Pub Date : 2018-12-10DOI: 10.1177/2059700218812634
E. Papathanasiou, T. Cronin, B. Seemungal, J. Sandhu
The diagnosis of mild traumatic brain injury in concussion is difficult since it is often unwitnessed, the patient’s recall is unreliable and initial clinical examination is often unrevealing, correlating poorly with the extent of brain injury. At present, there are no objective biomarkers of mild traumatic brain injury in concussion. Thus, a sensitive gold standard test is required to enable the effective and safe triage of patients who present to the acute services. As well as triage, objective monitoring of patients’ recovery over time and separate from clinical features that patients may develop following the injury (e.g. depression and migraine) is also needed. In contrast to neuroimaging, which is widely used to investigate traumatic brain injury patients, electrophysiology is readily available, is cheap and there are internationally recognized standardised methodologies. Herein, we review the existing literature on electrophysiological testing in concussion and mild traumatic brain injury; specifically, electroencephalogram, polysomnography, brainstem auditory evoked potentials, electro- and videonystagmography, vestibular evoked myogenic potentials, visually evoked potentials, somatosensory evoked potentials and transcranial magnetic stimulation.
{"title":"Electrophysiological testing in concussion: A guide to clinical applications","authors":"E. Papathanasiou, T. Cronin, B. Seemungal, J. Sandhu","doi":"10.1177/2059700218812634","DOIUrl":"https://doi.org/10.1177/2059700218812634","url":null,"abstract":"The diagnosis of mild traumatic brain injury in concussion is difficult since it is often unwitnessed, the patient’s recall is unreliable and initial clinical examination is often unrevealing, correlating poorly with the extent of brain injury. At present, there are no objective biomarkers of mild traumatic brain injury in concussion. Thus, a sensitive gold standard test is required to enable the effective and safe triage of patients who present to the acute services. As well as triage, objective monitoring of patients’ recovery over time and separate from clinical features that patients may develop following the injury (e.g. depression and migraine) is also needed. In contrast to neuroimaging, which is widely used to investigate traumatic brain injury patients, electrophysiology is readily available, is cheap and there are internationally recognized standardised methodologies. Herein, we review the existing literature on electrophysiological testing in concussion and mild traumatic brain injury; specifically, electroencephalogram, polysomnography, brainstem auditory evoked potentials, electro- and videonystagmography, vestibular evoked myogenic potentials, visually evoked potentials, somatosensory evoked potentials and transcranial magnetic stimulation.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2059700218812634","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42889668","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 : 2018-10-29DOI: 10.1177/2059700218808121
M. Sargeant, E. Sykes, M. Saviour, A. Sawhney, E. Calzolari, J. Arthur, A. McGoldrick, B. Seemungal
The Sports Concussion Assessment Tool 3rd version is a sports screening tool that is often used to support return to play decisions following a head injury. The Sports Concussion Assessment Tool 3rd version is presumed to identify brain dysfunction (implying a degree of brain injury); however, the Sports Concussion Assessment Tool has never been validated with patients with definite acute brain injury. In this study, we found that all three Sports Concussion Assessment Tool 3rd version domains – symptoms, cognitive and balance assessments – were sensitive in discriminating traumatic brain injury patients (all with abnormal acute neuroimaging) from healthy controls. Through a correlation matrix (Bonferroni corrected), we found no correlation between the subjective (symptoms) and objective (examination) Sports Concussion Assessment Tool 3rd version assessments, e.g. complaints of imbalance and memory dysfunction were not correlated, respectively, with performance on testing balance and memory function. When relaxing the correction for multiple comparisons we found that of all Sports Concussion Assessment Tool 3rd version symptoms, a feeling of ‘pressure in the head’ had the largest number of co-correlations (including affective symptoms) and overwhelmingly in a pattern indicative of migraine. Taken together, that objective and subjective assessments in the Sports Concussion Assessment Tool 3rd version are poorly correlated, could suggest that symptoms in the Sports Concussion Assessment Tool 3rd version poorly reflect brain injury but rather indicate non-brain injury processes such as migraine. It follows that the current prominent orthodoxy of resting athletes following a head injury until their symptoms settle for fear of exacerbating brain injury may be unfavourable for their recovery – at least in some cases. Prospective clinical studies would be required to assess patient recovery from concussion with early active investigation and treatment versus rest – a notion supported by recent international consensus.
