Pub Date : 2023-01-01DOI: 10.1177/20597002231173772
Shazia Malik, Rahim Ahmed, Teresa Gambale, Michel Rathbone
Many head trauma patients who present with prolonged post-concussion symptoms do not meet the American Congress of Rehabilitation Medicine (ACRM) diagnostic criteria for mild traumatic brain injuries (mTBI). This population has not been extensively studied and its clinical characteristics are currently uncertain. A retrospective chart review was conducted to explore the symptomatic differences between mTBI and non-mTBI head trauma patients presenting at a concussion clinic with chronic post-concussion symptoms (PCSx). Patient information was extracted from 161 charts, of which 128 subjects met the ACRM criteria for mTBI (ACRM + PCSx), while 33 did not (non-ACRM + PCSx). These two groups were compared for demographic variables and symptomology. This study found that 20.5% of subjects presenting with chronic post-concussion symptoms do not meet ACRM criteria. No symptom-specific differences were found between the two populations in any of the categories tested. These results show that chronic post-concussion symptoms are similar in both mTBI and non-mTBI head trauma patients in the general population, suggesting a need for further research focusing on this group.
{"title":"Do concussed and non-concussed head trauma individuals have similar symptoms? A retrospective chart review of chronic post-concussive symptomatology","authors":"Shazia Malik, Rahim Ahmed, Teresa Gambale, Michel Rathbone","doi":"10.1177/20597002231173772","DOIUrl":"https://doi.org/10.1177/20597002231173772","url":null,"abstract":"Many head trauma patients who present with prolonged post-concussion symptoms do not meet the American Congress of Rehabilitation Medicine (ACRM) diagnostic criteria for mild traumatic brain injuries (mTBI). This population has not been extensively studied and its clinical characteristics are currently uncertain. A retrospective chart review was conducted to explore the symptomatic differences between mTBI and non-mTBI head trauma patients presenting at a concussion clinic with chronic post-concussion symptoms (PCSx). Patient information was extracted from 161 charts, of which 128 subjects met the ACRM criteria for mTBI (ACRM + PCSx), while 33 did not (non-ACRM + PCSx). These two groups were compared for demographic variables and symptomology. This study found that 20.5% of subjects presenting with chronic post-concussion symptoms do not meet ACRM criteria. No symptom-specific differences were found between the two populations in any of the categories tested. These results show that chronic post-concussion symptoms are similar in both mTBI and non-mTBI head trauma patients in the general population, suggesting a need for further research focusing on this group.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43223570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/20597002231198616
M. W. Weber Rawlins, T. V. Valovich McLeod
Nutrients may have implications following concussion, such as inflammation reduction or neuroprotection. The purpose of this study was to describe nutrition practices of athletic trainers (AT) and dietitians for patients regarding sport-related concussion, with respect to prevention, recommendations, and barriers to implementation. Due to the descriptive nature of this study, hypotheses were not warranted. Mixed methods. Level 3. A survey was distributed through professional memberships and included multiple-choice and open-ended items about nutritional practices regarding concussions. Participants included 1465 ATs and 51 dietitians accessing the survey (AT: age = 35.7 ± 11.4 years, females = 43.1%; dietitians: age = 31.8 ± 8.17 years, females = 45.1%). Open-ended survey responses regarding nutritional practices for concussion prevention, recommendations, and changes following concussion were analyzed by identifying key words or repeating phrases, theme development and categories into an initial codebook, using the codebook on responses, and coding all responses with the finalized codebook. Barriers to implementation was analyzed with descriptive statistics. Themes were identified for prevention strategies, and recommendations and changes following concussion. For concussion prevention, ATs noted overall health, specific target nutrients, barriers and limited research support, while dietitians identified overall health, specific target nutrients, recommendations/guidelines as themes. Post-injury themes for patient recommendations and changes were noted as overall health, specific target nutrients, resources, interprofessional collaboration by ATs, whereas dietitians identified overall health, specific target nutrients, interprofessional collaboration. ATs and dietitians noted numerous barriers including the lack of clinician knowledge and athlete compliance. ATs and dietitians are utilizing nutritional practices regarding concussion in numerous ways by focusing on use for whole body, brain health and specific targets such as omega fatty acids, hydration, micronutrients/supplements, and macronutrients. With these findings and the barriers listed by respondents, we can use this information to design focused research to influence evidence-based nutritional practices and concussion.
