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Knapp CP, Papadopoulos E, Loweth JA, Raghupathi R, Floresco SB, Waterhouse BD, Navarra RL. Perturbations in risk/reward decision making and frontal cortical catecholamine regulation induced by mild traumatic brain injury. Behav Brain Res 2024; 467:115002. [PMID: 38636779 DOI: 10.1016/j.bbr.2024.115002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/03/2024] [Accepted: 04/14/2024] [Indexed: 04/20/2024]
Abstract
Mild traumatic brain injury (mTBI) disrupts cognitive processes that influence risk taking behavior. Little is known regarding the effects of repetitive mild injury (rmTBI) or whether these outcomes are sex specific. Risk/reward decision making is mediated by the prefrontal cortex (PFC), which is densely innervated by catecholaminergic fibers. Aberrant PFC catecholamine activity has been documented following TBI and may underlie TBI-induced risky behavior. The present study characterized the effects of rmTBI on risk/reward decision making behavior and catecholamine transmitter regulatory proteins within the PFC. Rats were exposed to sham, single (smTBI), or three closed-head controlled cortical impact (CH-CCI) injuries and assessed for injury-induced effects on risk/reward decision making using a probabilistic discounting task (PDT). In the first week post-final surgery, mTBI increased risky choice preference. By the fourth week, males exhibited increased latencies to make risky choices following rmTBI, demonstrating a delayed effect on processing speed. When levels of tyrosine hydroxylase (TH) and the norepinephrine reuptake transporter (NET) were measured within subregions of the PFC, females exhibited dramatic increases of TH levels within the orbitofrontal cortex (OFC) following smTBI. However, both males and females demonstrated reduced levels of OFC NET following rmTBI. These results indicate the OFC is susceptible to catecholamine instability after rmTBI and suggests that not all areas of the PFC contribute equally to TBI-induced imbalances. Overall, the CH-CCI model of rmTBI has revealed time-dependent and sex-specific changes in risk/reward decision making and catecholamine regulation following repetitive mild head injuries.
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Affiliation(s)
- Christopher P Knapp
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA.
| | - Eleni Papadopoulos
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA
| | - Jessica A Loweth
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA
| | - Ramesh Raghupathi
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Stan B Floresco
- Department of Psychology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Barry D Waterhouse
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA
| | - Rachel L Navarra
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA.
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Antonellis P, Weightman MM, Fino PC, Chen S, Lester ME, Hoppes CW, Dibble LE, King LA. Relation Between Cognitive Assessment and Clinical Physical Performance Measures After Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2024; 105:868-875. [PMID: 37931890 DOI: 10.1016/j.apmr.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To investigate the relation between cognitive and motor performance in individuals with mild traumatic brain injury (mTBI) and examine differences in both cognitive and motor performance between adults after mTBI and healthy controls. DESIGN Multi-center, cross-sectional study. SETTING Three institutional sites (Courage Kenny Research Center, Minneapolis, MN, Oregon Health & Science University, Portland, OR, and University of Utah, Salt Lake City, UT). PARTICIPANTS Data were collected from 110 participants (N=110), including those with mTBI and healthy controls, who completed cognitive and physical performance assessments. INTERVENTIONS Not applicable. OUTCOME MEASURES Cognitive assessments involved the Automated Neuropsychological Assessment Metrics to evaluate domains of attention, memory, reaction time, processing speed, and executive function. Physical performance was evaluated through clinical performance assessments, such as the 1-min walk test, the modified Illinois Agility Test, the Functional Gait Assessment Tool, the High-Level Mobility Assessment Tool, a complex turning course, and a 4-Item Hybrid Assessment of Mobility for mTBI. Participants also completed additional trials of the 1-min walk test, modified Illinois Agility Test, and complex turning course with a simultaneous cognitive task. RESULTS Individuals with mTBI performed worse on cognitive assessments, as well as several of the physical performance assessments compared with healthy controls. Complex tasks were more strongly related to cognitive assessments compared with simple walking tasks. CONCLUSIONS Combining complex motor tasks with cognitive demands may better demonstrate functional performance in individuals recovering from mTBI. By understanding the relation between cognitive and physical performance in individuals recovering from mTBI, clinicians may be able to improve clinical care and assist in return to activity decision-making.
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Affiliation(s)
| | | | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT
| | - Siting Chen
- School of Public Health, Oregon Health & Science University, Portland, OR
| | - Mark E Lester
- Department of Physical Therapy, University of Texas Rio Grande Valley, Harlingen, TX
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR
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Preszler J, Manderino L, Eagle SR, Trbovich A, Kissinger-Knox A, Feder A, Mehmel B, Collins MW, Kontos AP. Evaluating Recovery After Two and Three Repeated Concussions Using Growth Curves. J Neurotrauma 2024. [PMID: 38323540 DOI: 10.1089/neu.2023.0148] [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: 02/08/2024] Open
Abstract
The results of prior research concerning the effects of repeated concussions have been mixed. The aim of this study was to evaluate how concussion outcomes and presentation changed within patients who were evaluated at a concussion specialty clinic multiple times with a concussion. Subjects included 202 patients (54% male) aged 10-21 years (M = 13.17) who presented to a specialty concussion clinic for two and three concussions (77% sport-related) and were followed through formal clearance. First, growth curve models were estimated to determine recovery time and initial symptom burden across the multiple injuries. Second, covariates were added to these models to evaluate which demographic, risk factor, or injury variables predicted any change that did occur in evaluation or outcome variables. Models indicated that each subsequent concussion linearly resulted in significantly fewer days to recovery (-4.62 days, p < 0.047) across three concussions, and significantly lower (and linear) symptom scores on the post-concussion symptom scale (PCSS) (-2.16, p = 0.05). More severe presentation (i.e., days to recovery; higher symptom score) was significantly associated (-.62, p = 0.005) with greater improvement in recovery time (-.62, p = 0.005) and symptom burden (-.56, p < 0.001) at subsequent injuries. No covariates were significantly associated with improvement (or lack thereof) at subsequent injuries. This study adds to evidence suggesting multiple injuries is not associated with protracted recovery at subsequent injuries, in the context of treatment and full clearance for each injury at a multi-disciplinary clinic.
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Affiliation(s)
- Jonathan Preszler
- Department of Neuropsychology, Sanford Health, Bismarck, North Dakota, USA
| | - Lisa Manderino
- Aptiva Health Concussion Program, Louisville, Kentucky, USA
| | - Shawn R Eagle
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alicia Trbovich
- UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Abigail Feder
- Northside Hospital Concussion Institute, Duluth, Georgia, USA
| | - Bindal Mehmel
- UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
| | - Michael W Collins
- UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony P Kontos
- UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Özcan D, Unver B, Karatosun V. Balance assessment under dual task conditions in patients with total knee arthroplasty: a test-retest reliability and concurrent validity study. Physiother Theory Pract 2024:1-6. [PMID: 38384122 DOI: 10.1080/09593985.2024.2321222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Under dual-task (DT), functional mobility and balance testing can detect balance and mobility problems in activities of daily living, especially in situations that cannot be identified under single-task conditions. OBJECTIVE Determine the test-retest reliability and concurrent validity of the Four Square Step Test (FSST) under DT conditions for people with total knee arthroplasty (TKA). METHOD A total of 30 patients with TKA participated in this research, and patients were tested with the FSST under DT conditions. In addition, concurrent validity of the dual-task FSST was calculated using Timed Up and Go (TUG) under the single-task condition and Hospital for Special Surgery (HSS) Knee Score. Patients performed two FSST trials on the same day under DT conditions. RESULTS The intraclass correlation coefficients (ICC2,1) two-way random effects model, and minimal detectable changes with 95% confidence intervals (MDC95) values of the FSST under DT conditions were .97 and 3.43, respectively. The Pearson's correlation coefficient of the FSST with the TUG and HSS was .65 and -.40, respectively. CONCLUSION The FSST has been found to be a reliable and valid clinical assessment tool for dynamic balance under DT conditions in patients with TKA. For identify balance disorders in daily life at early points, clinicians and researchers can use the FSST under DT conditions in TKA. CLINICAL TRIAL REGISTRATION NUMBER NCT06108466.
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Affiliation(s)
- Damla Özcan
- Health Sciences Institute, Dokuz Eylul University, Balcova, Izmir, Turkey
| | - Bayram Unver
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Balcova, Izmir Turkey
| | - Vasfi Karatosun
- Department of Orthopaedics and Traumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
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Stern-Green EA, Klimo KR, Day E, Shelton ER, Robich ML, Jordan LA, Racine J, VanNasdale DA, McDaniel CE, Yuhas PT. Henle fiber layer thickening and deficits in objective retinal function in participants with a history of multiple traumatic brain injuries. Front Neurol 2024; 15:1330440. [PMID: 38379704 PMCID: PMC10876769 DOI: 10.3389/fneur.2024.1330440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/16/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction This study tested whether multiple traumatic brain injuries (TBIs) alter the structure of the Henle fiber layer (HFL) and degrade cell-specific function in the retinas of human participants. Methods A cohort of case participants with multiple TBIs and a cohort of pair-matched control participants were prospectively recruited. Directional optical coherence tomography and scanning laser polarimetry measured HFL thickness and phase retardation, respectively. Full-field flash electroretinography (fERG) assessed retinal function under light-adapted (LA) 3.0, LA 30 Hz, dark-adapted (DA) 0.01, DA 3.0, and DA 10 conditions. Retinal imaging and fERG outcomes were averaged between both eyes, and paired t-tests or Wilcoxon signed-rank tests analyzed inter-cohort differences. Results Global HFL thickness was significantly (p = 0.02) greater in cases (8.4 ± 0.9 pixels) than in controls (7.7 ± 1.1 pixels). There was no statistically significant difference (p = 0.91) between the cohorts for global HFL phase retardation. For fERG, LA 3.0 a-wave amplitude was significantly reduced (p = 0.02) in cases (23.5 ± 4.2 μV) compared to controls (29.0 ± 8.0 μV). There were no other statistically significant fERG outcomes between the cohorts. Discussion In summary, the HFL thickens after multiple TBIs, but phase retardation remains unaltered in the macula. Multiple TBIs may also impair retinal function, indicated by a reduction in a-wave amplitude. These results support the potential of the retina as a site to detect TBI-associated pathology.
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Affiliation(s)
| | - Kelly R. Klimo
- College of Optometry, The Ohio State University, Columbus, OH, United States
| | - Elizabeth Day
- College of Optometry, The Ohio State University, Columbus, OH, United States
| | - Erica R. Shelton
- College of Optometry, The Ohio State University, Columbus, OH, United States
| | - Matthew L. Robich
- College of Optometry, The Ohio State University, Columbus, OH, United States
| | - Lisa A. Jordan
- College of Optometry, The Ohio State University, Columbus, OH, United States
| | - Julie Racine
- Department of Ophthalmology, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Dean A. VanNasdale
- College of Optometry, The Ohio State University, Columbus, OH, United States
| | | | - Phillip T. Yuhas
- College of Optometry, The Ohio State University, Columbus, OH, United States
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Wilmoth K, Brett BL, Emmert NA, Cook CM, Schaffert J, Caze T, Kotsonis T, Cusick M, Solomon G, Resch JE, Cullum CM, Nelson LD, McCrea M. Psychometric Properties of Computerized Cognitive Tools and Standard Neuropsychological Tests Used to Assess Sport Concussion: A Systematic Review. Neuropsychol Rev 2023; 33:675-692. [PMID: 36040610 DOI: 10.1007/s11065-022-09553-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/03/2022] [Indexed: 11/29/2022]
Abstract
Athletic programs are more frequently turning to computerized cognitive tools in order to increase efficiencies in concussion assessment. However, assessment using a traditional neuropsychological test battery may provide a more comprehensive and individualized evaluation. Our goal was to inform sport clinicians of the best practices for concussion assessment through a systematic literature review describing the psychometric properties of standard neuropsychological tests and computerized tools. We conducted our search in relevant databases including Ovid Medline, Web of Science, PsycINFO, and Scopus. Journal articles were included if they evaluated psychometric properties (e.g., reliability, sensitivity) of a cognitive assessment within pure athlete samples (up to 30 days post-injury). Searches yielded 4,758 unique results. Ultimately, 103 articles met inclusion criteria, all of which focused on adolescent or young adult participants. Test-retest reliability estimates ranged from .14 to .93 for computerized tools and .02 to .95 for standard neuropsychological tests, with strongest correlations on processing speed tasks for both modalities, although processing speed tasks were most susceptible to practice effects. Reliability was improved with a 2-factor model (processing speed and memory) and by aggregating multiple baseline exams, yet remained below acceptable limits for some studies. Sensitivity to decreased cognitive performance within 72 h of injury ranged from 45%-93% for computerized tools and 18%-80% for standard neuropsychological test batteries. The method for classifying cognitive decline (normative comparison, reliable change indices, regression-based methods) affected sensitivity estimates. Combining computerized tools and standard neuropsychological tests with the strongest psychometric performance provides the greatest value in clinical assessment. To this end, future studies should evaluate the efficacy of hybrid test batteries comprised of top-performing measures from both modalities.