{"title":"The utility of the Sports Concussion Assessment Tool in hospitalized traumatic brain injury patients","authors":"M. Sargeant, E. Sykes, M. Saviour, A. Sawhney, E. Calzolari, J. Arthur, A. McGoldrick, B. Seemungal","doi":"10.1177/2059700218808121","DOIUrl":"https://doi.org/10.1177/2059700218808121","url":null,"abstract":"The Sports Concussion Assessment Tool 3rd version is a sports screening tool that is often used to support return to play decisions following a head injury. The Sports Concussion Assessment Tool 3rd version is presumed to identify brain dysfunction (implying a degree of brain injury); however, the Sports Concussion Assessment Tool has never been validated with patients with definite acute brain injury. In this study, we found that all three Sports Concussion Assessment Tool 3rd version domains – symptoms, cognitive and balance assessments – were sensitive in discriminating traumatic brain injury patients (all with abnormal acute neuroimaging) from healthy controls. Through a correlation matrix (Bonferroni corrected), we found no correlation between the subjective (symptoms) and objective (examination) Sports Concussion Assessment Tool 3rd version assessments, e.g. complaints of imbalance and memory dysfunction were not correlated, respectively, with performance on testing balance and memory function. When relaxing the correction for multiple comparisons we found that of all Sports Concussion Assessment Tool 3rd version symptoms, a feeling of ‘pressure in the head’ had the largest number of co-correlations (including affective symptoms) and overwhelmingly in a pattern indicative of migraine. Taken together, that objective and subjective assessments in the Sports Concussion Assessment Tool 3rd version are poorly correlated, could suggest that symptoms in the Sports Concussion Assessment Tool 3rd version poorly reflect brain injury but rather indicate non-brain injury processes such as migraine. It follows that the current prominent orthodoxy of resting athletes following a head injury until their symptoms settle for fear of exacerbating brain injury may be unfavourable for their recovery – at least in some cases. Prospective clinical studies would be required to assess patient recovery from concussion with early active investigation and treatment versus rest – a notion supported by recent international consensus.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2059700218808121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45158280","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 : 2018-10-11DOI: 10.1177/2059700218804917
Coren Walters-Stewart, C. Rochefort, A. Longtin, R. Zemek, H. Sveistrup
Background Mild traumatic brain injury is a common neurological condition affecting adolescents in North America. In adults, symptoms related to balance are some of the most commonly reported. Methods The purpose of this study was to investigate the balance in adolescents with mild traumatic brain injury using linear and non-linear centre of pressure (COP) measures in quiet stance and during dual-task. Adolescents aged 13.00 to 17.99 years were tested once at one month following mild traumatic brain injury (n = 25), and healthy adolescents (n = 22) were tested once as controls in four conditions: standing with eyes open, standing with eyes closed, standing on a single leg and standing while performing a visual Stroop task. Results In general, compared to healthy adolescents, adolescents with mild traumatic brain injury demonstrated more variability (p = 0.007, 95% CI (0.9, 5.4) and p = 0.049, 95% CI (0.009, 4.0), mediolateral and anteroposterior, respectively), showed more cumulative movement (path length, p = 0.016, 95% CI (1.3, 11.9)) and required greater speed of movement (p = 0.012, 95% CI (0.99, 7.4) and p = 0.035, 95% CI (0.28, 7.5), mediolateral and anteroposterior, respectively) in maintaining balance, and in underlying temporal organization showed less local stability (mediolateral largest Lyapunov, p = 0.033, 95% CI (0.001, 0.027)), more short-term complexity anteroposteriorly (p = 0.029, 95% CI (0.005, 0.099)) and less long-term complexity mediolaterally (p = 0.001, 95% CI (0.015, 0.056)). Condition differences are additionally presented. Conclusions Findings suggest that, for adolescents with mild traumatic brain injury, when maintaining balance visual input is relied on differently, the effectiveness of control may be an issue during dual-task, and consequently, the challenge of dual-task may be on par with single leg stance.
