1
|
Sanclemente D, Belair JA, Talekar KS, Roedl JB, Stache S. Return to Play Following Concussion: Role for Imaging? Semin Musculoskelet Radiol 2024; 28:193-202. [PMID: 38484771 DOI: 10.1055/s-0043-1778031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This review surveys concussion management, focusing on the use of neuroimaging techniques in return to play (RTP) decisions. Clinical assessments traditionally were the foundation of concussion diagnoses. However, their subjective nature prompted an exploration of neuroimaging modalities to enhance diagnosis and management. Magnetic resonance spectroscopy provides information about metabolic changes and alterations in the absence of structural abnormalities. Diffusion tensor imaging uncovers microstructural changes in white matter. Functional magnetic resonance imaging assesses neuronal activity to reveal changes in cognitive and sensorimotor functions. Positron emission tomography can assess metabolic disturbances using radiotracers, offering insight into the long-term effects of concussions. Vestibulo-ocular dysfunction screening and eye tracking assess vestibular and oculomotor function. Although these neuroimaging techniques demonstrate promise, continued research and standardization are needed before they can be integrated into the clinical setting. This review emphasizes the potential for neuroimaging in enhancing the accuracy of concussion diagnosis and guiding RTP decisions.
Collapse
Affiliation(s)
- Drew Sanclemente
- Medical Student, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jeffrey A Belair
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kiran S Talekar
- Department of Radiology, Brain Mapping (fMRI and DTI) in Neuroradiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Johannes B Roedl
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Stephen Stache
- Division of Non-Operative Sports Medicine, Department of Orthopaedics and Family and Community Medicine, Rothman Orthopaedic Institute, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Department of Orthopaedics and Pediatrics, University Athletics, Drexel University and Drexel College of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
2
|
Lilley RL, Kabaliuk N, Reynaud A, Devananthan P, Smith N, Docherty PD. A Novel Experimental Approach for the Measurement of Vibration-Induced Changes in the Rheological Properties of Ex Vivo Ovine Brain Tissue. SENSORS (BASEL, SWITZERLAND) 2024; 24:2022. [PMID: 38610233 PMCID: PMC11014318 DOI: 10.3390/s24072022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024]
Abstract
Increased incidence of traumatic brain injury (TBI) imposes a growing need to understand the pathology of brain trauma. A correlation between the incidence of multiple brain traumas and rates of behavioural and cognitive deficiencies has been identified amongst people that experienced multiple TBI events. Mechanically, repetitive TBIs may affect brain tissue in a similar way to cyclic loading. Hence, the potential susceptibility of brain tissue to mechanical fatigue is of interest. Although temporal changes in ovine brain tissue viscoelasticity and biological fatigue of other tissues such as tendons and arteries have been investigated, no methodology currently exists to cyclically load ex vivo brain tissue. A novel rheology-based approach found a consistent, initial stiffening response of the brain tissue before a notable softening when subjected to a subsequential cyclic rotational shear. History dependence of the mechanical properties of brain tissue indicates susceptibility to mechanical fatigue. Results from this investigation increase understanding of the fatigue properties of brain tissue and could be used to strengthen therapy and prevention of TBI, or computational models of repetitive head injuries.
Collapse
Affiliation(s)
- Rebecca L. Lilley
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8140, New Zealand; (R.L.L.); (N.K.); (A.R.); (P.D.)
| | - Natalia Kabaliuk
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8140, New Zealand; (R.L.L.); (N.K.); (A.R.); (P.D.)
- Biomolecular Interaction Centre, Christchurch 8140, New Zealand
| | - Antoine Reynaud
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8140, New Zealand; (R.L.L.); (N.K.); (A.R.); (P.D.)
- École Nationale Supérieure de Mécanique et des Microtechniques, 25000 Besançon, France
| | - Pavithran Devananthan
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8140, New Zealand; (R.L.L.); (N.K.); (A.R.); (P.D.)
- Biomolecular Interaction Centre, Christchurch 8140, New Zealand
| | - Nicole Smith
- Department of Electrical Engineering, University of Canterbury, Christchurch 8140, New Zealand;
| | - Paul D. Docherty
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8140, New Zealand; (R.L.L.); (N.K.); (A.R.); (P.D.)
- Institute for Technical Medicine, Furtwangen University, 78120 Villingen Schwenningen, Germany
| |
Collapse
|
3
|
Bigler ED. PREFACE to what traditional neuropsychological assessment got wrong about mild traumatic brain injury. A four-part opinion review. Brain Inj 2024:1-7. [PMID: 38415677 DOI: 10.1080/02699052.2024.2321931] [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: 01/19/2024] [Accepted: 02/16/2024] [Indexed: 02/29/2024]
Abstract
This Preface overviews a four-part opinion series on the role of tradtional neuropsychological tests in evaluating mild traumatic brain injury (mTBI), juxtaposed to all of the progress that has occurred with advanced neuroimaging and allied technologies. The four areas of review and critique are: I. Neuropathology; II: Limitations in Test Development, Statistical and Psychometric Issues; III. Implications of Advanced Neuroimaging Findings inn the Neuropsychological Assessment of the mTBI Patient, and IV: Clinical Applications and Future Directions. The example is made that since their inception in the early to mid-20th Century, traditional neuropsychological measures mostly have remained invariant, have been used as omnibus measures for assessing all types of neurological and neuropsychiatric conditions, and were never specifically designed to asses the effects of mTBI. Extensive discussion is provided across all four parts concerning the limits of traditional neuropsychological methods, especially in the absences of any integration with advanced neuroimaging and biomarker findings. Part IV provides an outline for future research and clinical application in the development of novel neuropsychological assessment mesasures specific to mTBI.
Collapse
Affiliation(s)
- Erin D Bigler
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
- Departments of Neurology and Psychiatry, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
4
|
Wang Y, Bartels HM, Nelson LD. A Systematic Review of ASL Perfusion MRI in Mild TBI. Neuropsychol Rev 2023; 33:160-191. [PMID: 32808244 PMCID: PMC7889778 DOI: 10.1007/s11065-020-09451-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 08/06/2020] [Indexed: 01/06/2023]
Abstract
Mild traumatic brain injury (mTBI) is a major public health concern. Cerebrovascular alterations play a significant role in the evolution of injury sequelae and in the process of post-traumatic brain repair. Arterial spin labeling (ASL) is an advanced perfusion magnetic resonance imaging technique that permits noninvasive quantification of cerebral blood flow (CBF). This is the first systematic review of ASL research findings in patients with mTBI. Our approach followed the American Academy of Neurology (AAN) and PRISMA guidelines. We searched Ovid/MEDLINE, Web of Science, Scopus, and the Cochrane Index for relevant articles published as of February 20, 2020. Full-text results were combined into Rayyan software for further evaluation. Data extraction, including risk of bias ratings, was performed using American Academy of Neurology's four-tiered classification scheme. Twenty-three articles met inclusion criteria comprising data on up to 566 mTBI patients and 654 control subjects. Of the 23 studies, 18 reported some type of regional CBF abnormality in mTBI patients at rest or during a cognitive task, with more findings of decreased than increased CBF. The evidence supports the conclusion that mTBI likely causes ASL-derived CBF anomalies. However, synthesis of findings was challenging due to substantial methodological variations across studies and few studies with low risk of bias. Thus, larger-scale prospective cohort studies are needed to more definitively chart the course of CBF changes in humans after mTBI and to understand how individual difference factors contribute to post-injury CBF changes.
Collapse
Affiliation(s)
- Yang Wang
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Hannah M Bartels
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| |
Collapse
|
5
|
Hoffman LJ, Mis RE, Brough C, Ramirez S, Langford D, Giovannetti T, Olson IR. Concussions in young adult athletes: No effect on cerebral white matter. Front Hum Neurosci 2023; 17:1113971. [PMID: 36936617 PMCID: PMC10014705 DOI: 10.3389/fnhum.2023.1113971] [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: 12/01/2022] [Accepted: 02/10/2023] [Indexed: 03/05/2023] Open
Abstract
Introduction The media's recent focus on possible negative health outcomes following sports- related concussion has increased awareness as well as anxiety among parents and athletes. However, the literature on concussion outcomes is equivocal and limited by a variety of diagnostic approaches. Methods The current study used a rigorous, open- access concussion identification method-the Ohio State University Traumatic Brain Injury Identification method (OSU TBI-ID) to identify concussion and periods of repeated, subclinical head trauma in 108 young adult athletes who also underwent a comprehensive protocol of cognitive tests, mood/anxiety questionnaires, and high-angular-resolution diffusion-weighted brain imaging to evaluate potential changes in white matter microstructure. Results Analyses showed that athletes with a history of repetitive, subclinical impacts to the head performed slightly worse on a measure of inhibitory impulse control and had more anxiety symptoms compared to those who never sustained any type of head injury but were otherwise the same as athletes with no history of concussion. Importantly, there were no group differences in cerebral white matter as measured by tract- based spatial statistics (TBSS), nor were there any associations between OSU TBI-ID measures and whole-brain principal scalars and free-water corrected scalars. Discussion Our results provide support for the hypothesis that it is not concussion per se, but repetitive head impacts that beget worse outcomes.
Collapse
Affiliation(s)
- Linda J. Hoffman
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
| | - Rachel E. Mis
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
| | - Caroline Brough
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
| | - Servio Ramirez
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Dianne Langford
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Tania Giovannetti
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
| | - Ingrid R. Olson
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
- *Correspondence: Ingrid R. Olson,
| |
Collapse
|
6
|
Sheldrake E, Lam B, Al-Hakeem H, Wheeler AL, Goldstein BI, Dunkley BT, Ameis S, Reed N, Scratch SE. A Scoping Review of Magnetic Resonance Modalities Used in Detection of Persistent Postconcussion Symptoms in Pediatric Populations. J Child Neurol 2022; 38:85-102. [PMID: 36380680 DOI: 10.1177/08830738221120741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Up to 30% of youth with concussion experience PPCSs (PPCS) lasting 4 weeks or longer, and can significantly impact quality of life. Magnetic resonance imaging (MRI) has the potential to increase understanding of causal mechanisms underlying PPCS. However, there are no clear modalities to assist in detecting PPCS. This scoping review aims to synthesize findings on utilization of MRI among children and youth with PPCS, and summarize progress and limitations. Thirty-six studies were included from 4907 identified papers. Many studies used multiple modalities, including (1) structural (n = 27) such as T1-weighted imaging, diffusion weighted imaging, and susceptibility weighted imaging; and (2) functional (n = 23) such as functional MRI and perfusion-weighted imaging. Findings were heterogeneous among modalities and regions of interest, which warrants future reviews that report on the patterns and potential advancements in the field. Consideration of modalities that target PPCS prediction and sensitive modalities that can supplement a biopsychosocial approach to PPCS would benefit future research.