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Affiliation(s)
- Kristin Wilmoth
- Departments of Psychiatry and Physical Medicine & Rehabilitation, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9055, USA.
| | - Benjamin L Brett
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Natalie A Emmert
- Department of Neurology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Carolyn M Cook
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jeffrey Schaffert
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Todd Caze
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Kotsonis
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Margaret Cusick
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gary Solomon
- Player Health and Safety Department, National Football League and Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - C Munro Cullum
- Departments of Psychiatry, Neurology, and Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Lindsay D Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
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Kakavas G, Giannakopoulos I, Tsiokanos A, Potoupnis M, Tsaklis PV. The Effect of Ball Heading and Subclinical Concussion On the Neuromuscular Control Of The Lower Limb: A Systematic Review. Int J Sports Phys Ther 2023; 18:1054-1064. [PMID: 37795323 PMCID: PMC10547093 DOI: 10.26603/001c.87922] [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: 05/16/2023] [Accepted: 08/19/2023] [Indexed: 10/06/2023] Open
Abstract
Background Soccer is unique among sports because it is the only sport that involves purposeful use of the head to control, pass, or shoot the ball. Over the previous five years, a relationship between lower extremity (LE) injury and sports related concussion (SRC) has been established in various sporting populations. Athletes at the high school, collegiate, and professional levels have demonstrated a greater risk for sustaining a LE injury post SRC. The purpose of this systematic review was to examine the relationship of the SRC with the incidence of LE injuries. Methods Ten databases were searched with the following keywords: Lower limb, ball heading, neuromuscular control, concussion, MEDLINE, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R), EMBASE, and Scopus. The search was limited to English-language and peer-reviewed publications, until 15/12/2022. The PEDro scale was used for the assessment of the risk of bias among the included studies. All included papers were qualitatively analyzed. Results A total of 834 studies were identified and 10 articles (four concussion-MSK biomechanics, six concussion-MSK injury) were included in the qualitative analyses. Included papers ranged from low to high quality. Due to the heterogeneous nature of the included study designs, quantitative meta-analysis was unable to be performed. All four of the included concussion-MSK biomechanics studies demonstrated, to some degree, that worse cognitive performance was associated with lower extremity MSK biomechanical patterns suggestive of greater risk for MSK injury. Among the six injury related studies, two investigations failed to determine group differences in cognitive performance between subsequently injured and non-injured athletes. Conclusion More research is needed to better understand the relationship of SRC and lower extremity injuries and the extent to which they are related to concussions and/or repetitive neurotrauma after ball heading sustained in soccer. Level of Evidence 2.
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Affiliation(s)
- Georgios Kakavas
- Fysiotek Spine and Sports Lab Athens, Greece
- Department of Physical Education and Sport Science, University of Thessaly, ErgoMech- Lab, Greece
| | - Ioannis Giannakopoulos
- Department of Physical Education and Sport Science, University of Thessaly, ErgoMech- Lab, Greece
| | - Athanasios Tsiokanos
- Department of Physical Education and Sport Science, University of Thessaly, ErgoMech- Lab, Greece
| | | | - Panagiotis V Tsaklis
- Department of Physical Education and Sport Science, University of Thessaly, ErgoMech- Lab, Greece
- Department of Molecular Medicine and Surgery, Growth and Metabolism, Karolinska Institute, Sweden
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Lystad RP, McMaugh A, Herkes G, Browne G, Badgery-Parker T, Cameron CM, Mitchell RJ. Risk of impaired school performance in children hospitalized with concussion: a population-based matched cohort study. Concussion 2023; 8:CNC105. [PMID: 37691853 PMCID: PMC10488614 DOI: 10.2217/cnc-2022-0012] [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: 11/10/2022] [Accepted: 02/21/2023] [Indexed: 09/12/2023] Open
Abstract
Aim To examine the impact of concussion on objective measures of school performance. Materials & methods Population-based matched cohort study using linked health and education records of young people aged ≤18 years hospitalized with concussion in New South Wales, Australia, during 2005-2018, and matched comparisons not hospitalized with any injury. Results Young people with concussion had higher risk of not achieving the national minimum standards for literacy and numeracy assessments, ranging from 30% for numeracy to 43% for spelling, and not completing high school, ranging from 29% for year 10 to 77% for year 12, compared with matched peers. Conclusion Young people hospitalized with concussion have impaired school performance compared with uninjured matched peers.
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Affiliation(s)
- Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park NSW, 2109, Australia
| | - Anne McMaugh
- The Macquarie School of Education, Macquarie University, Macquarie Park NSW, 2109, Australia
| | - Geoffrey Herkes
- Sydney Medical School, University of Sydney, Camperdown NSW, 2006, Australia
- Royal North Shore Hospital, St Leonards NSW, 2065, Australia
| | - Gary Browne
- Sydney Medical School, University of Sydney, Camperdown NSW, 2006, Australia
- The Children's Hospital at Westmead, Westmead NSW, 2145, Australia
| | - Tim Badgery-Parker
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park NSW, 2109, Australia
| | - Cate M Cameron
- Jamieson Trauma Institute, Royal Brisbane & Women's Hospital, Metro North Health, Herston QLD, 4029, Australia
- Centre for Healthcare Transformation, Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane QLD, 4000, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park NSW, 2109, Australia
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Penn C, Katnik C, Cuevas J, Mohapatra SS, Mohapatra S. Multispectral optoacoustic tomography (MSOT): Monitoring neurovascular changes in a mouse repetitive traumatic brain injury model. J Neurosci Methods 2023; 393:109876. [PMID: 37150303 PMCID: PMC10388337 DOI: 10.1016/j.jneumeth.2023.109876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Evidence suggests that mild TBI injuries, which comprise > 75% of all TBIs, can cause chronic post-concussive symptoms, especially when experienced repetitively (rTBI). rTBI is a major cause of cognitive deficit in athletes and military personnel and is associated with neurovascular changes. Current methods to monitor neurovascular changes in detail are prohibitively expensive and invasive for patients with mild injuries. NEW METHOD We evaluated the potential of multispectral optoacoustic tomography (MSOT) to monitor neurovascular changes and assess therapeutic strategies in a mouse model of rTBI. Mice were subjected to rTBI or sham via controlled cortical impact and administered pioglitazone (PG) or vehicle. Oxygenated and deoxygenated hemoglobin were monitored using MSOT. Indocyanine green clearance was imaged via MSOT to evaluate blood-brain-barrier (BBB) integrity. RESULTS Mice subjected to rTBI show a transient increase in oxygenated/total hemoglobin ratio which can be mitigated by PG administration. rTBI mice also show BBB disruption shortly after injury and reduction of oxygenated/total hemoglobin in the chronic stage, neither of which were affected by PG intervention. COMPARISON WITH EXISTING METHODS MSOT imaging has the potential as a noninvasive in vivo imaging method to monitor neurovascular changes and assess therapeutics in mouse models of rTBI. In comparison to standard methods of tracking inflammation and BBB disruption, MSOT can be used multiple times throughout the course of injury without the need for surgery. Thus, MSOT is especially useful in research of rTBI models for screening therapeutics, and with further technological improvements may be extended for use in rTBI patients.
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Affiliation(s)
- Courtney Penn
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Blvd, Tampa, FL 33612, USA; Department of Molecular Medicine, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA
| | - Chris Katnik
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA
| | - Javier Cuevas
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA
| | - Shyam S Mohapatra
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Blvd, Tampa, FL 33612, USA; Department of Internal Medicine, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA
| | - Subhra Mohapatra
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Blvd, Tampa, FL 33612, USA; Department of Molecular Medicine, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA.
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Neumann KD, Seshadri V, Thompson XD, Broshek DK, Druzgal J, Massey JC, Newman B, Reyes J, Simpson SR, McCauley KS, Patrie J, Stone JR, Kundu BK, Resch JE. Microglial activation persists beyond clinical recovery following sport concussion in collegiate athletes. Front Neurol 2023; 14:1127708. [PMID: 37034078 PMCID: PMC10080132 DOI: 10.3389/fneur.2023.1127708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction In concussion, clinical and physiological recovery are increasingly recognized as diverging definitions. This study investigated whether central microglial activation persisted in participants with concussion after receiving an unrestricted return-to-play (uRTP) designation using [18F]DPA-714 PET, an in vivo marker of microglia activation. Methods Eight (5 M, 3 F) current athletes with concussion (Group 1) and 10 (5 M, 5 F) healthy collegiate students (Group 2) were enrolled. Group 1 completed a pre-injury (Visit1) screen, follow-up Visit2 within 24 h of a concussion diagnosis, and Visit3 at the time of uRTP. Healthy participants only completed assessments at Visit2 and Visit3. At Visit2, all participants completed a multidimensional battery of tests followed by a blood draw to determine genotype and study inclusion. At Visit3, participants completed a clinical battery of tests, brain MRI, and brain PET; no imaging tests were performed outside of Visit3. Results For Group 1, significant differences were observed between Visits 1 and 2 (p < 0.05) in ImPACT, SCAT5 and SOT performance, but not between Visit1 and Visit3 for standard clinical measures (all p > 0.05), reflecting clinical recovery. Despite achieving clinical recovery, PET imaging at Visit3 revealed consistently higher [18F]DPA-714 tracer distribution volume (VT) of Group 1 compared to Group 2 in 10 brain regions (p < 0.001) analyzed from 164 regions of the whole brain, most notably within the limbic system, dorsal striatum, and medial temporal lobe. No notable differences were observed between clinical measures and VT between Group 1 and Group 2 at Visit3. Discussion Our study is the first to demonstrate persisting microglial activation in active collegiate athletes who were diagnosed with a sport concussion and cleared for uRTP based on a clinical recovery.
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Affiliation(s)
- Kiel D Neumann
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, United States
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
| | - Vikram Seshadri
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
| | - Xavier D Thompson
- Department of Kinesiology, University of Virginia, Charlottesville, VA, United States
| | - Donna K Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, United States
| | - Jason Druzgal
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
| | - James C Massey
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
| | - Benjamin Newman
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
| | - Jose Reyes
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
| | - Spenser R Simpson
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Katelyenn S McCauley
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
| | - James Patrie
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - James R Stone
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Bijoy K Kundu
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, VA, United States
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11
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Russell BK, McGeown J, Beard BL. Developing AI enabled sensors and decision support for military operators in the field. J Sci Med Sport 2023:S1440-2440(23)00039-7. [PMID: 36934030 DOI: 10.1016/j.jsams.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 02/17/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
Wearable sensors enable down range data collection of physiological and cognitive performance of the warfighter. However, autonomous teams may find the sensor data impractical to interpret and hence influence real-time decisions without the support of subject matter experts. Decision support tools can reduce the burden of interpreting physiological data in the field and incorporate a systems perspective where noisy field data can contain useful additional signals. We present a methodology of how artificial intelligence can be used for modeling human performance with decision-making to achieve actionable decision support. We provide a framework for systems design and advancing from the laboratory to real world environments. The result is a validated measure of down-range human performance with a low burden of operation.
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Affiliation(s)
- B K Russell
- Sports Performance Institute of New Zealand, Auckland University of Technology, New Zealand; Ambient Cognition Limited, Aukland, New Zealand.
| | - J McGeown
- Matai Medical Research Institute Inc, New Zealand
| | - B L Beard
- NASA Ames Research Center, Moffett Field, USA
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12
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Lennon MJ, Brooker H, Creese B, Thayanandan T, Rigney G, Aarsland D, Hampshire A, Ballard C, Corbett A, Raymont V. Lifetime Traumatic Brain Injury and Cognitive Domain Deficits in Late Life: The PROTECT-TBI Cohort Study. J Neurotrauma 2023. [PMID: 36716779 DOI: 10.1089/neu.2022.0360] [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: 02/01/2023] Open
Abstract
Traumatic brain injury (TBI) causes cognitive impairment but it remains contested regarding which cognitive domains are most affected. Further, moderate-severe TBI is known to be deleterious, but studies of mild TBI (mTBI) show a greater mix of negative and positive findings. This study examines the longer-term cognitive effects of TBI severity and number of mTBIs in later life. We examined a subset (n = 15,764) of the PROTECT study, a cohort assessing risk factors for cognitive decline (ages between 50 and 90 years). Participants completed cognitive assessments annually for 4 years. Cognitive tests were grouped using a principal components analysis (PCA) into working memory, episodic memory, attention, processing speed, and executive function. Lifetime TBI severity and number were retrospectively recalled by participants using the Brain Injury Screening Questionnaire (BISQ). Linear mixed models (LMMs) examined the effect of severity of head injury (non-TBI head strike, mTBI, and moderate-severe TBI) and number of mTBI at baseline and over time. mTBI was considered as a continuous and categorical variable (groups: 0 mTBI, 1 mTBI, 2 mTBIs, 3 mTBIs, and 4+ mTBIs). Of the participants 5725 (36.3%) reported at least one mTBI and 510 (3.2%) at least one moderate-severe TBI, whereas 3711 (23.5%) had suffered at worst a non-TBI head strike and 5818 (32.9%) reported no head injuries. The participants had suffered their last reported head injury an average (standard deviation, SD) of 29.6 (20.0) years prior to the study. Regarding outcomes, there was no worsening in longitudinal cognitive trajectories over the study duration but at baseline there were significant cognitive deficits associated with TBI. At baseline, compared with those without head injury, individuals reporting at least one moderate-severe TBI had significantly poorer attention (B = -0.163, p < 0.001), executive scores (B = -0.151, p = 0.004), and processing speed (B = -0.075, p = 0.033). Those who had suffered at least a single mTBI also demonstrated significantly poorer attention scores at baseline compared with the no head injury group (B = -0.052, p = 0.001). Compared with those with no mTBI, those in the 3 mTBI group manifested poorer baseline executive function (B = -0.149, p = 0.025) and attention scores (B = -0.085, p = 0.015). At baseline, those who had suffered four or more mTBIs demonstrated poorer attention (B = -0.135, p < 0.001), processing speed (B = -0.072, p = 0.009), and working memory (B = -0.052, p = 0.036), compared with those reporting no mTBI. TBI is associated with fixed, dose, and severity-dependent cognitive deficits. The most sensitive cognitive domains are attention and executive function, with approximately double the effect compared with processing speed and working memory. Post-TBI cognitive rehabilitation should be targeted appropriately to domain-specific effects. Significant long-term cognitive deficits were associated with three or more lifetime mTBIs, a critical consideration when counseling individuals post-TBI about continuing high-risk activities.
