WorldWideScience

Sample records for repeated brain concussion

  1. [Autoradiographic investigations in repeated experimental brain concussion (author's transl)].

    Science.gov (United States)

    Weitbrecht, W U; Noetzel, H

    1976-12-31

    Single brain concussion in rabbits causes an increased proliferation of glial and mesenchymal cells. Repeated experimental concussions in rabbits (3 times at intervals of 24 h) led to an increased incorporation of H3-thymidine in glial and mesenchymal cells with a maximum at 48 h after the third concussion. This is interpreted as an indication of increased cell proliferation. The first and the second concussion did not cause a comparable reaction, thus suggesting that concussions may inhibit DNA synthesis under the conditions of our experimental setup. When the concussions were induced at an interval of 48 h the result was different: 48 h after each concussion we found an increase of labeled cells compared with the controls. After the second concussion the reaction was still more enhanced compared with the reaction following the first concussion. In contrast to this the number of labeled cells after the third concussion was significantly decreased compared with those after the second one. Parallels with pugilistic encephalopathy are discussed.

  2. [Brain concussion].

    Science.gov (United States)

    Pälvimäki, Esa-Pekka; Siironen, Jari; Pohjola, Juha; Hernesniemi, Juha

    2011-01-01

    Brain concussion is a common disturbance caused by external forces or acceleration affecting the head. It may be accompanied by transient loss of consciousness and amnesia. Typical symptoms include headache, nausea and dizziness; these may remain for a week or two. Some patients may experience transient loss of inability to create new memories or other brief impairment of mental functioning. Treatment is symptomatic. Some patients may suffer from prolonged symptoms, the connection of which with brain concession is difficult to show. Almost invariably the prognosis of brain concussion is good.

  3. Concussion and Traumatic Brain Injury

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Concussion Concussion and Traumatic Brain Injury Past Issues / Summer 2015 ... have a concussion or more serious brain injury. Concussion Signs Observed Can't recall events prior to ...

  4. Repeated mild lateral fluid percussion brain injury in the rat causes cumulative long-term behavioral impairments, neuroinflammation, and cortical loss in an animal model of repeated concussion.

    Science.gov (United States)

    Shultz, Sandy R; Bao, Feng; Omana, Vanessa; Chiu, Charlotte; Brown, Arthur; Cain, Donald Peter

    2012-01-20

    There is growing evidence that repeated brain concussion can result in cumulative and long-term behavioral symptoms, neuropathological changes, and neurodegeneration. Little is known about the factors and mechanisms that contribute to these effects. The current study addresses the need to investigate and better understand the effects of repeated concussion through the development of an animal model. Male Long-Evans rats received 1, 3, or 5 mild lateral fluid percussion injuries or sham injuries spaced 5 days apart. After the final injury, rats received either a short (24 h) or long (8 weeks) post-injury recovery period, followed by a detailed behavioral analysis consisting of tests for rodent anxiety-like behavior, cognition, social behavior, sensorimotor function, and depression-like behavior. Brains were examined immunohistochemically to assess neuroinflammation and cortical damage. Rats given 1, 3, or 5 mild percussion injuries displayed significant short-term cognitive impairments. Rats given repeated mild percussion injuries displayed significantly worse short- and long-term cognitive impairments. Rats given 5 mild percussion injuries also displayed increased anxiety- and depression-like behaviors. Neuropathological analysis revealed short-term neuroinflammation in 3-injury rats, and both short- and long-term neuroinflammation in 5-injury rats. There was also evidence that repeated injuries induced short- and long-term cortical damage. These cumulative and long-term changes are consistent with findings in human patients suffering repeated brain concussion, provide support for the use of repeated mild lateral fluid percussion injuries to study repeated concussion in the rat, and suggest that neuroinflammation may be important for understanding the cumulative and chronic effects of repeated concussion.

  5. Repeat concussions in the national football league.

    Science.gov (United States)

    Casson, Ira R; Viano, David C; Powell, John W; Pellman, Elliot J

    2011-01-01

    Repeat concussion is an important issue in the National Football League (NFL). An initial description of repeat injuries was published for 6 years (1996-2001). The characteristics and frequency of repeat concussion in the NFL have not changed in the subsequent 6 years (2002-2007). Case control. From 1996 to 2007, concussions were reported using a standardized form documenting signs and symptoms, loss of consciousness and medical action taken. Data on repeat concussions were analyzed for the 12 years and compared between the 2 periods. In 2002-2007, 152 players had repeat concussions (vs 160 in 1996-2001); 44 had 3+ head injuries (vs 52). The positions most often associated with repeat concussion in 2002-2007 were the defensive secondary, kick unit, running back, and linebacker. The odds for repeat concussion were elevated for wide receivers, tight ends, and linebackers but lower than in the earlier period. During 2002-2007, over half of players with repeat concussion were removed from play, and fewer immediately returned (vs 1996-2001). The average duration between concussions was 1.25 years for 2002-2007 and 1.65 years for the 12-year period. Over 12 years, 7.6% of all repeat concussions occurred within 2 weeks of the prior concussion. The defensive secondary, kick unit, running back, and linebacker have the highest incidence of repeat concussion. During 2002-2007, more than half of players with repeat concussion were removed from play, and only a fraction immediately returned. Although concussion was managed more conservatively by team physicians in the recent 6 years, repeat concussions occurred at similar rates during both periods.

  6. Concussion

    Science.gov (United States)

    A concussion is a type of brain injury. It involves a short loss of normal brain function. It happens ... damage your brain cells. Sometimes people call a concussion a "mild" brain injury. It is important to ...

  7. [The expression of GFAP after brain concussion in rats].

    Science.gov (United States)

    Zhang, Chun-Bing; Li, Yong-Hong

    2006-04-01

    To study the expression of GFAP and pathologic changes after rats brain concussion, so that to provide evidence on brain concussion for forensic identification. Forty-five SD rats were divided into 3, 6, 12, 24 h and 2, 4, 7, 10 d and normal control groups in terms of different wounding time after brain concussion model established, and the expression of GFAP after rats brain concussion were then observed by using SP immunohistochemical method. In normal control brain, low-level GFAP expressions could be observed. After six hours' brain concussion, GFAP positive cells increased obviously. The trend reached to the peak at 7d, partly declined at 10d, then decreased gradually. Brain concussion induced the expression of GFAP. The detection of GFAP could be useful for diagnosis of brain concussion on forensic pathology, and could be a reference index for timing of injury after brain concussion.

  8. Concussion

    Science.gov (United States)

    ... Saunders; 2014:chap 41. Kerr HA. Closed head injury. Clin Sports Med . 2013;32:273-287. PMID: 23522509 www. ... Elsevier; 2016:chap 710. Liebig CW, Congeni JA. Sports-related traumatic brain injury (Concussion). In: Kliegman RM, Stanton BF, St Geme ...

  9. Concussion in professional football: morphology of brain injuries in the NFL concussion model--part 16.

    Science.gov (United States)

    Hamberger, Anders; Viano, David C; Säljö, Annette; Bolouri, Hayde

    2009-06-01

    An animal model of concussions in National Football League players has been described in a previous study. It involves a freely moving 300-g Wistar rat impacted on the side of the head at velocities of 7.4 to 11.2 m/s with a 50-g impactor. The impact causes a 6% to 28% incidence of meningeal hemorrhages and 0.1- to 0.3-mm focal petechiae depending on the impact velocity. This study addresses the immunohistochemical responses of the brain. Twenty-seven tests were conducted with a 50-g impactor and velocities of 7.4, 9.3, or 11.2 m/s. The left temporal region of the helmet-protected head was hit 1 or 3 times. Thirty-one additional tests were conducted with a 100-g impactor. Diffuse axonal injury in distant regions of the brain was assessed with immunohistochemistry for NF-200, the heaviest neurofilament subunit, and glial fibrillary acidic protein, an intermediate filament protein in astrocytes. Hemorrhages were analyzed by unspecific peroxidase. There were 10 controls. A single impact at 7.4 and 9.3 m/s velocity with the 50-g impactor causes minimal neuronal injury and astrocytosis. Repeat impacts with 11.2 m/s velocity and more than 9.3-m/s impacts with 100 g cause diffuse axonal injury and distant injury bilaterally in the cerebral cortex, the subcortical, the white matter, the hippocampus CA1, the corpus callosum, and the striatum, as indicated by NF-200 accumulation in neuronal perikarya 10 days after impact. It also causes reactive astrocytosis in the midline regions of the cerebral cortex and periventricularly. Regions with erythrocyte-loaded blood capillaries indicated brain edema in regions of the cerebral cortex, the brainstem, and the cerebellum. When the immunohistochemical results are extrapolated to professional football players, concussions result in no or minimal brain injury. Repeat impacts at higher velocity or with a heavier mass impactor cause extensive and distant diffuse axonal injury. Based on this model, the threshold for diffuse axonal injury

  10. 199 Multiple Concussions in Young Athletes: Identifying Patients at Risk for Repeat Injury.

    Science.gov (United States)

    Murphy, Meghan; McCutcheon, Brandon A; Kerezoudis, Panagiotis; Rinaldo, Lorenzo; Shepherd, Daniel Levi; Maloney, Patrick R; Gates, Marcus J; Bydon, Mohamad

    2016-08-01

    Concussion diagnosis and management is a topic of interest for health care, education, and government professionals. Given the evidence concerning the association of long-term effects and cumulative insult of multiple concussions, we sought to identify risk factors in young athletes for repeat injury. This study is a retrospective cohort analysis of our institution's series of pediatric sports related concussions. Patient demographics, characteristics, and clinical features of concussion were analyzed in an unadjusted fashion. Bivariate analysis examined these variables in relation to occurrence of subsequent concussion. Multivariable analysis was then used to evaluate for predictors of repeat injury. One hundred ninety-one patients with a mean age of 13.5 years were included for analysis. Relative to patients whose injury was associated with football, patients playing soccer (odds ratio [OR], 5.36; 95% confidence interval [CI], 1.18-24.5), ice hockey/skating (OR, 6.97; 95% CI, 1.60-30.37), and basketball (OR, 5.99; 95% CI, 1.23-29.07) were associated with a significant increased odds of having a subsequent concussion. History of prior concussion was also significantly associated with an increased odds of repeat injury following the index concussion, defined as the first concussion evaluated at our institution (OR, 12.54; 95% CI, 3.78-41.62). Relative to a concussion resulting from a mechanism involving blunt force to the head, patients with a concussion in the setting of a fall were significantly less likely to experience a subsequent concussion (OR, 0.19; 95% CI, 0.05-0.71). Efforts to protect young athletes are of immeasurable value given the potential life years at risk for productivity and quality of life. With the identification of specific sports, prior injury, and mechanism influencing risk of repeat injury, clinicians are more informed to assess and discuss both risk and potential consequences of concussions with young athletes and their families.

  11. Concussion - adults - discharge

    Science.gov (United States)

    Brain injury - concussion - discharge; Traumatic brain injury - concussion - discharge; Closed head injury - concussion - discharge ... Getting better from a concussion takes days to weeks or even months. ... have trouble concentrating, or be unable to remember things. ...

  12. School-Based Traumatic Brain Injury and Concussion Management Program

    Science.gov (United States)

    Davies, Susan C.

    2016-01-01

    Traumatic brain injuries (TBIs), including concussions, can result in a constellation of physical, cognitive, emotional, and behavioral symptoms that affect students' well-being and performance at school. Despite these effects, school personnel remain underprepared identify, educate, and assist this population of students. This article describes a…

  13. Sports and Concussion

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Concussion Sports and Concussion Past Issues / Summer 2015 Table of Contents For ... vital to a healthy life. What Is a Concussion? A concussion is a type of traumatic brain ...

  14. Post-Concussion Syndrome

    Science.gov (United States)

    Post-concussion syndrome Overview By Mayo Clinic Staff Post-concussion syndrome is a complex disorder in which various symptoms — ... sometimes months after the injury that caused the concussion. Concussion is a mild traumatic brain injury that ...

  15. The Young Brain and Concussion: Imaging as a Biomarker for Diagnosis and Prognosis

    Science.gov (United States)

    Toledo, E.; Lebel, A.; Becerra, L.; Minster, A.; Linnman, C; Maleki, N; Dodick, D.W.; Borsook, D.

    2012-01-01

    Concussion (mild traumatic brain injury (mTBI)) is a significant pediatric public health concern. Despite increased awareness, a comprehensive understanding of the acute and chronic effects of concussion on central nervous system structure and function remains incomplete. Here we review the definition, epidemiology, and sequelae of concussion within the developing brain, during childhood and adolescence, with current data derived from studies of pathophysiology and neuroimaging. These findings may contribute to a better understanding of the neurological consequences of traumatic brain injuries, which in turn, may lead to the development of brain biomarkers to improve identification, management and prognosis of pediatric patients suffering from concussion. PMID:22476089

  16. NIH Research on Concussion and the Brain

    Science.gov (United States)

    ... Boston University In 2012, the National Football League (NFL) donated $30 million to the Foundation for the ... Brain Bank, there are 87 that are former NFL players. And 83 of those—95 percent—had ...

  17. Concussion in professional football: animal model of brain injury--part 15.

    Science.gov (United States)

    Viano, David C; Hamberger, Anders; Bolouri, Hayde; Säljö, Annette

    2009-06-01

    A concussion model was developed to study injury mechanisms, functional effects, treatment, and recovery. Concussions in National Football League football involve high-impact velocity (7.4-11.2 m/s) and rapid change in head velocity (DeltaV) (5.4-9.0 m/s). Current animal models do not simulate these head impact conditions. One hundred eight adult male Wistar rats weighing 280 to 350 g were used in ballistic impacts simulating 3 collision severities causing National Football League-type concussion. Pneumatic pressure accelerated a 50 g impactor to velocities of 7.4, 9.3, and 11.2 m/s at the left side of the helmet-protected head. A thin layer of padding on the helmet controlled head acceleration, which was measured on the opposite side of the head, in line with the impact. Peak head acceleration, DeltaV, impact duration, and energy transfer were determined. Fifty-four animals were exposed to single impact, with 18 each having 1, 4, or 10 days of survival. Similar tests were conducted on another 54 animals, which received 3 impacts at 6-hour intervals. An additional 72 animals were tested with a 100g impactor to study more serious brain injuries. Brains were perfused, and surface injuries were identified. The 50 g impactor matches concussion conditions scaled to the rat. Impact velocity and head DeltaV were within 1% and 3% of targets on average. Head acceleration reached 450 g to 1750 g without skull fracture. The test is repeatable and robust. Gross pathology was observed in 11%, 28%, and 33% of animals in the 7.4-, 9.3-, and 11.2-m/s single impacts, respectively. At 7.4 m/s, a single diameter area of less than 0.5 mm of fine petechial hemorrhage occurred on the brain surface in the parenchyma and meninges nearest the point of impact. At higher velocities, there were larger areas of bleeding, sometimes with subdural hemorrhage. When the 50 g impactor tests were examined by logistic regression, greater energy transfer increased the probability of injury (odds ratio

  18. Sports and Concussions

    Science.gov (United States)

    ... Help Someone Who's Being Bullied? Volunteering Sports and Concussions KidsHealth > For Teens > Sports and Concussions Print A ... completely helps prevent long-term problems. How Do Concussions Happen? The brain is soft. The body protects ...

  19. School and Concussions

    Science.gov (United States)

    ... Help Someone Who's Being Bullied? Volunteering School and Concussions KidsHealth > For Teens > School and Concussions Print A ... a type of brain injury. How Can a Concussion Affect Me at School? All injured body parts ...

  20. Do brain activation changes persist in athletes with a history of multiple concussions who are asymptomatic?

    Science.gov (United States)

    Elbin, R J; Covassin, Tracey; Hakun, Jonathan; Kontos, Anthony P; Berger, Kevin; Pfeiffer, Karin; Ravizza, Susan

    2012-01-01

    To evaluate brain activation patterns of asymptomatic athletes with a history of two or more concussions. A paired case-control design was used to evaluate brain activation patterns during cognitive performance in 14 athletes with a history of two or more concussions and 14 age- and sex-matched controls with no previous concussion. Percentage Blood-Oxygen-Level-Dependent (BOLD) change during an N-back working memory task was assessed in all participants. Performance on the Trail-Making Test Form A and B, Symbol-Digit Modalities Test and the Immediate Post-concussion Assessment and Cognitive Test (ImPACT) was also compared between groups. As expected, brain regions activated during the performance of the N-back were equivalent between groups. The groups performed similarly on the neurocognitive measures. The history of concussion group was less accurate than controls on the 1-, 2- and 3-back conditions of the N-back. Following the complete resolution of symptoms, a history of two or more concussions is not associated with changes in regional brain activation during the performance of working memory task. Compensatory brain activation may only persist during the typically brief time athletes experience symptoms following concussion.

  1. An introduction to sports concussions.

    Science.gov (United States)

    Giza, Christopher C; Kutcher, Jeffrey S

    2014-12-01

    Concussions are a major public health issue, and particularly so in the setting of sports. Millions of athletes of all ages may face the risks of concussion and repeat concussion. This article introduces the terminology, epidemiology, and underlying pathophysiology associated with concussion, focused on sports-related injuries. Concussion is a clinical syndrome of symptoms and signs occurring after biomechanical force is imparted to the brain. Because of the subjective nature of symptom reporting, definitions of concussion differ slightly in different guidelines. Concussion nomenclature also includes mild traumatic brain injury, postconcussion symptoms, postconcussion syndrome, chronic neurocognitive impairment, subconcussive injury, and chronic traumatic encephalopathy. Between 1.6 and 3.8 million sports-related concussions are estimated in the United States annually, particularly in youth athletes. Rates of concussion are higher in sports such as football, rugby, ice hockey, and wrestling in males, and soccer and basketball in females. The underlying pathophysiology of concussion centers on membrane leakage, ionic flux, indiscriminate glutamate release, and energy crisis. These initial events then trigger ongoing metabolic impairment, vulnerability to second injury, altered neural activation, and axonal dysfunction. While the linkage between acute neurobiology and chronic deficits remains to be elucidated, activation of cell death pathways, ongoing inflammation, persistent metabolic problems, and accumulation of abnormal or toxic proteins have all been implicated. Concussion is a biomechanically induced syndrome of neural dysfunction. Millions of concussions occur annually, many of them related to sports. Biologically, a complex sequence of events occurs from initial ionic flux, glutamate release, and axonal damage, resulting in vulnerability to second injury and possibly to longer-term neurodegeneration.

  2. A history of sport-related concussion on event-related brain potential correlates of cognition.

    Science.gov (United States)

    Broglio, Steven P; Moore, Robert D; Hillman, Charles H

    2011-10-01

    Over the past decade, a growing body of research has detailed persistent changes to neuroelectric indices of cognition in amateur and professional athletes with a concussion history. Here, we review the relevant neuroelectric findings on this relationship while considering the duration from the last concussive event. Collectively, the findings support a negative relation of concussive injury to neuroelectric indices of brain health and cognition in the presence of normal clinical findings. The results suggest that event-related brain potentials are especially well-suited for identifying aspects of cognition that remain dysfunctional for an extended period of time, which are otherwise unidentified using standard neuropsychological tests. Such findings also suggest the need for additional research to fully elucidate the extent to which concussive injuries negatively impact brain health and cognition.

  3. Consequences of repeated blood-brain barrier disruption in football players.

    Directory of Open Access Journals (Sweden)

    Nicola Marchi

    Full Text Available The acknowledgement of risks for traumatic brain injury in American football players has prompted studies for sideline concussion diagnosis and testing for neurological deficits. While concussions are recognized etiological factors for a spectrum of neurological sequelae, the consequences of sub-concussive events are unclear. We tested the hypothesis that blood-brain barrier disruption (BBBD and the accompanying surge of the astrocytic protein S100B in blood may cause an immune response associated with production of auto-antibodies. We also wished to determine whether these events result in disrupted white matter on diffusion tensor imaging (DT scans. Players from three college football teams were enrolled (total of 67 volunteers. None of the players experienced a concussion. Blood samples were collected before and after games (n = 57; the number of head hits in all players was monitored by movie review and post-game interviews. S100B serum levels and auto-antibodies against S100B were measured and correlated by direct and reverse immunoassays (n = 15 players; 5 games. A subset of players underwent DTI scans pre- and post-season and after a 6-month interval (n = 10. Cognitive and functional assessments were also performed. After a game, transient BBB damage measured by serum S100B was detected only in players experiencing the greatest number of sub-concussive head hits. Elevated levels of auto-antibodies against S100B were elevated only after repeated sub-concussive events characterized by BBBD. Serum levels of S100B auto-antibodies also predicted persistence of MRI-DTI abnormalities which in turn correlated with cognitive changes. Even in the absence of concussion, football players may experience repeated BBBD and serum surges of the potential auto-antigen S100B. The correlation of serum S100B, auto-antibodies and DTI changes support a link between repeated BBBD and future risk for cognitive changes.

  4. Consequences of Repeated Blood-Brain Barrier Disruption in Football Players

    Science.gov (United States)

    Puvenna, Vikram; Janigro, Mattia; Ghosh, Chaitali; Zhong, Jianhui; Zhu, Tong; Blackman, Eric; Stewart, Desiree; Ellis, Jasmina; Butler, Robert; Janigro, Damir

    2013-01-01

    The acknowledgement of risks for traumatic brain injury in American football players has prompted studies for sideline concussion diagnosis and testing for neurological deficits. While concussions are recognized etiological factors for a spectrum of neurological sequelae, the consequences of sub-concussive events are unclear. We tested the hypothesis that blood-brain barrier disruption (BBBD) and the accompanying surge of the astrocytic protein S100B in blood may cause an immune response associated with production of auto-antibodies. We also wished to determine whether these events result in disrupted white matter on diffusion tensor imaging (DT) scans. Players from three college football teams were enrolled (total of 67 volunteers). None of the players experienced a concussion. Blood samples were collected before and after games (n = 57); the number of head hits in all players was monitored by movie review and post-game interviews. S100B serum levels and auto-antibodies against S100B were measured and correlated by direct and reverse immunoassays (n = 15 players; 5 games). A subset of players underwent DTI scans pre- and post-season and after a 6-month interval (n = 10). Cognitive and functional assessments were also performed. After a game, transient BBB damage measured by serum S100B was detected only in players experiencing the greatest number of sub-concussive head hits. Elevated levels of auto-antibodies against S100B were elevated only after repeated sub-concussive events characterized by BBBD. Serum levels of S100B auto-antibodies also predicted persistence of MRI-DTI abnormalities which in turn correlated with cognitive changes. Even in the absence of concussion, football players may experience repeated BBBD and serum surges of the potential auto-antigen S100B. The correlation of serum S100B, auto-antibodies and DTI changes support a link between repeated BBBD and future risk for cognitive changes. PMID:23483891

  5. Exposure to Surgery and Anesthesia After Concussion Due to Mild Traumatic Brain Injury.

    Science.gov (United States)

    Abcejo, Arnoley S; Savica, Rodolfo; Lanier, William L; Pasternak, Jeffrey J

    2017-07-01

    To describe the epidemiology of surgical and anesthetic procedures in patients recently diagnosed as having a concussion due to mild traumatic brain injury. Study patients presented to a tertiary care center after a concussion due to mild traumatic brain injury from July 1, 2005, through June 30, 2015, and underwent a surgical procedure and anesthesia support under the direct or indirect care of a physician anesthesiologist. During the study period, 1038 patients met all the study inclusion criteria and subsequently received 1820 anesthetics. In this population of anesthetized patients, rates of diagnosed concussions due to sports injuries, falls, and assaults, but not motor vehicle accidents, increased during 2010-2011. Concussions were diagnosed in 965 patients (93%) within 1 week after injury. In the 552 patients who had surgery within 1 week after concussive injury, 29 (5%) had anesthesia and surgical procedures unrelated to their concussion-producing traumatic injury. The highest use of surgery occurred early after injury and most frequently required general anesthesia. Orthopedic and general surgical procedures accounted for 57% of procedures. Nine patients received 29 anesthetics before a concussion diagnosis, and all of these patients had been involved in motor vehicle accidents and received at least 1 anesthetic within 1 week of injury. Surgical and anesthesia use are common in patients after concussion. Clinicians should have increased awareness for concussion in patients who sustain a trauma and may need to take measures to avoid potentially injury-augmenting cerebral physiology in these patients. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  6. Technical knockout: when is traumatic brain injury “just” a concussion?

    LENUS (Irish Health Repository)

    O’Halloran, P J

    2016-05-01

    While cricket is an unlikely source of concussion, the fierce contagion of media coverage surrounding Rugby and Gaelic Football has led to difficulties in deciphering real from perceived risk. The surge in public interest has forced this young science to mature quickly. The principles of managing head injury have not changed, but there is now a greater awareness that concussion is a traumatic brain injury (TBI).\\r\

  7. Sports-related concussions.

    Science.gov (United States)

    Conder, Robert L; Conder, Alanna A

    2015-04-01

    Concussions are an inherent part of collision sports such as football and soccer. As a subset of traumatic brain injury, concussions are neurometabolic events that cause transient neurologic dysfunction. Following a concussion, some athletes require longer neurologic recovery than others. Education and intervention aimed at prevention and management can minimize the long-term sequelae of sports-related concussions.

  8. Diminished brain resilience syndrome: A modern day neurological pathology of increased susceptibility to mild brain trauma, concussion, and downstream neurodegeneration

    OpenAIRE

    Morley, Wendy A.; Stephanie Seneff

    2014-01-01

    The number of sports-related concussions has been steadily rising in recent years. Diminished brain resilience syndrome is a term coined by the lead author to describe a particular physiological state of nutrient functional deficiency and disrupted homeostatic mechanisms leading to increased susceptibility to previously considered innocuous concussion. We discuss how modern day environmental toxicant exposure, along with major changes in our food supply and lifestyle practices, profoundly red...

  9. Concussion and Mild Traumatic Brain Injury: An Annotated Bibliography

    Science.gov (United States)

    2013-08-01

    Diffusion tensor imaging (DTI) may be a useful index of micro structural changes implicated in diffuse axonal injury linked to persistent post concussive...the convulsive theory is readily compatible with neurophysiological data and can provide a totally viable explanation for concussion. Shultz, S.R...sensitivity of diffusion tensor imaging to micro -structural white matter damage in mild and moderate pediatric TBI was tested with children with and without

  10. Distinct time courses of secondary brain damage in the hippocampus following brain concussion and contusion in rats.

    Science.gov (United States)

    Nakajima, Yuko; Horiuchi, Yutaka; Kamata, Hiroshi; Yukawa, Masayoshi; Kuwabara, Masato; Tsubokawa, Takashi

    2010-07-01

    Secondary brain damage (SBD) is caused by apoptosis after traumatic brain injury that is classified into concussion and contusion. Brain concussion is temporary unconsciousness or confusion caused by a blow on the head without pathological changes, and contusion is a brain injury with hemorrhage and broad extravasations. In this study, we investigated the time-dependent changes of apoptosis in hippocampus after brain concussion and contusion using rat models. We generated the concussion by dropping a plumb on the dura from a height of 3.5 cm and the contusion by cauterizing the cerebral cortex. SBD was evaluated in the hippocampus by histopathological analyses and measuring caspase-3 activity that induces apoptotic neuronal cell death. The frequency of abnormal neuronal cells with vacuolation or nuclear condensation, or those with DNA fragmentation was remarkably increased at 1 hr after concussion (about 30% for each abnormality) from the pre-injury level (0%) and reached the highest level (about 50% for each) by 48 hrs, whereas the frequency of abnormal neuronal cells was increased at 1 hr after contusion (about 10%) and reached the highest level (about 40%) by 48 hrs. In parallel, caspase-3 activity was increased sevenfold in the hippocampus at 1 hr after concussion and returned to the pre-injury level by 48 hrs, whereas after contusion, caspase-3 activity was continuously increased to the highest level at 48 hrs (fivefold). Thus, anti-apoptotic-cell-death treatment to prevent SBD must be performed by 1 hr after concussion and at latest by 48 hrs after contusion.

  11. Changes in functional brain networks following sports-related concussion in adolescents.

    Science.gov (United States)

    Virji-Babul, Naznin; Hilderman, Courtney G E; Makan, Nadia; Liu, Aiping; Smith-Forrester, Jenna; Franks, Chris; Wang, Z J

    2014-12-01

    Sports-related concussion is a major public health issue; however, little is known about the underlying changes in functional brain networks in adolescents following injury. Our aim was to use the tools from graph theory to evaluate the changes in brain network properties following concussion in adolescent athletes. We recorded resting state electroencephalography (EEG) in 33 healthy adolescent athletes and 9 adolescent athletes with a clinical diagnosis of subacute concussion. Graph theory analysis was applied to these data to evaluate changes in brain networks. Global and local metrics of the structural properties of the graph were calculated for each group and correlated with Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) scores. Brain networks of both groups showed small-world topology with no statistically significant differences in the global metrics; however, significant differences were found in the local metrics. Specifically, in the concussed group, we noted: 1) increased values of betweenness and degree in frontal electrode sites corresponding to the (R) dorsolateral prefrontal cortex and the (R) inferior frontal gyrus and 2) decreased values of degree in the region corresponding to the (R) frontopolar prefrontal cortex. In addition, there was significant negative correlation between degree and hub value, with total symptom score at the electrode site corresponding to the (R) prefrontal cortex. This preliminary report in adolescent athletes shows for the first time that resting-state EEG combined with graph theoretical analysis may provide an objective method of evaluating changes in brain networks following concussion. This approach may be useful in identifying individuals at risk for future injury.

  12. Eye tracking detects disconjugate eye movements associated with structural traumatic brain injury and concussion.

    Science.gov (United States)

    Samadani, Uzma; Ritlop, Robert; Reyes, Marleen; Nehrbass, Elena; Li, Meng; Lamm, Elizabeth; Schneider, Julia; Shimunov, David; Sava, Maria; Kolecki, Radek; Burris, Paige; Altomare, Lindsey; Mehmood, Talha; Smith, Theodore; Huang, Jason H; McStay, Christopher; Todd, S Rob; Qian, Meng; Kondziolka, Douglas; Wall, Stephen; Huang, Paul

    2015-04-15

    Disconjugate eye movements have been associated with traumatic brain injury since ancient times. Ocular motility dysfunction may be present in up to 90% of patients with concussion or blast injury. We developed an algorithm for eye tracking in which the Cartesian coordinates of the right and left pupils are tracked over 200 sec and compared to each other as a subject watches a short film clip moving inside an aperture on a computer screen. We prospectively eye tracked 64 normal healthy noninjured control subjects and compared findings to 75 trauma subjects with either a positive head computed tomography (CT) scan (n=13), negative head CT (n=39), or nonhead injury (n=23) to determine whether eye tracking would reveal the disconjugate gaze associated with both structural brain injury and concussion. Tracking metrics were then correlated to the clinical concussion measure Sport Concussion Assessment Tool 3 (SCAT3) in trauma patients. Five out of five measures of horizontal disconjugacy were increased in positive and negative head CT patients relative to noninjured control subjects. Only one of five vertical disconjugacy measures was significantly increased in brain-injured patients relative to controls. Linear regression analysis of all 75 trauma patients demonstrated that three metrics for horizontal disconjugacy negatively correlated with SCAT3 symptom severity score and positively correlated with total Standardized Assessment of Concussion score. Abnormal eye-tracking metrics improved over time toward baseline in brain-injured subjects observed in follow-up. Eye tracking may help quantify the severity of ocular motility disruption associated with concussion and structural brain injury.

  13. fMRI and brain activation after sport concussion: a tale of two cases

    Directory of Open Access Journals (Sweden)

    Michael G Hutchison

    2014-04-01

    Full Text Available Sport-related concussions are now recognized as a major public health concern: The number of participants in sport and recreation is growing, possibly playing their games faster, and there is heightened public awareness of injuries to some high-profile athletes. However, many clinicians still rely on subjective symptom reports for the clinical determination of recovery. Relying on subjective symptom reports can be dangerous, as it has been shown that some concussed athletes may downplay their symptoms. The use of neuropsychological (NP testing tools has enabled clinicians to measure the effects and extent of impairment following concussion more precisely, providing more objective metrics for determining recovery after concussion. Nevertheless, there is a remaining concern that brain abnormalities may exist beyond the point at which individuals achieve recovery in self-reported symptoms and cognition measured by NP testing. Our understanding of brain recovery after concussion is important not only from a neuroscience perspective, but also from the perspective of clinical decision making for safe return-to-play (RTP. A number of advanced neuroimaging tools, including blood oxygen level dependent (BOLD functional magnetic resonance imaging (fMRI, have independently yielded early information on these abnormal brain functions. In the two cases presented in this article, we report contrasting brain activation patterns and recovery profiles using fMRI. Importantly, fMRI was conducted using adapted versions of the most sensitive computerized NP tests administered in current clinical practice to determine impairments and recovery after sport-related concussion. One of the cases is consistent with the concept of lagging brain recovery.

  14. Concussion in Motor Vehicle Accidents: The Concussion Identification Index

    Science.gov (United States)

    2016-08-03

    Motor Vehicle Accidents; TBI (Traumatic Brain Injury); Brain Contusion; Brain Injuries; Cortical Contusion; Concussion Mild; Cerebral Concussion; Brain Concussion; Accidents, Traffic; Traffic Accidents; Traumatic Brain Injury With Brief Loss of Consciousness; Traumatic Brain Injury With no Loss of Consciousness; Traumatic Brain Injury With Loss of Consciousness

  15. Mild Traumatic Brain Injury: Lessons Learned from Clinical, Sports, and Combat Concussions

    Directory of Open Access Journals (Sweden)

    Judy C. Kelly

    2012-01-01

    Full Text Available Over the past forty years, a tremendous amount of information has been gained on the mechanisms and consequences of mild traumatic brain injuries. Using sports as a laboratory to study this phenomenon, a natural recovery curve emerged, along with standards for managing concussions and returning athletes back to play. Although advances have been made in this area, investigation into recovery and return to play continues. With the increase in combat-related traumatic brain injuries in the military setting, lessons learned from sports concussion research are being applied by the Department of Defense to the assessment of blast concussions and return to duty decision making. Concussion management and treatment for military personnel can be complicated by additional combat related stressors not present in the civilian environment. Cognitive behavioral therapy is one of the interventions that has been successful in treating symptoms of postconcussion syndrome. While we are beginning to have an understanding of the impact of multiple concussions and subconcussive blows in the sports world, much is still unknown about the impact of multiple blast injuries.

  16. Brain function decline in healthy retired athletes who sustained their last sports concussion in early adulthood.

    Science.gov (United States)

    De Beaumont, Louis; Théoret, Hugo; Mongeon, David; Messier, Julie; Leclerc, Suzanne; Tremblay, Sébastien; Ellemberg, Dave; Lassonde, Maryse

    2009-03-01

    Recent studies have shown that the detrimental effects of sports concussions on cognitive and motor function may persist up to a few years post-injury. The present study sought to investigate the effects of having sustained a sports concussion more than 30 years prior to testing on cognitive and motor functions. Nineteen healthy former athletes, in late adulthood (mean age = 60.79; SD = 5.16), who sustained their last sport-related concussion in early adulthood (mean age = 26.05; SD = 9.21) were compared with 21 healthy former athletes with no history of concussion (mean age = 58.89; SD = 9.07). Neuropsychological tests sensitive to age-related changes in cognition were administered. An auditory oddball paradigm was used to evoke P3a and P3b brain responses. Four TMS paradigms were employed to assess motor cortex excitability: (i) resting motor threshold; (ii) paired-pulse intracortical inhibition and intracortical facilitation; (iii) input/output curve and (iv) cortical silent period (CSP). A rapid alternating movement task was also used to characterize motor system dysfunctions. Relative to controls, former athletes with a history of concussion had: (i) lower performance on neuropsychological tests of episodic memory and response inhibition; (ii) significantly delayed and attenuated P3a/P3b components; (iii) significantly prolonged CSP and (iv) significantly reduced movement velocity (bradykinesia). The finding that the P3, the CSP as well as neuropsychological and motor indices were altered more than three decades post-concussion provides evidence for the chronicity of cognitive and motor system changes consecutive to sports concussion.

  17. FMRI and brain activation after sport concussion: a tale of two cases.

    Science.gov (United States)

    Hutchison, Michael G; Schweizer, Tom A; Tam, Fred; Graham, Simon J; Comper, Paul

    2014-01-01

    Sport-related concussions are now recognized as a major public health concern: the number of participants in sport and recreation is growing, possibly playing their games faster, and there is heightened public awareness of injuries to some high-profile athletes. However, many clinicians still rely on subjective symptom reports for the clinical determination of recovery. Relying on subjective symptom reports can be problematic, as it has been shown that some concussed athletes may downplay their symptoms. The use of neuropsychological (NP) testing has enabled clinicians to measure the effects and extent of impairment following concussion more precisely, providing more objective metrics for determining recovery. Nevertheless, there is a remaining concern that brain abnormalities may exist beyond the point at which individuals achieve recovery in self-reported symptoms and cognition measured by NP testing. Our understanding of brain recovery after concussion is important, not only from a neuroscience perspective, but also from the perspective of clinical decision-making for safe return-to-play. A number of advanced neuroimaging tools, including blood oxygen level dependent functional magnetic resonance imaging (fMRI), have independently yielded early information on abnormal brain functioning. In the two cases presented in this article, we report contrasting brain activation patterns and recovery profiles using fMRI. Importantly, fMRI was conducted using adapted versions of the most sensitive computerized NP tests administered in our current clinical practice to determine impairments and recovery after sport-related concussion. One of the cases is consistent with the concept of lagging brain recovery.

  18. Brain functions after sports-related concussion: insights from event-related potentials and functional MRI.

    Science.gov (United States)

    Gosselin, Nadia; Saluja, Rajeet Singh; Chen, Jen-Kai; Bottari, Carolina; Johnston, Karen; Ptito, Alain

    2010-10-01

    The high incidence of concussions in contact sports and their impact on brain functions are a major cause for concern. To improve our understanding of brain functioning after sports-related concussion, advanced functional assessment techniques, namely event-related potentials (ERPs) and functional magnetic resonance imaging (fMRI), have been recently used in research studies. Contrary to neuropsychological tests that measure verbal and/or motor responses, ERPs and fMRI assess the neural activities associated with cognitive/behavioral demands, and thus provide access to better comprehension of brain functioning. In fact, ERPs have excellent temporal resolution, and fMRI identifies the involved structures during a task. This article describes ERP and fMRI techniques and reviews the results obtained with these tools in sports-related concussion. Although these techniques are not yet readily available, they offer a unique clinical approach, particularly for complex cases (ie, athletes with multiple concussions, chronic symptoms) and objective measures that provide valuable information to guide management and return-to-play decision making.

  19. Second time around:Corticospinal responses following repeated sports-related concussions within the same season. A transcranial magnetic stimulation study

    Institute of Scientific and Technical Information of China (English)

    Alan J Pearce; Daniel T Corp; Charlotte B Davies; Brendan P Major; Jerome J Maller

    2014-01-01

    Objective:To investigate the degree of neurophysiological and cognitive performance changes resulting from repeat concussions sustained in a single season ofAustralianRules football. Methods:Three amateur football players were recruited after sustainingtwo concussions during a single season of playing.Each player was assessed at multiple time points by transcranial magnetic stimulation(TMS) and electromyography, as well as tested for fine motor and cognitive performance after each concussion.Results:In all three cases, concussions resulted in reduction in fine dexterity and visuomotor reaction time, cognitive attention performance and increase in intracortical inhibition fromTMS.No changes in performance orTMS outcomes were found as a result of the order of the concussions.However, changes observed were dependent on the severity of the concussion.Conclusions:This multiple-case study has demonstrated that concussion result in increased intracortical inhibition and reduction in cognitive and motor performance. Further,TMS, in conjunction with tests of cognitive and motor performance, can be useful as a prognostic technique in assessing recovery from acute concussion injury.