{"title":"A mixed methods investigation into athletic trainer and dietitian's nutrition practices for sport-related concussion patients","authors":"M. W. Weber Rawlins, T. V. Valovich McLeod","doi":"10.1177/20597002231198616","DOIUrl":"https://doi.org/10.1177/20597002231198616","url":null,"abstract":"Nutrients may have implications following concussion, such as inflammation reduction or neuroprotection. The purpose of this study was to describe nutrition practices of athletic trainers (AT) and dietitians for patients regarding sport-related concussion, with respect to prevention, recommendations, and barriers to implementation. Due to the descriptive nature of this study, hypotheses were not warranted. Mixed methods. Level 3. A survey was distributed through professional memberships and included multiple-choice and open-ended items about nutritional practices regarding concussions. Participants included 1465 ATs and 51 dietitians accessing the survey (AT: age = 35.7 ± 11.4 years, females = 43.1%; dietitians: age = 31.8 ± 8.17 years, females = 45.1%). Open-ended survey responses regarding nutritional practices for concussion prevention, recommendations, and changes following concussion were analyzed by identifying key words or repeating phrases, theme development and categories into an initial codebook, using the codebook on responses, and coding all responses with the finalized codebook. Barriers to implementation was analyzed with descriptive statistics. Themes were identified for prevention strategies, and recommendations and changes following concussion. For concussion prevention, ATs noted overall health, specific target nutrients, barriers and limited research support, while dietitians identified overall health, specific target nutrients, recommendations/guidelines as themes. Post-injury themes for patient recommendations and changes were noted as overall health, specific target nutrients, resources, interprofessional collaboration by ATs, whereas dietitians identified overall health, specific target nutrients, interprofessional collaboration. ATs and dietitians noted numerous barriers including the lack of clinician knowledge and athlete compliance. ATs and dietitians are utilizing nutritional practices regarding concussion in numerous ways by focusing on use for whole body, brain health and specific targets such as omega fatty acids, hydration, micronutrients/supplements, and macronutrients. With these findings and the barriers listed by respondents, we can use this information to design focused research to influence evidence-based nutritional practices and concussion.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44635307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/20597002231160941
C. Thomas, Stephen H. Thomas, B. Bloom
and importance Each year, 1.4 million patients attend a UK ED with a head injury. Mild traumatic brain injury affects up to 300/100 000 admitted patients/year and a greater number of non-admitted patients. Identifying those patients with a head injury that have concussion, and of those, which will have a prolonged recovery, is critical for discharge planning. The Vestibular/Ocular Motor Screening test (VOMS) has been reported as a useful “sideline tool” to evaluate for sports-related concussion (SRC). VOMS has been assessed for utility primarily for predicting in head-injured, which cases will have concussion, and secondarily in predicting in concussed patients, which will have prolonged recovery. Originally described in 2014, VOMS has not been subject to systematic review or meta-analysis, with regard to its predictive performance for concussion. To assess the state of VOMS evidence for dichotomously classifying concussion status in patients with non-severe head injury Systematic review. Studies comprising the review enrolled ambulatory head-injured adults and children, usually from sports-related settings, in Europe or the USA. VOMS. Presence of concussion, presence of prolonged recovery in concussed patients The review identified 17 studies, characterized by a wide variety of specific approaches to administering and scoring VOMS. While VOMS showed promise as a screening tool for concussion, marked study heterogeneity precluded generation of a pooled effect estimate for VOMS performance. VOMS is potentially useful as a concussion screening tool. Available evidence from the SRC arena suggests sensitivity ranging from 58–96%, with specificity 46−92%. Directions for future VOMS research should include evaluation of standardized administration and scoring, potentially of a simpler VOMS (with fewer components), in a general head-injured population. Further analysis of precisely defined VOMS application may be useful to determine the proper place of VOMS screening for the head-injured.