{"title":"Centre of pressure during quiet stance and dual-task one month after mild traumatic brain injury: In adolescents","authors":"Coren Walters-Stewart, C. Rochefort, A. Longtin, R. Zemek, H. Sveistrup","doi":"10.1177/2059700218804917","DOIUrl":"https://doi.org/10.1177/2059700218804917","url":null,"abstract":"Background Mild traumatic brain injury is a common neurological condition affecting adolescents in North America. In adults, symptoms related to balance are some of the most commonly reported. Methods The purpose of this study was to investigate the balance in adolescents with mild traumatic brain injury using linear and non-linear centre of pressure (COP) measures in quiet stance and during dual-task. Adolescents aged 13.00 to 17.99 years were tested once at one month following mild traumatic brain injury (n = 25), and healthy adolescents (n = 22) were tested once as controls in four conditions: standing with eyes open, standing with eyes closed, standing on a single leg and standing while performing a visual Stroop task. Results In general, compared to healthy adolescents, adolescents with mild traumatic brain injury demonstrated more variability (p = 0.007, 95% CI (0.9, 5.4) and p = 0.049, 95% CI (0.009, 4.0), mediolateral and anteroposterior, respectively), showed more cumulative movement (path length, p = 0.016, 95% CI (1.3, 11.9)) and required greater speed of movement (p = 0.012, 95% CI (0.99, 7.4) and p = 0.035, 95% CI (0.28, 7.5), mediolateral and anteroposterior, respectively) in maintaining balance, and in underlying temporal organization showed less local stability (mediolateral largest Lyapunov, p = 0.033, 95% CI (0.001, 0.027)), more short-term complexity anteroposteriorly (p = 0.029, 95% CI (0.005, 0.099)) and less long-term complexity mediolaterally (p = 0.001, 95% CI (0.015, 0.056)). Condition differences are additionally presented. Conclusions Findings suggest that, for adolescents with mild traumatic brain injury, when maintaining balance visual input is relied on differently, the effectiveness of control may be an issue during dual-task, and consequently, the challenge of dual-task may be on par with single leg stance.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2059700218804917","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48230308","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 : 2018-09-03DOI: 10.1177/2059700218799146
Christopher D Bedore, Jasmine Livermore, Hugo Lehmann, L. E. Brown
The assessment of visuomotor function can provide important information about neurological status. Many tasks exist for testing visuomotor function in the laboratory, but the availability of portable, easy-to-use versions that allow reliable, accurate, and precise measurement of movement timing and accuracy has been limited. We developed a tablet application that uses three laboratory visuomotor tests: the double-step task, interception task, and stop-signal task. We asked the participants to perform both the lab and tablet versions of each task and compared their response patterns across equipment types to assess the validity of the tablet versions. On the double-step task, the participants adjusted to the displaced target adequately in both the lab and tablet versions. On the interception task, the participants intercepted nonaccelerating targets and performed worse on accelerating targets in both versions of the task. On the stop-signal task, the participants successfully inhibited their reaching movements on short stop-signal delays (50–150 ms) more frequently than on long stop-signal delays (200 ms) in both versions of the task. Our findings suggest that the tablet version of each task assesses visuomotor processing in the same way as their respective laboratory version, thus providing the research community with a new tool to assess visuomotor function.