  20. Brain activation during neurocognitive testing using functional near-infrared spectroscopy in patients following concussion compared to healthy controls

    Science.gov (United States)

    Huppert, T. J.; Beluk, N. H.; Elbin, R. J.; Henry, L. C.; French, J.; Dakan, S. M.; Collins, M. W.

    2016-01-01

    There is no accepted clinical imaging modality for concussion, and current imaging modalities including fMRI, DTI, and PET are expensive and inaccessible to most clinics/ patients. Functional near-infrared spectroscopy (fNIRS) is a non-invasive, portable, and low-cost imaging modality that can measure brain activity. The purpose of this study was to compare brain activity as measured by fNIRS in concussed and age-matched controls during the performance of cognitive tasks from a computerized neurocognitive test battery. Participants included nine currently symptomatic patients aged 18–45 years with a recent (15–45 days) sport-related concussion and five age-matched healthy controls. The participants completed a computerized neurocognitive test battery while wearing the fNIRS unit. Our results demonstrated reduced brain activation in the concussed subject group during word memory, (spatial) design memory, digit-symbol substitution (symbol match), and working memory (X’s and O’s) tasks. Behavioral performance (percent-correct and reaction time respectively) was lower for concussed participants on the word memory, design memory, and symbol match tasks than controls. The results of this preliminary study suggest that fNIRS could be a useful, portable assessment tool to assess reduced brain activation and augment current approaches to assessment and management of patients following concussion. PMID:24477579

  1. Treatment with an anti-CD11d integrin antibody reduces neuroinflammation and improves outcome in a rat model of repeated concussion

    OpenAIRE

    2013-01-01

    Background Concussions account for the majority of traumatic brain injuries (TBI) and can result in cumulative damage, neurodegeneration, and chronic neurological abnormalities. The underlying mechanisms of these detrimental effects remain poorly understood and there are presently no specific treatments for concussions. Neuroinflammation is a major contributor to secondary damage following more severe TBI, and recent findings from our laboratory suggest it may be involved in the cumulative pr...

  2. The New Neurometabolic Cascade of Concussion

    Science.gov (United States)

    Giza, Christopher C.; Hovda, David A.

    2015-01-01

    Since the original descriptions of post-concussive pathophysiology, there has been a significant increase in interest and ongoing research to study the biological underpinnings of concussion. The initial ionic flux and glutamate release result in significant energy demands and a period of metabolic crisis for the injured brain. These physiological perturbations can now be linked to clinical characteristics of concussion, including migrainous symptoms, vulnerability to repeat injury and cognitive impairment. Furthermore, advanced neuroimaging now allows a research window to monitor post-concussion pathophysiology in humans noninvasively. There is also increasing concern about the risk for chronic or even progressive neurobehavioral impairment after concussion/mild TBI. Critical studies are underway to better link the acute pathobiology of concussion with potential mechanisms of chronic cell death, dysfunction and neurodegeneration. This “new and improved” paper summarizes in a translational fashion and updates what is known about the acute neurometabolic changes after concussive brain injury. Furthermore, new connections are proposed between this neurobiology and early clinical symptoms as well as to cellular processes that may underlie long term impairment. PMID:25232881

  3. Sport-related concussions

    Directory of Open Access Journals (Sweden)

    Jéssica Natuline Ianof

    Full Text Available ABSTRACT Traumatic brain injury (TBI is a major cause of lifelong disability and death worldwide. Sport-related traumatic brain injury is an important public health concern. The purpose of this review was to highlight the importance of sport-related concussions. Concussion refers to a transient alteration in consciousness induced by external biomechanical forces transmitted directly or indirectly to the brain. It is a common, although most likely underreported, condition. Contact sports such as American football, rugby, soccer, boxing, basketball and hockey are associated with a relatively high prevalence of concussion. Various factors may be associated with a greater risk of sport-related concussion, such as age, sex, sport played, level of sport played and equipment used. Physical complaints (headache, fatigue, dizziness, behavioral changes (depression, anxiety, irritability and cognitive impairment are very common after a concussion. The risk of premature return to activities includes the prolongation of post-concussive symptoms and increased risk of concussion recurrence.

  4. Advances in sport concussion assessment: from behavioral to brain imaging measures.

    Science.gov (United States)

    Ellemberg, Dave; Henry, Luke C; Macciocchi, Steve N; Guskiewicz, Kevin M; Broglio, Steven P

    2009-12-01

    Given that the incidence of sports-related concussion is considered to have reached epidemic proportions, in the past 15 years we have witnessed an explosion of research in this field. The purpose of the current review is to compare the results provided by the different assessment tools used in the scientific literature in order to gain a better understanding of the sequelae and recovery following a concussion. Until recently, the bulk of the has literature focused on the immediate outcome in the hours and days post-injury as a means to plan the safest return-to-play strategy. This has led to the development of several assessment batteries that are relatively easy and rapid to administer and that allow for multiple testing sessions. The main conclusion derived from that literature is that cognitive symptoms tend to resolve within 1 week. However, accumulating evidence indicates that cognitive testing should be viewed as one of several complementary tools necessary for a comprehensive assessment of concussion. Including an objective measure of postural stability increases the sensitivity of the return-to-play decision-making process and minimizes the consequences of mitigating factors (e.g., practice effects and motivation) on neuropsychological test results. This is consistent with findings that symptom severity, neuropsychological function, and postural stability do not appear to be related or affected to the same degree after a concussion. Furthermore, recent evidence from brain imaging, including event-related potentials and functional and metabolic imaging, suggest abnormalities in the electrical responses, metabolic balance, and oxygen consumption of neurons that persist several months after the incident. We explain this apparent discrepancy in recovery by suggesting an initial and rapid phase of functional recovery driven by compensatory mechanisms and brain plasticity, which is followed by a prolonged neuronal recovery period during which subtle deficits in

  5. Brain MRI CO2 stress testing: a pilot study in patients with concussion.

    Directory of Open Access Journals (Sweden)

    W Alan C Mutch

    Full Text Available There is a real need for quantifiable neuro-imaging biomarkers in concussion. Here we outline a brain BOLD-MRI CO2 stress test to assess the condition.This study was approved by the REB at the University of Manitoba. A group of volunteers without prior concussion were compared to post-concussion syndrome (PCS patients--both symptomatic and recovered asymptomatic. Five 3-minute periods of BOLD imaging at 3.0 T were studied--baseline 1 (BL1--at basal CO2 tension, hypocapnia (CO2 decreased ∼5 mmHg, BL2, hypercapnia (CO2 increased ∼10 mmHg and BL3. Data were processed using statistical parametric mapping (SPM for 1st level analysis to compare each subject's response to the CO2 stress at the p = 0.001 level. A 2nd level analysis compared each PCS patient's response to the mean response of the control subjects at the p = 0.05 level.We report on 5 control subjects, 8 symptomatic and 4 asymptomatic PCS patients. Both increased and decreased response to CO2 was seen in all PCS patients in the 2nd level analysis. The responses were quantified as reactive voxel counts: whole brain voxel counts (2.0±1.6%, p = 0.012 for symptomatic patients for CO2 response controls: 0.49±0.31%, p = 0.053 for asymptomatic patients for CO2 response controls.Quantifiable alterations in regional cerebrovascular responsiveness are present in concussion patients during provocative CO2 challenge and BOLD MRI and not in healthy controls. Future longitudinal studies must aim to clarify the relationship between CO2 responsiveness and individual patient symptoms and outcomes.

  6. Role of Akt and mammalian target of rapamycin in functional outcome after concussive brain injury in mice.

    Science.gov (United States)

    Zhu, Xiaoxia; Park, Juyeon; Golinski, Julianne; Qiu, Jianhua; Khuman, Jugta; Lee, Christopher C H; Lo, Eng H; Degterev, Alexei; Whalen, Michael J

    2014-09-01

    Akt (protein kinase B) and mammalian target of rapamycin (mTOR) have been implicated in the pathogenesis of cell death and cognitive outcome after cerebral contusion in mice; however, a role for Akt/mTOR in concussive brain injury has not been well characterized. In a mouse closed head injury (CHI) concussion traumatic brain injury (TBI) model, phosphorylation of Akt (p-Akt), mTOR (p-mTOR), and S6RP (p-S6RP) was increased by 24 hours in cortical and hippocampal brain homogenates (Pconcussion TBI independent of cell death that may contribute to improved outcome by Nec-1.

  7. Repeated Concussion Among U.S. Military Personnel During Operation Iraqi Freedom

    Science.gov (United States)

    2011-01-01

    dizziness, tinnitus , and sensitivity to noise or light), and affective ( depression , irritability, and anxiety), utilization of mental health and...concussion and risk of depression in retired professional football players. Med Sci Sports Exerc. 2007;39(6):903–9. [PMID: 17545878] http://dx.doi.org

  8. The Relationship between Concussion Knowledge and the High School Athlete's Intention to Report Traumatic Brain Injury Symptoms: A Systematic Review of the Literature

    Science.gov (United States)

    Taylor, Mary Ellen; Sanner, Jennifer E.

    2017-01-01

    Sports-related concussion or traumatic brain injury (TBI) is a frequent occurrence among high school athletes. Long-term and short-term effects of TBI on the athlete's developing brain can be minimized if the athlete reports and is effectively treated for TBI symptoms. Knowledge of concussion symptoms and a school culture of support are critical…

  9. The Relationship between Concussion Knowledge and the High School Athlete's Intention to Report Traumatic Brain Injury Symptoms: A Systematic Review of the Literature

    Science.gov (United States)

    Taylor, Mary Ellen; Sanner, Jennifer E.

    2017-01-01

    Sports-related concussion or traumatic brain injury (TBI) is a frequent occurrence among high school athletes. Long-term and short-term effects of TBI on the athlete's developing brain can be minimized if the athlete reports and is effectively treated for TBI symptoms. Knowledge of concussion symptoms and a school culture of support are critical…

  10. Dietary intake alters behavioral recovery and gene expression profiles in the brain of juvenile rats that have experienced a concussion.

    Science.gov (United States)

    Mychasiuk, Richelle; Hehar, Harleen; Ma, Irene; Esser, Michael J

    2015-01-01

    Concussion and mild traumatic brain injury (mTBI) research has made minimal progress diagnosing who will suffer from lingering symptomology or generating effective treatment strategies. Research demonstrates that dietary intake affects many biological systems including brain and neurological health. This study determined if exposure to a high fat diet (HFD) or caloric restriction (CR) altered post-concussion susceptibility or resiliency using a rodent model of pediatric concussion. Rats were maintained on HFD, CR, or standard diet (STD) throughout life (including the prenatal period and weaning). At postnatal day 30, male and female rats experienced a concussion or a sham injury which was followed by 17 days of testing. Prefrontal cortex and hippocampus tissue was collected for molecular profiling. Gene expression changes in BDNF, CREB, DNMT1, FGF-2, IGF1, LEP, PGC-1α, SIRT1, Tau, and TERT were analyzed with respect to injury and diet. Analysis of telomere length (TL) using peripheral skin cells and brain tissue found that TL in skin significantly correlated with TL in brain tissue and TL was affected by dietary intake and injury status. With respect to mTBI outcomes, diet was correlated with recovery as animals on the HFD often displayed poorer performance than animals on the CR diet. Molecular analysis demonstrated that diet induced epigenetic changes that can be associated with differences in individual predisposition and resiliency to post-concussion syndrome.

  11. Early Clinical Predictors of 5-Year Outcome After Concussive Blast Traumatic Brain Injury.

    Science.gov (United States)

    Mac Donald, Christine L; Barber, Jason; Jordan, Mary; Johnson, Ann M; Dikmen, Sureyya; Fann, Jesse R; Temkin, Nancy

    2017-07-01

    The long-term clinical effects of wartime traumatic brain injuries (TBIs), most of which are mild, remain incompletely described. Current medical disability cost estimates from world conflicts continually surpass projections. Additional information regarding long-term functional trajectory is needed to reduce this extensive public health burden. To examine 5-year clinical outcomes leveraging existing clinical data collected at 1 year after injury in the same patients and to identify early risk factors for long-term disability. This prospective, longitudinal study enrolled active-duty US military after concussive blast injury (n = 50) in the acute to subacute stage and combat-deployed control individuals (n = 44) in Afghanistan or after medical evacuation to Germany from November 1, 2008, through July 1, 2013. One- and 5-year clinical evaluations were completed in the United States. All concussive blast injuries met the Department of Defense definition of mild, uncomplicated TBI. In-person clinical evaluations included standardized evaluations for neurobehavior, neuropsychological performance, and mental health burden that were essentially identical to the evaluations completed at 1-year follow-up. Data were analyzed from October 1 through November 30, 2016. Changes in the in-person standardized evaluations for neurobehavior, neuropsychological performance, and mental health burden from the 1- to 5-year follow-up. Predictive modeling was used to identify early risk factors for long-term disability. Among the 94 participants (87 men [93%] and 7 women [7%]; mean [SD] age, 34 [8] years), global disability, satisfaction with life, neurobehavioral symptom severity, psychiatric symptom severity, and sleep impairment were significantly worse in patients with concussive blast TBI compared with combat-deployed controls, whereas performance on cognitive measures was no different between groups at the 5-year evaluation. Logistic regression on the dichotomized Extended

  12. Mild Concussion, but Not Moderate Traumatic Brain Injury, Is Associated with Long-Term Depression-Like Phenotype in Mice.

    Science.gov (United States)

    Bajwa, Nikita M; Halavi, Shina; Hamer, Mary; Semple, Bridgette D; Noble-Haeusslein, Linda J; Baghchechi, Mohsen; Hiroto, Alex; Hartman, Richard E; Obenaus, André

    2016-01-01

    Mild traumatic brain injuries can lead to long-lasting cognitive and motor deficits, increasing the risk of future behavioral, neurological, and affective disorders. Our study focused on long-term behavioral deficits after repeated injury in which mice received either a single mild CHI (mCHI), a repeated mild CHI (rmCHI) consisting of one impact to each hemisphere separated by 3 days, or a moderate controlled cortical impact injury (CCI). Shams received only anesthesia. Behavioral tests were administered at 1, 3, 5, 7, and 90 days post-injury (dpi). CCI animals showed significant motor and sensory deficits in the early (1-7 dpi) and long-term (90 dpi) stages of testing. Interestingly, sensory and subtle motor deficits in rmCHI animals were found at 90 dpi. Most importantly, depression-like behaviors and social passiveness were observed in rmCHI animals at 90 dpi. These data suggest that mild concussive injuries lead to motor and sensory deficits and affective disorders that are not observed after moderate TBI.

  13. Mild Concussion, but Not Moderate Traumatic Brain Injury, Is Associated with Long-Term Depression-Like Phenotype in Mice.

    Directory of Open Access Journals (Sweden)

    Nikita M Bajwa

    Full Text Available Mild traumatic brain injuries can lead to long-lasting cognitive and motor deficits, increasing the risk of future behavioral, neurological, and affective disorders. Our study focused on long-term behavioral deficits after repeated injury in which mice received either a single mild CHI (mCHI, a repeated mild CHI (rmCHI consisting of one impact to each hemisphere separated by 3 days, or a moderate controlled cortical impact injury (CCI. Shams received only anesthesia. Behavioral tests were administered at 1, 3, 5, 7, and 90 days post-injury (dpi. CCI animals showed significant motor and sensory deficits in the early (1-7 dpi and long-term (90 dpi stages of testing. Interestingly, sensory and subtle motor deficits in rmCHI animals were found at 90 dpi. Most importantly, depression-like behaviors and social passiveness were observed in rmCHI animals at 90 dpi. These data suggest that mild concussive injuries lead to motor and sensory deficits and affective disorders that are not observed after moderate TBI.

  14. Diminished brain resilience syndrome: A modern day neurological pathology of increased susceptibility to mild brain trauma, concussion, and downstream neurodegeneration.

    Science.gov (United States)

    Morley, Wendy A; Seneff, Stephanie

    2014-01-01

    The number of sports-related concussions has been steadily rising in recent years. Diminished brain resilience syndrome is a term coined by the lead author to describe a particular physiological state of nutrient functional deficiency and disrupted homeostatic mechanisms leading to increased susceptibility to previously considered innocuous concussion. We discuss how modern day environmental toxicant exposure, along with major changes in our food supply and lifestyle practices, profoundly reduce the bioavailability of neuro-critical nutrients such that the normal processes of homeostatic balance and resilience are no longer functional. Their diminished capacity triggers physiological and biochemical 'work around' processes that result in undesirable downstream consequences. Exposure to certain environmental chemicals, particularly glyphosate, the active ingredient in the herbicide, Roundup(®), may disrupt the body's innate switching mechanism, which normally turns off the immune response to brain injury once danger has been removed. Deficiencies in serotonin, due to disruption of the shikimate pathway, may lead to impaired melatonin supply, which reduces the resiliency of the brain through reduced antioxidant capacity and alterations in the cerebrospinal fluid, reducing critical protective buffering mechanisms in impact trauma. Depletion of certain rare minerals, overuse of sunscreen and/or overprotection from sun exposure, as well as overindulgence in heavily processed, nutrient deficient foods, further compromise the brain's resilience. Modifications to lifestyle practices, if widely implemented, could significantly reduce this trend of neurological damage.

  15. Diminished brain resilience syndrome: A modern day neurological pathology of increased susceptibility to mild brain trauma, concussion, and downstream neurodegeneration

    Directory of Open Access Journals (Sweden)

    Wendy A Morley

    2014-01-01

    Full Text Available The number of sports-related concussions has been steadily rising in recent years. Diminished brain resilience syndrome is a term coined by the lead author to describe a particular physiological state of nutrient functional deficiency and disrupted homeostatic mechanisms leading to increased susceptibility to previously considered innocuous concussion. We discuss how modern day environmental toxicant exposure, along with major changes in our food supply and lifestyle practices, profoundly reduce the bioavailability of neuro-critical nutrients such that the normal processes of homeostatic balance and resilience are no longer functional. Their diminished capacity triggers physiological and biochemical ′work around′ processes that result in undesirable downstream consequences. Exposure to certain environmental chemicals, particularly glyphosate, the active ingredient in the herbicide, Roundup; , may disrupt the body′s innate switching mechanism, which normally turns off the immune response to brain injury once danger has been removed. Deficiencies in serotonin, due to disruption of the shikimate pathway, may lead to impaired melatonin supply, which reduces the resiliency of the brain through reduced antioxidant capacity and alterations in the cerebrospinal fluid, reducing critical protective buffering mechanisms in impact trauma. Depletion of certain rare minerals, overuse of sunscreen and/or overprotection from sun exposure, as well as overindulgence in heavily processed, nutrient deficient foods, further compromise the brain′s resilience. Modifications to lifestyle practices, if widely implemented, could significantly reduce this trend of neurological damage.

  16. The relationship between suboptimal effort and post-concussion symptoms in children and adolescents with mild traumatic brain injury.

    Science.gov (United States)

    Araujo, Gabriel C; Antonini, Tanya N; Monahan, Kerry; Gelfius, Carl; Klamar, Karl; Potts, Michelle; Yeates, Keith O; Bodin, Doug

    2014-01-01

    This retrospective chart review study explored the relationship between suboptimal effort and post-concussion symptoms in pediatric mild traumatic brain injury (mTBI). Participants were 382 clinically referred children and adolescents between 8 and 16 years of age who sustained an mTBI. Suboptimal effort was identified using reliable digit span and age-corrected scaled scores from the Numbers subtest of the Children's Memory Scale (CMS); 20% of the sample were classified as non-credible performers. Chi-square analyses and t-tests were used to examine differences in post-concussion symptoms and neuropsychological test performance between credible and non-credible performers. Linear regression was used to examine whether CMS Numbers performance predicted post-concussion symptoms after controlling for baseline symptoms and other relevant demographic- and injury-related factors. We found that non-credible performers presented with a greater number of post-concussion symptoms as compared with credible performers. Additionally, non-credible performers demonstrated comparatively poorer performance on neuropsychological tests of focused attention and processing speed. These results suggest that children and adolescents with mTBI who fail effort testing might have a greater tendency to exaggerate post-concussion symptoms and cognitive impairment. The clinical implications of these findings are discussed.

  17. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... concussion are at increased risk for another concussion. C Young children and teens are more likely to ... how the brain works and a serious issue. C While rare, permanent brain damage and death are ...

  18. Concussions, Traumatic Brain Injury, and the Innovative Use of Omega-3s.

    Science.gov (United States)

    Lewis, Michael D

    2016-07-01

    Traumatic brain injury (TBI), with its diverse heterogeneity and prolonged secondary pathogenesis, remains a clinical challenge. Clinical studies thus far have failed to identify an effective treatment strategy when a combination of targets controlling aspects of neuroprotection, neuroinflammation, and neuroregeneration is needed. Omega-3 fatty acids (n-3FA) offer the advantage of this approach. Although further clinical trial research is needed, there is a growing body of strong preclinical evidence and clinical experience that suggests that benefits may be possible from aggressively adding substantial amounts of n-3FA to optimize the nutritional foundation of TBI, concussion, and postconcussion syndrome patients. Early and optimal doses of n-3FA, even in a prophylactic setting, have the potential to improve outcomes from this potentially devastating problem. With evidence of unsurpassed safety and tolerability, n-3FA should be considered mainstream, conventional medicine, if conventional medicine can overcome its inherent bias against nutritional, nonpharmacologic therapies.

  19. Sport-related concussions

    OpenAIRE

    2014-01-01

    ABSTRACT Traumatic brain injury (TBI) is a major cause of lifelong disability and death worldwide. Sport-related traumatic brain injury is an important public health concern. The purpose of this review was to highlight the importance of sport-related concussions. Concussion refers to a transient alteration in consciousness induced by external biomechanical forces transmitted directly or indirectly to the brain. It is a common, although most likely underreported, condition. Contact sports such...

  20. Second time around: Corticospinal responses following repeated sports-related concussions within the same season. A transcranial magnetic stimulation study

    Directory of Open Access Journals (Sweden)

    Alan J Pearce

    2014-01-01

    Conclusions: This multiple-case study has demonstrated that concussion result in increased intracortical inhibition and reduction in cognitive and motor performance. Further, TMS, in conjunction with tests of cognitive and motor performance, can be useful as a prognostic technique in assessing recovery from acute concussion injury.

  1. White matter damage and brain network alterations in concussed patients: a review of recent diffusion tensor imaging and resting-state functional connectivity data.

    Science.gov (United States)

    Chong, Catherine D; Schwedt, Todd J

    2015-05-01

    Over 2 million people are diagnosed with concussion each year in the USA, resulting in substantial individual and societal burdens. Although 'routine' clinical neuroimaging is useful for the diagnosis of more severe forms of traumatic brain injury, it is insensitive for detecting pathology associated with concussion. Diffusion tensor imaging (DTI) and blood-oxygenation-level-dependent (BOLD) resting-state functional connectivity magnetic resonance imaging (rs-fMRI) are techniques that allow for investigation of brain structural and functional connectivity patterns. DTI and rs-fMRI may be more sensitive than routine neuroimaging for detecting brain sequelae of concussion. This review summarizes recent DTI and rs-fMRI findings of altered structural and functional connectivity patterns in concussed patients.

  2. The Neurometabolic Cascade of Concussion

    National Research Council Canada - National Science Library

    Giza, Christopher C; Hovda, David A

    2001-01-01

    Data Synthesis: The primary elements of the pathophysiologic cascade following concussive brain injury include abrupt neuronal depolarization, release of excitatory neurotransmitters, ionic shifts, changes...

  3. Persistent differences in patterns of brain activation after sports-related concussion: a longitudinal functional magnetic resonance imaging study.

    Science.gov (United States)

    Dettwiler, Annegret; Murugavel, Murali; Putukian, Margot; Cubon, Valerie; Furtado, John; Osherson, Daniel

    2014-01-15

    Avoiding recurrent injury in sports-related concussion (SRC) requires understanding the neural mechanisms involved during the time of recovery after injury. The decision for return-to-play is one of the most difficult responsibilities facing the physician, and so far this decision has been based primarily on neurological examination, symptom checklists, and neuropsychological (NP) testing. Functional magnetic resonance imaging (fMRI) may be an additional, more objective tool to assess the severity and recovery of function after concussion. The purpose of this study was to define neural correlates of SRC during the 2 months after injury in varsity contact sport athletes who suffered a SRC. All athletes were scanned as they performed an n-back task, for n=1, 2, 3. Subjects were scanned within 72 hours (session one), at 2 weeks (session two), and 2 months (session three) post-injury. Compared with age and sex matched normal controls, concussed subjects demonstrated persistent, significantly increased activation for the 2 minus 1 n-back contrast in bilateral dorsolateral prefrontal cortex (DLPFC) in all three sessions and in the inferior parietal lobe in session one and two (α≤0.01 corrected). Measures of task performance revealed no significant differences between concussed versus control groups at any of the three time points with respect to any of the three n-back tasks. These findings suggest that functional brain activation differences persist at 2 months after injury in concussed athletes, despite the fact that their performance on a standard working memory task is comparable to normal controls and normalization of clinical and NP test results. These results might indicate a delay between neural and behaviorally assessed recovery after SRC.

  4. Concussion associated with head trauma in athletes

    Directory of Open Access Journals (Sweden)

    Gabriela Murguía Cánovas

    2013-01-01

    Full Text Available Recently, there has been increased attention to concussions that occur during sports activities, both at school level or amateur and professional level. Concussion is defined as a sudden and transient alteration of consciousness induced by traumatic biomechanical forces transmitted directly or indirectly to the brain. Such injuries most commonly occur in contact sports such as boxing, football, soccer, wrestling, hockey, among others. Concussion should be suspected in any athlete who suffers a head injury, whether or not it is associated to loss of consciousness. These athletes should not return to their sports activities immediately, and a few days of mental and physical leave are recommended in order to ensure full recovery. Repeat head injuries should be avoided, since there is evidence that in some athletes they can lead to chronic traumatic encephalopathy. The present review focuses on the different definitions of concussion, management and long-term consequences. It also contains the Spanish version of the Sport Concussion Assessment Tool 2 (SCAT2.

  5. Concussion - what to ask your doctor - child

    Science.gov (United States)

    What to ask your doctor about concussion - child; Mild brain injury - what to ask your doctor - child ... school people I should tell about my child's concussion? Can my child stay for a full day? ...

  6. Diagnostic terminology, athlete status, and history of concussion affect return to play expectations and anticipated symptoms following mild traumatic brain injury.

    Science.gov (United States)

    Kelly, Kiersten; Erdal, Kristi

    2016-11-13

    "Mild traumatic brain injury" (mTBI) and "concussion" are terms often used interchangeably. However, "mTBI" is frequently seen as representing a broader injury that encompasses the construct of "concussion," which often conveys transience or decreased severity. The present study examined the influence of varying diagnostic terminology on acute injury expectations in an undergraduate population (N = 105). Participants were presented with an mTBI vignette and were randomly assigned to one of two conditions in which the term "mTBI" or "concussion" was used to describe the injury. There were no significant differences between the two conditions on anxiety, symptomatology, timeline, or consequence scales. However, participants in the "mTBI" group allocated more days to return to play than participants in the "concussion" group, suggesting that terminology has an effect on perceptions of the severity of the injury. Varsity athletes allocated fewer days to return to play than nonathletes. Individuals with a history of concussion, both athletes and nonathletes, indicated fewer days to return to play, but greater symptomatology than individuals with no history of concussion. Clinicians should consider the influence of diagnostic terminology, athletic background, and history of concussion on perceptions of the severity of an injury because expectations can influence injury outcomes and compliance in a recovery process.

  7. Influence of Combat Blast-Related Mild Traumatic Brain Injury Acute Symptoms on Mental Health and Service Discharge Outcomes

    Science.gov (United States)

    2013-08-15

    is a stronger predictor of outcome in blast related TBI compared with blunt trauma. Further, sports concussions may not be a good model for blast...the multi variate model. Although a history of previous concussions was not predictive of any outcomes, undiagnosed concussions may have oc curred...during these blast events. The cumulative effect of brain in juries has been well documented in repeat concussions occurring in sports related injuries

  8. Time interval between concussions and symptom duration.

    Science.gov (United States)

    Eisenberg, Matthew A; Andrea, John; Meehan, William; Mannix, Rebekah

    2013-07-01

    To test the hypothesis that children with a previous history of concussion have a longer duration of symptoms after a repeat concussion than those without such a history. Prospective cohort study of consecutive patients 11 to 22 years old presenting to the emergency department of a children's hospital with an acute concussion. The main outcome measure was time to symptom resolution, assessed by the Rivermead Post-Concussion Symptoms Questionnaire (RPSQ). Patients and providers completed a questionnaire describing mechanism of injury, associated symptoms, past medical history, examination findings, diagnostic studies, and the RPSQ. Patients were then serially administered the RPSQ for 3 months after the concussion or until all symptoms resolved. A total of 280 patients were enrolled over 12 months. Patients with a history of previous concussion had a longer duration of symptoms than those without previous concussion (24 vs 12 days, P = .02). Median symptom duration was even longer for patients with multiple previous concussions (28 days, P = .03) and for those who had sustained a concussion within the previous year (35 days, P = .007) compared with patients without those risk factors. In a multivariate model, previous concussion, absence of loss of consciousness, age ≥13, and initial RPSQ score >18 were significant predictors of prolonged recovery. Children with a history of a previous concussion, particularly recent or multiple concussions, are at increased risk for prolonged symptoms after concussion. These findings have direct implications on the management of patients with concussion who are at high risk for repeat injuries.

  9. Acute reduction of microglia does not alter axonal injury in a mouse model of repetitive concussive traumatic brain injury.

    Science.gov (United States)

    Bennett, Rachel E; Brody, David L

    2014-10-01

    The pathological processes that lead to long-term consequences of multiple concussions are unclear. Primary mechanical damage to axons during concussion is likely to contribute to dysfunction. Secondary damage has been hypothesized to be induced or exacerbated by inflammation. The main inflammatory cells in the brain are microglia, a type of macrophage. This research sought to determine the contribution of microglia to axon degeneration after repetitive closed-skull traumatic brain injury (rcTBI) using CD11b-TK (thymidine kinase) mice, a valganciclovir-inducible model of macrophage depletion. Low-dose (1 mg/mL) valganciclovir was found to reduce the microglial population in the corpus callosum and external capsule by 35% after rcTBI in CD11b-TK mice. At both acute (7 days) and subacute (21 days) time points after rcTBI, reduction of the microglial population did not alter the extent of axon injury as visualized by silver staining. Further reduction of the microglial population by 56%, using an intermediate dose (10 mg/mL), also did not alter the extent of silver staining, amyloid precursor protein accumulation, neurofilament labeling, or axon injury evident by electron microscopy at 7 days postinjury. Longer treatment of CD11b-TK mice with intermediate dose and treatment for 14 days with high-dose (50 mg/mL) valganciclovir were both found to be toxic in this injury model. Altogether, these data are most consistent with the idea that microglia do not contribute to acute axon degeneration after multiple concussive injuries. The possibility of longer-term effects on axon structure or function cannot be ruled out. Nonetheless, alternative strategies directly targeting injury to axons may be a more beneficial approach to concussion treatment than targeting secondary processes of microglial-driven inflammation.

  10. fMRI and Brain Activation after Sport Concussion: A Tale of Two Cases

    OpenAIRE

    2014-01-01

    Sport-related concussions are now recognized as a major public health concern: the number of participants in sport and recreation is growing, possibly playing their games faster, and there is heightened public awareness of injuries to some high-profile athletes. However, many clinicians still rely on subjective symptom reports for the clinical determination of recovery. Relying on subjective symptom reports can be problematic, as it has been shown that some concussed athletes may downplay the...

  11. Systematic review of clinical studies examining biomarkers of brain injury in athletes after sports-related concussion.

    Science.gov (United States)

    Papa, Linda; Ramia, Michelle M; Edwards, Damyan; Johnson, Brian D; Slobounov, Semyon M

    2015-05-15

    The aim of this study was to systematically review clinical studies examining biofluid biomarkers of brain injury for concussion in athletes. Data sources included PubMed, MEDLINE, and the Cochrane Database from 1966 to October 2013. Studies were included if they recruited athletes participating in organized sports who experienced concussion or head injury during a sports-related activity and had brain injury biomarkers measured. Acceptable research designs included experimental, observational, and case-control studies. Review articles, opinion papers, and editorials were excluded. After title and abstract screening of potential articles, full texts were independently reviewed to identify articles that met inclusion criteria. A composite evidentiary table was then constructed and documented the study title, design, population, methods, sample size, outcome measures, and results. The search identified 52 publications, of which 13 were selected and critically reviewed. All of the included studies were prospective and were published either in or after the year 2000. Sports included boxing (six studies), soccer (five studies), running/jogging (two studies), hockey (one study), basketball (one study), cycling (one study), and swimming (one study). The majority of studies (92%) had fewer than 100 patients. Three studies (23%) evaluated biomarkers in cerebrospinal fluid (CSF), one in both serum and CSF, and 10 (77%) in serum exclusively. There were 11 different biomarkers assessed, including S100β, glial fibrillary acidic protein, neuron-specific enolase, tau, neurofilament light protein, amyloid beta, brain-derived neurotrophic factor, creatine kinase and heart-type fatty acid binding protein, prolactin, cortisol, and albumin. A handful of biomarkers showed a correlation with number of hits to the head (soccer), acceleration/deceleration forces (jumps, collisions, and falls), postconcussive symptoms, trauma to the body versus the head, and dynamics of different sports

  12. Concussion Awareness: Getting School Psychologists into the Game

    Science.gov (United States)

    Davies, Susan C.

    2011-01-01

    A concussion is a serious injury--a mild traumatic brain injury (TBI)--that induces physiological disruption of brain function. A concussion is caused by a bump, blow, or jolt to the head or body. The sudden movement causes stretching and tearing of brain cells; cells become damaged and chemical changes occur within the brain. Concussions can lead…

  13. Postural control deficits identify lingering post-concussion neurological deficits

    Institute of Scientific and Technical Information of China (English)

    Thomas A. Buckley; Jessie R. Oldham; Jaclyn B. Caccese

    2016-01-01

    Concussion, or mild traumatic brain injury, incidence rates have reached epidemic levels and impaired postural control is a cardinal symptom. The purpose of this review is to provide an overview of the linear and non-linear assessments of post-concussion postural control. The current acute evaluation for concussion utilizes the subjective balance error scoring system (BESS) to assess postural control. While the sensitivity of the overall test battery is high, the sensitivity of the BESS is unacceptably low and, with repeat administration, is unable to accurately identify recovery. Sophisticated measures of postural control, utilizing traditional linear assessments, have identified impairments in postural control well beyond BESS recovery. Both assessments of quiet stance and gait have identified lingering impairments for at least 1 month post-concussion. Recently, the application of non-linear metrics to concussion recovery have begun to receive limited attention with the most commonly utilized metric being approximate entropy (ApEn). ApEn, most commonly in the medial-lateral plane, has successfully identified impaired postural control in the acute post-concussion timeframe even when linear assessments of instrumented measures are equivalent to healthy pre-injury values;unfortunately these studies have not gone beyond the acute phase of recovery. One study has identified lingering deficits in postural control, utilizing Shannon and Renyi entropy metrics, which persist at least through clinical recovery and return to participation. Finally, limited evidence from two studies suggest that individuals with a previous history of a single concussion, even months or years prior, may display altered ApEn metrics. Overall, non-linear metrics provide a fertile area for future study to further the understanding of postural control impairments acutely post-concussion and address the current challenge of sensitive identification of recovery.

  14. The independent influence of concussive and sub-concussive impacts on soccer players' neurophysiological and neuropsychological function.

    Science.gov (United States)

    Moore, R Davis; Lepine, Julien; Ellemberg, Dave

    2017-02-01

    Accumulating research demonstrates that repetitive sub-concussive impacts can alter the structure, function and connectivity of the brain. However, the functional significance of these alterations as well as the independent contribution of concussive and sub-concussive impacts to neurophysiological and neuropsychological health are unclear. Accordingly, we compared the neurophysiological and neuropsychological function of contact athletes with (concussion group) and without (sub-concussion group) a history of concussion, to non-contact athletes. We evaluated event-related brain potentials (ERPs) elicited during an oddball task and performance on a targeted battery of neuropsychological tasks. Athletes in the sub-concussion and concussion groups exhibited similar amplitude reductions in the ERP indices of attentional resource allocation (P3b) and attentional orienting (P3a) relative to non-contact athletes. However, only athletes in the concussion group exhibited reduced amplitude in the ERP index of perceptual attention (N1). Athletes in the sub-concussion and concussion groups also exhibited deficits in memory recall relative to non-contact athletes, but athletes in the concussion group also exhibited significantly more recall errors than athletes in the sub-concussion group. Additionally, only athletes in the concussion group exhibited response delays during the oddball task. The current findings suggest that sub-concussive impacts are associated with alterations in the neurophysiological and neuropsychological indices of essential cognitive functions, albeit to a lesser degree than the combination of sub-concussive and concussive impacts.

  15. Concussion symptoms and neurocognitive performance of high school and college athletes who incur multiple concussions.

    Science.gov (United States)

    Covassin, Tracey; Moran, Ryan; Wilhelm, Kristyn

    2013-12-01

    Multiple concussions have been associated with prolonged symptoms, recovery time, and risk for future concussions. However, very few studies have examined the effect of multiple concussions on neurocognitive performance and the recently revised symptom clusters using a large database. To examine concussed athletes with a history of 0, 1, 2, or ≥3 concussions on neurocognitive performance and the recently revised symptom clusters. Cohort study (prognosis); Level of evidence, 2. The independent variables were concussion group (0, 1, 2, and ≥3 concussions) and time (baseline, 3 days, and 8 days). The dependent variables were neurocognitive test scores as measured by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) neurocognitive test battery (verbal and visual memory, processing speed, and reaction time) and 4 concussion symptom clusters (migraine-cognitive-fatigue, affective, somatic, and sleep). All concussed athletes (n = 596) were administered the ImPACT test at a mean 2.67 ± 1.98 and 7.95 ± 4.46 days after injury. A series of 4 (concussion group) × 3 (time) repeated-measures analyses of covariance (age = covariate) were performed on ImPACT composite scores and symptom clusters. Concussed athletes with ≥3 concussions were still impaired 8 days after a concussion compared with baseline scores on verbal memory (P Concussed athletes with a history of ≥3 concussions take longer to recover than athletes with 1 or no previous concussion. Future research should concentrate on validating the new symptom clusters on multiple concussed athletes, examining longer recovery times (ie, >8 days) among athletes with multiple concussions.

  16. The pathophysiology of concussion.

    Science.gov (United States)

    Signoretti, Stefano; Lazzarino, Giuseppe; Tavazzi, Barbara; Vagnozzi, Roberto

    2011-10-01

    Concussion is defined as a biomechanically induced brain injury characterized by the absence of gross anatomic lesions. Early and late clinical symptoms, including impairments of memory and attention, headache, and alteration of mental status, are the result of neuronal dysfunction mostly caused by functional rather than structural abnormalities. The mechanical insult initiates a complex cascade of metabolic events leading to perturbation of delicate neuronal homeostatic balances. Starting from neurotoxicity, energetic metabolism disturbance caused by the initial mitochondrial dysfunction seems to be the main biochemical explanation for most postconcussive signs and symptoms. Furthermore, concussed cells enter a peculiar state of vulnerability, and if a second concussion is sustained while they are in this state, they may be irreversibly damaged by the occurrence of swelling. This condition of concussion-induced brain vulnerability is the basic pathophysiology of the second impact syndrome. N-acetylaspartate, a brain-specific compound representative of neuronal metabolic wellness, is proving a valid surrogate marker of the post-traumatic biochemical damage, and its utility in monitoring the recovery of the aforementioned "functional" disturbance as a concussion marker is emerging, because it is easily detectable through proton magnetic resonance spectroscopy. Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  17. The use of telomere length as a predictive biomarker for injury prognosis in juvenile rats following a concussion/mild traumatic brain injury.

