, CA, Sacramento, USA.,University of California Davis, Sacramento, CA, 95817, USA
| | | | - Jonathan Lifshitz
- BARROW Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA. .,Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA. .,Phoenix VA Health Care System, Phoenix, AZ, USA. .,Neurotrauma & Social Impact research team, University of Arizona College of Medicine - Phoenix, 7th Floor BSPB
- 475 N. 5th St., Phoenix, AZ, 85004-2127, USA.
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8
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Machan M, Tabor JB, Wang M, Sutter B, Wiley JP, Mychasiuk R, Debert CT. The Impact of Concussion, Sport, and Time in Season on Saliva Telomere Length in Healthy Athletes. Front Sports Act Living 2022; 4:816607. [PMID: 35243342 PMCID: PMC8886719 DOI: 10.3389/fspor.2022.816607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
To date, sport-related concussion diagnosis and management is primarily based on subjective clinical tests in the absence of validated biomarkers. A major obstacle to clinical validation and application is a lack of studies exploring potential biomarkers in non-injured populations. This cross-sectional study examined the associations between saliva telomere length (TL) and multiple confounding variables in a healthy university athlete population. One hundred eighty-three (108 male and 75 female) uninjured varsity athletes were recruited to the study and provided saliva samples at either pre- or mid-season, for TL analysis. Multiple linear regression was used to determine the associations between saliva TL and history of concussion, sport contact type, time in season (pre vs. mid-season collection), age, and sex. Results showed no significant associations between TL and history of concussion, age, or sport contact type. However, TL from samples collected mid-season were longer than those collected pre-season [β = 231.4, 95% CI (61.9, 401.0), p = 0.008], and males had longer TL than females [β = 284.8, 95% CI (111.5, 458.2), p = 0.001] when adjusting for all other variables in the model. These findings population suggest that multiple variables may influence TL. Future studies should consider these confounders when evaluating saliva TL as a plausible fluid biomarker for SRC.
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Affiliation(s)
- Matthew Machan
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Jason B. Tabor
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Meng Wang
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Bonnie Sutter
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - J. Preston Wiley
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- University of Calgary Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Richelle Mychasiuk
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Chantel T. Debert
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- *Correspondence: Chantel T. Debert
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Vike NL, Bari S, Stetsiv K, Walter A, Newman S, Kawata K, Bazarian JJ, Martinovich Z, Nauman EA, Talavage TM, Papa L, Slobounov SM, Breiter HC. A preliminary model of football-related neural stress that integrates metabolomics with transcriptomics and virtual reality. iScience 2022; 25:103483. [PMID: 35106455 PMCID: PMC8786649 DOI: 10.1016/j.isci.2021.103483] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/23/2021] [Accepted: 11/19/2021] [Indexed: 12/06/2022] Open
Abstract
Research suggests contact sports affect neurological health. This study used permutation-based mediation statistics to integrate measures of metabolomics, neuroinflammatory miRNAs, and virtual reality (VR)-based motor control to investigate multi-scale relationships across a season of collegiate American football. Fourteen significant mediations (six pre-season, eight across-season) were observed where metabolites always mediated the statistical relationship between miRNAs and VR-based motor control (pSobelperm≤ 0.05; total effect > 50%), suggesting a hypothesis that metabolites sit in the statistical pathway between transcriptome and behavior. Three results further supported a model of chronic neuroinflammation, consistent with mitochondrial dysfunction: (1) Mediating metabolites were consistently medium-to-long chain fatty acids, (2) tricarboxylic acid cycle metabolites decreased across-season, and (3) accumulated head acceleration events statistically moderated pre-season metabolite levels to directionally model post-season metabolite levels. These preliminary findings implicate potential mitochondrial dysfunction and highlight probable peripheral blood biomarkers underlying repetitive head impacts in otherwise healthy collegiate football athletes. Permutation-based mediation statistics can be applied to multi-scale biology problems Fatty acids were a critical link between elevated miRNAs and motor control HAEs interacted with pre-season metabolite levels to model post-season levels Together, our observations point to brain-related mitochondrial dysfunction
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Affiliation(s)
- Nicole L Vike
- Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Sumra Bari
- Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Khrystyna Stetsiv
- Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Alexa Walter