Collapse
Affiliation(s)
- Elena Sheldrake
- Bloorview Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Brendan Lam
- Bloorview Research Institute, Toronto, Ontario, Canada
| | | | - Anne L Wheeler
- Neuroscience and Mental Health Program, 7979Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- 7978Centre for Addiction and Mental Health, Toronto, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin T Dunkley
- Neuroscience and Mental Health Program, 7979Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Ameis
- 7978Centre for Addiction and Mental Health, Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Shannon E Scratch
- Bloorview Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Jervis CG, Adams SA, Fawkner S, Griffin SA. Concussion education in medical students studying in Scotland: an assessment of knowledge and future needs. Brain Inj 2022; 36:1196-1203. [PMID: 35996323 DOI: 10.1080/02699052.2022.2115139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Physicians play a key role in ensuring athletes with concussion safely return to sport. Research has shown deficiencies in concussion education amongst physicians and medical students. However, studies have not previously been conducted in UK medical schools. OBJECTIVES To assess students' concussion knowledge and learning in Scottish Medical Schools. DESIGN A survey with 23 questions was distributed to Year 3-6 medical students studying in Scotland in October 2020. The survey included the following: (1) demographics, (2) concussion knowledge, e.g. 'What is the role of headgear in preventing concussion?' (3) concussion learning, 'In which part of the curriculum should concussion be taught?.' Frequencies of responses were calculated for each question. RESULTS 200 students responded (response rate 8%). The average symptoms and management score were 87.3% and 31% respectively. 15% of participants knew that headgear has no role in preventing concussions and one participant identified the minimum "return to sport" timeframes for adults and children. 15% had learnt about concussion at medical school with 92.5% interested in receiving concussion teaching at medical school. CONCLUSION Knowledge gaps exist in managing and preventing sports-related concussion. There is a discrepancy between levels of concussion teaching and the desire and importance placed on concussion education.
Collapse
Affiliation(s)
| | - Stephanie A Adams
- Moray House School of Education and Sport, The University of Edinburgh, Edinburgh, UK
| | - Samantha Fawkner
- Moray House School of Education and Sport, The University of Edinburgh, Edinburgh, UK
| | - Steffan A Griffin
- Moray House School of Education and Sport, The University of Edinburgh, Edinburgh, UK.,Medical Services, Rugby Football Union, London, UK.,Centre for Sport and Exercise, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
8
|
Schlemmer E, Nicholson N. Vestibular Rehabilitation Effectiveness for Adults With Mild Traumatic Brain Injury/Concussion: A Mini-Systematic Review. Am J Audiol 2022; 31:228-242. [PMID: 35077655 DOI: 10.1044/2021_aja-21-00165] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Millions of people suffer from traumatic brain injuries every year with common sequelae, including dizziness, disequilibrium, compromised vision, and gait abnormalities. Individuals suffering a mild traumatic brain injury (mTBI) or concussion may be prescribed bed rest, but for some, symptoms may persist and require different treatment options. The aim of this mini-systematic review was to synthesize the best available evidence regarding the effectiveness of vestibular rehabilitation therapy (VRT) as a treatment option for adults with mTBIs. METHOD A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search term concepts were VRT and mTBI. Records meeting the inclusion criteria were extracted from the following databases: PubMed and CINAHL. A manual search of reference lists identified additional studies. Inclusion criteria were (a) participants with mTBI/concussion characterized by dizziness, balance, and/or other vestibular symptoms; (b) VRT as the primary treatment; and (c) self-reported and/or performance-based outcome measures. Data were extracted using a standardized tool, and studies were critically appraised. RESULTS Five studies were included in the systematic review: one randomized controlled trial, two retrospective chart reviews, one pre-/post-intervention study, and one case series. Four of the five studies found VRT to be effective at reducing postconcussion symptoms after head injury. Self-reported measures were included in all studies; performance-based measures were included in four out of five studies. None of the studies reported adverse effects of intervention. CONCLUSIONS Results suggest VRT is an effective treatment option for patients with persistent/lingering symptoms after concussion/mTBI, as demonstrated by self-reported and performance-based outcome measures. Results of this study emphasize the need for audiologists to be thoroughly familiar with VRT as an effective treatment for patients with persistent symptoms following mTBI.
Collapse
Affiliation(s)
- Erica Schlemmer
- Department of Audiology, Nova Southeastern University, Fort Lauderdale, FL
| | - Nannette Nicholson
- Department of Audiology, Nova Southeastern University, Fort Lauderdale, FL
| |
Collapse
|
9
|
Collision avoidance strategies between two athlete walkers: Understanding impaired avoidance behaviours in athletes with a previous concussion. Gait Posture 2022; 92:24-29. [PMID: 34801953 DOI: 10.1016/j.gaitpost.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals who have sustained a concussion often display associated balance control deficits and visuomotor impairments despite being cleared by a physician to return to sport. Such visuomotor impairments can be highlighted in collision avoidance tasks that involves a mutual adaptation between two walkers. However, studies have yet to challenged athletes with a previous concussion during an everyday collision avoidance task, following return to sport. RESEARCH QUESTION Do athletes with a previous concussion display associated behavioural changes during a 90°-collision avoidance task with an approaching pedestrian? METHODS Thirteen athletes (ATH; 9 females, 23 ± 4years) and 13 athletes with a previous concussion (CONC; 9 females, 22 ± 3 years, concussion <6 months) walked at a comfortable walking speed along a 12.6 m pathway while avoiding another athlete on a 90º-collision course. Each participant randomly interacted with individuals from the same group 20 times and interacted with individuals from the opposite group 21 times. Minimum predicted distance (mpd) was used to examine collision avoidance behaviours between ATH and CONC groups. RESULTS The overall progression of mpd(t) did not differ between groups (p > .05). During the collision avoidance task, previously concussed athletes contributed less when passing second compared to their peers(p < .001). When two previously concussed athletes were on a collision course, there was a greater amount of variability resulting in inappropriate adaptive behaviours. SIGNIFICANCE Although successful at avoiding a collision with an approaching athlete, previously concussed athletes exhibit behavioural changes manifesting in riskier behaviours. The current findings suggest that previously concussed athletes possess behavioural changes even after being cleared to returned to sport, which may increase their risk of a subsequent injury when playing.
Collapse
|
10
|
Mansouri A, Ledwidge P, Sayood K, Molfese DL. A Routine Electroencephalography Monitoring System for Automated Sports-Related Concussion Detection. Neurotrauma Rep 2021; 2:626-638. [PMID: 35018364 PMCID: PMC8742301 DOI: 10.1089/neur.2021.0047] [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] [Indexed: 11/12/2022] Open
Abstract
Cases of concussions in the United States keep increasing and are now up to 2 million to 3 million incidents per year. Although concussions are recoverable and usually not life-threatening, the degree and rate of recovery may vary depending on age, severity of the injury, and past concussion history. A subsequent concussion before full recovery may lead to more-severe brain damage and poorer outcomes. Electroencephalography (EEG) recordings can identify brain dysfunctionality and abnormalities, such as after a concussion. Routine EEG monitoring can be a convenient method for reducing unreported injuries and preventing long-term damage, especially among groups with a greater risk of experiencing a concussion, such as athletes participating in contact sports. Because of the relative availability of EEG compared to other brain-imaging techniques (e.g., functional magnetic resonance imaging), the use of EEG monitoring is growing for various neurological disorders. In this longitudinal study, EEG was analyzed from 4 football athletes before their athletic season and also within 7 days of concussion. Compared to a control group of 4 additional athletes, a concussion was detected with up to 99.5% accuracy using EEG recordings in the Theta-Alpha band. Classifiers that use data from only a subset of the EEG electrodes providing reliable detection are also proposed. The most effective classifiers used EEG recordings from the Central scalp region in the Beta band and over the Temporal scalp region using the Theta-Alpha band. This proof-of-concept study and preliminary findings suggest that EEG monitoring may be used to identify a sports-related concussion occurrence with a high level of accuracy and thus reduce the chance of unreported concussion.
Collapse
Affiliation(s)
- Amirsalar Mansouri
- Department of Electrical and Computer Engineer, Baldwin Wallace University, Berea, Ohio, USA
| | - Patrick Ledwidge
- Department of Psychology, Baldwin Wallace University, Berea, Ohio, USA
| | - Khalid Sayood
- Department of Electrical and Computer Engineer, Baldwin Wallace University, Berea, Ohio, USA
| | - Dennis L. Molfese
- Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, Nebraska, USA Baldwin Wallace University, Berea, Ohio, USA
| |
Collapse
|
11
|
Chaudhary M, Adams MS, Mukhopadhyay S, Litoiu M, Sergio LE. Sabotage Detection Using DL Models on EEG Data From a Cognitive-Motor Integration Task. Front Hum Neurosci 2021; 15:662875. [PMID: 34690715 PMCID: PMC8531592 DOI: 10.3389/fnhum.2021.662875] [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: 02/11/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Objective clinical tools, including cognitive-motor integration (CMI) tasks, have the potential to improve concussion rehabilitation by helping to determine whether or not a concussion has occurred. In order to be useful, however, an individual must put forth their best effort. In this study, we have proposed a novel method to detect the difference in cortical activity between best effort (no-sabotage) and willful under-performance (sabotage) using a deep learning (DL) approach on the electroencephalogram (EEG) signals. The EEG signals from a wearable four-channel headband were acquired during a CMI task. Each participant completed sabotage and no-sabotage conditions in random order. A multi-channel convolutional neural network with long short term memory (CNN-LSTM) model with self-attention has been used to perform the time-series classification into sabotage and no-sabotage, by transforming the time-series into two-dimensional (2D) image-based scalogram representations. This approach allows the inspection of frequency-based, and temporal features of EEG, and the use of a multi-channel model facilitates in capturing correlation and causality between different EEG channels. By treating the 2D scalogram as an image, we show that the trained CNN-LSTM classifier based on automated visual analysis can achieve high levels of discrimination and an overall accuracy of 98.71% in case of intra-subject classification, as well as low false-positive rates. The average intra-subject accuracy obtained was 92.8%, and the average inter-subject accuracy was 86.15%. These results indicate that our proposed model performed well on the data of all subjects. We also compare the scalogram-based results with the results that we obtained by using raw time-series, showing that scalogram-based gave better performance. Our method can be applied in clinical applications such as baseline testing, assessing the current state of injury and recovery tracking and industrial applications like monitoring performance deterioration in workplaces.
