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The Journal of International Advanced... Nov 2021Traumatic brain injury occurs frequently worldwide. Half of traumatic brain injuries are related to falls or motor vehicle accidents. The term "concussion" is often used... (Review)
Review
OBJECTIVES
Traumatic brain injury occurs frequently worldwide. Half of traumatic brain injuries are related to falls or motor vehicle accidents. The term "concussion" is often used to describe a minor form of traumatic brain injury. These often involve decelerative events to the head (e.g., flexion/extension injury) and can also cause damage to the vestibular system of the inner ear.
MATERIALS AND METHODS
The European Society for Clinical Evaluation of Balance Disorders meets yearly and has proposed an investigation and analysis of the vestibular consequences of traumatic brain injury. This review paper outlines these discussions.
RESULTS
The Society discussed all aspects of trauma-induced vestibular disorders along with diagnosis and management. They also assessed the diagnostic tests available to investigate these disorders.
CONCLUSION
Trauma-induced vestibular disorders are difficult to manage, as our level of understanding of the pathology can be poor and anatomical localization can also be difficult. Accordingly, a definitive diagnosis cannot be pinpointed in many patients, but an extensive history taking is crucial to determine the nature and extent of vestibular involvement. Trauma can not only result in microtrauma to the central nervous system but can also significantly affect peripheral vestibular structures, particularly the otolith organs. The committee hopes that better understanding of trauma to the vestibular system, along with improvements in the field of radiology and vestibular assessments, will aid in more precise techniques of pinpointing pathology in order to develop an adapted treatment plan.
Topics: Brain Concussion; Brain Injuries; Humans; Postural Balance; Vestibular Diseases; Vestibule, Labyrinth
PubMed: 35177395
DOI: 10.5152/iao.2021.21258 -
The Journal of Head Trauma...The objective of this study was to compare individuals who were not evaluated by a doctor or nurse for a self-reported concussion versus individuals who were evaluated...
OBJECTIVE
The objective of this study was to compare individuals who were not evaluated by a doctor or nurse for a self-reported concussion versus individuals who were evaluated for a concussion by demographic variables, concussion history, and concussion circumstances.
SETTINGS AND PARTICIPANTS
Data were collected from 2018 SpringStyles, a web-based panel survey of US adults 18 years or older ( n = 6427), fielded in March-April.
DESIGN
Cross-sectional.
MAIN MEASURES
Respondents were asked whether they believed they had sustained a concussion in their lifetime and details about their most recent concussion, including whether they were evaluated by a doctor or nurse.
RESULTS
Twenty-seven percent of adults in the survey reported a lifetime concussion ( n = 1835). Among those individuals, 50.4% were not evaluated by a healthcare provider for their most recent concussion. Not being evaluated was higher among individuals whose concussion was caused by a slip, trip, or fall (adjusted prevalence ratio [APR] = 2.22; 95% CI, 1.65-2.99), riding a bicycle (APR = 2.28; 95% CI, 1.58-3.27), being struck by or against something by accident (APR = 2.50; 95% CI, 1.88-3.34), or being struck by or against something during a fight or argument (APR = 2.89; 95% CI, 2.11-3.97), compared with individuals whose concussion was caused by a motor vehicle crash. No evaluation was also higher among individuals whose concussion occurred while engaging in a sports or recreational activity (APR = 1.39; 95% CI, 1.07-1.82) or engaging in regular activities around the house (APR = 1.65; 95% CI, 1.27-2.14), compared with individuals whose concussion occurred while working for pay.
CONCLUSION
More than a quarter of adults reported a lifetime concussion; however, half of them were not evaluated for their last concussion by a healthcare provider. Examination by a healthcare professional for a suspected concussion may prevent or mitigate potential long-term sequelae. Furthermore, current US surveillance methods may underestimate the burden of TBI because many individuals do not seek evaluation.
Topics: Adult; Athletic Injuries; Brain Concussion; Cross-Sectional Studies; Humans; Prevalence; Self Report; Surveys and Questionnaires
PubMed: 35125431
DOI: 10.1097/HTR.0000000000000756 -
The Journal of School Health Feb 2022Although parents play an instrumental role in youth concussion management, few studies have qualitatively explored youth concussion recovery from the parents'...
BACKGROUND
Although parents play an instrumental role in youth concussion management, few studies have qualitatively explored youth concussion recovery from the parents' perspective. This study explored parents' experiences with and perceptions of their child's recovery from concussion, particularly with regards to the return-to-school process.
METHODS
We conducted 11 face-to-face semi-structured interviews with the parents of concussed youth aged 11 to 17 years between October 2018 and April 2019. We used the methods of open coding, axial coding, and selective coding to analyze the data.
RESULTS
We identified 7 themes during data analysis, which we divided into 2 categories: at home (prior to school re-entry) and at school (during the school reintegration process). The at-home category included 4 themes: (1) physical and cognitive rest; (2) child-led decision-making; (3) the role of parent-child communication in recovery; and (4) feelings about returning to school following concussion. The at-school category included 3 themes: (1) availability and utilization of academic accommodations; (2) return-to-school policies and procedures; and (3) support from school officials and teachers.