- Department of Kinesiology, Pennsylvania State University, University Park, PA 16801, USA
| | - Sharlene Newman
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405, USA
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA.,Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN 47405, USA
| | - Jeffrey J Bazarian
- Department of Emergency Medicine, University of Rochester, Rochester, NY 14627, USA
| | - Zoran Martinovich
- Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Eric A Nauman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA.,School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA.,Department of Basic Medical Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - Thomas M Talavage
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA.,School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN 47907, USA.,Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Linda Papa
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL 32806, USA
| | - Semyon M Slobounov
- Department of Kinesiology, Pennsylvania State University, University Park, PA 16801, USA
| | - Hans C Breiter
- Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.,Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard School of Medicine, Boston, MA 02114, USA
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10
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Powell D, Stuart S, Godfrey A. Sports related concussion: an emerging era in digital sports technology. NPJ Digit Med 2021; 4:164. [PMID: 34857868 PMCID: PMC8639973 DOI: 10.1038/s41746-021-00538-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/19/2021] [Indexed: 11/24/2022] Open
Abstract
Sports-related concussion (SRC) is defined as a mild traumatic brain injury (mTBI) leading to complex impairment(s) in neurological function with many seemingly hidden or difficult to measure impairments that can deteriorate rapidly without any prior indication. Growing numbers of SRCs in professional and amateur contact sports have prompted closer dialog regarding player safety and welfare. Greater emphasis on awareness and education has improved SRC management, but also highlighted the difficulties of diagnosing SRC in a timely manner, particularly during matches or immediately after competition. Therefore, challenges exist in off-field assessment and return to play (RTP) protocols, with current traditional (subjective) approaches largely based on infrequent snapshot assessments. Low-cost digital technologies may provide more objective, integrated and personalized SRC assessment to better inform RTP protocols whilst also enhancing the efficiency and precision of healthcare assessment. To fully realize the potential of digital technologies in the diagnosis and management of SRC will require a significant paradigm shift in clinical practice and mindset. Here, we provide insights into SRC clinical assessment methods and the translational utility of digital approaches, with a focus on off-field digital techniques to detect key SRC metrics/biomarkers. We also provide insights and recommendations to the common benefits and challenges facing digital approaches as they aim to transition from novel technologies to an efficient, valid, reliable, and integrated clinical assessment tool for SRC. Finally, we highlight future opportunities that digital approaches have in SRC assessment and management including digital twinning and the "digital athlete".
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Affiliation(s)
- Dylan Powell
- Department of Computer and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Sam Stuart
- Department of Sports, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Alan Godfrey
- Department of Computer and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.
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11
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Wright B, Wilmoth K, Juengst SB, Didehbani N, Maize R, Cullum CM. Perceived Recovery and Self-Reported Functioning in Adolescents with Mild Traumatic Brain Injury: The Role of Sleep, Mood, and Physical Symptoms. Dev Neurorehabil 2021; 24:237-243. [PMID: 33356738 DOI: 10.1080/17518423.2020.1858456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To determine the contributions of anxiety, depressive, and concussion symptoms and sleep quality to self-perceived recovery in adolescents with concussion.Method: Adolescents aged 12-20 (n = 298) completed anxiety, depression, concussion symptoms, and sleep measures at an initial concussion clinic visit and three-month follow-up. At follow-up, they reported self-perceived recovery as percent back to normal.Results: Injury-related factors alone did not predict self-perceived recovery (R2Adj =.017, p =.074). More concurrent physical, mental health, and sleep symptoms explained 18.8% additional variance in poorer self-perceived recovery (R2Adj Change =.188, p <.05). Physical symptoms (Bstand = -.292) and anxiety (Bstand = -.260) accounted for the most variance in self-perceived recovery.Conclusion: Post-concussive symptoms, in particular anxiety and self-reported physical symptoms, seem to characterize protracted recovery. Self-perceived recovery as an outcome measure may provide a more holistic understanding of adolescents' experiences after concussion.
