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Duquette-Laplante F, Macaskill M, Jutras B, Jemel B, Koravand A. Brain functional connectivity in children with a mild traumatic brain injury: A scoping review. APPLIED NEUROPSYCHOLOGY. CHILD 2023:1-12. [PMID: 38100747 DOI: 10.1080/21622965.2023.2293248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
INTRODUCTION The occurrence of mild traumatic brain injury(mTBI) is estimated at 0,2-0,3% cases annually. Following a mTBI, some children experience persistent symptoms, and functional connectivity(FC) changes may be implicated. However, characteristics of FC have not been widely described in this population. This scoping review aimed to identify and understand the impacts of mTBI on EEG-measured FC in children, provide an overview of the available literature, detail analysis techniques, and describe gaps in the research. METHODS PubMed, Web of Science, Medline, Embase, ProQuest and CINAHL were searched up to June 25, 2023, with the terms child, mTBI, EEG, FC, and their synonyms. Ten studies were identified. RESULTS Five studies reported significant differences between the mTBI group and controls. In addition to group differences, six studies reported significant variation over time. Brain Network Analysis(BNA), utilized in seven studies, was the primary FC analysis recorded. Two of the five studies that reported significant differences following mTBI utilized the BNA. The other three applied alternative analysis methods. DISCUSSION FC assessment based on EEG can identify some differences in children with mTBI. BNA was more useful in following changes over time. Further research is suggested, considering the limited age range and number of retrieved studies.
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Affiliation(s)
- F Duquette-Laplante
- Audiology and Speech Pathology Program, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
- School of Speech-Language Pathology and Audiology, Université de Montréal, Montreal, Canada
- Research Center, CHU Sainte-Justine, Montreal, Canada
| | - M Macaskill
- Centre de Recherche en Audiologie pédiatrique, Hôpital Necker, Paris, France
| | - B Jutras
- School of Speech-Language Pathology and Audiology, Université de Montréal, Montreal, Canada
- Research Center, CHU Sainte-Justine, Montreal, Canada
| | - B Jemel
- School of Speech-Language Pathology and Audiology, Université de Montréal, Montreal, Canada
- Research Laboratory in Neurosciences and Cognitive Electrophysiology, Research Center CIUSS-NIM, Hôpital Rivière des Prairies, Montréal, Canada
| | - A Koravand
- Audiology and Speech Pathology Program, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
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Coenen J, Reinsberger C. Neurophysiological Markers to Guide Return to Sport After Sport-Related Concussion. J Clin Neurophysiol 2023; 40:391-397. [PMID: 36930211 DOI: 10.1097/wnp.0000000000000996] [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: 03/18/2023] Open
Abstract
SUMMARY Sport-related concussion (SRC) has been defined as a subset of mild traumatic brain injury (mTBI), without structural abnormalities, reflecting a functional disturbance. Over the past decade, SRC has gained increasing awareness and attention, which coincides with an increase in incidence rates. Because this injury has been considered one of the most challenging encounters for clinicians, there is a need for objective biomarkers to aid in diagnosis (i.e., presence/severity) and management (i.e., return to sport) of SRC/mTBI.The primary aim of this article was to present state-of-the-art neurophysiologic methods (e.g., electroencephalography, magnetoencephalography, transcranial magnetic stimulation, and autonomic nervous system) that are appropriate to investigate the complex pathophysiological process of a concussion. A secondary aim was to explore the potential for evidence-based markers to be used in clinical practice for SRC management. The article concludes with a discussion of future directions for SRC research with specific focus on clinical neurophysiology.
