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Continuum (Minneapolis, Minn.) Dec 2014To provide the neurologist with a framework for the clinical approach to sports concussion diagnosis and management. (Review)
Review
PURPOSE OF REVIEW
To provide the neurologist with a framework for the clinical approach to sports concussion diagnosis and management.
RECENT FINDINGS
As the issue of brain injury in athletes has emerged and developed, shifting the landscape of public concern, neurologists have become more directly involved in the diagnosis and management of sports concussion. Neurologists are now playing an increased role in acute concussion diagnosis, early injury management, return-to-play decisions, and evaluation for potential long-term effects from exposure to biomechanical forces on brain health. Concussion is only one part of this spectrum, but it is no small concern. Sports concussion diagnosis and management require a comprehensive neurologic approach as the return-to-play decision is a medical one covering a spectrum of potential complications and future risks. Understanding the clinical syndrome of concussion as well as the underlying pathophysiologic mechanism is essential to providing care. Employing classic neurologic diagnostic techniques while concurrently respecting the unique nature of caring for athletes is also critical. Without an objective method of measuring the underlying metabolic injury, concussion management is, by necessity, a clinically intense endeavor that requires a broad skill set.
SUMMARY
Providing recommendations regarding the long-term effects of brain trauma and the need for retirement from contact sports requires an appreciation for both the reason for concern and the lack of data to frame this risk. As science continues to advance in this area, so will our diagnostic approaches and management schema. Neurologists caring for athletes with brain trauma should continue to seek the best possible evidence to help shape their clinical decisions.
Topics: Athletic Injuries; Brain Concussion; Humans
PubMed: 25470160
DOI: 10.1212/01.CON.0000458974.78766.58 -
Human Brain Mapping Jul 2020Studies using blood-oxygenation-level-dependent functional magnetic resonance imaging (BOLD fMRI) have characterized how the resting brain is affected by concussion. The...
Studies using blood-oxygenation-level-dependent functional magnetic resonance imaging (BOLD fMRI) have characterized how the resting brain is affected by concussion. The literature to date, however, has largely focused on measuring changes in the spatial organization of functional brain networks. In the present study, changes in the temporal dynamics of BOLD signals are examined throughout concussion recovery using scaling (or fractal) analysis. Imaging data were collected for 228 university-level athletes, 61 with concussion and 167 athletic controls. Concussed athletes were scanned at the acute phase of injury (1-7 days postinjury), the subacute phase (8-14 days postinjury), medical clearance to return to sport (RTS), 1 month post-RTS and 1 year post-RTS. The wavelet leader multifractal approach was used to assess scaling ( c ) and multifractal ( c ) behavior. Significant longitudinal changes were identified for c , which was lowest at acute injury, became significantly elevated at RTS, and returned near control levels by 1 year post-RTS. No longitudinal changes were identified for c . Secondary analyses showed that clinical measures of acute symptom severity and time to RTP were related to longitudinal changes in c . Athletes with both higher symptoms and prolonged recovery had elevated c values at RTS, while athletes with higher symptoms but rapid recovery had reduced c at acute injury. This study provides the first evidence for long-term recovery of BOLD scale-free brain dynamics after a concussion.
Topics: Adolescent; Adult; Athletic Injuries; Brain Concussion; Connectome; Female; Fractals; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Male; Nerve Net; Young Adult
PubMed: 32348019
DOI: 10.1002/hbm.24962 -
The Journal of the American Osteopathic... Oct 2018Concussions have been increasingly reported over the past decade, but the reported incidence likely minimizes the actual numbers of people affected. Associated symptoms... (Review)
Review
Concussions have been increasingly reported over the past decade, but the reported incidence likely minimizes the actual numbers of people affected. Associated symptoms include emotional, somatic, and cognitive complaints, which may be prolonged in patients with certain risk factors. Neurologic examination is necessary to exclude upper motor neuron lesions and thus the need for brain imaging. Cervical conditions are often found concurrently with head injury and displays a similar presentation to concussions. Therefore, determining symptom origin can be problematic. Neuropsychological, oculomotor, and balance evaluations expose specific deficits that can be successfully managed with rehabilitation. Osteopathic assessment of the cranium, spine, sacrum, and thorax for somatic dysfunctions allows for prudent interventions. Patients involved in sports may begin an established graduated return-to-play protocol once cleared by their physician. Concurrently, a parallel return-to-learn program, with applicable academic accommodations, is recommended.