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Affiliation(s)
- Matthew J Lennon
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Helen Brooker
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Byron Creese
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Tony Thayanandan
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Grant Rigney
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
| | - Dag Aarsland
- Department of Old Age Psychiatry, IoPPN, Kings College London, London, United Kingdom.,Centre for Age-Related Research, Stavanger University Hospital, Stavanger, Norway
| | - Adam Hampshire
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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13
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Corrigan F, Arulsamy A, Shultz SR, Wright DK, Collins-Praino LE. Initial Severity of Injury Has Little Effect on the Temporal Profile of Long-Term Deficits in Locomotion, Anxiety, and Cognitive Function After Diffuse Traumatic Brain Injury. Neurotrauma Rep 2023; 4:41-50. [PMID: 36726871 PMCID: PMC9886190 DOI: 10.1089/neur.2022.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Traumatic brain injury (TBI) is associated with persistent impairments in multiple domains, including cognitive and neuropsychiatric function. Previous literature has suggested that the risk of such impairments may differ as a function of the initial severity of injury, with moderate-severe TBI (msTBI) associated with more severe cognitive dysfunction and mild TBI (mTBI) associated with a higher risk of developing an anxiety disorder. Despite this, relatively few pre-clinical studies have investigated the time course of behavioral change after different severities of injury. The current study compared the temporal profile of functional deficits incorporating locomotion, cognition, and anxiety up to 12 months post-injury after an mTBI, repeated mild TBI (rmTBI), and single msTBI in an experimental model of diffuse TBI. Injury appeared to alter the effect of aging on locomotor activity, with both msTBI and rmTBI rats showing a decrease in locomotion at 12 months relative to their earlier performance on the task, an effect not observed in shams or after a single mTBI. Further, mTBI seemed to be associated with decreased anxiety over time, as measured by increased time spent in the open arm of the elevated plus maze from 3 to 12 months post-injury. No significant findings were observed on spatial memory or volumetric magnetic resonance imaging. Future studies will need to use a more comprehensive behavioral battery, capable of capturing subtle alterations in function, and longer time points, following rats into old age, in order to more fully assess the evolution of persistent behavioral deficits in key domains after different severities of TBI, as well as their accompanying neuroimaging changes. Given the prevalence and significance of such deficits post-TBI for a person's quality of life, as well as the elevated risk of neurodegenerative disease post-injury, such investigations may play a critical role in identifying optimal windows of therapeutic intervention post-injury.
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Affiliation(s)
- Frances Corrigan
- Head Injury Lab, Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Alina Arulsamy
- Cognition, Ageing and Neurodegenerative Disease Lab, School of Biomedicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sandy R. Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Health and Human Services, Vancouver Island University, Nanaimo, British Columbia, Canada
| | - David K. Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lyndsey E. Collins-Praino
- Cognition, Ageing and Neurodegenerative Disease Lab, School of Biomedicine, The University of Adelaide, Adelaide, South Australia, Australia.,Address correspondence to: Lyndsey E. Collins-Praino, PhD, Discipline of Anatomy and Pathology, School of Biomedicine, University of Adelaide, Adelaide, South Australia, Australia 5005;
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14
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Jenkins AS, Moore ML, Pollock JR, Brinkman JC, Verhey J, Chhabra A. The 50 Most Cited Papers Pertaining to American Football: Analysis of Studies From the Past 40 Years. Orthop J Sports Med 2022; 10:23259671221141089. [PMID: 36582927 PMCID: PMC9793059 DOI: 10.1177/23259671221141089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Abstract
Background Bibliometric citation analyses have been widely used in medicine to help researchers gain foundational knowledge about a topic and identify subtopics of popular interest for further investigations. Purpose To identify the 50 most cited research publications related to American football. Study Design Cross-sectional study. Methods The Clarivate Analytics Web of Science database was used to generate a list of publications relating to football. Articles were filtered by the total number of citations, and the top 50 most cited articles studying the sport of football were selected for this analysis. Articles were analyzed by author, publication year, country of origin, institution affiliation, journal, article type, main research topic area, competitive level, and the level of evidence. A total of 247 articles were reviewed to reach the top 50 articles. Results The most studied topic within the top 50 articles was concussion/chronic traumatic encephalopathy (n = 40). Collegiate football was the most studied level of competition (n = 25). The journal publishing the greatest number of top articles was Neurosurgery. Two institutions, the University of North Carolina at Chapel Hill and Boston University School of Medicine, produced over one-third of top 50 articles (n = 18). Conclusion Our analysis indicated that most of the top 50 publications related to the sport of football focused on concussion and CTE, were observational, and were published during or after 2000. The most studied level of competition was collegiate football.
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Affiliation(s)
- Anna S. Jenkins
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale,
Arizona, USA
| | - Michael L. Moore
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale,
Arizona, USA
| | - Jordan R. Pollock
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale,
Arizona, USA
| | | | - Jens Verhey
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona,
USA
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona,
USA.,Anikar Chhabra, MD, Department of Orthopedic Surgery, Mayo
Clinic Arizona, 5777 E Mayo Boulevard, Phoenix, AZ 85054, USA (
)
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15
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Broggi M, Ready RE. Academic skills, self-perceptions, and grades in university students with a history of multiple concussions: The mediating roles of processing speed and psychological symptoms. Clin Neuropsychol 2022; 36:2188-2204. [PMID: 34402398 DOI: 10.1080/13854046.2021.1958924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study determined if university students with a history of multiple concussions may be at risk for academic difficulties and poor academic performance. We investigated if executive functioning, processing speed, and/or psychological symptoms might partially account for differences in academic performance of students with and without a history of multiple concussions. University students with a history of three or more concussions (n = 58), one concussion (n = 57), or no concussion (n = 57) completed academic, cognitive, and psychological assessments. Students with a history of multiple concussions read fewer words per minute and reported more learning difficulties than the no concussion group. Processing speed mediated the association between concussion status and reading rate. Psychological symptoms mediated the association between concussion status and self-reported learning difficulties. University students with a history of multiple concussions may be at risk for poor academic outcomes due, at least in part, to slower processing speed and psychological symptoms.Treatment of psychological symptoms, cognitive rehabilitation to augment processing speed, and academic accommodations might improve academic outcomes for students with a history of three or more concussions.
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Affiliation(s)
- Michael Broggi
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Rebecca E Ready
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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16
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Moody JN, Hayes JP, Buckley TA, Schmidt JD, Broglio SP, McAllister TW, McCrea M, Pasquina PF, Caccese JB. Age of First Concussion and Cognitive, Psychological, and Physical Outcomes in NCAA Collegiate Student Athletes. Sports Med 2022; 52:2759-2773. [PMID: 35794432 PMCID: PMC9833421 DOI: 10.1007/s40279-022-01719-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Concussions are common among youth athletes and could disrupt critical neurodevelopment. This study examined the association between age of first concussion (AFC) and neurocognitive performance, psychological distress, postural stability, and symptoms commonly associated with concussion in healthy collegiate men and women student athletes. METHODS Participants included 4267 collegiate athletes from various contact, limited-contact, and non-contact sports (1818 women and 2449 men) who completed baseline assessments as part of the Concussion Assessment, Research and Education (CARE) Consortium. Psychological distress was assessed with the Brief Symptom Inventory 18; neurocognitive performance was assessed with the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT); symptoms commonly associated with concussion were assessed with the ImPACT Post-Concussion Symptom Scale; postural stability was assessed with the Balance Error Scoring System. Generalized linear models were used to examine the effects of AFC on clinical outcomes separately in men and women. RESULTS Later AFC was associated with lower global (Exp(B) = 0.96, P = 0.001) and somatic (Exp(B) = 0.96, P = 0.002) psychological distress on the Brief Symptom Inventory 18 and faster ImPACT reaction time (B = - 0.003, P = 0.001) in women. AFC was not associated with any clinical outcomes in men. CONCLUSION Younger AFC was associated with some differences in psychological distress and reaction time among women but not men; however, these results are likely not clinically meaningful. Sociodemographic disparities, pre-existing conditions, and sport type may impact clinical and cognitive outcomes in collegiate athletes more than concussion history. Future work should examine the relationship between AFC and lifespan-related outcomes.
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Affiliation(s)
- Jena N Moody
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Jasmeet P Hayes
- Department of Psychology, The Ohio State University, Columbus, OH, USA
- Chronic Brain Injury Initiative, The Ohio State University, Columbus, OH, USA
| | - Thomas A Buckley
- Interdisciplinary Biomechanics and Movement Science Program, Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | | | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | | | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul F Pasquina
- Uniformed Services University of the Health Science and Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jaclyn B Caccese
- Chronic Brain Injury Initiative, The Ohio State University, Columbus, OH, USA.
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, 453 W 10th Ave, Columbus, OH, USA.
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17
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Querzola G, Lovati C, Laganà MM, Pirastru A, Baglio F, Pantoni L. Incipient chronic traumatic encephalopathy in active American football players: neuropsychological assessment and brain perfusion measures. Neurol Sci 2022; 43:5383-5390. [PMID: 35750948 PMCID: PMC9385804 DOI: 10.1007/s10072-022-06212-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 06/12/2022] [Indexed: 12/02/2022]
Abstract
Background and aims Chronic traumatic encephalopathy (CTE) is a degenerative disease caused by repetitive traumatic brain injury (TBI). Because CTE can be definitely diagnosed only post-mortem, it would be important to explore clinical and radiological correlates of CTE and TBI. The aims of this study were to assess (1) the relationship between the neuropsychological profile of active American football players and the traumatic load; (2) whether traumatic brain injury associated with American football activity has a specific cerebral perfusion pattern; and (3) whether this perfusion pattern correlates with neuropsychological performances. Methods In 20 American football players [median age [25th–75th percentile] 25.0 [21.6–31.2] years, all males], we evaluated history, traumatic load and symptoms using the TraQ (Trauma Questionnaire), and cognitive performances on neuropsychological tests. Brain perfusion was estimated using arterial spin labeling MRI and compared to a group of 19 male age-matched (28.0 [24.8–32.3] years) healthy subjects. Results We found different cognitive performances between American football players stratified according to field position and career length. Linemen had poorer executive, verbal, and visual performances; a career > 7 years was associated with poorer verbal fluency performances. American football players had statistically significant reduced cerebral blood flow values in sensory-motor areas in comparison with healthy controls. Poorer neuropsychological performances correlated with lower perfusion in specific brain areas. Conclusions Our study seems to confirm that CTE in American football players is influenced by the field position and the career length, and correlates with lower cognitive performances linked to lower perfusion in specific brain areas. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-022-06212-7.
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Affiliation(s)
- Giacomo Querzola
- 'Luigi Sacco' Department of Biomedical and Clinical Sciences, University of Milan, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy.
| | - Carlo Lovati
- Headache Center, Neurology Unit, Luigi Sacco Hospital, Milan, Italy
| | | | | | | | - Leonardo Pantoni
- 'Luigi Sacco' Department of Biomedical and Clinical Sciences, University of Milan, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy
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18
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Stephen SJ, Hasman L, Goldenberg M, Merchant-Borna K, Kawata K, Mannix R, Bazarian JJ. Short-Term Neurologic Manifestations of Repetitive Head Impacts Among Athletes: A Scoping Review. J Head Trauma Rehabil 2022; 37:318-325. [PMID: 35293363 DOI: 10.1097/htr.0000000000000767] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To summarize the evidence linking contact sports-related repetitive head impacts (RHIs) and short-term declines in neurologic function. METHODS A scoping review following the guidelines in the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and searching 3 databases (PubMed, EMBASE, and Web of Science) was performed. Peer-reviewed research articles were eligible for inclusion if they were full-length English language articles published between 1999 and 2019 examining athletes between the ages of 14 and 40 years exposed to RHIs, and reporting cognitive, vestibular, and/or oculomotor outcomes within 4 weeks of last head hit exposure. RESULTS Fifty-two articles met criteria for review: 14 reported oculomotor outcomes, 23 reported vestibular outcomes, and 36 reported cognitive function. Short-term RHI-related declines in neurologic function were reported in 42.9% of oculomotor studies, in 20.8% of vestibular studies, and in 33.3% of cognitive studies. Most of the 52 studies involved American football, soccer, or ice hockey athletes at the collegiate ( n = 23) or high school ( n = 14) level. Twenty-four (46%) studies involved only male athletes. Wearable sensors were used to measure RHIs in 24 studies (46%), while RHIs were not measured in 26 studies (50%). In addition, many studies failed to control for attention-deficit/hyperactivity disorder/learning disability and/or concussion history. CONCLUSION The results of this scoping review suggest that the evidence linking RHIs to short-term declines in neurologic function is relatively sparse and lacking in methodological rigor. Although most studies failed to find a link, those that did were more likely to use objective measures of RHIs and to control for confounders. More careful trial design may be needed to definitively establish a causal link between RHIs and short-term neurologic dysfunction.