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Affiliation(s)
- Jessica Coenen
- Department of Exercise and Health, Institute of Sports Medicine, Paderborn University, Paderborn, Germany; and
| | - Claus Reinsberger
- Department of Exercise and Health, Institute of Sports Medicine, Paderborn University, Paderborn, Germany; and
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Brigham and Women's Hospital, Boston, Massachusetts
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Tabor JB, Brett BL, Nelson L, Meier T, Penner LC, Mayer AR, Echemendia RJ, McAllister T, Meehan WP, Patricios J, Makdissi M, Bressan S, Davis GA, Premji Z, Schneider KJ, Zetterberg H, McCrea M. Role of biomarkers and emerging technologies in defining and assessing neurobiological recovery after sport-related concussion: a systematic review. Br J Sports Med 2023; 57:789-797. [PMID: 37316184 DOI: 10.1136/bjsports-2022-106680] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Determine the role of fluid-based biomarkers, advanced neuroimaging, genetic testing and emerging technologies in defining and assessing neurobiological recovery after sport-related concussion (SRC). DESIGN Systematic review. DATA SOURCES Searches of seven databases from 1 January 2001 through 24 March 2022 using keywords and index terms relevant to concussion, sports and neurobiological recovery. Separate reviews were conducted for studies involving neuroimaging, fluid biomarkers, genetic testing and emerging technologies. A standardised method and data extraction tool was used to document the study design, population, methodology and results. Reviewers also rated the risk of bias and quality of each study. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were included if they: (1) were published in English; (2) represented original research; (3) involved human research; (4) pertained only to SRC; (5) included data involving neuroimaging (including electrophysiological testing), fluid biomarkers or genetic testing or other advanced technologies used to assess neurobiological recovery after SRC; (6) had a minimum of one data collection point within 6 months post-SRC; and (7) contained a minimum sample size of 10 participants. RESULTS A total of 205 studies met inclusion criteria, including 81 neuroimaging, 50 fluid biomarkers, 5 genetic testing, 73 advanced technologies studies (4 studies overlapped two separate domains). Numerous studies have demonstrated the ability of neuroimaging and fluid-based biomarkers to detect the acute effects of concussion and to track neurobiological recovery after injury. Recent studies have also reported on the diagnostic and prognostic performance of emerging technologies in the assessment of SRC. In sum, the available evidence reinforces the theory that physiological recovery may persist beyond clinical recovery after SRC. The potential role of genetic testing remains unclear based on limited research. CONCLUSIONS Advanced neuroimaging, fluid-based biomarkers, genetic testing and emerging technologies are valuable research tools for the study of SRC, but there is not sufficient evidence to recommend their use in clinical practice. PROSPERO REGISTRATION NUMBER CRD42020164558.
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Affiliation(s)
- Jason B Tabor
- Sport Injury Prevention Research Centre, Faculty of Kinesiology; University of Calgary, Calgary, Alberta, Canada
| | - Benjamin L Brett
- Department of Neurosurgery and Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lindsay Nelson
- Department of Neurosurgery and Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy Meier
- Department of Neurosurgery and Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Linden C Penner
- Sport Injury Prevention Research Centre, Faculty of Kinesiology; University of Calgary, Calgary, Alberta, Canada
| | - Andrew R Mayer
- The Mind Research Network, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc, State College, PA, USA
| | - Thomas McAllister
- Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - William P Meehan
- Micheli Center for Sports Injury Prevention, Boston Children's Hospital, Boston, Massachusetts, USA
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jon Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand South, Johannesburg, South Africa
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- Australian Football League, Melbourne, Victoria, Australia
| | - Silvia Bressan
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology; University of Calgary, Calgary, Alberta, Canada
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Molndal, Sweden
| | - Michael McCrea
- Department of Neurosurgery and Center for Neurotrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Corbin-Berrigan LA, Teel E, Vinet SA, P De Koninck B, Guay S, Beaulieu C, De Beaumont L. The Use of Electroencephalography as an Informative Tool in Assisting Early Clinical Management after Sport-Related Concussion: a Systematic Review. Neuropsychol Rev 2023; 33:144-159. [PMID: 32577950 DOI: 10.1007/s11065-020-09442-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 06/07/2020] [Indexed: 12/21/2022]
Abstract
Sport-related concussion (SRC) is managed primarily through serial clinical evaluations throughout recovery. However, studies suggest that clinical measures may not be suitable to detect subtle alterations in functioning and are limited by numerous internal and external factors. Electroencephalography (EEG) has been used for over eight decades to discern altered function following illnesses and injuries, including traumatic brain injury. This study evaluated the associations between EEG measures and clinical presentation within three-months following SRC. A systematic review of the literature was performed in Medline, Embase, PsycINFO, CINAHL and Web of Science databases following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines, yielding a total of 13 peer-reviewed articles. Most studies showed low to moderate bias and moderate to high quality. The majority of the existing literature on the impact of concussion within the first 3 months post-injury suggests that individuals with concussion show altered brain function, with EEG abnormalities outlasting clinical dysfunction. Of all EEG biomarkers evaluated, P300 shows the most promise and should be explored further. Despite the relatively high quality of included articles, significant limitations are still present within this body of literature, including potential conflicts of interest and proprietary algorithms, making it difficult to draw strong and meaningful conclusions on the use of EEG in the early stages of SRC. Therefore, further exploration of the relationship between EEG measures and acute clinical presentation is warranted to determine if EEG provides additional benefits over current clinical assessments and is a feasible tool in clinical settings.
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Affiliation(s)
- Laurie-Ann Corbin-Berrigan
- Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | | | | | - Béatrice P De Koninck
- Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Université de Montréal, Montréal, Quebec, Canada
| | - Samuel Guay
- Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Université de Montréal, Montréal, Quebec, Canada
| | | | - Louis De Beaumont
- Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Quebec, Canada. .,Université de Montréal, Montréal, Quebec, Canada.
