A Nonliquid Crystal Display Screen Computer for Treatment of Photosensitivity and Computer Screen Intolerance in Post-Concussion Syndrome

Double Vision and Light Sensitivity Symptoms are Associated With Return-to-School Timing After Pediatric Concussion

OBJECTIVE

To determine the association between academic time loss postconcussion and vision symptoms/impairments among pediatric patients.

DESIGN

Cross-sectional.

SETTING

Sports medicine clinic.

PATIENTS

Pediatric patients seen for care in a sports medicine clinic between the ages 6 and 18 years (n = 212; mean age = 14.3, SD = 2.4 years; 48% female) were evaluated within 21 days of concussion (mean = 9.8, SD = 5.7 days).

INDEPENDENT VARIABLE

Patients were grouped based on academic time loss (missed >5 days vs ≤5 days of school) at their initial postconcussion evaluation.

OUTCOME MEASURES

Patients rated concussion symptoms using the Health and Behavior Inventory (HBI) and underwent near point of convergence (NPC) testing. We compared groups on specific HBI symptom ratings of dizziness, blurry vision, seeing double, and light sensitivity, as well as NPC break and recovery point distances.

RESULTS

Two hundred twelve patients were included; n = 36 (17%) who reported missing >5 days of school. After adjusting for time since injury, parental education level, mechanism of injury, and preinjury anxiety, patients who reported missing >5 days of school had higher ratings of double vision (β = 0.27; 95% confidence interval [CI], 0.01-0.53; P = 0.04) and light sensitivity (β = 0.506; 95% CI, 0.061-0.951; P = 0.02), but not dizziness (β = 0.390; 95% CI, -0.047 to 0.827; P = 0.08) or blurry vision (β = 0.026; 95% CI, -0.352 to 0.404; P = 0.89).

CONCLUSION

Missing >5 days of school was associated with worse double vision and light sensitivity symptoms. Given the importance of vision in learning, assessing postconcussion vision symptoms may facilitate a successful return to school. Clinicians should assess a wide spectrum of vision-specific symptoms to ensure appropriate support during the return-to-school process.

Sensory sensitivity after acquired brain injury: A systematic review

Patients with acquired brain injury frequently report experiencing sensory stimuli as abnormally under- (sensory hyposensitivity) or overwhelming (sensory hypersensitivity). Although they can negatively impact daily functioning, these symptoms are poorly understood. To provide an overview of the current evidence on atypical sensory sensitivity after acquired brain injury, we conducted a systematic literature review. The primary aim of the review was to investigate the behavioural and neural mechanisms that are associated with self-reported sensory sensitivity. Studies were included when they studied sensory sensitivity in acquired brain injury populations, and excluded when they were not written in English, consisted of non-empirical research, did not study human subjects, studied pain, related sensory sensitivity to peripheral injury or studied patients with a neurodegenerative disorder, meningitis, encephalitis or a brain tumour. The Web of Science, PubMed and Scopus databases were searched for appropriate studies. A qualitative synthesis of the results of the 81 studies that were included suggests that abnormal sensory thresholds and a reduced information processing speed are candidate behavioural mechanisms of atypical subjective sensory sensitivity after acquired brain injury. Furthermore, there was evidence for an association between subjective sensory sensitivity and structural grey or white matter abnormalities, and to functional abnormalities in sensory cortices. However, further research is needed to explore the causation of atypical sensory sensitivity. In addition, there is a need for the development of adequate diagnostic tools. This can significantly advance the quantity and quality of research on the prevalence, aetiology, prognosis and treatment of these symptoms.

Visual effects of concussion: A review

A concussion occurs when a direct or indirect force is transmitted to the brain, causing a change in brain function. Given that approximately half the brain circuits are involved in vision and the control of eye movements, a concussion frequently results in visual symptoms. Ophthalmic abnormalities are helpful in the assessment of acute concussion, identified by rapid automized naming tasks and eye movement assessments. In particular, convergence, eye-tracking and the vestibular-ocular motor screening tool may be used. For patients suffering from post-concussion syndrome more than 3 months from the original injury, abnormalities may be found in convergence, accommodation and smooth pursuit. Orthoptic exercises are useful rehabilitation tools to allow patients to return to school, work and recreation. This article provides a brief overview of concussion as it relates to vision and ophthalmic practice.

