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Jo J, Berkner PD, Stephenson K, Maxwell BA, Iverson GL, Zuckerman SL, Terry DP. Examining Acute Symptoms After Sport-Related Concussion in Collegiate Athletes With Preinjury Migraines. Clin J Sport Med 2024:00042752-990000000-00188. [PMID: 38780403 DOI: 10.1097/jsm.0000000000001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 04/28/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To examine whether a personal history of migraines is associated with worse acute symptom burden after sport-related concussion (SRC). DESIGN Retrospective cohort study. SETTING National Collegiate Athletic Association Division III collegiate programs. PARTICIPANTS Collegiate athletes from a prospective concussion surveillance system between 09, 2014, and 01, 2023. INTERVENTION Preinjury migraines (yes/no) were self-reported by athletes. MAIN OUTCOME MEASURES Post-Concussion Symptom Scale (PCSS) were collected within 3 days postinjury. Mann-Whitney U tests compared total PCSS scores and individual symptom scores between athletes with and without preinjury migraines. Chi-squared tests were used to compare proportions of athletes endorsing individual symptoms (ie, item score ≥1) between 2 groups. Multivariable regression analyzed potential predictors of PCSS scores. RESULTS Of 1190 athletes with SRC, 93 (7.8%) reported a preinjury history of migraines. No significant difference in total PCSS scores was found between athletes with and without preinjury migraines (22.0 ± 16.4 vs 20.5 ± 15.8, U = 48 719.0, P = 0.471). Athletes with preinjury migraines reported greater severity of "sensitivity to light" (1.59 ± 1.59 vs 1.23 ± 1.41, P = 0.040) and "feeling more emotional" (0.91 ± 1.27 vs 0.70 ± 1.30; P = 0.008) and were more likely to endorse "feeling more emotional" (45.2% vs 29.5%, P = 0.002). No differences were found across all other symptoms, including headaches (migraine = 87.1% vs no migraine = 86.3%, P = 0.835). In a multivariable model, a history of migraine was not a significant predictor of acute PCSS scores, but those with a history of psychological disorders (β = 0.12, P <0 .001) and greater number of days to symptom evaluation (β = 0.08, P = 0.005) had higher PCSS scores. CONCLUSIONS Collegiate athletes with a pre-existing history of migraines did not have higher acute symptom burden after SRC.
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Affiliation(s)
- Jacob Jo
- Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul D Berkner
- College of Osteopathic Medicine, University of New England, Biddeford, Maine
| | - Katie Stephenson
- College of Osteopathic Medicine, University of New England, Biddeford, Maine
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Bruce A Maxwell
- Khoury College of Computer Science, Northeastern University, Seattle, Washington
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- MassGeneral Hospital for Children Sports Concussion Program, Waltham, Massachusetts; and
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and the Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas P Terry
- Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Fan F, Anderson V, Morawakage T, Khan N, Shapiro JS, Ignjatovic V, Takagi M. Post-traumatic headache pathophysiology in paediatric concussion: A systematic review. Neurosci Biobehav Rev 2024; 156:105498. [PMID: 38043751 DOI: 10.1016/j.neubiorev.2023.105498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/05/2023]
Abstract
Post-traumatic headache (PTH) represents the most common acute and persistent symptom following concussion in children, yet the underlying pathophysiology remains unclear. This systematic review sought to: (i) rigorously examine the current evidence of PTH pathophysiology in paediatric concussion (0-18 years), (ii) assess the quality of evidence, and (iii) provide directions for future research in accordance with PRISMA guidelines. Eligible studies (n = 19) totalling 1214 concussion participants investigated cerebrovascular function (n = 6), white matter integrity (n = 3), functional connectivity (n = 3), electrophysiology (n = 1), neurometabolics (n = 2), biological fluid markers (n = 4), vestibular and oculomotor function (n = 4); two studies used a multi-modal approach. Majority of studies were rated as fair quality (90%) and Level 3 evidence (84%). The true underlying mechanisms of PTH following paediatric concussion remain unclear. Overall quality of the available evidence is generally weak with a fair risk of bias and characterised by relative scarcity and lack of specificity of PTH pathophysiology. Future research is required to rigorously isolate pathophysiology specific to PTH with strict adherence to clinical definitions and standardised measurement tools of PTH.