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Mortazavi M, Lucini FA, Joffe D, Oakley DS. Electrophysiological trajectories of concussion recovery: From acute to prolonged stages in late teenagers. J Pediatr Rehabil Med 2023; 16:287-299. [PMID: 36710690 PMCID: PMC10894572 DOI: 10.3233/prm-210114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 10/17/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Numerous studies have reported electrophysiological differences between concussed and non-concussed groups, but few studies have systematically explored recovery trajectories from acute concussion to symptom recovery and the transition from acute concussion to prolonged phases. Questions remain about recovery prognosis and the extent to which symptom resolution coincides with injury resolution. This study therefore investigated the electrophysiological differences in recoveries between simple and complex concussion. METHODS Student athletes with acute concussion from a previous study (19(2) years old) were tracked from pre-injury baseline, 24-48 hours after concussion, and through in-season recovery. The electroencephalography (EEG) with P300 evoked response trajectories from this acute study were compared to an age-matched population of 71 patients (18(2) years old) with prolonged post-concussive symptoms (PPCS), 61 (SD 31) days after concussion. RESULTS Acute, return-to-play, and PPCS groups all experienced a significant deficit in P300 amplitude compared to the pre-injury baseline group. The PPCS group, however, had significantly different EEG spectral and coherence patterns from every other group. CONCLUSION These data suggest that while the evoked response potentials deficits of simple concussion may persist in more prolonged stages, there are certain EEG measures unique to PPCS. These metrics are readily accessible to clinicians and may provide useful parameters to help predict trajectories, characterize injury (phenotype), and track the course of injury.
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Affiliation(s)
- Mo Mortazavi
- SPARCC Sports Medicine, Rehabilitation, and Concussion Center, Tucson, AZ, USA
- Department of Pediatrics, Tucson Medical Center, Tucson, AZ, USA
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Hassin-Baer S, Cohen OS, Israeli-Korn S, Yahalom G, Benizri S, Sand D, Issachar G, Geva AB, Shani-Hershkovich R, Peremen Z. Identification of an early-stage Parkinson's disease neuromarker using event-related potentials, brain network analytics and machine-learning. PLoS One 2022; 17:e0261947. [PMID: 34995285 PMCID: PMC8741046 DOI: 10.1371/journal.pone.0261947] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The purpose of this study is to explore the possibility of developing a biomarker that can discriminate early-stage Parkinson's disease from healthy brain function using electroencephalography (EEG) event-related potentials (ERPs) in combination with Brain Network Analytics (BNA) technology and machine learning (ML) algorithms. BACKGROUND Currently, diagnosis of PD depends mainly on motor signs and symptoms. However, there is need for biomarkers that detect PD at an earlier stage to allow intervention and monitoring of potential disease-modifying therapies. Cognitive impairment may appear before motor symptoms, and it tends to worsen with disease progression. While ERPs obtained during cognitive tasks performance represent processing stages of cognitive brain functions, they have not yet been established as sensitive or specific markers for early-stage PD. METHODS Nineteen PD patients (disease duration of ≤2 years) and 30 healthy controls (HC) underwent EEG recording while performing visual Go/No-Go and auditory Oddball cognitive tasks. ERPs were analyzed by the BNA technology, and a ML algorithm identified a combination of features that distinguish early PD from HC. We used a logistic regression classifier with a 10-fold cross-validation. RESULTS The ML algorithm identified a neuromarker comprising 15 BNA features that discriminated early PD patients from HC. The area-under-the-curve of the receiver-operating characteristic curve was 0.79. Sensitivity and specificity were 0.74 and 0.73, respectively. The five most important features could be classified into three cognitive functions: early sensory processing (P50 amplitude, N100 latency), filtering of information (P200 amplitude and topographic similarity), and response-locked activity (P-200 topographic similarity preceding the motor response in the visual Go/No-Go task). CONCLUSIONS This pilot study found that BNA can identify patients with early PD using an advanced analysis of ERPs. These results need to be validated in a larger PD patient sample and assessed for people with premotor phase of PD.