Collapse
Affiliation(s)
- Mahima Chaudhary
- Lassonde School of Engineering, York University, Toronto, ON, Canada
| | - Meaghan S Adams
- Faculty of Health, York University, Toronto, ON, Canada.,KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | | | - Marin Litoiu
- Lassonde School of Engineering, York University, Toronto, ON, Canada
| | | |
Collapse
|
12
|
Morelli N, Johnson NF, Kaiser K, Andreatta RD, Heebner NR, Hoch MC. Resting state functional connectivity responses post-mild traumatic brain injury: a systematic review. Brain Inj 2021; 35:1326-1337. [PMID: 34487458 DOI: 10.1080/02699052.2021.1972339] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Mild traumatic brain injuries (mTBI) are associated with functional network connectivity alterations throughout recovery. Yet, little is known about the adaptive or maladaptive nature of post-mTBI connectivity and which networks are predisposed to altered function and adaptation. The objective of this review was to determine functional connectivity changes post-mTBI and to determine the adaptive or maladaptive nature of connectivity through direct comparisons of connectivity and behavioral data. Literature was systematically searched and appraised for methodological quality. A total of 16 articles were included for review. There was conflicting evidence of post-mTBI connectivity responses as decreased connectivity was noted in 4 articles, 6 articles reported increased connectivity, 5 reported a mixture of increased and decreased connectivity, while 1 found no differences in connectivity. Supporting evidence for adaptive post-mTBI increases in connectivity were found, particularly in the frontoparietal, cerebellar, and default mode networks. Although initial results are promising, continued longitudinal research that systematically controls for confounding variables and that standardizes methodologies is warranted to adequately understand the neurophysiological recovery trajectory of mTBI.
Collapse
Affiliation(s)
- Nathan Morelli
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA
| | - Nathan F Johnson
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Kimberly Kaiser
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Richard D Andreatta
- Rehabilitation Sciences Doctoral Program, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Nicholas R Heebner
- Sports Medicine Research Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Matthew C Hoch
- Sports Medicine Research Institute, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
13
|
Koerte IK, Esopenko C, Hinds SR, Shenton ME, Bonke EM, Bazarian JJ, Bickart KC, Bigler ED, Bouix S, Buckley TA, Choe MC, Echlin PS, Gill J, Giza CC, Hayes J, Hodges CB, Irimia A, Johnson PK, Kenney K, Levin HS, Lin AP, Lindsey HM, Lipton ML, Max JE, Mayer AR, Meier TB, Merchant-Borna K, Merkley TL, Mills BD, Newsome MR, Porfido T, Stephens JA, Tartaglia MC, Ware AL, Zafonte RD, Zeineh MM, Thompson PM, Tate DF, Dennis EL, Wilde EA, Baron D. The ENIGMA sports injury working group:- an international collaboration to further our understanding of sport-related brain injury. Brain Imaging Behav 2021; 15:576-584. [PMID: 32720179 PMCID: PMC7855299 DOI: 10.1007/s11682-020-00370-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sport-related brain injury is very common, and the potential long-term effects include a wide range of neurological and psychiatric symptoms, and potentially neurodegeneration. Around the globe, researchers are conducting neuroimaging studies on primarily homogenous samples of athletes. However, neuroimaging studies are expensive and time consuming, and thus current findings from studies of sport-related brain injury are often limited by small sample sizes. Further, current studies apply a variety of neuroimaging techniques and analysis tools which limit comparability among studies. The ENIGMA Sports Injury working group aims to provide a platform for data sharing and collaborative data analysis thereby leveraging existing data and expertise. By harmonizing data from a large number of studies from around the globe, we will work towards reproducibility of previously published findings and towards addressing important research questions with regard to diagnosis, prognosis, and efficacy of treatment for sport-related brain injury. Moreover, the ENIGMA Sports Injury working group is committed to providing recommendations for future prospective data acquisition to enhance data quality and scientific rigor.
Collapse
Affiliation(s)
- Inga K Koerte
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität München, Waltherstr. 23, 80337, Munich, Germany.
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Carrie Esopenko
- Department of Rehabilitation and Movement Science, Rutgers Biomedical Health Sciences, Newark, NJ, USA
- School of Graduate Studies, Rutgers Biomedical Health Sciences, Newark, NJ, USA
| | - Sidney R Hinds
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Elena M Bonke
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-Universität München, Waltherstr. 23, 80337, Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University, Munich, Germany
| | - Jeffrey J Bazarian
- Departments of Emergency Medicine & Neurology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Kevin C Bickart
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
- Neurology and Neuropsychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Erin D Bigler
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
| | - Meeryo C Choe
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
- Department of Pediatrics, Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA, USA
| | - Paul S Echlin
- Elliott Sports Medicine Clinic, Burlington, ON, Canada
| | - Jessica Gill
- Department of Intramural Research, National Institutes of Health, Bethesda, MD, USA
| | - Christopher C Giza
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
- Department of Pediatrics, Division of Neurology, UCLA Mattel Children's Hospital, Los Angeles, CA, USA
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jasmeet Hayes
- Psychology Department, The Ohio State University, Columbus, OH, USA
- Chronic Brain Injury Program, The Ohio State University, Columbus, OH, USA
| | - Cooper B Hodges
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Andrei Irimia
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Paula K Johnson
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Kimbra Kenney
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Harvey S Levin
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Alexander P Lin
- Center for Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hannah M Lindsey
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Michael L Lipton
- Departments of Radiology, Psychiatry and Behavioral Sciences and The Dominick P. Purpura Department of Neuroscience, The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Radiology, Montefiore Medicine, Bronx, NY, USA
| | - Jeffrey E Max
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, Rady Children's Hospital, San Diego, CA, USA
| | - Andrew R Mayer
- Mind Research Network, Albuquerque, NM, USA
- Departments of Neurology and Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kian Merchant-Borna
- Departments of Emergency Medicine & Neurology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Tricia L Merkley
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Brian D Mills
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Mary R Newsome
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Tara Porfido
- School of Graduate Studies, Rutgers Biomedical Health Sciences, Newark, NJ, USA
| | - Jaclyn A Stephens
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
| | - Maria Carmela Tartaglia
- Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
| | - Ashley L Ware
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Ross D Zafonte
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
- Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology, USC, Los Angeles, CA, USA
| | - David F Tate
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Emily L Dennis
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - David Baron
- Western University of Health Sciences, Pomona, CA, USA
| |
Collapse
|
14
|
Giudice JS, Alshareef A, Wu T, Gancayco CA, Reynier KA, Tustison NJ, Druzgal TJ, Panzer MB. An Image Registration-Based Morphing Technique for Generating Subject-Specific Brain Finite Element Models. Ann Biomed Eng 2020; 48:2412-2424. [PMID: 32725547 DOI: 10.1007/s10439-020-02584-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/22/2020] [Indexed: 01/10/2023]
Abstract
Finite element (FE) models of the brain are crucial for investigating the mechanisms of traumatic brain injury (TBI). However, FE brain models are often limited to a single neuroanatomy because the manual development of subject-specific models is time consuming. The objective of this study was to develop a pipeline to automatically generate subject-specific FE brain models using previously developed nonlinear image registration techniques, preserving both external and internal neuroanatomical characteristics. To verify the morphing-induced mesh distortions did not influence the brain deformation response, strain distributions predicted using the morphed model were compared to those from manually created voxel models of the same subject. Morphed and voxel models were generated for 44 subjects ranging in age, and simulated using head kinematics from a football concussion case. For each subject, brain strain distributions predicted by each model type were consistent, and differences in strain prediction was less than 4% between model type. This automated technique, taking approximately 2 h to generate a subject-specific model, will facilitate interdisciplinary research between the biomechanics and neuroimaging fields and could enable future use of biomechanical models in the clinical setting as a tool for improving diagnosis.
Collapse
Affiliation(s)
- J Sebastian Giudice
- Department of Mechanical and Aerospace Engineering, Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Dr., Charlottesville, VA, 229011, USA
| | - Ahmed Alshareef
- Department of Mechanical and Aerospace Engineering, Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Dr., Charlottesville, VA, 229011, USA
| | - Taotao Wu
- Department of Mechanical and Aerospace Engineering, Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Dr., Charlottesville, VA, 229011, USA
| | | | - Kristen A Reynier
- Department of Mechanical and Aerospace Engineering, Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Dr., Charlottesville, VA, 229011, USA
| | - Nicholas J Tustison
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - T Jason Druzgal
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Matthew B Panzer
- Department of Mechanical and Aerospace Engineering, Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Dr., Charlottesville, VA, 229011, USA. .,Brain Injury and Sports Concussion Center, University of Virginia, Charlottesville, VA, USA.
| |
Collapse
|
15
|
Adams MS, Niechwiej-Szwedo E, McIlroy WE, Staines WR. A History of Concussion Affects Relevancy-Based Modulation of Cortical Responses to Tactile Stimuli. Front Integr Neurosci 2020; 14:33. [PMID: 32719591 PMCID: PMC7350857 DOI: 10.3389/fnint.2020.00033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/28/2020] [Indexed: 11/13/2022] Open
Abstract
Modulating cortical excitability based on a stimulus’ relevance to the task at hand is a component of sensory gating, and serves to protect higher cortical centers from being overwhelmed with irrelevant information (McIlroy et al., 2003; Kumar et al., 2005; Wasaka et al., 2005). This study examined relevancy-based modulation of cortical excitability, and corresponding behavioral responses, in the face of distracting stimuli in participants with and without a history of concussion (mean age 22 ± 3 SD years; most recent concussion 39.1 ± 30 SD months). Participants were required to make a scaled motor response to the amplitudes of visual and tactile stimuli presented individually or concurrently. Task relevance was manipulated, and stimuli were occasionally presented with irrelevant distractors. Electroencephalography (EEG) and task accuracy data were collected from participants with and without a history of concussion. The somatosensory-evoked N70 event-related potential (ERP) was significantly modulated by task relevance in the control group but not in those with a history of concussion, and there was a significantly greater cost to task accuracy in the concussion history group when relevant stimuli were presented with an irrelevant distractor. This study demonstrated that relevancy-based modulation of electrophysiological responses and behavioral correlates of sensory gating differ in people with and without a history of concussion, even after patients were symptom-free and considered recovered from their injuries.
Collapse
Affiliation(s)
- Meaghan S Adams
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | | | - William E McIlroy
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - William R Staines
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| |
Collapse
|
16
|
Muftuler LT, Meier TB, Keith M, Budde MD, Huber DL, McCrea MA. Serial Diffusion Kurtosis Magnetic Resonance Imaging Study during Acute, Subacute, and Recovery Periods after Sport-Related Concussion. J Neurotrauma 2020; 37:2081-2092. [PMID: 32253977 DOI: 10.1089/neu.2020.6993] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Sport-related concussion (SRC) is common in contact sports, but there remains a lack of reliable, unbiased biomarkers of brain injury and recovery. Although the symptoms of SRC generally resolve over a period of days to weeks, the lack of a biomarker impairs detection and return-to-play decisions. To this date, the pathophysiological recovery profile and relationships between brain changes and symptoms remained unclear. In the current study, diffusion kurtosis imaging (DKI) was used to monitor the effects of SRC on the brain and the trajectory of recovery in concussed American football players (n = 96) at <48 h, and 8, 15, and 45 days post-injury, who were compared with a matched group of uninjured players (n = 82). The concussed group reported significantly higher symptoms within 48 h after injury than controls, which resolved by the 8-day follow-up. The concussed group also demonstrated poorer performance on balance testing at <48 h and 8 days than controls. There were no significant differences between the groups in the Standardized Assessment of Concussion (SAC), a cognitive screening measure. DKI data were acquired with 3 mm isotropic resolution, and analyzed using tract-based spatial statistics (TBSS). Additionally, voxel- and region of interest-based analyses were also conducted. At <48 h, the concussed group showed significantly higher axial kurtosis than the control group. These differences increased in extent and magnitude at 8 days, then receded at 15 days, and returned to the normal levels by 45 days. Kurtosis fractional anisotropy (FA) exhibited a delayed response, with a consistent increase by days 15 and 45. The results indicate that changes detected in the acute period appear to be prolonged compared with clinical recovery, but additional brain changes not observable acutely appear to progress. Although further studies are needed to understand the pathological features of DKI changes after SRC, these findings highlight a potential disparity between clinical symptoms and pathophysiological recovery after SRC.