{"title":"Comparing three portable, tablet-based visuomotor tasks to laboratory versions: An assessment of test validity","authors":"Christopher D Bedore, Jasmine Livermore, Hugo Lehmann, L. E. Brown","doi":"10.1177/2059700218799146","DOIUrl":"https://doi.org/10.1177/2059700218799146","url":null,"abstract":"The assessment of visuomotor function can provide important information about neurological status. Many tasks exist for testing visuomotor function in the laboratory, but the availability of portable, easy-to-use versions that allow reliable, accurate, and precise measurement of movement timing and accuracy has been limited. We developed a tablet application that uses three laboratory visuomotor tests: the double-step task, interception task, and stop-signal task. We asked the participants to perform both the lab and tablet versions of each task and compared their response patterns across equipment types to assess the validity of the tablet versions. On the double-step task, the participants adjusted to the displaced target adequately in both the lab and tablet versions. On the interception task, the participants intercepted nonaccelerating targets and performed worse on accelerating targets in both versions of the task. On the stop-signal task, the participants successfully inhibited their reaching movements on short stop-signal delays (50–150 ms) more frequently than on long stop-signal delays (200 ms) in both versions of the task. Our findings suggest that the tablet version of each task assesses visuomotor processing in the same way as their respective laboratory version, thus providing the research community with a new tool to assess visuomotor function.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2059700218799146","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49011550","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 : 2018-08-31DOI: 10.1177/2059700218797818
Tara A. Whitten, C. Mang, Madeline S Cosh, S. Scott, S. Dukelow, B. Benson
Introduction An important problem in the field of sport-related concussion is the lack of a ‘gold-standard’ clinical assessment tool. Currently, the diagnosis relies heavily on self-reporting of symptoms and observation of clinical signs by medical professionals. To address this, our group has been motivated to develop objective measures of neurological impairment following concussion. Spatial working memory is an important aspect of cognitive function that might be impaired following concussion. In the present study, we measured spatial working memory using a robotic spatial span task. We first assessed test–retest reliability in 82 healthy athletes who underwent baseline testing across two athletic seasons using intraclass correlation coefficients. We then assessed spatial span performance relative to baseline in 47 athletes acutely following sport-related concussion using a reliable change index with 80% confidence limits to define impairment on an individual basis. Results We found good test–retest reliability for the mean span (a measure of spatial working memory span length; intraclass correlation coefficient = 0.79), and moderate reliability for the response duration (time taken per spatial target; intraclass correlation coefficient = 0.64) in healthy athletes. However, only 19% of acutely concussed athletes showed evidence of impairment relative to baseline in mean span, and even fewer (9%) showed evidence of impairment in response duration. Analysis of serial position curves revealed primacy and recency effects for this task, but no group-level differences between concussed and healthy athletes. Analysis of specific types of errors showed a higher rate of substitution errors in the concussed group at baseline, suggesting possible malingering in a small number of athletes. Conclusion Overall, few athletes showed evidence of impaired spatial working memory acutely following concussion, suggesting either that spatial working memory is not commonly impaired acutely post-concussion, or that the present task is not sufficiently demanding.