    Science.gov (United States)

    Hehar, Harleen; Mychasiuk, Richelle

    2016-03-01

    Telomeres were originally believed to be passive players in cellular replication, but recent research has highlighted their more active role in epigenetic patterning and promotion of cellular growth and survival. Furthermore, literature demonstrates that telomere length (TL) is responsive to environmental manipulations such as prenatal stress and dietary programming. As the search for a prognostic biomarker of concussion has had limited success, this study sought to examine whether or not telomere length (TL) could be an efficacious predictor of symptom severity in juvenile rats following concussion. Rats from four distinct experimental groups (caloric restriction (CR), high fat diet (HFD), exercise (EX), and standard controls (STD)) received a mild traumatic brain injury (mTBI)/concussion and were then subjected to a behavioural test battery. The test battery was scored and the animals were categorized as poor, average, or good, based on their performance on the 6 tests examined. Skin cells (from ear notch samples) were taken 17days post-injury and DNA was extracted for telomere length analysis. Ear notch skin cell TL was highly correlated with brain tissue TL for a given individual. Animals in the CR and EX cohorts had significantly longer telomeres, while animals in the HFD cohort had significantly shorter telomeres, when compared to controls. The mTBI/concussion reduced TL in all cohorts except the EX group. A significant linear relationship was found between TL and performance on the behavioural test battery, whereby shorter telomeres were associated with poorer performance and longer telomeres with better performance. As performance on the test battery is linked to symptom severity, this study found TL to be a reasonable tool for concussion prognosis. Future studies with human populations should examine the validity of TL in peripheral cells, as a predictor of concussion pathology. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Adolescent concussions.

    Science.gov (United States)

    Lee, Michael A; Fine, Benjamin

    2010-03-01

    The amount of literature dealing with the diagnosis and treatment of adolescent concussions is considerable. Most articles focus on the athlete. This study examines both sports-related and nonsports-related concussions in adolescents, their etiology, mechanisms of injury (categorized by sport), symptoms exhibited, physical findings, computerized tomography scan results and the problem of prolonged recovery (persistent postconcussion syndrome used in this article to mean symptoms lasting over four weeks.) The purpose of this study is to present the data, their significance and a new method of management that has successfully allowed the author's concussed patients to recover more rapidly. A retrospective review of 863 adolescent concussions, in 11-year-old to 19-year-old patients, from July 2004 through December 31, 2008. Subjects were seen as a result of referrals largely from the author's practice (Pediatric Healthcare Associates), other physicians, athletic trainers or patients previously treated. All concussions, including nonsports-related concussions, were included in the study. Some patients had multiple concussions; 774 individuals accounted for the 863 concussions. The number of patients by age and the number of concussions they sustained are listed below.

  19. Governing sporting brains: concussion, neuroscience, and the biopolitical regulation of sport

    OpenAIRE

    Hardes, J

    2017-01-01

    Drawing on the recent concussion litigation from the United States’ National Football League (NFL) the paper examines the emergence of neuroscience knowledge as part of a defining justification of the lawsuit. The paper argues that neuroscience knowledge is best understood as a regulatory discourse that is attached to larger social, political, and economic realities that bring it into being as a legitimate type of knowledge. This larger socio-political governance logic is one that scholars ca...

  20. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... GET MORE INFORMATION ON CONCUSSION and TRAUMATIC BRAIN INJURY IN THE UNITED STATES Statistics Causes Outcomes Prevention ... School Health Association American Sports Education Program Brain Injury Association of America Brain Trauma Foundation Center for ...

  1. Toward objective markers of concussion in sport: a review of white matter and neurometabolic changes in the brain after sports-related concussion.

    Science.gov (United States)

    Dimou, Stefan; Lagopoulos, Jim

    2014-03-01

    Abstract Sports-related concussion is an issue that has piqued the public's attention of late as concerns surrounding potential long-term sequelae as well as new methods of characterizing the effects of this form of injury continue to develop. For the most part, diagnosis of concussion is based on subjective clinical measures and thus is prone to under-reporting. In the current environment, where conventional imaging modalities, such as computed tomography and magnetic resonance imaging, are unable to elucidate the degree of white matter damage and neurometabolic change, a discussion of two advanced imaging techniques-diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS)-is undertaken with a view to highlighting their potential utility. Our aim is to outline a variety of the approaches to concussion research that have been employed, with special attention given to the clinical considerations and acute complications attributed to concussive injury. DTI and MRS have been at the forefront of research as a result of their noninvasiveness and ease of acquisition, and hence it is thought that the use of these neuroimaging modalities has the potential to aid clinical decision making and management, including guiding return-to-play protocols.

  2. Concussion in Winter Sports

    Science.gov (United States)

    ... Heads Up! Tool Kit Prevent Concussions Prevent Head Injuries Sports Safety Students Play Safe Youth Sports Safety Download ... — United States, 2001–2009 Nonfatal Traumatic Brain Injuries from Sports and Recreation Activities — United States, 2001–2005 ( ...

  3. Concussion: Doug Flutie: "Be on the Safe Side."

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Concussion Doug Flutie: "Be on the Safe Side." Past ... for NBC Sports. Flutie is often asked about concussions and brain trauma associated with sports like football, ...

  4. Concussion/mild traumatic brain injury-related chronic pain in males and females: A diagnostic modelling study

    Science.gov (United States)

    Mollayeva, Tatyana; Cassidy, J. David; Shapiro, Colin M.; Mollayeva, Shirin; Colantonio, Angela

    2017-01-01

    Abstract Pain is an unpleasant, complex, and perceived experience that places a significant burden on patients and clinicians. Its severity may be mediated by emotion, attitude, and environmental influences, and pain may be expressed differently in males and females. Traumatic brain injury (TBI) is frequently associated with chronic pain. This diagnostic modeling study examined sex differences in the construct of chronic pain in patients with delayed recovery from concussion/mild traumatic brain injury (mTBI). Data were collected from standardized questionnaires, neuroimaging records, and comprehensive clinical assessments. Bivariate associations were calculated using the Spearman correlation coefficient or analysis of variance. We established sex-specific stepwise multivariate linear regression models of factors associated with pain. Of the 94 participants diagnosed with mTBI (the mean age was 45.20 ± 9.94 years; 61.2% were males; the median time since injury was 197 days [interquartile range 139–416]), head/neck, and bodily pain were reported by 93% and 64%, respectively. No sex differences were identified in pain frequencies or severity. Pain was significantly associated with certain socio-demographic, injury-related, behavioral, and clinical variables. In the multivariable regression analysis, several determinants explained 60% of the pain variance in males and 46% in females. Pain is common in patients with delayed recovery from mTBI and is significantly associated with potentially modifiable clinical and nonclinical variables. Examining the multidimensional construct of pain in concussion/mTBI through a sex lens garners new directions for future longitudinal research on the pain mechanisms involved in postconcussion syndrome. PMID:28207508

  5. Sports-related concussions and the Louisiana Youth Concussion Act.

    Science.gov (United States)

    Nanda, Anil; Khan, Imad Saeed; Goldman, Rose; Testa, Marcia

    2012-01-01

    Concussion, also referred to as mild traumatic brain injury (TBI), is defined as a "complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces." Various symptoms may be observed in patients with concussions. All of these might not be evident at the time of the injury and be intermittent in their nature. It is estimated that 300,000 of the yearly TBIs in the United States are sports-related, the second leading cause for TBIs after motor vehicle accidents among people aged 15 to 24 years old. Due to some recently reported high profile injuries and deaths of sports personalities, sports-related concussion has seen increasing media and public interest in the last decade. We review the role of football in youth concussions and analyze the Nationwide Inpatient Sample from 2007 to 2009 to elucidate the outcome and costs associated with sports-related concussions of the youth in the United States. We also review the latest state legislative efforts to decrease the incidence of dangerous sports-related concussions in youth--the Louisiana Youth Concussion Act.

  6. Concussions (For Kids)

    Science.gov (United States)

    ... Too Tall or Too Short All About Puberty Concussions KidsHealth > For Kids > Concussions Print A A A ... bony surface of the skull. Signs of a Concussion Concussions are tricky. Your mom or coach probably ...

  7. This is your brain on sports. Measuring concussions in high school athletes in the Twin Cities metropolitan area.

    Science.gov (United States)

    Dugan, Sarah; Seymour, Leslie; Roesler, Jon; Glover, Lori; Kinde, Mark

    2014-09-01

    Concussions can have a negative impact on students' ability to perform in the classroom as well as on their health and well-being. Therefore, timely treatment is especially important. To better understand the scope of the problem in Minnesota, the Minnesota Department of Health piloted an online sports-related concussion reporting system in 36 public high schools in the Twin Cities metropolitan area. In the 2013-2014 academic year, 730 concussions were reported to our system from certified athletic trainers working with those schools, with one out of every 100 athletes sustaining concussions. From this, we estimated that 2,974 sports-related concussions occurred among high school athletes statewide. This information is useful for evaluating and guiding prevention efforts and for informing clinicians on how to treat concussions.

  8. The relationship between insomnia and disability in workers with mild traumatic brain injury/concussion: Insomnia and disability in chronic mild traumatic brain injury.

    Science.gov (United States)

    Mollayeva, Tatyana; Pratt, Brandy; Mollayeva, Shirin; Shapiro, Colin M; Cassidy, J David; Colantonio, Angela

    2016-04-01

    The principal aim of this study was to, for the first time, examine the relationship between insomnia and perceived disability among workers with mild traumatic brain injury (mTBI)/concussion. A cross-sectional study was conducted at the Workplace Safety and Insurance Board Clinic of the largest rehabilitation teaching hospital in Canada. Data from questionnaires, insurer records and clinical investigations were analysed. The Insomnia Severity Index measured the primary independent variable, and the Sheehan Disability Scale measured disability outcomes, classified as 'mild/moderate' or 'marked/extreme'. Two-sided t-tests and Chi-squared tests were used for bivariate associations. A binomial logistic regression model was fit using previously identified variables. The sample comprised 92 workers (45.1 ± 9.9 years old, 61% male) with mTBI/concussion at median time 196 days after injury. When compared with workers reporting lower disability, workers with higher disability were found with more severe insomnia, depression, anxiety and pain. In the multivariable analysis, the odds of reporting higher global disability increased with increasing insomnia and pain [adjusted odds ratio (OR) 1.16 (95% CI 1.03-1.31) and 1.117 (95% CI 1.01-1.24), respectively]. Insomnia was the only significant covariate in a fully adjusted work disability model. None of the variables studied were statistically significant in the social and family life disability models. Greater attention should be given to the diagnosis and management of insomnia in persons with mTBI/concussion. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. Current Public Knowledge Pertaining to Traumatic Brain Injury: Influence of Demographic Factors, Social Trends, and Sport Concussion Experience on the Understanding of Traumatic Brain Injury Sequelae.

    Science.gov (United States)

    Merz, Zachary C; Van Patten, Ryan; Lace, John

    2017-03-01

    The current study aimed to assess current broad traumatic brain injury (TBI)-related knowledge in the general public, as well as understanding regarding specific TBI-related conditions including post-concussive syndrome (PCS) and chronic traumatic encephalopathy (CTE). Data were collected from 307 domestic and 73 international individuals via online researcher-developed survey instrumentation utilizing the Amazon Mechanical Turk marketplace, a recently developed website that allows for a streamlined process of survey-based participant recruitment and data collection. Participants completed background demographics questions, a 31-item true/false questionnaire pertaining to TBI-related knowledge, and an inquiry related to willingness to allow (future) child(ren) to participate in several popular U.S. sports. The overall accuracy rate of our U.S. sample was 61%. No accuracy differences were present for gender or geographic region (p's > .05). Participants who self-reported a prior concussion diagnosis, who reported receiving formal concussion training, and who endorsed participation in collegiate, semi-professional, or professional athletic competition, all exhibited lower accuracy rates than the respective comparison groups (p's < .001). Finally, individual item analysis revealed the presence of significant misconceptions pertaining to PCS and CTE. Misconceptions regarding TBI remain highly prevalent within the general public and may be explained, to some extent, by inefficiencies in current TBI-education practices. Moreover, misconceptions regarding PCS and CTE are also prevalent and likely reflect inconsistencies in the scientific literature, coupled with misleading media reports. To combat these trends, greater emphasis must be placed on construct definition within the field and streamlined, efficient communication with the general public.

  10. American Medical Society for Sports Medicine position statement: concussion in sport.

    Science.gov (United States)

    Harmon, Kimberly G; Drezner, Jonathan A; Gammons, Matthew; Guskiewicz, Kevin M; Halstead, Mark; Herring, Stanley A; Kutcher, Jeffrey S; Pana, Andrea; Putukian, Margot; Roberts, William O

    2013-01-01

    PURPOSE OF THE STATEMENT: ▸ To provide an evidence-based, best practises summary to assist physicians with the evaluation and management of sports concussion. ▸ To establish the level of evidence, knowledge gaps and areas requiring additional research. ▸ Sports medicine physicians are frequently involved in the care of patients with sports concussion. ▸ Sports medicine physicians are specifically trained to provide care along the continuum of sports concussion from the acute injury to return-to-play (RTP) decisions. ▸ The care of athletes with sports concussion is ideally performed by healthcare professionals with specific training and experience in the assessment and management of concussion. Competence should be determined by training and experience, not dictated by specialty. ▸ While this statement is directed towards sports medicine physicians, it may also assist other physicians and healthcare professionals in the care of patients with sports concussion. ▸ Concussion is defined as a traumatically induced transient disturbance of brain function and involves a complex pathophysiological process. Concussion is a subset of mild traumatic brain injury (MTBI) which is generally self-limited and at the less-severe end of the brain injury spectrum. ▸ Animal and human studies support the concept of postconcussive vulnerability, showing that a second blow before the brain has recovered results in worsening metabolic changes within the cell. ▸ Experimental evidence suggests the concussed brain is less responsive to usual neural activation and when premature cognitive or physical activity occurs before complete recovery the brain may be vulnerable to prolonged dysfunction. ▸ It is estimated that as many as 3.8 million concussions occur in the USA per year during competitive sports and recreational activities; however, as many as 50% of the concussions may go unreported. ▸ Concussions occur in all sports with the highest incidence in football, hockey

  11. Longitudinal Brain Magnetic Resonance Imaging CO2 Stress Testing in Individual Adolescent Sports-Related Concussion Patients: A Pilot Study.

    Science.gov (United States)

    Mutch, W Alan C; Ellis, Michael J; Ryner, Lawrence N; Morissette, Marc P; Pries, Philip J; Dufault, Brenden; Essig, Marco; Mikulis, David J; Duffin, James; Fisher, Joseph A

    2016-01-01

    Advanced neuroimaging studies in concussion have been limited to detecting group differences between concussion patients and healthy controls. In this small pilot study, we used brain magnetic resonance imaging (MRI) CO2 stress testing to longitudinally assess cerebrovascular responsiveness (CVR) in individual sports-related concussion (SRC) patients. Six SRC patients (three males and three females; mean age = 15.7, range = 15-17 years) underwent longitudinal brain MRI CO2 stress testing using blood oxygen level-dependent (BOLD) MRI and model-based prospective end-tidal CO2 targeting under isoxic conditions. First-level and second-level comparisons were undertaken using statistical parametric mapping (SPM) to score the scans and compare them to an atlas of 24 healthy control subjects. All tests were well tolerated and without any serious adverse events. Anatomical MRI was normal in all study participants. The CO2 stimulus was consistent between the SRC patients and control subjects and within SRC patients across the longitudinal study. Individual SRC patients demonstrated both quantitative and qualitative patient-specific alterations in CVR (p correlated strongly with clinical findings, and that persisted beyond clinical recovery. Standardized brain MRI CO2 stress testing is capable of providing a longitudinal assessment of CVR in individual SRC patients. Consequently, larger prospective studies are needed to examine the utility of brain MRI CO2 stress testing as a clinical tool to help guide the evaluation, classification, and longitudinal management of SRC patients.

  12. Sir Hugh Cairns and World War II British advances in head injury management, diffuse brain injury, and concussion: an Oxford tale.

    Science.gov (United States)

    Stone, James L; Patel, Vimal; Bailes, Julian E

    2016-11-01

    The authors trace the Oxford, England, roots of World War II (WWII)-related advances in head injury management, the biomechanics of concussion and brain injury, and postwar delineation of pathological findings in severe concussion and diffuse brain injury in man. The prominent figure in these developments was the charismatic and innovative Harvey Cushing-trained neurosurgeon Sir Hugh Cairns. Cairns, who was to closely emulate Cushing's surgical and scholarly approach, is credited with saving thousands of lives during WWII by introducing and implementing innovative programs such as helmets for motorcyclists, mobile neurosurgical units near battle zones, and the military usage of penicillin. In addition, he inspired and taught a generation of neurosurgeons, neurologists, and neurological nurses in the care of brain and spinal cord injuries at Oxford's Military Hospital for Head Injuries. During this time Cairns also trained the first full-time female neurosurgeon. Pivotal in supporting animal research demonstrating the critical role of acceleration in the causation of concussion, Cairns recruited the physicist Hylas Holbourn, whose research implicated rotary acceleration and shear strains as particularly damaging. Cairns' work in military medicine and head injury remain highly influential in efforts to mitigate and manage brain injury.

  13. Responses of dural mast cells in concussive and blast models of mild traumatic brain injury in mice: Potential implications for post-traumatic headache.

    Science.gov (United States)

    Levy, Dan; Edut, Shahaf; Baraz-Goldstein, Renana; Rubovitch, Vardit; Defrin, Ruth; Bree, Dara; Gariepy, Helaine; Zhao, Jun; Pick, Chaim G

    2016-09-01

    Chronic post-traumatic headache (PTH) is one of the most common symptoms of mild traumatic brain injury (mTBI) but its underlying mechanisms remain unknown. Inflammatory degranulation of dural mast cells (MCs) is thought to promote headache, and may play a role in PTH. Whether mTBI is associated with persistent degranulation of dural MCs is yet to be determined. Histochemistry was used to evaluate time course changes in dural MC density and degranulation level in concussive head trauma and blast mouse models of mTBI. The effects of sumatriptan and the MC stabilizer cromolyn sodium on concussion-evoked dural MC degranulation were also investigated. Concussive head injury evoked persistent MC degranulation for at least 30 days. Blast trauma gave rise to a delayed MC degranulation response commencing at seven days that also persisted for at least 30 days. Neither sumatriptan nor cromolyn treatment reduced concussion-evoked persistent MC degranulation. mTBI evoked by closed head injury or blast exposure is associated with persistent dural MC degranulation. Such a response in mTBI patients may contribute to PTH. Amelioration of PTH by sumatriptan may not involve inhibition of dural MC degranulation. If persistent dural MC degranulation contributes to PTH, then cromolyn treatment may not be effective. © International Headache Society 2015.

  14. Hyperbaric Oxygen Therapy in the Treatment of Chronic Mild-Moderate Blast-Induced Traumatic Brain Injury Post-Concussion Syndrome (PCS) and Post Traumatic Stress Disorder (PTSD)

    Science.gov (United States)

    2016-10-01

    secure funding. There are no study results to report at this time and no significant adverse advents. 15. SUBJECT TERMS HBOT: hyperbaric oxygen...therapy; TBI: traumatic brain injury; PPCS: persistent post-concussion syndrome 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18...published 11/2011 in the Journal of Neurotrauma (http://www.liebertonline.com/doi/abs/10.1089/ neu .2011 .1895). The original purpose of the present

  15. Potential Long-Term Consequences of Concussive and Subconcussive Injury.

    Science.gov (United States)

    Huber, Bertrand R; Alosco, Michael L; Stein, Thor D; McKee, Ann C

    2016-05-01

    Repeated concussive and subconcussive trauma is associated with the later development of chronic traumatic encephalopathy (CTE), a neurodegenerative disease associated with clinical symptoms in multiple domains and a unique pattern of pathologic changes. CTE has been linked to boxing and American football; CTE has also been identified in soccer, ice hockey, baseball, rugby, and military service. To date, most large studies of CTE have come from enriched cohorts associated with brain bank donations for traumatic brain injury, although several recent studies re-examining neurodegenerative disease brain banks suggest that CTE is more common than is currently appreciated.

  16. Increased gray matter diffusion anisotropy in patients with persistent post-concussive symptoms following mild traumatic brain injury.

    Directory of Open Access Journals (Sweden)

    Sylvain Bouix

    Full Text Available A significant percentage of individuals diagnosed with mild traumatic brain injury (mTBI experience persistent post-concussive symptoms (PPCS. Little is known about the pathology of these symptoms and there is often no radiological evidence based on conventional clinical imaging. We aimed to utilize methods to evaluate microstructural tissue changes and to determine whether or not a link with PPCS was present. A novel analysis method was developed to identify abnormalities in high-resolution diffusion tensor imaging (DTI when the location of brain injury is heterogeneous across subjects. A normative atlas with 145 brain regions of interest (ROI was built from 47 normal controls. Comparing each subject's diffusion measures to the atlas generated subject-specific profiles of injury. Abnormal ROIs were defined by absolute z-score values above a given threshold. The method was applied to 11 PPCS patients following mTBI and 11 matched controls. Z-score information for each individual was summarized with two location-independent measures: "load" (number of abnormal regions and "severity" (largest absolute z-score. Group differences were then computed using Wilcoxon rank sum tests. Results showed statistically significantly higher load (p = 0.018 and severity (p = 0.006 for fractional anisotropy (FA in patients compared with controls. Subject-specific profiles of injury evinced abnormally high FA regions in gray matter (30 occurrences over 11 patients, and abnormally low FA in white matter (3 occurrences over 11 subjects. Subject-specific profiles provide important information regarding the pathology associated with PPCS. Increased gray matter (GM anisotropy is a novel in-vivo finding, which is consistent with an animal model of brain trauma that associates increased FA in GM with pathologies such as gliosis. In addition, the individualized analysis shows promise for enhancing the clinical care of PPCS patients as it could play a role in the

  17. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... Materials for School Professionals Learn More about the Brain and How it Works Order Free Copies of ... Associations) GET MORE INFORMATION ON CONCUSSION and TRAUMATIC BRAIN INJURY IN THE UNITED STATES Statistics Causes Outcomes ...

  18. Repeated swim stress alters brain benzodiazepine receptors measured in vivo

    Energy Technology Data Exchange (ETDEWEB)

    Weizman, R.; Weizman, A.; Kook, K.A.; Vocci, F.; Deutsch, S.I.; Paul, S.M.

    1989-06-01

    The effects of repeated swim stress on brain benzodiazepine receptors were examined in the mouse using both an in vivo and in vitro binding method. Specific in vivo binding of (/sup 3/H)Ro15-1788 to benzodiazepine receptors was decreased in the hippocampus, cerebral cortex, hypothalamus, midbrain and striatum after repeated swim stress (7 consecutive days of daily swim stress) when compared to nonstressed mice. In vivo benzodiazepine receptor binding was unaltered after repeated swim stress in the cerebellum and pons medulla. The stress-induced reduction in in vivo benzodiazepine receptor binding did not appear to be due to altered cerebral blood flow or to an alteration in benzodiazepine metabolism or biodistribution because there was no difference in (14C)iodoantipyrine distribution or whole brain concentrations of clonazepam after repeated swim stress. Saturation binding experiments revealed a change in both apparent maximal binding capacity and affinity after repeated swim stress. Moreover, a reduction in clonazepam's anticonvulsant potency was also observed after repeated swim stress (an increase in the ED50 dose for protection against pentylenetetrazol-induced seizures), although there was no difference in pentylenetetrazol-induced seizure threshold between the two groups. In contrast to the results obtained in vivo, no change in benzodiazepine receptor binding kinetics was observed using the in vitro binding method. These data suggest that environmental stress can alter the binding parameters of the benzodiazepine receptor and that the in vivo and in vitro binding methods can yield substantially different results.

  19. [Asthenic syndrome in clinical course of acute period of brain concussion during complex treatment using nootropic agents].

    Science.gov (United States)

    Tkachov, A V

    2008-01-01

    The comparative analysis of a complex examination of 108 persons aged from 16 till 60 years in acute period of closed craniocerebral injury (CCCT) has been done. Every participants have been divided into 2 groups depending on a nootrop medication they receive in a complex treatment. A control group consisted of 30 practically healthy people. Objective examination by means of tests was done on the 1-st, 10-th that 30-th day of treatment. Patients of 1-st (37 persons) group received piracetam in complex treatment and patients of the 2-nd group (71 persons) pramistar. Patients of the first group received a base treatment (analgetics, tranquilizers, vitamins of group B, magnesium sulfate, diuretic preparations) as well as piracetam at dosage 0.2, two tablets three times per day. The Patients of the 2-nd group received a base treatment as well as pramistar at dosage 0.6, one tablet 2 times per day. Specially developed multiaspects scales and questionnaires, MRT of the brain and EEG have been used for objectification of patient, complaints. During a complex clinico-neuropsychological examination it was found that all cases of concussion of the brain are accompanied by those or other asthenic disorders.

  20. Return to Learning: Going Back to School Following a Concussion

    Science.gov (United States)

    McAvoy, Karen

    2012-01-01

    A concussion is a brain injury that affects cognitive, emotional, behavioral, physical, and sleep/energy patterns. The Centers for Disease Control and Prevention (CDC) estimate that approximately 1.6 to 3.8 million sports and recreational concussions occur each year. Countless more children sustain concussions from nonsports activities such as…

  1. Neuroimaging Biomarkers of a History of Concussion Observed in Asymptomatic Young Athletes.

    Science.gov (United States)

    Orr, Catherine A; Albaugh, Matthew D; Watts, Richard; Garavan, Hugh; Andrews, Trevor; Nickerson, Joshua P; Gonyea, Jay; Hipko, Scott; Zweber, Cole; Logan, Katherine; Hudziak, James J

    2016-05-01

    Participation in contact sports places athletes at elevated risk for repeated head injuries and is associated with negative mental health outcomes later in life. The current study identified changes observable on neuroimaging that persisted beyond the apparent resolution of acute symptoms of concussion. Sixteen young adult ice hockey players with a remote history of concussion but no subjective complaints were compared against 13 of their teammates with no history of concussion. Participants completed a detailed phenotypic assessment and a neuroimaging battery including diffusion kurtosis imaging and resting-state functional magnetic resonance imaging. Athletes with a history of concussion performed no differently from those without on phenotypic assessment, but showed significantly elevated fractional anisotropy (FA) in the left genu and anterior corona radiata relative to those without. Post hoc analyses revealed that elevated FA was associated with increased microstructural complexity perpendicular to the primary axon (radial kurtosis). Athletes with concussion history also showed significant differences in the organization of the default mode network (DMN) characterized by stronger temporal coherence in posterior DMN, decreased temporal coherence in anterior DMN, and increased functional connectivity outside the DMN. In the absence of deficits on detailed phenotypic assessment, athletes with a history of concussion displayed changes to the microstructural architecture of the cerebral white matter and to the functional connectivity of the brain at rest. Some of these changes are consistent with those previously associated with persisting deficits and complaints, but we also report novel, complementary changes that possibly represent compensatory mechanisms.

  2. Absence of chronic traumatic encephalopathy in retired football players with multiple concussions and neurological symptomatology

    Directory of Open Access Journals (Sweden)

    Lili-Naz eHazrati

    2013-05-01

    Full Text Available Background: Chronic traumatic encephalopathy (CTE is the term coined for the neurodegenerative disease often suspected in athletes with histories of repeated concussion and progressive dementia. Histologically, CTE is defined as a tauopathy with a distribution of tau-positive neurofibrillary tangles that is distinct from other tauopathies, and usually shows an absence of beta-amyloid deposits, in contrast to Alzheimer’s disease. Although the connection between repeated concussions and CTE-type neurodegeneration has been recently proposed, this causal relationship has not yet been firmly established. Also, the prevalence of CTE among athletes with multiple concussions is unknown. Methods: We performed a consecutive case series brain autopsy study on six retired professional football players from the Canadian Football League with histories of multiple concussions and significant neurological decline. Results: All participants had progressive neurocognitive decline prior to death; however, only 3 cases had post-mortem neuropathological findings consistent with CTE. The other 3 participants had pathological diagnoses of Alzheimer’s disease, amyotrophic lateral sclerosis and Parkinson’s disease. Moreover, the CTE cases showed co-morbid pathology of cancer, vascular disease and Alzheimer’s disease. Discussion: Our case studies highlight that not all athletes with history of repeated concussions and neurological symptomalogy present neuropathological changes of CTE. These preliminary findings support the need for further research into the link between concussion and CTE as well as the need to expand the research to other possible causes of taupathy in athletes. They point to a critical need for prospective studies with good sampling methods to allow us to understand the relationship between multiple concussions and the development of CTE.

  3. Absence of chronic traumatic encephalopathy in retired football players with multiple concussions and neurological symptomatology.

    Science.gov (United States)

    Hazrati, Lili-Naz; Tartaglia, Maria C; Diamandis, Phedias; Davis, Karen D; Green, Robin E; Wennberg, Richard; Wong, Janice C; Ezerins, Leo; Tator, Charles H

    2013-01-01

    Chronic traumatic encephalopathy (CTE) is the term coined for the neurodegenerative disease often suspected in athletes with histories of repeated concussion and progressive dementia. Histologically, CTE is defined as a tauopathy with a distribution of tau-positive neurofibrillary tangles (NFTs) that is distinct from other tauopathies, and usually shows an absence of beta-amyloid deposits, in contrast to Alzheimer's disease (AD). Although the connection between repeated concussions and CTE-type neurodegeneration has been recently proposed, this causal relationship has not yet been firmly established. Also, the prevalence of CTE among athletes with multiple concussions is unknown. We performed a consecutive case series brain autopsy study on six retired professional football players from the Canadian Football League (CFL) with histories of multiple concussions and significant neurological decline. All participants had progressive neurocognitive decline prior to death; however, only 3 cases had post-mortem neuropathological findings consistent with CTE. The other 3 participants had pathological diagnoses of AD, amyotrophic lateral sclerosis (ALS), and Parkinson's disease (PD). Moreover, the CTE cases showed co-morbid pathology of cancer, vascular disease, and AD. Our case studies highlight that not all athletes with history of repeated concussions and neurological symptomology present neuropathological changes of CTE. These preliminary findings support the need for further research into the link between concussion and CTE as well as the need to expand the research to other possible causes of taupathy in athletes. They point to a critical need for prospective studies with good sampling methods to allow us to understand the relationship between multiple concussions and the development of CTE.

  4. A potential biomarker in sports-related concussion: brain functional connectivity alteration of the default-mode network measured with longitudinal resting-state fMRI over thirty days.

    Science.gov (United States)

    Zhu, David C; Covassin, Tracey; Nogle, Sally; Doyle, Scarlett; Russell, Doozie; Pearson, Randolph L; Monroe, Jeffrey; Liszewski, Christine M; DeMarco, J Kevin; Kaufman, David I

    2015-03-01

    Current diagnosis and monitoring of sports-related concussion rely on clinical signs and symptoms, and balance, vestibular, and neuropsychological examinations. Conventional brain imaging often does not reveal abnormalities. We sought to assess if the longitudinal change of functional and structural connectivity of the default-mode network (DMN) can serve as a potential biomarker. Eight concussed Division I collegiate football student-athletes in season (one participated twice) and 11 control subjects participated in this study. ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) was administered over the course of recovery. High-resolution three dimensional T1-weighted, T2*-weighted diffusion-tensor images and resting-state functional magnetic resonance imaging (rs-fMRI) scans were collected from each subject within 24 h, 7±1 d and 30±1 d after concussion. Both network based and whole-brain based functional correlation analyses on DMN were performed. ImPACT findings demonstrated significant cognitive impairment across multiple categories and a significant increase of symptom severity on Day 1 following a concussion but full recovery by 6.0±2.4 d. While the structural connectivity within DMN and gross anatomy appeared unchanged, a significantly reduced functional connectivity within DMN from Day 1 to Day 7 was found in the concussed group in this small pilot study. This reduction was seen in eight of our nine concussion cases. Compared with the control group, there appears a general trend of increased DMN functional connectivity on Day 1, a significant drop on Day 7, and partial recovery on Day 30. The results of this pilot study suggest that the functional connectivity of DMN measured with longitudinal rs-fMRI can serve as a potential biomarker to monitor the dynamically changing brain function after sports-related concussion, even in patients who have shown clinical improvement.

  5. Mild Concussion, but Not Moderate Traumatic Brain Injury, Is Associated with Long-Term Depression-Like Phenotype in Mice

    OpenAIRE

    Nikita M Bajwa; Shina Halavi; Mary Hamer; Semple, Bridgette D.; Noble-Haeusslein, Linda J; Mohsen Baghchechi; Alex Hiroto; Hartman, Richard E.; André Obenaus

    2016-01-01

    Mild traumatic brain injuries can lead to long-lasting cognitive and motor deficits, increasing the risk of future behavioral, neurological, and affective disorders. Our study focused on long-term behavioral deficits after repeated injury in which mice received either a single mild CHI (mCHI), a repeated mild CHI (rmCHI) consisting of one impact to each hemisphere separated by 3 days, or a moderate controlled cortical impact injury (CCI). Shams received only anesthesia. Behavioral tests were ...

  6. A systematic review of concussion in rugby league.

    Science.gov (United States)

    Gardner, Andrew; Iverson, Grant L; Levi, Christopher R; Schofield, Peter W; Kay-Lambkin, Frances; Kohler, Ryan M N; Stanwell, Peter

    2015-04-01

    Concussion remains one of the inherent risks of participation in rugby league. While other injuries incurred by rugby league players have been well studied, less focus and attention has been directed towards concussion. The current review examined all articles published in English from 1900 up to June 2013 pertaining to concussion in rugby league players. Publications were retrieved via six databases using the key search terms: rugby league, league, football; in combination with injury terms: athletic injuries, concussion, sports concussion, sports-related concussion, brain concussion, brain injury, brain injuries, mild traumatic brain injury, mTBI, traumatic brain injury, TBI, craniocerebral trauma, head injury and brain damage. Observational, cohort, correlational, cross-sectional and longitudinal studies were all included. 199 rugby league injury publications were identified. 39 (20%) were related in some way to concussion. Of the 39 identified articles, 6 (15%) had the main aim of evaluating concussion, while the other 33 reported on concussion incidence as part of overall injury data analyses. Rugby league concussion incidence rates vary widely from 0.0 to 40.0/1000 playing hours, depending on the definition of injury (time loss vs no time loss). The incidence rates vary across match play versus training session, seasons (winter vs summer) and playing position (forwards vs backs). The ball carrier has been found to be at greater risk for injury than tacklers. Concussion accounts for 29% of all injuries associated with illegal play, but only 9% of injuries sustained in legal play. In comparison with other collision sports, research evaluating concussion in rugby league is limited. With such limited published rugby league data, there are many aspects of concussion that require attention, and future research may be directed towards these unanswered questions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

  7. The neurophysiology of concussion.

    Science.gov (United States)

    Hovda, David A

    2014-01-01

    The following report reviews our current understanding of the neurobiological response to concussion which is often referred to as mild traumatic brain injury. The historical accomplishments to reveal the brain's response to this injury are discussed along with the neurochemical and metabolic cascade that results in an energy crisis. The massive ionic flux induced by cerebral concussion is discussed as it pertains to primarily potassium and calcium. The ensuing metabolic demands placed on cells exposed to this ionic flux is discussed as it relates to an injury-induced diaschisis. As this cascade produces neuronal dysfunction and corresponding deficits, it also results in a state of vulnerability to secondary insults and long-term neurological problems. While experimental studies are the primary focus of this report, relevant human observations are discussed and put into context. It is now clear that cerebral concussion is not a benign event. It carries with it neuroscientific consequences that result in symptoms and an increase in risk for many other challenges to the central nervous system. © 2014 S. Karger AG, Basel.

  8. Tumor necrosis factor alpha and Fas receptor contribute to cognitive deficits independent of cell death after concussive traumatic brain injury in mice.

    Science.gov (United States)

    Khuman, Jugta; Meehan, William P; Zhu, Xiaoxia; Qiu, Jianhua; Hoffmann, Ulrike; Zhang, Jimmy; Giovannone, Eric; Lo, Eng H; Whalen, Michael J

    2011-02-01

    Tumor necrosis factor alpha (TNFα) and Fas receptor contribute to cell death and cognitive dysfunction after focal traumatic brain injury (TBI). We examined the role of TNFα/Fas in postinjury functional outcome independent of cell death in a novel closed head injury (CHI) model produced with weight drop and free rotational head movement in the anterior-posterior plane. The CHI produced no cerebral edema or blood-brain barrier damage at 24 to 48 hours, no detectable cell death, occasional axonal injury (24 hours), and no brain atrophy or hippocampal cell loss (day 60). Microglia and astrocytes were activated (48 to 72 hours). Tumor necrosis factor-α mRNA, Fas mRNA, and TNFα protein were increased in the brain at 3 to 6 hours after injury (Pcell death after CHI. Therapies targeting TNFα/Fas together may be inappropriate for patients with concussive TBI.

  9. Coping Strategies as a Predictor of Post-concussive Symptoms in Children with Mild Traumatic Brain Injury versus Mild Orthopedic Injury

    OpenAIRE

    2011-01-01

    This study examined whether children’s coping strategies are related to post-concussive symptoms following mild traumatic brain injury (TBI) versus orthopedic injury (OI). Participants were 8- to 15-year-old children with mild TBI (n =167) or OI (n =84). They rated their current preferred coping strategies and post-injury symptoms at 2 weeks (baseline) and 1, 3, and 12 months post-injury. Children’s reported use of coping strategies did not vary significantly over time, so their baseline copi...

  10. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... Free Online Training (Developed in partnership with the National Federation of State High School Associations) GET MORE INFORMATION ON CONCUSSION and TRAUMATIC BRAIN INJURY IN THE UNITED STATES Statistics Causes Outcomes Prevention COMMUNICATING EFFECTIVELY ABOUT ...

  11. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... to Know,” [Exit Disclaimer] Free Online Training (Developed in partnership with the National Federation of State High ... MORE INFORMATION ON CONCUSSION and TRAUMATIC BRAIN INJURY IN THE UNITED STATES Statistics Causes Outcomes Prevention COMMUNICATING ...

  12. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... Learn More about the Brain and How it Works Order Free Copies of CDC's “Heads Up” Educational ... Up! Prevent Concussions Prevent Head Injuries Sports Safety Students Play Safe Youth Sports Safety PROMOTIONAL MATERIALS "Heads ...

  13. Concussion and football: a review and editorial.

    Science.gov (United States)

    Abdullah, Kalil G; Grady, M Sean; Levine, Joshua M

    2015-04-01

    The issue of concussion in football is of substantial interest to players, coaches, fans, and physicians. In this article, we review specific cultural hindrances to diagnosis and treatment of concussion in football. We review current trends in management and identify areas for improvement. We also discuss the obligations that physicians, particularly neurosurgeons and neurologists, have toward brain-injured football players and the larger societal role they may play in helping to minimize football-associated brain injury.