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Affiliation(s)
- Feiven Fan
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia.
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Psychology Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Noor Khan
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Jesse S Shapiro
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Vera Ignjatovic
- Department of Paediatrics, University of Melbourne, Victoria, Australia; Institute for Clinical & Translational Research, Johns Hopkins All Children's, St Petersburg, FL, USA; Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
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Mavroudis I, Ciobica A, Luca AC, Balmus IM. Post-Traumatic Headache: A Review of Prevalence, Clinical Features, Risk Factors, and Treatment Strategies. J Clin Med 2023; 12:4233. [PMID: 37445267 DOI: 10.3390/jcm12134233] [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] [Received: 04/25/2023] [Revised: 05/23/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Post-traumatic headache (PTH) is a common and debilitating consequence of mild traumatic brain injury (mTBI) that can occur over one year after the head impact event. Thus, better understanding of the underlying pathophysiology and risk factors could facilitate early identification and management of PTH. There are several factors that could influence the reporting of PTH prevalence, including the definition of concussion and PTH. The main risk factors for PTHs include a history of migraines or headaches, female gender, younger age, greater severity of the head injury, and co-occurring psychological symptoms, such as anxiety and depression. PTH clinical profiles vary based on onset, duration, and severity: tension-type headache, migraine headaches, cervicogenic headache, occipital neuralgia, and new daily persistent headache. Pharmacological treatments often consist of analgesics and non-steroidal anti-inflammatory drugs, tricyclic antidepressants, or antiepileptic medication. Cognitive behavioral therapy, relaxation techniques, biofeedback, and physical therapy could also be used for PTH treatment. Our work highlighted the need for more rigorous studies to better describe the importance of identifying risk factors and patient-centered treatments and to evaluate the effectiveness of the existing treatment options. Clinicians should consider a multidisciplinary approach to managing PTH, including pharmacotherapy, cognitive behavioral therapy, and lifestyle changes.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals, NHS Trust, Leeds LS2 9JT, UK
- Faculty of Medicine, Leeds University, Leeds LS2 9JT, UK
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University, 700506 Iasi, Romania
- Centre of Biomedical Research, Romanian Academy, B dul Carol I, No. 8, 700506 Iasi, Romania
- Academy of Romanian Scientists, Splaiul Independentei nr. 54, Sector 5, 050094 Bucuresti, Romania
| | - Alina Costina Luca
- Department of Mother and Child, Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 16, Universitatii Street, 700115 Iasi, Romania
| | - Ioana-Miruna Balmus
- Department of Exact Sciences and Natural Sciences, Institute of Interdisciplinary Research, "Alexandru Ioan Cuza" University of Iasi, 700057 Iasi, Romania
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Muir B, Boot B, Hamilton M. Can a structural leg length discrepancy contribute to persistent concussion symptoms? A case report. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2022; 66:300-309. [PMID: 36818361 PMCID: PMC9914830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
In the past several years, concussions and post-concussion syndrome (PCS) have become more commonly recognized conditions. However, with limited physiological explanation for post-concussion syndrome, there is also limited evidence supporting effective treatment. The vestibular system plays a role in postural reflexes and coordinated eye and cervical spine movements and is often disrupted in patients with prolonged concussion symptoms. This disruption has contributed to some of the most debilitating symptoms in PCS patients including dizziness, nausea, and balance deficits. Ongoing, post-concussion, vestibulo-ocular/cervical-ocular disruption due to an underlying structural leg length discrepancy as a contributing factor has not been previously described in the literature. A case of PCS with initial conservative treatment of their structural leg length discrepancy and subsequent vestibulo-ocular/cervical-ocular rehabilitation is presented.