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Affiliation(s)
- Sharon Hassin-Baer
- Movement Disorders Institute and Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oren S. Cohen
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Simon Israeli-Korn
- Movement Disorders Institute and Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Yahalom
- Department of Neurology and Movement Disorders Clinic, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sandra Benizri
- Movement Disorders Unit, Functional Neurosurgery Center, Assuta Ramat Ha Hayal Hospital, Tel Aviv, Israel
| | - Daniel Sand
- elminda Ltd., Herzliya, Israel
- Faculty of Medicine, Department of Medical Neurobiology, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel
| | | | - Amir B. Geva
- elminda Ltd., Herzliya, Israel
- Department of Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Kaufman MW, Su CA, Trivedi NN, Lee MK, Nelson GB, Cupp SA, Voos JE. The Current Status of Concussion Assessment Scales: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202106000-00001. [PMID: 34101673 DOI: 10.2106/jbjs.rvw.20.00108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Concussion is a complex pathophysiologic process that affects the brain; it is induced by biomechanical forces, with alteration in mental status with or without loss of consciousness. » Concussion assessment tools may be broadly categorized into (1) screening tests such as the SAC (Standardized Assessment of Concussion), the BESS (Balance Error Scoring System), and the King-Devick (KD) test; (2) confirmatory tests including the SCAT (Sport Concussion Assessment Tool), the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), and the VOMS (Vestibular Oculomotor Screening); and (3) objective examinations such as brain network activation (BNA) analysis, imaging studies, and physiologic markers. » The KD, child SCAT3 (cSCAT3), child ImPACT (cImPACT), and VOMS tests may be used to evaluate for concussion in the pediatric athlete. » Future work with BNA, functional magnetic resonance imaging, diffusion tensor imaging, and serum biomarkers may provide more objective assessment of concussion, neurologic injury, and subsequent recovery.
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Affiliation(s)
| | - Charles A Su
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Nikunj N Trivedi
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Michelle K Lee
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Grant B Nelson
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sean A Cupp
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - James E Voos
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Kerasidis H, Simmons J. Quantitative EEG Analysis in Clinical Practice: Concussion Injury. Clin EEG Neurosci 2021; 52:114-118. [PMID: 33601899 DOI: 10.1177/1550059421989112] [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: 11/15/2022]
Abstract
Concussion is a common brain injury. The American Academy of Neurology provides a definition of concussion: "Concussion is a traumatically, or biomechanically, induced alteration of brain function. Emphasis is placed on a pathophysiological process, or functional disruption, as opposed to anatomic, structural, or tissue injury.". The incidence of mild traumatic brain injury (mTBI) is estimated at 200 per 100 000. The Centers for Disease Control and Prevention (CDC) estimates 3.8 million sport and recreational mTBIs occurring in the United States each year. A more recent CDC assessment estimates 2.5 million concussion injuries in high school sports alone. The controlled environment and opportunity for direct surveillance and observation has made the sports arena the scientific "wet lab" for the study of mTBI natural history, short- and long-term consequences and opportunities to intervene. Quantitative EEG methods have been utilized in the assessment and management of mTBI and lends to provide a cost-effective procedure that has the sensitivities needed to identify pathology where routine visual inspection of the EEG has failed.
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Affiliation(s)
| | - Jerald Simmons
- Comprehensive Sleep Medicine Associates, The Woodlands, TX, USA
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9
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Quantitative Multimodal Assessment of Concussion Recovery in Youth Athletes. Clin J Sport Med 2021; 31:133-138. [PMID: 30762699 DOI: 10.1097/jsm.0000000000000722] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/21/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate recovery trajectories among youth athletes with a concussion and healthy controls across different domains using a quantitative and multifaceted protocol. STUDY DESIGN Prospective repeated measures. PARTICIPANTS Youth athletes diagnosed with a concussion between the ages of 8 and 18 years were evaluated (1) within 10 days after injury, (2) approximately 3 weeks after injury, and (3) after return-to-play clearance. Control participants completed the same protocol. SETTING Sport concussion clinic. INTERVENTIONS N/A. MAIN OUTCOME MEASURES Participants underwent a multifaceted protocol that assessed symptoms (postconcussion symptom scale [PCSS]), dual-task gait, event-related potentials (ERPs), and eye tracking. RESULTS Sixty-seven athletes participated: 36 after concussion (age = 14.0 ± 2.6 years; 44% female) and 31 controls (age = 14.6 ± 2.2 years; 39% female). Concussion symptoms were higher for the concussion group compared with controls at the first (PCSS = 31.7 ± 18.8 vs 1.9 ± 2.9; P < 0.001) and second time points (PCSS = 10.8 ± 11.2 vs 1.8 ± 3.6; P = 0.001) but resolved by the final assessment (PCSS = 1.7 ± 3.6 vs 2.0 ± 3.8; P = 0.46). The concussion group walked slower during dual-task gait than controls at all 3 tests including after return-to-play clearance (0.83 ± 0.19 vs 0.95 ± 0.15 m/s; P = 0.049). There were no between-group differences for ERP connectivity or eye tracking. Those with concussions had a decrease in ERP connectivity recovery over the 3 time points, whereas control participants' scores increased (concussion Δ = -8.7 ± 28.0; control Δ = 13.9 ± 32.2; χ2 = 14.1, P = 0.001). CONCLUSIONS Concussion is associated with altered dual-task gait speeds after resolution of concussion symptoms, but ERP and eye tracking measures did not demonstrate between-group differences across time. Some objective approaches to concussion monitoring may support with identifying deficits after concussion, but further work is required to delineate the role of gait, electrophysiological, and eye tracking methods for clinical decision-making.