Collapse
Affiliation(s)
- L Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Monica Keith
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Daniel L Huber
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
17
|
Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Scale-free functional brain dynamics during recovery from sport-related concussion. Hum Brain Mapp 2020; 41:2567-2582. [PMID: 32348019 PMCID: PMC7294069 DOI: 10.1002/hbm.24962] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/06/2020] [Accepted: 02/12/2020] [Indexed: 11/24/2022] Open
Abstract
Studies using blood‐oxygenation‐level‐dependent functional magnetic resonance imaging (BOLD fMRI) have characterized how the resting brain is affected by concussion. The literature to date, however, has largely focused on measuring changes in the spatial organization of functional brain networks. In the present study, changes in the temporal dynamics of BOLD signals are examined throughout concussion recovery using scaling (or fractal) analysis. Imaging data were collected for 228 university‐level athletes, 61 with concussion and 167 athletic controls. Concussed athletes were scanned at the acute phase of injury (1–7 days postinjury), the subacute phase (8–14 days postinjury), medical clearance to return to sport (RTS), 1 month post‐RTS and 1 year post‐RTS. The wavelet leader multifractal approach was used to assess scaling (c1) and multifractal (c2) behavior. Significant longitudinal changes were identified for c1, which was lowest at acute injury, became significantly elevated at RTS, and returned near control levels by 1 year post‐RTS. No longitudinal changes were identified for c2. Secondary analyses showed that clinical measures of acute symptom severity and time to RTP were related to longitudinal changes in c1. Athletes with both higher symptoms and prolonged recovery had elevated c1 values at RTS, while athletes with higher symptoms but rapid recovery had reduced c1 at acute injury. This study provides the first evidence for long‐term recovery of BOLD scale‐free brain dynamics after a concussion.
Collapse
Affiliation(s)
- Nathan W Churchill
- Neuroscience Research Program, St. Michael's Hospital, Toronto, Canada.,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada
| | - Michael G Hutchison
- Neuroscience Research Program, St. Michael's Hospital, Toronto, Canada.,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Simon J Graham
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada.,Department of Medical Biophysics, University of Toronto Faculty of Medicine, Toronto, Canada
| | - Tom A Schweizer
- Neuroscience Research Program, St. Michael's Hospital, Toronto, Canada.,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada.,Faculty of Medicine (Neurosurgery), University of Toronto, Toronto, Canada
| |
Collapse
|
18
|
Pagani LS, Ellemberg D, Moore RD. Clinically Historical and Prospective Associations Between Learning Disorders and Concussion in Young Adult Athletes. Am J Lifestyle Med 2020; 14:187-193. [PMID: 32231484 PMCID: PMC7092401 DOI: 10.1177/1559827618793350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/17/2018] [Accepted: 07/18/2018] [Indexed: 11/16/2022] Open
Abstract
Background. Athletes with specific learning disorder (LD) tend to score lower on neuropsychological tests and are at increased risk of personal injury than their counterparts without such disorders. Using a retrospective historical and prospective design, we examined whether adult athletes with LD, the most prevalent of neurodevelopmental disorders, experience greater chances of past and future concussions than their counterparts without LD. We expected to find that young athletes with LD would show greater risk of past (historical) and future (prospective) cerebral concussions. Methods. Participants (95 men and 53 women aged 18 to 25 years) were recruited from university sports teams and followed during an entire season. Of these, 38 participants had a history of LD and 101 had a history of at least 1 concussion (72 males, 29 females) at the preseason baseline. One-third experienced a new concussion. Data analytic procedures include inferential cross-tabulations. Results. Athletes with LD were twice more likely to have a concussion history at baseline and to have a history of multiple concussions than athletes without LD; 95% CI = [0.86, 4.92] and [0.77, 3.40], respectively. Athletes with LD were twice more likely to incur a new concussion than those without LD; 95% CI = [0.86, 4.92]. Conclusions. Adult athletes with LD experience greater chances of previous and future concussions compared with counterparts without LD. Preventive practices regarding individuals with neurodevelopmental disorders may not only prevent the biopsychosocial consequences of brain trauma for the individual, but also represent a cost-effective public health measure.
Collapse
Affiliation(s)
- Linda S. Pagani
- Linda S. Pagani, PhD, School of
Psycho-Education, Université de Montréal, CP 6128, succursale Centre-ville,
Montréal, QC H3C 3J7, Canada; e-mail:
| | - Dave Ellemberg
- École de psychoéducation, Université de Montréal,
Canada (LSP)
- Sainte-Justine’s Hospital Research Center (Brain
Diseases Division), Université de Montréal, Canada (LSP, DE)
- Laboratoire de la neuropsychologie du sport et du
développement, Université de Montréal, Canada (DE)
- Arnold School of Public Health, University of South
Carolina, Columbia, North Carolina (RDM)
| | - Robert Davis Moore
- École de psychoéducation, Université de Montréal,
Canada (LSP)
- Sainte-Justine’s Hospital Research Center (Brain
Diseases Division), Université de Montréal, Canada (LSP, DE)
- Laboratoire de la neuropsychologie du sport et du
développement, Université de Montréal, Canada (DE)
- Arnold School of Public Health, University of South
Carolina, Columbia, North Carolina (RDM)
| |
Collapse
|
19
|
Wang Y, Nencka AS, Meier TB, Guskiewicz K, Mihalik JP, Alison Brooks M, Saykin AJ, Koch KM, Wu YC, Nelson LD, McAllister TW, Broglio SP, McCrea MA. Cerebral blood flow in acute concussion: preliminary ASL findings from the NCAA-DoD CARE consortium. Brain Imaging Behav 2020; 13:1375-1385. [PMID: 30159767 DOI: 10.1007/s11682-018-9946-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sport-related concussion (SRC) has become a major health problem, affecting millions of athletes each year. Despite the increasing occurrence and prevalence of SRC, its underlying mechanism and recovery course have yet to be fully elucidated. The National Collegiate Athletic Association-Department of Defense Grand Alliance: Concussion Assessment, Research and Education (CARE) Consortium is a large-scale, multisite study of the natural history of concussion across multiple sports. The Advanced Research Core (ARC) of CARE is focused on the advanced biomarker assessment of a reduced subject cohort. This paper reports findings from two ARC sites to evaluate cerebral blood flow (CBF) changes in acute SRC, as measured using advanced arterial spin labeling (ASL) magnetic resonance imaging (MRI). We compared relative CBF maps assessed in 24 concussed contact sport athletes obtained at 24-48 h after injury to those of a control group of 24 matched contact sport players. Significantly less CBF was detected in several brain regions in concussed athletes, while clinical assessments also indicated clinical symptom and performance impairments in SRC patients. Correlations were found between decreased CBF in acute SRC and clinical assessments, including Balance Error Scoring System total score and Immediate Post-Concussion Assessment and Cognitive Test memory composite and impulse control composite scores, as well as days from injury to asymptomatic. Although using different ASL MRI sequences, our preliminary results from two sites are consistent with previous reports and suggest that advanced ASL MRI methods might be useful for detecting acute neurobiological changes in acute SRC.
Collapse
Affiliation(s)
- Yang Wang
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Andrew S Nencka
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
| | - Kevin Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina, 250 East Franklin Street, Chapel Hill, NC, USA
| | - Jason P Mihalik
- Department of Exercise and Sport Science, University of North Carolina, 250 East Franklin Street, Chapel Hill, NC, USA
| | - M Alison Brooks
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Science, Indiana University School of Medicine, 340 West 10th Street, Indianapolis, IN, USA
| | - Kevin M Koch
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Yu-Chien Wu
- Department of Radiology and Imaging Science, Indiana University School of Medicine, 340 West 10th Street, Indianapolis, IN, USA
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, 340 West 10th Street, Indianapolis, IN, USA
| | - Steven P Broglio
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
| |
Collapse
|
20
|
Tate DF, Wilde EA, York GE, Bigler ED. Neuroimaging in Traumatic Brain Injury Rehabilitation. Concussion 2020. [DOI: 10.1016/b978-0-323-65384-8.00003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
21
|
Abstract
Concussion is an ongoing concern for health care providers. The incidence rates continue to be high and the rate of recovery is variable due to potential risk factors. With no valid biomarkers, diagnosis and assessment of concussion remain a clinical challenge. The heterogeneity in presentation following injury provides an additional level of complexity, requiring the screening and evaluation of diverse body systems, including oculomotor, vestibular, autonomic, psychiatric, cervical, and cognitive symptoms. While a few tools, such as the Vestibular/Ocular Motor Screening and Balance Error Scoring System, have been developed specifically for concussion, the vast majority of tests are adapted from other conditions. Further complicating the process is the overlapping and interactive nature of the multiple domains of postconcussion presentation. This commentary illustrates how clinicians can conceptualize the multiple profiles that present following concussion and describes tools that are available to assist with screening and evaluation of each area. The multifaceted nature of concussion warrants broad clinical screening skills and an interdisciplinary approach to management. J Orthop Sports Phys Ther 2019;49(11):787-798. doi:10.2519/jospt.2019.8855.
Collapse
|
22
|
Atlan LS, Margulies SS. Frequency-Dependent Changes in Resting State Electroencephalogram Functional Networks after Traumatic Brain Injury in Piglets. J Neurotrauma 2019; 36:2558-2578. [PMID: 30909806 PMCID: PMC6709726 DOI: 10.1089/neu.2017.5574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Traumatic brain injury (TBI) is a major health concern in children, as it can cause chronic cognitive and behavioral deficits. The lack of objective involuntary metrics for the diagnosis of TBI makes prognosis more challenging, especially in the pediatric context, in which children are often unable to articulate their symptoms. Resting state electroencephalograms (EEG), which are inexpensive and non-invasive, and do not require subjects to perform cognitive tasks, have not yet been used to create functional brain networks in relation to TBI in children or non-human animals; here we report the first such study. We recorded resting state EEG in awake piglets before and after TBI, from which we generated EEG functional networks from the alpha (8-12 Hz), beta (16.5-25 Hz), broad (1-35 Hz), delta (1-3.5 Hz), gamma (30-35 Hz), sigma (13-16 Hz), and theta (4-7.5 Hz) frequency bands. We hypothesize that mild TBI will induce persistent frequency-dependent changes in the 4-week-old piglet at acute and chronic time points. Hyperconnectivity was found in several frequency band networks after TBI. This study serves as proof of concept that the study of EEG functional networks in awake piglets may be useful for the development of diagnostic metrics for TBI in children.