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Affiliation(s)
- Steve J Stephen
- University of Rochester, Rochester, New York (Mr Stephen, Mss Hasman, Goldenberg, and Mr Merchant-Borna, and Dr Bazarian); Indiana University, Bloomington (Dr Kawata); and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Mannix)
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19
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Klimo KR, Stern-Green EA, Shelton E, Day E, Jordan L, Robich M, Racine J, McDaniel CE, VanNasdale DA, Yuhas PT. Structure and function of retinal ganglion cells in subjects with a history of repeated traumatic brain injury. Front Neurol 2022; 13:963587. [PMID: 36034275 PMCID: PMC9412167 DOI: 10.3389/fneur.2022.963587] [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: 06/07/2022] [Accepted: 07/22/2022] [Indexed: 01/21/2023] Open
Abstract
This study tested whether repeated traumatic brain injuries (TBIs) alter the objective structure or the objective function of retinal ganglion cells (RGCs) in human subjects recruited from an optometry clinic. Case subjects (n = 25) with a history of repeated TBIs (4.12 ± 2.76 TBIs over 0-41 years) and healthy pair-matched control subjects (n = 30) were prospectively recruited. Retinal nerve fiber layer (RNFL) thickness was quantified with spectral-domain optical coherence tomography, and scanning laser polarimetry measured RNFL phase retardation. Measurements of the photopic negative response were made using full-field flash electroretinography. There was no statistically significant difference (p = 0.42) in global RNFL thickness between the case cohort (96.6 ± 9.4 microns) and the control cohort (94.9 ± 7.0 microns). There was no statistically significant difference (p = 0.80) in global RNFL phase retardation between the case cohort (57.9 ± 5.7 nm) and the control cohort (58.2 ± 4.6 nm). There were no statistically significant differences in the peak time (p = 0.95) of the PhNR or in the amplitude (p = 0.11) of the PhNR between the case cohort (69.9 ± 6.9 ms and 24.1 ± 5.1 μV, respectively) and the control cohort (70.1 ± 8.9 ms and 27.8 ± 9.1 μV, respectively). However, PhNR amplitude was more variable (p < 0.025) in the control cohort than in the case cohort. Within the case cohort, there was a strong positive (r = 0.53), but not statistically significant (p = 0.02), association between time since last TBI and PhNR amplitude. There was also a modest positive (r = 0.45), but not statistically significant (p = 0.04), association between time since first TBI and PhNR amplitude. Our results suggest that there were no statistically significant differences in the objective structure or in the objective function of RGCs between the case cohort and the control cohort. Future large, longitudinal studies will be necessary to confirm our negative results and to more fully investigate the potential interaction between PhNR amplitude and time since first or last TBI.
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Affiliation(s)
- Kelly R. Klimo
- College of Optometry, The Ohio State University, Columbus, OH, United States
| | | | - Erica Shelton
- College of Optometry, The Ohio State University, Columbus, OH, United States
| | - Elizabeth Day
- College of Optometry, The Ohio State University, Columbus, OH, United States
| | - Lisa Jordan
- College of Optometry, The Ohio State University, Columbus, OH, United States
| | - Matthew Robich
- College of Optometry, The Ohio State University, Columbus, OH, United States
| | - Julie Racine
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, OH, United States
| | | | - Dean A. VanNasdale
- College of Optometry, The Ohio State University, Columbus, OH, United States
| | - Phillip T. Yuhas
- College of Optometry, The Ohio State University, Columbus, OH, United States,*Correspondence: Phillip T. Yuhas
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20
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Kaya D, Micili SC, Kizmazoglu C, Mucuoglu AO, Buyukcoban S, Ersoy N, Yilmaz O, Isik AT. Allopurinol attenuates repeated traumatic brain injury in old rats: A preliminary report. Exp Neurol 2022; 357:114196. [PMID: 35931122 DOI: 10.1016/j.expneurol.2022.114196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/13/2022] [Accepted: 07/31/2022] [Indexed: 12/01/2022]
Abstract
Traumatic brain injury (TBI) is an overlooked cause of morbidity, which was shown to accelerate inflammation, oxidative stress, and neuronal cell loss and is associated with spatial learning and memory impairments and some psychiatric disturbances in older adults. However, there is no effective treatment in order to offer a favorable outcome encompassing a good recovery after TBI in older adults. Hence, the present study aimed to investigate the histological and neurobehavioral effects of Allopurinol (ALL) in older rats that received repeated TBI (rTBI). For this purpose, a weight-drop rTBI model was used on old male Wistar rats. Rats received 5 repeated TBI/sham injuries 24 h apart and were treated with saline or Allopurinol 100 mg/kg, i.p. each time. They were randomly assigned to three groups: control group (no injury); rTBI group (received 5 rTBI and treated with saline); rTBI+ALL group (received 5 rTBI and treated with Allopurinol). Then, half of the animals from each group were sacrificed on day 6 and the remaining animals were assessed with Open field, Elevated plus maze and Morris Water Maze test. Basic neurological tasks were evaluated with neurological assessment protocol every other day until after the 19th day from the last injury. Brain sections were processed for neuronal cell count in the hippocampus (CA1), dentate gyrus (DG), and prefrontal cortex (PC). Also, an immunohistochemical assay was performed to determine NeuN, iNOS, and TNFα levels in the brain regions. The number of neurons was markedly reduced in CA1, GD, and PC in rats receiving saline compared to those receiving allopurinol treatment. Immunohistochemical analysis showed marked induction of iNOS and TNFα expression in the brain tissues which were reduced after allopurinol at 6 and 19 days post-injury. Also, ALL-treated rats demonstrated a remarkable induce in NeuN expression, indicating a reduction in rTBI-induced neuronal cell death. In neurobehavioral analyses, time spent in closed arms, in the corner of the open field, swimming latency, and distance were impaired in injured rats; however, all of them were significantly improved by allopurinol therapy. To sum up, this study demonstrated that ALL may mitigate rTBI-induced damage in aged rats, which suggests ALL as a potential therapeutic strategy for the treatment of recurrent TBI.
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Affiliation(s)
- Derya Kaya
- Dokuz Eylul University Faculty of Medicine, Department of Geriatric Medicine, Unit for Brain Aging and Dementia, Izmir, Turkey; Geriatric Science Association, Izmir, Turkey.
| | - Serap Cilaker Micili
- Dokuz Eylul University Faculty of Medicine, Department of Histology and Embryology, Izmir, Turkey
| | - Ceren Kizmazoglu
- Dokuz Eylul University Faculty of Medicine, Department of Neurosurgery, Izmir, Turkey
| | - Ali Osman Mucuoglu
- Dokuz Eylul University Faculty of Medicine, Department of Neurosurgery, Izmir, Turkey
| | - Sibel Buyukcoban
- Dokuz Eylul University Faculty of Medicine, Department of Anaesthesiology and Reanimation, İzmir, Turkey
| | - Nevin Ersoy
- Dokuz Eylul University Faculty of Medicine, Department of Histology and Embryology, Izmir, Turkey
| | - Osman Yilmaz
- Dokuz Eylul University Health Sciences Institute, Department of Laboratory Animal Science, Izmir, Turkey
| | - Ahmet Turan Isik
- Dokuz Eylul University Faculty of Medicine, Department of Geriatric Medicine, Unit for Brain Aging and Dementia, Izmir, Turkey; Geriatric Science Association, Izmir, Turkey
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21
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Jenkins AS, Pollock JR, Moore ML, Makovicka JL, Brinkman JC, Chhabra A. The 100 Most-Cited and Influential Articles in Collegiate Athletics. Orthop J Sports Med 2022; 10:23259671221108401. [PMID: 35837444 PMCID: PMC9274432 DOI: 10.1177/23259671221108401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/11/2022] [Indexed: 12/26/2022] Open
Abstract
Background Bibliometric citation analyses have been widely used in medicine to help researchers gain foundational knowledge about a topic and identify subtopics of popular interest for further investigations. There is a lack of similar research in collegiate athletics. Purpose To identify the 100 most-cited research publications related to collegiate athletics. Study Design Cross-sectional study. Methods The Clarivate Analytics Web of Knowledge database was used to generate a list of articles relating to collegiate athletics on January 24, 2022. Articles were filtered by the total number of citations, and the 100 most-cited articles were selected. For each article, we identified and analyzed the following: author name, publication year, country of origin, journal name, article type, main research topic area, competitive level, sex of study population, and level of evidence. Results Of the top 100 most-cited articles, 63 were related to medicine. In total, 96% of articles were published in the United States, and 80% were published in the year 2000 or later. Of the top 100 articles, 85 were observational; only 5 were experimental. The sport most represented was soccer, followed by football, baseball, and basketball. Of the top 100 articles, 21 were published in a single journal, the American Journal of Sports Medicine. Ten authors published ≥5 of the top 100 most-cited studies. Conclusion The majority of top 100 articles were published in the United States after 1999 and primarily focused on medicine-related topics. Soccer was studied by more articles than football, baseball, and basketball. An author's prestige may have influenced the likelihood of citation. The top 100 most-cited studies provide researchers, medical students, residents, and fellows with a foundational list of the most important and influential academic contributions to the literature on collegiate athletics.
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Affiliation(s)
- Anna S Jenkins
- Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - M Lane Moore
- Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
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22
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Glendon K, Desai A, Blenkinsop G, Belli A, Pain M. Recovery of symptoms, neurocognitive and vestibular-ocular-motor function and academic ability after sports-related concussion (SRC) in university-aged student-athletes: a systematic review. Brain Inj 2022; 36:455-468. [PMID: 35377822 DOI: 10.1080/02699052.2022.2051740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Physiological differences between a maturing and matured brain alters how Sports-Related Concussion (SRC) affects different age groups; therefore, a review specific to university-aged student-athletes is needed. OBJECTIVES Determine time to recovery for symptom burden, neurocognitive and Vestibular-Ocular-Motor (VOM) function and academic impact in university-aged student-athletes. METHODS Searches were conducted in PubMed, SpringerLink, PsycINFO, Science Direct, Scopus, Cochrane, Web of Science and EMBASE. Articles were included if they contained original data collected within 30 days in university-aged student-athletes, analysed SRC associated symptoms, neurocognitive or VOM function or academic ability and published in English. Two reviewers independently reviewed sources, using the Oxford Classification of Evidence-Based Medicine (CEBM) and the Downs and Black checklist, and independently extracting data before achieving consensus. RESULTS 58 articles met the inclusion criteria. Recovery of symptoms occurred by 7 and 3-5.3 days for neurocognition. The evidence base did not allow for a conclusion on recovery time for VOM function or academic ability. Few papers investigated recovery times at specified re-assessment time-points and have used vastly differing methodologies. CONCLUSIONS To fully understand the implication of SRC on the university-aged student-athlete' studies using a multi-faceted approach at specific re-assessments time points are required.Systematic review registration number: CRD42019130685.
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Affiliation(s)
- K Glendon
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A Desai
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - G Blenkinsop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A Belli
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, UK
| | - M Pain
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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23
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Brady M, Hume PA, Mahon S, Theadom A. What Is the Evidence on Natural Recovery Over the Year Following Sports-Related and Non-sports-Related Mild Traumatic Brain Injury: A Scoping Review. Front Neurol 2022; 12:756700. [PMID: 35069407 PMCID: PMC8766792 DOI: 10.3389/fneur.2021.756700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Treatment approaches often differ dependent upon whether a person experiences a sports-related or a non-sports-related mild traumatic brain injury. It remains unclear if recovery from these injuries is comparable or unique to context of the injury. Objective: To identify knowledge gaps on self-reported outcomes and trajectories between sports- and non-sports-related mild traumatic brain injuries and how they are assessed in adults. Methods: This scoping review used a systematic search of key electronic databases, including PubMed, SPORTDiscus, Embase, MEDLINE, and CINAHL for articles published in 1937 until March 10, 2021. Articles were included if they were available in English; full text published in a peer-reviewed journal; had a prospective or retrospective study design; reported data on mild TBI cases >16 years of age, and included data from at least two time points on self-reported outcomes within 12 months post-injury. A standardized data extraction spreadsheet was used to determine the participant characteristics, definitions, assessment methods, outcomes, and recovery time frames. Results: Following removal of duplicates, the search strategy elicited 6,974 abstracts. Following abstract review, 174 were retained for full text review. Of the 42 articles that met inclusion criteria, 18 were sports related (15 in the USA and three in Canada) and 24 were general population studies (six in USA, three in Canada, three in Australasia, nine in Europe, two in Taiwan, and one in Morocco). Direct comparison in recovery trajectories between the sport and general population studies was difficult, given notable differences in methodology, definitions, types of outcome measures, and timing of follow-up assessments. Only one article reported on both sports-related and non-sports-related traumatic brain injuries separately at comparable timepoints. This study revealed no differences in recovery time frames or overall symptom burden. Discussion: Whilst there is a clear benefit in researching specific subpopulations in detail, standardized outcome measures and follow-up time frames are needed across contexts to facilitate understanding of similarities and differences between sports- and non-sports-related mild traumatic brain injuries to inform clinical treatment.