Reading Abilities Post Traumatic Brain Injury in Adolescents and Adults: A Systematic Review and Meta-Analysis

Purpose People with traumatic brain injury (TBI) often struggle with complex reading, limiting participation in work and educational settings. This systematic review and meta-analysis examined studies of reading conducted with adolescents and adults with TBI to describe reading problems post TBI and investigate underlying factors for the effects of TBI on reading abilities. Method The search was conducted in EBSCO (including MEDLINE, PsycINFO, etc.), BIOSIS, ProQuest, and Web of Science. Empirical studies that used samples with a mean age greater than 10 years, reported injury characteristics, and investigated complex reading abilities (defined as greater than single-word reading) were eligible for this review. Study quality was evaluated using QualSyst. Study and sample characteristics, measures, and outcomes of interest were extracted and synthesized in the review. Studies that compared reading abilities between people with and without TBI were included in the meta-analysis. Results Twenty-four studies met inclusion criteria, six of which addressed reading in pediatric samples. Findings from heterogeneous samples supported the existence of reading deficits post TBI, including mild TBI. In studies of children, comprehension was examined most frequently, whereas reading speed was the focus of most adult studies. Oculomotor functions and processing speed were related to reading speed; cognitive functions, such as attention and memory, were associated with reading comprehension. Intervention studies were limited, but most reported positive effects. The meta-analysis confirmed the impact of TBI on reading with a large effect size (g = 1.23). Demographic, injury, and study variables did not moderate overall reading outcomes, but male sex was a significant moderator of impairment in reading speed. Discussion Global reading ability, including both comprehension and speed, is negatively impacted by TBI. Future research should continue to explore reading after TBI, including its underlying mechanisms, effects on complex reading activities such as inferencing, development of screening and assessment tools that address a range of functional reading needs, and efficacy of reading-related interventions.

Technology and concussion: A scoping review

Background

Technology for concussion identification and management is rapidly expanding across the continuum of care. Although many technologies offer a range of services around concussion, there is an absence of a non-commercial online location for medical providers to access regarding the functionality of the various technologies used in concussion identification and management.

Objective

The purpose of this review is to present research findings on technology for concussion identification and management.

Methods

Searches for eligible studies were conducted using the PubMed, EMBASE, and Scopus databases with specific search criteria. Through a stepwise process, full-text articles were selected for inclusion if they described clinically useful electronic technologies (i.e. electronics able to be used in standard clinical environments including telehealth) by healthcare providers or end users (i.e. parents or athletes).

Results

A total of 29 articles were included in this review and described technology used to measure symptoms (3), neurocognitive performance (7), the visual system (4), and balance or dual task performance (18). Within the results, various technologies demonstrated increased utility for concussion identification, often detecting subtle deficits not possible with current low-tech clinical methods, differentiating those with concussion from those without concussion, with strong reliability and validity.

Conclusion

Innovative technologies included in this review demonstrate enhanced ability to identify and manage symptoms of concussion, neurocognitive deficits, visual deficits, and balance and dual-task deficits.

A Systematic Review of Telehealth and Sport-Related Concussion: Baseline Testing, Diagnosis, and Management

Background: The use of telehealth has increased as a result of the COVID-19 pandemic. As sports at all levels resume, sports medicine physicians may be interested in how telehealth can be used for concussion care. Questions/Purpose: We sought to assess how telehealth has been used in the baseline testing, diagnosis, and/or management of concussion. Secondarily, we sought to assess the strengths and weaknesses of telehealth for concussion care and identify aspects of concussion care for which telehealth has not yet been studied. Methods: A systematic review was performed in September 2020 of PubMed and Embase using the following terms: concuss*, "mild traumatic brain," "head injur*," telehealth, telemedicine, telecare, "mobile health," m-health, virtual. Studies included were original research articles investigating the use of telehealth in the care of concussion (including baseline testing, diagnosis, and management), published in English, and had full text available. Results: A total of 356 articles were screened, of which 5 were determined to meet inclusion criteria. These articles described the use of telehealth for managing concussion in military and rural settings. No articles involved the use of telehealth for baseline concussion testing of athletes or for sideline evaluation. Conclusion: Despite the limited original research on the use of telehealth for concussion care, the articles identified provide a foundation for exploring the potential value of telehealth in the office practice and sports team setting. Telehealth may expand the ability of a sports medicine physician to provide timely and effective concussion care to athletes during the COVID-19 pandemic and beyond. More rigorous research is needed.