{"title":"Vestibular/ocular motor screening (VOMS) score for identification of concussion in cases of non-severe head injury: A systematic review","authors":"C. Thomas, Stephen H. Thomas, B. Bloom","doi":"10.1177/20597002231160941","DOIUrl":"https://doi.org/10.1177/20597002231160941","url":null,"abstract":"and importance Each year, 1.4 million patients attend a UK ED with a head injury. Mild traumatic brain injury affects up to 300/100 000 admitted patients/year and a greater number of non-admitted patients. Identifying those patients with a head injury that have concussion, and of those, which will have a prolonged recovery, is critical for discharge planning. The Vestibular/Ocular Motor Screening test (VOMS) has been reported as a useful “sideline tool” to evaluate for sports-related concussion (SRC). VOMS has been assessed for utility primarily for predicting in head-injured, which cases will have concussion, and secondarily in predicting in concussed patients, which will have prolonged recovery. Originally described in 2014, VOMS has not been subject to systematic review or meta-analysis, with regard to its predictive performance for concussion. To assess the state of VOMS evidence for dichotomously classifying concussion status in patients with non-severe head injury Systematic review. Studies comprising the review enrolled ambulatory head-injured adults and children, usually from sports-related settings, in Europe or the USA. VOMS. Presence of concussion, presence of prolonged recovery in concussed patients The review identified 17 studies, characterized by a wide variety of specific approaches to administering and scoring VOMS. While VOMS showed promise as a screening tool for concussion, marked study heterogeneity precluded generation of a pooled effect estimate for VOMS performance. VOMS is potentially useful as a concussion screening tool. Available evidence from the SRC arena suggests sensitivity ranging from 58–96%, with specificity 46−92%. Directions for future VOMS research should include evaluation of standardized administration and scoring, potentially of a simpler VOMS (with fewer components), in a general head-injured population. Further analysis of precisely defined VOMS application may be useful to determine the proper place of VOMS screening for the head-injured.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45448881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/20597002221142379
D. Walker, A. Qureshi, David C. Marchant, Ben Ford, A. Balani
Sport-related concussion (SRC) and physical pain are both associated with poor mental health, impaired cognition, and reduced quality of life. Despite SRC and physical pain often co-occurring, there is little research that investigates these two factors together, and therefore it is difficult to conclude which of these contributes to the negative outcomes associated with them. Therefore, the present study aimed to investigate the effect of SRC and physical pain on mental health, cognitive ability, and quality of life. Depression was measured using the Center for Epidemiological Studies Depression Scale, anxiety was assessed using the State-Trait Anxiety Inventory while the SF-12 recorded health-related quality of life. A trail making task (TMT) assessed cognitive flexibility of participants. Analysis of 83 participants (43 concussed) revealed that SRC led to reduced accuracy on TMT(A) and (B), whereas physical pain was responsible for poorer mental health and reduced quality of life. This study highlights the influence that SRC has on cognitive ability and the impact that physical pain has on mental health and quality of life. With this information, we are better placed to predict the negative consequences of SRC and physical pain and therefore tailor support accordingly.