  14. Concussion knowledge in high school football players.

    Science.gov (United States)

    Cournoyer, Janie; Tripp, Brady L

    2014-01-01

    Participating in sports while experiencing symptoms of a concussion can be dangerous. An athlete's lack of knowledge may be one factor influencing his or her decision to report symptoms. In an effort to enhance concussion education among high school athletes, legislation in Florida has attempted to address the issue through parental consent forms. To survey high school varsity football players to determine their level of knowledge about concussions after the initiation of new concussion-education legislation. Cross-sectional study. Descriptive survey administered in person during a team meeting. A total of 334 varsity football players from 11 high schools in Florida. Participants completed a survey and identified the symptoms and consequences of a concussion among distractors. They also indicated whether they had received education about concussions from a parent, formal education, neither, or both. The most correctly identified symptoms were headache (97%), dizziness (93%), and confusion (90%), and the most correctly identified consequence was persistent headache (93%). Participants reported receiving education from their parents (54%) or from a formal source (60%). Twenty-five percent reported never receiving any education regarding concussions. No correlations were found between the method of education and the knowledge of symptoms or consequences of concussion. The high school football players we surveyed did not have appropriate knowledge of the symptoms and consequences of concussions. Nausea or vomiting, neck pain, grogginess, difficulty concentrating, and personality or behavioral changes were often missed by participants, and only a small proportion correctly identified brain hemorrhage, coma, and death as possible consequences of inappropriate care after a concussion. Even with parents or guardians signing a consent form indicating they discussed concussion awareness with their child, 46% of athletes suggested they had not.

  15. Progressive Return to Activity Following Acute Concussion/Mild Traumatic Brain Injury: Guidance for the Primary Care Manager in Deployed and Non-deployed Settings (BRIEFING SLIDES)

    Science.gov (United States)

    2014-01-01

    percent) in the DoD are mild TBIs (mTBI), also known as concussions DCoE photo Learning Objectives 4 Source: Assistant Secretary of Defense for...mandatory recovery • 24 hours for first or second concussion within 12 months 2. For three or more concussions within 12 months refer to higher...activity process All concussions should be evaluated in accordance with Department of Defense Instruction (DoDI) 6490.11; or the VA/DoD Clinical

  16. [Application of nootropic agents in complex treatment of patients with concussion of the brain].

    Science.gov (United States)

    Tkachev, A V

    2007-01-01

    65 patients with a mild craniocereberal trauma have been observed. Medical examination included among general clinical methods the following methods: KT (MRT) of the brain, oculist examination including the observation of eye fundus. For objectification of a patient' complaints the authors used orientation and Galvestona's amnesia tests, feeling scale (psychological test), the table to determine the level of memory. Tests have been carried out on the first, tenth and thirty day of the treatment. Patients of the first group received in a complex treatment -pramistar, patients of the second group - piracetam. Patients of both groups noted considerable improvement during a complex treatment (disappearance of headache, dizziness and nausea) and at the same time patients receiving pramistar had better restoration of orientation and feeling. Pramistar was also more effective in patients with amnesia.

  17. Sports concussions and aging: a neuroimaging investigation.

    Science.gov (United States)

    Tremblay, Sebastien; De Beaumont, Louis; Henry, Luke C; Boulanger, Yvan; Evans, Alan C; Bourgouin, Pierre; Poirier, Judes; Théoret, Hugo; Lassonde, Maryse

    2013-05-01

    Recent epidemiological and experimental studies suggest a link between cognitive decline in late adulthood and sports concussions sustained in early adulthood. In order to provide the first in vivo neuroanatomical evidence of this relation, the present study probes the neuroimaging profile of former athletes with concussions in relation to cognition. Former athletes who sustained their last sports concussion >3 decades prior to testing were compared with those with no history of traumatic brain injury. Participants underwent quantitative neuroimaging (optimized voxel-based morphometry [VBM], hippocampal volume, and cortical thickness), proton magnetic resonance spectroscopy ((1)H MRS; medial temporal lobes and prefrontal cortices), and neuropsychological testing, and they were genotyped for APOE polymorphisms. Relative to controls, former athletes with concussions exhibited: 1) Abnormal enlargement of the lateral ventricles, 2) cortical thinning in regions more vulnerable to the aging process, 3) various neurometabolic anomalies found across regions of interest, 4) episodic memory and verbal fluency decline. The cognitive deficits correlated with neuroimaging findings in concussed participants. This study unveiled brain anomalies in otherwise healthy former athletes with concussions and associated those manifestations to the long-term detrimental effects of sports concussion on cognitive function. Findings from this study highlight patterns of decline often associated with abnormal aging.

  18. Repetitive concussive traumatic brain injury interacts with post-injury foot shock stress to worsen social and depression-like behavior in mice.

    Directory of Open Access Journals (Sweden)

    Kristen C Klemenhagen

    Full Text Available The debilitating effects of repetitive concussive traumatic brain injury (rcTBI have been increasingly recognized in both military and civilian populations. rcTBI may result in significant neurological, cognitive, and affective sequelae, and is often followed by physical and/or psychological post-injury stressors that may exacerbate the effects of the injury and prolong the recovery period for injured patients. However, the consequences of post-injury stressors and their subsequent effects on social and emotional behavior in the context of rcTBI have been relatively little studied in animal models. Here, we use a mouse model of rcTBI with two closed-skull blunt impacts 24 hours apart and social and emotional behavior testing to examine the consequences of a stressor (foot shock fear conditioning following brain injury (rcTBI. rcTBI alone did not affect cued or contextual fear conditioning or extinction compared to uninjured sham animals. In the sucrose preference test, rcTBI animals had decreased preference for sucrose, an anhedonia-like behavior, regardless of whether they experienced foot shock stress or were non-shocked controls. However, rcTBI and post-injury foot shock stress had synergistic effects in tests of social recognition and depression-like behavior. In the social recognition test, animals with both injury and shock were more impaired than either non-shocked injured mice or shocked but uninjured mice. In the tail suspension test, injured mice had increased depression-like behavior compared with uninjured mice, and shock stress worsened the depression-like behavior only in the injured mice with no effect in the uninjured mice. These results provide a model of subtle emotional behavioral deficits after combined concussive brain injury and stress, and may provide a platform for testing treatment and prevention strategies for social behavior deficits and mood disorders that are tailored to patients with traumatic brain injury.

  19. The Impact of Multiple Concussions on Emotional Distress, Post-Concussive Symptoms, and Neurocognitive Functioning in Active Duty United States Marines Independent of Combat Exposure or Emotional Distress

    Science.gov (United States)

    Lathan, Corinna E.; Bleiberg, Joseph; Tsao, Jack W.

    2014-01-01

    Abstract Controversy exists as to whether the lingering effects of concussion on emotional, physical, and cognitive symptoms is because of the effects of brain trauma or purely to emotional factors such as post-traumatic stress disorder or depression. This study examines the independent effects of concussion on persistent symptoms. The Defense Automated Neurobehavioral Assessment, a clinical decision support tool, was used to assess neurobehavioral functioning in 646 United States Marines, all of whom were fit for duty. Marines were assessed for concussion history, post-concussive symptoms, emotional distress, neurocognitive functioning, and deployment history. Results showed that a recent concussion or ever having experienced a concussion was associated with an increase in emotional distress, but not with persistent post-concussive symptoms (PPCS) or neurocognitive functioning. Having had multiple lifetime concussions, however, was associated with greater emotional distress, PPCS, and reduced neurocognitive functioning that needs attention and rapid discrimination, but not for memory-based tasks. These results are independent of deployment history, combat exposure, and symptoms of post-traumatic stress disorder and depression. Results supported earlier findings that a previous concussion is not generally associated with post-concussive symptoms independent of covariates. In contrast with other studies that failed to find a unique contribution for concussion to PPCS, however, evidence of recent and multiple concussion was seen across a range of emotional distress, post-concussive symptoms, and neurocognitive functioning in this study population. Results are discussed in terms of implications for assessing concussion on return from combat. PMID:25003552

  20. Concussions in soccer: a current understanding.

    Science.gov (United States)

    Levy, Michael L; Kasasbeh, Aimen S; Baird, Lissa Catherine; Amene, Chiazo; Skeen, Jeff; Marshall, Larry

    2012-11-01

    Traumatic brain injury (TBI) is a significant public health problem in the United States, with approximately 1.5-2 million TBIs occurring each year. However, it is believed that these figures underestimate the true toll of TBI. Soccer is the most popular sport in the world and has a following of millions in the United States. Soccer is a sport not traditionally identified as high-risk for concussions, yet several studies have shown that concussion rates in soccer are comparable to, and often exceed those of, other contact sports. As many as 22% of all soccer injuries are concussions. Soccer is a sport not traditionally identified as high risk for concussions, yet several studies have shown that concussion rates in soccer are comparable to, and often exceed those of, other contact sports. As many as 22% of all soccer injuries are concussions. Head injury during soccer is usually the result of either "direct contact" or contact with the ball while "heading" the ball. Relationships between the number of headers sustained in a single season and the degree of cognitive impairment (attention and visual/verbal memory) have been demonstrated. It is also likely that multiple concussions may cause cumulative neuropsychologic impairment in soccer players. Although our understanding of risk factors for sports-related concussions is far from complete, there is great potential for prevention in sports-related concussions. Several measures must be taken to avert the development of concussions in soccer and, when they take place, reduce their effects. These include the development and testing of effective equipment during play, the maintenance of regulatory standards for all such equipment, educating young athletes on the safe and appropriate techniques used during play, and strict adherence to the rules of competition. In spite of such preventive measures, concussions in soccer will continue to occur. Considering the frequency of concussions in soccer, the serious sequelae of

  1. Neurometabolic aspects of sports-related concussion.

    Science.gov (United States)

    Domínguez, Delfina C; Raparla, Mrudula

    2014-08-01

    Concussion is a transitory brain injury resulting from a blow to the head. Concussion is considered a mild traumatic brain injury (mTBI), which is self-limited. Repetitive mTBI has been associated with chronic, progressive neurologic damage. Extreme biochemical changes occur in neuron cells as a result of mTBI. These metabolic disturbances may reflect the symptoms observed in patients who had concussions. However, it has been difficult to match clinical signs and symptoms. Currently, there is no test to diagnose concussion. Further studies are needed to elucidate the biochemical details of the metabolic cascade and the associated time frame, which will help determine when an athlete can safely return to the game. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Concussions and Risk Within Cultural Contexts of Play.

    Science.gov (United States)

    Torres Colón, Gabriel Alejandro; Smith, Sharia; Fucillo, Jenny

    2017-06-01

    Concussions are a type of traumatic injury caused by a jolting of the brain that disrupts normal brain function, and multiple concussions can lead to serious long-term health consequences. In this article, we examine the relationship between college students' understanding of concussions and their willingness to continue playing despite the possibility of sustaining multiple head injuries. We use a mixed-methods approach that includes participant observation, cultural domain analysis, and structured interviews. Our research finds that students hold a robust cognitive understanding of concussion yet discursively frame concussions as skeletomuscular injuries. More importantly, students affirm the importance of playing sports for themselves and others, so their decisions to risk multiple concussions must be understood within cultural and biocultural contexts of meaningful social play. We suggest that peoples' decision to risk multiple head injuries should be understood as a desire for meaningful social play rather than an uninformed health risk.

  3. The WRAIR projectile concussive impact model of mild traumatic brain injury: re-design, testing and preclinical validation.

    Science.gov (United States)

    Leung, Lai Yee; Larimore, Zachary; Holmes, Larry; Cartagena, Casandra; Mountney, Andrea; Deng-Bryant, Ying; Schmid, Kara; Shear, Deborah; Tortella, Frank

    2014-08-01

    The WRAIR projectile concussive impact (PCI) model was developed for preclinical study of concussion. It represents a truly non-invasive closed-head injury caused by a blunt impact. The original design, however, has several drawbacks that limit the manipulation of injury parameters. The present study describes engineering advancements made to the PCI injury model including helmet material testing, projectile impact energy/head kinematics and impact location. Material testing indicated that among the tested materials, 'fiber-glass/carbon' had the lowest elastic modulus and yield stress for providing an relative high percentage of load transfer from the projectile impact, resulting in significant hippocampal astrocyte activation. Impact energy testing of small projectiles, ranging in shape and size, showed the steel sphere produced the highest impact energy and the most consistent impact characteristics. Additional tests confirmed the steel sphere produced linear and rotational motions on the rat's head while remaining within a range that meets the criteria for mTBI. Finally, impact location testing results showed that PCI targeted at the temporoparietal surface of the rat head produced the most prominent gait abnormalities. Using the parameters defined above, pilot studies were conducted to provide initial validation of the PCI model demonstrating quantifiable and significant increases in righting reflex recovery time, axonal damage and astrocyte activation following single and multiple concussions.

  4. Psychological evaluation of patients with brain concussion%脑震荡患者心理状况评定(附186例报告)

    Institute of Scientific and Technical Information of China (English)

    赵鹏洲; 罗江兵; 杨本生; 欧英雄; 谭社练; 方胜; 赵伯端

    2008-01-01

    目的 探讨脑震荡患者的心理状况特征.方法 对186例脑震荡患者进行90项症状自评量表(SCL-90)评定,并与常模(正常人阳件症状均分)比较.结果 腩震荡患者SCL-90总分(137.71±39.48),总均分(1.53±0.44),阳性项目数(32.90±19.41),躯体化症状因子分(1.57±0.52)、强迫症状因子分(1.79±0.50)、焦虑症状因子分(1.50±0.49)、敌对症状因子分(1.63±0.57)、恐惧症状因子分(1.57±0.51)、偏执症状因子分(1.62±0.51)、精神病性因子分(1.49±0.43)明显高于常模(129.96±38.76、1.44±0.43、24.92±18.41、1.37±0.48、1.62±0.58、1.39±0.43、1.48±0.56、1.23±0.41、1.43±0.57、1.29±0.42),差异有统计学意义(P0.05).结论 脑震荡可导致患者心理障碍的产生,应早期就对患者进行心理治疗.%Objective To investigate the psychological status of patients with brain concussion. Methods A total of 186 patients with brain concussion were evaluated using Symptom Check-List 90 (SCL-90) and the scores were compared with the norms. Results The general scores (137.71±39.48), total mean scores (1.53±0.44) and positive object number (32.90±19.41) of SCL-90, as well as the factor scores ofsomatization(1.57±0.52), compulsion(1.79±0.50), anxiety disorder(1.50±0.49), hostility(1.63± 0.57), phobic anxiety(1.57±0.51), paranoid ideation(1.62±0.51) and psychoticism ( 1.49±0.43) in the patients with brain concussion were all higher than the normal ones (129.96±38.76, 1.44±0.43, 24.92± 18.41, 1.37±0.48, 1.62±0.58, 1.39±0.43, 1.48±0.56, 1.23±0.41, 1.43±0.57, 1.29±0.42, respectively)(P0.05). Conclusion Brain concussion may lead to psychological disturbance, for which early interventions should be administered.

  5. Evaluation of the anatomical and functional consequences of repetitive mild cervical contusion using a model of spinal concussion.

    Science.gov (United States)

    Jin, Ying; Bouyer, Julien; Haas, Christopher; Fischer, Itzhak

    2015-09-01

    Spinal cord concussion is characterized by a transient loss of motor and sensory function that generally resolves without permanent deficits. Spinal cord concussions usually occur during vehicular accidents, falls, and sport activity, but unlike brain concussions, have received much less attention despite the potential for repeated injury leading to permanent neurological sequelae. Consequently, there is no consensus regarding decisions related to return to play following an episode of spinal concussion, nor an understanding of the short- and long-term consequences of repeated injury. Importantly, there are no models of spinal concussion to study the anatomical and functional sequelae of single or repeated injury. We have developed a new model of spinal cord concussion focusing on the anatomical and behavioral outcomes of single and repeated injury. Rats received a very mild (50 kdyn, IH impactor) spinal contusion at C5 and were separated into two groups three weeks after the initial injury--C1, which received a second, sham surgery, and C2, which received a second contusion at the same site. To track motor function and recovery, animals received weekly behavioral tests--BBB, CatWalk™, cylinder, and Von Frey. Analysis of locomotor activity by BBB demonstrated that rats rapidly recovered, regaining near-normal function by one week after the first and second injury, which was confirmed using the more detailed CatWalk™ analysis. The cylinder test showed that a single contusion did not induce significant deficits of the affected limb, but that repeated injury resulted in significant alteration in paw preference, with animals favoring the unaffected limb. Intriguingly, Von Frey analysis demonstrated an increased sensitivity in the contralateral hindlimb in the C2 group vs. the C1 group. Anatomical analyses revealed that while the lesion volume of both groups was minimal, the area of spared white matter in the C2 group was significantly reduced 1 and 2mm rostral to

  6. Pediatric Issues in Sports Concussions

    Science.gov (United States)

    Giza, Christopher C.

    2014-01-01

    Purpose of Review: Sports-related concussions are receiving increasing attention in both the lay press and medical literature. While most media attention has been on high-profile collegiate or professional athletes, the vast majority of individuals participating in contact and collision sports are adolescents and children. This review provides a practical approach toward youth sports-related concussion with a foundation in the recent guidelines, but including specific considerations when applying these management principles to children and adolescents. Recent Findings: Objective measurement of early signs and symptoms is challenging in younger patients, and many commonly used assessment tools await rigorous validation for younger patients. Excellent evidence-based guidelines exist for CT evaluation of mild traumatic brain injury presenting to the emergency department. Evidence suggests that recovery from sports-related concussion takes longer in high school athletes compared with collegiate or professionals; however, rigorous studies below high school age are still lacking. Summary: Proper care for concussion in youth requires a delicate balance of clinical skills, age-appropriate assessment, and individualized management to achieve optimal outcomes. PMID:25470161

  7. Nuclear Medicine Imaging in Concussive Head Injuries in Sports

    NARCIS (Netherlands)

    Vállez Garcia, David; Otte, Andreas; Glaudemans, Andor WJM; Dierckx, Rudi AJO; Gielen, Jan LMA; Zwerver, Johannes

    2015-01-01

    Concussions in sports and during recreational activities are a major source of traumatic brain injury in our society. This is mainly relevant in adolescence and young adulthood, where the annual rate of diagnosed concussions is increasing from year to year. Contact sports (e.g., ice hockey, American

  8. The Role of a School Psychologist in Concussion

    Science.gov (United States)

    Lewandowski, Lawrence J.; Rieger, Brian

    2009-01-01

    School psychologists historically have received little training on topics such as mild traumatic brain injury or concussion, yet they could play a significant role in assessment, consultation, and intervention with students who have sustained a concussion. The purpose of this article is to educate school psychologists with regard to definition,…

  9. Nuclear Medicine Imaging in Concussive Head Injuries in Sports

    NARCIS (Netherlands)

    Vállez Garcia, David; Otte, Andreas; Glaudemans, Andor WJM; Dierckx, Rudi AJO; Gielen, Jan LMA; Zwerver, Johannes

    2015-01-01

    Concussions in sports and during recreational activities are a major source of traumatic brain injury in our society. This is mainly relevant in adolescence and young adulthood, where the annual rate of diagnosed concussions is increasing from year to year. Contact sports (e.g., ice hockey, American

  10. Concussions in wheelchair basketball.

    Science.gov (United States)

    Wessels, Karla K; Broglio, Steven P; Sosnoff, Jacob J

    2012-02-01

    To estimate the incidence rate of concussions in wheelchair basketball. Survey. Wheelchair basketball tournaments during the 2009 to 2010 season. Wheelchair basketball players (N=263) ranging in age from 18 to 60 years. Not applicable. Participants completed a survey on their concussion history including how many concussions they have sustained, how many days they refrained from physical activity because of injury, to whom they reported their injury, and reasons for not reporting an injury if they did not. Participants also provided demographic information about their disability, age, sex, and length of wheelchair use and sports participation. Within the sample of 263 wheelchair basketball players, 6.1% reported experiencing a concussion in the current season. Of those experiencing concussions during the current season, 44% did not report their concussion. Of those not reporting the incident, 67% did not because they did not want to be removed from physical activity. Analysis by sex indicated that 5.82% of the male athletes sustained a concussion during the current season, and 14.36% had sustained an injury during their athletic career. Female athletes, however, sustained concussions at a higher rate, with 6.67% having concussions during the current season and 30.6% during their athletic careers. Women were also 2.5 times more likely to sustain a concussion than men. Athletes were most likely to report their concussion to their coach (60% of concussed athletes). The current investigation was consistent with previous research in that women were more likely to sustain a concussion than men, and injury rates were similar to those in able-bodied basketball. Further work is needed in concussion assessment in persons with disability, as well as greater education concerning concussion in disability sports. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  11. Concussions Among United States High School and Collegiate Athletes

    Science.gov (United States)

    Gessel, Luke M; Fields, Sarah K; Collins, Christy L; Dick, Randall W; Comstock, R. Dawn

    2007-01-01

    Context: An estimated 300 000 sport-related traumatic brain injuries, predominantly concussions, occur annually in the United States. Sports are second only to motor vehicle crashes as the leading cause of traumatic brain injury among people aged 15 to 24 years. Objective: To investigate the epidemiology of concussions in a nationally representative sample of high school athletes and to compare rates of concussion among high school and collegiate athletes. Design: Descriptive epidemiologic study Setting: 100 United States high schools and 180 US colleges. Patients or Other Participants: United States high school and collegiate athletes. Main Outcome Measure(s): Data from 2 injury surveillance systems, High School Reporting Information Online (RIO) and the National Collegiate Athletic Association Injury Surveillance System, were analyzed to calculate rates, describe patterns, and evaluate potential risk factors for sport-related concussion. Results: Concussions represented 8.9% (n = 396) of all high school athletic injuries and 5.8% (n = 482) of all collegiate athletic injuries. Among both groups, rates of concussions were highest in the sports of football and soccer. In high school sports played by both sexes, girls sustained a higher rate of concussions, and concussions represented a greater proportion of total injuries than in boys. In all sports, collegiate athletes had higher rates of concussion than high school athletes, but concussions represented a greater proportion of all injuries among high school athletes. Conclusions: Sport-related injury surveillance systems can provide scientific data to drive targeted injury-prevention projects. Developing effective sport-related concussion preventive measures depends upon increasing our knowledge of concussion rates, patterns, and risk factors. PMID:18174937

  12. Effects of Two Concussions on the Neuropsychological Functioning and Symptom Reporting of High School Athletes.

    Science.gov (United States)

    Tsushima, William T; Geling, Olga; Arnold, Monica; Oshiro, Ross

    2016-01-01

    To assess the effects of two sports-related concussions on neuropsychological functioning and symptom reporting, the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) was administered to 483 high school athletes. Three groups of athletes were determined based on the number of previous concussions: no concussion (n = 409), 1 concussion (n = 58), and 2 concussions (n = 16). The results showed that the three groups did not differ in terms of their ImPACT composite scores (Verbal Memory, Visual Memory, Reaction Time, and Processing Speed) and the Total Symptom Score. As there are only a few studies that have reported the sequelae of 2 concussions in high school athletes, it is premature to declare that a repeated concussion does not have persistent neurocognitive effects on high school athletes.

  13. Is there a gender difference in concussion incidence and outcomes?

    Science.gov (United States)

    Dick, R W

    2009-05-01

    To determine if there is a gender difference in the incidence and outcomes of sport concussion. Critical literature review of sport concussion by gender. PubMed and major sports medicine journals were reviewed using the keywords concussion and gender. Articles included in this paper were English prospective surveillance that included concussion as an injury option conducted over the past 10 years, involved data collected by qualified medical personnel (athletic trainers/therapists or medical doctors) and used injury rates as opposed to raw counts. Only data from sports (soccer, basketball and ice hockey) where actions, equipment and most rules were similar between genders were reviewed. For the PubMed search, using "concussion" and "gender" as keywords, there were 51 articles. Ten studies (four in football (soccer), four in basketball and two in ice hockey, including high school, college and professional athletes) were included in the incidence portion of the paper. Nine of the studies showed higher absolute injury rates for female concussion compared to their male counterparts with four of them reaching statistical significance. Five of the studies (two football (soccer), two basketball and one ice hockey) examined concussion mechanism and in all cases, males had a higher absolute percent of player contact concussions while females had a higher absolute percentage of surface or ball contact concussion episodes. Two brain injury and four sport concussion outcome papers were reviewed. Traumatic brain injury outcome was shown to be worse in females than in males for a majority of measured variables; females also are shown to have different baseline and post-concussion outcomes on neuropsychological testing. After evaluating multiple years of concussion data in comparable sports, the evidence indicates that female athletes may be at greater risk for concussion than their male counterparts. There also is some evidence that gender differences exist in outcomes of

  14. Dance-related concussion: a case series.

    Science.gov (United States)

    Stein, Cynthia J; Kinney, Susan A; McCrystal, Tara; Carew, Elizabeth A; Bottino, Nicole M; Meehan Iii, William P; Micheli, Lyle J

    2014-01-01

    Sport-related concussion is a topic of increasing public and media attention; the medical literature on this topic is growing rapidly. However, to our knowledge no published papers have described concussion specifically in the dancer. This case series involved a retrospective chart review at a large teaching hospital over a 5.5-year period. Eleven dancers (10 female, 1 male) were identified who experienced concussions while in dance class, rehearsal, or performance: 2 in classical ballet, 2 in modern dance, 2 in acro dance, 1 in hip hop, 1 in musical theater, and 3 were unspecified. Dancers were between 12 and 20 years old at the time of presentation. Three concussions occurred during stunting, diving, or flipping. Three resulted from unintentional drops while partnering. Two followed slips and falls. Two were due to direct blows to the head, and one dancer developed symptoms after repeatedly whipping her head and neck in a choreographed movement. Time to presentation in the sports medicine clinic ranged from the day of injury to 3 months. Duration of symptoms ranged from less than 3 weeks to greater than 2 years at last documented follow-up appointment. It is concluded that dancers do suffer dance-related concussions that can result in severe symptoms, limitations in dance participation, and difficulty with activities of daily living. Future studies are needed to evaluate dancers' recognition of concussion symptoms and care-seeking behaviors. Additional work is also necessary to tailor existing guidelines for gradual, progressive, safe return to dance.

  15. Assessment, management and knowledge of sport-related concussion: systematic review.

    Science.gov (United States)

    King, Doug; Brughelli, Matt; Hume, Patria; Gissane, Conor

    2014-04-01

    Sport-related concussions are a subset of mild traumatic brain injuries and are a concern for many sporting activities worldwide. To review and update the literature in regard to the history, pathophysiology, recognition, assessment, management and knowledge of concussion. Searches of electronic literature databases were performed to identify studies published up until April 2013. 292 publications focussing on concussion met the inclusion criteria, and so they were quality rated and reviewed. Concussion is hard to recognize and diagnose. Initial sideline assessment via the Sports Concussion Assessment Tool 3 (SCAT3), Child-SCAT3 or King-Devick test should be undertaken to identify athletes with concussion as part of a continuum of assessment modalities and athlete management. Sports medicine practitioners should be cognisant of the definition, extent and nature of concussion, and should work with coaches, athletes and trainers to identify and manage concussions. The most common reason for variations in management of concussion is lack of awareness of-and confusion about-the many available published guidelines for concussion. Future research should focus on better systems and tools for recognition, assessment and management of concussion. Sport participants' knowledge of concussion should be evaluated more rigorously, with interventions for sports where there is little knowledge of recognition, assessment and appropriate management of concussion.

  16. Multiple Past Concussions in High School Football Players

    Science.gov (United States)

    Brooks, Brian L.; Mannix, Rebekah; Maxwell, Bruce; Zafonte, Ross; Berkner, Paul D.; Iverson, Grant L.

    2017-01-01

    Background There is increasing concern about the possible long-term effects of multiple concussions, particularly on the developing adolescent brain. Whether the effect of multiple concussions is detectable in high school football players has not been well studied, although the public health implications are great in this population. Purpose To determine if there are measureable differences in cognitive functioning or symptom reporting in high school football players with a history of multiple concussions. Study Design Cross-sectional study; Level of evidence, 3. Methods Participants included 5232 male adolescent football players (mean [±SD] age, 15.5 ± 1.2 years) who completed baseline testing between 2009 and 2014. On the basis of injury history, athletes were grouped into 0 (n = 4183), 1 (n = 733), 2 (n = 216), 3 (n = 67), or ≥4 (n = 33) prior concussions. Cognitive functioning was measured by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery, and symptom ratings were obtained from the Post-Concussion Symptom Scale. Results There were no statistically significant differences between groups (based on the number of reported concussions) regarding cognitive functioning. Athletes with ≥3 prior concussions reported more symptoms than did athletes with 0 or 1 prior injury. In multivariate analyses, concussion history was independently related to symptom reporting but less so than developmental problems (eg, attention or learning problems) or other health problems (eg, past treatment for psychiatric problems, headaches, or migraines). Conclusion In the largest study to date, high school football players with multiple past concussions performed the same on cognitive testing as those with no prior concussions. Concussion history was one of several factors that were independently related to symptom reporting. PMID:27474382

  17. A comparison in a youth population between those with and without a history of concussion using biomechanical reconstruction.

    Science.gov (United States)

    Post, Andrew; Hoshizaki, T Blaine; Gilchrist, Michael D; Koncan, David; Dawson, Lauren; Chen, Wesley; Ledoux, Andrée-Anne; Zemek, Roger

    2017-04-01

    OBJECTIVE Concussion is a common topic of research as a result of the short- and long-term effects it can have on the affected individual. Of particular interest is whether previous concussions can lead to a biomechanical susceptibility, or vulnerability, to incurring further head injuries, particularly for youth populations. The purpose of this research was to compare the impact biomechanics of a concussive event in terms of acceleration and brain strains of 2 groups of youths: those who had incurred a previous concussion and those who had not. It was hypothesized that the youths with a history of concussion would have lower-magnitude biomechanical impact measures than those who had never suffered a previous concussion. METHODS Youths who had suffered a concussion were recruited from emergency departments across Canada. This pool of patients was then separated into 2 categories based on their history of concussion: those who had incurred 1 or more previous concussions, and those who had never suffered a concussion. The impact event that resulted in the brain injury was reconstructed biomechanically using computational, physical, and finite element modeling techniques. The output of the events was measured in biomechanical parameters such as energy, force, acceleration, and brain tissue strain to determine if those patients who had a previous concussion sustained a brain injury at lower magnitudes than those who had no previously reported concussion. RESULTS The results demonstrated that there was no biomechanical variable that could distinguish between the concussion groups with a history of concussion versus no history of concussion. CONCLUSIONS The results suggest that there is no measureable biomechanical vulnerability to head impact related to a history of concussions in this youth population. This may be a reflection of the long time between the previous concussion and the one reconstructed in the laboratory, where such a long period has been associated with

  18. Vomiting as a reliable sign of concussion.

    Science.gov (United States)

    Ledic, Darko; Sosa, Ivan; Linic, Ines Strenja; Cvijanovic, Olga; Kovacevic, Miljenko; Desnica, Andrej; Banicek, Ivanka

    2012-01-01

    Concussion is the most common type of traumatic brain injury, with headache being the most frequent symptom of mild traumatic brain injury (MTBI) (including dizziness, vomiting, nausea, lack of motor coordination or difficulty balancing). Concussion may be caused by a blow to the head, or by acceleration forces without a direct impact. Often, MTBI occurs as the result of a sports injury. Loss of consciousness is always present, unlike vomiting. Therefore, we hypothesize vomiting to be considered as a cardinal sign of concussion. Stimulation of vomiting centres finally triggers vomiting. Professional boxers and mixed martial arts competitions reluctantly agree with stringent rules and protective clothing. We discuss the issue of further protection for those engaged in these and other sports. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. Cumulative effects of concussions in athletes revealed by electrophysiological abnormalities on visual working memory.

    Science.gov (United States)

    Theriault, Martin; De Beaumont, Louis; Tremblay, Sebastien; Lassonde, Maryse; Jolicoeur, Pierre

    2011-01-01

    Event-related potentials (ERPs) have been useful to detect subtle, pervasive alterations of cognition-related waveforms in athletes with multiple concussions. This study used the sustained posterior contralateral negativity (SPCN) waveform component recorded while participants performed a visual short-term memory task to investigate how working memory (WM) storage capacity was affected among athletes who differed according to their history of sports concussions. Fifty-five university-level football players were assigned to three groups: 1-2 concussion athletes; 3+ concussion athletes; non-concussed athletes. The main finding of the present study was that athletes with a history of three concussions or more exhibited significantly attenuated SPCN amplitude relative to both concussed athletes with only one or two prior concussions and athletes without concussions. The latter finding adds to previous evidence of disproportionately worse outcome in athletes presenting with a history of three or more concussions relative to those with fewer concussions. In addition, SPCN amplitude was found to correlate significantly with a visual memory capacity estimate (K), but this K value did not significantly differ across groups. This suggests that attenuated SPCN amplitude after three or more concussions did not interfere with apparent WM function. Taken together, these findings suggest that the altered neurophysiological index of WM storage might be a more sensitive measure of a latent WM function abnormality which may well worsen with aging, or perhaps additional brain insults.

  20. Brain Vulnerability to Repeated Blast Overpressure and Polytrauma

    Science.gov (United States)

    2013-11-01

    discrimination procedures were developed, refined and implemented to test visual acuity and visually based cognitive performance and reaction time. Telemetric...exposure: The shock tube consists of a 2.5 ft long compression chamber that is separated from a 15 ft long expansion chamber by polyester Mylar...single BOP (figs 8 & 9) or 2 BOPs separated by 24 hr (not shown), closely coupled repeated BOP exposure increased reaction times (fig 11

  1. Concussion Management in Schools: Issues and Implications

    Science.gov (United States)

    Canto, Angela I.; Pierson, Eric E.

    2015-01-01

    The school psychology literature base is lacking in information and resources for working with students with traumatic brain injuries, and concussions specifically. This special issue includes five articles from school psychology based researchers committed to increasing the awareness of the identification, assessment, and intervention for…

  2. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... and obey the rules of safety. B By working with parents, athletes, school and club administrators to spread awareness about concussions ... Sports Materials for Health Care Providers Materials for School ... about the Brain and How it Works Order Free Copies of CDC's “Heads Up” Educational ...

  3. Sport-related concussion and sensory function in young adults.

    Science.gov (United States)

    Moore, Robert D; Broglio, Steven P; Hillman, Charles H

    2014-01-01

    The long-term implications of concussive injuries for brain and cognitive health represent a growing concern in the public consciousness. As such, identifying measures sensitive to the subtle yet persistent effects of concussive injuries is warranted. To investigate how concussion sustained early in life influences visual processing in young adults. We predicted that young adults with a history of concussion would show decreased sensory processing, as noted by a reduction in P1 event-related potential component amplitude. Cross-sectional study. Research laboratory. Thirty-six adults (18 with a history of concussion, 18 controls) between the ages of 20 and 28 years completed a pattern-reversal visual evoked potential task while event-related potentials were recorded. The groups did not differ in any demographic variables (all P values > .05), yet those with a concussive history exhibited reduced P1 amplitude compared with the control participants (P = .05). These results suggest that concussion history has a negative effect on visual processing in young adults. Further, upper-level neurocognitive deficits associated with concussion may, in part, result from less efficient downstream sensory capture.

  4. Talking with young children about concussions: an exploratory study.

    Science.gov (United States)

    Kroshus, E; Gillard, D; Haarbauer-Krupa, J; Goldman, R E; Bickham, D S

    2017-09-01

    Concussion education for children early in their participation in organized sport may help shape lasting attitudes about concussion safety. However, existing programming and research focus on older ages. Qualitative interviews about concussions were conducted with twenty children between the ages of six and eight. Structural, descriptive and pattern coding were used to organize the transcribed interviews and identify emergent themes. Eighteen of the participants indicated that they had heard of the word concussion, with 12 describing the injury as related to the brain or head. The most frequently described mechanisms of injury were impacts to the head or falls, and symptoms tended to be somatic, such as generalized pain. The most frequently endorsed strategy to avoid sustaining a concussion was to 'follow the rules.' Multiple participants referenced parents as an informal source of information about concussions. While most participants demonstrated some awareness about concussions, there were clear knowledge gaps that can be addressed with developmentally appropriate concussion education programming. Consistent with their developmental stage, interventions targeted at children in this age range may be most successful if they use basic logic, concrete ideas, provide rules to be followed and engage parents in dissemination. © 2016 John Wiley & Sons Ltd.

  5. Sport-Related Concussions

    Science.gov (United States)

    Brady, Don; Brady, Flo

    2011-01-01

    Sport-related concussions (SRC) are not limited to specific age ranges, professional athletes, or gender. The primary focus of much of SRC research pertains to the assessment, management, and return to play (RTP) of the concussed athlete. This article highlights some major issues of SRC along with some controversies that presently exist within the…

  6. Post-Concussion Syndrome

    Science.gov (United States)

    ... if you're having problems with memory or problem-solving. There is no specific treatment for post-concussion ... for post-concussion syndrome if you have cognitive problems, as most of them ... or other techniques to work around memory deficits and attention skills. ...

  7. Sport-Related Concussions

    Science.gov (United States)

    Brady, Don; Brady, Flo

    2011-01-01

    Sport-related concussions (SRC) are not limited to specific age ranges, professional athletes, or gender. The primary focus of much of SRC research pertains to the assessment, management, and return to play (RTP) of the concussed athlete. This article highlights some major issues of SRC along with some controversies that presently exist within the…

  8. Concussions in Kids

    Science.gov (United States)

    ... Infofamilydoctor.org editorial staffMind/Body Connection: How Your Emotions Affect Your HealthJune 2017February 2004Mental Healthfamilydoctor.org editorial staff Home Prevention and Wellness Exercise and Fitness Sports Safety Concussions in Kids Concussions in Kids Share ...

  9. Defining a multimodal signature of remote sports concussions.

    Science.gov (United States)

    Tremblay, Sébastien; Iturria-Medina, Yasser; Mateos-Pérez, José María; Evans, Alan C; De Beaumont, Louis

    2017-08-01

    Sports-related concussions lead to persistent anomalies of the brain structure and function that interact with the effects of normal ageing. Although post-mortem investigations have proposed a bio-signature of remote concussions, there is still no clear in vivo signature. In the current study, we characterized white matter integrity in retired athletes with a history of remote concussions by conducting a full-brain, diffusion-based connectivity analysis. Next, we combined MRI diffusion markers with MR spectroscopic, MRI volumetric, neurobehavioral and genetic markers to identify a multidimensional in vivo signature of remote concussions. Machine learning classifiers trained to detect remote concussions using this signature achieved detection accuracies up to 90% (sensitivity: 93%, specificity: 87%). These automated classifiers identified white matter integrity as the hallmark of remote concussions and could provide, following further validation, a preliminary unbiased detection tool to help medical and legal experts rule out concussion history in patients presenting or complaining about late-life abnormal cognitive decline. © 2017 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

  10. Future directions in brain injury research.

    Science.gov (United States)

    Gennarelli, Thomas A

    2014-01-01

    This paper reviews the potential future directions that are important for brain injury research, especially with regard to concussion. The avenues of proposed research are categorized according to current concepts of concussion, types of concussion, and a global schema for globally reducing the burden of concussion.

  11. Sex-Related Differences in Emotion Recognition in Multi-concussed Athletes.

    Science.gov (United States)

    Léveillé, Edith; Guay, Samuel; Blais, Caroline; Scherzer, Peter; De Beaumont, Louis

    2017-01-01

    Concussion is defined as a complex pathophysiological process affecting the brain. Although the cumulative and long-term effects of multiple concussions are now well documented on cognitive and motor function, little is known about their effects on emotion recognition. Recent studies have suggested that concussion can result in emotional sequelae, particularly in females and multi-concussed athletes. The objective of this study was to investigate sex-related differences in emotion recognition in asymptomatic male and female multi-concussed athletes. We tested 28 control athletes (15 males) and 22 multi-concussed athletes (10 males) more than a year since the last concussion. Participants completed the Post-Concussion Symptom Scale, the Beck Depression Inventory-II, the Beck Anxiety Inventory, a neuropsychological test battery and a morphed emotion recognition task. Pictures of a male face expressing basic emotions (anger, disgust, fear, happiness, sadness, surprise) morphed with another emotion were randomly presented. After each face presentation, participants were asked to indicate the emotion expressed by the face. Results revealed significant sex by group interactions in accuracy and intensity threshold for negative emotions, together with significant main effects of emotion and group. Male concussed athletes were significantly impaired in recognizing negative emotions and needed more emotional intensity to correctly identify these emotions, compared to same-sex controls. In contrast, female concussed athletes performed similarly to same-sex controls. These findings suggest that sex significantly modulates concussion effects on emotional facial expression recognition. (JINS, 2017, 23, 65-77).