CONCLUSIONS
Parents' experiences of their child's return-to-school post-concussion underscore the need for evidence-based guidelines for cognitive rest post-concussion and a collaborative, team-based approach to concussion management.
Topics: Adolescent; Brain Concussion; Child; Humans; Parent-Child Relations; Parents; Qualitative Research; Schools
PubMed: 34806778
DOI: 10.1111/josh.13114 -
Personality and Mental Health Nov 2022Mild traumatic brain injury (mTBI) poses risk to the neurocognitive, emotional, and financial well-being of affected individuals. While aggression and impulsivity have...
Mild traumatic brain injury (mTBI) poses risk to the neurocognitive, emotional, and financial well-being of affected individuals. While aggression and impulsivity have been examined in relation to mTBI, little work has been done to evaluate the relationship between history of mTBI and personality disorder (PD). The authors examined the associations between history of mTBI and PD in a control group without history of mTBI (N = 1189) and individuals with history of mTBI (N = 267). Results demonstrated that any PD diagnosis is a significant risk factor for mTBI (p < 0.001). Cluster B diagnoses, particularly borderline and antisocial PD, were independently significant risk factors for mTBI. These data suggest a role for screening for a history of mTBI in patients with PDs and associated traits.
Topics: Humans; Brain Concussion; Personality Disorders; Impulsive Behavior; Antisocial Personality Disorder; Aggression
PubMed: 35598165
DOI: 10.1002/pmh.1550 -
Journal of Sport and Health Science Mar 2021
Topics: Athletic Injuries; Automobile Driving; Brain Concussion; Health Knowledge, Attitudes, Practice; Humans; Military Personnel; Musculoskeletal System; Parents; Post-Concussion Syndrome; Research; Soccer; Sports Medicine; Students
PubMed: 33453432
DOI: 10.1016/j.jshs.2021.01.005 -
The Journal of Neuroscience Nursing :... Dec 2011Traumatic brain injury (TBI) is a complex and debilitating neurological injury that places a significant financial and emotional burden on both families and medical... (Review)
Review
Traumatic brain injury (TBI) is a complex and debilitating neurological injury that places a significant financial and emotional burden on both families and medical providers. Accumulating evidence suggests that mild TBI or concussion remains grossly underdiagnosed, as compared with more severe TBI, due to a poor understanding of the clinical signs and symptoms involved with a head injury. Notably, pediatric head injury may be associated with the subsequent development of serious, long-term neurological consequences, emphasizing the need for improved diagnosis and acute medical intervention. The purpose of this minireview is to summarize the association between participation in youth athletics and the occurrence of concussions, a primary source of mild TBI in the adolescent population, with the goal of increasing awareness within the nursing profession for this clinically important yet underdiagnosed form of brain injury.
Topics: Adolescent; Athletes; Athletic Injuries; Brain Concussion; Humans; Specialties, Nursing; Students
PubMed: 22045196
DOI: 10.1097/JNN.0b013e31823858a6 -
Annals of Neurology Feb 2023Sports concussion has recently assumed special importance because of the widely publicized entity of chronic traumatic encephalopathy (CTE). Identified primarily in... (Review)
Review
Sports concussion has recently assumed special importance because of the widely publicized entity of chronic traumatic encephalopathy (CTE). Identified primarily in former contact sports athletes with repeated mild traumatic brain injury (mTBI), CTE is a distinct tauopathy that can only be diagnosed postmortem and for which no specific treatment is available. Although the hazards of repeated mTBI are generally acknowledged, a spirited controversy has developed because a firm link between sports concussion and CTE has been questioned. We briefly review the history of CTE, discuss areas of uncertainty, and offer suggestions to assist neurologists confronting these issues and advance understanding of this vexing problem. ANN NEUROL 2023;93:222-225.
Topics: Humans; Chronic Traumatic Encephalopathy; Brain Concussion; Tauopathies; Athletes; Autopsy
PubMed: 36504163
DOI: 10.1002/ana.26566 -
Clinical Autonomic Research : Official... Apr 2023Concussion commonly results in exercise intolerance, often limiting return to activities. Improved understanding of the underlying mechanisms of post-concussive exercise... (Review)
Review
PURPOSE
Concussion commonly results in exercise intolerance, often limiting return to activities. Improved understanding of the underlying mechanisms of post-concussive exercise intolerance could help guide mechanism-directed rehabilitation approaches. Signs of altered cardiovascular autonomic regulation-a potential contributor to exercise intolerance-have been reported following concussion, although it is not clear how these findings inform underlying mechanisms of post-concussive symptoms. Systematic summarization and synthesis of prior work is needed to best understand current evidence, allowing identification of common themes and gaps requiring further study. The purpose of this review was to (1) summarize published data linking exercise intolerance to autonomic dysfunction, and (2) summarize key findings, highlighting opportunities for future investigation.