{"title":"Providing a clearer insight into how sport-related concussion and physical pain impact mental health, cognition, and quality of life","authors":"D. Walker, A. Qureshi, David C. Marchant, Ben Ford, A. Balani","doi":"10.1177/20597002221142379","DOIUrl":"https://doi.org/10.1177/20597002221142379","url":null,"abstract":"Sport-related concussion (SRC) and physical pain are both associated with poor mental health, impaired cognition, and reduced quality of life. Despite SRC and physical pain often co-occurring, there is little research that investigates these two factors together, and therefore it is difficult to conclude which of these contributes to the negative outcomes associated with them. Therefore, the present study aimed to investigate the effect of SRC and physical pain on mental health, cognitive ability, and quality of life. Depression was measured using the Center for Epidemiological Studies Depression Scale, anxiety was assessed using the State-Trait Anxiety Inventory while the SF-12 recorded health-related quality of life. A trail making task (TMT) assessed cognitive flexibility of participants. Analysis of 83 participants (43 concussed) revealed that SRC led to reduced accuracy on TMT(A) and (B), whereas physical pain was responsible for poorer mental health and reduced quality of life. This study highlights the influence that SRC has on cognitive ability and the impact that physical pain has on mental health and quality of life. With this information, we are better placed to predict the negative consequences of SRC and physical pain and therefore tailor support accordingly.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43231461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/20597002231200372
Mitchell Doughty, Ethan Danielli, Rober Boshra, Kyle I. Ruiter, Luciano Minuzzi, John F. Connolly, M. Noseworthy
Introduction: Concussive and sub-concussive blows are commonly sustained during contact sports. Through a detailed neuroimaging analysis, this pilot study aimed to determine if a history of sport-related concussions exacerbated cognitive decline later in life. It was hypothesized that clinical health assessments and magnetic resonance imaging (MRI) techniques would provide insight into lasting health and well-being, structural, microstructural, and functional alterations caused by a history of concussive injuries. Materials and Methods: Twenty aging, retired Canadian Football League (rCFL) players (aged 56.9 ± 6.9) had clinical testing and MRI data acquired. Cortical thickness, voxel-wise diffusion tensor imaging (DTI), and Default Mode Network (DMN) connectivity data was collected for each subject and compared against healthy controls. Retired athlete age, playing position, and career length were also examined. Results: This study found widespread cortical thinning, significantly increased mean diffusivity, increased axial diffusivity, and both hyperactivity and hypoactivity within the DMN. Athlete age, position, and career length all influenced microstructural integrity. On average, retired athletes scored about 4 times greater depression-like and concussion-related symptoms and scored significantly lower in all health categories compared to healthy controls. Conclusions: These findings suggested that lasting signs of neurological injuries were present years after retiring from professional play.
{"title":"Years of play alter MRI measures of brain health in former Canadian Football League athletes: a pilot study","authors":"Mitchell Doughty, Ethan Danielli, Rober Boshra, Kyle I. Ruiter, Luciano Minuzzi, John F. Connolly, M. Noseworthy","doi":"10.1177/20597002231200372","DOIUrl":"https://doi.org/10.1177/20597002231200372","url":null,"abstract":"Introduction: Concussive and sub-concussive blows are commonly sustained during contact sports. Through a detailed neuroimaging analysis, this pilot study aimed to determine if a history of sport-related concussions exacerbated cognitive decline later in life. It was hypothesized that clinical health assessments and magnetic resonance imaging (MRI) techniques would provide insight into lasting health and well-being, structural, microstructural, and functional alterations caused by a history of concussive injuries. Materials and Methods: Twenty aging, retired Canadian Football League (rCFL) players (aged 56.9 ± 6.9) had clinical testing and MRI data acquired. Cortical thickness, voxel-wise diffusion tensor imaging (DTI), and Default Mode Network (DMN) connectivity data was collected for each subject and compared against healthy controls. Retired athlete age, playing position, and career length were also examined. Results: This study found widespread cortical thinning, significantly increased mean diffusivity, increased axial diffusivity, and both hyperactivity and hypoactivity within the DMN. Athlete age, position, and career length all influenced microstructural integrity. On average, retired athletes scored about 4 times greater depression-like and concussion-related symptoms and scored significantly lower in all health categories compared to healthy controls. Conclusions: These findings suggested that lasting signs of neurological injuries were present years after retiring from professional play.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46655824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/20597002231183234
Dennis Wellm, K. Zentgraf
Research has improved the understanding of sports related concussion (SRC), and several classification systems and guidelines are available in the literature. The exact timing and clearing of athletes for return-to-play (RTP) is still based primarily on subjective reports of concussion symptoms, however symptoms link poorly to objective recovery. Current literature suggest that symptoms alone cannot accurately identify either all concussed athletes or their recovery. The difficult task of interpreting which symptoms are directly related to concussion, and which are related to other conditions, speaks for an increased focus on the RTP process itself. This study examines the literature on neurocognitive assessments and their importance as indicators of accurate timing of when athletes can return to either ball training with duels or the playing field. Entries in three electronic databases (PubMed, Web of Science, and SURF) were searched from January 2000 to June 2022. Search terms were concussion, mild traumatic brain injury (mTBI), sport, athlete, expert, elite, professional, diagnostic, testing, return to play, management, neurocognitive, and cognitive. Inclusion criteria comprised performance-based participation in a team sport and being in the age range of possible peak performance (18–40 years). In addition, only studies with pre-post designs were considered. The PEDro scale was used to assess methodological quality. The methodological quality of the fifteen included studies ranged from 5 (one study) to 6 (fourteen studies) from a maximum of 10. Despite being symptom-free, athletes in all fifteen studies showed lower performance compared to controls on tests of visual and verbal memory (approx. 3–5% deficit) and on processing speed (approx. 6% deficit) after mTBI. All studies report specific neurocognitive deficits after mTBI, although the athletes were declared clinically symptom-free. Therefore, the systematic consideration of neurocognitive parameters in RTP decision making is recommended, especially in light of subsequent muscular injuries of the lower musculoskeletal system, recurrence of mTBI, and residual neurodegenerative disorders.