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Affiliation(s)
- Brad Muir
- Canadian Memorial Chiropractic College
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5
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Stephen SJ, Hasman L, Goldenberg M, Merchant-Borna K, Kawata K, Mannix R, Bazarian JJ. Short-Term Neurologic Manifestations of Repetitive Head Impacts Among Athletes: A Scoping Review. J Head Trauma Rehabil 2022; 37:318-325. [PMID: 35293363 DOI: 10.1097/htr.0000000000000767] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To summarize the evidence linking contact sports-related repetitive head impacts (RHIs) and short-term declines in neurologic function. METHODS A scoping review following the guidelines in the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and searching 3 databases (PubMed, EMBASE, and Web of Science) was performed. Peer-reviewed research articles were eligible for inclusion if they were full-length English language articles published between 1999 and 2019 examining athletes between the ages of 14 and 40 years exposed to RHIs, and reporting cognitive, vestibular, and/or oculomotor outcomes within 4 weeks of last head hit exposure. RESULTS Fifty-two articles met criteria for review: 14 reported oculomotor outcomes, 23 reported vestibular outcomes, and 36 reported cognitive function. Short-term RHI-related declines in neurologic function were reported in 42.9% of oculomotor studies, in 20.8% of vestibular studies, and in 33.3% of cognitive studies. Most of the 52 studies involved American football, soccer, or ice hockey athletes at the collegiate ( n = 23) or high school ( n = 14) level. Twenty-four (46%) studies involved only male athletes. Wearable sensors were used to measure RHIs in 24 studies (46%), while RHIs were not measured in 26 studies (50%). In addition, many studies failed to control for attention-deficit/hyperactivity disorder/learning disability and/or concussion history. CONCLUSION The results of this scoping review suggest that the evidence linking RHIs to short-term declines in neurologic function is relatively sparse and lacking in methodological rigor. Although most studies failed to find a link, those that did were more likely to use objective measures of RHIs and to control for confounders. More careful trial design may be needed to definitively establish a causal link between RHIs and short-term neurologic dysfunction.
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Affiliation(s)
- Steve J Stephen
- University of Rochester, Rochester, New York (Mr Stephen, Mss Hasman, Goldenberg, and Mr Merchant-Borna, and Dr Bazarian); Indiana University, Bloomington (Dr Kawata); and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Mannix)
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6
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Parrington L, King LA, Hoppes CW, Klaiman MJ, Michielutti P, Fino PC, Dibble LE, Lester ME, Weightman MM. Exploring Vestibular Ocular Motor Screening in Adults With Persistent Complaints After Mild Traumatic Brain Injury. J Head Trauma Rehabil 2022; 37:E346-E354. [PMID: 35067602 DOI: 10.1097/htr.0000000000000762] [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: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to (1) explore differences in vestibular ocular motor screening (VOMS) symptoms between healthy adults and adults with persistent symptoms after mild traumatic brain injury (mTBI), and (2) explore the relationships between VOMS symptoms and other measures (self-reported vestibular symptoms, clinical measures of balance and gait, and higher-level motor ability tasks). SETTING Research laboratory setting. PARTICIPANTS Fifty-three persons with persistent symptoms (>3 weeks) following mTBI and 57 healthy controls were recruited. Eligibility for participation included being 18 to 50 years of age and free of medical conditions that may affect balance, with the exception of recent mTBI for the mTBI group. DESIGN Cross-sectional. MAIN MEASURES The primary outcomes were the VOMS symptom scores and near point of convergence (NPC) distance. Secondary outcomes included the Dizziness Handicap Inventory (DHI) total and subdomain scores, sway area, Functional Gait Analysis total score, gait speed, and modified Illinois Agility Task completion time, and Revised High-Level Mobility Assessment Tool total score. RESULTS The mTBI group reported more VOMS symptoms ( z range, -7.28 to -7.89) and a further NPC ( t = -4.16) than healthy controls (all P s < .001). DHI self-reported symptoms (total and all subdomain scores) were strongly associated with the VOMS symptom scores (rho range, 0.53-0.68; all P s < .001). No significant relationships existed between VOMS symptoms and other measures. CONCLUSION Significant group differences support the relevance of the VOMS for mTBI in an age-diverse sample with persistent symptoms. Furthermore, strong association with DHI symptoms supports the ability of the VOMS to capture vestibular complaints in this population.