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Affiliation(s)
- Brittany Wright
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - K Wilmoth
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Medical College of Wisconsin, Milwaukee, WI, USA
| | - S B Juengst
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Medical College of Wisconsin, Milwaukee, WI, USA
| | - N Didehbani
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - R Maize
- Carlow University, Pittsburgh, PA, USA
| | - C M Cullum
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Carlow University, Pittsburgh, PA, USA
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12
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Rao HM, Yuditskaya S, Williamson JR, Vian TR, Lacirignola JJ, Shenk TE, Talavage TM, Heaton KJ, Quatieri TF. Using Oculomotor Features to Predict Changes in Optic Nerve Sheath Diameter and ImPACT Scores From Contact-Sport Athletes. Front Neurol 2021; 12:584684. [PMID: 33746869 PMCID: PMC7969804 DOI: 10.3389/fneur.2021.584684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
There is mounting evidence linking the cumulative effects of repetitive head impacts to neuro-degenerative conditions. Robust clinical assessment tools to identify mild traumatic brain injuries are needed to assist with timely diagnosis for return-to-field decisions and appropriately guide rehabilitation. The focus of the present study is to investigate the potential for oculomotor features to complement existing diagnostic tools, such as measurements of Optic Nerve Sheath Diameter (ONSD) and Immediate Post-concussion Assessment and Cognitive Testing (ImPACT). Thirty-one high school American football and soccer athletes were tracked through the course of a sports season. Given the high risk of repetitive head impacts associated with both soccer and football, our hypotheses were that (1) ONSD and ImPACT scores would worsen through the season and (2) oculomotor features would effectively capture both neurophysiological changes reflected by ONSD and neuro-functional status assessed via ImPACT. Oculomotor features were used as input to Linear Mixed-Effects Regression models to predict ONSD and ImPACT scores as outcomes. Prediction accuracy was evaluated to identify explicit relationships between eye movements, ONSD, and ImPACT scores. Significant Pearson correlations were observed between predicted and actual outcomes for ONSD (Raw = 0.70; Normalized = 0.45) and for ImPACT (Raw = 0.86; Normalized = 0.71), demonstrating the capability of oculomotor features to capture neurological changes detected by both ONSD and ImPACT. The most predictive features were found to relate to motor control and visual-motor processing. In future work, oculomotor models, linking neural structures to oculomotor function, can be built to gain extended mechanistic insights into neurophysiological changes observed through seasons of participation in contact sports.
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Affiliation(s)
- Hrishikesh M Rao
- Human Health & Performance Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Sophia Yuditskaya
- Human Health & Performance Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - James R Williamson
- Human Health & Performance Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Trina R Vian
- Counter-Weapons of Mass Destruction Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Joseph J Lacirignola
- Counter-Weapons of Mass Destruction Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Trey E Shenk
- Advanced Radio Frequency Techniques & Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Thomas M Talavage
- Department of Biomedical Engineering, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States.,Department of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States
| | - Kristin J Heaton
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Thomas F Quatieri
- Human Health & Performance Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
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13
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Ha S, Jeong HS, Park SK, Lee SY. Can Neurocognitive Function Predict Lower Extremity Injuries in Male Collegiate Athletes? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239061. [PMID: 33291771 PMCID: PMC7731352 DOI: 10.3390/ijerph17239061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
The purpose of this study is to demonstrate whether neurocognitive evaluation can confirm the association between neurocognitive level and postural control and to analyze the relationship between neurocognitive level and acute musculoskeletal injury in male non-net sports athletes. Seventy-seven male non-net sports athletes participated in this study. The Standardized Assessment of Concussion (SAC), Landing Error Scoring System (LESS), Balance Error Scoring System (BESS), and Star Excursion Balance Test (SEBT) were used for testing; we collected data related to injury history for six months after testing. Pearson's correlation analysis, logistic regression, and the independent sample t-test were used for statistical analysis. The correlation between SAC and SEBT results was weak to moderate (p < 0.05). Eleven of the seventy-seven participants experienced acute lower limb injuries. SAC, LESS, BESS, and SEBT results have no effect on the occurrence of acute lower extremity injuries (p > 0.05) and were not statistically different between the injured and non-injured groups (p > 0.05). Therefore, using the SAC score alone to determine the risk factor of lower extremity injuries, except in the use of assessment after a concussion, should be cautioned against.