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Affiliation(s)
- Morgan Brady
- Traumatic Brain Injury Network (TBIN), Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Patria A Hume
- Traumatic Brain Injury Network (TBIN), Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,Sport Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Susan Mahon
- Traumatic Brain Injury Network (TBIN), Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- Traumatic Brain Injury Network (TBIN), Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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24
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Iverson GL, Berkner PD, Zafonte R, Maxwell B, Terry DP. Preseason Symptom Reporting and Cognition in Middle School Athletes with Past Concussions. Int J Sports Med 2022; 43:553-560. [PMID: 35030638 DOI: 10.1055/a-1538-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study examined the association between past concussions and current preseason symptom reporting and cognitive performance in 9,257 youth ages 11-13. Participants completed neurocognitive testing prior to participating in a school sports between 2009 and 2019. We stratified the sample by gender and number of prior concussions and assessed group differences on the Post-Concussion Symptom Scale total score and the ImPACT cognitive composite scores. Those with≥2 prior concussions reported more symptoms than those with 0 concussions (d=0.43-0.46). Multiple regressions examining the contribution of concussion history and developmental/health history to symptom reporting showed the most significant predictors of symptoms scores were (in descending order): treatment for a psychiatric condition, treatment for headaches, history of learning disability (in boys only), history of attention-deficit/hyperactivity disorder, and age. Concussion history was the weakest statistically significant predictor in boys and not significant in girls. Cognitively, boys with 1 prior concussion had worse speed those with 0 concussions (d=0.11), and girls with≥2 prior concussions had worse verbal/visual memory than girls with 0 concussions (ds=0.38-0.39). In summary, youth with≥2 prior concussions reported more symptoms than those with no concussions. Boys with multiple concussions performed similarly on cognitive testing, while girls had worse memory scores.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, United States.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, United States.,MassGeneral Hospital for Children Sports Concussion Program, Boston, United States
| | - Paul D Berkner
- College of Osteopathic Medicine, University of New England College of Osteopathic Medicine, Biddeford, United States
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, United States.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, United States.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, United States.,Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, United States
| | - Bruce Maxwell
- Department of Computer Science, Colby College,Waterville, United States
| | - Douglas P Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, United States.,MassGeneral Hospital for Children Sports Concussion Program, Boston, United States
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25
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McQuivey KS, Moore ML, Pollock JR, Hassebrock JD, Patel KA, Chhabra A. Top-100 Most-Cited Sports-Related Concussion Articles Focus on Symptomatology, Epidemiology, and Demographics. Arthrosc Sports Med Rehabil 2021; 3:e1585-e1597. [PMID: 34977610 PMCID: PMC8689224 DOI: 10.1016/j.asmr.2021.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/30/2021] [Indexed: 11/06/2022] Open
Abstract
Purpose To analyze the top-100 cited articles on sports-related concussions together with a bibliometric analysis to determine citations by year, level of evidence, study design, and several other factors related to the top referenced articles in sports concussions. Methods The Clarivate Analytics Web of Knowledge database was used to gather data using Boolean queries to capture all possible iterations of sports-related concussion research. Articles were organized in descending order based on the number of citations and included or excluded based on relevance to concussion. Collected information included author name, publication year, country of origin, journal name, article type, study focus, and the level of evidence. Results The top-100 articles were cited 31,197 times with an average of 312.0 citations per publication. More than one half were published in 2006 or later (52). Cohort studies and descriptive articles were the most prevalent study types (22 each). Studies with Level V evidence were the most common (33). The most common areas of study were symptomatology (short term, long term) with 17 articles, followed by epidemiology/demographics with 16 articles. The least common area of study was concussion prevention (2 articles), followed by management/treatment, diagnostics (labs, imaging) with 4 articles each. Conclusions We identified the most influential studies in sports-related concussion based on number of citations and citation density. A majority of these articles were published in the United States after 2006 and are most commonly cohort studies (Level IV evidence) and descriptive articles (Level V evidence). Current research focuses most heavily on the symptomatology and epidemiology/demographics of sports concussion. Clinical Relevance This study serves to identify the most influential articles in sports-related concussion and identify research topics with general deficiencies within the field of sports-related concussion research.
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Affiliation(s)
| | - M Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A
| | | | | | - Karan A Patel
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix
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26
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Glendon K, Blenkinsop G, Belli A, Pain M. Prospective study with specific Re-Assessment time points to determine time to recovery following a Sports-Related Concussion in university-aged student-athletes. Phys Ther Sport 2021; 52:287-296. [PMID: 34715487 DOI: 10.1016/j.ptsp.2021.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Time to recovery for symptom burden and neurocognition following a Sports-Related Concussion (SRC) has previously been determined by consolidating varying re-assessment time points into a singular point, and has not been established for Vestibular-Ocular-Motor (VOM) function or academic ability. OBJECTIVES Establish when recovery of symptom burden, neurocognition, VOM function, and academic ability occurs in university-aged student-athletes. METHODS Student-athletes completed an assessment battery (Post-Concussion Symptom Scale (PCSS), Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Vestibular Ocular-Motor Screening (VOMS), Perceived Academic Impairment Tool (PAIT)) during pre-season (n = 140), within 48 hours, 4, 8 and 14 days post-SRC and prior to Return To Play (RTP) and were managed according to the Rugby Football Union' community pathway (n = 42). Student-athletes were deemed recovered or impaired according to Reliable Change Index' (RCI) or compared to their individual baseline. RESULTS Symptom burden recovers by four days post-SRC on RCI and to baseline by eight days. VOM function and academic ability recovers by 8 days. Some student-athletes demonstrated worse performance at RTP on all tests by RCI and to baseline, except for on VOMS score and near point convergence by RCI change. CONCLUSIONS Variation in individual university-aged student-athletes requires a multi-faceted approach to establish what dysfunctions post-SRC exist and when recovery occurs.
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Affiliation(s)
- K Glendon
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
| | - G Blenkinsop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A Belli
- Institute of Inflammation and Ageing, University of Birmingham, UK
| | - M Pain
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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27
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Walton SR, Brett BL, Chandran A, DeFreese JD, Mannix R, Echemendia RJ, Meehan WP, McCrea M, Guskiewicz KM, Kerr ZY. Mild Cognitive Impairment and Dementia Reported by Former Professional Football Players over 50 Years of Age: An NFL-LONG Study. Med Sci Sports Exerc 2021; 54:424-431. [PMID: 34593716 DOI: 10.1249/mss.0000000000002802] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To estimate prevalences of MCI and dementia diagnoses in former National Football League (NFL) players ≥50 years old and examine the relationships among these diagnoses and an array of predictors of long-term brain health. METHODS A cross-section of former NFL players (n = 922; aged [mean ± SD] 64.8 ± 8.9 years) completed a questionnaire. Prevalences of self-reported medical diagnoses of MCI and dementia were reported alongside U.S. population estimates across 5-year age intervals (e.g., 60-64 years). Prevalence ratios (PRs) were calculated for multiple predictors of long-term brain health. RESULTS Overall, MCI and dementia prevalences were n = 219(23.8%) and n = 82(8.9%), respectively. Each diagnosis was more prevalent in former NFL players across age groups than U.S. norms, with greater disparities at relatively younger ages (e.g., 65-69) compared with older ages. Greater prevalences of MCI and dementia were associated with: self-reported concussion history (10+ vs. 0; PRadjusted[95%CI] = 1.66[1.02-2.71] and 2.61[1.01-6.71], respectively); recent pain intensity (PRadjusted[95%CI] = 1.13[1.07-1.20] and 1.15[1.03-1.28]); and diagnoses of depression (PRadjusted[95%CI] = 2.70[1.92-3.81] and 3.22[1.69-6.14]), anxiety (PRadjusted[95%CI] = 1.96[1.26-3.07] and 3.14[1.47-6.74]), or both (PRadjusted[95%CI] = 3.11[2.38-4.08] and 4.43[2.71-7.25]). Higher MCI prevalence was related to sleep apnea (PRadjusted[95%CI] = 1.30[1.06-1.60]); higher dementia prevalence was associated with age (5-year interval, PRadjusted[95%CI] = 1.42[1.26-1.60]) and race (non-White vs. White, PRadjusted[95%CI] = 1.64[1.07-2.53]). CONCLUSIONS Self-reported MCI and dementia prevalences were higher in former NFL players than national estimates and were associated with numerous personal factors, including mood-related disorders and a high number of self-reported concussions. Predictors of higher MCI and dementia prevalence may be modifiable and warrant consideration by clinicians and researchers as potential targets to mitigate the onset of these conditions.
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Affiliation(s)
- Samuel R Walton
- Department of Exercise and Sport Science and Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC Department of Neurosurgery/Neurology, Medical College of Wisconsin, Milwaukee, WI Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN Division of Emergency Medicine, Boston Children's Hospital, Boston, MA Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA Department of Psychology, University of Missouri - Kansas City, Kansas City, MO University Orthopedics Center Concussion Care Clinic, State College, PA Sports Medicine Division, Boston Children's Hospital, Boston, MA The Micheli Center for Sports Injury Prevention, Boston, MA Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA
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28
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Chen A, Zhang Z, Cao C, Lu J, Wu S, Ma S, Feng Y, Wang S, Xu G, Song J. Altered Attention Network in Paratroopers Exposed to Repetitive Subconcussion: Evidence Based on Behavioral and Event-Related Potential Results. J Neurotrauma 2021; 38:3306-3314. [PMID: 34549595 DOI: 10.1089/neu.2021.0253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Cognitive impairment caused by repetitive subconcussion has received increasing attention in recent years. Although the dysfunction of attention has been confirmed by neuropsychological research using scales, there is no event-related potentials (ERPs) research. The Attention Network Test (ANT) has been widely used to evaluate the three separate components of attention processing (alerting, orienting, and executive control). Twenty-seven paratroopers exposed to repetitive subconcussion (subconcussion group) and 25 matched healthy control participants (HCs group) were enrolled, and all of them performed the ANT test while continuous scalp electroencephalography data were recorded. On the behavioral performance level, the subconcussion group showed a slower task response, with an especially significant slower reaction time in alerting. Concerning ERP results, reduction amplitudes of cue-N1 in the alerting network were observed, indicating that this group was less able to make efficient use of cues and maintain an alerting state for incoming information. For the orienting network, no difference in N1 amplitude was observed between the two groups. Moreover, there was a reduced P3 amplitude in the executive control network in the subconcussion group compared with the HCs group, suggesting a dysfunction of attentional resource allocation and inhibition control in the former group. This study is, to our knowledge, the first analysis of the altered attention network caused by repetitive subconcussion from the perspectives of behavioral and neuropsychology levels. These preliminary results revealed the possible damage of the alerting and executive control networks and provided a reference for further research on subconcussion cognitive impairment.
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Affiliation(s)
- Aobo Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China
| | - Zhihao Zhang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China
| | - Chenglong Cao
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China.,Department of Cognitive Neuroscience, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jinjiang Lu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China
| | - Shukai Wu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China
| | - Shenghui Ma
- Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China.,Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Yu Feng
- Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China.,Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Shuochen Wang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China
| | - Guozheng Xu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China
| | - Jian Song
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan, China
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29
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McGowan AL, Bretzin AC, Anderson M, Pontifex MB, Covassin T. Paired cognitive flexibility task with symptom factors improves detection of sports-related concussion in high school and collegiate athletes. J Neurol Sci 2021; 428:117575. [PMID: 34304023 DOI: 10.1016/j.jns.2021.117575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/24/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022]
Abstract
Determining the sensitivity and specificity of short neurocognitive assessments to objectively detect concussion will help clinicians more confidently integrate such tools in clinical management decisions. This study quantified the sensitivity and specificity of a computerized cognitive flexibility task isolating shifts of visuospatial attention in combination with clinical symptoms acutely (< 72 h) following concussion. A total of 100 athletes (53 concussed; 47 non-injured control; 42% female) completed computerized neurocognitive testing and clinical symptom reports (Sport Concussion Assessment Tool 3rd edition: SCAT3). Separate discriminant function analyses were performed for individual, combination, and stepwise inclusion of neurocognitive and clinical symptomology assessments. Findings revealed the combination of neurocognitive outcomes (i.e., mean reaction time, response accuracy, and response accuracy cost) with clinical symptom factor scores exhibited the greatest sensitivity (95.7%) and specificity (88.7%) as well as the highest positive predictive value (95.9%) and negative predictive value (88%) relative to other approaches. Further, a stepwise approach predicting concussion status using the discriminant functions improved detection of concussion (98.2% sensitivity, 95.7% specificity, 96.4% positive predictive value, and 97.8% negative predictive value) when clinical symptom factors failed to indicate the presence of a concussion. Incorporating a cognitive flexibility task involving shifts of visuospatial attention combined with clinical symptom factor scores may improve clinical decision-making as this approach exceeds the sensitivity and specificity of widely popular neurocognitive test batteries and takes less than 10 min to administer.
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Affiliation(s)
- Amanda L McGowan
- Addiction, Health, and Adolescence Lab, Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Abigail C Bretzin
- Penn Injury Science Center, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Morgan Anderson
- Department of Kinesiology, Michigan State University, East Lansing, MI, United States of America
| | - Matthew B Pontifex
- Department of Kinesiology, Michigan State University, East Lansing, MI, United States of America
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, MI, United States of America
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30
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The role of salivary vesicles as a potential inflammatory biomarker to detect traumatic brain injury in mixed martial artists. Sci Rep 2021; 11:8186. [PMID: 33854105 PMCID: PMC8047010 DOI: 10.1038/s41598-021-87180-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/22/2021] [Indexed: 11/25/2022] Open
Abstract
Traumatic brain injury (TBI) is of significant concern in the realm of high impact contact sports, including mixed martial arts (MMA). Extracellular vesicles (EVs) travel between the brain and oral cavity and may be isolated from salivary samples as a noninvasive biomarker of TBI. Salivary EVs may highlight acute neurocognitive or neuropathological changes, which may be particularly useful as a biomarker in high impact sports. Pre and post-fight samples of saliva were isolated from 8 MMA fighters and 7 from controls. Real-time PCR of salivary EVs was done using the TaqMan Human Inflammatory array. Gene expression profiles were compared pre-fight to post-fight as well as pre-fight to controls. Largest signals were noted for fighters sustaining a loss by technical knockout (higher impact mechanism of injury) or a full match culminating in referee decision (longer length of fight), while smaller signals were noted for fighters winning by joint or choke submission (lower impact mechanism as well as less time). A correlation was observed between absolute gene information signals and fight related markers of head injury severity. Gene expression was also significantly different in MMA fighters pre-fight compared to controls. Our findings suggest that salivary EVs as a potential biomarker in the acute period following head injury to identify injury severity and can help elucidate pathophysiological processes involved in TBI.