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Affiliation(s)
- Lucy Parrington
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Victoria, Australia (Dr Parrington); Department of Neurology, Oregon Health & Science University, Portland (Drs Parrington and King); Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, Texas (Drs Hoppes and Lester); Courage Kenny Research Center, Allina Health, Minneapolis, Minnesota (Mr Klaiman and Drs Michielutti and Weightman); Departments of Health and Kinesiology (Dr Fino) and Physical Therapy & Athletic Training (Dr Dibble), University of Utah, Salt Lake City; Department of Physical Therapy, Texas State University, Round Rock (Dr Lester)
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7
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Burns KN, Langford TD, Tierney R, McDevitt J. Premorbid Primary Headache and Vestibular and Oculomotor Baseline Assessments in Collegiate Athletes. Clin J Sport Med 2022; 32:e457-e460. [PMID: 36083331 DOI: 10.1097/jsm.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 10/06/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the effects of premorbid headache status on vestibular and oculomotor baseline tests in collegiate club athletes. DESIGN Retrospective case-control study. SETTING Sport Concussion Laboratory. PATIENTS OR PARTICIPANTS Collegiate club athletes with a self-reported premorbid headache history (n = 32, 19.50 ± 1.98 years, and 31% women) and age-sex-sport-matched controls (n = 32, 19.56 ± 1.47 years, and 31% women) without a self-reported headache history were included. INTERVENTIONS Participants were grouped based on a self-reported headache history at baseline. Controls were randomly matched to self-reported headache participants by age, sex, and sport. MAIN OUTCOME MEASURES Vestibular/ocular motor screen (VOMS) baseline symptoms, symptom provocation, near point of convergence (NPC) distance, and King-Devick (K-D) test time were compared between groups. RESULTS Athletes with a self-reported headache history at baseline are 3.82 times more likely to have abnormal NPC scores (P = 0.032) and 4.76 times more likely to have abnormal K-D test times (P = 0.014) than those without a headache history. There was no difference in VOMS baseline symptoms or symptom provocation between groups (P > 0.05). CONCLUSIONS Club collegiate athletes with a headache history were more likely to screen as abnormal during a vestibular/ocular motor function assessment than athletes without a history of headaches. Healthcare professionals should screen for pre-existing headache during baseline concussion assessments before test interpretation. CLINICAL RELEVANCE A premorbid headache history at preseason baseline assessment may influence vestibular and oculomotor function, and care should be taken when interpreting these individuals' tests.
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Affiliation(s)
- Karlee N Burns
- Department of Kinesiology, Temple University, Philadelphia, Pennsylvania
| | - Theresa Dianne Langford
- Department of Neuroscience, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania; and
| | - Ryan Tierney
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania
| | - Jane McDevitt
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania
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8
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Tomczyk CP, Anderson M, Petit KM, Savage JL, Covassin T. Vestibular/Ocular Motor Screening Assessment Outcomes After Sport-Related Concussion in High School and Collegiate Athletes. J Athl Train 2021; 56:1285-1291. [PMID: 34911074 PMCID: PMC8675312 DOI: 10.4085/1062-6050-0588.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Vestibular and ocular motor assessment is an emerging clinical assessment for patients with sport-related concussion (SRC). The increased use of these assessments by clinicians calls for the examination of outcomes that may affect clinical practice. OBJECTIVE To compare vestibular and ocular motor impairments in high school and collegiate athletes within 72 hours of SRC and examine the distribution of impairments in these populations based on pre-established clinical cutoff scores. DESIGN Cross-sectional study. SETTING High school and collegiate athletics. PATIENTS OR OTHER PARTICIPANTS Data were collected from 110 athletes (high school: n = 47, age = 15.40 ± 1.35 years; college: n = 63, age = 19.46 ± 1.28 years) within 72 hours of sustaining an SRC. MAIN OUTCOME MEASURE(S) Total and change scores were calculated for the Vestibular/Ocular Motor Screening (VOMS) tool, along with average near point of convergence (NPC) distance. Separate Mann-Whitney U tests were used to compare group differences, and χ2 analyses were used to examine the proportion of athletes with scores greater than clinical cutoff scores for all VOMS outputs. The α level was set a priori at .05. RESULTS No differences were found between high school and collegiate athletes for VOMS total and change scores and NPC distance. A larger proportion of the sample had scores greater than the cutoff for all total scores (P < .001) and change scores in horizontal vestibulo-ocular reflex (59.01%; P < .001), vertical vestibulo-ocular reflex (60.91%; P < .001), and visual motion sensitivity (60.91%; P < .001). However, a larger proportion demonstrated smooth pursuit change scores (85.45%; P < .001) and NPC distances (73.64%; P = .01) that were less than the cutoff scores. CONCLUSIONS During the acute phase of SRC, high school and collegiate athletes presented with similar vestibular and ocular motor impairments as measured using the VOMS, but vestibular tasks appeared to cause greater symptom provocation. Lastly, VOMS change scores may offer more clinical utility compared with total scores in assessing specific impairments after SRC.