Collapse
Affiliation(s)
- Lorre S. Atlan
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan S. Margulies
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
23
|
Dalecki M, Gorbet DJ, Macpherson A, Sergio LE. Sport experience is correlated with complex motor skill recovery in youth following concussion. Eur J Sport Sci 2019; 19:1257-1266. [DOI: 10.1080/17461391.2019.1584249] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Marc Dalecki
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA
| | - Diana J. Gorbet
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
- Centre for Vision Research, York University, Toronto, ON, Canada
| | - Alison Macpherson
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Lauren E. Sergio
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
- Centre for Vision Research, York University, Toronto, ON, Canada
| |
Collapse
|
24
|
McKeithan L, Hibshman N, Yengo-Kahn AM, Solomon GS, Zuckerman SL. Sport-Related Concussion: Evaluation, Treatment, and Future Directions. Med Sci (Basel) 2019; 7:medsci7030044. [PMID: 30884753 PMCID: PMC6473667 DOI: 10.3390/medsci7030044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 01/16/2023] Open
Abstract
Sport-related concussion (SRC) is a highly prevalent injury predominantly affecting millions of youth through high school athletes every year. In recent years, SRC has received a significant amount of attention due to potential for long-term neurologic sequelae. However, the acute symptoms and possibility of prolonged recovery account for the vast majority of morbidity from SRC. Modifying factors have been identified and may allow for improved prediction of a protracted course. Potential novel modifying factors may include genetic determinants of recovery, as well as radiographic biomarkers, which represent burgeoning subfields in SRC research. Helmet design and understanding the biomechanical stressors on the brain that lead to concussion also represent active areas of research. This narrative review provides a general synopsis of SRC, including relevant definitions, current treatment paradigms, and modifying factors for recovery, in addition to novel areas of research and future directions for SRC research.
Collapse
Affiliation(s)
- Lydia McKeithan
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
| | - Natalie Hibshman
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Gary S Solomon
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| |
Collapse
|
25
|
Jeong E, Ryu H, Shin JH, Kwon GH, Jo G, Lee JY. High Oxygen Exchange to Music Indicates Auditory Distractibility in Acquired Brain Injury: An fNIRS Study with a Vector-Based Phase Analysis. Sci Rep 2018; 8:16737. [PMID: 30425287 PMCID: PMC6233191 DOI: 10.1038/s41598-018-35172-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/31/2018] [Indexed: 01/30/2023] Open
Abstract
Attention deficits due to auditory distractibility are pervasive among patients with acquired brain injury (ABI). It remains unclear, however, whether attention deficits following ABI specific to auditory modality are associated with altered haemodynamic responses. Here, we examined cerebral haemodynamic changes using functional near-infrared spectroscopy combined with a topological vector-based analysis method. A total of thirty-seven participants (22 healthy adults, 15 patients with ABI) performed a melodic contour identification task (CIT) that simulates auditory distractibility. Findings demonstrated that the melodic CIT was able to detect auditory distractibility in patients with ABI. The rate-corrected score showed that the ABI group performed significantly worse than the non-ABI group in both CIT1 (target contour identification against environmental sounds) and CIT2 (target contour identification against target-like distraction). Phase-associated response intensity during the CITs was greater in the ABI group than in the non-ABI group. Moreover, there existed a significant interaction effect in the left dorsolateral prefrontal cortex (DLPFC) during CIT1 and CIT2. These findings indicated that stronger hemodynamic responses involving oxygen exchange in the left DLPFC can serve as a biomarker for evaluating and monitoring auditory distractibility, which could potentially lead to the discovery of the underlying mechanism that causes auditory attention deficits in patients with ABI.
Collapse
Affiliation(s)
- Eunju Jeong
- Department of Arts and Technology, Hanyang University, Seoul, 04763, Republic of Korea.
- Division of Industrial Information Studies, Hanyang University, Seoul, 04763, Republic of Korea.
| | - Hokyoung Ryu
- Department of Arts and Technology, Hanyang University, Seoul, 04763, Republic of Korea
- Graduate School of Technology and Innovation Management, Hanyang University, Seoul, 04763, Republic of Korea
| | - Joon-Ho Shin
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, 01022, Republic of Korea
| | - Gyu Hyun Kwon
- Department of Arts and Technology, Hanyang University, Seoul, 04763, Republic of Korea
- Graduate School of Technology and Innovation Management, Hanyang University, Seoul, 04763, Republic of Korea
| | - Geonsang Jo
- Department of Arts and Technology, Hanyang University, Seoul, 04763, Republic of Korea
| | - Ji-Yeong Lee
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, 01022, Republic of Korea
| |
Collapse
|
26
|
The long-term outcomes of sport-related concussion in pediatric populations. Int J Psychophysiol 2018; 132:14-24. [DOI: 10.1016/j.ijpsycho.2018.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/08/2018] [Accepted: 04/04/2018] [Indexed: 12/14/2022]
|
27
|
Kenzie ES, Parks EL, Bigler ED, Wright DW, Lim MM, Chesnutt JC, Hawryluk GWJ, Gordon W, Wakeland W. The Dynamics of Concussion: Mapping Pathophysiology, Persistence, and Recovery With Causal-Loop Diagramming. Front Neurol 2018; 9:203. [PMID: 29670568 PMCID: PMC5893805 DOI: 10.3389/fneur.2018.00203] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/14/2018] [Indexed: 12/21/2022] Open
Abstract
Despite increasing public awareness and a growing body of literature on the subject of concussion, or mild traumatic brain injury, an urgent need still exists for reliable diagnostic measures, clinical care guidelines, and effective treatments for the condition. Complexity and heterogeneity complicate research efforts and indicate the need for innovative approaches to synthesize current knowledge in order to improve clinical outcomes. Methods from the interdisciplinary field of systems science, including models of complex systems, have been increasingly applied to biomedical applications and show promise for generating insight for traumatic brain injury. The current study uses causal-loop diagramming to visualize relationships between factors influencing the pathophysiology and recovery trajectories of concussive injury, including persistence of symptoms and deficits. The primary output is a series of preliminary systems maps detailing feedback loops, intrinsic dynamics, exogenous drivers, and hubs across several scales, from micro-level cellular processes to social influences. Key system features, such as the role of specific restorative feedback processes and cross-scale connections, are examined and discussed in the context of recovery trajectories. This systems approach integrates research findings across disciplines and allows components to be considered in relation to larger system influences, which enables the identification of research gaps, supports classification efforts, and provides a framework for interdisciplinary collaboration and communication-all strides that would benefit diagnosis, prognosis, and treatment in the clinic.
Collapse
Affiliation(s)
- Erin S. Kenzie
- Systems Science Program, Portland State University, Portland, OR, United States
| | - Elle L. Parks
- Systems Science Program, Portland State University, Portland, OR, United States
| | - Erin D. Bigler
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, United States
| | - David W. Wright
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Miranda M. Lim
- Sleep Disorders Clinic, Division of Hospital and Specialty Medicine, Research Service, VA Portland Health Care System, Portland, OR, United States
- Departments of Neurology, Medicine, and Behavioral Neuroscience, Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
| | - James C. Chesnutt
- TBI/Concussion Program, Orthopedics & Rehabilitation, Neurology and Family Medicine, Oregon Health & Science University, Portland, OR, United States
| | | | - Wayne Gordon
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Wayne Wakeland
- Systems Science Program, Portland State University, Portland, OR, United States
| |
Collapse
|
28
|
Churchill NW, Hutchison MG, Graham SJ, Schweizer TA. Connectomic markers of symptom severity in sport-related concussion: Whole-brain analysis of resting-state fMRI. NEUROIMAGE-CLINICAL 2018; 18:518-526. [PMID: 29560308 PMCID: PMC5857899 DOI: 10.1016/j.nicl.2018.02.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/22/2018] [Accepted: 02/07/2018] [Indexed: 12/15/2022]
Abstract
Concussion is associated with significant adverse effects within the first week post-injury, including physical complaints and altered cognition, sleep and mood. It is currently unknown whether these subjective disturbances have reliable functional brain correlates. Resting-state functional magnetic resonance imaging (rs-fMRI) has been used to measure functional connectivity of individuals after traumatic brain injury, but less is known about the relationship between functional connectivity and symptom assessments after a sport concussion. In this study, rs-fMRI was used to evaluate whole-brain functional connectivity for seventy (70) university-level athletes, including 35 with acute concussion and 35 healthy matched controls. Univariate analyses showed that greater symptom severity was mainly associated with lower pairwise connectivity in frontal, temporal and insular regions, along with higher connectivity in a sparser set of cerebellar regions. A novel multivariate approach also extracted two components that showed reliable covariation with symptom severity: (1) a network of frontal, temporal and insular regions where connectivity was negatively correlated with symptom severity (replicating the univariate findings); and (2) a network with anti-correlated elements of the default-mode network and sensorimotor system, where connectivity was positively correlated with symptom severity. These findings support the presence of connectomic signatures of symptom complaints following a sport-related concussion, including both increased and decreased functional connectivity within distinct functional brain networks. Analyzed relationship between resting brain function and symptoms of concussion Whole-brain analysis, using both univariate and multivariate methods Symptoms associated with lower connectivity for frontal/temporal/insular network Symptoms associated with higher connectivity for default-mode/sensorimotor network
Collapse
Affiliation(s)
- Nathan W Churchill
- Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Neuroscience Research Program, St. Michael's Hospital, Toronto, ON, Canada.
| | - Michael G Hutchison
- Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Neuroscience Research Program, St. Michael's Hospital, Toronto, ON, Canada; Faculty of Kinesiology and Physical Education, University of Toronto, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tom A Schweizer
- Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Neuroscience Research Program, St. Michael's Hospital, Toronto, ON, Canada; Faculty of Medicine (Neurosurgery), University of Toronto, Toronto, ON, Canada; The Institute of Biomaterials & Biomedical Engineering (IBBME) at the University of Toronto, Toronto, ON, Canada
| |
Collapse
|
29
|
Olson RL, Brush CJ, Ehmann PJ, Buckman JF, Alderman BL. A history of sport-related concussion is associated with sustained deficits in conflict and error monitoring. Int J Psychophysiol 2018; 132:145-154. [PMID: 29355581 DOI: 10.1016/j.ijpsycho.2018.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 11/19/2017] [Accepted: 01/11/2018] [Indexed: 12/22/2022]
Abstract
Previous research has demonstrated long-term deficits in neurocognitive function in individuals with a history of sport-related concussion. The purpose of this study was to examine the relationship between a history of concussion and behavioral and event-related potential (ERP) indices of pre- and post-response conflict and error monitoring. A secondary aim was to determine whether years of high risk sport participation were related to impairments in these cognitive control processes. Forty-seven former athletes (age = 20.8 ± 2.2 years) with (n = 25; 5 females) and without (n = 22; 9 females) a history of concussion completed a modified flanker task while behavioral performance, N2, error-related negativity (ERN), and error positivity (Pe) components were assessed. An increase in post-response error-related (ERN) brain activity and a nonsignificant trend of increased pre-response conflict (N2) was observed in individuals with a prior sport-related concussion relative to non-concussed controls; however, no behavioral performance differences were found between groups. No significant associations were found between ERP and behavioral measures and the number of years of high-risk sport participation; however, time since last head injury was associated with shorter N2 latency. Together, these findings suggest a persistent impairment in cognitive control and error-related processing in individuals with a history of concussion. These findings are interpreted within the framework of the compensatory error-monitoring hypothesis.