{"title":"Spatial working memory performance following acute sport-related concussion","authors":"Tara A. Whitten, C. Mang, Madeline S Cosh, S. Scott, S. Dukelow, B. Benson","doi":"10.1177/2059700218797818","DOIUrl":"https://doi.org/10.1177/2059700218797818","url":null,"abstract":"Introduction An important problem in the field of sport-related concussion is the lack of a ‘gold-standard’ clinical assessment tool. Currently, the diagnosis relies heavily on self-reporting of symptoms and observation of clinical signs by medical professionals. To address this, our group has been motivated to develop objective measures of neurological impairment following concussion. Spatial working memory is an important aspect of cognitive function that might be impaired following concussion. In the present study, we measured spatial working memory using a robotic spatial span task. We first assessed test–retest reliability in 82 healthy athletes who underwent baseline testing across two athletic seasons using intraclass correlation coefficients. We then assessed spatial span performance relative to baseline in 47 athletes acutely following sport-related concussion using a reliable change index with 80% confidence limits to define impairment on an individual basis. Results We found good test–retest reliability for the mean span (a measure of spatial working memory span length; intraclass correlation coefficient = 0.79), and moderate reliability for the response duration (time taken per spatial target; intraclass correlation coefficient = 0.64) in healthy athletes. However, only 19% of acutely concussed athletes showed evidence of impairment relative to baseline in mean span, and even fewer (9%) showed evidence of impairment in response duration. Analysis of serial position curves revealed primacy and recency effects for this task, but no group-level differences between concussed and healthy athletes. Analysis of specific types of errors showed a higher rate of substitution errors in the concussed group at baseline, suggesting possible malingering in a small number of athletes. Conclusion Overall, few athletes showed evidence of impaired spatial working memory acutely following concussion, suggesting either that spatial working memory is not commonly impaired acutely post-concussion, or that the present task is not sufficiently demanding.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2059700218797818","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47269314","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 : 2018-06-19DOI: 10.1177/2059700218784826
M. Albicini, A. McKinlay
Currently, there is a lack of clear, “gold standard” guidelines for the identification and management of sports-related concussion. This is of concern considering the importance of preventing further injury during game-play. Moreover, a number of assessment measures and tools aim to detect concussion in athletes and help inform return to play decisions, including the assessment of posture and balance, eye-saccades, memory, attention, orientation and post-concussive symptomatology. However, they have often not been widely disseminated for validity studies, and their utility or sensitivity in detecting concussion is limited due to a number of factors. As such, this review will examine current guidelines and sideline assessments measures which aim to inform decisions about return to play following sports-related concussion.
{"title":"A review of sideline assessment measures for identifying sports-related concussion","authors":"M. Albicini, A. McKinlay","doi":"10.1177/2059700218784826","DOIUrl":"https://doi.org/10.1177/2059700218784826","url":null,"abstract":"Currently, there is a lack of clear, “gold standard” guidelines for the identification and management of sports-related concussion. This is of concern considering the importance of preventing further injury during game-play. Moreover, a number of assessment measures and tools aim to detect concussion in athletes and help inform return to play decisions, including the assessment of posture and balance, eye-saccades, memory, attention, orientation and post-concussive symptomatology. However, they have often not been widely disseminated for validity studies, and their utility or sensitivity in detecting concussion is limited due to a number of factors. As such, this review will examine current guidelines and sideline assessments measures which aim to inform decisions about return to play following sports-related concussion.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2059700218784826","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43196919","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 : 2018-05-30DOI: 10.1177/2059700218777829
L. Falland-Cheung, J. Neil Waddell, K. Li, D. Tong, P. Brunton
When the human head is subjected to blunt force impact, there are several mechanical responses that may result from the forces involved, including absorption of impact forces through the various layers of the head. The purpose of this study was to develop an anatomical head model to measure force transfer through the various head layers and their displacement when subject to short-duration high-velocity impacts. An anatomical head model was constructed using previously validated simulant materials: epoxy resin (skull), polyvinyl siloxane (scalp), agar/glycerol/water (brain) and modified intravenous fluid for the cerebrospinal fluid. An array of accelerometers (4 mm × 4 mm × 1.45 mm) was incorporated into the various layers of the head to measure forces in x- (anterior/posterior), y- (left/right) and z- (up/down) axis. All sensors were connected to a signal conditioning board and USB powered data loggers. The head model was placed into a rigid metal stand with an optical sensor to trigger data capturing. A weight (750 g) was dropped from a height of 0.5 m (n= 20). Impact forces (z-axis) of 1107.05 N were recorded on top of the skin, with decreasing values through the different layers (bottom of skin 78.48 N, top of skull 319.82 N, bottom of skull 87.30 N, top and centre of brain 47.09 N and base of brain 78.41 N. Forces in the x- and y-axes were similar to those of the z-axis. With the base of the brain still receiving 78.41 N, this highlights the potential danger of repetitive impact forces to the head. Upon impact the layers of the head are displaced in the x-, y- and z-direction, with the highest values shown in the z-axis. In conclusion, this study identified the importance of considering short-duration high-intensity impacts to the head and their effect on underlying tissues.