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Affiliation(s)
- Sunghe Ha
- Department of Physical Education, College of Sciences in Education, Yonsei University, Seoul 03722, Korea; (S.H.); (H.S.J.)
- International Olympic Committee Research Centre Korea, Yonsei University, Seoul 03722, Korea
| | - Hee Seong Jeong
- Department of Physical Education, College of Sciences in Education, Yonsei University, Seoul 03722, Korea; (S.H.); (H.S.J.)
- International Olympic Committee Research Centre Korea, Yonsei University, Seoul 03722, Korea
| | - Sang-Kyoon Park
- School of Physical Education, Korea National Sport University, Seoul 05541, Korea
- Correspondence: (S.-K.P.); (S.Y.L.); Tel.: +82-2-410-6952 (S.-K.P.); +82-2-2123-6189 (S.Y.L.); Fax: +82-2-410-6952 (S.-K.P.); +82-2-2123-8375 (S.Y.L.)
| | - Sae Yong Lee
- Department of Physical Education, College of Sciences in Education, Yonsei University, Seoul 03722, Korea; (S.H.); (H.S.J.)
- International Olympic Committee Research Centre Korea, Yonsei University, Seoul 03722, Korea
- Institute of Convergence Science, Yonsei University, Seoul 03722, Korea
- Correspondence: (S.-K.P.); (S.Y.L.); Tel.: +82-2-410-6952 (S.-K.P.); +82-2-2123-6189 (S.Y.L.); Fax: +82-2-410-6952 (S.-K.P.); +82-2-2123-8375 (S.Y.L.)
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14
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Laverse E, Guo T, Zimmerman K, Foiani MS, Velani B, Morrow P, Adejuwon A, Bamford R, Underwood N, George J, Brooke D, O'Brien K, Cross MJ, Kemp SPT, Heslegrave AJ, Hardy J, Sharp DJ, Zetterberg H, Morris HR. Plasma glial fibrillary acidic protein and neurofilament light chain, but not tau, are biomarkers of sports-related mild traumatic brain injury. Brain Commun 2020; 2:fcaa137. [PMID: 33543129 PMCID: PMC7846133 DOI: 10.1093/braincomms/fcaa137] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 12/17/2022] Open
Abstract
Mild traumatic brain injury is a relatively common event in contact sports and there is increasing interest in the long-term neurocognitive effects. The diagnosis largely relies on symptom reporting and there is a need for objective tools to aid diagnosis and prognosis. There are recent reports that blood biomarkers could potentially help triage patients with suspected injury and normal CT findings. We have measured plasma concentrations of glial and neuronal proteins and explored their potential in the assessment of mild traumatic brain injury in contact sport. We recruited a prospective cohort of active male rugby players, who had pre-season baseline plasma sampling. From this prospective cohort, we recruited 25 players diagnosed with mild traumatic brain injury. We sampled post-match rugby players without head injuries as post-match controls. We measured plasma neurofilament light chain, tau and glial fibrillary acidic protein levels using ultrasensitive single molecule array technology. The data were analysed at the group and individual player level. Plasma glial fibrillary acidic protein concentration was significantly increased 1-h post-injury in mild traumatic brain injury cases compared to the non-injured group (P = 0.017). Pairwise comparison also showed that glial fibrillary acidic protein levels were higher in players after a head injury in comparison to their pre-season levels at both 1-h and 3- to 10-day post-injury time points (P = 0.039 and 0.040, respectively). There was also an increase in neurofilament light chain concentration in brain injury cases compared to the pre-season levels within the same individual at both time points (P = 0.023 and 0.002, respectively). Tau was elevated in both the non-injured control group and the 1-h post-injury group compared to pre-season levels (P = 0.007 and 0.015, respectively). Furthermore, receiver operating characteristic analysis showed that glial fibrillary acidic protein and neurofilament light chain can separate head injury cases from control players. The highest diagnostic power was detected when biomarkers were combined in differentiating 1-h post-match control players from 1-h post-head injury players (area under curve 0.90, 95% confidence interval 0.79–1.00, P < 0.0002). The brain astrocytic marker glial fibrillary acidic protein is elevated in blood 1 h after mild traumatic brain injury and in combination with neurofilament light chain displayed the potential as a reliable biomarker for brain injury evaluation. Plasma total tau is elevated following competitive rugby with and without a head injury, perhaps related to peripheral nerve trauma and therefore total tau does not appear to be suitable as a blood biomarker.