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31
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Li AY, Schupper AJ, Quinones A, Shuman WH, Ali M, Hannah TC, Durbin JR, Dreher N, Spiera Z, Marayati NF, Gometz A, Lovell MR, Choudhri TF. Sport Contact Level Affects Post-Concussion Neurocognitive Performance in Young Athletes. Arch Clin Neuropsychol 2021; 37:19-29. [PMID: 33829227 DOI: 10.1093/arclin/acab021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/25/2021] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Contact level affects the incidence of sports-related concussion. However, the effects of contact level on injury severity and recovery are less clear and are the focus of this study. METHOD Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) for athletes aged 12-22 was performed at baseline (n = 10,907 for 7,058 athletes), after suspected concussion determined by physicians or athletic trainers (n = 5,062 for 4,419 athletes), and during follow-up visits (n = 3,264 for 2,098 athletes). Athletes played contact/collision (CC), limited contact (LC), and noncontact (NC) sports. Injury incidence, severity, and recovery were measured using raw and change from baseline neurocognitive test scores. Comparisons between groups used univariate analysis and multivariable regression controlling for demographic variables. RESULTS Compared to CC athletes, LC and NC athletes showed decreased suspected concussion incidence. At initial post-injury testing, all neurocognitive test scores were similar between groups except changes from baseline for processing speed were improved for LC compared to CC athletes. Upon follow-up testing, raw neurocognitive scores were better for NC compared to the contact collision athletes in verbal memory, processing speed, total symptom score, migraine cluster, cognitive cluster, and neuropsychiatric cluster scores. For change from baseline scores, LC athletes exhibited better performance on verbal memory, processing speed, and reaction time but also showed higher neuropsychiatric scores than CC athletes. CONCLUSION Neurocognitive scores between contact levels were similar at the first post-injury test. However, follow up showed many improved scores and symptoms for limited and NC sports compared to CC sports, which may indicate faster recovery.
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Affiliation(s)
- Adam Y Li
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Addison Quinones
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William H Shuman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Theodore C Hannah
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John R Durbin
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nickolas Dreher
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zachary Spiera
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naoum Fares Marayati
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex Gometz
- Concussion Management of New York, New York, NY, USA
| | - Mark R Lovell
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
Objective: To assess discrepancies between child and parent symptom reports following concussion.Methods: Prospective cohort study involving 61 patients, age 7-21 years, diagnosed with a concussion within the previous 14 days. Children/parents completed the Child SCAT-3 symptom inventory at enrollment and 4 weeks post-injury. A within-subjects t-test was used to compare differences in child/parent response for each of 20 individual symptoms, 4 symptom domains, and total symptom severity. Pearson correlations were used to measure agreement between child/parent responses. A repeated measures analysis of variance assessed the effect of time on child/parent symptom discrepancy.Results: At enrollment, children reported higher symptom severity for 'distracted easily' (adj. p = .015) and 'confused' (adj. p = .015). There was moderate-to-high (r > 0.3) agreement between children and parents for more individual symptoms at enrollment (18/20) than at 4 weeks post-injury (14/20). Age had no effect (p > .05) on the discrepancy between child/parent reports.Conclusions: Although there was moderate-to-strong agreement between child/parent reports of concussion symptoms, discrepancies in individual cognitive symptom reports exist, in both children and adolescents. Therefore, collection of parent scales may provide useful information when tracking cognitive symptoms in adolescent patients, who may under-report or under-recognize cognitive deficits.
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Affiliation(s)
- Ruikang Liu
- Department of Pediatrics, Penn State Hershey, Hershey, Pennsylvania, USA
| | - Steven D Hicks
- Department of Pediatrics, Penn State Hershey, Hershey, Pennsylvania, USA
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Iqubal A, Bansal P, Iqubal MK, Pottoo FH, Haque SE. An Overview and Therapeutic Promise of Nutraceuticals against Sports-Related Brain Injury. Curr Mol Pharmacol 2021; 15:3-22. [PMID: 33538684 DOI: 10.2174/1874467214666210203211914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/30/2020] [Accepted: 11/17/2020] [Indexed: 11/22/2022]
Abstract
Sports-related traumatic brain injury (TBI) is one of the common neurological maladies experienced by athletes. Earlier the term 'punch drunk syndrome' was used in the case TBI of boxers and now this term is replaced by chronic traumatic encephalopathy (CTE). Sports-related brain injury can either be short term or long term. A common instance of brain injury encompasses subdural hematoma, concussion, cognitive dysfunction, amnesia, headache, vision issue, axonopathy, or even death if remain undiagnosed or untreated. Further, chronic TBI may lead to pathogenesis of neuroinflammation and neurodegeneration via tauopathy, formation of neurofibrillary tangles, and damage to the blood-brain barrier, microglial, and astrocyte activation. Thus, altered pathological, neurochemical, and neurometabolic attributes lead to the modulation of multiple signaling pathways and cause neurological dysfunction. Available pharmaceutical interventions are based on one drug one target hypothesis and thereby unable to cover altered multiple signaling pathways. However, in recent time's pharmacological intervention of nutrients and nutraceuticals have been explored as they exert a multifactorial mode of action and maintain over homeostasis of the body. There are various reports available showing the positive therapeutic effect of nutraceuticals in sport-related brain injury. Therefore, in the current article we have discussed the pathology, neurological consequence, sequelae, and perpetuation of sports-related brain injury. Further, we have discussed various nutraceutical supplements as well as available animal models to explore the neuroprotective effect/ upshots of these nutraceuticals in sports-related brain injury.
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Affiliation(s)
- Ashif Iqubal
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, . India
| | - Pratichi Bansal
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, . India
| | - Mohammad Kashif Iqubal
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, . India
| | - Faheem Hyder Pottoo
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal, University, P.O.BOX 1982, Damman, 31441, . Saudi Arabia
| | - Syed Ehtaishamul Haque
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, . India
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Cheever K, McDevit J, Wright WG, Tierney R. Differences in cervical kinesthesia between amateur athletes with and without a history of contact sport participation. Brain Inj 2021; 35:404-410. [PMID: 33523714 DOI: 10.1080/02699052.2021.1878551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Identify cervical sensorimotor function differences between amateur athletes with and without a history of contact sport participation. A secondary aim of the study was to explore the association between neck reposition error and previously identified injury risk factors.Design: Cross-sectional.Participants: 27 amateur campus recreation sport athletes with a history of contact sport participation and 20 amateur campus recreation sport athletes with no history of contact sport.Main Outcome Measures: Baseline signs and symptoms (S/S) number and severity, Neck Disability Index, total neck reposition error, maximum reposition error, cervical range of motion, and cervical isometric strength were then compared between independent factor groups (contact vs. non-contact).Results: Amateur sport athletes with a history of contact sport exposure exhibited 25.2% more total neck reposition error and 24.6% more maximum neck reposition error than athletes with no history of contact sport participation. S/S number (r2 = .12, F(2,44) = 6.2, p = .017) and S/S severity (r2 = .14, F(2,44) = 5.6, p = .02) were significantly correlated with total neck reposition error.Conclusions: Athletes with a history of contact sport participation exhibited greater cervical spine reposition error. The degree to which these sensory position-sense deficits increase risk of injury and long-term quality of life is unknown, but should be explored in future studies.
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Affiliation(s)
- Kelly Cheever
- Department of Kinesiology, College of Health, Community and Policy, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Jane McDevit
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
| | - W Geoffrey Wright
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA.,Neuromotor Science Program, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Ryan Tierney
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
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Ye S, Ko B, Phi HQ, Sun K, Eagleman DM, Flores B, Katz Y, Huang B, Ghomi RH. Detection of mild traumatic brain injury in pediatric populations using BrainCheck, a tablet-based cognitive testing software: a preliminary study. EXPLORATION OF MEDICINE 2020. [DOI: 10.37349/emed.2020.00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aim: Despite its high frequency of occurrence, mild traumatic brain injury (mTBI), or concussion, is difficult to recognize and diagnose, particularly in pediatric populations. Conventional methods to diagnose mTBI primarily rely on clinical questionnaires and sometimes include neuroimaging or pencil and paper neuropsychological testing. However, these methods are time consuming, require administration/interpretation from health professionals, and lack adequate test sensitivity and specificity. This study explores the use of BrainCheck Sport, a computerized neurocognitive test that is available on iPad, iPhone, or computer desktop, for mTBI assessment. The BrainCheck Sport Battery consists of 6 gamified traditional neurocognitive tests that assess areas of cognition vulnerable to mTBI such as attention, processing speed, executing functioning, and coordination.
Methods: We administered BrainCheck Sport to 10 participants diagnosed with mTBI at the emergency department of Children’s hospital or local high school within 96 hours of injury, and 115 normal controls at a local high school. Statistical analysis included Mann-Whitney U test, chi-square tests, and Hochberg tests to examine differences between the mTBI group and control group on each assessment in the battery. Significant metrics from these assessments were used to build a logistic regression model that distinguishes mTBI from control participants.
Results: BrainCheck Sport was able to detect significant differences in Coordination, Stroop, Immediate/Delayed Recognition between normal controls and mTBI patients. Receiver operating characteristic (ROC) analysis of our logistic regression model found a sensitivity of 84% and specificity of 81%, with an area under the curve of 0.884.
Conclusions: BrainCheck Sport has potential in distinguishing mTBI from control participants, by providing a shorter, gamified test battery to assess cognitive function after brain injury, while also providing a method for tracking recovery with the opportunity to do so remotely from a patient’s home.
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Affiliation(s)
- Siao Ye
- Department of Biosciences, Rice University, Houston, TX 77005, USA
| | - Brian Ko
- University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Huy Q. Phi
- College of Arts and Sciences, University of Washington, Seattle, WA 98195, USA
| | - Kevin Sun
- BrainCheck, Inc, Houston, TX 77021, USA
| | - David M. Eagleman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Yael Katz
- BrainCheck, Inc, Houston, TX 77021, USA
| | - Bin Huang
- BrainCheck, Inc, Houston, TX 77021, USA
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Effect of subconcussive impacts on functional outcomes over a single collegiate football season. JOURNAL OF CONCUSSION 2020. [DOI: 10.1177/2059700220983165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Context In collision sports, particularly American football, athletes can accumulate thousands of subconcussive impacts, or head acceleration events (HAEs), across a single season; however, the short-term consequences of these impacts are not well understood. Objective To investigate the effects of the accumulation of impacts during practices on cognitive functions over a single football season. Design Prospective observational study. Setting Athletic training room and University laboratory. Participants Twenty-three NCAA Football Bowl Subdivision players. Main outcome measures Helmet accelerometers during practices and virtual reality testing (VR; balance, reaction time, spatial memory) before and after the season. Results Preseason had the majority of ≥80 G impacts while during the season had the majority of ≥25 G to <80 G impacts and positional differences showed that linemen had the majority of both types. Virtual reality analysis revealed that scores significantly decreased after the season for spatial navigation ( p < 0.05) but not for balance or reaction time. Significant correlations ( p < 0.05) were found between cognitive measures and player demographic variables. Conclusions Even in the absence of clinical symptoms and concussion diagnosis, repetitive impacts may cause cognitive alterations. Documenting the distribution of impact quantity and intensity as a function of time and position may be considered by coaches and clinicians to reduce the accumulation of impacts in athletes exposed in contact sports.
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Sensitivity and Specificity of Computer-Based Neurocognitive Tests in Sport-Related Concussion: Findings from the NCAA-DoD CARE Consortium. Sports Med 2020; 51:351-365. [PMID: 33315231 DOI: 10.1007/s40279-020-01393-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND To optimally care for concussed individuals, a multi-dimensional approach is critical and a key component of this assessment in the athletic environment is computer-based neurocognitive testing. However, there continues to be concerns about the reliability and validity of these testing tools. The purpose of this study was to determine the sensitivity and specificity of three common computer-based neurocognitive tests (Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT], CNS Vital Signs, and CogState Computerized Assessment Tool [CCAT]), to provide guidance on their clinical utility. METHODS This study analyzed assessments from a cohort of collegiate athletes and non-varsity cadets from the NCAA-DoD CARE Consortium. The data were collected from 2014-2018. Study participants were divided into two testing groups [concussed, n = 1414 (baseline/24-48 h) and healthy, n = 8305 (baseline/baseline)]. For each test type, change scores were calculated for the components of interest. Then, the Normative Change method, which used normative data published in a similar cohort, and the Reliable Change Index (RCI) method were used to determine if the change scores were significant. RESULTS Using the Normative Change method, ImPACT performed best with an 87.5%-confidence interval and 1 number of components failed (NCF; sensitivity = 0.583, specificity = 0.625, F1 = 0.308). CNS Vital Signs performed best with a 90%-confidence interval and 1 NCF (sensitivity = 0.587, specificity = 0.532, F1 = 0.314). CCAT performed best when using a 75%-confidence interval and 2 NCF (sensitivity = 0.513, specificity = 0.715, F1 = 0.290). When using the RCI method, ImPACT performed best with an 87.5%-confidence interval and 1 NCF (sensitivity = 0.626, specificity = 0.559, F1 = 0.297). CONCLUSION When considering all three computer-based neurocognitive tests, the overall low sensitivity and specificity results provide additional evidence for the use of a multi-dimensional assessment for concussion diagnosis, including symptom evaluation, postural control assessment, neuropsychological status, and other functional assessments.