  12. Prolonged repeated acupuncture stimulation induces habituation effects in pain-related brain areas: an FMRI study.

    Science.gov (United States)

    Li, Chuanfu; Yang, Jun; Park, Kyungmo; Wu, Hongli; Hu, Sheng; Zhang, Wei; Bu, Junjie; Xu, Chunsheng; Qiu, Bensheng; Zhang, Xiaochu

    2014-01-01

    Most previous studies of brain responses to acupuncture were designed to investigate the acupuncture instant effect while the cumulative effect that should be more important in clinical practice has seldom been discussed. In this study, the neural basis of the acupuncture cumulative effect was analyzed. For this experiment, forty healthy volunteers were recruited, in which more than 40 minutes of repeated acupuncture stimulation was implemented at acupoint Zhusanli (ST36). Three runs of acupuncture fMRI datasets were acquired, with each run consisting of two blocks of acupuncture stimulation. Besides general linear model (GLM) analysis, the cumulative effects of acupuncture were analyzed with analysis of covariance (ANCOVA) to find the association between the brain response and the cumulative duration of acupuncture stimulation in each stimulation block. The experimental results showed that the brain response in the initial stage was the strongest although the brain response to acupuncture was time-variant. In particular, the brain areas that were activated in the first block and the brain areas that demonstrated cumulative effects in the course of repeated acupuncture stimulation overlapped in the pain-related areas, including the bilateral middle cingulate cortex, the bilateral paracentral lobule, the SII, and the right thalamus. Furthermore, the cumulative effects demonstrated bimodal characteristics, i.e. the brain response was positive at the beginning, and became negative at the end. It was suggested that the cumulative effect of repeated acupuncture stimulation was consistent with the characteristic of habituation effects. This finding may explain the neurophysiologic mechanism underlying acupuncture analgesia.

  13. Traumatic Brain Injury (TBI) Data and Statistics

    Science.gov (United States)

    ... The CDC Cancel Submit Search The CDC Traumatic Brain Injury & Concussion Note: Javascript is disabled or is not ... please visit this page: About CDC.gov . Traumatic Brain Injury & Concussion Basic Information Get the Facts Signs and ...

  14. Repetitive Concussions in Adolescent Athletes – Translating Clinical and Experimental Research into Perspectives on Rehabilitation Strategies

    Science.gov (United States)

    Semple, Bridgette D.; Lee, Sangmi; Sadjadi, Raha; Fritz, Nora; Carlson, Jaclyn; Griep, Carrie; Ho, Vanessa; Jang, Patrice; Lamb, Annick; Popolizio, Beth; Saini, Sonia; Bazarian, Jeffrey J.; Prins, Mayumi L.; Ferriero, Donna M.; Basso, D. Michele; Noble-Haeusslein, Linda J.

    2015-01-01

    Sports-related concussions are particularly common during adolescence, a time when even mild brain injuries may disrupt ongoing brain maturation and result in long-term complications. A recent focus on the consequences of repetitive concussions among professional athletes has prompted the development of several new experimental models in rodents, as well as the revision of guidelines for best management of sports concussions. Here, we consider the utility of rodent models to understand the functional consequences and pathobiology of concussions in the developing brain, identifying the unique behavioral and pathological signatures of concussive brain injuries. The impact of repetitive concussions on behavioral consequences and injury progression is also addressed. In particular, we focus on the epidemiological, clinical, and experimental evidence underlying current recommendations for physical and cognitive rest after concussion, and highlight key areas in which further research is needed. Lastly, we consider how best to promote recovery after injury, recognizing that optimally timed, activity-based rehabilitative strategies may hold promise for the adolescent athlete who has sustained single or repetitive concussions. The purpose of this review is to inform the clinical research community as it strives to develop and optimize evidence-based guidelines for the concussed adolescent, in terms of both acute and long-term management. PMID:25883586

  15. Repetitive concussions in adolescent athletes – translating clinical and experimental research into perspectives on rehabilitation strategies

    Directory of Open Access Journals (Sweden)

    Bridgette D Semple

    2015-04-01

    Full Text Available Sports-related concussions are particularly common during adolescence, a time when even mild brain injuries may disrupt ongoing brain maturation and result in long-term complications. A recent focus on the consequences of repetitive concussions amongst professional athletes has prompted the development of several new experimental models in rodents, as well as the revision of guidelines for best management of sports concussions. Here, we consider the utility of rodent models to understand the functional consequences and pathobiology of concussions in the developing brain, identifying the unique behavioral and pathological signatures of concussive brain injuries. The impact of repetitive concussions on behavioral consequences and injury progression is also addressed. In particular, we focus on the epidemiological, clinical and experimental evidence underlying current recommendations for physical and cognitive rest after concussion, and highlight key areas in which further research is needed. Lastly, we consider how best to promote recovery after injury, recognizing that optimally-timed, activity-based rehabilitative strategies may hold promise for the adolescent athlete who has sustained single or repetitive concussions. The purpose of this review is to inform the clinical research community as it strives to develop and optimize evidence-based guidelines for the concussed adolescent, in terms of both acute and long-term management.

  16. Repetitive concussions in adolescent athletes - translating clinical and experimental research into perspectives on rehabilitation strategies.

    Science.gov (United States)

    Semple, Bridgette D; Lee, Sangmi; Sadjadi, Raha; Fritz, Nora; Carlson, Jaclyn; Griep, Carrie; Ho, Vanessa; Jang, Patrice; Lamb, Annick; Popolizio, Beth; Saini, Sonia; Bazarian, Jeffrey J; Prins, Mayumi L; Ferriero, Donna M; Basso, D Michele; Noble-Haeusslein, Linda J

    2015-01-01

    Sports-related concussions are particularly common during adolescence, a time when even mild brain injuries may disrupt ongoing brain maturation and result in long-term complications. A recent focus on the consequences of repetitive concussions among professional athletes has prompted the development of several new experimental models in rodents, as well as the revision of guidelines for best management of sports concussions. Here, we consider the utility of rodent models to understand the functional consequences and pathobiology of concussions in the developing brain, identifying the unique behavioral and pathological signatures of concussive brain injuries. The impact of repetitive concussions on behavioral consequences and injury progression is also addressed. In particular, we focus on the epidemiological, clinical, and experimental evidence underlying current recommendations for physical and cognitive rest after concussion, and highlight key areas in which further research is needed. Lastly, we consider how best to promote recovery after injury, recognizing that optimally timed, activity-based rehabilitative strategies may hold promise for the adolescent athlete who has sustained single or repetitive concussions. The purpose of this review is to inform the clinical research community as it strives to develop and optimize evidence-based guidelines for the concussed adolescent, in terms of both acute and long-term management.

  17. Concussions in the National Football League: A Current Concepts Review.

    Science.gov (United States)

    Yengo-Kahn, Aaron M; Johnson, Daniel J; Zuckerman, Scott L; Solomon, Gary S

    2016-03-01

    Significant attention has been directed toward the immediate and long-term effects of sport-related concussions on athletes participating in contact sports, particularly football. The highest level of football, the National Football League (NFL), has received significant attention and criticism regarding player management and safety after mild traumatic brain injury (mTBI). Several review articles have reported data related to concussion in the NFL, but a succinct review and synthesis of data regarding NFL concussions is currently lacking. To (1) review systematically the published data regarding concussion in the NFL and assess limitations of the studies, (2) elucidate areas where further research is needed, and (3) identify methods to improve future investigations of concussion in the NFL. Systematic review of literature. English-language titles and abstracts published between 1900 and September 2014 were searched systematically across electronic databases, and a review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Peer-reviewed journal articles were included if they contained NFL concussion data with or without additional associated long-term effects. Reviews, editorials, letters to the editor, and comments were not included. Of the 344 records screened for review, 88 articles were assessed for eligibility. There were 31 studies that met the inclusion criteria and formed the basis of the evidence synthesis. Included in the current review were 8 case-control studies (Oxford Centre for Evidence-Based Medicine evidence level 3b), 6 descriptive epidemiological studies (level 4), 6 cross-sectional studies (level 4), 6 cohort studies (level 2b), and 5 case series (level 4). The study of concussions in the NFL has been limited by lack of recent empirical data, reliance on self-reported concussion history, and ascertainment bias of brains donated for autopsy studies. The scientific community

  18. Functional Status after Blast-Plus-Impact Complex Concussive Traumatic Brain Injury in Evacuated United States Military Personnel

    Science.gov (United States)

    2014-01-01

    vulnerability to PTSD and depression, blast-related hormonal abnormalities,51 and blast-related injuries to specific parts of the brain causing impaired emotional ...Homaifar, B.Y., Gutierrez, P.M., Staves, P.J., Harwood, J.E., Reeves , D., Adler, L.E., Ivins, B.J., Helmick, K., and Warden, D. (2010

  19. Psychometric properties of self-report concussion scales and checklists.

    Science.gov (United States)

    McLeod, Tamara C Valovich; Leach, Candace

    2012-01-01

    Alla S, Sullivan SJ, Hale L, McCrory P. Self-report scales/checklists for the measurement of concussion symptoms: a systematic review. Br J Sports Med. 2009;43 (suppl 1):i3-i12. Which self-report symptom scales or checklists are psychometrically sound for clinical use to assess sport-related concussion? Articles available in full text, published from the establishment of each database through December 2008, were identified from PubMed, Medline, CINAHL, Scopus, Web of Science, SPORTDiscus, PsycINFO, and AMED. Search terms included brain concussion, signs or symptoms, and athletic injuries, in combination with the AND Boolean operator, and were limited to studies published in English. The authors also hand searched the reference lists of retrieved articles. Additional searches of books, conference proceedings, theses, and Web sites of commercial scales were done to provide additional information about the psychometric properties and development for those scales when needed in articles meeting the inclusion criteria. Articles were included if they identified all the items on the scale and the article was either an original research report describing the use of scales in the evaluation of concussion symptoms or a review article that discussed the use or development of concussion symptom scales. Only articles published in English and available in full text were included. From each study, the following information was extracted by the primary author using a standardized protocol: study design, publication year, participant characteristics, reliability of the scale, and details of the scale or checklist, including name, number of items, time of measurement, format, mode of report, data analysis, scoring, and psychometric properties. A quality assessment of included studies was done using 16 items from the Downs and Black checklist1 and assessed reporting, internal validity, and external validity. The initial database search identified 421 articles. After 131 duplicate

  20. The Rise of Concussions in the Adolescent Population.

    Science.gov (United States)

    Zhang, Alan L; Sing, David C; Rugg, Caitlin M; Feeley, Brian T; Senter, Carlin

    2016-08-01

    Concussion injuries have been highlighted to the American public through media and research. While recent studies have shown increased traumatic brain injuries (TBIs) diagnosed in emergency departments across the United States, no studies have evaluated trends in concussion diagnoses across the general US population in various age groups. To evaluate the current incidence and trends in concussions diagnosed across varying age groups and health care settings in a large cross-sectional population. Descriptive epidemiological study. Administrative health records of 8,828,248 members of a large private-payer insurance group in the United States were queried. Patients diagnosed with concussion from years 2007 through 2014 were stratified by year of diagnosis, age group, sex, classification of concussion, and health care setting of diagnosis (eg, emergency department vs physician's office). Chi-square testing was used for statistical analysis. From a cohort of 8,828,248 patients, 43,884 patients were diagnosed with a concussion. Of these patients, 55% were male and over 32% were in the adolescent age group (10-19 years old). The highest incidence of concussion was seen in patients aged 15 to 19 years (16.5/1000 patients), followed by those aged 10 to 14 years (10.5/1000 patients), 20 to 24 years (5.2/1000 patients), and 5 to 9 years (3.5/1000 patients). Overall, there was a 60% increase in concussion incidence from 2007 to 2014. The largest increases were in the 10- to 14-year (143%) and 15- to 19-year (87%) age groups. Based on International Classification of Disease-9th Revision classification, 29% of concussions were associated with some form of loss of consciousness. Finally, 56% of concussions were diagnosed in the emergency department and 29% in a physician's office, with the remainder in urgent care clinics or inpatient settings. The incidence of concussion diagnosed in the general US population is increasing, driven largely by a substantial rise in the adolescent

  1. Parallel Human and Animal Models of Blast- and Concussion-Induced Tinnitus and Related Traumatic Brain Injury (TBI)

    Science.gov (United States)

    2013-01-01

    not be feasible without episodic representation to form a spatial environment map ( Eichenbaum , 1999). Moreover, current study is the first study to...and GABA(B) receptors in the regulation of the nucleus accumbens dopamine response to stress. Brain research. 1150, 62-8. Eichenbaum , H., 1999. The...and hyperactivity following cochlear damage. HearRes 147, 261-274. Sanderson, K.L., Raghupathi, R., Saatman, K.E., Martin , D., Miller, G., and

  2. Know the Signs of Concussion

    Science.gov (United States)

    ... news/fullstory_167572.html Know the Signs of Concussion This serious health threat affects kids as well ... 2, 2017 WEDNESDAY, Aug. 2, 2017 (HealthDay News) -- Concussions have been in the news a lot because ...

  3. Know the Facts: Understand Concussion

    Centers for Disease Control (CDC) Podcasts

    2010-03-17

    This podcast discusses concussions and provides information to help people better understand concussion.  Created: 3/17/2010 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 3/17/2010.

  4. Self-reported concussion history: impact of providing a definition of concussion

    Directory of Open Access Journals (Sweden)

    Robbins CA

    2014-05-01

    Full Text Available Clifford A Robbins,1 Daniel H Daneshvar,1,2 John D Picano,1,3 Brandon E Gavett,1,4 Christine M Baugh,1,2 David O Riley,1 Christopher J Nowinski,1,2,5 Ann C McKee,1,2,6–8 Robert C Cantu,1,5,9,10 Robert A Stern1,2,8,91Center for the Study of Traumatic Encephalopathy, 2Department of Neurology, Boston University School of Medicine, Boston, MA, USA; 3School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA; 4Department of Psychology, University of Colorado, Colorado Springs, CO, USA; 5Sports Legacy Institute, Waltham MA, USA; 6United States Department of Veterans Affairs, VA Boston Healthcare System, Boston, MA, USA; 7Department of Pathology, 8Alzheimer's Disease Center, 9Department of Neurosurgery, Boston University School of Medicine, Boston, MA, USA; 10Department of Neurosurgery, Emerson Hospital, Concord, MA, USABackground: In recent years, the understanding of concussion has evolved in the research and medical communities to include more subtle and transient symptoms. The accepted definition of concussion in these communities has reflected this change. However, it is unclear whether this shift is also reflected in the understanding of the athletic community.What is known about the subject: Self-reported concussion history is an inaccurate assessment of someone's lifetime exposure to concussive brain trauma. However, unfortunately, in many cases it is the only available tool.Hypothesis/purpose: We hypothesize that athletes' self-reported concussion histories will be significantly greater after reading them the current definition of concussion, relative to the reporting when no definition was provided. An increase from baseline to post-definition response will suggest that athletes are unaware of the currently accepted medical definition.Study design: Cross-sectional study of 472 current and former athletes.Methods: Investigators conducted structured telephone interviews with current and former athletes between January

  5. Concussions From Youth Football

    Science.gov (United States)

    Jacobson, Nathan A.; Buzas, David; Morawa, Lawrence G.

    2013-01-01

    Background: Youth football programs across the United States represent an at-risk population of approximately 3.5 million athletes for sports-related concussions. The frequency of concussions in this population is not known. Study Design: Descriptive epidemiology study. Methods: Over an 11-year span from January 2002 to December 2012, the authors reviewed the concussions sustained by athletes aged 5 to 13 years while playing football, as evaluated in emergency departments (EDs) in the United States and captured by the National Electronic Injury Surveillance System (NEISS) database of the US Consumer Product Safety Commission. Results: There were 2028 (national estimate, 49,185) young football players evaluated in NEISS EDs with concussion from 2002 to 2012. There were 1987 (97.9%) males and 41 (2.1%) females, with a mean age of 11.2 years. The total number of concussions reported increased with age and by year. The majority of concussions were treated in the outpatient setting, with 1878 (91.7%) being treated and released. The total number of head-to-head injury mechanisms mirrored the total number of concussions by year, which increased throughout the 11-year span. The total number of players experiencing a loss of consciousness increased throughout the study period but did not match the total number of concussions over the 11-year time period. Fractures occurred in 11 (0.5%) patients, with 2 being severe (1 skull fracture and 1 thoracic compression fracture). Conclusion: Within the 5- to 13-year age range, there were a significant number of young athletes who presented to EDs with concussion as a result of playing organized football. Older children may be at greater risk for sustaining concussions, fractures, and catastrophic injuries while playing football when compared with younger children. Clinical Relevance: Younger children are more susceptible to long-term sequelae from head injuries, and thus, improved monitoring systems for these athletes are needed to

  6. Concussion Frequency Associates with Musculoskeletal Injury in Retired NFL Players.

    Science.gov (United States)

    Pietrosimone, Brian; Golightly, Yvonne M; Mihalik, Jason P; Guskiewicz, Kevin M

    2015-11-01

    Concussion is commonly associated with immediate and persistent alterations in motor function affecting postural control and gait. Patients with lower extremity joint injury have demonstrated functional alterations in the cerebral cortex, suggesting that musculoskeletal injury may be linked to alterations in brain function. Therefore, we examined the associations between concussion frequency and lower extremity musculoskeletal injury sustained during professional careers of National Football League (NFL) players in a cross-sectional study. An inclusive health history survey was mailed to 3647 NFL players who retired during 1930-2001. Respondents reported total concussion frequency (zero, one, two, or three or more) and presence (yes/no) of specific knee and ankle musculoskeletal injury during their NFL career. Separate logistic regression models were used to estimate associations between concussion frequency and each musculoskeletal injury type, adjusting for number of years played in the NFL, body mass index while playing in the NFL, and playing position. Data from 2429 players (66.6% response rate) were available for analysis. Nearly 61% reported experiencing a concussion while competing in the NFL. Meniscal tear was the most commonly reported musculoskeletal injury (32%). Compared with NFL players who did not sustain a concussion, retired NFL players with one, two, or three or more concussions had between 18% and 63%, 15% and 126%, and 73% and 165% higher odds of reporting various musculoskeletal injuries, respectively. A history of concussions was associated with a history of musculoskeletal injuries during NFL careers. These data suggest that a higher number of concussions is linked with higher odds of reporting a musculoskeletal injury.

  7. Prolonged repeated acupuncture stimulation induces habituation effects in pain-related brain areas: an FMRI study.

    Directory of Open Access Journals (Sweden)

    Chuanfu Li

    Full Text Available Most previous studies of brain responses to acupuncture were designed to investigate the acupuncture instant effect while the cumulative effect that should be more important in clinical practice has seldom been discussed. In this study, the neural basis of the acupuncture cumulative effect was analyzed. For this experiment, forty healthy volunteers were recruited, in which more than 40 minutes of repeated acupuncture stimulation was implemented at acupoint Zhusanli (ST36. Three runs of acupuncture fMRI datasets were acquired, with each run consisting of two blocks of acupuncture stimulation. Besides general linear model (GLM analysis, the cumulative effects of acupuncture were analyzed with analysis of covariance (ANCOVA to find the association between the brain response and the cumulative duration of acupuncture stimulation in each stimulation block. The experimental results showed that the brain response in the initial stage was the strongest although the brain response to acupuncture was time-variant. In particular, the brain areas that were activated in the first block and the brain areas that demonstrated cumulative effects in the course of repeated acupuncture stimulation overlapped in the pain-related areas, including the bilateral middle cingulate cortex, the bilateral paracentral lobule, the SII, and the right thalamus. Furthermore, the cumulative effects demonstrated bimodal characteristics, i.e. the brain response was positive at the beginning, and became negative at the end. It was suggested that the cumulative effect of repeated acupuncture stimulation was consistent with the characteristic of habituation effects. This finding may explain the neurophysiologic mechanism underlying acupuncture analgesia.

  8. No neurochemical evidence of brain injury after blast overpressure by repeated explosions or firing heavy weapons.

    Science.gov (United States)

    Blennow, K; Jonsson, M; Andreasen, N; Rosengren, L; Wallin, A; Hellström, P A; Zetterberg, H

    2011-04-01

    Psychiatric and neurological symptoms are common among soldiers exposed to blast without suffering a direct head injury. It is not known whether such symptoms are direct consequences of blast overpressure. To examine if repeated detonating explosions or firing if of heavy weapons is associated with neurochemical evidence of brain damage. Three controlled experimental studies. In the first, army officers were exposed to repeated firing of a FH77B howitzer or a bazooka. Cerebrospinal fluid (CSF) was taken post-exposure to measure biomarkers for brain damage. In the second, officers were exposed for up to 150 blasts by firing a bazooka, and in the third to 100 charges of detonating explosives of 180 dB. Serial serum samples were taken after exposure. Results were compared with a control group consisting of 19 unexposed age-matched healthy volunteers. The CSF biomarkers for neuronal/axonal damage (tau and neurofilament protein), glial cell injury (GFAP and S-100b), blood-brain barrier damage (CSF/serum albumin ratio) and hemorrhages (hemoglobin and bilirubin) and the serum GFAP and S-100b showed normal and stable levels in all exposed officers. Repeated exposure to high-impact blast does not result in any neurochemical evidence of brain damage. These findings are of importance for soldiers regularly exposed to high-impact blast when firing artillery shells or other types of heavy weapons. © 2010 John Wiley & Sons A/S.

  9. Relationship between CAG repeat length and brain volume in premanifest and early Huntington's disease.

    Science.gov (United States)

    Henley, Susie M D; Wild, Edward J; Hobbs, Nicola Z; Scahill, Rachael I; Ridgway, Gerard R; Macmanus, David G; Barker, Roger A; Fox, Nick C; Tabrizi, Sarah J

    2009-02-01

    Huntington's disease (HD) is caused by an expanded CAG repeat on the gene encoding for the protein huntingtin. There are conflicting findings about the extent to which repeat length predicts signs of the disease or severity of disease progression in adults. This study examined the relationship between CAG repeat length and brain volume in a large cohort of pre- and post-motor onset HD gene carriers, using voxel-based morphometry (VBM), an approach which allowed us to investigate the whole brain without defining a priori regions of interest. We also used VBM to examine group differences between 20 controls, 21 premanifest, and 40 early HD subjects. In the 61 mutation-positive subjects higher CAG repeat length was significantly associated with reduced volume of the body of the caudate nucleus bilaterally, left putamen, right insula, right parahippocampal gyrus, right anterior cingulate, and right occipital lobe, after correcting for age. The group contrasts showed significant reduction in grey matter volume in the early HD group relative to controls in widespread cortical as well as subcortical areas but there was no evidence of difference between controls and premanifest subjects. Overall we have demonstrated that increased CAG repeat length is associated with atrophy in extra-striatal as well as striatal regions, which has implications for the monitoring of disease-modifying therapies in the condition.

  10. Heart Rate Variability Interventions for Concussion and Rehabilitation

    Directory of Open Access Journals (Sweden)

    Robert Lake Conder

    2014-08-01

    Full Text Available The study of Heart Rate Variability (HRV has emerged as an essential component of cardiovascular health, as well as a physiological mechanism by which one can increase the interactive communication between the cardiac and the neurocognitive systems (i.e., the body and the brain. It is well-established that lack of heart rate variability implies cardiopathology, morbidity, reduced quality-of-life, and precipitous mortality. On the positive, optimal heart rate variability has been associated with good cardiovascular health, autonomic nervous system (ANS control, emotional regulation, and enhanced neurocognitive processing. In addition to health benefits, optimal HRV has been shown to improve neurocognitive performance by enhancing focus, visual acuity and readiness, and by promoting emotional regulation needed for peak performance. In concussed athletes and soldiers, concussions not only alter brain connectivity, but also alter cardiac functioning and impair cardiovascular performance upon exertion. Altered sympathetic and parasympathetic balance in the ANS has been postulated as a critical factor in refractory Post Concussive Syndrome (PCS. This article will review both the pathological aspects of reduced heart rate variability on athletic performance, as well as the cardiovascular and cerebrovascular components of concussion and PCS. Additionally, this article will review interventions with HRV biofeedback (HRV BFB training as a promising and underutilized treatment for sports and military-related concussion. Finally, this article will review research and promising case studies pertaining to use of HRV BFB for enhancement of cognition and performance, with applicability to concussion rehabilitation.

  11. Heart rate variability interventions for concussion and rehabilitation.

    Science.gov (United States)

    Conder, Robert L; Conder, Alanna A

    2014-01-01

    The study of heart rate variability (HRV) has emerged as an essential component of cardiovascular health, as well as a physiological mechanism by which one can increase the interactive communication between the cardiac and the neurocognitive systems (i.e., the body and the brain). It is well-established that lack of HRV implies cardiopathology, morbidity, reduced quality-of-life, and precipitous mortality. On the positive, optimal HRV has been associated with good cardiovascular health, autonomic nervous system (ANS) control, emotional regulation, and enhanced neurocognitive processing. In addition to health benefits, optimal HRV has been shown to improve neurocognitive performance by enhancing focus, visual acuity and readiness, and by promoting emotional regulation needed for peak performance. In concussed athletes and soldiers, concussions not only alter brain connectivity, but also alter cardiac functioning and impair cardiovascular performance upon exertion. Altered sympathetic and parasympathetic balance in the ANS has been postulated as a critical factor in refractory post concussive syndrome (PCS). This article will review both the pathological aspects of reduced HRV on athletic performance, as well as the cardiovascular and cerebrovascular components of concussion and PCS. Additionally, this article will review interventions with HRV biofeedback (HRV BFB) training as a promising and underutilized treatment for sports and military-related concussion. Finally, this article will review research and promising case studies pertaining to use of HRV BFB for enhancement of cognition and performance, with applicability to concussion rehabilitation.

  12. Primary malignant melanoma of the vagina with repeated local recurrences and brain metastasis

    Directory of Open Access Journals (Sweden)

    Li-Te Lin

    2011-08-01

    Full Text Available Malignant melanoma of the vagina, a very rare malignancy, has a notoriously aggressive behavior associated with a high risk of local recurrence and distant metastasis. At present, there are various treatment options for this disease but no standard guideline. We describe a case of a 54-year-old woman with a locally advanced melanoma of the vagina, who underwent radical surgery, biochemotherapy with interferon-α-2b, chemotherapy, radiotherapy, and repeat excision of local recurrent lesions and brain metastasis. In conclusion, malignant melanoma of the vagina has a high risk for local recurrence. Repeated local excision followed by biochemotherapy is a tolerable treatment.

  13. The effects of performing the YMCA Bike protocol on general brain function in athletes with and without mild traumatic brain injury

    Science.gov (United States)

    Gay, Michael

    Research into concussion or mild traumatic brain injury (mTBI) has increased significantly within the past decade. In the literature some researchers are reporting 1.6 to 3.8 million concussions occurring in sports (Langlois, 2006), mTBI accounts for 80% of all reported traumatic brain injuries (Ruff, 2011). With these alarming statistics and an increasing number of athletes suffering a concussion there has been an increased emphasis for sports medicine practitioners to properly diagnose and treat those recovering from brain injury so that they may return safely to school, sports or work. Current clinical tools available to practitioners give them the ability to assess functional recovery in clinical measures of personality change; patient self reported symptom scales; functional cognitive domains (computer based neuropsychological batteries) and clinical balance measures. These current methods of clinical measurement, diagnosis and return to play protocols have remained largely unchanged for the past 20 years. In addition, there is some controversy into the application of these clinical measures within repeated measure testing as improvement does not necessarily reflect post-traumatic recovery but may instead reflect practice or "ceiling effects" of measurement. Therefore, diagnostic platforms that measure structural physiologic recovery must be implemented to assist the clinician in the 'Return to Play' process for athletic participation. In this study quantitative EEG (qEEG) analysis using a 128-lead dense array system during the first aerobic challenge in a 'Return to Play' protocol was performed. Subjects recovering from concussion and normal volunteers with no history of concussion were included and their neuroelectric activity recorded before, during, after and 24 hours post light aerobic exercise on a stationary bike. Subjects recovering from concussion demonstrated altered spectral absolute power across relevant regions of interest in the frontal, central

  14. Wireless nanosensors for monitoring concussion of football players

    Science.gov (United States)

    Ramasamy, Mouli; Harbaugh, Robert E.; Varadan, Vijay K.

    2015-04-01

    Football players are more to violent impacts and injuries more than any athlete in any other sport. Concussion or mild traumatic brain injuries were one of the lesser known sports injuries until the last decade. With the advent of modern technologies in medical and engineering disciplines, people are now more aware of concussion detection and prevention. These concussions are often overlooked by football players themselves. The cumulative effect of these mild traumatic brain injuries can cause long-term residual brain dysfunctions. The principle of concussion is based the movement of the brain in the neurocranium and viscerocranium. The brain is encapsulated by the cerebrospinal fluid which acts as a protective layer for the brain. This fluid can protect the brain against minor movements, however, any rapid movements of the brain may mitigate the protective capability of the cerebrospinal fluid. In this paper, we propose a wireless health monitoring helmet that addresses the concerns of the current monitoring methods - it is non-invasive for a football player as helmet is not an additional gear, it is efficient in performance as it is equipped with EEG nanosensors and 3D accelerometer, it does not restrict the movement of the user as it wirelessly communicates to the remote monitoring station, requirement of individual monitoring stations are not required for each player as the ZigBee protocol can couple multiple transmitters with one receiver. A helmet was developed and validated according to the above mentioned parameters.

  15. Repeated Administration of Mercury Intensifies Brain Damage in Multiple Sclerosis through Mitochondrial Dysfunction

    Science.gov (United States)

    Kahrizi, Farzad; Salimi, Ahmad; Noorbakhsh, Farshid; Faizi, Mehrdad; Mehri, Freshteh; Naserzadeh, Parvaneh; Naderi, Nima; Pourahmad, Jalal

    2016-01-01

    In this study we investigated the additive effect of mercury on the brain mitochondrial dysfunction in experimental autoimmune encephalomyelitis (EAE) model. Experimental animals (female C57BL/6 mice) are divided into four groups (n = 8); control, Hg, EAE, EAE with Hg. EAE model of MS induced by injecting myelin oligodendrocyte glycoprotein (MOG). Neurobehavioral alterations are recorded and then mice were sacrificed at day 28 and brain mitochondria were isolated and mitochondrial toxicity parameters including mitochondrial swelling, reactive oxygen species (ROS) formation, collapse of mitochondrial membrane potential (MMP) and cytochrome c release were measured. Our results showed that repeated treatment of mercury following induction of EAE in mice significantly increased the neurobehavioral scores, as well as mitochondrial toxicity through ROS formation, mitochondrial swelling, collapse of MMP and cytochrome c release. Our findings proved that repeated exposure with mercury accelerates progression of MS through mitochondrial damage related to oxidative stress and finally apoptosis.

  16. More Years Playing Football, Greater Risk of Brain Disease

    Science.gov (United States)

    ... and Human Services. More Health News on: Concussion Sports Injuries Traumatic Brain Injury Recent Health News Related MedlinePlus Health Topics Concussion Sports Injuries Traumatic Brain Injury About MedlinePlus Site Map FAQs Customer Support ...

  17. Magnetoencephalography in the diagnosis of concussion.

    Science.gov (United States)

    Lee, Roland R; Huang, Mingxiong

    2014-01-01

    Magnetoencephalography (MEG) is a biomedical technique which measures the magnetic fields emitted by the brain, generated by neuronal activity. Commercial whole-head MEG units have been available for about 15 years, but currently there are only about 20 such units operating in the USA. Here, we review the basic concepts of MEG and list some of the usual clinical indications: noninvasive localization of epileptic spikes and presurgical mapping of eloquent cortex. We then discuss using MEG to diagnose mild traumatic brain injury (mTBI; concussions). Injured brain tissues in TBI patients generate abnormal low-frequency magnetic activity (delta-waves: 1-4 Hz) that can be measured and localized by MEG. These abnormal delta-waves originate from neurons that experience deafferentation from axonal injury to the associated white matter fiber tracts, also manifested on diffusion tensor imaging as reduced fractional anisotropy. Magnetoencephalographic evaluation of abnormal delta-waves (1-4 Hz) is probably the most sensitive objective test to diagnose concussions. An automated MEG low-frequency (slow wave) source imaging method, frequency-domain vector-based spatiotemporal analysis using a L1-minimum norm (VESTAL), achieved a positive finding rate of 87% for diagnosing concussions (blast-induced plus nonblast), 100% for moderate TBI, and no false-positive diagnoses in normal controls. There were also significant correlations between the number of cortical regions generating abnormal slow waves and the total postconcussive symptom scores in TBI patients.

  18. The effects of fatigue and the post-concussion syndrome on executive functioning in traumatic brain injury and healthy comparisons

    Directory of Open Access Journals (Sweden)

    Enid Schutte

    2010-03-01

    Full Text Available In this study, behavioural manifestations of compromised executive control, including perseveration and reduced inductive reasoning, on the Wisconsin Card Sorting Test (WCST were investigated.Performance was affected by fatigue in both a head-injured and matched population, which has implications for health care professionals involved in rehabilitation and assessment. A fatigue condition was manipulated for 15 moderate to severe traumatic brain injury (TBI individuals through the course of a three-hour neuropsychological testing session. A comparison sample of 15 participants in a group of ‘no history of TBI’ was fatigued through the same approach. All fatigued participants (with and without TBI displayed trends towards increased levels of perseveration and reduced inductive reasoning on the WCST. Thus, the effects of fatigue on high-level functioning are pervasive even when not head-injured. This finding supports the sub-optimal performance in cognitive skills, specifically in executive control, that is often found in fatigued people. These findings are relevant for the manner in which rehabilitation interventions and medico-legal assessments are structured. Importantly, the order of tests, their interpretation and rest sessions should be clearly indicated and interpreted in assessment reports and rehabilitation sessions.

    Opsomming

    In hierdie studie is gedragsmanifestering in individue met gekompromitteerde uitvoerende funksionering, met inbegrip van perseverasie en verminderde induktiewe redenering, op die Wisconsin-kaartsorteringstoets (WCST, bestudeer. Die waarneming dat prestasie deur uitputting beïnvloed word in sowel normale populasies as dié met kopbeserings het implikasies vir gesondheidsorgpersoneel wat by rehabilitasie en assessering betrokke is. ’n Uitputtingstoestand is gemanipuleer vir 15 matig ernstige individue met traumatiese kopbeserings (TKB vir die duur van ’n drie uur lange toetssessie.

  19. Thermal stability of chicken brain {alpha}-spectrin repeat 17: a spectroscopic study

    Energy Technology Data Exchange (ETDEWEB)

    Brenner, Annette K. [University of Bergen, Department of Chemistry (Norway); Kieffer, Bruno [Ecole Superieure de Biotechnologie de Strasbourg, IGBMC Biomolecular NMR Group, CNRS UMR 7104 (France); Trave, Gilles [Ecole Superieure de Biotechnologie de Strasbourg, Equipe Oncoproteines, IREBS, UMR 7242 (France); Froystein, Nils Age [University of Bergen, Department of Chemistry (Norway); Raae, Arnt J., E-mail: arnt.raae@mbi.uib.no [University of Bergen, Department of Molecular Biology (Norway)

    2012-06-15

    Spectrin is a rod-like multi-modular protein that is mainly composed of triple-helical repeats. These repeats show very similar 3D-structures but variable conformational and thermodynamical stabilities, which may be of great importance for the flexibility and dynamic behaviour of spectrin in the cell. For instance, repeat 17 (R17) of the chicken brain spectrin {alpha}-chain is four times less stable than neighbouring repeat 16 (R16) in terms of Increment G. The structure of spectrin repeats has mainly been investigated by X-ray crystallography, but the structures of a few repeats, e.g. R16, have also been determined by NMR spectroscopy. Here, we undertook a detailed characterization of the neighbouring R17 by NMR spectroscopy. We assigned most backbone resonances and observed NOE restraints, relaxation values and coupling constants that all indicated that the fold of R17 is highly similar to that of R16, in agreement with previous X-ray analysis of a tandem repeat of the two domains. However, {sup 15}N heteronuclear NMR spectra measured at different temperatures revealed particular features of the R17 domain that might contribute to its lower stability. Conformational exchange appeared to alter the linker connecting R17 to R16 as well as the BC-loop in close proximity. In addition, heat-induced splitting was observed for backbone resonances of a few spatially related residues including V99 of helix C, which in R16 is replaced by the larger hydrophobic tryptophan residue that is relatively conserved among other spectrin repeats. These data support the view that the substitution of tryptophan by valine at this position may contribute to the lower stability of R17.

  20. Repeated verum but not placebo acupuncture normalizes connectivity in brain regions dysregulated in chronic pain.

    Science.gov (United States)

    Egorova, Natalia; Gollub, Randy L; Kong, Jian

    2015-01-01

    Acupuncture, an ancient East Asian therapy, is aimed at rectifying the imbalance within the body caused by disease. Studies evaluating the efficacy of acupuncture with neuroimaging tend to concentrate on brain regions within the pain matrix, associated with acute pain. We, however, focused on the effect of repeated acupuncture treatment specifically on brain regions known to support functions dysregulated in chronic pain disorders. Transition to chronic pain is associated with increased attention to pain, emotional rumination, nociceptive memory and avoidance learning, resulting in brain connectivity changes, specifically affecting the periaqueductal gray (PAG), medial frontal cortex (MFC) and bilateral hippocampus (Hpc). We demonstrate that the PAG-MFC and PAG-Hpc connectivity in patients with chronic pain due to knee osteoarthritis indeed correlates with clinical severity scores and further show that verum acupuncture-induced improvement in pain scores (compared to sham) is related to the modulation of PAG-MFC and PAG-Hpc connectivity in the predicted direction. This study shows that repeated verum acupuncture might act by restoring the balance in the connectivity of the key pain brain regions, altering pain-related attention and memory.

  1. Repeated verum but not placebo acupuncture normalizes connectivity in brain regions dysregulated in chronic pain

    Directory of Open Access Journals (Sweden)

    Natalia Egorova

    2015-01-01

    Full Text Available Acupuncture, an ancient East Asian therapy, is aimed at rectifying the imbalance within the body caused by disease. Studies evaluating the efficacy of acupuncture with neuroimaging tend to concentrate on brain regions within the pain matrix, associated with acute pain. We, however, focused on the effect of repeated acupuncture treatment specifically on brain regions known to support functions dysregulated in chronic pain disorders. Transition to chronic pain is associated with increased attention to pain, emotional rumination, nociceptive memory and avoidance learning, resulting in brain connectivity changes, specifically affecting the periaqueductal gray (PAG, medial frontal cortex (MFC and bilateral hippocampus (Hpc. We demonstrate that the PAG–MFC and PAG–Hpc connectivity in patients with chronic pain due to knee osteoarthritis indeed correlates with clinical severity scores and further show that verum acupuncture-induced improvement in pain scores (compared to sham is related to the modulation of PAG–MFC and PAG–Hpc connectivity in the predicted direction. This study shows that repeated verum acupuncture might act by restoring the balance in the connectivity of the key pain brain regions, altering pain-related attention and memory.