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Affiliation(s)
- Etienne Laverse
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, Queen Square, UK
| | - Tong Guo
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, Queen Square, UK
| | - Karl Zimmerman
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Martha S Foiani
- Department of Neurodegenerative Disease, UK Dementia Research Institute at UCL, UCL Institute of Neurology, University College London, London, UK
| | - Bharat Velani
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, Queen Square, UK
| | | | | | | | | | | | | | | | | | | | - Amanda J Heslegrave
- Department of Neurodegenerative Disease, UK Dementia Research Institute at UCL, UCL Institute of Neurology, University College London, London, UK
| | - John Hardy
- Department of Neurodegenerative Disease, UK Dementia Research Institute at UCL, UCL Institute of Neurology, University College London, London, UK
| | - David J Sharp
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, UK Dementia Research Institute at UCL, UCL Institute of Neurology, University College London, London, UK
| | - Huw R Morris
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, Queen Square, UK
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15
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Lumba-Brown A, Ghajar J, Cornwell J, Bloom OJ, Chesnutt J, Clugston JR, Kolluri R, Leddy JJ, Teramoto M, Gioia G. Representation of concussion subtypes in common postconcussion symptom-rating scales. Concussion 2019; 4:CNC65. [PMID: 31827883 PMCID: PMC6902310 DOI: 10.2217/cnc-2019-0005] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/28/2019] [Indexed: 01/26/2023] Open
Abstract
AIM Postconcussion symptom-rating scales are frequently used concussion assessment tools that do not align directly with new expert, consensus-based concussion subtype classification systems. This may result in delays in concussion diagnosis, subspecialty referral and rehabilitative strategies. OBJECTIVE To determine the representation of subtype-directed symptomatology in common postconcussion symptom-rating scales. METHODS Literature review and expert consensus were used to compile commonly used concussion symptom-rating scales. Statistics were generated to describe the degree of representation of the consensus symptom set. RESULTS The percentage of symptoms representing each subtype/associated condition is low overall (15-26%). The ocular-motor (11%) and vestibular subtypes (19%) and cervical strain (5%)-associated condition were the most under-represented and also had the greatest unmet needs. CONCLUSION Concussion subtypes do not have equal representation on commonly used concussion symptom-rating scales. There is a need for a subtype-directed symptom assessment to allow for increased accuracy of diagnosis and to guide management.