METHODS
The protocol was developed a priori, and conducted in five stages; results were collated, summarized, and reported according to PRISMA guidelines. Studies including injuries classified as mild traumatic brain injury (mTBI)/concussion, regardless of mechanism of injury, were included. Studies were required to include both autonomic and exercise intolerance testing. Exclusion criteria included confounding central or peripheral nervous system dysfunction beyond those stemming from the concussion, animal model studies, and case reports.
RESULTS
A total of 3116 publications were screened; 17 were included in the final review.
CONCLUSION
There was wide variability in approach to autonomic/exercise tolerance testing, as well as inclusion criteria/testing timelines, which limited comparisons across studies. The reviewed studies support current clinical suspicion of autonomic dysfunction as an important component of exercise intolerance. However, the specific mechanisms of impairment and relationship to symptoms and recovery require additional investigation.
Topics: Humans; Autonomic Nervous System; Brain Concussion; Exercise; Post-Concussion Syndrome; Primary Dysautonomias
PubMed: 37038012
DOI: 10.1007/s10286-023-00937-x -
Fa Yi Xue Za Zhi Oct 2021To understand the current status of appraisal of post-concussion syndrome disability and the reasons for the changes in re-appraisal opinions.
OBJECTIVES
To understand the current status of appraisal of post-concussion syndrome disability and the reasons for the changes in re-appraisal opinions.
METHODS
The cases that were judged as "post-concussion syndrome and ten-level disability" in the first appraisal and re-appraised for psychiatric impairment by the Academy of Forensic Science in 2019 were analyzed retrospectively.
RESULTS
There were 75 cases, including 58 cases with pre-hospital emergency medical records, among which 39 cases were clearly recorded to be without a history of coma; 74 cases had emergency medical records, among which 44 cases were recorded of having a history of coma; 43 cases had follow-up medical records, among which 24 cases had a history of psychiatric follow-up. The most complained symptoms of the appraisee in appraisal and examination include headache, dizziness, poor sleep at night, irritability, memory loss, fatigue and inattention. The main reasons for the re-appraisal application include doubts about the history of coma, doubts about the credibility of mental symptoms, post-concussion syndrome didn't meet the disability criteria, and objections to the original appraisal procedure or the original appraisal agency. The appraisal opinions of a total of 47 cases were changed. Seven of them did not meet the disability criteria, and the main reason was that there was no clear history of coma and no head injury was admitted; the coma history of the 40 other cases had to be confirmed by the court before they can be clearly identified as disabilities. The reason was that the records about the history of coma were inconsistent or there were alterations and additional information.
CONCLUSIONS
In the past, the conditions for appraisal of post-concussion syndrome disability were too lax and must be further standardized and strictly controlled.
Topics: Brain Concussion; Craniocerebral Trauma; Headache; Humans; Mental Disorders; Post-Concussion Syndrome; Retrospective Studies
PubMed: 35187918
DOI: 10.12116/j.issn.1004-5619.2020.101101 -
Journal of Integrative Neuroscience Mar 2023An estimated 99 in 100,000 people experience a traumatic brain injury (TBI), with 85% being mild (mTBI) in nature. The Post-Concussion Symptom Scale (PCSS), is a...
BACKGROUND
An estimated 99 in 100,000 people experience a traumatic brain injury (TBI), with 85% being mild (mTBI) in nature. The Post-Concussion Symptom Scale (PCSS), is a reliable and valid measure of post-mTBI symptoms; however, diagnostic specificity is challenging due to high symptom rates in the general population. Understanding the neurobiological characteristics that distinguish high and low PCSS raters may provide further clarification on this phenomenon.
AIM
To explore the neurobiological characteristics of post-concussion symptoms through the association between PCSS scores, brain network connectivity (using quantitative electroencephalography; qEEG) and cognition in undergraduates.
HYPOTHESES
high PCSS scorers will have (1) more network dysregulation and (2) more cognitive dysfunction compared to the low PCSS scorers.
METHODS
A sample of 40 undergraduates were divided into high and low PCSS scorers. Brain connectivity was measured using qEEG, and cognition was measured via neuropsychological measures of sustained attention, inhibition, immediate attention, working memory, processing speed and inhibition/switching.
RESULTS
Contrary to expectations, greater frontoparietal network dysregulation was seen in the low PCSS score group ( = 0.003). No significant difference in cognitive dysfunction was detected between high and low PCSS scorers. Post-hoc analysis in participants who had experienced mTBI revealed greater network dysregulation in those reporting a more recent mTBI.
CONCLUSIONS
Measuring post-concussion symptoms alone is not necessarily informative about changes in underlying neural mechanisms. In an exploratory subset analysis, brain network dysregulation appears to be greater in the early post-injury phase compared to later. Further analysis of underlying PCSS constructs and how to measure these in a non-athlete population and clinical samples is warranted.
Topics: Humans; Post-Concussion Syndrome; Brain Concussion; Neuropsychological Tests; Australia; Brain; Cognition
PubMed: 36992597
DOI: 10.31083/j.jin2202050