  2. Treatment of bacterial brain abscess by repeated aspiration. Follow up by serial computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Masaaki; Fukushima, Takeo; Hirakawa, Katsuyuki; Kimura, Hideo; Tomonaga, Masamichi [Fukuoka Univ. (Japan). School of Medicine

    2000-02-01

    Bacterial brain abscess often requires repeated aspiration before the abscess finally resolves. However, there are no guidelines for treatment by aspiration; for example, when should the abscess be tapped again, or when can an abscess be treated by antibiotics alone without further aspiration. Eleven patients with bacterial brain abscess treated by aspiration were evaluated to establish treatment guidelines for brain abscess, in particular the abscess size on serial computed tomography (CT) after aspiration. CT was performed about 24 hours after aspiration to evaluate the size of the abscess, and almost weekly during follow up. The diameter of the brain abscess before and after the initial and last aspirations were reviewed. In eight of the 11 patients, abscesses were aspirated repeatedly: two to three times in most patients. The diameter of the abscesses was 2.5-4.5 cm (mean 3.5 cm) before the last aspiration, and 1.4-3.4 cm (mean 2.3 cm) after the last aspiration, or when continuous drainage was discontinued. Perifocal edema was moderately decreased within 3 weeks after the last aspiration by medical treatment alone, with a concomitant decrease in the volume of the abscess. There were no deaths, and most patients had a favorable outcome. These results suggest that after the diameter of the abscess becomes less than 2 to 3 cm and does not increase anymore on serial CT, medical treatment alone can be anticipated to give satisfactory results without further aspiration. (author)

  3. Progressive Return to Activity Following Acute Concussion/Mild Traumatic Brain Injury: Guidance for the Primary Care Manager in Deployed and Non-deployed Settings

    Science.gov (United States)

    2014-01-01

    through the stepwise progression of activity.10 Symptoms such as fatigue or headache are rarely completely absent, especially following exertion even...described as “activities that make your heart race” on the “Return to Activity Educational Brochure.” When headache , sleep difficulties or vestibular or...of ‘Return-to-Learn’ in Pediatric and Adolescent Concussion. Pediatric Annals, 41(9), 1-6. 27. Adams, R., Larson, M., Corrigan, J., Horgan, C

  4. Progressive Return to Activity Following Acute Concussion/Mild Traumatic Brain Injury: Guidance for the Rehabilitation Provider in Deployed and Non-deployed Settings

    Science.gov (United States)

    2014-01-01

    rest although total bed rest not recommended Sleep as desired Abstain from alcohol Avoid caffeine and nicotine Avoid breath holding RPE Scale...After Concussion sheets available at dvbic.dcoe.mil. Additional patient guidance to abstain from alcohol and to avoid substances such as caffeine and...than 100; resting BP not to exceed 140/90 Limited lifting of light objects; avoid repetitive lifting Encourage healthy sleep habits Maximum 30

  5. Repeat Whole Brain Radiation Therapy with a Simultaneous Infield Boost: A Novel Technique for Reirradiation

    Directory of Open Access Journals (Sweden)

    William A. Hall

    2014-01-01

    Full Text Available The treatment of patients who experience intracranial progression after whole brain radiation therapy (WBRT is a clinical challenge. Novel radiation therapy delivery technologies are being applied with the objective of improving tumor and symptom control in these patients. The purpose of this study is to describe the clinical outcomes of the application of a novel technology to deliver repeat WBRT with volume modulated arc therapy (VMAT and a simultaneous infield boost (WB-SIB to gross disease. A total of 16 patients were initially treated with WBRT between 2000 and 2008 and then experienced intracranial progression, were treated using repeat WB-SIB, and were analyzed. The median dose for the first course of WBRT was 35 Gy (range: 30–50.4 Gy. Median time between the initial course of WBRT and repeat WB-SIB was 11.3 months. The median dose at reirradiation was 20 Gy to the whole brain with a median boost dose of 30 Gy to gross disease. A total of 2 patients demonstrated radiographic disease progression after treatment. The median overall survival (OS time from initial diagnosis of brain metastases was 18.9 months (range: 7.1–66.6 (95% CI: 0.8–36.9. The median OS time after initiation of reirradiation for all patients was 2.7 months (range: 0.46–14.46 (95% CI: 1.3–8.7. Only 3 patients experienced CTCAE grade 3 fatigue. No other patients experienced any ≥ CTCAE grade 3 toxicity. This analysis reports the result of a novel RT delivery technique for the treatment of patients with recurrent brain metastases. Side effects were manageable and comparable to other conventional repeat WBRT series. Repeat WB-SIB using the VMAT RT delivery technology is feasible and appears to have acceptable short-term acute toxicity. These results may provide a foundation for further exploration of the WB-SIB technique for repeat WBRT in future prospective clinical trials.

  6. A systematic review and meta-analysis of concussion in rugby union.

    Science.gov (United States)

    Gardner, Andrew J; Iverson, Grant L; Williams, W Huw; Baker, Stephanie; Stanwell, Peter

    2014-12-01

    Rugby Union, a popular full-contact sport played throughout the world, has one of the highest rates of concussion of all full-contact sports. The aim of the current review was to systematically evaluate the available evidence on concussion in Rugby Union and to conduct a meta-analysis of findings regarding the incidence of concussion. Articles were retrieved via a number of online databases. The current review examined all articles published in English up to May 2014 pertaining to concussion in Rugby Union players. The key search terms included 'Rugby Union', 'rugby', 'union', and 'football', in combination with the injury terms 'athletic injuries', 'concussion', 'sports concussion', 'sports-related concussion', 'brain concussion', 'brain injury', 'brain injuries', 'mild traumatic brain injury', 'mTBI', 'traumatic brain injury', 'TBI', 'craniocerebral trauma', 'head injury', and 'brain damage'. The final search outcome following the eligibility screening process resulted in the inclusion of 96 articles for this review. The meta-analysis included a total of 37 studies. The results of the meta-analysis revealed an overall incidence of match-play concussion in men's rugby-15s of 4.73 per 1,000 player match hours. The incidence of concussion during training was 0.07 per 1,000 practice hours. The incidence of concussion in women's rugby-15s was 0.55 per 1,000 player match hours. In men's rugby-7s match-play, concussion incidence was 3.01 per 1,000 player match hours. The incidence of concussion varied considerably between levels of play, with elite level play recording a rate of 0.40 concussions per 1,000 player match hours, schoolboy level 0.62 concussions per 1,000 player match hours, and the community or sub-elite level recording a rate of 2.08 concussions per 1,000 player match hours. The incidence of concussion in men's rugby-15s as a function of playing position (forwards vs. backs) was 4.02 and 4.85 concussions per 1,000 player match hours, respectively

  7. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... 2 Which of the following is true? A Most concussions occur without loss of consciousness. B Athletes ... QUIZ QUESTION 3 Concussions affect people differently. While most athletes with a concussion recover quickly and fully, ...

  8. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... To Concussions Getting Back In The Game Concussion Prevention Resource Center Menu Button Return To Training Downloadable ... concussion than adults and they take longer to recover than adults. D All of the above. Submit ...

  9. Long-Term Cognitive and Neuropsychiatric Consequences of Repetitive Concussion and Head-Impact Exposure.

    Science.gov (United States)

    McAllister, Thomas; McCrea, Michael

    2017-03-01

    Initially, interest in sport-related concussion arose from the premise that the study of athletes engaged in sports associated with high rates of concussion could provide insight into the mechanisms, phenomenology, and recovery from mild traumatic brain injury. Over the last decade, concerns have focused on the possibility that, for some athletes, repetitive concussions may raise the long-term risk for cognitive decline, neurobehavioral changes, and neurodegenerative disease. First conceptualized as a discrete event with variable recovery trajectories, concussion is now viewed by some as a trigger of neurobiological events that may influence neurobehavioral function over the course of the life span. Furthermore, advances in technology now permit us to gain a detailed understanding of the frequency and intensity of repetitive head impacts associated with contact sports (eg, football, ice hockey). Helmet-based sensors can be used to characterize the kinematic features of concussive impacts, as well as the profiles of typical head-impact exposures experienced by athletes in routine sport participation. Many large-magnitude impacts are not associated with diagnosed concussions, whereas many diagnosed concussions are associated with more modest impacts. Therefore, a full understanding of this topic requires attention to not only the effects of repetitive concussions but also overall exposure to repetitive head impacts. This article is a review of the current state of the science on the long-term neurocognitive and neurobehavioral effects of repetitive concussion and head-impact exposure in contact sports.

  10. Differentiating Concussion From Intracranial Pathology in Athletes.

    Science.gov (United States)

    Cripps, Andrea; Livingston, Scott C

    2017-01-01

    Clinical Scenario: A cerebral concussion is a traumatically induced transient disturbance of brain function characterized by a complex pathophysiologic process and is classified as a subset of mild traumatic brain injury. The occurrence of intracranial lesions after sport-related head injury is relatively uncommon, but the possibility of serious intracranial injury (ICI) should be included in the differential diagnosis. ICIs are potentially life threatening and necessitate urgent medical management; therefore, prompt recognition and evaluation are critical to proper medical management. One of the primary objectives of the initial evaluation is to determine if the concussed athlete has an acute traumatic ICI. Athletic trainers must be able promptly recognize clinical signs and symptoms that will enable them to accurately differentiate between a concussion (ie, a closed head injury not associated with significant ICI) and an ICI. The identification of predictors of intracranial lesions is, however, relatively broad. Focused Clinical Question: Which clinical examination findings (ie, clinical signs and symptoms) indicate possible intracranial pathology in individuals with acute closed head injuries?

  11. Vestibular Deficits Following Concussion

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2015-05-01

    Full Text Available Investigators from the Division of Emergency Medicine, Sports Medicine, and Department of Pediatrics, Children’s Hospital of Philadelphia, PA, and Sports Medicine, Somerset, NJ, performed a retrospective cohort study of 247 patients ages 5-18 years with concussion referred from July 2010 to Dec 2011; 81% of patients showed a vestibular abnormality on initial clinical examination.

  12. Sports and Concussions

    Science.gov (United States)

    ... teams, you probably know that concussions are a serious issue. Playing sports increases a person's risk of falls and collisions ... it might happen on the sidelines during a game. Sideline testing is common in schools and sports leagues. By watching you and doing a few ...

  13. The prevalence of undiagnosed concussions in athletes.

    Science.gov (United States)

    Meehan, William P; Mannix, Rebekah C; O'Brien, Michael J; Collins, Michael W

    2013-09-01

    Previous studies suggest athletes underreport concussions. We sought to determine whether athletes in our clinics have sustained previous concussions that went undiagnosed. Multicentered cross sectional study. Two sport concussion clinics. Patients diagnosed with sport-related concussions or concussions with injury mechanisms and forces similar to those observed in sports were included. The proportion of patients who answered "yes" to the following question were defined as having a previously undiagnosed concussion: "Have you ever sustained a blow to the head which was NOT diagnosed as a concussion but was followed by one or more of the signs and symptoms listed in the Post Concussion Symptom Scale?" Of the 486 patients included in the final analysis, 148 (30.5%) patients reported a previously undiagnosed concussion. Athletes reporting previously undiagnosed concussions had a higher mean Post Concussion Symptom Scale (PCSS) score (33 vs 25; P concussions. Nearly one-third of athletes have sustained previously undiagnosed concussions, defined as a blow to the head followed by the signs and symptoms included in the PCSS. Furthermore, these previously undiagnosed concussions are associated with higher PCSS scores and higher loss of consciousness rates when future concussions occur. Many athletes have sustained previous blows to the head that result in the signs and symptoms of concussion but have not been diagnosed with a concussion. These injuries are associated with increased rates of loss of consciousness and higher symptom scale scores with future concussions.

  14. A Case for Mental and Physical Rest in Youth Sports Concussion: It's Never too Late.

    Science.gov (United States)

    Moser, Rosemarie Scolaro; Schatz, Philip

    2012-01-01

    Over the past decade, there has been a considerable increase in research on, and media attention to, sports-related concussion. However, despite accurate diagnosis, effective treatment and management of sports-related concussion have remained a challenge. There are approximately 1.8 million traumatic brain injuries in the United States annually (Faul et al., 2010) and emergency department pediatric visits for suspected concussion have doubled in the past decade (Bakhos et al., 2010). However, health care providers and medical researchers have yet to offer an effective, reliable evidence-based treatment for concussive brain injury. The Zurich 2008 Consensus Statement on Concussion in Sport codified the prescription for cognitive and physical rest immediately following a concussion based on clinical acumen and common sense (McCrory et al., 2009). Currently, rest is the considered the best immediate treatment for concussion. Other supportive and anecdotal treatments are often applied throughout the post-concussive recovery process to address persistent symptoms. The need for empirical research to translate current guidelines for rest into evidence-based treatment protocols is essential. A recent study evaluated the efficacy of comprehensive rest and concluded that such rest may be helpful whether applied soon after a concussion or weeks to months later (Moser et al., 2012). Here, we present a case illustrating the effectiveness of rest in a youth athlete, commenced after experiencing 13 months of post-concussion symptoms. There appears to be value in applying a specific period of cognitive and physical rest following concussion, whether immediately or later in the recovery phase.

  15. Intergenic and repeat transcription in human, chimpanzee and macaque brains measured by RNA-Seq.

    Directory of Open Access Journals (Sweden)

    Augix Guohua Xu

    Full Text Available Transcription is the first step connecting genetic information with an organism's phenotype. While expression of annotated genes in the human brain has been characterized extensively, our knowledge about the scope and the conservation of transcripts located outside of the known genes' boundaries is limited. Here, we use high-throughput transcriptome sequencing (RNA-Seq to characterize the total non-ribosomal transcriptome of human, chimpanzee, and rhesus macaque brain. In all species, only 20-28% of non-ribosomal transcripts correspond to annotated exons and 20-23% to introns. By contrast, transcripts originating within intronic and intergenic repetitive sequences constitute 40-48% of the total brain transcriptome. Notably, some repeat families show elevated transcription. In non-repetitive intergenic regions, we identify and characterize 1,093 distinct regions highly expressed in the human brain. These regions are conserved at the RNA expression level across primates studied and at the DNA sequence level across mammals. A large proportion of these transcripts (20% represents 3'UTR extensions of known genes and may play roles in alternative microRNA-directed regulation. Finally, we show that while transcriptome divergence between species increases with evolutionary time, intergenic transcripts show more expression differences among species and exons show less. Our results show that many yet uncharacterized evolutionary conserved transcripts exist in the human brain. Some of these transcripts may play roles in transcriptional regulation and contribute to evolution of human-specific phenotypic traits.

  16. Repeated exposure to sublethal doses of the organophosphorus compound VX activates BDNF expression in mouse brain.

    Science.gov (United States)

    Pizarro, Jose M; Chang, Wenling E; Bah, Mariama J; Wright, Linnzi K M; Saviolakis, George A; Alagappan, Arun; Robison, Christopher L; Shah, Jinesh D; Meyerhoff, James L; Cerasoli, Douglas M; Midboe, Eric G; Lumley, Lucille A

    2012-04-01

    The highly toxic organophosphorus compound VX [O-ethyl S-[2-(diisopropylamino)ethyl]methylphosphonate] is an irreversible inhibitor of the enzyme acetylcholinesterase (AChE). Prolonged inhibition of AChE increases endogenous levels of acetylcholine and is toxic at nerve synapses and neuromuscular junctions. We hypothesized that repeated exposure to sublethal doses of VX would affect genes associated with cell survival, neuronal plasticity, and neuronal remodeling, including brain-derived neurotrophic factor (BDNF). We examined the time course of BDNF expression in C57BL/6 mouse brain following repeated exposure (1/day × 5 days/week × 2 weeks) to sublethal doses of VX (0.2 LD(50) and 0.4 LD(50)). BDNF messenger RNA expression was significantly (p VX exposure. BDNF protein expression, however, was only increased in the CA3 region of the hippocampus. Whether increased BDNF in response to sublethal doses of VX exposure is an adaptive response to prevent cellular damage or a precursor to impending brain damage remains to be determined. If elevated BDNF is an adaptive response, exogenous BDNF may be a potential therapeutic target to reduce the toxic effects of nerve agent exposure.

  17. Safety Validation of Repeated Blood-Brain Barrier Disruption Using Focused Ultrasound.

    Science.gov (United States)

    Kobus, Thiele; Vykhodtseva, Natalia; Pilatou, Magdalini; Zhang, Yongzhi; McDannold, Nathan

    2016-02-01

    The purpose of this study was to investigate the effects on the brain of multiple sessions of blood-brain barrier (BBB) disruption using focused ultrasound (FUS) in combination with micro-bubbles over a range of acoustic exposure levels. Six weekly sessions of FUS, using acoustical pressures between 0.66 and 0.80 MPa, were performed under magnetic resonance guidance. The success and degree of BBB disruption was estimated by signal enhancement of post-contrast T1-weighted imaging of the treated area. Histopathological analysis was performed after the last treatment. The consequences of repeated BBB disruption varied from no indications of vascular damage to signs of micro-hemorrhages, macrophage infiltration, micro-scar formations and cystic cavities. The signal enhancement on the contrast-enhanced T1-weighted imaging had limited value for predicting small-vessel damage. T2-weighted imaging corresponded well with the effects on histopathology and could be used to study treatment effects over time. This study demonstrates that repeated BBB disruption by FUS can be performed with no or limited damage to the brain tissue.

  18. Traumatic Brain Injury and Delayed Sequelae: A Review - Traumatic Brain Injury and Mild Traumatic Brain Injury (Concussion) are Precursors to Later-Onset Brain Disorders, Including Early-Onset Dementia

    OpenAIRE

    Kiraly, Michael A.; Kiraly, Stephen J.

    2007-01-01

    Brain injuries are too common. Most people are unaware of the incidence of and horrendous consequences of traumatic brain injury (TBI) and mild traumatic brain injury (MTBI). Research and the advent of sophisticated imaging have led to progression in the understanding of brain pathophysiology following TBI. Seminal evidence from animal and human experiments demonstrate links between TBI and the subsequent onset of premature, psychiatric syndromes and neurodegenerative diseases, including Alzh...

  19. Value of repeat brain MRI in children with focal epilepsy and negative findings on initial MRI

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Tae Yeon; Kim, Ji Hye; Lee, Jee Hun; Yoo, So Young; Hwang, Sook Min; Lee, Mun Hyang [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2017-08-01

    To evaluate the value of repeat brain magnetic resonance imaging (MRI) in identifying potential epileptogenic lesions in children with initial MRI-negative focal epilepsy. Our Institutional Review Board approved this retrospective study and waived the requirement for informed consent. During a 15-year period, 257 children (148 boys and 109 girls) with initial MRI-negative focal epilepsy were included. After re-evaluating both initial and repeat MRIs, positive results at repeat MRI were classified into potential epileptogenic lesions (malformation of cortical development and hippocampal sclerosis) and other abnormalities. Contributing factors for improved lesion conspicuity of the initially overlooked potential epileptogenic lesions were analyzed and classified into lesion factors and imaging factors. Repeat MRI was positive in 21% (55/257) and negative in 79% cases (202/257). Of the positive results, potential epileptogenic lesions comprised 49% (27/55) and other abnormalities comprised 11% of the cases (28/257). Potential epileptogenic lesions included focal cortical dysplasia (n = 11), hippocampal sclerosis (n = 10), polymicrogyria (n = 2), heterotopic gray matter (n = 2), microlissencephaly (n = 1), and cortical tumor (n = 1). Of these, seven patients underwent surgical resection. Contributing factors for new diagnoses were classified as imaging factors alone (n = 6), lesion factors alone (n = 2), both (n = 18), and neither (n = 1). Repeat MRI revealed positive results in 21% of the children with initial MRI-negative focal epilepsy, with 50% of the positive results considered as potential epileptogenic lesions. Enhanced MRI techniques or considering the chronological changes of lesions on MRI may improve the diagnostic yield for identification of potential epileptogenic lesions on repeat MRI.

  20. Recognizing and managing concussion in school sport.

    Science.gov (United States)

    Evans, Vicki

    2014-08-01

    Every country around the world enjoys some sort of sport. The Olympics sees countries from all over the globe participate in elite sport, in both winter and summer competitions. Australia is widely known for cricket and rugby; America is known for baseball and gridiron football (among others). These sports are played at an elite level as well as beginners from early ages as young as 4 years in the backyard. Yet, it is also these sports that can deliver a ball at the speed of 100 km/h (football), 105 km/h (baseball), 112 km/h (rugby), 150 km/h (cricket), and 211 km/h (soccer). This is the same force that a car collision can produce. That force eventually finds a target, and in some cases, unfortunately, it is a head. Damage to the brain is not only from the impact of the ball hitting its target but rather also the shearing forces of acceleration-deceleration injury that can cause extensive injuries. There has been much discussion of late regarding concussion in sport and the accumulative effects of head blows resulting in varying degrees of memory loss and dementia later in life. The media have been saturated with heightened awareness of chronic traumatic encephalopathy. This, however, is still being researched. It is true that each concussion compounds the one before, but rather than focus on the injury, managers/coaches and sporting codes should be focusing on the identification and proper management of a suspected concussion and the return-to-play protocols. This is especially important in our schools where growing brains need nurturing. Neuroscience nurses are at the forefront of educating school children, teachers, and coaches through partnering with local schools. This article will focus on concussion recognition and management in school sport.

  1. Rotational head kinematics in football impacts: an injury risk function for concussion.

    Science.gov (United States)

    Rowson, Steven; Duma, Stefan M; Beckwith, Jonathan G; Chu, Jeffrey J; Greenwald, Richard M; Crisco, Joseph J; Brolinson, P Gunnar; Duhaime, Ann-Christine; McAllister, Thomas W; Maerlender, Arthur C

    2012-01-01

    Recent research has suggested a possible link between sports-related concussions and neurodegenerative processes, highlighting the importance of developing methods to accurately quantify head impact tolerance. The use of kinematic parameters of the head to predict brain injury has been suggested because they are indicative of the inertial response of the brain. The objective of this study is to characterize the rotational kinematics of the head associated with concussive impacts using a large head acceleration dataset collected from human subjects. The helmets of 335 football players were instrumented with accelerometer arrays that measured head acceleration following head impacts sustained during play, resulting in data for 300,977 sub-concussive and 57 concussive head impacts. The average sub-concussive impact had a rotational acceleration of 1230 rad/s(2) and a rotational velocity of 5.5 rad/s, while the average concussive impact had a rotational acceleration of 5022 rad/s(2) and a rotational velocity of 22.3 rad/s. An injury risk curve was developed and a nominal injury value of 6383 rad/s(2) associated with 28.3 rad/s represents 50% risk of concussion. These data provide an increased understanding of the biomechanics associated with concussion and they provide critical insight into injury mechanisms, human tolerance to mechanical stimuli, and injury prevention techniques.

  2. Traumatic Brain Injury and Delayed Sequelae: A Review - Traumatic Brain Injury and Mild Traumatic Brain Injury (Concussion are Precursors to Later-Onset Brain Disorders, Including Early-Onset Dementia

    Directory of Open Access Journals (Sweden)

    Michael A. Kiraly

    2007-01-01

    Full Text Available Brain injuries are too common. Most people are unaware of the incidence of and horrendous consequences of traumatic brain injury (TBI and mild traumatic brain injury (MTBI. Research and the advent of sophisticated imaging have led to progression in the understanding of brain pathophysiology following TBI. Seminal evidence from animal and human experiments demonstrate links between TBI and the subsequent onset of premature, psychiatric syndromes and neurodegenerative diseases, including Alzheimer's disease (AD and Parkinson's disease (PD. Objectives of this summary are, therefore, to instill appreciation regarding the importance of brain injury prevention, diagnosis, and treatment, and to increase awareness regarding the long-term delayed consequences following TBI.

  3. Exaggerated phosphorylation of brain tau protein in CRH KO mice exposed to repeated immobilization stress.

    Science.gov (United States)

    Kvetnansky, Richard; Novak, Petr; Vargovic, Peter; Lejavova, Katarina; Horvathova, Lubica; Ondicova, Katarina; Manz, George; Filipcik, Peter; Novak, Michal; Mravec, Boris

    2016-07-01

    Neuroendocrine and behavioral stress responses are orchestrated by corticotropin-releasing hormone (CRH) and norepinephrine (NE) synthesizing neurons. Recent findings indicate that stress may promote development of neurofibrillary pathology in Alzheimer's disease. Therefore, we investigated relationships among stress, tau protein phosphorylation, and brain NE using wild-type (WT) and CRH-knockout (CRH KO) mice. We assessed expression of phosphorylated tau (p-tau) at the PHF-1 epitope and NE concentrations in the locus coeruleus (LC), A1/C1 and A2/C2 catecholaminergic cell groups, hippocampus, amygdala, nucleus basalis magnocellularis, and frontal cortex of unstressed, singly stressed or repeatedly stressed mice. Moreover, gene expression and protein levels of tyrosine hydroxylase (TH) and CRH receptor mRNA were determined in the LC. Plasma corticosterone levels were also measured. Exposure to a single stress increases tau phosphorylation throughout the brain in WT mice when compared to singly stressed CRH KO animals. In contrast, repeatedly stressed CRH KO mice showed exaggerated tau phosphorylation relative to WT controls. We also observed differences in extent of tau phosphorylation between investigated structures, e.g. the LC and hippocampus. Moreover, CRH deficiency leads to different responses to stress in gene expression of TH, NE concentrations, CRH receptor mRNA, and plasma corticosterone levels. Our data indicate that CRH effects on tau phosphorylation are dependent on whether stress is single or repeated, and differs between brain regions. Our findings indicate that CRH attenuates mechanisms responsible for development of stress-induced tau neuropathology, particularly in conditions of chronic stress. However, the involvement of central catecholaminergic neurons in these mechanisms remains unclear and is in need of further investigation.

  4. Effect of Sport Related Concussion on Clinically Measured Simple Reaction Time

    Science.gov (United States)

    Eckner, James T.; Kutcher, Jeffrey S.; Broglio, Steven P.; Richardson, James K.

    2013-01-01

    Background Reaction time (RT) is a valuable component of the sport concussion assessment battery. RT is typically measured using computers running specialized software, which limits its applicability in some athletic settings and populations. To address this, we developed a simple clinical test of RT (RTclin) that involves grasping a falling measuring stick. Purpose To determine the effect of concussion on RTclin and its sensitivity and specificity for concussion. Materials and methods Concussed athletes (n=28) and non-concussed control teammates (n=28) completed RTclin assessments at baseline and within 48 hours of injury. Repeated measures ANOVA compared mean baseline and follow-up RTclin values between groups. Sensitivity and specificity were calculated over a range of reliable change confidence levels. Results RTclin differed significantly between groups (p < .001): there was significant prolongation from baseline to post-injury in the concussed group (p= .003), with a trend toward improvement in the control group (p = .058). Sensitivity and specificity were maximized when a critical change value of 0 ms was applied (i.e., any increase in RTclin from baseline was interpreted as abnormal), which corresponded to a sensitivity of 75%, specificity of 68%, and a 65% reliable change confidence level. Conclusions RTclin appears sensitive to the effects of concussion and distinguished concussed and non-concussed athletes with similar sensitivity and specificity to other commonly used concussion assessment tools. Given its simplicity, low cost, and minimal time requirement, RTclin should be considered a viable component of the sports medicine provider’s multifaceted concussion assessment battery. PMID:23314889

  5. Molecular mechanisms of increased cerebral vulnerability after repeated mild blast-induced traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Alaa Kamnaksh

    2014-06-01

    Full Text Available The consequences of a mild traumatic brain injury can be especially severe if it is repeated within the period of increased cerebral vulnerability (ICV that follows the initial insult. To better understand the molecular mechanisms that contribute to ICV, we exposed rats to different levels of mild blast overpressure (5 exposures; total pressure range: 15.54–19.41 psi or 107.14–133.83 kPa at a rate of 1 per 30 min, monitored select physiological parameters, and assessed behavior. Two days post-injury or sham, we determined changes in protein biomarkers related to various pathologies in behaviorally relevant brain regions and in plasma. We found that oxygen saturation and heart rate were transiently depressed following mild blast exposure and that injured rats exhibited significantly increased anxiety- and depression-related behaviors. Proteomic analyses of the selected brain regions showed evidence of substantial oxidative stress and vascular changes, altered cell adhesion, and inflammation predominantly in the prefrontal cortex. Importantly, these pathological changes as well as indications of neuronal and glial cell loss/damage were also detected in the plasma of injured rats. Our findings illustrate some of the complex molecular changes that contribute to the period of ICV in repeated mild blast-induced traumatic brain injury. Further studies are needed to determine the functional and temporal relationship between the various pathomechanisms. The validation of these and other markers can help to diagnose individuals with ICV using a minimally invasive procedure and to develop evidence-based treatments for chronic neuropsychiatric conditions.

  6. Concussion in High School Sports: Overall Estimate of Occurrence Is Not Available, but Key State Laws and Nationwide Guidelines Address Injury Management. Testimony before the Committee on Education and Labor, House of Representatives. GAO-10-569T

    Science.gov (United States)

    Kohn, Linda T.

    2010-01-01

    Participation in school sports can benefit children but also carries a risk of injury, including concussion. Concussion is a brain injury that can affect memory, speech, and muscle coordination and can cause permanent disability or death. Concussion can be especially serious for children, who are more likely than adults both to sustain a…

  7. Concussions: What a neurosurgeon should know about current scientific evidence and management strategies

    Science.gov (United States)

    Neal, Matthew T.; Wilson, Jonathan L.; Hsu, Wesley; Powers, Alexander K.

    2012-01-01

    Background: There has been a tremendous amount of interest focused on the topic of concussions over the past few decades. Neurosurgeons are frequently consulted to manage patients with mild traumatic brain injuries (mTBI) that have radiographic evidence of cerebral injury. These injuries share significant overlap with concussions, injuries that typically do not reveal radiographic evidence of structural injury, in the realms of epidemiology, pathophysiology, outcomes, and management. Further, neurosurgeons often manage patients with extracranial injuries that have concomitant concussions. In these cases, neurosurgeons are often the only “concussion experts” that patients encounter. Results: The literature has been reviewed and data have been synthesized on the topic including sections on historical background, epidemiology, pathophysiology, diagnostic advances, clinical sequelae, and treatment suggestions, with neurosurgeons as the intended target audience. Conclusions: Neurosurgeons should have a fundamental knowledge of the scientific evidence that has developed regarding concussions and be prepared to guide patients with treatment plans. PMID:22439107

  8. Repeat stereotactic radiosurgery in the management of brain metastases from NSCLC: A case report and review of the literature

    OpenAIRE

    2013-01-01

    The aims of radiotherapeutic treatment of brain metastases include maintaining neurocognitive function and improvement of survival. Based on these premises, we present a case report in which the role of repeat stereotactic radiosurgery (SRS) was investigated in a patient with a recurrent brain metastasis from non-small cell lung cancer in the same area as previously treated with radiosurgery. A 40-year-old male caucasian patient was diagnosed with brain metastasis from non-small cell lung can...

  9. UNDERSTANDING THE NEUROINFLAMMATORY RESPONSE FOLLOWING CONCUSSION TO DEVELOP TREATMENT STRATEGIES

    Directory of Open Access Journals (Sweden)

    Zachary Robert Patterson

    2012-12-01

    Full Text Available Mild traumatic brain injuries (mTBI have been associated with long-term cognitive deficits relating to trauma-induced neurodegeneration. These long-term deficits include impaired memory and attention, changes in executive function, emotional instability and sensorimotor deficits. Furthermore, individuals with concussions show a high co-morbidity with a host of psychiatric illnesses (e.g. depression, anxiety, addiction and dementia. The neurological damage seen in mTBI patients is the result of the direct impact and mechanical injury, followed by a delayed neuroimmune response that can last hours, days and even months after the injury. As part of the neuroimmune response, a cascade of pro- and anti-inflammatory cytokines are released and can be detected at the site of injury as well as subcortical, and often contralateral, regions. It has been suggested that the delayed neuroinflammatory response to concussions is more damaging then the initial impact itself. However, evidence exists for favourable consequences of cytokine production following traumatic brain injuries as well. In some cases, treatments that reduce the inflammatory response will also hinder the brain's intrinsic repair mechanisms. At present, there is no evidence-based pharmacological treatment for concussions in humans. The ability to treat concussions with drug therapy requires an in-depth understanding of the pathophysiological and neuroinflammatory changes that accompany concussive injuries. The use of neurotrophic factors (e.g. nerve growth factor and anti-inflammatory agents as an adjunct for the management of post-concussion symptomology will be explored in this review.

  10. Understanding the neuroinflammatory response following concussion to develop treatment strategies.

    Science.gov (United States)

    Patterson, Zachary R; Holahan, Matthew R

    2012-01-01

    Mild traumatic brain injuries (mTBI) have been associated with long-term cognitive deficits relating to trauma-induced neurodegeneration. These long-term deficits include impaired memory and attention, changes in executive function, emotional instability, and sensorimotor deficits. Furthermore, individuals with concussions show a high co-morbidity with a host of psychiatric illnesses (e.g., depression, anxiety, addiction) and dementia. The neurological damage seen in mTBI patients is the result of the impact forces and mechanical injury, followed by a delayed neuroimmune response that can last hours, days, and even months after the injury. As part of the neuroimmune response, a cascade of pro- and anti-inflammatory cytokines are released and can be detected at the site of injury as well as subcortical, and often contralateral, regions. It has been suggested that the delayed neuroinflammatory response to concussions is more damaging then the initial impact itself. However, evidence exists for favorable consequences of cytokine production following traumatic brain injuries as well. In some cases, treatments that reduce the inflammatory response will also hinder the brain's intrinsic repair mechanisms. At present, there is no evidence-based pharmacological treatment for concussions in humans. The ability to treat concussions with drug therapy requires an in-depth understanding of the pathophysiological and neuroinflammatory changes that accompany concussive injuries. The use of neurotrophic factors [e.g., nerve growth factor (NGF)] and anti-inflammatory agents as an adjunct for the management of post-concussion symptomology will be explored in this review.

  11. Safe treatment of sport related concussion

    NARCIS (Netherlands)

    Van Kampen, D.A.; Lovell, M.R.; Diercks, Ron

    2006-01-01

    Sport related concussion is a hot item. The Health Council of the Netherlands published its report on concussions in 2003 and there is much concern about the negative health effects of sports related concussion. Neuropsychological testing has recently been endorsed as a 'cornerstone' of concussion

  12. Safe treatment of sport related concussion

    NARCIS (Netherlands)

    Van Kampen, D.A.; Lovell, M.R.; Diercks, Ron

    2006-01-01

    Sport related concussion is a hot item. The Health Council of the Netherlands published its report on concussions in 2003 and there is much concern about the negative health effects of sports related concussion. Neuropsychological testing has recently been endorsed as a 'cornerstone' of concussion m

  13. Examining Neurocognitive Function in Previously Concussed Interscholastic Female Soccer Players.

    Science.gov (United States)

    Forbes, Cameron R; Glutting, Joseph J; Kaminski, Thomas W

    2016-01-01

    Awareness of sport-related concussions in soccer has gained recent attention in the medical community. Interestingly, purposeful heading-a unique yet strategic and inherent part of soccer-involves repeated subconcussive blows to the head. We divided 210 female interscholastic soccer players into control (CON [never concussed]) and experimental (EXP [previously concussed]) groups. We assessed neurocognitive performance using the Automated Neuropsychological Assessment Metrics computer program before and after the players' competitive season. Headers were recorded at all sanctioned matches. Data were analyzed using a series of one-way analyses of covariance and t tests. Both groups essentially played in the same number of games (EXP = 16.1 vs. CON = 16.1) and had an equal number of total headers (EXP = 24.9 vs. CON = 24.3). Additionally, headers per game were surprisingly low in both groups (1.4 in EXP vs. 1.3 in CON). Unexpectedly, there were no significant differences between the EXP and CON groups across all dependent variables measured (p > .05). This study suggests that although previously concussed players involve themselves in purposeful heading (i.e., subconcussive insults) throughout a competitive season, there appear to be no negative consequences on neuropsychological test performance or concussion-related symptoms. Additional research is needed to determine what may result during the course of a playing career.

  14. Return to play after an initial or recurrent concussion in a prospective study of physician-observed junior ice hockey concussions: implications for return to play after a concussion.

    Science.gov (United States)

    Echlin, Paul Sean; Tator, Charles H; Cusimano, Michael D; Cantu, Robert C; Taunton, Jack E; Upshur, Ross E G; Czarnota, Michael; Hall, Craig R; Johnson, Andrew M; Forwell, Lorie A; Driediger, Molly; Skopelja, Elaine N

    2010-11-01

    by players who suffered a concussion (15 cases) was 2.1 ± 1.29 (median 1.5 visits). Five of the 17 players who sustained a concussion also suffered a recurrent or second concussion. One of the 5 individuals who suffered a repeat concussion sustained his initial concussion in a regular season game that was not observed by a physician, and as a result this single case was not included in the total of 21 concussions. This initial concussion of the player was identified during baseline testing 2 days after the injury and was subsequently medically diagnosed and treated. The mean interval between the first and second concussions in these 5 players was 78.6 ± 39.8 days (median 82 days), and the mean time between the return-to-play date of the first and second concussions was 61.8 ± 39.7 days (median 60 days). The mean rates of return to play for single and recurrent concussions were higher than rates cited in recent studies involving sport concussions. The time interval between the first and second concussions was also greater than previously cited. This difference may be the result of the methodology of direct independent physician observation, diagnosis, and adherence to the Zurich return-to-play protocol.

  15. Concussions and Their Effects on Performance Measures of Major League Soccer Players: A Teaching Tool for Physical Education Teachers

    Science.gov (United States)

    Hardy, Richard; Jordan, Torri; Wolf, Allison; Johnson, Matteus; Brand, Jefferson

    2017-01-01

    Concussions are a brain injury that affects the athlete on and off the playing field. The aim of our investigation was to give PE teachers another strategy to use in addition to the recommended approaches set forth by national organizations to convey the message to adolescents regarding the negative effects of concussion. Using the website…

  16. Mismanaging Concussions in Intercollegiate Football

    Science.gov (United States)

    Moser, Austin; Miller, John J.

    2014-01-01

    In 2011, Adrian Arrington filed a class action lawsuit against the National Collegiate Athletic Association (NCAA) on behalf of himself and other athletes who had sustained concussions that resulted in long-term injuries. In the lawsuit, Arrington alleged that the NCAA employed a negligent approach to concussed student-athletes.

  17. Triplet repeat mutation length gains correlate with cell-type specific vulnerability in Huntington disease brain.

    Science.gov (United States)

    Shelbourne, Peggy F; Keller-McGandy, Christine; Bi, Wenya Linda; Yoon, Song-Ro; Dubeau, Louis; Veitch, Nicola J; Vonsattel, Jean Paul; Wexler, Nancy S; Arnheim, Norman; Augood, Sarah J

    2007-05-15

    Huntington disease is caused by the expansion of a CAG repeat encoding an extended glutamine tract in a protein called huntingtin. Here, we provide evidence supporting the hypothesis that somatic increases of mutation length play a role in the progressive nature and cell-selective aspects of HD pathogenesis. Results from micro-dissected tissue and individual laser-dissected cells obtained from human HD cases and knock-in HD mice indicate that the CAG repeat is unstable in all cell types tested although neurons tend to have longer mutation length gains than glia. Mutation length gains occur early in the disease process and continue to accumulate as the disease progresses. In keeping with observed patterns of cell loss, neuronal mutation length gains tend to be more prominent in the striatum than in the cortex of low-grade human HD cases, less so in more advanced cases. Interestingly, neuronal sub-populations of HD mice appear to have different propensities for mutation length gains; in particular, smaller mutation length gains occur in nitric oxide synthase-positive striatal interneurons (a relatively spared cell type in HD) compared with the pan-striatal neuronal population. More generally, the data demonstrate that neuronal changes in HD repeat length can be at least as great, if not greater, than those observed in the germline. The fact that significant CAG repeat length gains occur in non-replicating cells also argues that processes such as inappropriate mismatch repair rather than DNA replication are involved in generating mutation instability in HD brain tissue.