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Piedade SR, Hutchinson MR, Ferreira DM, Cristante AF, Maffulli N. The management of concussion in sport is not standardized. A systematic review. JOURNAL OF SAFETY RESEARCH 2021; 76:262-268. [PMID: 33653558 DOI: 10.1016/j.jsr.2020.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/16/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Concussion is traumatic brain injury with associated tissue damage commonly produced by an indirect or direct head or facial trauma that can negatively impact an athletes' career and personal life. In this context, the importance on how to deal with a concussion has received attention from worldwide literature and has become a topic of enormous interest in the sports medicine arena. OBJECTIVE This systematic review aimed to investigate how sports-related concussion is being managed regarding athletic injuries, athletes' age, clinical signs of concussion, adopted questionnaires, as well as decision making in sports medicine. METHODS A systematic review of the literature was performed searching 10 electronic databases with no limitations for year of publication up to December 2019. The search terms used were: Brain Concussion, Athletes, Sports Medicine, Athletic Injuries, Clinical Decision-Making, and Decision Making. The articles were considered eligible when the studies related to populations of regular sports practitioners, professional or recreational, of any age; sports injury; articles reporting concussion evaluation in at least 30 athletes; and articles published in English, French, Portuguese, Italian. We excluded systematic review articles, reviews, editorials, sport-unrelated concussion, no questionnaire application, approaching retired athletes, consensus statement letters, author's reply to editorials, synopsis, and abstracts. RESULTS The parameters adopted for decision-making and management were broadly variable and were based on a variety of clinical signs or scoring outcomes from a myriad of questionnaires with little consistency in protocol or management guidelines, which could guide the average clinician. CONCLUSION This systematic review provides current evidence that post-concussion management in sports medicine has yet to accomplish a standardized protocol that clinicians could use to optimally care for athletes. The extensive number of manuscripts and studies addressing the topic confirms that sports-related concussion in the pediatric and adolescent population has come to the forefront in the sports medicine field.
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Affiliation(s)
- Sergio Rocha Piedade
- Exercise and Sports Medicine, Department of Orthopedics, Rheumatology and Traumatology, University of Campinas, UNICAMP, Campinas, SP, Brazil.
| | | | - Daniel Miranda Ferreira
- Exercise and Sports Medicine, Department of Orthopedics, Rheumatology and Traumatology, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | | | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
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Laufer O, Geva A, Ellis JD, Barber Foss K, Ettinger M, Stern Y, Arthur T, Kutcher J, Myer G, Reches A. Prospective longitudinal investigation shows correlation of event-related potential to mild traumatic brain injury in adolescents. Brain Inj 2020; 34:871-880. [PMID: 32508153 DOI: 10.1080/02699052.2020.1763459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Prospective longitudinal cohort study. BACKGROUND Adolescent athletes may be more susceptible to the long-term effects of mild traumatic brain injury (mTBI). A diagnostic and prognostic neuromarker may optimize management and return-to-activity decision-making in athletes who experience mTBI. OBJECTIVE Measure an event-related potential (ERP) component captured with electroencephalography (EEG), called processing negativity (PN), at baseline and post-injury in adolescents who suffered mTBI and determine their longitudinal response relative to healthy controls. METHODS Thirty adolescents had EEG recorded during an auditory oddball task at a pre-mTBI baseline session and subsequent post-mTBI sessions. Longitudinal EEG data from patients and healthy controls (n= 77) were obtained from up to four sessions in total and processed using Brain Network Analysis algorithms. RESULTS The average PN amplitude in healthy controls significantly decreased over sessions 2 and 3; however, it remained steady in the mTBI group's 2nd (post-mTBI) session and decreased only in sessions 3 and 4. Pre- to post-mTBI amplitude changes correlated with the time interval between sessions. CONCLUSION These results demonstrate that PN amplitude changes may be associated with mTBI exposure and subsequent recovery in adolescent athletes. Further study of PN may lead to it becoming a neuromarker for mTBI prognosis and return-to-activity decision-making in adolescents.