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Pryhoda MK, Shelburne KB, Gorgens K, Ledreux A, Granholm AC, Davidson BS. Centre of pressure velocity shows impairments in NCAA Division I athletes six months post-concussion during standing balance. J Sports Sci 2020; 38:2677-2687. [PMID: 32715955 DOI: 10.1080/02640414.2020.1795561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
Sport-related concussion return to play (RTP) decisions are largely based on the resolution of self-reported symptoms and neurocognitive function. Some evaluators also incorporate balance; however, an objective approach to balance that can detect effects beyond the acute condition is warranted. The purpose of this study is to examine linear measures of biomechanical balance up to 6 months post-concussion, and to present preliminary diagnostic thresholds useful for RTP. Each concussed athlete participated in instrumented standing balance tasks at 4 timepoints post-concussion. The measures from concussed athletes were compared to the sport-matched non-concussed athlete group at each timepoint. Centre of pressure (COP) mediolateral (ML) velocity in double-leg stance on a hard surface discriminated well between non-concussed and concussed athletes. COP anterior-posterior (AP) velocity in tandem stance on foam showed sensitivity to concussion. Sixty per cent of athletes at 6 months post-concussion did not recover to within the proposed COP ML velocity threshold in double-leg stance on a hard surface. Seventy-one per cent of athletes at 6 months post-concussion did not recover to within the COP AP velocity threshold in tandem stance on foam. This lack of recovery potentially indicates vestibular and motor control impairments long past the typical period of RTP.
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Affiliation(s)
- Moira K Pryhoda
- Human Dynamics Laboratory, Department of Mechanical and Materials Engineering, University of Denver , Denver, CO, USA
| | - Kevin B Shelburne
- Human Dynamics Laboratory, Department of Mechanical and Materials Engineering, University of Denver , Denver, CO, USA
| | - Kim Gorgens
- Graduate School of Professional Psychology, University of Denver , Denver, CO, USA
| | - Aurélie Ledreux
- Knoebel Institute for Healthy Aging, University of Denver , Denver, CO, USA
| | | | - Bradley S Davidson
- Human Dynamics Laboratory, Department of Mechanical and Materials Engineering, University of Denver , Denver, CO, USA
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Jennings S, Collins MW, Taylor AM. Neuropsychological Assessment of Sport-Related Concussion. Clin Sports Med 2020; 40:81-91. [PMID: 33187615 DOI: 10.1016/j.csm.2020.08.002] [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: 11/29/2022]
Abstract
Neuropsychological assessment is a key component in a comprehensive, multidisciplinary approach to assessment of sport-related concussion (SRC). Currently computerized tests are the most commonly used modality of neurocognitive testing and involve both baseline and postinjury assessments. A comprehensive neuropsychological assessment should not only include neurocognitive testing but also incorporate symptom inventories, vestibular-ocular screening, and a psychological evaluation. Neuropsychological assessments are most effective when completed by a Clinical Neuropsychologist, given their specialized training in test interpretation and conceptualization of the psychological, cognitive, behavioral, physiologic, as well as neurologic principals when treating and managing SRC.
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Affiliation(s)
- Sabrina Jennings
- Department of Orthopedics, UPMC Sport Medicine Concussion Program, 3200 South Water Street, Pittsburgh 15203, PA, USA.
| | - Michael W Collins
- Department of Orthopedics, UPMC Sport Medicine Concussion Program, 3200 South Water Street, Pittsburgh 15203, PA, USA
| | - Alex M Taylor
- Brain Injury Center, Boston's Children Center, 300 Longwood Avenue, Boston, MA 02115, USA
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40
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Lee JK, Wu J, Bullen J, Banks S, Bernick C, Modic MT, Ruggieri P, Bennett L, Jones SE. Association of Cavum Septum Pellucidum and Cavum Vergae With Cognition, Mood, and Brain Volumes in Professional Fighters. JAMA Neurol 2020; 77:35-42. [PMID: 31498371 DOI: 10.1001/jamaneurol.2019.2861] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Many studies have investigated the imaging findings showing sequelae of repetitive head trauma, with mixed results. Objective To determine whether fighters (boxers and mixed martial arts fighters) with cavum septum pellucidum (CSP) and cavum vergae (CV) have reduced volumes in various brain structures or worse clinical outcomes on cognitive and mood testing. Design, Setting, and Participants This cohort study assessed participants from the Professional Fighters Brain Health Study. Data were collected from April 14, 2011, to January 17, 2018, and were analyzed from September 1, 2018, to May 23, 2019. This study involved a referred sample of 476 active and retired professional fighters. Eligible participants were at least 18 years of age and had at least a fourth-grade reading level. Healthy age-matched controls with no history of trauma were also enrolled. Exposures Presence of CSP, CV, and their total (additive) length (CSPV length). Main Outcomes and Measures Information regarding depression, impulsivity, and sleepiness among study participants was obtained using the Patient Health Questionnaire depression scale, Barrett Impulsiveness Scale, and the Epworth Sleepiness Scale. Cognition was assessed using raw scores from CNS Vital Signs. Volumes of various brain structures were measured via magnetic resonance imaging. Results A total of 476 fighters (440 men, 36 women; mean [SD] age, 30.0 [8.2] years [range, 18-72 years]) and 63 control participants (57 men, 6 women; mean [SD] age, 30.8 [9.6] years [range, 18-58 years]) were enrolled in the study. Compared with fighters without CV, fighters with CV had significantly lower mean psychomotor speed (estimated difference, -11.3; 95% CI, -17.4 to -5.2; P = .004) and lower mean volumes in the supratentorium (estimated difference, -31 191 mm3; 95% CI, -61 903 to -479 mm3; P = .05) and other structures. Longer CSPV length was associated with lower processing speed (slope, -0.39; 95% CI, -0.49 to -0.28; P < .001), psychomotor speed (slope, -0.43; 95% CI, -0.53 to -0.32; P < .001), and lower brain volumes in the supratentorium (slope, -1072 mm3 for every 1-mm increase in CSPV length; 95% CI, -1655 to -489 mm3; P < .001) and other structures. Conclusions and Relevance This study suggests that the presence of CSP and CV is associated with lower regional brain volumes and cognitive performance in a cohort exposed to repetitive head trauma.
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Affiliation(s)
| | - Jenny Wu
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Sarah Banks
- Department of Psychology, University of California San Diego Health-La Jolla, San Diego
| | - Charles Bernick
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio
| | - Michael T Modic
- Department of Radiology, Vanderbilt University, Medical Center North, South Nashville, Tennessee
| | - Paul Ruggieri
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lauren Bennett
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio
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41
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Ruiter KI, Boshra R, DeMatteo C, Noseworthy M, Connolly JF. Neurophysiological markers of cognitive deficits and recovery in concussed adolescents. Brain Res 2020; 1746:146998. [PMID: 32574566 DOI: 10.1016/j.brainres.2020.146998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/29/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The present study sought to determine: 1) whether concussed adolescents exhibited deficits in neurocognitive functioning as reflected by neurophysiological alterations; 2) if neurophysiological alterations could be linked to supplementary data such as the number of previous concussions and days since injury; and 3) if deficits in psychological health and behavioural tests increased during diagnosis duration. METHODS Twenty-six concussed adolescents were compared to twenty-eight healthy controls with no prior concussions. Self-report inventories evaluated depressive and concussive symptomatology, while behavioral tests evaluated cognitive ability qualitatively. To assess neurophysiological markers of cognitive function, two separate auditory oddball tasks were employed: 1) an active oddball task measuring executive control and attention as reflected by the N2b and P300, respectively; and 2) a passive oddball task assessing the early, automatic pre-conscious awareness processes as reflected by the MMN. RESULTS Concussed adolescents displayed delayed N2b and attenuated P300 responses relative to controls; showed elevated levels of depressive and concussive symptomatology; scored average-to- low-average in behavioral tests; and exhibited N2b response latencies that correlated with number of days since injury. CONCLUSION These findings demonstrate that concussed adolescents exhibit clear deficiencies in neurocognitive function, and that N2b response latency may be a marker of concussion recovery.
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Affiliation(s)
- Kyle I Ruiter
- McMaster University - ARiEAL Research Centre, L.R. Wilson Hall, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4M2, Canada; McMaster University - Department of Linguistics and Languages, Canada.
| | - Rober Boshra
- McMaster University - ARiEAL Research Centre, L.R. Wilson Hall, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4M2, Canada; McMaster University - School of Biomedical Engineering, McMaster University, ETB-406, 1280 Main St., West, Hamilton, ON L8S 4K1, Canada; MaRS Centre - Vector Institute, Canada.
| | - Carol DeMatteo
- McMaster University - School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON L8S 1C7, Canada.
| | - Michael Noseworthy
- McMaster University - School of Biomedical Engineering, McMaster University, ETB-406, 1280 Main St., West, Hamilton, ON L8S 4K1, Canada.
| | - John F Connolly
- McMaster University - ARiEAL Research Centre, L.R. Wilson Hall, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4M2, Canada; McMaster University - Department of Linguistics and Languages, Canada; McMaster University - School of Biomedical Engineering, McMaster University, ETB-406, 1280 Main St., West, Hamilton, ON L8S 4K1, Canada; McMaster University - Department of Psychology, Neuroscience and Behaviour, Canada; MaRS Centre - Vector Institute, Canada.
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Saliva microRNA Biomarkers of Cumulative Concussion. Int J Mol Sci 2020; 21:ijms21207758. [PMID: 33092191 PMCID: PMC7589940 DOI: 10.3390/ijms21207758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 12/27/2022] Open
Abstract
Recurrent concussions increase risk for persistent post-concussion symptoms, and may lead to chronic neurocognitive deficits. Little is known about the molecular pathways that contribute to persistent concussion symptoms. We hypothesized that salivary measurement of microribonucleic acids (miRNAs), a class of epitranscriptional molecules implicated in concussion pathophysiology, would provide insights about the molecular cascade resulting from recurrent concussions. This hypothesis was tested in a case-control study involving 13 former professional football athletes with a history of recurrent concussion, and 18 age/sex-matched peers. Molecules of interest were further validated in a cross-sectional study of 310 younger individuals with a history of no concussion (n = 230), a single concussion (n = 56), or recurrent concussions (n = 24). There was no difference in neurocognitive performance between the former professional athletes and their peers, or among younger individuals with varying concussion exposures. However, younger individuals without prior concussion outperformed peers with prior concussion on three balance assessments. Twenty salivary miRNAs differed (adj. p < 0.05) between former professional athletes and their peers. Two of these (miR-28-3p and miR-339-3p) demonstrated relationships (p < 0.05) with the number of prior concussions reported by younger individuals. miR-28-3p and miR-339-5p may play a role in the pathophysiologic mechanism involved in cumulative concussion effects.
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Mundluru J, Subhan A, Lo TWB, Churchill N, Fornazzari L, Munoz DG, Schweizer TA, Fischer CE. Neuropsychiatric Presentations due to Traumatic Brain Injury in Cognitively Normal Older Adults. J Neurotrauma 2020; 38:566-572. [PMID: 32977734 DOI: 10.1089/neu.2020.7282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Neuropsychiatric symptoms (NPS) are common sequelae of traumatic brain injuries (TBI) among adults. However, little is known about NPS associated with a history of TBI in adults relative to adults without a history of TBI and to what extent NPS may be modulated by sex and other factors. Using the National Alzheimer's Coordinating Center Uniform Data Set, we examined the association between Neuropsychiatric Inventory-Questionnaire (NPI-Q) scores in cognitively normal older adults with and without a history of TBI. A binomial logistic regression model was used to examine NPI-Q domains in adults with a history of TBI (n = 266) versus without a history of TBI (n = 1508). History of TBI, sex, age, and body mass index were used as covariates. Adults with a history of TBI had a greater probability of exhibiting agitation, anxiety, apathy, disinhibition and aberrant motor behavior relative to adults without a history of TBI. In terms of sex differences, males with and without a history of TBI had an increased likelihood of agitation, apathy, disinhibition, and apnea, whereas females had an increased likelihood of anxiety and insomnia relative to males. Our study confirms that history of TBI is associated with an increased prevalence of specific NPS, including agitation, anxiety, apathy, disinhibition, and aberrant motor behavior. Given that the aforementioned NPS are linked through different pathways, damage to any of them may cause an alteration in behavior. As well, NPS appear to be modulated by sex, with symptoms differing between males and females. Our research suggests future studies examining NPS sequelae of TBI should adjust for sex.