Patient and clinician experiences of a computerised cognitive battery for use after concussion: a preliminary qualitative study

Objective:

The Cognition Battery of the National Institute of Health (NIH) Toolbox for Assessment of Neurological and Behavioural Function is a computerised neuropsychological battery recommended for clinical practice, neurological research and clinical trials. We investigated the utility of the NIH Toolbox Cognition Battery (NIHTB-CB) for people with concussion.

Methods:

In this small qualitative study, semi-structured interviews were conducted with five adults with concussion who were participating in a larger study using the NIHTB-CB. Three clinician participants and two cultural advisors familiar with the tool were also interviewed. Interview transcripts were analysed using a general thematic approach and qualitative description.

Results:

Participants described both positive and negative experiences with the NIHTB-CB and using qualitative description, their experiences were organised into three broad themes: (1) using technology for cognitive testing made sense, (2) there were some cultural relevance questions and (3) cognitive testing after concussion could have challenges. They were positive about the computerised format and range of domains assessed for the concussion context but identified the contextual relevance of some content as having potential to impact on performances.

Conclusion:

This was a small study examining the experiences of a select group of participants, but nevertheless does suggest a need for future research validating the NIHTB-CB for use in different cultural and clinical contexts.

Preliminary evidence-based recommendations for return to learn: a novel pilot study tracking concussed college students

Aim:

Students re-entering the academic setting after a concussion is commonly referred to as return-to-learn and, to date, very few studies have examined the return-to-learn aspect of concussion recovery.

Methodology:

Nine college-aged, full-time students who were diagnosed with concussions were monitored throughout their concussion recovery. The severity for five chief symptoms (headache, dizziness, difficulty concentrating, fatigue, anxiety) were recorded six-times per day through text messages, and daily phone calls recorded participant's behavioral traits.

Results:

We identified five behavioral variables which significantly influenced symptom resolution (music, sleep, physical activity, water and time) (p = 0.0004 to p = 0.036). Additionally, subjects reported math and computer-oriented courses as the most difficult (33 and 44%, respectively).

Conclusion:

We introduce a novel approach to monitor concussed students throughout their recovery, as well as factors that may influence concussion recovery process.

Concussed students and student-athletes returning to the classroom is commonly referred as return-to-learn. To date, there are very few recommendations that can aid students’ concussion recovery in relation to their academic responsibilities. This is trouble giving that every student-athlete is first and foremost a ‘student’. In light of this, we sought to track behavioral factors that might influence the resolution of college students’ concussion symptoms as they recover from their injury and return to their coursework. Students also gave a perception of their recovery, including what types of activities and school accommodations appeared beneficial. In turn, behaviors such as minimizing music, getting more sleep, introducing more physical activity, drinking more water and overall time since injury appeared to help resolving the concussion symptoms. Additionally, students reported that math and computer-oriented courses were the most difficult, and that additional time on assignments/exams and reducing screen brightness were the most beneficial accommodations. These results are the first of their kind and will optimistically lead to recommendations utilized by healthcare professionals.

Narrative Review of the Pathophysiology of Headaches and Photosensitivity in Mild Traumatic Brain Injury and Concussion

The most common symptom of post-concussive syndrome (PCS) is post-traumatic headache (PTH) accompanied by photophobia. Post-traumatic headache is currently categorized as a secondary headache disorder with a clinical phenotype described by its main features and resembling one of the primary headache disorders: tension, migraine, migraine-like cluster. Although PTH is often treated with medication used for primary headache disorders, the underlying mechanism for PTH has yet to be elucidated. The goal of this narrative literature review is to determine the current level of knowledge of these PTHs and photophobia in mild traumatic brain injury (mTBI) in order to guide further research and attempt to discover the underlying mechanism to both symptoms. The ultimate purpose is to better understand the pathophysiology of these symptoms in order to provide better and more targeted care to afflicted patients. A review of the literature was conducted using the databases CINAHL, EMBASE, PubMed. All papers were screened for sections on pathophysiology of PTH or photophobia in mTBI patients. Our paper summarizes current hypotheses. Although the exact pathophysiology of PTH and photophobia in mTBI remains to be determined, we highlight several interesting findings and avenues for future research, including central and peripheral explanations for PTH, neuroinflammation, cortical spreading depolarization and the role of glutamate excitotoxicity. We discuss the possible neuroanatomical pathways for photophobia and hypothesize a possible common pathophysiological basis between PTH and photophobia.