Collapse
Affiliation(s)
- Ryan L Olson
- Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, TX, USA
| | - Christopher J Brush
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Peter J Ehmann
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Jennifer F Buckman
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Brandon L Alderman
- Department of Kinesiology and Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.
| |
Collapse
|
30
|
Petley L, Bardouille T, Chiasson D, Froese P, Patterson S, Newman A, Omisade A, Beyea S. Attentional dysfunction and recovery in concussion: effects on the P300m and contingent magnetic variation. Brain Inj 2018; 32:464-473. [DOI: 10.1080/02699052.2018.1429022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Lauren Petley
- Biomedical Translational Imaging Centre (BIOTIC), IWK Health Centre, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Tim Bardouille
- Biomedical Translational Imaging Centre (BIOTIC), IWK Health Centre, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Darrell Chiasson
- Nova Scotia Health Authority, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Patrick Froese
- Nova Scotia Health Authority, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | - Aaron Newman
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Antonina Omisade
- Nova Scotia Health Authority, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Steven Beyea
- Biomedical Translational Imaging Centre (BIOTIC), IWK Health Centre, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| |
Collapse
|
31
|
Lancaster MA, Olson DV, McCrea MA, Nelson LD, LaRoche AA, Muftuler LT. Acute white matter changes following sport-related concussion: A serial diffusion tensor and diffusion kurtosis tensor imaging study. Hum Brain Mapp 2018; 37:3821-3834. [PMID: 27237455 DOI: 10.1002/hbm.23278] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/05/2016] [Accepted: 05/23/2016] [Indexed: 01/23/2023] Open
Abstract
Recent neuroimaging studies have suggested that following sport-related concussion (SRC) physiological brain alterations may persist after an athlete has shown full symptom recovery. Diffusion MRI is a versatile technique to study white matter injury following SRC, yet serial follow-up studies in the very acute stages following SRC utilizing a comprehensive set of diffusion metrics are lacking. The aim of the current study was to characterize white matter changes within 24 hours of concussion in a group of high school and collegiate athletes, using Diffusion Tensor and Diffusion Kurtosis Tensor metrics. Participants were reassessed a week later. At 24 hours post-injury, the concussed group reported significantly more concussion symptoms than a well-matched control group and demonstrated poorer performance on a cognitive screening measure, yet these differences were nonsignificant at the 8-day follow-up. Similarly, within 24-hours after injury, the concussed group exhibited a widespread decrease in mean diffusivity, increased axial kurtosis and, to a lesser extent, decreased axial and radial diffusivities compared with control subjects. At 8 days post injury, the differences in these diffusion metrics were even more widespread in the injured athletes, despite improvement of symptoms and cognitive performance. These MRI findings suggest that the athletes might not have reached full physiological recovery a week after the injury. These findings have significant implications for the management of SRC because allowing an athlete to return to play before the brain has fully recovered from injury may have negative consequences. Hum Brain Mapp 37:3821-3834, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Melissa A Lancaster
- Department of Neurology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226.,Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - Daniel V Olson
- Department of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - Michael A McCrea
- Department of Neurology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226.,Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - Lindsay D Nelson
- Department of Neurology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226.,Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - Ashley A LaRoche
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226
| | - L Tugan Muftuler
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226.
| |
Collapse
|
32
|
Bishop SA, Dech RT, Guzik P, Neary JP. Heart rate variability and implication for sport concussion. Clin Physiol Funct Imaging 2017; 38:733-742. [PMID: 29144026 DOI: 10.1111/cpf.12487] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 10/19/2017] [Indexed: 12/12/2022]
Abstract
Finding sensitive and specific markers for sports-related concussion is both challenging and clinically important. Such biomarkers might be helpful in the management of patients with concussion (i.e. diagnosis, monitoring and risk prediction). Among many parameters, blood flow-pressure metrics and heart rate variability (HRV) have been used to gauge concussion outcomes. Reports on the relation between HRV and both acute and prolonged concussion recovery are conflicting. While some authors report on differences in the low-frequency (LF) component of HRV during postural manipulations and postexercise conditions, others observe no significant differences in various HRV measures. Despite the early success of using the HRV LF for concussion recovery, the interpretation of the LF is debated. Recent research suggests the LF power is a net effect of several intrinsic modulatory factors from both sympathetic and parasympathetic branches of the autonomic nervous system, vagally mediated baroreflex and even some respiratory influences at lower respiratory rate. There are only a few well-controlled concussion studies that specifically examine the contribution of the autonomic nervous system branches with HRV for concussion management. This study reviews the most recent HRV- concussion literature and the underlying HRV physiology. It also highlights cerebral blood flow studies related to concussion and the importance of multimodal assessment of various biological signals. It is hoped that a better understanding of the physiology behind HRV might generate cost-effective, repeatable and reliable protocols, all of which will improve the interpretation of HRV throughout concussion recovery.
Collapse
Affiliation(s)
- Scott A Bishop
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - Ryan T Dech
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - Przemyslaw Guzik
- Department of Cardiology-Intensive Care Therapy & Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - J Patrick Neary
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| |
Collapse
|
33
|
Neuroimaging of sport concussion: persistent alterations in brain structure and function at medical clearance. Sci Rep 2017; 7:8297. [PMID: 28839132 PMCID: PMC5571165 DOI: 10.1038/s41598-017-07742-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/29/2017] [Indexed: 12/27/2022] Open
Abstract
The medical decision of return to play (RTP) after a sport concussion is largely based on symptom status following a graded exercise protocol. However, it is currently unknown how objective markers of brain structure and function relate to clinical recovery. The goal of this study was to determine whether differences in brain structure and function at acute injury remain present at RTP. In this longitudinal study, 54 active varsity athletes were scanned using magnetic resonance imaging (MRI), including 27 with recent concussion, imaged at both acute injury and medical clearance, along with 27 matched controls. Diffusion tensor imaging was used to measure fractional anisotropy (FA) and mean diffusivity (MD) of white matter and resting-state functional MRI was used to measure global functional connectivity (Gconn). At acute injury, concussed athletes had reduced FA and increased MD, along with elevated Gconn; these effects remained present at RTP. Athletes who took longer to reach RTP also showed elevated Gconn in dorsal brain regions, but no significant white matter effects. This study presents the first evidence of altered brain structure and function at the time of medical clearance to RTP, with greater changes in brain function for athletes with a longer recovery time.
Collapse
|
34
|
Bishop SA, Neary JP. Assessing prefrontal cortex oxygenation after sport concussion with near-infrared spectroscopy. Clin Physiol Funct Imaging 2017. [DOI: 10.1111/cpf.12447] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Scott A. Bishop
- Faculty of Kinesiology and Health Studies; University of Regina; Regina SK Canada
| | - J. Patrick Neary
- Faculty of Kinesiology and Health Studies; University of Regina; Regina SK Canada
| |
Collapse
|
35
|
Churchill NW, Hutchison MG, Richards D, Leung G, Graham SJ, Schweizer TA. The first week after concussion: Blood flow, brain function and white matter microstructure. NEUROIMAGE-CLINICAL 2017; 14:480-489. [PMID: 28280686 PMCID: PMC5334547 DOI: 10.1016/j.nicl.2017.02.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/25/2017] [Accepted: 02/18/2017] [Indexed: 01/22/2023]
Abstract
Concussion is a major health concern, associated with short-term deficits in physical function, emotion and cognition, along with negative long-term health outcomes. However, we remain in the early stages of characterizing MRI markers of concussion, particularly during the first week post-injury when symptoms are most severe. In this study, 52 varsity athletes were scanned using Magnetic Resonance Imaging (MRI), including 26 athletes with acute concussion (scanned 1–7 days post-injury) and 26 matched control athletes. A comprehensive set of functional and structural MRI measures were analyzed, including cerebral blood flow (CBF) and global functional connectivity (Gconn) of grey matter, along with fractional anisotropy (FA) and mean diffusivity (MD) of white matter. An analysis comparing acutely concussed athletes and controls showed limited evidence for reliable mean effects of acute concussion, with only MD showing spatially extensive differences between groups. We subsequently demonstrated that the number of days post-injury explained a significant proportion of inter-subject variability in MRI markers of acutely concussed athletes. Athletes scanned at early acute injury (1–3 days) had elevated CBF and Gconn and reduced FA, but those scanned at late acute injury (5–7 days) had the opposite response. In contrast, MD showed a more complex, spatially-dependent relationship with days post-injury. These novel findings highlight the variability of MRI markers during the acute phase of concussion and the critical importance of considering the acute injury time interval, which has significant implications for studies relating acute MRI data to concussion outcomes. First study of acute concussion using fMRI, DTI and ASL in a single cohort Lack of reliable mean effects of concussion, indicating variability of acute injury Number of days post-injury is a significant predictor of acute brain variability.
Collapse
Affiliation(s)
- Nathan W Churchill
- The Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1M8, Canada
| | - Michael G Hutchison
- The Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1M8, Canada; Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON M5S 2W6, Canada
| | - Doug Richards
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON M5S 2W6, Canada
| | - General Leung
- The Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1M8, Canada; Department of Medical Imaging, University of Toronto, Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1M8, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Sunnybrook Hospital, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Tom A Schweizer
- The Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1M8, Canada; Faculty of Medicine (Neurosurgery), University of Toronto, Toronto, Ontario, Canada; Institute of Biomaterals and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
36
|
Churchill N, Hutchison M, Richards D, Leung G, Graham S, Schweizer TA. Brain Structure and Function Associated with a History of Sport Concussion: A Multi-Modal Magnetic Resonance Imaging Study. J Neurotrauma 2017; 34:765-771. [DOI: 10.1089/neu.2016.4531] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Nathan Churchill
- Keenan Research Centre of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Doug Richards
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - General Leung
- Keenan Research Centre of St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Simon Graham
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Tom A. Schweizer
- Keenan Research Centre of St. Michael's Hospital, Toronto, Ontario, Canada
- Faculty of Medicine (Neurosurgery), University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterals and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
37
|
Reches A, Kutcher J, Elbin RJ, Or-Ly H, Sadeh B, Greer J, McAllister DJ, Geva A, Kontos AP. Preliminary investigation of Brain Network Activation (BNA) and its clinical utility in sport-related concussion. Brain Inj 2017; 31:237-246. [PMID: 28055228 PMCID: PMC5351793 DOI: 10.1080/02699052.2016.1231343] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: The clinical diagnosis and management of patients with sport-related concussion is largely dependent on subjectively reported symptoms, clinical examinations, cognitive, balance, vestibular and oculomotor testing. Consequently, there is an unmet need for objective assessment tools that can identify the injury from a physiological perspective and add an important layer of information to the clinician’s decision-making process. Objective: The goal of the study was to evaluate the clinical utility of the EEG-based tool named Brain Network Activation (BNA) as a longitudinal assessment method of brain function in the management of young athletes with concussion. Methods: Athletes with concussion (n = 86) and age-matched controls (n = 81) were evaluated at four time points with symptom questionnaires and BNA. BNA scores were calculated by comparing functional networks to a previously defined normative reference brain network model to the same cognitive task. Results: Subjects above 16 years of age exhibited a significant decrease in BNA scores immediately following injury, as well as notable changes in functional network activity, relative to the controls. Three representative case studies of the tested population are discussed in detail, to demonstrate the clinical utility of BNA. Conclusion: The data support the utility of BNA to augment clinical examinations, symptoms and additional tests by providing an effective method for evaluating objective electrophysiological changes associated with sport-related concussions.