当人类头部受到钝力冲击时，所涉及的力可能会产生几种机械反应，包括通过头部各层吸收冲击力。本研究的目的是开发一种头部解剖模型，以测量在受到短时间高速撞击时通过不同头部层的力传递及其位移。使用先前验证的模拟材料构建了解剖头部模型：环氧树脂（颅骨）、聚乙烯基硅氧烷（头皮）、琼脂/甘油/水（大脑）和改良的脑脊液静脉输液。加速计阵列（4 mm × 4毫米 × 1.45mm）结合到头部的各个层中以测量x-（前/后）、y-（左/右）和z-（上/下）轴上的力。所有传感器都连接到信号调节板和USB供电的数据记录器上。头部模型被放置在一个带有光学传感器的刚性金属支架中，以触发数据采集。将重量（750g）从0.5m（n＝20）的高度下落。在皮肤顶部记录了1107.05N的冲击力（z轴），在不同层（皮肤底部78.48N，颅骨顶部319.82N，颅骨底部87.30N，大脑顶部和中心47.09N和大脑底部78.41N）的冲击力值呈下降趋势。x轴和y轴上的力与z轴上的类似。由于大脑底部仍承受78.41 N，这突出了头部受到重复冲击力的潜在危险。撞击时，头部各层在x、y和z方向上发生位移，最高值显示在z轴上。总之，这项研究确定了考虑对头部的短时间高强度影响及其对底层组织影响的重要性。
{"title":"Anatomical head model to measure impact force transfer through the head layers and their displacement","authors":"L. Falland-Cheung, J. Neil Waddell, K. Li, D. Tong, P. Brunton","doi":"10.1177/2059700218777829","DOIUrl":"https://doi.org/10.1177/2059700218777829","url":null,"abstract":"When the human head is subjected to blunt force impact, there are several mechanical responses that may result from the forces involved, including absorption of impact forces through the various layers of the head. The purpose of this study was to develop an anatomical head model to measure force transfer through the various head layers and their displacement when subject to short-duration high-velocity impacts. An anatomical head model was constructed using previously validated simulant materials: epoxy resin (skull), polyvinyl siloxane (scalp), agar/glycerol/water (brain) and modified intravenous fluid for the cerebrospinal fluid. An array of accelerometers (4 mm × 4 mm × 1.45 mm) was incorporated into the various layers of the head to measure forces in x- (anterior/posterior), y- (left/right) and z- (up/down) axis. All sensors were connected to a signal conditioning board and USB powered data loggers. The head model was placed into a rigid metal stand with an optical sensor to trigger data capturing. A weight (750 g) was dropped from a height of 0.5 m (n= 20). Impact forces (z-axis) of 1107.05 N were recorded on top of the skin, with decreasing values through the different layers (bottom of skin 78.48 N, top of skull 319.82 N, bottom of skull 87.30 N, top and centre of brain 47.09 N and base of brain 78.41 N. Forces in the x- and y-axes were similar to those of the z-axis. With the base of the brain still receiving 78.41 N, this highlights the potential danger of repetitive impact forces to the head. Upon impact the layers of the head are displaced in the x-, y- and z-direction, with the highest values shown in the z-axis. In conclusion, this study identified the importance of considering short-duration high-intensity impacts to the head and their effect on underlying tissues.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2059700218777829","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41913919","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 : 2018-01-01Epub Date: 2018-04-15DOI: 10.1177/2059700218769218
Dana Waltzman, Jill Daugherty
Background: Recently, there has been a strong emphasis on educating athletes, parents, coaches, and health care providers about concussions. However, not much is known about whether these efforts are affecting the general public's level of concussion knowledge.
Purpose: To determine what is currently known among the public about concussions and where education campaigns may be targeted in order to fill in the gaps.