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Affiliation(s)
| | - Morgan Anderson
- Department of Kinesiology, Michigan State University, East Lansing
| | - Kyle M. Petit
- School of Health Sciences, University of Mary, Bismarck, ND
| | | | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing
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Eagle SR, Kontos AP, Collins MW, Connaboy C, Flanagan SD. Network Analysis of Sport-Related Concussion Research During the Past Decade (2010-2019). J Athl Train 2021; 56:454353. [PMID: 33543307 PMCID: PMC8063657 DOI: 10.4085/1062-6050-0280.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Research into sport-related concussion (SRC) has grown substantially over the past decade, yet no authors to date have synthesized developments over this critical time period. OBJECTIVE To apply a network-analysis approach in evaluating trends in the SRC literature using a comprehensive search of original, peer-reviewed research articles involving human participants published between January 1, 2010, and December 15, 2019. DESIGN Narrative review. MAIN OUTCOME MEASURE(S) Bibliometric maps were derived from a comprehensive search of all published, peer-reviewed SRC articles in the Web of Science database. A clustering algorithm was used to evaluate associations among journals, organizations or institutions, authors, and key words. The online search yielded 6130 articles, 528 journals, 7598 authors, 1966 organizations, and 3293 key words. RESULTS The analysis supported 5 thematic clusters of journals: (1) biomechanics/sports medicine (n = 15), (2) pediatrics/rehabilitation (n = 15), (3) neurotrauma/neurology/neurosurgery (n = 11), (4) general sports medicine (n = 11), and (5) neuropsychology (n = 7). The analysis identified 4 organizational clusters of hub institutions: (1) University of North Carolina (n = 19), (2) University of Toronto (n = 19), (3) University of Michigan (n = 11), and (4) University of Pittsburgh (n = 10). Network analysis revealed 8 clusters for SRC key words, each with a central topic area: (1) epidemiology (n = 14), (2) rehabilitation (n = 12), (3) biomechanics (n = 11), (4) imaging (n = 10), (5) assessment (n = 9), (6) mental health/chronic traumatic encephalopathy (n = 9), (7) neurocognition (n = 8), and (8) symptoms/impairments (n = 5). CONCLUSIONS The findings suggest that during the past decade SRC research has (1) been published primarily in sports medicine, pediatric, and neuro-focused journals, (2) involved a select group of researchers from several key institutions, and (3) concentrated on new topical areas, including treatment or rehabilitation and mental health.