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Affiliation(s)
| | | | - Jonathan D Ellis
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, USA.,University of Cincinnati College of Medicine , Cincinnati, Ohio, USA
| | - Kim Barber Foss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, USA
| | | | | | - Todd Arthur
- University of Cincinnati College of Medicine , Cincinnati, Ohio, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | | | - Gregory Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, USA.,Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati , Cincinnati, Ohio, USA.,The Micheli Center for Sports Injury Prevention , Waltham, Massachusetts, USA.,Department of Orthopaedics, University of Pennsylvania , Philadelphia, Pennsylvania, USA
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Clayton G, Davis N, Holliday A, Joffe D, Oakley DS, Palermo FX, Poddar S, Rueda M. In-clinic event related potentials after sports concussion: A 4-year study. J Pediatr Rehabil Med 2020; 13:81-92. [PMID: 32176669 PMCID: PMC7242851 DOI: 10.3233/prm-190620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Electrophysiological event-related potentials (ERP's) have been reported to change after concussion. The objective of this study is to use a simple 2-tone auditory P300 ERP in routine clinical settings to measure changes from baseline after concussion and to determine if these changes persist at return to play when other standard measures have normalized. METHODS Three-hundred sixty-four (364) student athletes, aged 17-23 years, participating in contact sports were tracked over consecutive years. In this blinded study P300, plus physical reaction times and Trail Making tests, were collected alongside standard clinical evaluations. Changes in these measures after concussion were compared to clinical outcomes over various stages of post-injury recovery. RESULTS Concussed players experienced significant reaction time and/or P300 amplitude changes compared to pre-concussion baseline measurements (p< 0.005). P300 changes persisted in 38% of the players after standard measures, including reaction times, had cleared. Many of those players slow to normalize were part of the sub-concussive symptom group and/or appeared more prone to repeat concussions. CONCLUSION These data suggest significant P300 amplitude changes after concussion that are quantifiable and consistent. These changes often normalized slower than other standard assessments. More data are needed to determine if slow normalization relates to sub-concussive or repeated events.
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Affiliation(s)
- Gerald Clayton
- School of Medicine, University of Colorado, Aurora, CO, USA.,Children's Hospital Colorado, Aurora, CO, USA
| | - Natalie Davis
- Department of Athletics, University of Colorado, Boulder, CO, USA
| | - Adam Holliday
- Department of Athletics, University of Colorado, Boulder, CO, USA
| | | | | | | | - Sourav Poddar
- School of Medicine, University of Colorado, Aurora, CO, USA
| | - Miguel Rueda
- Department of Athletics, University of Colorado, Boulder, CO, USA
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13
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McNerney MW, Hobday T, Cole B, Ganong R, Winans N, Matthews D, Hood J, Lane S. Objective Classification of mTBI Using Machine Learning on a Combination of Frontopolar Electroencephalography Measurements and Self-reported Symptoms. SPORTS MEDICINE-OPEN 2019; 5:14. [PMID: 31001724 PMCID: PMC6473006 DOI: 10.1186/s40798-019-0187-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/28/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND The reliable diagnosis of a mild traumatic brain injury (mTBI) is a pervasive problem in sports and in the military. The frequency and severity of each occurrence, while difficult to quantify, may impact long term cognitive function and quality of life. Despite the new revelations concerning brain disfunction from head injuries, individuals still feel pressure to remain on the field despite a debilitating injury. In this study, we evaluated the accuracy of a system that could be employed on the sidelines or in the locker room to provide an immediate objective mTBI assessment. METHODS Participants consisted of 38 individuals with a recent mTBI and 47 controls with no history of mTBI within the last 5 years. Participants were administered a simple symptom questionnaire, behavioral tests, and resting state EEG was measured using three frontopolar electrodes. An advanced machine learning algorithm called boosting was utilized to classify subjects into either injured or controls using power spectral densities on 1-min of resting EEG and the symptom questionnaire. RESULTS Results based on leave-one-out cross-validation revealed that the addition of EEG measurements boosted the accuracy to approximately 91 ± 2% compared to 82 ± 4% from the symptom questionnaire alone. CONCLUSION This study demonstrated the potential benefit of including EEG measurements to diagnose suspected brain injury patients. This is a step toward accurate and objective classification measurements that can be implemented on the field as a future injury assessment tool.
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Affiliation(s)
- M Windy McNerney
- Tahoe Institute for Rural Health Research, 10121 Pine Ave, PO Box 759, Truckee, CA, 96160, USA.