Topics: Athletic Injuries; Brain Concussion; Humans; Neurologic Examination; Neuropsychological Tests; Osteopathic Medicine; Return to Sport
PubMed: 30242340
DOI: 10.7556/jaoa.2018.144 -
Pediatric Emergency Care Sep 2022The aim of this study was to compare demographic characteristics, medical care, and outcomes among patients with assault-related concussion (ARC) versus sports and...
OBJECTIVES
The aim of this study was to compare demographic characteristics, medical care, and outcomes among patients with assault-related concussion (ARC) versus sports and recreation-related concussion (SRC).
METHODS
We conducted a retrospective chart review of 124 patients (62 ARC, 62 SRC) aged 8 to 17 years presenting to the care network of a large tertiary care pediatric hospital between July 1, 2012, and June 30, 2014 with a concussion diagnosis at time of presentation. We abstracted patient demographics, initial medical care visit characteristics, and outcome data, and compared proportions using χ2 testing and Fisher exact test and medians using Wilcoxon rank sum test.
RESULTS
Patients with ARC were more likely to be Black, publicly insured, and present first for care to the emergency department. Significantly fewer patients with ARC received visio-vestibular testing at initial visit (27% vs 74%, P < 0.001). During recovery, the total number of reported physical, cognitive, emotional, and sleep symptoms did not differ between groups; however, more than twice as many patients with ARC reported decline in grades postinjury compared with patients with SRC (47% vs 20%, P = 0.012). There were trends toward prolonged symptom recovery and time to physician clearance for full return to activities among patients with ARC compared with SRC.
CONCLUSIONS
This study highlights potential disparities in the initial evaluation and outcomes of pediatric concussion patients based on mechanism of injury. Patients with ARC were less likely to receive a concussion-specific diagnostic evaluation and reported a greater impact on educational outcomes, suggesting differences in concussion diagnosis and management among assault-injured patients. Further examination in larger populations with prospective studies is needed to address potential inequities in concussion care and outcomes among patients with ARC.
Topics: Athletic Injuries; Brain Concussion; Child; Humans; Post-Concussion Syndrome; Retrospective Studies; Sports
PubMed: 36040470
DOI: 10.1097/PEC.0000000000002664 -
Canadian Family Physician Medecin de... Mar 2022
Topics: Athletic Injuries; Brain Concussion; Humans
PubMed: 35292444
DOI: 10.46747/cfp.6803167 -
Journal of Athletic Training Oct 2020Concussion-symptom education remains the primary approach used by athletic trainers to address underreporting of possible sport-related concussions. Social marketing... (Randomized Controlled Trial)
Randomized Controlled Trial
CONTEXT
Concussion-symptom education remains the primary approach used by athletic trainers to address underreporting of possible sport-related concussions. Social marketing represents an untapped approach to promote concussion reporting by communicating the benefits or consequences of reporting or not reporting, respectively.
OBJECTIVE
To apply expectancy value theory and identify how marketing the possible consequences of concealing concussion symptoms influenced young adults' concussion-reporting beliefs to increase the likelihood of reporting.
DESIGN
Randomized controlled clinical trial.
SETTING
Laboratory.
PATIENTS OR OTHER PARTICIPANTS
A total of 468 competitive collegiate club sport athletes at a large US university who engaged in 1 of 46 sports with various levels of concussion risk.
INTERVENTION(S)
Participants were randomly assigned by team to 1 of 3 conditions. The treatment condition was a social-marketing program focused on the possible consequences of the reporting decision. The control condition was traditional concussion-symptom education based on the National Collegiate Athletic Association's publication, "Concussion: A Fact Sheet for Student-Athletes." An additional condition mirrored the traditional symptom education but included a less clinical delivery.