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Affiliation(s)
- Jahnavi Mundluru
- Keenan Research Center for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Abdul Subhan
- Keenan Research Center for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tsz Wai Bentley Lo
- Keenan Research Center for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nathan Churchill
- Keenan Research Center for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.,Neuroscience Research Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Luis Fornazzari
- Keenan Research Center for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David G Munoz
- Keenan Research Center for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Pathology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tom A Schweizer
- Keenan Research Center for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.,Neuroscience Research Program, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Corinne E Fischer
- Keenan Research Center for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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McMurry HS, Tsang DC, Lin N, Symes SN, Dong C, Monteith TS. Head injury and neuropsychiatric sequelae in asylum seekers. Neurology 2020; 95:e2605-e2609. [PMID: 33004606 DOI: 10.1212/wnl.0000000000010929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 07/14/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Asylum seekers experience a high burden of physical and psychological trauma, yet there is a scarcity of literature regarding the epidemiology and sequelae of head injury (HI) in asylum seekers. We examined HI prevalence and association with neuropsychiatric comorbidities in asylum seekers. METHODS A retrospective cross-sectional study was performed through review of 139 medical affidavits from an affidavit database. Affidavits written from 2010 to 2018 were included. Demographic and case-related data were collected and classified based on the presence of HI. For neuropsychiatric sequelae, the primary study outcome was headache and the secondary outcomes were depression, posttraumatic stress disorder, and anxiety. Multivariable logistic regression was performed to examine the association between HI and neuropsychiatric sequelae, adjusted for demographic and clinical characteristics. RESULTS A total of 139 medical affidavits of asylum seekers were included. The mean age was 27.4 ± 12.1 years, 56.8% were female, and 38.8% were <19 years. Almost half (42.5%) explicitly self-reported history of HI. Compared to clients who did not report HI, clients with HI were older and more likely to report a history of headache, physical abuse, physical trauma, concussion, and loss of consciousness. After adjustment for demographic and clinical characteristics, clients with HI had greater odds for neuropsychological sequelae such as headache (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0-8.7) and depression (OR 2.5, 95% CI 1.1-5.7). CONCLUSIONS We observed a high prevalence of HI in asylum seekers. Comprehensive screening for HI and neuropsychiatric comorbidities is encouraged when evaluating asylum seekers.
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Affiliation(s)
- Hannah S McMurry
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Darren C Tsang
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Nicole Lin
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Stephen N Symes
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Chuanhui Dong
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Teshamae S Monteith
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL.
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Holden J, Francisco E, Tommerdahl A, Lensch R, Kirsch B, Zai L, Pearce AJ, Favorov OV, Dennis RG, Tommerdahl M. Methodological Problems With Online Concussion Testing. Front Hum Neurosci 2020; 14:509091. [PMID: 33132870 PMCID: PMC7559397 DOI: 10.3389/fnhum.2020.509091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 08/26/2020] [Indexed: 01/25/2023] Open
Abstract
Reaction time testing is widely used in online computerized concussion assessments, and most concussion studies utilizing the metric have demonstrated varying degrees of difference between concussed and non-concussed individuals. The problem with most of these online concussion assessments is that they predominantly rely on consumer grade technology. Typical administration of these reaction time tests involves presenting a visual stimulus on a computer monitor and prompting the test subject to respond as quickly as possible via keypad or computer mouse. However, inherent delays and variabilities are introduced to the reaction time measure by both computer and associated operating systems that the concussion assessment tool is installed on. The authors hypothesized systems that are typically used to collect concussion reaction time data would demonstrate significant errors in reaction time measurements. To remove human bias, a series of experiments was conducted robotically to assess timing errors introduced by reaction time tests under four different conditions. In the first condition, a visual reaction time test was conducted by flashing a visual stimulus on a computer monitor. Detection was via photodiode and mechanical response was delivered via computer mouse. The second condition employed a mobile device for the visual stimulus, and the mechanical response was delivered to the mobile device's touchscreen. The third condition simulated a tactile reaction time test, and mechanical response was delivered via computer mouse. The fourth condition also simulated a tactile reaction time test, but response was delivered to a dedicated device designed to store the interval between stimulus delivery and response, thus bypassing any problems hypothesized to be introduced by computer and/or computer software. There were significant differences in the range of responses recorded from the four different conditions with the reaction time collected from visual stimulus on a mobile device being the worst and the device with dedicated hardware designed for the task being the best. The results suggest that some of the commonly used visual tasks on consumer grade computers could be (and have been) introducing significant errors for reaction time testing and that dedicated hardware designed for the reaction time task is needed to minimize testing errors.
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Affiliation(s)
| | | | | | | | - Bryan Kirsch
- Cortical Metrics LLC, Carrboro, NC, United States
| | - Laila Zai
- Lucent Research, Denver, CO, United States
| | - Alan J Pearce
- College of Health Science and Engineering, LaTrobe University, Melbourne, VIC, Australia
| | - Oleg V Favorov
- Department of Biomedical Engineering, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Robert G Dennis
- Cortical Metrics LLC, Carrboro, NC, United States.,Department of Biomedical Engineering, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mark Tommerdahl
- Cortical Metrics LLC, Carrboro, NC, United States.,Department of Biomedical Engineering, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Cantarero G, Choynowski J, St Pierre M, Anaya M, Statton M, Stokes W, Capaldi V, Chib V, Celnik P. Repeated Concussions Impair Behavioral and Neurophysiological Changes in the Motor Learning System. Neurorehabil Neural Repair 2020; 34:804-813. [PMID: 32723160 PMCID: PMC7501144 DOI: 10.1177/1545968320943578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Concussions affect nearly 3 million people a year and are the leading cause of traumatic brain injury-related emergency department visits among youth. Evidence shows neuromotor regions are sensitive to concussive events and that motor symptoms may be the earliest clinical manifestations of neurodegenerative traumatic brain injuries. However, little is known about the effects repeated concussions play on motor learning. Namely, how does concussion acuity (time since injury) affect different behavioral and neurophysiological components of motor learning? Methods. Using a 3-pronged approach, we assessed (1) behavioral measures of motor learning, (2) neurophysiological measures underlying retention of motor learning known as occlusion, and (3) quantitative survey data capturing affective symptoms of each participant. Collegiate student athletes were stratified across 3 groups depending on their concussion history: (1) NonCon, no history of concussion; (2) Chronic, chronic-state of concussion (>1 year postinjury), or (3) Acute, acute state of concussion (<2 weeks postinjury). Results. We found that athletes in both the acute and chronic state of injury following a concussion had impaired retention and aberrant occlusion in motor skill learning as compared with athletes with no history of concussion. Moreover, higher numbers of previous concussions (regardless of the time since injury) correlated with more severe behavioral and neurophysiological motor impairments by specifically hindering neurophysiological mechanisms of learning to affect behavior. Conclusions. These results indicate the presence of motor learning impairment that is evident within 2 weeks postinjury. Our findings have significant implications for the prognosis of concussion and emphasize the need for prevention, but can also direct more relevant rehabilitation treatment targets.
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Affiliation(s)
| | - Jake Choynowski
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Maria St Pierre
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | | | | | - Vincent Capaldi
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Vikram Chib
- Johns Hopkins University, Baltimore, MD, USA
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Abstract
OBJECTIVES To describe historic baseline session administration practices, to assess the utility of a practice trial (an acclimation trial) before the official balance session, and to examine the within-session reliability of the Sway Balance Mobile Application (SBMA). DESIGN Retrospective observational study. SETTING Middle schools, high schools, and colleges across the United States. PARTICIPANTS More than 17 000 student-athletes were included in the Sway Medical database with 7968 individuals meeting this study's inclusion criteria. INDEPENDENT VARIABLES The Sway Medical database included the following subject characteristics for each student-athlete: age, sex, weight, and height. MAIN OUTCOME MEASURES Balance assessment score generated by the SBMA. RESULTS Variable administration practices with significant differences between baseline session averages across methods were found. Individuals who performed an acclimation trial had a significantly higher baseline session average than those who did not. Within-session reliability estimates were in the low to adequate range (r = 0.53-0.78), with higher estimates found for 2 consecutive baseline tests (r = 0.75-0.78). CONCLUSIONS For maximum clinical utility, a standardized protocol for postural control baseline acquisition is necessary. Acclimation trial should be administered before a baseline session to minimize variability, especially with only 1 to 2 baseline tests. The highest reliability was observed across 2 consecutive baseline tests within the same baseline session. We suggest obtaining baseline balance measurements with an acclimation trial followed by a baseline session with 2 baseline tests. Prospective studies are required for validation.
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Rodríguez-Lorenzana A, Núñez-Fernández S, Adana-Díaz L, Mascialino G, Ponce TY, Rivera D, Arango-Lasprilla JC. Normative data for test of learning and memory in an ecuadorian adult population. Clin Neuropsychol 2020; 34:54-69. [PMID: 32544370 DOI: 10.1080/13854046.2020.1775892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective of this study was to develop norms for two neuropsychological tests of learning and memory in an Ecuadorian adult population. METHOD 322 healthy individuals, ages between 18 and 84, were enrolled in the Metropolitan District of Quito. Participants were administered a comprehensive neuropsychological evaluation that included tests of learning and memory (Rey-Osterrieth Complex Figure Test [ROCF] and Hopkins Verbal Learning Test-Revised [HVLT-R]). Backward stepwise multiple linear regression analyses were used to examine the influence of demographic variables age, education, and gender on test performance. Normative data were developed adjusting for demographic variables found to be significant in the final regression models. RESULTS The final multiple linear models revealed performance on tests of learning and memory worsened with age and improved as a function of education. A user-friendly Excel-based calculator is presented to calculate the z score and percentile automatically based on raw score and sociodemographic information. CONCLUSION This is the first study that presents normative data for tests of learning and memory for an adult population in Ecuador. It is expected that these norms will help to improve the clinical practice of neuropsychology in Ecuador by limiting erroneous raw score interpretation and incrementing diagnostic accuracy.
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Affiliation(s)
| | | | - Lila Adana-Díaz
- Escuela de psicología, Universidad de Las Américas, Quito, Ecuador
| | - Guido Mascialino
- Escuela de psicología, Universidad de Las Américas, Quito, Ecuador
| | | | - Diego Rivera
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, España
| | - Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.,Department of Cell Biology and Histology, University of the Basque Country, (UPV/EHU), Leioa, Spain
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Li Y, Singman E, McCulley T, Wu C, Daphalapurkar N. The Biomechanics of Indirect Traumatic Optic Neuropathy Using a Computational Head Model With a Biofidelic Orbit. Front Neurol 2020; 11:346. [PMID: 32411088 PMCID: PMC7198902 DOI: 10.3389/fneur.2020.00346] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
Indirect traumatic optic neuropathy (ITON) is an injury to the optic nerve due to head trauma and usually results in partial or complete loss of vision. In order to advance a mechanistic understanding of the injury to the optic nerve, we developed a head model with a biofidelic orbit. Head impacts were simulated under controlled conditions of impactor velocity. The locations of impact were varied to include frontal, lateral, and posterior parts of the head. Impact studies were conducted using two types of impactors that differed in their rigidity relative to the skull. The simulated results from both the impactors suggest that forehead impacts are those to which the optic nerve is most vulnerable. The mode and location of optic nerve injury is significantly different between the impacting conditions. Simulated results using a relatively rigid impactor (metal cylinder) suggest optic nerve injury initiates at the location of the intracranial end of the optic canal and spreads to the regions of the optic nerve in the vicinity of the optic canal. In this case, the deformation of the skull at the optic canal, resulting in deformation of the optic nerve, was the primary mode of injury. On the other hand, simulated results using a relatively compliant impactor (soccer ball) suggest that primary mode of injury comes from the brain tugging upon the optic nerve (from where it is affixed to the intracranial end of the optic canal) during coup countercoup motion of the brain. This study represents the first published effort to employ a biofidelic simulation of the full length of the optic nerve in which the orbit is integrated within the whole head.
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Affiliation(s)
- Yang Li
- State Key Laboratory of Structural Analysis for Industrial Equipment, Department of Engineering Mechanics, Dalian University of Technology, Dalian, China.,Hopkins Extreme Materials Institute, Johns Hopkins University, Baltimore, MD, United States
| | - Eric Singman
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Timothy McCulley
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Chengwei Wu
- State Key Laboratory of Structural Analysis for Industrial Equipment, Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Nitin Daphalapurkar
- Hopkins Extreme Materials Institute, Johns Hopkins University, Baltimore, MD, United States.,Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, United States
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50
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Rosenblum DJ, Walton SR, Erdman NK, Broshek DK, Hart JM, Resch JE. If Not Now, When? An Absence of Neurocognitive and Postural Stability Deficits in Collegiate Athletes with One or More Concussions. J Neurotrauma 2020; 37:1211-1220. [PMID: 31910071 DOI: 10.1089/neu.2019.6813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A history of concussion has been associated with decreased neurocognitive function and postural control. The purpose of our study was to compare neurocognitive function and postural control in collegiate athletes with and without varying histories of concussion. Collegiate athletes were divided into groups based on 0 (n = 129), 1 (n = 91), 2 (n = 52), and 3+ (n = 34) prior concussions. Participants in each group were carefully matched by sport, sex, height, weight, and age. Athletes were administered the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT™) and the Sensory Organization Test (SOT) as part of a standard of care pre-season assessment. Group ImPACT (Verbal and Visual Memory, Visual Motor Speed, and Reaction Time) and SOT (Equilibrium Score and Somatosensory, Visual, and Vestibular sensory ratios) outcome scores were compared using one-way analyses of variance (ANOVAs). Coefficients of variation (CVs) were also calculated for each outcome score and were compared using two-sample tests with 95% confidence intervals (CIs). Participants with and without a history of concussion were not significantly different for any ImPACT or SOT outcome score (p's > 0.10). Groups (0, 1, 2, and 3+ previous concussions) were not different from each other for any ImPACT or SOT outcome score (p's ≥ 0.11). Likewise, the CVs associated with each ImPACT and SOT outcome score did not vary significantly between outcome scores for any group comparison (p ≥ 0.09). Our findings suggest that a history of one or more concussions does not influence neurocognitive performance or postural stability in collegiate athletes at their pre-season baseline assessment.
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Affiliation(s)
- Daniel J Rosenblum
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Samuel R Walton
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Nicholas K Erdman
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Donna K Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Joeseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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