| | - Thomas Hobday
- Tahoe Institute for Rural Health Research, 10121 Pine Ave, PO Box 759, Truckee, CA, 96160, USA
| | - Betsy Cole
- Tahoe Institute for Rural Health Research, 10121 Pine Ave, PO Box 759, Truckee, CA, 96160, USA
| | | | | | - Dennis Matthews
- Tahoe Institute for Rural Health Research, 10121 Pine Ave, PO Box 759, Truckee, CA, 96160, USA.,Department of Neurological Surgery, University of California, Davis, Sacramento, CA, USA
| | - Jim Hood
- Tahoe Institute for Rural Health Research, 10121 Pine Ave, PO Box 759, Truckee, CA, 96160, USA
| | - Stephen Lane
- Tahoe Institute for Rural Health Research, 10121 Pine Ave, PO Box 759, Truckee, CA, 96160, USA.,Department of Neurological Surgery, University of California, Davis, Sacramento, CA, USA
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14
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Theta-Band Functional Connectivity and Single-Trial Cognitive Control in Sports-Related Concussion: Demonstration of Proof-of-Concept for a Potential Biomarker of Concussion. J Int Neuropsychol Soc 2019; 25:314-323. [PMID: 30681045 DOI: 10.1017/s135561771800108x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This report examined theta-band neurodynamics for potential biomarkers of brain health in athletes with concussion. METHODS Participants included college-age contact/collision athletes with (N=24) and without a history of concussion (N=16) in Study 1. Study 2 (N=10) examined changes over time in contact/collision athletes. There were two primary dependent variables: (1) theta-band phase-synchronization (e.g., functional connectivity) between medial and right-lateral electrodes; and (2) the within-subject correlation between synchronization strength on error trials and post-error reaction time (i.e., operationalization of cognitive control). RESULTS Head injury history was inversely related with medial-lateral connectivity. Head injury was also related to declines in a neurobehavioral measure of cognitive control (i.e., the single-trial relationship between connectivity and post-error slowing). CONCLUSIONS Results align with a theory of connectivity-mediated cognitive control. Mild injuries undetectable by behavioral measures may still be apparent on direct measures of neural functioning. This report demonstrates that connectivity and cognitive control measures may be useful for tracking recovery from concussion. Theoretically relevant neuroscientific findings in healthy adults may have applications in patient populations, especially with regard to monitoring brain health. (JINS 2019, 25, 314-323).
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Satarasinghe P, Hamilton DK, Buchanan RJ, Koltz MT. Unifying Pathophysiological Explanations for Sports-Related Concussion and Concussion Protocol Management: Literature Review. J Exp Neurosci 2019; 13:1179069518824125. [PMID: 30675103 PMCID: PMC6330734 DOI: 10.1177/1179069518824125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/19/2018] [Indexed: 11/15/2022] Open
Abstract
Objective There is a plethora of theories about the pathophysiology behind a sport-related concussion. In this review of the literature, the authors evaluated studies on the pathophysiology of sport-related concussion and professional athlete return-to-play guidelines. The goal of this article is to summarize the most common hypotheses for sport-related concussion, evaluate if there are common underlying mechanisms, and determine if correlations are seen between published mechanisms and the most current return-to-play recommendations. Methods Two authors selected papers from the past 5 years for literature review involving discussion of sport-related concussion and pathophysiology, pathology, or physiology of concussion using mutually agreed-upon search criteria. After the articles were filtered based on search criteria, pathophysiological explanations for concussion were organized into tables. Following analysis of pathophysiology, concussion protocols and return-to-play guidelines were obtained via a Google search for the major professional sports leagues and synthesized into a summary table. Results Out of 1112 initially identified publications, 53 met our criteria for qualitative analysis. The 53 studies revealed 5 primary neuropathological explanations for sport-related concussion, regardless of the many theories talked about in the different papers. These 5 explanations, in order of predominance in the articles analyzed, were (1) tauopathy, (2) white matter changes, (3) neural connectivity alterations, (4) reduction in cerebral perfusion, and (5) gray matter atrophy. Pathology may be sport specific: white matter changes are seen in 47% of football reports, tauopathy is seen in 50% of hockey reports, and soccer reports 50% tauopathy as well as 50% neural connectivity alterations. Analysis of the return-to-play guidelines across professional sports indicated commonalities in concussion management despite individual policies. Conclusions Current evidence on pathophysiology for sport-related concussion does not yet support one unifying mechanism, but published hypotheses may potentially be simplified into 5 primary groups. The unification of the complex, likely multifactorial mechanisms for sport-related concussion to a few common explanations, combined with unique findings within individual sports presented in this report, may help filter and link concussion pathophysiology in sport. By doing so, the authors hope that this review will help guide future concussion research, treatment, and management.
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Affiliation(s)
- Praveen Satarasinghe
- Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - D Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert J Buchanan
- Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Department of Neurosurgery, Seton Brain and Spine Institute, Austin, TX, USA
| | - Michael T Koltz
- Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Department of Neurosurgery, Seton Brain and Spine Institute, Austin, TX, USA
- Michael T Koltz, Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA.