研究提高了对运动相关脑震荡(SRC)的理解，文献中有几种分类系统和指南。运动员恢复比赛(RTP)的确切时间和清理仍然主要基于对脑震荡症状的主观报告，然而症状与客观恢复的联系很差。目前的文献表明，仅凭症状不能准确地识别所有脑震荡运动员或他们的恢复情况。解释哪些症状与脑震荡直接相关，哪些症状与其他疾病相关的艰巨任务，说明了对RTP过程本身的更多关注。本研究考察了有关神经认知评估的文献，以及它们作为准确计时指标的重要性，以确定运动员何时可以回到球训练中进行决斗或比赛。检索了2000年1月至2022年6月三个电子数据库(PubMed、Web of Science和SURF)中的条目。搜索词包括脑震荡、轻度创伤性脑损伤(mTBI)、运动、运动员、专家、精英、专业人士、诊断、测试、重返赛场、管理、神经认知和认知。入选标准包括参加团队运动的表现，以及处于可能达到最佳表现的年龄范围(18-40岁)。此外，只考虑了前后设计的研究。采用PEDro量表评估方法学质量。纳入的15项研究的方法学质量从最多10项研究中的5项(1项研究)到6项(14项研究)不等。尽管没有症状，但在所有15项研究中，运动员在视觉和言语记忆测试中的表现都低于对照组。3-5%的赤字)和处理速度(大约。6%的赤字)。所有的研究都报告了mTBI后特定的神经认知缺陷，尽管运动员被宣布无临床症状。因此，建议在RTP决策时系统地考虑神经认知参数，特别是考虑到随后的下肢肌肉骨骼系统肌肉损伤、mTBI复发和残留的神经退行性疾病。
{"title":"Diagnostic tools for return-to-play decisions in sports-related concussion","authors":"Dennis Wellm, K. Zentgraf","doi":"10.1177/20597002231183234","DOIUrl":"https://doi.org/10.1177/20597002231183234","url":null,"abstract":"Research has improved the understanding of sports related concussion (SRC), and several classification systems and guidelines are available in the literature. The exact timing and clearing of athletes for return-to-play (RTP) is still based primarily on subjective reports of concussion symptoms, however symptoms link poorly to objective recovery. Current literature suggest that symptoms alone cannot accurately identify either all concussed athletes or their recovery. The difficult task of interpreting which symptoms are directly related to concussion, and which are related to other conditions, speaks for an increased focus on the RTP process itself. This study examines the literature on neurocognitive assessments and their importance as indicators of accurate timing of when athletes can return to either ball training with duels or the playing field. Entries in three electronic databases (PubMed, Web of Science, and SURF) were searched from January 2000 to June 2022. Search terms were concussion, mild traumatic brain injury (mTBI), sport, athlete, expert, elite, professional, diagnostic, testing, return to play, management, neurocognitive, and cognitive. Inclusion criteria comprised performance-based participation in a team sport and being in the age range of possible peak performance (18–40 years). In addition, only studies with pre-post designs were considered. The PEDro scale was used to assess methodological quality. The methodological quality of the fifteen included studies ranged from 5 (one study) to 6 (fourteen studies) from a maximum of 10. Despite being symptom-free, athletes in all fifteen studies showed lower performance compared to controls on tests of visual and verbal memory (approx. 3–5% deficit) and on processing speed (approx. 6% deficit) after mTBI. All studies report specific neurocognitive deficits after mTBI, although the athletes were declared clinically symptom-free. Therefore, the systematic consideration of neurocognitive parameters in RTP decision making is recommended, especially in light of subsequent muscular injuries of the lower musculoskeletal system, recurrence of mTBI, and residual neurodegenerative disorders.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46626812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/20597002231160959
Josh W. Faulkner
The non-specificity of persisting concussion symptoms (PCS) following concussion can make treatment and rehabilitation a complex and challenging endeavour for clinicians. International studies have demonstrated that in neurologically healthy individuals similar symptoms also exist. This study aimed to examine the presence and frequency of symptoms similar to PCS in neurologically healthy adults in Aotearoa New Zealand and compare these to PCS following concussion. 252 neurologically healthy adults (34.22 years); completed the Rivermead Post-Concussion Questionnaire (RPQ). Scores on this measure were evaluated and compared with 146 individuals who were at least three months post-injury (34.62 years). 25.79% (n = 65) of the neurologically healthy individuals had scores on the RPQ of ≥16. Fatigue was the most commonly endorsed symptom (67.9%), followed by sleep disturbances (59.9%). Certain demographic factors (age, education history and gender) were associated with higher endorsement but only on specific symptoms. The concussion group had significantly higher scores on the RPQ and significantly more individuals with PCS. However, at the individual item level, just over half of PCS symptoms were significantly higher in the concussion group. These symptoms were predominately neurological, with only forgetfulness and irritability significantly different between the concussion and neurologically healthy groups. Symptoms similar to PCS are prevalent in neurologically healthy individuals in Aotearoa New Zealand. The implications of these findings on the rehabilitation and management of PCS are discussed.