  18. Game-specific characteristics of sport-related concussions.

    Science.gov (United States)

    Helmich, Ingo

    2016-09-14

    Concussions are common incidences in sports. However, game-specific characteristics such as tactics, field positions, etc. might positively/negatively contribute to the occurrence of mild traumatic brain injuries (mTBI) in various sports such as soccer, volleyball, handball, or basketball. Thus, the intention of this study was to analyze game- specific characteristics of concussive incidents in active players from the perspective of different sportive disciplines. Four sport-specific questionnaires for soccer, handball, volleyball and basketball were established using an online survey tool. 3001 participants completed the questionnaires. 18% of the participants answered that they had experienced a concussion which significantly differed depending on the sport practiced (χ2(3)=56,868, pconcussions on the amateur level, volleyball players experienced most on the professional level and basketball players during leisure play (χ2(9)=112,667, pconcussions by a collision with another player, volleyball players instead experienced most concussions by hits from the ball (χ2(6)=211,260, pconcussions (χ2(6)=13.617, pconcussions are sport-specific and particularly concern amateurs. This indicates that most concussions in ball games appear in situations, where medical care units are not necessarily present. Preventive measures should therefore especially address amateurs in ball sports.

  19. Functional, Structural, and Neurotoxicity Biomarkers in Integrative Assessment of Concussions

    Directory of Open Access Journals (Sweden)

    Svetlana A Dambinova

    2016-10-01

    Full Text Available Concussion is a complex, heterogenous process affecting the brain. Accurate assessment and diagnosis and appropriate management of concussion are essential to ensure athletes do not prematurely return to play or others to work or active military duty, risking re-injury. To date, clinical diagnosis relies primarily on evaluating subjects for functional impairment using instruments that include neurocognitive testing, subjective symptom report, and neurobehavioral assessments, such as balance and vestibular-ocular reflex testing. Structural biomarkers, defined as advanced neuroimaging techniques and biomarkers assessing neurotoxicity and immunoexcitotoxicity may complement the use of functional biomarkers. We hypothesize that neurotoxicity AMPA, NMDA, and kainite receptor biomarkers might be utilized as a part of comprehensive approach to concussion evaluations, with the goal of increasing diagnostic accuracy and facilitating treatment planning and prognostic assessment.

  20. Significance of Concussions in Hawai‘i: From Land to Sea

    Science.gov (United States)

    Cifu, David X; Uchima, Olivia K; Lower, Amy E; Jin, Jingyu L; Lew, Henry L

    2016-01-01

    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. PMID:27688951

  1. Addressing the needs of traumatic brain injury with clinical proteomics

    National Research Council Canada - National Science Library

    Shen, Sean; Loo, Rachel R Ogorzalek; Wanner, Ina-Beate; Loo, Joseph A

    2014-01-01

    ...% of all traumatic brain injuries (TBIs) are concussions or other mild TBI (mTBI) forms. Evaluation of concussion injury today is limited to an assessment of behavioral symptoms, often with delay and subject to motivation...

  2. School and the Concussed Youth – Recommendations for Concussion Education and Management

    Science.gov (United States)

    Sady, Maegan D.; Vaughan, Christopher G.; Gioia, Gerard A.

    2011-01-01

    Synopsis School learning and performance is arguably the critical centerpiece of child and adolescent development, and there can be significant temporary upset in cognitive processing after a mild traumatic brain injury, also called a concussion. This injury results in a cascade of neurochemical abnormalities, and in the wake of this dysfunction, both physical activity and cognitive activity become sources of additional neurometabolic demand on the brain and may cause symptoms to re-emerge or worsen. This paper provides a foundation for post-injury management of cognitive activity, particularly in the school setting, including design and implementation of school-wide concussion education and management programs. Definitions of cognitive over-exertion and cognitive rest are provided, with guidelines for managing cognitive load in individuals based on their symptom profile and neurocognitive performance. On a broader scale, guidance for the development of comprehensive concussion education and management programs in schools is provided. Proactive management could facilitate recovery by ensuring less cognitive exertion and stress during the recovery period. PMID:22050944

  3. What Are the Signs and Symptoms of Concussion?

    Science.gov (United States)

    ... Children What are the Signs and Symptoms of Concussion? Most people with a concussion recover well from ... recover if they have another concussion. Symptoms of concussion usually fall into four categories: Thinking/ Remembering Physical ...

  4. Repeat Courses of Stereotactic Radiosurgery (SRS), Deferring Whole-Brain Irradiation, for New Brain Metastases After Initial SRS

    Energy Technology Data Exchange (ETDEWEB)

    Shultz, David B.; Modlin, Leslie A.; Jayachandran, Priya; Von Eyben, Rie; Gibbs, Iris C. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Choi, Clara Y.H. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Department of Radiation Oncology, Santa Clara Valley Medical Center, San Jose, California (United States); Chang, Steven D.; Harsh, Griffith R.; Li, Gordon; Adler, John R. [Department of Neurosurgery, Stanford University School of Medicine, Stanford, California (United States); Hancock, Steven L. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Soltys, Scott G., E-mail: sgsoltys@stanford.edu [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States)

    2015-08-01

    Purpose: To report the outcomes of repeat stereotactic radiosurgery (SRS), deferring whole-brain radiation therapy (WBRT), for distant intracranial recurrences and identify factors associated with prolonged overall survival (OS). Patients and Methods: We retrospectively identified 652 metastases in 95 patients treated with 2 or more courses of SRS for brain metastases, deferring WBRT. Cox regression analyzed factors predictive for OS. Results: Patients had a median of 2 metastases (range, 1-14) treated per course, with a median of 2 courses (range, 2-14) of SRS per patient. With a median follow-up after first SRS of 15 months (range, 3-98 months), the median OS from the time of the first and second course of SRS was 18 (95% confidence interval [CI] 15-24) and 11 months (95% CI 6-17), respectively. On multivariate analysis, histology, graded prognostic assessment score, aggregate tumor volume (but not number of metastases), and performance status correlated with OS. The 1-year cumulative incidence, with death as a competing risk, of local failure was 5% (95% CI 4-8%). Eighteen (24%) of 75 deaths were from neurologic causes. Nineteen patients (20%) eventually received WBRT. Adverse radiation events developed in 2% of SRS sites. Conclusion: Multiple courses of SRS, deferring WBRT, for distant brain metastases after initial SRS, seem to be a safe and effective approach. The graded prognostic assessment score, updated at each course, and aggregate tumor volume may help select patients in whom the deferral of WBRT might be most beneficial.

  5. Concussions are associated with decreased batting performance among Major League Baseball players.

    Science.gov (United States)

    Wasserman, Erin B; Abar, Beau; Shah, Manish N; Wasserman, Daniel; Bazarian, Jeffrey J

    2015-05-01

    Concussions impair balance, visual acuity, and reaction time--all of which are required for high-level batting performance--but the effects of concussion on batting performance have not been reported. The authors examined this relationship between concussion and batting performance among Major League Baseball (MLB) players. Batting performance among concussed MLB players will be worse upon return to play than batting performance among players missing time for noninjury reasons. Cohort study; Level of evidence, 3. The authors identified MLB players who sustained a concussion between 2007 and 2013 through league disabled-list records and a Baseball Prospectus database. For a comparison group, they identified players who went on paternity or bereavement leave during the same period. Using repeated-measures generalized linear models, the authors compared 7 batting metrics between the 2 groups for the 2 weeks upon return, as well as 4 to 6 weeks after return, controlling for pre-leave batting metrics, number of days missed, and position. The authors identified 66 concussions and 68 episodes of bereavement/paternity leave to include in the analysis. In the 2 weeks after return, batting average (.235 vs .266), on-base percentage (.294 vs .326), slugging percentage (.361 vs .423), and on-base plus slugging (.650 vs .749) were significantly lower among concussed players relative to the bereavement/paternity leave players (time×group interaction, Pconcussed players but not statistically significantly so. Although concussed players may be asymptomatic upon return to play, the residual effects of concussion on the skills required for batting may still be present. Further work is needed to clarify the mechanism through which batting performance after concussion is adversely affected and to identify better measures to use for return-to-play decisions. © 2015 The Author(s).

  6. Plasma soluble prion protein, a potential biomarker for sport-related concussions: a pilot study.

    Directory of Open Access Journals (Sweden)

    Nam Pham

    Full Text Available Sport-related mild traumatic brain injury (mTBI or concussion is a significant health concern to athletes with potential long-term consequences. The diagnosis of sport concussion and return to sport decision making is one of the greatest challenges facing health care clinicians working in sports. Blood biomarkers have recently demonstrated their potential in assisting the detection of brain injury particularly, in those cases with no obvious physical injury. We have recently discovered plasma soluble cellular prion protein (PrP(C as a potential reliable biomarker for blast induced TBI (bTBI in a rodent animal model. In order to explore the application of this novel TBI biomarker to sport-related concussion, we conducted a pilot study at the University of Saskatchewan (U of S by recruiting athlete and non-athlete 18 to 30 year-old students. Using a modified quantitative ELISA method, we first established normal values for the plasma soluble PrP(C in male and female students. The measured plasma soluble PrP(C in confirmed concussion cases demonstrated a significant elevation of this analyte in post-concussion samples. Data collected from our pilot study indicates that the plasma soluble PrP(C is a potential biomarker for sport-related concussion, which may be further developed into a clinical diagnostic tool to assist clinicians in the assessment of sport concussion and return-to-play decision making.

  7. Plasma soluble prion protein, a potential biomarker for sport-related concussions: a pilot study.

    Science.gov (United States)

    Pham, Nam; Akonasu, Hungbo; Shishkin, Rhonda; Taghibiglou, Changiz

    2015-01-01

    Sport-related mild traumatic brain injury (mTBI) or concussion is a significant health concern to athletes with potential long-term consequences. The diagnosis of sport concussion and return to sport decision making is one of the greatest challenges facing health care clinicians working in sports. Blood biomarkers have recently demonstrated their potential in assisting the detection of brain injury particularly, in those cases with no obvious physical injury. We have recently discovered plasma soluble cellular prion protein (PrP(C)) as a potential reliable biomarker for blast induced TBI (bTBI) in a rodent animal model. In order to explore the application of this novel TBI biomarker to sport-related concussion, we conducted a pilot study at the University of Saskatchewan (U of S) by recruiting athlete and non-athlete 18 to 30 year-old students. Using a modified quantitative ELISA method, we first established normal values for the plasma soluble PrP(C) in male and female students. The measured plasma soluble PrP(C) in confirmed concussion cases demonstrated a significant elevation of this analyte in post-concussion samples. Data collected from our pilot study indicates that the plasma soluble PrP(C) is a potential biomarker for sport-related concussion, which may be further developed into a clinical diagnostic tool to assist clinicians in the assessment of sport concussion and return-to-play decision making.

  8. Acute motor, neurocognitive and neurophysiological change following concussion injury in Australian amateur football. A prospective multimodal investigation.

    Science.gov (United States)

    Pearce, Alan J; Hoy, Kate; Rogers, Mark A; Corp, Daniel T; Davies, Charlotte B; Maller, Jerome J; Fitzgerald, Paul B

    2015-09-01

    This multimodal study investigated the motor, neurocognitive and neurophysiological responses following a sports related concussion injury in the acute-phase (up to 10 days) in sub-elite Australian football players. Between-group, repeated measures. Over the course of one season (six months), 43 male players from one football club (25.1 ± 4.5 years) were assessed for fine motor dexterity, visuomotor reaction time, implicit learning and attention. Motor cortex excitability and inhibition were assessed using transcranial magnetic stimulation. Of the 43 players, eight suffered concussion injuries, and were compared to 15 non-concussed players (active control) who returned for follow up testing. Post-concussion assessments using the aforementioned tests were carried out at 48 and 96 h, and 10 days. Compared to the non-concussed players, those who suffered concussion showed slowed fine dexterity (P = 0.02), response (P = 0.02) and movement times (P = 0.01) 48 h post-concussion. Similarly, attentional performance was reduced in the concussed group at all time points (48 h: P football players show abnormalities in motor, cognitive and neurophysiological measures with variable rates of recovery. These findings suggest that measuring the recovery of concussed athletes should incorporate a range of testing modalities rather than relying on one area of measurement in determining return to play. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  9. Longitudinal assessment of white matter abnormalities following sports-related concussion.

    Science.gov (United States)

    Meier, Timothy B; Bergamino, Maurizio; Bellgowan, Patrick S F; Teague, T K; Ling, Josef M; Jeromin, Andreas; Mayer, Andrew R

    2016-02-01

    There is great interest in developing physiological-based biomarkers such as diffusion tensor imaging to aid in the management of concussion, which is currently entirely dependent on clinical judgment. However, the time course for recovery of white matter abnormalities following sports-related concussion (SRC) is unknown. We collected diffusion tensor imaging and behavioral data in forty concussed collegiate athletes on average 1.64 days (T1; n = 33), 8.33 days (T2; n = 30), and 32.15 days post-concussion (T3; n = 26), with healthy collegiate contact-sport athletes (HA) serving as controls (n = 46). We hypothesized that fractional anisotropy (FA) would be increased acutely and partially recovered by one month post-concussion. Mood symptoms were assessed using structured interviews. FA differences were assessed using both traditional and subject-specific analyses. An exploratory analysis of tau plasma levels was conducted in a subset of participants. Results indicated that mood symptoms improved over time post-concussion, but remained elevated at T3 relative to HA. Across both group and subject-specific analyses, concussed athletes exhibited increased FA in several white matter tracts at each visit post-concussion with no longitudinal evidence of recovery. Increased FA at T1 and T3 was significantly associated with an independent, real-world outcome measure for return-to-play. Finally, we observed a nonsignificant trend for reduced tau in plasma of concussed athletes at T1 relative to HA, with tau significantly increasing by T2. These results suggest white matter abnormalities following SRC may persist beyond one month and have potential as an objective biomarker for concussion outcome. Hum Brain Mapp 37:833-845, 2016. © 2015 Wiley Periodicals, Inc.

  10. Multiple Past Concussions in High School Football Players: Are There Differences in Cognitive Functioning and Symptom Reporting?

    Science.gov (United States)

    Brooks, Brian L; Mannix, Rebekah; Maxwell, Bruce; Zafonte, Ross; Berkner, Paul D; Iverson, Grant L

    2016-12-01

    There is increasing concern about the possible long-term effects of multiple concussions, particularly on the developing adolescent brain. Whether the effect of multiple concussions is detectable in high school football players has not been well studied, although the public health implications are great in this population. To determine if there are measureable differences in cognitive functioning or symptom reporting in high school football players with a history of multiple concussions. Cross-sectional study; Level of evidence, 3. Participants included 5232 male adolescent football players (mean [±SD] age, 15.5 ± 1.2 years) who completed baseline testing between 2009 and 2014. On the basis of injury history, athletes were grouped into 0 (n = 4183), 1 (n = 733), 2 (n = 216), 3 (n = 67), or ≥4 (n = 33) prior concussions. Cognitive functioning was measured by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery, and symptom ratings were obtained from the Post-Concussion Symptom Scale. There were no statistically significant differences between groups (based on the number of reported concussions) regarding cognitive functioning. Athletes with ≥3 prior concussions reported more symptoms than did athletes with 0 or 1 prior injury. In multivariate analyses, concussion history was independently related to symptom reporting but less so than developmental problems (eg, attention or learning problems) or other health problems (eg, past treatment for psychiatric problems, headaches, or migraines). In the largest study to date, high school football players with multiple past concussions performed the same on cognitive testing as those with no prior concussions. Concussion history was one of several factors that were independently related to symptom reporting. © 2016 The Author(s).

  11. Somatic expansion of the Huntington's disease CAG repeat in the brain is associated with an earlier age of disease onset.

    Science.gov (United States)

    Swami, Meera; Hendricks, Audrey E; Gillis, Tammy; Massood, Tiffany; Mysore, Jayalakshmi; Myers, Richard H; Wheeler, Vanessa C

    2009-08-15

    The age of onset of Huntington's disease (HD) is determined primarily by the length of the HD CAG repeat mutation, but is also influenced by other modifying factors. Delineating these modifiers is a critical step towards developing validated therapeutic targets in HD patients. The HD CAG repeat is somatically unstable, undergoing progressive length increases over time, particularly in brain regions that are the targets of neurodegeneration. Here, we have explored the hypothesis that somatic instability of the HD CAG repeat is itself a modifier of disease. Using small-pool PCR, we quantified somatic instability in the cortex region of the brain from a cohort of HD individuals exhibiting phenotypic extremes of young and old disease onset as predicted by the length of their constitutive HD CAG repeat lengths. After accounting for constitutive repeat length, somatic instability was found to be a significant predictor of onset age, with larger repeat length gains associated with earlier disease onset. These data are consistent with the hypothesis that somatic HD CAG repeat length expansions in target tissues contribute to the HD pathogenic process, and support pursuing factors that modify somatic instability as viable therapeutic targets.

  12. Greater neurobehavioral deficits occur in adult mice after repeated, as compared to single, mild traumatic brain injury (mTBI).

    Science.gov (United States)

    Nichols, Jessica N; Deshane, Alok S; Niedzielko, Tracy L; Smith, Cory D; Floyd, Candace L

    2016-02-01

    Mild traumatic brain injury (mTBI) accounts for the majority of all brain injuries and affected individuals typically experience some extent of cognitive and/or neuropsychiatric deficits. Given that repeated mTBIs often result in worsened prognosis, the cumulative effect of repeated mTBIs is an area of clinical concern and on-going pre-clinical research. Animal models are critical in elucidating the underlying mechanisms of single and repeated mTBI-associated deficits, but the neurobehavioral sequelae produced by these models have not been well characterized. Thus, we sought to evaluate the behavioral changes incurred after single and repeated mTBIs in mice utilizing a modified impact-acceleration model. Mice in the mTBI group received 1 impact while the repeated mTBI group received 3 impacts with an inter-injury interval of 24h. Classic behavior evaluations included the Morris water maze (MWM) to assess learning and memory, elevated plus maze (EPM) for anxiety, and forced swim test (FST) for depression/helplessness. Additionally, species-typical behaviors were evaluated with the marble-burying and nestlet shredding tests to determine motivation and apathy. Non-invasive vibration platforms were used to examine sleep patterns post-mTBI. We found that the repeated mTBI mice demonstrated deficits in MWM testing and poorer performance on species-typical behaviors. While neither single nor repeated mTBI affected behavior in the EPM or FST, sleep disturbances were observed after both single and repeated mTBI. Here, we conclude that behavioral alterations shown after repeated mTBI resemble several of the deficits or disturbances reported by patients, thus demonstrating the relevance of this murine model to study repeated mTBIs.

  13. The Sport Concussion Education Project. A brief report on an educational initiative: from concept to curriculum.

    Science.gov (United States)

    Echlin, Paul S; Johnson, Andrew M; Holmes, Jeffrey D; Tichenoff, Annalise; Gray, Sarah; Gatavackas, Heather; Walsh, Joanne; Middlebro, Tim; Blignaut, Angelique; MacIntyre, Martin; Anderson, Chris; Fredman, Eli; Mayinger, Michael; Skopelja, Elaine N; Sasaki, Takeshi; Bouix, Sylvain; Pasternak, Ofer; Helmer, Karl G; Koerte, Inga K; Shenton, Martha E; Forwell, Lorie A

    2014-12-01

    Current research on concussion is primarily focused on injury identification and treatment. Prevention initiatives are, however, important for reducing the incidence of brain injury. This report examines the development and implementation of an interactive electronic teaching program (an e-module) that is designed specifically for concussion education within an adolescent population. This learning tool and the accompanying consolidation rubric demonstrate that significant engagement occurs in addition to the knowledge gained among participants when it is used in a school curriculum setting.

  14. A Case for Mental and Physical Rest in Youth Sports Concussion: It’s Never Too Late

    Directory of Open Access Journals (Sweden)

    Rosemarie Scolaro Moser

    2012-12-01

    Full Text Available ABSTRACTOver the past decade, there has been a considerable increase in research on, and media attention to, sports-related concussion. However, despite accurate diagnosis, effective treatment and management of sports-related concussion have remained a challenge. There are approximately 1.8 million traumatic brain injuries in the United States annually (Faul, Xu, Wald, & Coronado, 2010 and emergency department pediatric visits for suspected concussion have doubled in the past decade (Bakhos, Lockhart, Myers, & Linakis, 2010. However, health care providers and medical researchers have yet to offer an effective, reliable evidence based treatment for concussive brain injury. The Zurich 2008 Consensus Statement on Concussion in Sport codified the prescription for cognitive and physical rest immediately following a concussion based on clinical acumen and common sense (McCrory et al., 2009. Currently, rest is the considered the best immediate treatment for concussion. Other supportive and anecdotal treatments are often applied throughout the post-concussive recovery process to address persistent symptoms. The need for empirical research to translate current guidelines for rest into evidence-based treatment protocols is essential. A recent study evaluated the efficacy of comprehensive rest and concluded that such rest may be helpful whether applied soon after a concussion or weeks to months later (Moser, Glatts, Schatz, 2012. Here, we present a case illustrating the effectiveness of rest in a youth athlete, commenced after experiencing 13 months of post-concussion symptoms. There appears to be value in applying a specific period of cognitive and physical rest following concussion, whether immediately or later in the recovery phase.

  15. Sex differences in outcome following sports-related concussion.

    Science.gov (United States)

    Broshek, Donna K; Kaushik, Tanya; Freeman, Jason R; Erlanger, David; Webbe, Frank; Barth, Jeffrey T

    2005-05-01

    Females comprise an increasing percentage of the athlete population across all age groups, and analysis of recent literature reveals that they sustain more concussions in collegiate sports. Results of human and animal studies indicate that females may have poorer outcomes after traumatic brain injury; however, no return-to-play guideline takes sex or other individual differences into account. In the present study the authors evaluated the influence of patient sex on objective neurocognitive performance and subjective reporting of symptoms following sports-related concussion. According to preseason baseline neurocognitive computerized testing in 2340 male and female high school and collegiate athletes, individuals who sustained sports-related concussions (155 persons) were reevaluated using an alternate form of the cognitive test. Sex differences in the magnitude of cognitive change from baseline levels and the subjective experience of symptoms were analyzed. To account for the possible protective effects of helmets, comparisons were performed among females, males with helmets, and males without helmets; none of the female athletes wore helmets. Female athletes had significantly greater declines in simple and complex reaction times relative to preseason baseline levels, and they reported more postconcussion symptoms compared with males. As a group, females were cognitively impaired approximately 1.7 times more frequently than males following concussions. Furthermore, females experienced more objective and subjective adverse effects from concussion even after adjusting for the use of helmets by some groups of male athletes (for example, in football). Return-to-play decisions and concussion management must be objective and made on an individual basis, including consideration of factors such as patient sex rather than relying on a one-size-fits-all guideline.

  16. CONCUSSION IN SPORT: PRACTICAL MANAGEMENT ...

    African Journals Online (AJOL)

    Enrique

    American football, ice hockey and horse riding also have a significant incidence of concussion. Traditionally, there has been a lack of universal agreement on a standard .... players, the hypothesis being that this .... large number of players.

  17. Clinical Characteristics of Labyrinthine Concussion

    OpenAIRE

    Choi, Mi Suk; Shin, See-Ok; Yeon, Je Yeob; Choi, Young Seok; Kim, Jisung; Park, Soo Kyoung

    2013-01-01

    Background and Objectives Inner ear symptoms like hearing loss, dizziness or tinnitus are often developed after head trauma, even in cases without inner ear destruction. This is also known as labyrinthine concussion. The purpose of this study is to determine the clinical manifestations, characteristics of audiometry and prognostic factors of these patients. Materials and Methods We reviewed the medical records of the 40 patients that had been diagnosed as labyrinthine concussion from 1996 to ...

  18. Hockey Concussion Education Project, Part 2. Microstructural white matter alterations in acutely concussed ice hockey players: a longitudinal free-water MRI study.

    Science.gov (United States)

    Pasternak, Ofer; Koerte, Inga K; Bouix, Sylvain; Fredman, Eli; Sasaki, Takeshi; Mayinger, Michael; Helmer, Karl G; Johnson, Andrew M; Holmes, Jeffrey D; Forwell, Lorie A; Skopelja, Elaine N; Shenton, Martha E; Echlin, Paul S

    2014-04-01

    Concussion is a common injury in ice hockey and a health problem for the general population. Traumatic axonal injury has been associated with concussions (also referred to as mild traumatic brain injuries), yet the pathological course that leads from injury to recovery or to long-term sequelae is still not known. This study investigated the longitudinal course of concussion by comparing diffusion MRI (dMRI) scans of the brains of ice hockey players before and after a concussion. The 2011-2012 Hockey Concussion Education Project followed 45 university-level ice hockey players (both male and female) during a single Canadian Interuniversity Sports season. Of these, 38 players had usable dMRI scans obtained in the preseason. During the season, 11 players suffered a concussion, and 7 of these 11 players had usable dMRI scans that were taken within 72 hours of injury. To analyze the data, the authors performed free-water imaging, which reflects an increase in specificity over other dMRI analysis methods by identifying alterations that occur in the extracellular space compared with those that occur in proximity to cellular tissue in the white matter. They used an individualized approach to identify alterations that are spatially heterogeneous, as is expected in concussions. Paired comparison of the concussed players before and after injury revealed a statistically significant (p brain tissue. Fractional anisotropy was significantly increased, but this change was no longer significant following the free-water elimination. Concussion during ice hockey games results in microstructural alterations that are detectable using dMRI. The alterations that the authors found suggest decreased extracellular space and decreased diffusivities in white matter tissue. This finding might be explained by swelling and/or by increased cellularity of glia cells. Even though these findings in and of themselves cannot determine whether the observed microstructural alterations are related to long

  19. A prospective study of physician-observed concussions during junior ice hockey: implications for incidence rates.

    Science.gov (United States)

    Echlin, Paul Sean; Tator, Charles H; Cusimano, Michael D; Cantu, Robert C; Taunton, Jack E; Upshur, Ross E G; Hall, Craig R; Johnson, Andrew M; Forwell, Lorie A; Skopelja, Elaine N

    2010-11-01

    The objective of this study was to measure the incidence of concussion (scaled relative to number of athlete exposures) and recurrent concussion within 2 teams of fourth-tier junior ice hockey players (16-21 years old) during 1 regular season. A prospective cohort study called the Hockey Concussion Education Project was conducted during 1 junior ice hockey regular season (2009-2010) involving 67 male fourth-tier ice hockey players (mean age 18.2 ± 1.2 years, range 16-21 years) from 2 teams. Prior to the start of the season, every player underwent baseline assessments using the Sideline Concussion Assessment Tool 2 (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). The study protocol also required players who entered the study during the season to complete baseline SCAT2 and ImPACT testing. If the protocol was not followed, the postinjury test results of a player without true baseline test results would be compared against previously established age and gender group normative levels. Each regular season game was observed by a qualified physician and at least 1 other neutral nonphysician observer. Players who suffered a suspected concussion were evaluated at the game. If a concussion diagnosis was made, the player was subsequently examined in the physician's office for a full clinical evaluation and the SCAT2 and ImPACT were repeated. Based on these evaluations, players were counseled on the decision of when to return to play. Athlete exposure was defined as 1 game played by 1 athlete. Twenty-one concussions occurred during the 52 physician-observed games (incidence 21.5 concussions per 1000 athlete exposures). Five players experienced repeat concussions. No concussions were reported during practice sessions. A concussion was diagnosed by the physician in 19 (36.5%) of the 52 observed games. One of the 5 individuals who suffered a repeat concussion sustained his initial concussion in a regular season game that was not observed by a

  20. Do Multiple Concussions Lead to Cumulative Cognitive Deficits? A Literature Review.

    Science.gov (United States)

    Yumul, Joy Noelle; McKinlay, Audrey

    2016-11-01

    A concussion is an important health concern for children and adolescents, particularly in the context of sporting injuries. Some research suggests a cumulative effect from multiple concussions (also referred to as mild traumatic brain injury), which creates a dilemma when considering how to manage children and young persons who may experience multiple concussive events within a sporting season. However, there is very little research regarding the outcomes of multiple concussions and their optimal management. The purpose of this review is to evaluate the evidence regarding the cognitive outcomes of multiple concussions. After assessing the eligibility of the articles from the literature search, 7 studies were identified and included in the review. In most of the available literature, the cognitive outcomes related to multiple concussions are measured during the same developmental age as when the injuries happened. Moreover, most studies that investigated multiple concussions are focused on sports-related injuries, and only some are conducted in children and adolescents in the general population. The current evidence is inconclusive; whereas some studies reported adverse outcomes, others reported null findings. The studies that reported adverse or cumulative effects based their findings on worse cognitive outcomes, more subjective symptoms, and prolonged recovery postinjury. II. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  1. Impact of repeated stress on traumatic brain injury-induced mitochondrial electron transport chain expression and behavioral responses in rats

    Directory of Open Access Journals (Sweden)

    Guoqiang eXing

    2013-12-01

    Full Text Available A significant proportion of the military personnel returning from Iraq and Afghanistan conflicts have suffered from both mild traumatic brain injury (mTBI and post-traumatic stress disorder (PTSD. The mechanisms are unknown. We used a rat model of repeated stress and mTBI to examine brain activity and behavioral function. Adult male Sprague-Dawley rats were divided into 4 groups: Naïve; 3 days repeated tail-shock stress; lateral fluid percussion mTBI; and repeated stress followed by mTBI (S-mTBI. Open field activity, sensorimotor responses, and acoustic startle responses were measured after mTBI. The protein expression of mitochondrial electron transport chain (ETC complex subunits (CI-V and pyruvate dehydrogenase (PDHE1α1 were determined in 4 brain regions at day 7 post mTBI. Compared to Naïves, repeated stress decreased horizontal activity; repeated stress and mTBI both decreased vertical activity; and the mTBI and S-mTBI groups were impaired in sensorimotor and acoustic startle responses. Repeated stress significantly increased CI, CII, and CIII protein levels in the prefrontal cortex (PFC, but decreased PDHE1α1 protein in the PFC and cerebellum, and decreased CIV protein in the hippocampus. The mTBI treatment decreased CV protein levels in the ipsilateral hippocampus. The S-mTBI treatment resulted in increased CII, CIII, CIV, and CV protein levels in the PFC, increased CI level in the cerebellum, and increased CIII and CV levels in the cerebral cortex, but decreased CI, CII, CIV, and PDHE1α1 protein levels in the hippocampus. Thus, repeated stress or mTBI alone differentially altered ETC expression in heterogeneous brain regions. Repeated stress followed by mTBI had synergistic effects on brain ETC expression, and resulted in more severe behavioral deficits. These results suggest that repeated stress could have contributed to the high incidence of long-term neurologic and neuropsychiatric morbidity in military personnel with or without

  2. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... Materials on Concussion in Sports Materials for Health Care Providers Materials for School Professionals Learn More about the ... Materials on Concussion in Sports Materials for Health Care Providers Materials for School Professionals Order Large Quantities of ...

  3. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... or longer. A True B False Submit POST TEST QUESTION 1 A concussion is a: A type ... loud sound heard from far away. Submit POST TEST QUESTION 2 When can concussions occur? A Only ...

  4. Identifying Concussion / Mild TBI in Service Members

    Science.gov (United States)

    2012-03-22

    more concussions o Median time between concussions equals 40 days o Based on reports from 2004-2008 in Iraq treated at Navy/Marine Corps facilities...Important because multiple concussions are often associated with slower recovery and increased risk of long-term sequelae Reference: *Wilk et...Injury Guidance 35 Screening Challenges for the Military  Concussions that occur in theater occur under unique circumstances: o In the context of

  5. Relationship of collegiate football experience and concussion with hippocampal volume and cognitive outcomes.

    Science.gov (United States)

    Singh, Rashmi; Meier, Timothy B; Kuplicki, Rayus; Savitz, Jonathan; Mukai, Ikuko; Cavanagh, LaMont; Allen, Thomas; Teague, T Kent; Nerio, Christopher; Polanski, David; Bellgowan, Patrick S F

    2014-05-14

    Concussion and subconcussive impacts have been associated with short-term disrupted cognitive performance in collegiate athletes, but there are limited data on their long-term neuroanatomic and cognitive consequences. To assess the relationships of concussion history and years of football experience with hippocampal volume and cognitive performance in collegiate football athletes. Cross-sectional study conducted between June 2011 and August 2013 at a US psychiatric research institute specializing in neuroimaging among collegiate football players with a history of clinician-diagnosed concussion (n = 25), collegiate football players without a history of concussion (n = 25), and non-football-playing, age-, sex-, and education-matched healthy controls (n = 25). History of clinician-diagnosed concussion and years of football experience. High-resolution anatomical magnetic resonance imaging was used to quantify brain volumes. Baseline scores on a computerized concussion-related cognitive battery were used for cognitive assessment in athletes. Players with and without a history of concussion had smaller hippocampal volumes relative to healthy control participants (with concussion: t48 = 7.58; P football played (t46 = -3.62; P football and reaction time (ρ42 = -0.43; 95% CI, -0.46 to -0.40; P = .005). Among a group of collegiate football athletes, there was a significant inverse relationship of concussion and years of football played with hippocampal volume. Years of football experience also correlated with slower reaction time. Further research is needed to determine the temporal relationships of these findings.

  6. Prolonged Repeated Acupuncture Stimulation Induces Habituation Effects in Pain-Related Brain Areas: An fMRI Study

    Science.gov (United States)

    Li, Chuanfu; Yang, Jun; Park, Kyungmo; Wu, Hongli; Hu, Sheng; Zhang, Wei; Bu, Junjie; Xu, Chunsheng; Qiu, Bensheng; Zhang, Xiaochu

    2014-01-01

    Most previous studies of brain responses to acupuncture were designed to investigate the acupuncture instant effect while the cumulative effect that should be more important in clinical practice has seldom been discussed. In this study, the neural basis of the acupuncture cumulative effect was analyzed. For this experiment, forty healthy volunteers were recruited, in which more than 40 minutes of repeated acupuncture stimulation was implemented at acupoint Zhusanli (ST36). Three runs of acupuncture fMRI datasets were acquired, with each run consisting of two blocks of acupuncture stimulation. Besides general linear model (GLM) analysis, the cumulative effects of acupuncture were analyzed with analysis of covariance (ANCOVA) to find the association between the brain response and the cumulative duration of acupuncture stimulation in each stimulation block. The experimental results showed that the brain response in the initial stage was the strongest although the brain response to acupuncture was time-variant. In particular, the brain areas that were activated in the first block and the brain areas that demonstrated cumulative effects in the course of repeated acupuncture stimulation overlapped in the pain-related areas, including the bilateral middle cingulate cortex, the bilateral paracentral lobule, the SII, and the right thalamus. Furthermore, the cumulative effects demonstrated bimodal characteristics, i.e. the brain response was positive at the beginning, and became negative at the end. It was suggested that the cumulative effect of repeated acupuncture stimulation was consistent with the characteristic of habituation effects. This finding may explain the neurophysiologic mechanism underlying acupuncture analgesia. PMID:24821143

  7. Efforts to Prevent Concussions Target Schools

    Science.gov (United States)

    Samuels, Christina A.

    2010-01-01

    The number of sports-related concussions reported by young athletes is on the rise, prompting awareness campaigns from athletic and medical groups, as well as proposed federal legislation to set minimum standards for concussion management in public schools. Concussions are caused by a jolt to the body or a blow to the head that causes the head to…

  8. Neuropsychological evaluation in the diagnosis and management of sports-related concussion.

    Science.gov (United States)

    Moser, Rosemarie Scolaro; Iverson, Grant L; Echemendia, Ruben J; Lovell, Mark R; Schatz, Philip; Webbe, Frank M; Ruff, Ronald M; Barth, Jeffrey T

    2007-11-01

    A mild traumatic brain injury in sports is typically referred to as a concussion. This is a common injury in amateur and professional athletics, particularly in contact sports. This injury can be very distressing for the athlete, his or her family, coaches, and school personnel. Fortunately, most athletes recover quickly and fully from this injury. However, some athletes have a slow recovery, and there are reasons to be particularly concerned about re-injury during the acute recovery period. Moreover, some athletes who have experienced multiple concussions are at risk for long-term adverse effects. Neuropsychologists are uniquely qualified to assess the neurocognitive and psychological effects of concussion. The National Academy of Neuropsychology recommends neuropsychological evaluation for the diagnosis, treatment, and management of sports-related concussion at all levels of play.

  9. Concussive convulsions as differential diagnosis of posttraumatic epilepsy

    Directory of Open Access Journals (Sweden)

    Vojvodić Nikola M.

    2002-01-01

    Full Text Available Concussive convulsions are motor manifestations in acute head injury. This clinical phenomenon should be distin- guished from epileptic seizures. We present two young men with motor and convulsive manifestations in acute head injury. Patient 1. A18-year old basketball player felt on the parquet during a game. Initially he was struck on the right shoulder which caused brief and vigorous twitch of the head towards the ground and additional temporal impact. At the moment of impact he lost consciousness and developed tonic leg and arm posturing with both clenched fists. His legs were extended during next 20 seconds. Thereafter he was still and his loss of consciousness lasted 3 minutes. Patient 2. A 26-year old man felt on the wooden ground from a 4 m high ferry. He got head impact and lost consciousness. In a few seconds he had tonic/clonic convulsions for the next 10-15 seconds. Ten minutes later he awaked. Results of subsequent neurological examination, electroencephalography and cerebral magnetic resonance imaging studies were normal in both patients. They returned to their occupations after four weeks without problems for a further one year. Conclusion. Described motor manifestations present concussive convulsions. These clinical features are due to transient functional decerebration and corticomedullary dissociation during cerebral concussion. Concussive convulsions are a non-epileptic phenomenon, they are not associated with structural brain injury and have good prognosis. Antiepileptic treatment is not indicated.

  10. The neuropathology and neurobiology of traumatic brain injury.

    Science.gov (United States)

    Blennow, Kaj; Hardy, John; Zetterberg, Henrik

    2012-12-06

    The acute and long-term consequences of traumatic brain injury (TBI) have received increased attention in recent years. In this Review, we discuss the neuropathology and neural mechanisms associated with TBI, drawing on findings from sports-induced TBI in athletes, in whom acute TBI damages axons and elicits both regenerative and degenerative tissue responses in the brain and in whom repeated concussions may initiate a long-term neurodegenerative process called dementia pugilistica or chronic traumatic encephalopathy (CTE). We also consider how the neuropathology and neurobiology of CTE in many ways resembles other neurodegenerative illnesses such as Alzheimer's disease, particularly with respect to mismetabolism and aggregation of tau, β-amyloid, and TDP-43. Finally, we explore how translational research in animal models of acceleration/deceleration types of injury relevant for concussion together with clinical studies employing imaging and biochemical markers may further elucidate the neurobiology of TBI and CTE.