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16
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Broglio SP, Williams R, Lapointe A, Rettmann A, Moore B, Meehan SK, Eckner JT. Brain Network Activation Technology Does Not Assist with Concussion Diagnosis and Return to Play in Football Athletes. Front Neurol 2017. [PMID: 28634467 PMCID: PMC5460056 DOI: 10.3389/fneur.2017.00252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Concussion diagnosis and management remains a largely subjective process. This investigation sought to evaluate the utility of a novel neuroelectric measure for concussion diagnosis and return to play decision-making. Hypothesis Brain Network Activation (BNA) scores obtained within 72-h of injury will be lower than the athlete’s preseason evaluation and that of a matched control athlete; and the BNA will demonstrate ongoing declines at the return to play and post-season time points, while standard measures will have returned to pre-injury and control athlete levels. Design Case–control study. Methods Football athletes with a diagnosed concussion (n = 8) and matched control football athletes (n = 8) completed a preseason evaluation of cognitive (i.e., Cogstate Computerized Cognitive Assessment Tool) and neuroelectric function (i.e., BNA), clinical reaction time, SCAT3 self-reported symptoms, and quality of life (i.e., Health Behavior Inventory and Satisfaction with Life Scale). Following a diagnosed concussion, injured and control athletes completed post-injury evaluations within 72-h, once asymptomatic, and at the conclusion of the football season. Results Case analysis of the neuroelectric assessment failed to provide improved diagnostics beyond traditional clinical measures. Statistical analyses indicated significant BNA improvements in the concussed and control groups from baseline to the asymptomatic timepoint. Conclusion With additional attention being placed on rapid and accurate concussion diagnostics and return to play decision-making, the addition of a novel neuroelectric assessment does not appear to provide additional clinical benefit at this time. Clinicians should continue to follow the recommendations for the clinical management of concussion with the assessment of the symptom, cognitive, and motor control domains.
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Affiliation(s)
- Steven P Broglio
- NeuroTrauma Research Laboratory, University of Michigan Injury Center, University of Michigan, Ann Arbor, MI, United States
| | - Richelle Williams
- NeuroTrauma Research Laboratory, University of Michigan, Ann Arbor, MI, United States
| | - Andrew Lapointe
- NeuroTrauma Research Laboratory, University of Michigan, Ann Arbor, MI, United States
| | - Ashley Rettmann
- NeuroTrauma Research Laboratory, University of Michigan, Ann Arbor, MI, United States
| | - Brandon Moore
- Michigan NeuroSport, University of Michigan, Ann Arbor, MI, United States
| | - Sean K Meehan
- Human Sensorimotor Laboratory, University of Michigan, Ann Arbor, MI, United States
| | - James T Eckner
- Department of Physical Medicine and Rehabilitation, Michigan NeuroSport, University of Michigan, Ann Arbor, MI, United States
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Cochrane GD, Owen M, Ackerson JD, Hale MH, Gould S. Exploration of US men's professional sport organization concussion policies. PHYSICIAN SPORTSMED 2017; 45:178-183. [PMID: 28287034 DOI: 10.1080/00913847.2017.1305875] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Concussion policies are increasingly being developed and adopted among professional sports organizations. We sought to compare the policies of the National Hockey League (NHL), the National Basketball Association (NBA), the National Football League (NFL), and Major League Baseball (MLB). Our objective was to summarize each policy and evaluate the extent to which each policy is organization-specific and/or consistent with medical guidelines. We visited websites for the NHL, NBA, NFL, and MLB. We searched media articles reporting concussion policy. We utilized only publically available data. We collected information on each league's approach to the definition of concussion, education provided about concussion, baseline testing requirements, minimum return to play time and return to play protocol. We found that concussion policies vary across these organizations. Most organizations utilize the Concussion in Sport Group (CISG) definition (2013) to define concussion. The NFL and NBA mandate preseason education. All organizations require some type of baseline testing. All organizations require sideline evaluation after suspected concussion. The NFL and MLB require Sport Concussion Assessment Tool (SCAT) testing for sideline evaluation of suspected concussion. MLB is the only organization to require minimum time before return to play. There is a return to play protocol in place for each organization. The NFL and MLB require independent neurologic consultation as part of their return to play protocol. There is variability in concussion policy among the professional sports organizations. The most pronounced variation from the CISG consensus statement is the variability in the minimum time to return to play. Further, the rules of the individual sports have a role in how concussion policy can be designed and implemented. Professional sports set an example for thousands of recreational sports enthusiasts so their publically available policies on concussion have a large impact.
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Affiliation(s)
- Graham Dean Cochrane
- a University of Alabama at Birmingham School of Medicine , Birmingham , AL , USA
| | - Matthew Owen
- a University of Alabama at Birmingham School of Medicine , Birmingham , AL , USA
| | - Joseph D Ackerson
- b Department of Psychology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Matthew H Hale
- a University of Alabama at Birmingham School of Medicine , Birmingham , AL , USA
| | - Sara Gould
- c Division of Orthopedics, Department of Surgery , University of Alabama at Birmingham , Birmingham , AL , USA
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