Collapse
Affiliation(s)
- A Reches
- a ElMindA Ltd , Herzliya , Israel
| | - J Kutcher
- b The Sports Neurology Clinic , University of Michigan , Ann Arbor , MI , USA
| | - R J Elbin
- c Department of Health, Human Performance and Recreation , University of Arkansas , Fayetteville , AR , USA
| | - H Or-Ly
- a ElMindA Ltd , Herzliya , Israel
| | - B Sadeh
- a ElMindA Ltd , Herzliya , Israel
| | - J Greer
- b The Sports Neurology Clinic , University of Michigan , Ann Arbor , MI , USA
| | - D J McAllister
- d UPMC Sports Medicine Concussion Program, Department of Orthopaedic Surgery , University of Pittsburgh , Pittsburgh , PA , USA
| | - A Geva
- a ElMindA Ltd , Herzliya , Israel
| | - A P Kontos
- d UPMC Sports Medicine Concussion Program, Department of Orthopaedic Surgery , University of Pittsburgh , Pittsburgh , PA , USA
| |
Collapse
|
38
|
Hurtubise J, Gorbet D, Hamandi Y, Macpherson A, Sergio L. The effect of concussion history on cognitive-motor integration in elite hockey players. Concussion 2016; 1:CNC17. [PMID: 30202559 PMCID: PMC6093836 DOI: 10.2217/cnc-2016-0006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/03/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To observe the effects of concussion history on cognitive-motor integration in elite-level athletes. METHODS The study included 102 National Hockey League draft prospects (n = 51 concussion history [CH]; n = 51 no history [NC]). Participants completed two computer-based visuomotor tasks, one involved 'standard' visuomotor mapping and one involved 'nonstandard' mapping in which vision and action were decoupled. RESULTS We observed a significant effect of group on reaction time (CH slower) and accuracy (CH worse), but a group by condition interaction only for reaction time (p < 0.05). There were no other deficits found. We discussed these findings in comparison to our previous work with non-elite athletes. CONCLUSION Previously concussed elite-level athletes may have lingering neurological deficits that are not detected using standard clinical assessments.
Collapse
Affiliation(s)
- Johanna Hurtubise
- School of Kinesiology & Health Science, York University, Toronto, ON, M3J 1P3, Canada
- York University Sports Medicine Team, York University Department of Athletics and Recreation, York University, Toronto, ON, M3J 1P3, Canada
| | - Diana Gorbet
- School of Kinesiology & Health Science, York University, Toronto, ON, M3J 1P3, Canada
- Center for Vision Research, York University, Toronto, ON, M3J 1P3, Canada
| | - Yehyah Hamandi
- School of Kinesiology & Health Science, York University, Toronto, ON, M3J 1P3, Canada
| | - Alison Macpherson
- School of Kinesiology & Health Science, York University, Toronto, ON, M3J 1P3, Canada
- York University Sports Medicine Team, York University Department of Athletics and Recreation, York University, Toronto, ON, M3J 1P3, Canada
| | - Lauren Sergio
- School of Kinesiology & Health Science, York University, Toronto, ON, M3J 1P3, Canada
- York University Sports Medicine Team, York University Department of Athletics and Recreation, York University, Toronto, ON, M3J 1P3, Canada
- Center for Vision Research, York University, Toronto, ON, M3J 1P3, Canada
| |
Collapse
|
39
|
Naeser MA, Martin PI, Ho MD, Krengel MH, Bogdanova Y, Knight JA, Yee MK, Zafonte R, Frazier J, Hamblin MR, Koo BB. Transcranial, Red/Near-Infrared Light-Emitting Diode Therapy to Improve Cognition in Chronic Traumatic Brain Injury. Photomed Laser Surg 2016; 34:610-626. [DOI: 10.1089/pho.2015.4037] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Margaret A. Naeser
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Paula I. Martin
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Michael D. Ho
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Maxine H. Krengel
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Yelena Bogdanova
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Jeffrey A. Knight
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Behavioral Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
| | - Megan K. Yee
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Judith Frazier
- TBI Research Program, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Michael R. Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts
| | - Bang-Bon Koo
- Boston University Center for Biomedical Imaging, Boston, Massachusetts
| |
Collapse
|
40
|
Churchill N, Hutchison MG, Leung G, Graham S, Schweizer TA. Changes in functional connectivity of the brain associated with a history of sport concussion: A preliminary investigation. Brain Inj 2016; 31:39-48. [DOI: 10.1080/02699052.2016.1221135] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nathan Churchill
- Neuroscience Research Program, St. Michael’s Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, St Michael’s Hospital, Toronto, ON, Canada
| | - Michael G. Hutchison
- Keenan Research Centre for Biomedical Science, St Michael’s Hospital, Toronto, ON, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - General Leung
- Keenan Research Centre for Biomedical Science, St Michael’s Hospital, Toronto, ON, Canada
- Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Simon Graham
- Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Sunnybrook Hospital, Toronto, ON, Canada
| | - Tom A. Schweizer
- Neuroscience Research Program, St. Michael’s Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, St Michael’s Hospital, Toronto, ON, Canada
- Faculty of Medicine (Neurosurgery), University of Toronto, Toronto, ON, Canada
| |
Collapse
|
41
|
Chen C, Zhou C, Cavanaugh JM, Kallakuri S, Desai A, Zhang L, King AI. Quantitative electroencephalography in a swine model of blast-induced brain injury. Brain Inj 2016; 31:120-126. [PMID: 27830938 DOI: 10.1080/02699052.2016.1216603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Electroencephalography (EEG) was used to examine brain activity abnormalities earlier after blast exposure using a swine model to develop a qEEG data analysis protocol. METHODS Anaesthetized swine were exposed to 420-450 Kpa blast overpressure and survived for 3 days after blast. EEG recordings were performed at 15 minutes before the blast and 15 minutes, 30 minutes, 2 hours and 1, 2 and 3 days post-blast using surface recording electrodes and a Biopac 4-channel data acquisition system. Off-line quantitative EEG (qEEG) data analysis was performed to determine qEEG changes. RESULTS Blast induced qEEG changes earlier after blast exposure, including a decrease of mean amplitude (MAMP), an increase of delta band power, a decrease of alpha band root mean square (RMS) and a decrease of 90% spectral edge frequency (SEF90). CONCLUSIONS This study demonstrated that qEEG is sensitive for cerebral injury. The changes of qEEG earlier after the blast indicate the potential of utilization of multiple parameters of qEEG for diagnosis of blast-induced brain injury. Early detection of blast induced brain injury will allow early screening and assessment of brain abnormalities in soldiers to enable timely therapeutic intervention.
Collapse
Affiliation(s)
- Chaoyang Chen
- a Department of Biomedical Engineering , Wayne State University , Detroit , MI , USA
| | - Chengpeng Zhou
- a Department of Biomedical Engineering , Wayne State University , Detroit , MI , USA
| | - John M Cavanaugh
- a Department of Biomedical Engineering , Wayne State University , Detroit , MI , USA
| | - Srinivasu Kallakuri
- a Department of Biomedical Engineering , Wayne State University , Detroit , MI , USA
| | - Alok Desai
- a Department of Biomedical Engineering , Wayne State University , Detroit , MI , USA
| | - Liying Zhang
- a Department of Biomedical Engineering , Wayne State University , Detroit , MI , USA
| | - Albert I King
- a Department of Biomedical Engineering , Wayne State University , Detroit , MI , USA
| |
Collapse
|
42
|
Liang J, Wang Y, Liang B. Zhoubo plus uncaria tincture in the treatment of cerebral concussion sequelae. J Phys Ther Sci 2016; 28:2027-30. [PMID: 27512257 PMCID: PMC4968499 DOI: 10.1589/jpts.28.2027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 04/07/2016] [Indexed: 12/03/2022] Open
Abstract
[Purpose] This study investigated the clinical efficacy of the compound gouteng tincture
combined with Zhoubo (GT-ZB) in treating the sequelae of cerebral concussion (CC) in
children. [Subjects and Methods] Sixty children with CC-sequelae were randomily divided
into a treatment group and a control group, with 30 cases in each group. The treatment
group was treated using GT-ZB, and the control group was treated using the standard method
of venoruton, dibazol, and Vitamin B6. The efficacies of the two treatments were compared.
[Results] Compared with the control group, the clinical symptoms and signs in the
treatment group were significantly mitigated. [Conclusion] GT-ZB demonstrated efficacy in
treating the sequelae of CC in children, and it is worthy of further studies and possible
clinical recommendations.