Methods: In order to achieve the project's objective, CDC analyzed self-reported data from Porter Novelli's 2017 SummerStyles survey, an annual survey of American adults aged 18 and older across the United States. The questions focused on personal concussion experiences, basic concussion knowledge, knowledge of prevention strategies, and perceived best sources of information about concussion.
Results: Analysis of the data showed that approximately 18% of respondents reported that they had personally experienced a concussion in their lifetime, and about two-thirds of these respondents were evaluated by a health care provider after their injury. In terms of concussion knowledge, the majority were aware of common causes of concussion. While 94% knew that headache was a symptom of concussion, just over half were aware that sleep problems were as well. Most respondents (>78%) correctly identified that wearing seat-belts, preventing falls, and reducing participation in contact sports were ways to prevent a concussion, while installing baby-gates across stairs was less frequently known (65.5%) as a prevention technique. Nearly all of the respondents believed that a doctor or other health professional was a good source of information about concussions. These results varied by age, sex, race/ethnicity, and education.
Conclusion: The results demonstrate that even though the public has a relatively high knowledge level of concussion, targeted education is needed to teach American adults about the symptoms and ways of getting a concussion.
{"title":"Concussion knowledge and experience among a sample of American adults.","authors":"Dana Waltzman, Jill Daugherty","doi":"10.1177/2059700218769218","DOIUrl":"https://doi.org/10.1177/2059700218769218","url":null,"abstract":"<p><strong>Background: </strong>Recently, there has been a strong emphasis on educating athletes, parents, coaches, and health care providers about concussions. However, not much is known about whether these efforts are affecting the general public's level of concussion knowledge.</p><p><strong>Purpose: </strong>To determine what is currently known among the public about concussions and where education campaigns may be targeted in order to fill in the gaps.</p><p><strong>Methods: </strong>In order to achieve the project's objective, CDC analyzed self-reported data from Porter Novelli's 2017 SummerStyles survey, an annual survey of American adults aged 18 and older across the United States. The questions focused on personal concussion experiences, basic concussion knowledge, knowledge of prevention strategies, and perceived best sources of information about concussion.</p><p><strong>Results: </strong>Analysis of the data showed that approximately 18% of respondents reported that they had personally experienced a concussion in their lifetime, and about two-thirds of these respondents were evaluated by a health care provider after their injury. In terms of concussion knowledge, the majority were aware of common causes of concussion. While 94% knew that headache was a symptom of concussion, just over half were aware that sleep problems were as well. Most respondents (>78%) correctly identified that wearing seat-belts, preventing falls, and reducing participation in contact sports were ways to prevent a concussion, while installing baby-gates across stairs was less frequently known (65.5%) as a prevention technique. Nearly all of the respondents believed that a doctor or other health professional was a good source of information about concussions. These results varied by age, sex, race/ethnicity, and education.</p><p><strong>Conclusion: </strong>The results demonstrate that even though the public has a relatively high knowledge level of concussion, targeted education is needed to teach American adults about the symptoms and ways of getting a concussion.</p>","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":"2 ","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2059700218769218","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36614315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01DOI: 10.1177/2059700217733916
Naomi D Deakin, T. Cronin, P. Trafford, S. Olvey, Ian Roberts, A. Mellor, P. Hutchinson
‘WARNING: motor sport can be dangerous’. The spectrum of head injuries in motor sport has shifted dramatically in recent decades, fuelled by advances in medicine and engineering. Despite these successes, there are growing public and professional concerns regarding concussion in motor sport. This review appraises the published literature concerning concussion in motor sport, with particular focus on the current medical and technical challenges in the field. The incidence and assessment of concussion in motor sport is discussed, in addition to modifiable risk factors within and outside the automobile environment. Lastly, areas for further research and development are outlined.