MAIN OUTCOME MEASURE(S)
Positive and negative beliefs regarding concussion reporting were assessed. We applied expectancy value theory, which posits that changing beliefs in the short term will produce greater reporting intentions in the long term.
RESULTS
Club sport athletes exposed to consequence-based social marketing showed higher levels of positive reporting beliefs and lower levels of negative reporting beliefs than athletes exposed to traditional or revised symptom education. We observed no differences between the traditional and revised symptom-education programs. Exposure to consequence-based marketing decreased negative beliefs about reporting (B = -0.165, P = .01) and increased positive beliefs about reporting (B = 0.165, P = .01).
CONCLUSIONS
Social marketing offers athletic trainers another strategic tool for motivating athletes to report concussion symptoms by translating scientific findings into marketable statements and then communicating the benefits of reporting or the negative consequences of concealing concussion symptoms.
Topics: Adolescent; Adult; Athletes; Athletic Injuries; Brain Concussion; Cross-Sectional Studies; Educational Status; Female; Humans; Intention; Male; Motivation; Social Marketing; Young Adult
PubMed: 32966568
DOI: 10.4085/1062-6050-242-19 -
Journal of Optometry 2023
Topics: Humans; Vision Screening; Brain Concussion; Post-Concussion Syndrome
PubMed: 37302954
DOI: 10.1016/j.optom.2023.04.003 -
Hawai'i Journal of Medicine & Public... Sep 2016Head injuries are a particular concern in Hawai'i given the large military population, the presence of many land and water sports such as football and surfing, and the... (Review)
Review
Head injuries are a particular concern in Hawai'i given the large military population, the presence of many land and water sports such as football and surfing, and the lenient helmet laws for motorcycle and bicycle riders. Physical, psychological, and cognitive symptoms from single or repeated concussions can affect an individual's reentry to society and activity. Current literature indicates that repeated head injuries are associated with chronic traumatic encephalopathy (CTE) which is thought to lead to dementia. This paper reviews literature discussing causes of concussion including its incidence and prevalence in Hawai'i. Furthermore, the neurophysiological and neurobiological etiologies are discussed followed by an overview of methods for identification and management of concussion. The paper serves as information for professionals in the community such as educators, military personnel, and healthcare workers to identify risks of concussion, management of symptoms, and to connect with resources and programs available in Hawai'i.
Topics: Brain Concussion; Hawaii; Humans
PubMed: 27688951
DOI: No ID Found -
Sports Health 2016
Topics: Athletes; Athletic Injuries; Brain Concussion; Brain Injuries; Football; Humans; Practice Guidelines as Topic; Primary Prevention
PubMed: 26733589
DOI: 10.1177/1941738115621030 -
Research in Nursing & Health Feb 2023Brain fog is one symptom that has been underexplored in traumatic brain injury (TBI). We explored the cognitive and affective correlates of brain fog in people with...
Brain fog is one symptom that has been underexplored in traumatic brain injury (TBI). We explored the cognitive and affective correlates of brain fog in people with symptomatic mild TBI (n = 15), moderate-to-severe TBI (n = 15), and a healthy control group (n = 16). Measures across the studies assessed "brain fog" (Mental Clutter Scale), objective cognition (Useful Field of View® and Cogstate Brief Battery®), post-concussive symptoms (Post-Concussion Symptom Scale), and depressive symptoms (Profile of Moods Scale). Brain fog was higher in symptomatic mild TBI and moderate-to-severe TBI compared with healthy controls. Greater brain fog corresponded to greater depressive symptoms in symptomatic mild TBI. Greater brain fog corresponded to poorer episodic memory and working memory in moderate-to-severe TBI. Brain fog appears to reflect challenges in recovery, including depressive symptoms and worse cognitive function. Screening for brain fog might be worthwhile in people with brain injuries.
Topics: Humans; Brain Injuries, Traumatic; Brain Concussion; Brain Injuries; Cognition; Brain
PubMed: 36504287
DOI: 10.1002/nur.22280