Collapse
Affiliation(s)
- Jianjun Liang
- Department of Physical Therapy, Xuzhou Cancer Hospital, China
| | - Ying Wang
- Department of Pediatrics, Xuzhou Cancer Hospital, China
| | | |
Collapse
|
43
|
Fino PC, Nussbaum MA, Brolinson PG. Locomotor deficits in recently concussed athletes and matched controls during single and dual-task turning gait: preliminary results. J Neuroeng Rehabil 2016; 13:65. [PMID: 27456969 PMCID: PMC4960701 DOI: 10.1186/s12984-016-0177-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background There is growing evidence that mild traumatic brain injury (concussion) can affect locomotor characteristics for prolonged periods of time even when physical signs and symptoms are absent. While most locomotor deficits post-concussion have involved straight walking, turning gait has received little attention despite its pervasiveness in everyday locomotion and athletic competition. Methods This study longitudinally examined kinematic characteristics during preplanned turning in a small sample of recently concussed athletes (n = 4) and healthy matched control athletes (n = 4) to examine potential deficits during single and dual-task turning gait over the initial 6 weeks post-injury, with a one-year follow-up. Turning path kinematics (curvature, obstacle clearance, path length), stride kinematics (stride length, stride width, stride time), and inclination angles were calculated from motion capture of participants walking around an obstacle. Results Concussed athletes had larger dual-task costs in turning speed and stride time compared to healthy controls. After controlling for speed and turn curvature, recently concussed athletes increased their inclination towards the inside of the turn over time and decreased their stride time compared to controls indicating a prolonged recovery. Kinematic differences between groups were estimated to recover to healthy levels between 100 and 300 days post-injury, suggesting future prospective longitudinal studies should span 6–12 months post-injury. Conclusion Turning gait should be included in future studies of concussion and may be a clinically useful tool. Future longitudinal studies should consider examining gait changes for up to 6–12 months post-injury. Electronic supplementary material The online version of this article (doi:10.1186/s12984-016-0177-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Peter C Fino
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L226, Portland, OR, 97239, USA. .,Department of Mechanical Engineering, Virginia Tech, Blacksburg, USA.
| | - Maury A Nussbaum
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, USA
| | - Per Gunnar Brolinson
- Department of Mechanical Engineering, Virginia Tech, Blacksburg, USA.,Edward Via College of Osteopathic Medicine, Blacksburg, USA
| |
Collapse
|
44
|
Dalecki M, Albines D, Macpherson A, Sergio LE. Prolonged cognitive-motor impairments in children and adolescents with a history of concussion. Concussion 2016; 1:CNC14. [PMID: 30202556 PMCID: PMC6094154 DOI: 10.2217/cnc-2016-0001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 02/26/2016] [Indexed: 01/01/2023] Open
Abstract
Aim: We investigated whether children and adolescents with concussion history show cognitive–motor integration (CMI) deficits. Method: Asymptomatic children and adolescents with concussion history (n = 50; mean 12.84 years) and no history (n = 49; mean: 11.63 years) slid a cursor to targets using their finger on a dual-touch-screen laptop; target location and motor action were not aligned in the CMI task. Results: Children and adolescents with concussion history showed prolonged CMI deficits, in that their performance did not match that of no history controls until nearly 2 years postevent. Conclusion: These CMI deficits may be due to disruptions in fronto-parietal networks, contributing to an increased vulnerability to further injury. Current return-to-play assessments that do not test CMI may not fully capture functional abilities postconcussion.
Collapse
Affiliation(s)
- Marc Dalecki
- School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.,Centre for Vision Research, York University, Toronto, Ontario, Canada.,School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.,Centre for Vision Research, York University, Toronto, Ontario, Canada
| | - David Albines
- School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.,School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada
| | - Alison Macpherson
- School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.,York University Sport Medicine Team, York University, Toronto, Ontario, Canada.,School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.,York University Sport Medicine Team, York University, Toronto, Ontario, Canada
| | - Lauren E Sergio
- School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.,Centre for Vision Research, York University, Toronto, Ontario, Canada.,York University Sport Medicine Team, York University, Toronto, Ontario, Canada.,School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.,Centre for Vision Research, York University, Toronto, Ontario, Canada.,York University Sport Medicine Team, York University, Toronto, Ontario, Canada
| |
Collapse
|
45
|
Decreased microvascular cerebral blood flow assessed by diffuse correlation spectroscopy after repetitive concussions in mice. J Cereb Blood Flow Metab 2015; 35:1995-2000. [PMID: 26154866 PMCID: PMC4671120 DOI: 10.1038/jcbfm.2015.161] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/04/2015] [Accepted: 06/01/2015] [Indexed: 12/14/2022]
Abstract
Repetitive concussions are associated with long-term cognitive dysfunction that can be attenuated by increasing the time intervals between concussions; however, biomarkers of the safest rest interval between injuries remain undefined. We hypothesize that deranged cerebral blood flow (CBF) is a candidate biomarker for vulnerability to repetitive concussions. Using a mouse model of human concussion, we examined the effect of single and repetitive concussions on cognition and on an index of CBF (CBFi) measured with diffuse correlation spectroscopy. After a single mild concussion, CBFi was reduced by 35±4% at 4 hours (P<0.01 versus baseline) and returned to preinjury levels by 24 hours. After five concussions spaced 1 day apart, CBFi was also reduced from preinjury levels 4 hours after each concussion but had returned to preinjury levels by 72 hours after the final concussion. Interestingly, in this repetitive concussion model, lower CBFi values measured both preinjury and 4 hours after the third concussion were associated with worse performance on the Morris water maze assessed 72 hours after the final concussion. We conclude that low CBFi measured either before or early on in the evolution of injury caused by repetitive concussions could be a useful predictor of cognitive outcome.
Collapse
|
46
|
Kiefer AW, Barber Foss K, Reches A, Gadd B, Gordon M, Rushford K, Laufer I, Weiss M, Myer GD. Brain Network Activation as a Novel Biomarker for the Return-to-Play Pathway Following Sport-Related Brain Injury. Front Neurol 2015; 6:243. [PMID: 26635720 PMCID: PMC4653293 DOI: 10.3389/fneur.2015.00243] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/30/2015] [Indexed: 12/02/2022] Open
Abstract
Children and adolescent athletes are at a higher risk for concussion than adults, and also experience longer recovery times and increased associated symptoms. It has also recently been demonstrated that multiple, seemingly mild concussions may result in exacerbated and prolonged neurological deficits. Objective assessments and return-to-play criteria are needed to reduce risk and morbidity associated with concussive events in these populations. Recent research has pushed to study the use of electroencephalography as an objective measure of brain injury. In the present case study, we present a novel approach that examines event-related potentials via a brain network activation (BNA) analysis as a biomarker of concussion and recovery. Specifically, changes in BNA scores, as indexed through this approach, offer a potential indicator of neurological health as the BNA assessment qualitatively and quantitatively indexes the network dynamics associated with brain injury. Objective tools, such as these support accurate and efficient assessment of brain injury and may offer a useful step in categorizing the temporal and spatial changes in brain activity following concussive blows, as well as the functional connectivity of brain networks, associated with concussion.
Collapse
Affiliation(s)
- Adam W Kiefer
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, OH , USA ; Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, OH , USA ; Center for Cognition Action and Perception, Department of Psychology, University of Cincinnati , Cincinnati, OH , USA
| | - Kim Barber Foss
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, OH , USA
| | | | - Brooke Gadd
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, OH , USA
| | | | | | | | | | - Gregory D Myer
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, OH , USA ; Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, OH , USA ; Department of Orthopaedic Surgery, University of Cincinnati , Cincinnati, OH , USA ; The Micheli Center for Sports Injury Prevention , Waltham, MA , USA ; Sports Health and Performance Institute, The Ohio State University , Columbus, OH , USA
| |
Collapse
|
47
|
Wang Y, Nelson LD, LaRoche AA, Pfaller AY, Nencka AS, Koch KM, McCrea MA. Cerebral Blood Flow Alterations in Acute Sport-Related Concussion. J Neurotrauma 2015; 33:1227-36. [PMID: 26414315 DOI: 10.1089/neu.2015.4072] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Sport-related concussion (SRC) is a major health problem, affecting millions of athletes each year. While the clinical effects of SRC (e.g., symptoms and functional impairments) typically resolve within several days, increasing evidence suggests persistent neurophysiological abnormalities beyond the point of clinical recovery after injury. This study aimed to evaluate cerebral blood flow (CBF) changes in acute SRC, as measured using advanced arterial spin labeling (ASL) magnetic resonance imaging (MRI). We compared CBF maps assessed in 18 concussed football players (age, 17.8 ± 1.5 years) obtained within 24 h and at 8 days after injury with a control group of 19 matched non-concussed football players. While the control group did not show any changes in CBF between the two time-points, concussed athletes demonstrated a significant decrease in CBF at 8 days relative to within 24 h. Scores on the clinical symptom (Sport Concussion Assessment Tool 3, SCAT3) and cognitive measures (Standardized Assessment of Concussion [SAC]) demonstrated significant impairment (vs. pre-season baseline levels) at 24 h (SCAT, p < 0.0001; SAC, p < 0.01) but returned to baseline levels at 8 days. Two additional computerized neurocognitive tests, the Automated Neuropsychological Assessment Metrics and Immediate Post-Concussion and Cognitive Testing, showed a similar pattern of changes. These data support the hypothesis that physiological changes persist beyond the point of clinical recovery after SRC. Our results also indicate that advanced ASL MRI methods might be useful for detecting and tracking the longitudinal course of underlying neurophysiological recovery from concussion.
Collapse
Affiliation(s)
- Yang Wang
- 1 Department of Radiology, Medical College of Wisconsin , Milwaukee, Wisconsin.,2 Department of Biophysics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Lindsay D Nelson
- 3 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin.,4 Department of Neurology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Ashley A LaRoche
- 3 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Adam Y Pfaller
- 3 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Andrew S Nencka
- 1 Department of Radiology, Medical College of Wisconsin , Milwaukee, Wisconsin.,2 Department of Biophysics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Kevin M Koch
- 1 Department of Radiology, Medical College of Wisconsin , Milwaukee, Wisconsin.,2 Department of Biophysics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Michael A McCrea
- 3 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin.,4 Department of Neurology, Medical College of Wisconsin , Milwaukee, Wisconsin
| |
Collapse
|
48
|
Neurophysiological correlates of persistent psycho-affective alterations in athletes with a history of concussion. Brain Imaging Behav 2015; 10:1108-1116. [DOI: 10.1007/s11682-015-9473-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
49
|
A Meta-Analytic Review of Minnesota Multiphasic Personality Inventory—2nd Edition (MMPI-2) Profile Elevations Following Traumatic Brain Injury. PSYCHOLOGICAL INJURY & LAW 2015. [DOI: 10.1007/s12207-015-9236-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
50
|
Kontos AP, Huppert TJ, Beluk NH, Elbin RJ, Henry LC, French J, Dakan SM, Collins MW. Brain activation during neurocognitive testing using functional near-infrared spectroscopy in patients following concussion compared to healthy controls. Brain Imaging Behav 2015; 8:621-34. [PMID: 24477579 DOI: 10.1007/s11682-014-9289-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There is no accepted clinical imaging modality for concussion, and current imaging modalities including fMRI, DTI, and PET are expensive and inaccessible to most clinics/patients. Functional near-infrared spectroscopy (fNIRS) is a non-invasive, portable, and low-cost imaging modality that can measure brain activity. The purpose of this study was to compare brain activity as measured by fNIRS in concussed and age-matched controls during the performance of cognitive tasks from a computerized neurocognitive test battery. Participants included nine currently symptomatic patients aged 18-45 years with a recent (15-45 days) sport-related concussion and five age-matched healthy controls. The participants completed a computerized neurocognitive test battery while wearing the fNIRS unit. Our results demonstrated reduced brain activation in the concussed subject group during word memory, (spatial) design memory, digit-symbol substitution (symbol match), and working memory (X's and O's) tasks. Behavioral performance (percent-correct and reaction time respectively) was lower for concussed participants on the word memory, design memory, and symbol match tasks than controls. The results of this preliminary study suggest that fNIRS could be a useful, portable assessment tool to assess reduced brain activation and augment current approaches to assessment and management of patients following concussion.
Collapse
Affiliation(s)
- A P Kontos
- UPMC Sports Medicine Concussion Program/Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA,
| | | | | | | | | | | | | | | |
Collapse
|