{"title":"The incidence and severity of symptoms similiar to peristing concussion symptoms in neurologically healthy individuals in aotearoa New Zealand","authors":"Josh W. Faulkner","doi":"10.1177/20597002231160959","DOIUrl":"https://doi.org/10.1177/20597002231160959","url":null,"abstract":"The non-specificity of persisting concussion symptoms (PCS) following concussion can make treatment and rehabilitation a complex and challenging endeavour for clinicians. International studies have demonstrated that in neurologically healthy individuals similar symptoms also exist. This study aimed to examine the presence and frequency of symptoms similar to PCS in neurologically healthy adults in Aotearoa New Zealand and compare these to PCS following concussion. 252 neurologically healthy adults (34.22 years); completed the Rivermead Post-Concussion Questionnaire (RPQ). Scores on this measure were evaluated and compared with 146 individuals who were at least three months post-injury (34.62 years). 25.79% (n = 65) of the neurologically healthy individuals had scores on the RPQ of ≥16. Fatigue was the most commonly endorsed symptom (67.9%), followed by sleep disturbances (59.9%). Certain demographic factors (age, education history and gender) were associated with higher endorsement but only on specific symptoms. The concussion group had significantly higher scores on the RPQ and significantly more individuals with PCS. However, at the individual item level, just over half of PCS symptoms were significantly higher in the concussion group. These symptoms were predominately neurological, with only forgetfulness and irritability significantly different between the concussion and neurologically healthy groups. Symptoms similar to PCS are prevalent in neurologically healthy individuals in Aotearoa New Zealand. The implications of these findings on the rehabilitation and management of PCS are discussed.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47587609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/20597002231210751
Silvia Bonacina, Nina Kraus, Jennifer Krizman, Jacob Farley, Trent Nicol, Cynthia R LaBella
Objective Concussions cause microstructural damage, which we hypothesize leads to a lack of synchrony in the brain. Interactive Metronome (IM) behaviorally assesses how well an individual can maintain a steady rhythm under both unsupervised (absence of feedback) and supervised (presence of visual feedback) conditions. If concussion causes dyssynchrony, then we predict that children with concussion do worse on IM than healthy children and that the difficulty should be greatest during the unsupervised condition, when the children must self-regulate their rhythm performance. Setting and Participants Seventy-four children and adolescents (age range 8–17 years) were assessed on IM across two different tasks (unsupervised – “no feedback” and supervised – “visual feedback”) during a clinic visit after their concussion injury and diagnosis. Design and Main Measures We compared the participants with concussion to a healthy control group (N = 73, age range 15–19 years) with respect to their ability to clap on time with a steady beat using IM, calculated as ms off the beat, separately for the unsupervised and supervised conditions. Results Results reveal participants with concussion struggled to maintain a steady rhythm compared to the control group, particularly during the unsupervised condition. Conclusion These results support the hypothesis that concussion can give rise to brain dyssynchrony. IM captures this dysfunction and, we suggest rhythmic training has the potential to re-establish synchronization among neural networks that may be compromised after a concussion. Interventional studies are a necessary next step for testing the efficacy of IM training to accelerate concussion recovery.