{"title":"Concussion in motor sport: A medical literature review and engineering perspective","authors":"Naomi D Deakin, T. Cronin, P. Trafford, S. Olvey, Ian Roberts, A. Mellor, P. Hutchinson","doi":"10.1177/2059700217733916","DOIUrl":"https://doi.org/10.1177/2059700217733916","url":null,"abstract":"‘WARNING: motor sport can be dangerous’. The spectrum of head injuries in motor sport has shifted dramatically in recent decades, fuelled by advances in medicine and engineering. Despite these successes, there are growing public and professional concerns regarding concussion in motor sport. This review appraises the published literature concerning concussion in motor sport, with particular focus on the current medical and technical challenges in the field. The incidence and assessment of concussion in motor sport is discussed, in addition to modifiable risk factors within and outside the automobile environment. Lastly, areas for further research and development are outlined.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2059700217733916","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44468937","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 : 2017-09-01DOI: 10.1177/2059700217730257
Michael P Jorgensen, Fergal T O'Hagan, Hugo Lehmann
Objective Identify and describe attitudes and intentions towards personal concussion risk and protective behaviours among varsity athletes. Determine subgroups of athletes characterized by problematic intentions towards concussion prevention and management behaviours. Design Cross-sectional survey. Main outcome measures Varsity athletes (N = 175; 60% male; 55.4% contact athletes; 56.6% history of concussion) completed a survey examining attitudes and intentions towards personal risk and concussion-management behaviours. Cluster and discriminant analyses were used to identify athlete risk response subgroups on intention items. The clusters were examined for differences in attitudes towards concussion prevention behaviours, demographics and concussion exposure. Results A substantially problematic subgroup of athletes (28% of the sample) reported low intent to engage in post concussion management practices or primary prevention behaviours. These individuals reported high concussion-risk acceptance and very low belief in the efficacy of concussion-management behaviours. They were also more likely to have sustained a concussion. Two other clusters demonstrated more acceptable behavioural intentions towards concussion prevention and management, with one holding model attitudes and intentions. Conclusions Varsity athletes exhibit one of three different patterns of intentions and attitudes towards concussion prevention and management behaviours. Athletes in one of these groups are at much greater risk of concussion injury and poorly follow recommended treatments. Intervention programmes need to target and aim to change these problematic intentions and attitudes to improve the effectiveness of concussion prevention and injury management.
{"title":"Concussion beliefs in varsity athletes: Identifying the good, the bad and the ugly","authors":"Michael P Jorgensen, Fergal T O'Hagan, Hugo Lehmann","doi":"10.1177/2059700217730257","DOIUrl":"https://doi.org/10.1177/2059700217730257","url":null,"abstract":"Objective Identify and describe attitudes and intentions towards personal concussion risk and protective behaviours among varsity athletes. Determine subgroups of athletes characterized by problematic intentions towards concussion prevention and management behaviours. Design Cross-sectional survey. Main outcome measures Varsity athletes (N = 175; 60% male; 55.4% contact athletes; 56.6% history of concussion) completed a survey examining attitudes and intentions towards personal risk and concussion-management behaviours. Cluster and discriminant analyses were used to identify athlete risk response subgroups on intention items. The clusters were examined for differences in attitudes towards concussion prevention behaviours, demographics and concussion exposure. Results A substantially problematic subgroup of athletes (28% of the sample) reported low intent to engage in post concussion management practices or primary prevention behaviours. These individuals reported high concussion-risk acceptance and very low belief in the efficacy of concussion-management behaviours. They were also more likely to have sustained a concussion. Two other clusters demonstrated more acceptable behavioural intentions towards concussion prevention and management, with one holding model attitudes and intentions. Conclusions Varsity athletes exhibit one of three different patterns of intentions and attitudes towards concussion prevention and management behaviours. Athletes in one of these groups are at much greater risk of concussion injury and poorly follow recommended treatments. Intervention programmes need to target and aim to change these problematic intentions and attitudes to improve the effectiveness of concussion prevention and injury management.","PeriodicalId":92541,"journal":{"name":"Journal of concussion","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2059700217730257","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42020155","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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