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Affiliation(s)
- Shawn R. Eagle
- Department of Orthopaedic Surgery, University of Pittsburgh, PA
| | | | | | - Chris Connaboy
- Neuromuscular Research Laboratory, University of Pittsburgh, PA
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10
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Keating CE, Browne KD, Duda JE, Cullen DK. Neurons in Subcortical Oculomotor Regions Are Vulnerable to Plasma Membrane Damage after Repetitive Diffuse Traumatic Brain Injury in Swine. J Neurotrauma 2020; 37:1918-1932. [PMID: 32178582 DOI: 10.1089/neu.2019.6738] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Oculomotor deficits, such as insufficiencies in accommodation, convergence, and saccades, are common following traumatic brain injury (TBI). Previous studies in patients with mild TBI attributed these deficits to insufficient activation of subcortical oculomotor nuclei, although the exact mechanism is unknown. A possible cause for neuronal dysfunction in these regions is biomechanically induced plasma membrane permeability. We used our established porcine model of head rotational TBI to investigate whether cell permeability changes occurred in subcortical oculomotor areas following single or repetitive TBI, with repetitive injuries separated by 15 min, 3 days, or 7 days. Swine were subjected to sham conditions or head rotational acceleration in the sagittal plane using a HYGE pneumatic actuator. Two hours prior to the final injury, the cell-impermeant dye Lucifer Yellow was injected into the ventricles to diffuse throughout the interstitial space to assess plasmalemmal permeability. Animals were sacrificed 15 min after the final injury for immunohistological analysis. Brain regions examined for cell membrane permeability included caudate, substantia nigra pars reticulata, superior colliculus, and cranial nerve oculomotor nuclei. We found that the distribution of permeabilized neurons varied depending on the number and spacing of injuries. Repetitive injuries separated by 15 min or 3 days resulted in the most permeability. Many permeabilized cells lost neuron-specific nuclear protein reactivity, although no neuronal loss occurred acutely after injury. Microglia contacted and appeared to begin phagocytosing permeabilized neurons in repetitively injured animals. These pathologies within oculomotor areas may mediate transient dysfunction and/or degeneration that may contribute to oculomotor deficits following diffuse TBI.
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Affiliation(s)
- Carolyn E Keating
- Center for Neurotrauma, Neurodegeneration and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.,Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin D Browne
- Center for Neurotrauma, Neurodegeneration and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.,Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John E Duda
- Center for Neurotrauma, Neurodegeneration and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.,Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - D Kacy Cullen
- Center for Neurotrauma, Neurodegeneration and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.,Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Aggarwal SS, Ott SD, Padhye NS, Schulz PE. Sex, race, ADHD, and prior concussions as predictors of concussion recovery in adolescents. Brain Inj 2020; 34:809-817. [DOI: 10.1080/02699052.2020.1740942] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Seema S. Aggarwal
- Center for Nursing Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Summer D. Ott
- Department of Orthopedics, McGovern Medical School of UTHealth, the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nikhil S. Padhye
- Center for Nursing Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Paul E. Schulz
- Department of Neurology, McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, Texas, USA
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12
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Houck ZM, Asken BM, Bauer RM, Caccese JB, Buckley TA, McCrea MA, McAllister TW, Broglio SP, Clugston JR. Academic aptitude mediates the relationship between socioeconomic status and race in predicting ImPACT scores in college athletes. Clin Neuropsychol 2019; 34:561-579. [PMID: 31549576 DOI: 10.1080/13854046.2019.1666923] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: To evaluate the influences of sociodemographic factors, estimated head impact exposure, and academic aptitude on ImPACT scores in college athletes.Methods: Data were reported on 18,886 participants (58% male) from the NCAA/DoD CARE Consortium. Race, SES, concussion history, estimated repetitive head impact exposure (eRHIE), and academic aptitude (SAT or ACT score) were our predictors of interest. Cognition was measured using ImPACT composite scores. We evaluated the mediating effects of academic aptitude on sociodemographic predictors and eRHIE on ImPACT scores. We then evaluated a football-only subsample and added age of first exposure to football (AFE) to the model. Males, females, and football players were analyzed separately using structural equation modeling.Results: Academic aptitude was associated with Black/African American race, SES, and each of the ImPACT composite scores. There were significant indirect effects of Black/African American race and SES on all ImPACT composite scores. Academic aptitude fully mediated SES effects and either fully or partially mediated race effects. Contrary to expectation, greater concussion history and eRHIE predicted better ImPACT scores.Conclusions: Academic aptitude, a stable indicator of premorbid cognitive function, consistently and most strongly predicted baseline ImPACT scores in collegiate student-athletes. Concussion and eRHIE history demonstrated a small positive, but non-significant, relationship with cognitive scores at the time of college athletic participation. This study suggests that attempts to characterize cognitive ability across the lifespan must consider premorbid functioning and sociodemographic variables.
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Affiliation(s)
- Zachary M Houck
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Breton M Asken
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Russell M Bauer
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Jaclyn B Caccese
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Michael A McCrea
- Department of Neurology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - James R Clugston
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA
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