{"title":"Concussion disrupts brain synchrony: Evidence from interactive metronome on young children with persisting symptoms and prolonged recovery post-concussion","authors":"Silvia Bonacina, Nina Kraus, Jennifer Krizman, Jacob Farley, Trent Nicol, Cynthia R LaBella","doi":"10.1177/20597002231210751","DOIUrl":"https://doi.org/10.1177/20597002231210751","url":null,"abstract":"Objective Concussions cause microstructural damage, which we hypothesize leads to a lack of synchrony in the brain. Interactive Metronome (IM) behaviorally assesses how well an individual can maintain a steady rhythm under both unsupervised (absence of feedback) and supervised (presence of visual feedback) conditions. If concussion causes dyssynchrony, then we predict that children with concussion do worse on IM than healthy children and that the difficulty should be greatest during the unsupervised condition, when the children must self-regulate their rhythm performance. Setting and Participants Seventy-four children and adolescents (age range 8–17 years) were assessed on IM across two different tasks (unsupervised – “no feedback” and supervised – “visual feedback”) during a clinic visit after their concussion injury and diagnosis. Design and Main Measures We compared the participants with concussion to a healthy control group (N = 73, age range 15–19 years) with respect to their ability to clap on time with a steady beat using IM, calculated as ms off the beat, separately for the unsupervised and supervised conditions. Results Results reveal participants with concussion struggled to maintain a steady rhythm compared to the control group, particularly during the unsupervised condition. Conclusion These results support the hypothesis that concussion can give rise to brain dyssynchrony. IM captures this dysfunction and, we suggest rhythmic training has the potential to re-establish synchronization among neural networks that may be compromised after a concussion. Interventional studies are a necessary next step for testing the efficacy of IM training to accelerate concussion recovery.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":"273 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135507826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/20597002231194151
Hilary C Pearson, Diane E MacKenzie, Darren T Oystreck, David A Westwood
Cognitive impairment is a common symptom of mild traumatic brain injury (mTBI) and can have long term cognitive and behavioral consequences. Despite this, there is no universally accepted protocol for assessment of cognition in this population. Conventional neuropsychological assessment tools rely on verbal or manual responses which lend themselves to confounding factors such as stress, intelligence, initiation, and motivation, suggesting the need for more objective tools. A scoping review was undertaken to explore the utility of eye-tracking methods for detecting cognitive impairment in mTBI patients, and to survey the kinds of tasks used in this context. Six academic databases were searched for studies related to brain injury, eye tracking, and cognition. Data from 17 articles were extracted and synthesized. In most cases, neuropsychological and eye-tracking methods were in accordance when detecting cognitive impairment. However, in many cases, eye-tracking measures detected impairments when neuropsychological tasks did not. This review suggests that eye tracking could provide an effective, objective method to measure cognitive impairment in mTBI.