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Affiliation(s)
- Angela Lumba-Brown
- Department of Emergency Medicine, Stanford University, Stanford, CA 94304, USA
| | - Jamshid Ghajar
- Department of Neurosurgery, Brain Performance Center, Stanford University, Stanford, CA 94304 USA
| | - Jordan Cornwell
- Department of Emergency Medicine, Stanford University, Stanford, CA 94304, USA
| | - O Josh Bloom
- Carolina Sports Concussion Clinic, Cary, NC 27513, USA
| | - James Chesnutt
- Departments of Family Medicine, Neurology, Oregon Health & Science University, Portland, OR & Rebound Orthopedics & Neurosurgery, Portland, OR 97239, USA
| | - James R Clugston
- Departments of Community Health & Family Medicine & Neurology, University of Florida, Gainesville, FL 32611, USA
| | - Raina Kolluri
- Department of Neurosurgery, Brain Performance Center, Stanford University, Stanford, CA 94304, USA
| | - John J Leddy
- UBMD Department of Orthopaedics & Sports Medicine, Jacobs School of Medicine & Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 14203, USA
| | - Masaru Teramoto
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT 84108, USA
| | - Gerard Gioia
- Division of Pediatric Neuropsychology, Safe Concussion Outcome Recovery & Education Program, Children’s National Health System, Departments of Pediatrics & Psychiatry & Behavioral Sciences, George Washington University School of Medicine, Rockville, MD 20850, USA
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16
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Legarreta AD, Mummareddy N, Yengo-Kahn AM, Zuckerman SL. On-field assessment of concussion: clinical utility of the King-Devick test. Open Access J Sports Med 2019; 10:115-121. [PMID: 31686924 PMCID: PMC6709031 DOI: 10.2147/oajsm.s171815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 08/01/2019] [Indexed: 11/23/2022] Open
Abstract
Sport-related concussion (SRC) is an important public health concern with up to 3.8 million SRCs occurring each year. As the incidence and rate of SRC increases, reliable and valid tools for diagnosis and management are needed. The King-Devick (K-D) test assesses a patient’s visual function based on reading a series of numbers as well as counting both time to completion and errors. Its rapid administration time and simplicity make the K-D test a potentially useful SRC diagnostic tool, though limitations exist in baseline testing and what constitutes an abnormal score. Additionally, the K-D tests should never be used in isolation to diagnose a concussion, but rather as one test in conjunction with additional clinical measures, as part of an individualized approach to each patient. The current review examines the clinical utility of the K-D test.
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Affiliation(s)
- Andrew D Legarreta
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nishit Mummareddy
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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17
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Hill T, Orchard J, Kountouris A. Incidence of Concussion and Head Impacts in Australian Elite-Level Male and Female Cricketers After Head Impact Protocol Modifications. Sports Health 2018; 11:180-185. [PMID: 30444677 PMCID: PMC6391555 DOI: 10.1177/1941738118811315] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Concussion in sport is a topic of growing interest in Australia and worldwide. To date, relatively few studies have examined the true incidence of concussion in cricket. Hypothesis: Concussion in cricket is more common than current literature suggests. Study Design: Descriptive epidemiology study. Level of Evidence: Level 4. Methods: This is a prospective registry and subsequent analysis of head impacts and concussions in elite-level male and female cricketers in Australia over 2 seasons (2015-2016 and 2016-2017). A total of 172 male and 106 female domestic and international players in 2015-2016 and 179 males and 98 females in 2016-2017 were included. Results: There were 92 head impacts (29 concussions) in men’s matches and 15 head impacts (8 concussions) in women’s matches. Match incidence rates per 1000 player days were 7.2 head impacts (2.3 concussions) in elite male cricket and 3.7 head impacts (2.0 concussions) in elite female cricket. This equates to a head impact every 2000 balls and concussion every 9000 balls in male domestic cricket. Concussion rates per 1000 player-match hours were 0.4 for elite males and 0.5 for elite females; 53% of head impacts in females were diagnosed as concussions compared with 32% in males, and 83% of concussions resulted in missing no more than 1 game. Conclusion: The rate of concussion in cricket is higher than previously appreciated; however, the majority of patients recovered quickly, and players generally did not miss much playing time as a result. The institution of concussion policies after head impact, including player substitution, appears to have had an effect on increasing reporting of symptoms, resulting in an increase in diagnosis of concussion. Clinical Relevance: Concussion in cricket is not as infrequent as previously assumed. Ongoing review of the rules and regulations is required to ensure that protection of player welfare lies in parallel with other sporting codes.
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Affiliation(s)
- Thomas Hill
- Cricket Australia, Melbourne, Victoria, Australia
| | - John Orchard
- Cricket Australia, Melbourne, Victoria, Australia
| | - Alex Kountouris
- Cricket Australia, Melbourne, Victoria, Australia.,Sports Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
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