{"title":"Using eye-tracking technology to measure cognitive function in mild traumatic brain injury: A scoping review","authors":"Hilary C Pearson, Diane E MacKenzie, Darren T Oystreck, David A Westwood","doi":"10.1177/20597002231194151","DOIUrl":"https://doi.org/10.1177/20597002231194151","url":null,"abstract":"Cognitive impairment is a common symptom of mild traumatic brain injury (mTBI) and can have long term cognitive and behavioral consequences. Despite this, there is no universally accepted protocol for assessment of cognition in this population. Conventional neuropsychological assessment tools rely on verbal or manual responses which lend themselves to confounding factors such as stress, intelligence, initiation, and motivation, suggesting the need for more objective tools. A scoping review was undertaken to explore the utility of eye-tracking methods for detecting cognitive impairment in mTBI patients, and to survey the kinds of tasks used in this context. Six academic databases were searched for studies related to brain injury, eye tracking, and cognition. Data from 17 articles were extracted and synthesized. In most cases, neuropsychological and eye-tracking methods were in accordance when detecting cognitive impairment. However, in many cases, eye-tracking measures detected impairments when neuropsychological tasks did not. This review suggests that eye tracking could provide an effective, objective method to measure cognitive impairment in mTBI.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44911685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/20597002231160946
S. Lucas, N. Bolter, Laura J. Petranek, Kurt J. Nilsson, K. Pardue, Hilary G. Flint
Sport-related concussions (SRCs) occur at alarming rates among adolescents and evidence suggests that adolescents experience more severe and longer-lasting symptoms compared to other age groups. Developmentally, adolescence is a time when youth become less reliant on their parents, establish their personal identity, and rely more on other social support networks (e.g., peers, teammates). However, previous studies show that parents play a prominent role in the recovery process from an SRC, especially in situations where recovery is prolonged. The purpose of this study was to examine the lived experiences of parents/guardians of teens who were recovering from a concussion and whose symptoms were persistent. Participants ( N = 12) were individually interviewed to better understand how they navigated and advocated for their teen during their prolonged recovery. An inductive content analysis revealed eight thematic categories that were interpreted with a developmental lens: (a) difficulties enforcing cognitive and physical rest, (b) concerns about depression and isolation, (c) observing struggles with athletic identity, (d) feelings of frustration, helplessness, and stress, (e) challenges of a hidden injury, (f) decisions about returning to sport, (g) being lied to about symptoms, and (h) offering strategies and practical advice. The themes illustrate how challenging and complicated the recovery process can be for parents of teenagers in particular, which is supported in previous concussion studies and the broader developmental literature. These results reinforce the idea that taking a biopsychosocial approach to care is best in order to adequately support parents/guardians and adolescents during the SRC recovery process.
{"title":"Parents’/guardians’ experiences with their adolescents’ prolonged recovery from a sport-related concussion","authors":"S. Lucas, N. Bolter, Laura J. Petranek, Kurt J. Nilsson, K. Pardue, Hilary G. Flint","doi":"10.1177/20597002231160946","DOIUrl":"https://doi.org/10.1177/20597002231160946","url":null,"abstract":"Sport-related concussions (SRCs) occur at alarming rates among adolescents and evidence suggests that adolescents experience more severe and longer-lasting symptoms compared to other age groups. Developmentally, adolescence is a time when youth become less reliant on their parents, establish their personal identity, and rely more on other social support networks (e.g., peers, teammates). However, previous studies show that parents play a prominent role in the recovery process from an SRC, especially in situations where recovery is prolonged. The purpose of this study was to examine the lived experiences of parents/guardians of teens who were recovering from a concussion and whose symptoms were persistent. Participants ( N = 12) were individually interviewed to better understand how they navigated and advocated for their teen during their prolonged recovery. An inductive content analysis revealed eight thematic categories that were interpreted with a developmental lens: (a) difficulties enforcing cognitive and physical rest, (b) concerns about depression and isolation, (c) observing struggles with athletic identity, (d) feelings of frustration, helplessness, and stress, (e) challenges of a hidden injury, (f) decisions about returning to sport, (g) being lied to about symptoms, and (h) offering strategies and practical advice. The themes illustrate how challenging and complicated the recovery process can be for parents of teenagers in particular, which is supported in previous concussion studies and the broader developmental literature. These results reinforce the idea that taking a biopsychosocial approach to care is best in order to adequately support parents/guardians and adolescents during the SRC recovery process.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44109612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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