  11. 脑震荡综合征患者脑网络效率的变化%Alterations of brain network efficiency in patients with post-concussion syndrome

    Institute of Scientific and Technical Information of China (English)

    彭楠; 钱若兵; 傅先明; 李顺利; 亢志强; 林彬; 季学兵; 魏祥品; 牛朝诗

    2015-01-01

    Objective To discuss the alterations of brain network efficiency in patients with postconcussion syndrome.Methods A total of 23 patients from Anhui Provincial Hospital in the period from 2013/6 to 2014/3 who have had the concussion for 3 months were enrolled and 23 volunteers paired in sex,age and education were also enrolled as healthy controls.Comparisons of selective attention of both groups were conducted using Stroop Word-Color Test.The data of resting-state functional magnetic resonance imaging (fMRI) in both groups were collected and the data were dealt with Network Construction which is a part of GRETNA software to obtain the Matrix of brain network.Network analysis was used to obtain Global and Nodal efficiency,then independent t-test was used for statistical analyses of the value of Global and Nodal efficiency.Results The difference in Global efficiency of two groups in every threshold value had no statisticalsignificance.Compared with healthy controls,the Nodal efficienciesin patients with post-concussion syndrome weresignificantly different in the brain regionsas below:left orbital middle frontal gyrus,left posterior cingulate,left lingual,left thalamus,left superior temporal gyrus,right anterior cingulate,right posterior cingulate,right supramarginalgyrus.Conclusions Compared with healthy controls,there is no significant changes of Globe efficiency in patients with post-concussion syndrome,and the brain function deficits in these patients may be caused by changes of Nodal efficiency in their brain network.%目的 探讨采用图论的方法对脑震荡综合征患者脑网络效率的改变.方法 2013年6月至2014年3月在安徽医科大学附属省立医院就诊的脑震荡综合征患者23例,有迁延不愈的头晕、头痛、注意力下降、注意力不集中、记忆下降、睡眠障碍等功能障碍,另招募23例健康对照者;两组被试进行Stroop色词实验了解选择性注意功能是否存在差别;采集两

  12. Sport and Sex-Specific Reporting Trends in the Epidemiology of Concussions Sustained by High School Athletes.

    Science.gov (United States)

    Schallmo, Michael S; Weiner, Joseph A; Hsu, Wellington K

    2017-08-02

    Approximately 300,000 U.S. adolescents sustain concussions annually while participating in organized athletics. This study aimed to track sex and sport-specific trends among high school sports-related concussions over time, to identify whether a particular sport predisposes athletes to a higher risk, and to assess whether traumatic brain injury law enactments have been successful in improving recognition. Injury data for academic years 2005 to 2014 were collected from annual reports generated by High School RIO (Reporting Information Online). The relative proportions of total estimated concussions to total estimated injuries were compared using an injury proportion ratio. The concussion rate was defined as the number of concussions per 10,000 athlete exposures (1 athlete participating in 1 practice or competition), with rates compared using a rate ratio. To evaluate the impact of legislation on sports-related concussions in this population, trends in concussion rates and proportions were analyzed before enactment (academic years 2005-2009) and after enactment (academic years 2010-2014). Between 2005-2006 and 2014-2015, a significant increase (p concussions for all sports combined, the overall concussion rate (rate ratio, 2.30 [95% confidence interval, 2.04 to 2.59]), and the overall proportion of concussions (injury proportion ratio, 2.68 [95% confidence interval, 2.66 to 2.70]) was seen. Based on the injury proportion ratio, during the 2014-2015 academic year, concussions were more common in girls' soccer than in any other sport (p concussions during the past decade could have been affected by traumatic brain injury legislation. To our knowledge, this is the first study to show that girls' soccer players may have an even greater risk of sustaining a concussion than all other sports. Sports-related concussions in adolescent athletes can have devastating consequences, and we now know that female athletes, especially girls' soccer players, may be at an even greater

  13. Concussion reporting intention: a valuable metric for predicting reporting behavior and evaluating concussion education.

    Science.gov (United States)

    Kroshus, Emily; Baugh, Christine M; Daneshvar, Daniel H; Nowinski, Christopher J; Cantu, Robert C

    2015-05-01

    This study aimed to evaluate whether preseason concussion knowledge and reporting intention predicted in-season concussion reporting behavior. Prospective cohort study. Collegiate athletic facility of each participating team. National Collegiate Athletic Association Division I men's ice hockey players in 1 conference of competition (n = 116). Intention to report symptoms of a "minor" concussion and concussion knowledge were assessed at preseason. Postseason recall of non-report of postimpact symptoms. Preseason concussion knowledge was not significantly associated with in-season reporting behavior. Intention to report concussion symptoms was significantly related to in-season reporting behavior. There was a significant interaction between the number of different symptoms experienced and both preseason reporting intention and in-season reporting behavior. Evaluations of concussion education programs tend to measure concussion knowledge. The present findings suggest that reporting intention may be more strongly predictive of reporting behavior than concussion knowledge and should be included in evaluations of concussion effectiveness. New concussion education initiatives should consider targeting psychosocial constructs that increase reporting intention. Sports medicine clinicians who are involved in evaluating concussion education programs should measure constructs other than just concussion knowledge. Intention, to report symptoms or to continue play while experiencing symptoms of a concussion, seems to be an important and feasible construct to include as part of proximal evaluations of education effectiveness.

  14. The cognitive effects and decrements following concussion

    Directory of Open Access Journals (Sweden)

    Tracey Covassin

    2010-05-01

    Full Text Available Tracey Covassin, Robert J ElbinMichigan State University, Department of Kinesiology, East Lansing, MI, USAAbstract: Sports-related concussion is an injury that continues to receive attention from both the popular media and sports medicine community. The many different symptom presentations and cognitive decrements that follow concussions, have made this injury difficult to detect and manage. Furthermore, concussed athletes should not always be entrusted to appropriately self-report their concussion symptoms; therefore the burden falls on the clinician and coach. Recent management recommendations call for using a multi-faceted approach to managing concussion, which consists of neurocognitive testing before (ie, baseline/preseason and after injury. In addition age, sex, and previous history of concussion have been found to influence the risk and recovery from this injury.Keywords: cognitive function, neurocognitive testing, concussion

  15. Emergency Medical Service Personnel Recognize Pediatric Concussions.

    Science.gov (United States)

    Speirs, Joshua N; Lyons, Matthew I; Johansson, Bert E

    2017-01-01

    Concussions are a major cause of morbidity in pediatrics. Many concussions occur during activities with emergency medical service (EMS) providers present to determine if a higher level of care is needed. Data are limited on how capable these providers are. We assessed the ability of EMS providers to recognize pediatric concussions. Fifty-six total responses were included, 38 from EMS and 18 from our MD/RN (medical doctor/registered nurse) group. No statistical differences were found between the 2 groups when adjusted for age, gender, number of years in practice, and number of pediatric concussions managed. This first of its kind pilot study was designed to assess EMS personnel's ability to recognize and triage pediatric concussions. Our findings show EMS providers are statistically identical in their ability to recognize and triage concussions to physicians. The performance of our MD participants was lower than expected. Larger studies are needed to further investigate EMS providers' ability to recognize a concussion.

  16. Concussion Management in the Classroom.

    Science.gov (United States)

    Graff, Danielle M; Caperell, Kerry S

    2016-12-01

    There is a new emphasis on the team approach to pediatric concussion management, particularly in the classroom. However, it is expected that educators are unfamiliar with the "Returning to Learning" recommendations. The authors' primary objective was to assess and improve high school educators' knowledge regarding concussions and management interventions using an online education tool. A total of 247 high school educators completed a 12 question pretest to assess core knowledge of concussions and classroom management followed by a 20-minute online literature-based education module. Participants then completed an identical posttest. The improvement in core knowledge was statistically significant (P classroom management also showed a statistically significant increase in scores (P classroom management as well as the significant improvement after an online educational module. © The Author(s) 2016.

  17. Isolation and characterization of human brain genes with (CCA){sub n} trinucleotide repeats

    Energy Technology Data Exchange (ETDEWEB)

    Longshore, J.W.; Finley, W.H.; Descartes, M. [Univ. of Alabama, Birmingham, AL (United States)] [and others

    1994-09-01

    Expansion of trinucleotide repeats has been described as a new form of mutation. To date, only the expansion of (CGG){sub n} and (CAG){sub n} repeats have been associated with disease. Expansion of (CAG){sub n} repeats has been found to cause Huntington`s disease, Kennedy`s disease, myotonic dystrophy, spinocerebellar ataxia type 1, and dentatorubral pallidoluysian atrophy. (CGG){sub n} repeat expansion has been implicated in the fragile X syndrome and FRAXE mental retardation. In an effort to identify other potential repeats as candidates for expansion, a DNA linguistics approach was used to study 10 Mb of human DNA sequences in GenBank. Our study found the (CCA){sub n} repeat and the disease-associated (CGG){sub n} and (CAG){sub n} repeats to be over-represented in the human genome. The (CCA){sub n} repeat also shares other characteristics with (CGG){sub n} and (CAG){sub n}, making it a good candidate for expansion. Trinucleotide repeat numbers in disease-associated genes are normally polymorphic in a population. Therefore, by studying genes for polymorphisms, candidate genes may be identified. Twelve sequences previously deposited in GenBank with at least five tandem copies of (CCA) were studied and no polymorphisms were found. To identify other candidate genes, a human hippocampus cDNA library was screened with a (CCA){sub 8} probe. This approach identified 19 novel expressed sequences having long tandem (CCA){sub n} repeats which are currently under investigation for polymorphisms. Genes with polymorphic repeats may serve as markers for linkage studies or as candidate genes for genetic diseases showing anticipation.

  18. A mouse model of human repetitive mild traumatic brain injury

    OpenAIRE

    Kane, Michael J; Pérez, Mariana Angoa; Briggs, Denise I.; Viano, David C.; Kreipke, Christian W.; Kuhn, Donald M.

    2011-01-01

    A novel method for the study of repetitive mild traumatic brain injury (rmTBI) that models the most common form of head injury in humans is presented. Existing animal models of TBI impart focal, severe damage unlike that seen in repeated and mild concussive injuries, and few are configured for repetitive application. Our model is a modification of the Marmarou weight drop method and allows repeated head impacts to lightly anesthetized mice. A key facet of this method is the delivery of an imp...

  19. Effect of snowboard-related concussion safety education for recognizing possible concussions.

    Science.gov (United States)

    Koh, J O

    2011-12-01

    The aim of this study was to examine the understanding of snowboard-related concussion and to measure the recognition of possible concussion occurrence after an intervention of snowboard-related concussion safety education in snowboarding. Incidence cohort design. 2008-2009 season Gangwon-do Ski resorts, South Korea. A total of 208 university students (female-72; male-136; age-18 to 32) who registered for a snowboarding class and received credit participated in this project. Snowboard-related concussion safety education class was administered for 30 minutes before the snowboard class began. The knowledge of snowboard-related concussion before and after the safety education was evaluated. Concussion data were collected via a self-report case form at the last day of snowboarding class. The incidence of possible concussion and factors associated with concussions were analyzed by χ2 test. The mean score of snowboard-related concussion knowledge improved from fifteen points to eighteen points out of 20 total points possible. Overall the incidence of concussion was 10 per 100 snowboarder-exposures. χ2 tests showed concussion rates to be significantly different in female snowboarders (P=0.00) and in helmet users (P=0.02). The incidence of possible concussion is high among snowboarding class participants. Emphasis should be given for instituting pre-participation balance training, especially for females to reduce falling in snowboarding. To verify the effects of pre-participation balance training and falling results in a concussion, more research is needed in the future.

  20. The impact of patient characteristics on nurse practitioners' assessment and management of adolescent concussion.

    Science.gov (United States)

    Graves, Janessa M; Klein, Tracy A

    2017-03-01

    To evaluate the effect of patient sex and type of activity on concussion assessment and management recommendations. We administered a web-based survey to all nurse practitioners (NPs) actively licensed in Washington and Oregon. Participants were randomized to view one of four standardized patient scenario videos of an adolescent seeking care for a concussion, portraying the same symptomology but differing by sex and activity (soccer/hiking). Respondents provided assessment and management recommendations. In total, 1021 NPs provided sufficient data for analysis. Most NPs correctly identified the injury as a concussion (92.8%); fewer identified it as a mild traumatic brain injury (55.3%). NPs who viewed hiking videos were 40% more likely to indicate that the patient was definitely or likely safe to return to activity in 1 week, compared to a soccer player, after adjusting for covariates (RR = 1.40, 95% CI [1.16, 1.68]). While most assessment and management recommendations did not vary according to patient sex, providers may manage concussions differently based on etiology. Appropriate and consistent concussion assessment and management is important, as NPs are authorized to assess adolescents with concussions and make determinations regarding return to activity or school. ©2016 American Association of Nurse Practitioners.

  1. Episodic memory in former professional football players with a history of concussion: an event-related functional neuroimaging study.

    Science.gov (United States)

    Ford, Jaclyn H; Giovanello, Kelly S; Guskiewicz, Kevin M

    2013-10-15

    Previous research has demonstrated that sport-related concussions can have short-term effects on cognitive processes, but the long-term consequences are less understood and warrant more research. This study was the first to use event-related functional magnetic resonance imaging (fMRI) to examine long-term differences in neural activity during memory tasks in former athletes who have sustained multiple sport-related concussions. In an event-related fMRI study, former football players reporting multiple sport-related concussions (i.e., three or more) were compared with players who reported fewer than three concussions during a memory paradigm examining item memory (i.e., memory for the particular elements of an event) and relational memory (i.e., memory for the relationships between elements). Behaviorally, we observed that concussion history did not significantly affect behavioral performance, because persons in the low and high concussion groups had equivalent performance on both memory tasks, and in addition, that concussion history was not associated with any behavioral memory measures. Despite demonstrating equivalent behavioral performance, the two groups of former players demonstrated different neural recruitment patterns during relational memory retrieval, suggesting that multiple concussions may be associated with functional inefficiencies in the relational memory network. In addition, the number of previous concussions significantly correlated with functional activity in a number of brain regions, including the medial temporal lobe and inferior parietal lobe. Our results provide important insights in understanding the long-term functional consequences of sustaining multiple sports-related concussions.

  2. High school coaches perceptions of physicians’ role in the assessment and management of sports-related concussive injury

    Directory of Open Access Journals (Sweden)

    Nolan eWilliams

    2012-10-01

    Full Text Available Sports concussions are an increasingly recognized common type of mild traumatic brain injury (TBI that affect athletes of all ages. The need for an increased involvement of trained physicians in the diagnosis and treatment of concussion has become more obvious as the pathophysiology and long-term sequelae of sports concussion are better understood. To date, there has been great variability in the athletic community about the recognition of symptoms, diagnosis, management, and physician role in concussion care. An awareness assessment survey administered to 96 high school coaches in a large metropolitan city demonstrated that 37.5% of responders refer their concussed players to an emergency department after the incident, only 39.5% of responders have a physician available to evaluate their players after a concussion, 71.6% of those who had a physician available sent their players to a sports medicine physician, and none of the responders had their player’s concussion evaluated by a neurologist. Interestingly, 71.8% of responders stated that their players returned to the team with return to play guidelines from their physician. This survey has highlighted two important areas where the medical community can better serve the athletic community. Because a concussion is a sport-inflicted injury to the nervous system, it is optimally evaluated and managed by a clinician with relevant training in both clinical neuroscience and sports medicine. Furthermore, all physicians who see patients suffering concussion should be educated in the current recommendations from the Consensus Statement on Concussion and provide return to play instructions that outline a graduated return to play, allowing the athlete to return to the field safely.

  3. Diffuse white matter tract abnormalities in clinically normal ageing retired athletes with a history of sports-related concussions.

    Science.gov (United States)

    Tremblay, Sebastien; Henry, Luke C; Bedetti, Christophe; Larson-Dupuis, Camille; Gagnon, Jean-François; Evans, Alan C; Théoret, Hugo; Lassonde, Maryse; De Beaumont, Louis

    2014-11-01

    Sports-related concussions have been shown to lead to persistent subclinical anomalies of the motor and cognitive systems in young asymptomatic athletes. In advancing age, these latent alterations correlate with detectable motor and cognitive function decline. Until now, the interacting effects of concussions and the normal ageing process on white matter tract integrity remain unknown. Here we used a tract-based spatial statistical method to uncover potential white matter tissue damage in 15 retired athletes with a history of concussions, free of comorbid medical conditions. We also investigated potential associations between white matter integrity and declines in cognitive and motor functions. Compared to an age- and education-matched control group of 15 retired athletes without concussions, former athletes with concussions exhibited widespread white matter anomalies along many major association, interhemispheric, and projection tracts. Group contrasts revealed decreases in fractional anisotropy, as well as increases in mean and radial diffusivity measures in the concussed group. These differences were primarily apparent in fronto-parietal networks as well as in the frontal aspect of the corpus callosum. The white matter anomalies uncovered in concussed athletes were significantly associated with a decline in episodic memory and lateral ventricle expansion. Finally, the expected association between frontal white matter integrity and motor learning found in former non-concussed athletes was absent in concussed participants. Together, these results show that advancing age in retired athletes presenting with a history of sports-related concussions is linked to diffuse white matter abnormalities that are consistent with the effects of traumatic axonal injury and exacerbated demyelination. These changes in white matter integrity might explain the cognitive and motor function declines documented in this population. © The Author (2014). Published by Oxford University

  4. Suppression of oxidative stress and 5-lipoxygenase activation by edaravone improves depressive-like behavior after concussion.

    Science.gov (United States)

    Higashi, Youichirou; Hoshijima, Michihiro; Yawata, Toshio; Nobumoto, Atsuya; Tsuda, Masayuki; Shimizu, Takahiro; Saito, Motoaki; Ueba, Tetuya

    2014-10-15

    Brain concussions are a serious public concern and are associated with neuropsychiatric disorders, such as depression. Patients with concussion who suffer from depression often experience distress. Nevertheless, few pre-clinical studies have examined concussion-induced depression, and there is little information regarding its pharmacological management. Edaravone, a free radical scavenger, can exert neuroprotective effects in several animal models of neurological disorders. However, the effectiveness of edaravone in animal models of concussion-induced depression remains unclear. In this study, we examined whether edaravone could prevent concussion-induced depression. Mice were subjected to a weight-drop injury and intravenously administered edaravone (3.0 mg/kg) or vehicle immediately after impact. Serial magnetic resonance imaging showed no abnormalities of the cerebrum on diffusion T1- and T2-weighted images. We found that edaravone suppressed concussion-induced depressive-like behavior in the forced swim test, which was accompanied by inhibition of increased hippocampal and cortical oxidative stress (OS) and suppression of 5-lipoxygenase (5-LOX) translocation to the nuclear envelope in hippocampal astrocytes. Hippocampal OS in concussed mice was also prevented by the nicotinamide adenine dinucleotide phosphate oxidase inhibitor, apocynin, and administration of BWB70C, a 5-LOX inhibitor, immediately and 24 h after injury prevented depressive-like behaviors in concussed mice. Further, antidepressant effects of edaravone were observed in mice receiving 1.0 or 3.0 mg/kg of edaravone immediately after impact, but not at a lower dose of 0.1 mg/kg. This antidepressant effect persisted up to 1 h after impact, whereas edaravone treatment at 3 h after impact had no effect on concussion-induced depressive-like behavior. These results suggest that edaravone protects against concussion-induced depression, and this protection is mediated by suppression of OS and 5

  5. Underreporting of Concussions and Concussion-Like Symptoms in Female High School Athletes.

    Science.gov (United States)

    McDonald, Tracy; Burghart, Mark A; Nazir, Niaman

    2016-01-01

    Underreporting of concussions and concussion-like symptoms in athletes continues to be a serious medical concern and research focus. Despite mounting worry, little evidence exists examining incidence of underreporting and documenting characteristics of head injury in female athletes participating in high school sports. This study examined the self-reporting behaviors of female high school athletes. Seventy-seven athletes participated, representing 14 high school sports. Nearly half of the athletes (31 participants) reported a suspected concussion, with 10 of the 31 athletes refraining from reporting symptoms to training staff after injury. Only 66% reported receiving concussion education. Concussion education appeared to have no relationship with diagnosed concussion rates in athletes, removing athletes from play, or follow-up medical care after injury. In conclusion, female high school athletes underreport signs and symptoms of concussions. Concussion education should occur at higher rates among female athletes to influence reporting behaviors.

  6. Concussions in Collision Youth Sports

    Directory of Open Access Journals (Sweden)

    Kathleen A. Linzmeier

    2016-03-01

    Full Text Available Investigators from the University of Pittsburg, University of Arkansas, Lake Erie College of Osteopathic Medicine, and Boston Children’s Hospital/Harvard Medical College researched the incidence of concussions in youth hockey in relation to age and activity setting.

  7. Taking Care After A Concussion

    Centers for Disease Control (CDC) Podcasts

    2010-03-17

    This podcast describes how to take care of yourself after a concussion, including proper recognition and response recommendations.  Created: 3/17/2010 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 3/17/2010.

  8. Brain-specific noncoding RNAs are likely to originate in repeats and may play a role in up-regulating genes in cis

    DEFF Research Database (Denmark)

    Francescatto, Margherita; Vitezic, Morana; Heutink, Peter;

    2014-01-01

    . Dysregulation of specific long ncRNAs (lncRNAs) has been shown in neuro-developmental and neuro-degenerative diseases thus highlighting the importance of lncRNAs in brain function. Even though it is known that lncRNAs are expressed in cells at low levels in a tissue-specific manner, bioinformatics analyses...... in the vicinity of brain-specific ncRNAs are significantly up regulated in the brain. Investigations of repeat representation show that brain-specific ncRNAs are significantly more likely to originate in repeat regions especially DNA/TcMar-Tigger compared with non-tissue-specific ncRNAs. We find SINE...

  9. Repeated exposure of the developing rat brain to magnetic resonance imaging did not affect neurogenesis, cell death or memory function

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Changlian [Center for Brain Repair and Rehabilitation, University of Gothenburg (Sweden); Department of Pediatrics, The Third Affiliated Hospital, Zhengzhou University (China); Gao, Jianfeng [Center for Brain Repair and Rehabilitation, University of Gothenburg (Sweden); Department of Pediatrics, The Third Affiliated Hospital, Zhengzhou University (China); Department of Physiology, Henan Traditional Medical University (China); Li, Qian; Huang, Zhiheng; Zhang, Yu; Li, Hongfu [Center for Brain Repair and Rehabilitation, University of Gothenburg (Sweden); Department of Pediatrics, The Third Affiliated Hospital, Zhengzhou University (China); Kuhn, Hans-Georg [Center for Brain Repair and Rehabilitation, University of Gothenburg (Sweden); Blomgren, Klas, E-mail: klas.blomgren@neuro.gu.se [Center for Brain Repair and Rehabilitation, University of Gothenburg (Sweden); Department of Pediatric Oncology, The Queen Silvia Children' s Hospital, Gothenburg (Sweden)

    2011-01-07

    Research highlights: {yields} The effect of MRI on the developing brain is a matter of debate. {yields} Repeated exposure to MRI did not affect neurogenesis. {yields} Memory function was not affected by repeated MRI during development. {yields} Neither late gestation nor young postnatal brains were affected by MRI. {yields} Repeated MRI did not cause cell death in the neurogenic region of the hippocampus. -- Abstract: The effect of magnetic fields on the brain is a matter of debate. The objective of this study was to investigate whether repeated exposure to strong magnetic fields, such as during magnetic resonance imaging (MRI), could elicit changes in the developing rat brain. Embryonic day 15 (E15) and postnatal day 14 (P14) rats were exposed to MRI using a 7.05 T MR system. The animals were anesthetized and exposed for 35 min per day for 4 successive days. Control animals were anesthetized but no MRI was performed. Body temperature was maintained at 37 {sup o}C. BrdU was injected after each session (50 mg/kg). One month later, cell proliferation, neurogenesis and astrogenesis in the dentate gyrus were evaluated, revealing no effects of MRI, neither in the E15, nor in the P14 group. DNA damage in the dentate gyrus in the P14 group was evaluated on P18, 1 day after the last session, using TUNEL staining. There was no difference in the number of TUNEL-positive cells after MRI compared with controls, neither in mature neurons, nor in newborn progenitors (BrdU/TUNEL double-labeled cells). Novel object recognition was performed to assess memory function 1 month after MRI. There was no difference in the recognition index observed after MRI compared with the control rats, neither for the E15, nor for the P14 group. In conclusion, repeated exposure to MRI did not appear to affect neurogenesis, cell death or memory function in rats, neither in late gestation (E15-E18) nor in young postnatal (P14-P17) rats.

  10. Utility of providing a concussion definition in the assessment of concussion history in former NFL players.

    Science.gov (United States)

    Alosco, Michael L; Jarnagin, Johnny; Tripodis, Yorghos; Martin, Brett; Chaisson, Christine; Baugh, Christine M; Torres, Alcy; Nowinski, Christopher J; Cantu, Robert C; Stern, Robert A

    2017-01-01

    Former National Football League (NFL) players' working knowledge of concussion has not yet been evaluated, despite this population being a major clinical research target due to the association between repetitive head impacts (RHI) and long-term clinical impairments. This study examined former NFL players' understanding of the current concussion definition, and the association between number of concussions with clinical function. 95 former NFL players (mean age = 55.29; mean NFL year = 8.10) self-reported number of concussions before being provided with a concussion definition and after being read a modern definition of concussion. Subjects reported number of concussions with loss of consciousness (LOC). Principal Component Analysis of a battery of tests generated behaviour/mood, psychomotor speed/executive function, and verbal and visual memory factor scores. Post-definition number of concussions (median = 50) was five times the pre-definition (median = 10; p < 0.001). Greater pre- (p = 0.019) and post-definition concussions (p = 0.036) correlated with worse behaviour/mood scores, after controlling for years of football played, with specific effects for depressive symptoms and impulsivity. LOC did not account for variance beyond number of concussions. Practitioners and clinical researchers should provide a definition of concussion in the assessment of concussion history in former football players to facilitate accuracy and standardization.

  11. Retirement-from-sport considerations following pediatric sports-related concussion: case illustrations and institutional approach.

    Science.gov (United States)

    Ellis, Michael J; McDonald, Patrick J; Cordingley, Dean; Mansouri, Behzad; Essig, Marco; Ritchie, Lesley

    2016-04-01

    The decision to advise an athlete to retire from sports following sports-related concussion (SRC) remains a persistent challenge for physicians. In the absence of strong empirical evidence to support recommendations, clinical decision making must be individualized and should involve a multidisciplinary team of experts in concussion and traumatic brain injury. Although previous authors have advocated for a more conservative approach to these issues in child and adolescent athletes, there are few reports outlining considerations for this process among this unique population. Here, the authors use multiple case illustrations to discuss 3 subgroups of clinical considerations for sports retirement among pediatric SRC patients including the following: those with structural brain abnormalities identified on neuroimaging, those presenting with focal neurological deficits and abnormalities on physical examination, and those in whom the cumulative or prolonged effects of concussion are suspected or demonstrated. The authors' evolving multidisciplinary institutional approach to return-to-play and retirement decision making in pediatric SRC is also presented.

  12. Evaluation and management of sport-related concussions in adolescent athletes.

    Science.gov (United States)

    Patel, Dilip R; Parachuri, Venu; Shettigar, Amrith

    2017-07-01

    Sport-related concussions in young athletes are common, generally under reported and often go unrecognized. Concussion in sport may result either from a direct impact to the head or from indirect forces transmitted to the brain from impact elsewhere on the body. Concussions may also result from sudden acceleration, deceleration or rotational forces to the brain. The key features of concussion include confusion, impaired memory and reduced speed of information processing. Recovery may occur from a few days to several weeks or months. Both physical and cognitive rests are recommended for recovery. Long-term cognitive and behavioral complications are a concern. Preventive strategies include education, modification of sport rules, use of equipment such as headgears, face masks and mouth guards, and neck muscle training. Evidence is limited to support effectiveness of these preventive measures with the exception of rule modification in some sports. Laws have been enacted that require medical evaluation and clearance prior to return to play; however, evidence thus far does not show that laws have been effective in reducing the incidence of concussions in sport. More research is needed in all areas of preventive measures. Sports participation is a complex personal decision on the part of adolescent and his or her family. They should be provided with all information on inherent risks so that they can make an informed decision.

  13. A case matched study examining the reliability of using ImPACT to assess effects of multiple concussions.

    Science.gov (United States)

    Barker, Trevor; Russo, Stephen A; Barker, Gaytri; Rice, Mark A; Jeffrey, Mary G; Broderick, Gordon; Craddock, Travis J A

    2017-04-28

    Approximately 3.8 million sport and recreational concussions occur per year, creating a need for accurate diagnosis and management of concussions. Researchers and clinicians are exploring the potential dose-response cumulative effects of concussive injuries using computerized neuropsychological exams, however, results have been mixed and/or contradictory. This study starts with a large adolescent population and applies strict inclusion criteria to examine how previous mild traumatic brain injuries affect symptom reports and neurocognitive performance on the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) computerized tool. After applying exclusion criteria and case matching, 204 male and 99 female participants remained. These participants were grouped according to sex and the number of previous self-reported concussions and examined for overall differences on symptoms reported and scores obtained on the ImPACT neurocognitive battery composites. In an effort to further reduce confounding factors due to the varying group sizes, participants were then case matched on age, sex, and body mass index and analyzed for differences on symptoms reported and scores obtained on the ImPACT neurocognitive battery composites. Case matched analysis demonstrated males with concussions experience significantly higher rates of dizziness (p = .027, η(2) = .035), fogginess (p = .038, η(2) = .032), memory problems (p = .003, η(2) = .055), and concentration problems (p = .009, η(2) = .046) than males with no reported previous concussions. No significant effects were found for females, although females reporting two concussions demonstrated a slight trend for experiencing higher numbers of symptoms than females reporting no previous concussions. The results suggest that male adolescent athletes reporting multiple concussions have lingering concussive symptoms well after the last concussive event; however, these symptoms were found to

  14. Concussions and Repercussions.

    Directory of Open Access Journals (Sweden)

    Donald A Redelmeier

    2016-08-01

    Full Text Available In their Perspective, Donald A. Redelmeier and Sheharyar Raza discuss the significance of Seena Fazel and colleagues' longitudinal study of traumatic brain injury (TBI-associated outcomes.

  15. Concussion management in soccer

    Directory of Open Access Journals (Sweden)

    Jason P. Mihalik

    2014-12-01

    Full Text Available Brain injuries in sports drew more and more public attentions in recent years. Brain injuries vary by name, type, and severity in the athletic setting. It should be noted, however, that these injuries are not isolated to only the athletic arena, as non-athletic mechanisms (e.g., motor vehicle accidents are more common causes of traumatic brain injuries (TBI among teenagers. Notwithstanding, as many as 1.6 to 3.8 million TBI result from sports and recreation each year in the United States alone. These injuries are extremely costly to the global health care system, and make TBI among the most expensive conditions to treat in children. This article serves to define common brain injuries in sport; describe their prevalence, what happens to the brain following injury, how to recognize and manage these injuries, and what you can expect as the athlete recovers. Some return-to-activity considerations for the brain-injured athlete will also be discussed.

  16. Association of Concussion With Abnormal Menstrual Patterns in Adolescent and Young Women.

    Science.gov (United States)

    Snook, Meredith L; Henry, Luke C; Sanfilippo, Joseph S; Zeleznik, Anthony J; Kontos, Anthony P

    2017-09-01

    Brain injury may interrupt menstrual patterns by altering hypothalamic-pituitary-ovarian axis function. Investigators have yet to evaluate the association of concussion with menstrual patterns in young women. To compare abnormal menstrual patterns in adolescent and young women after a sport-related concussion with those after sport-related orthopedic injuries to areas other than the head (nonhead). This prospective cohort study of adolescent and young women with a sport-related concussion (n = 68) or a nonhead sport-related orthopedic injury (n = 61) followed up participants for 120 days after injury. Patients aged 12 to 21 years who presented within 30 days after a sport-related injury to a concussion or sports medicine clinic at a single academic center were eligible. Menstrual patterns were assessed using a weekly text message link to an online survey inquiring about bleeding episodes each week. The first patient was enrolled on October 14, 2014, and follow-up was completed on January 24, 2016. Inclusion criteria required participants to be at least 2 years postmenarche, to report regular menses in the previous year, and to report no use of hormonal contraception. Sport-related concussion or nonhead sport-related orthopedic injury. Abnormal menstrual patterns were defined by an intermenstrual interval of less than 21 days (short) or more than 35 days (long) or a bleeding duration of less than 3 days or more than 7 days. A total of 1784 survey responses were completed of the 1888 text messages received by patients, yielding 487 menstrual patterns in 128 patients (mean [SD] age, 16.2 [2.0] years). Of the 68 patients who had a concussion, 16 (23.5%) experienced 2 or more abnormal menstrual patterns during the study period compared with 3 of 60 patients (5%) who had an orthopedic injury. Despite similar gynecologic age, body mass index, and type of sports participation between groups, the risk of 2 or more abnormal menstrual bleeding patterns after injury

  17. Bodychecking rules and concussion in elite hockey.

    Directory of Open Access Journals (Sweden)

    Laura Donaldson

    Full Text Available Athletes participating in contact sports such as ice hockey are exposed to a high risk of suffering a concussion. We determined whether recent rule changes regulating contact to the head introduced in 2010-11 and 2011-12 have been effective in reducing the incidence of concussion in the National Hockey League (NHL. A league with a longstanding ban on hits contacting the head, the Ontario Hockey League (OHL, was also studied. A retrospective study of NHL and OHL games for the 2009-10 to 2011-12 seasons was performed using official game records and team injury reports in addition to other media sources. Concussion incidence over the 3 seasons analyzed was 5.23 per 100 NHL regular season games and 5.05 per 100 OHL regular season games (IRR 1.04; 95% CI 1.01, 1.50. When injuries described as concussion-like or suspicious of concussion were included, incidences rose to 8.8 and 7.1 per 100 games respectively (IRR 1.23; 95% CI 0.81, 1.32. The number of NHL concussions or suspected concussions was lower in 2009-10 than in 2010-11 (IRR 0.61; 95% CI 0.45, 0.83, but did not increase from 2010-11 to 2011-12 (IRR 1.05; 95% CI 0.80, 1.38. 64.2% of NHL concussions were caused by bodychecking, and only 28.4% of concussions and 36.8% of suspected concussions were caused by illegal incidents. We conclude that rules regulating bodychecking to the head did not reduce the number of players suffering concussions during NHL regular season play and that further changes or stricter enforcement of existing rules may be required to minimize the risk of players suffering these injuries.

  18. Repeated Exposure to Sublethal Doses of the Organophosphorus Compound VX Activates BDNF Expression in Mouse Brain

    Science.gov (United States)

    2012-01-01

    cresyl/-4 H-1: 3: 2-benzodioxa- phosphorin-2-oxide (CBDP) on organophosphate poisoning and its therapy. Arch. Toxicol. 42, 207–216. French, S. J... organophosphates or other environmental insults, have a greater FIG. 4. Mice that received repeated exposure to low levels of VX (0.2 LD50 and 0.4 LD50...to neuro- behavioral deficits and neuropathology. Although exposure to organophosphates such as pesticides has been shown to affect the expression of

  19. Distribution of dearomatised white spirit in brain, blood, and fat tissue after repeated exposure of rats

    DEFF Research Database (Denmark)

    Lof, A.; Lam, Henrik Rye; Gullstrand, E.

    1999-01-01

    spirit was 1.5 and 5.6 mg/kg in blood; 7.1 and 17.1 mg/kg in brain; 432 and 1452 mg/kg in fat tissue at the exposure levels of 400 and 800 p.p.m., respectively. The concentrations of n-nonane, n-decane, n-undecane, and total white spirit in blood and brain were not affected by the duration of exposure....... Two hours after the end of exposure the n-decane concentration decreased to about 25% in blood and 50% in brain. A similar pattern of elimination was also observed for n-nonane, n-undecane and total white spirit in blood and brain. In fat tissue the concentrations of n-nonane, n-decane, n......-undecane, and total white spirit increased during the 3 weeks of exposure. The time to reach steady-state concentrations is longer than 3 weeks. After the 3 weeks' exposure the fat tissue concentration of n-nonane, n-decane, n-undecane, and total white spirit decreased very slowly compared with the rate of decrease...

  20. Concussion Education for High School Football Players: A Pilot Study

    Science.gov (United States)

    Manasse-Cohick, Nancy J.; Shapley, Kathy L.

    2014-01-01

    This survey study compared high school football players' knowledge and attitudes about concussion before and after receiving concussion education. There were no significant changes in the Concussion Attitude Index. Results revealed a statistically significant difference in the athletes' scores for the Concussion Knowledge Index,…

  1. Concussion Education for High School Football Players: A Pilot Study

    Science.gov (United States)

    Manasse-Cohick, Nancy J.; Shapley, Kathy L.

    2014-01-01

    This survey study compared high school football players' knowledge and attitudes about concussion before and after receiving concussion education. There were no significant changes in the Concussion Attitude Index. Results revealed a statistically significant difference in the athletes' scores for the Concussion Knowledge Index, "t"(244)…

  2. Concussion Education for High School Football Players: A Pilot Study

    Science.gov (United States)

    Manasse-Cohick, Nancy J.; Shapley, Kathy L.

    2014-01-01

    This survey study compared high school football players' knowledge and attitudes about concussion before and after receiving concussion education. There were no significant changes in the Concussion Attitude Index. Results revealed a statistically significant difference in the athletes' scores for the Concussion Knowledge Index, "t"(244)…

  3. Biomechanics of sport concussion: quest for the elusive injury threshold.

    Science.gov (United States)

    Guskiewicz, Kevin M; Mihalik, Jason P

    2011-01-01

    Previous concussion biomechanics research has relied heavily on the animal model or laboratory reconstruction of concussive injuries captured on video footage. Real-time data collection involves a novel approach to better understanding the medical issues related to sport concussion. Recent studies suggest that a concussive injury threshold is elusive and may, in fact, be irrelevant when predicting the clinical outcome.

  4. Sport-Related Concussion and Occupational Therapy: Expanding the Scope of Practice

    Science.gov (United States)

    Reed, Nick

    2011-01-01

    Sport participation is a common occupation for many children and youth and can lead to improved physical and psychosocial health. Despite these benefits, it exposes children and youth to the increased risk of injury. Concussion, also referred to as mild traumatic brain injury (mTBI), is one of the most common sports injuries reported in the…

  5. Sport-Related Concussion and Occupational Therapy: Expanding the Scope of Practice

    Science.gov (United States)

    Reed, Nick

    2011-01-01

    Sport participation is a common occupation for many children and youth and can lead to improved physical and psychosocial health. Despite these benefits, it exposes children and youth to the increased risk of injury. Concussion, also referred to as mild traumatic brain injury (mTBI), is one of the most common sports injuries reported in the…

  6. Examining prescribed rest as treatment for adolescents who are slow to recover from concussion.

    Science.gov (United States)

    Moser, Rosemarie Scolaro; Schatz, Philip; Glenn, Megan; Kollias, Kelly E; Iverson, Grant L

    2015-01-01

    Rest is a widely recommended treatment for concussion, but its utility is unclear following the acute stage of recovery. This study examined the effects of 1-week of prescribed rest in concussed adolescent athletes. Participants were 13 adolescent athletes with persistent symptoms following a concussion. More than three-quarters (77%) had self-reported ADHD, learning disability or two prior concussions. All completed ImPACT at another facility, but none completed a period of comprehensive rest prior to examination at a specialty practice. Three time points of test data were compared, to control for possible spontaneous recovery: Test 1 (external facility), Test 2 (before prescribed rest) and Test 3 (following prescribed rest). Repeated measures ANOVAs revealed a significant effect of prescribed rest on all ImPACT composite scores and the total symptom score. Post-hoc analyses revealed no significant differences between Time 1 and Time 2, whereas significant differences were present after prescribed rest. Following prescribed rest, having two or more reliably improved cognitive test scores or having improved symptoms was present in eight of the 13 patients (61.5%). A substantial percentage of adolescents with persistent symptoms following concussion showed improvement in symptoms and cognitive functioning following education, reassurance and 1-week of prescribed rest.

  7. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... in Spanish [Podcast: 1:27 minutes] Send a Health eCard Heads Up! Prevent Concussions Prevent Head Injuries ... in Spanish [Podcast: 1:27 minutes] Send a Health eCard Heads Up! Prevent Concussions Prevent Head Injuries ...

  8. Concussions More Likely in Female Athletes

    Science.gov (United States)

    ... a higher risk of concussions. For women, the sports included field hockey, soccer, basketball, softball and lacrosse, said study lead author ... that have shown that women participating in similar sports as men -- like soccer, basketball, baseball/softball -- report concussions at a higher ...

  9. What You Need to Know About Concussion

    Centers for Disease Control (CDC) Podcasts

    2010-03-17

    This podcast provides the essential facts about concussions and describes symptoms, danger signs, and ways to recover and heal after a concussion.  Created: 3/17/2010 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 3/17/2010.

  10. Smartphone-enabled optofluidic exosome diagnostic for concussion recovery

    Science.gov (United States)

    Ko, Jina; Hemphill, Matthew A.; Gabrieli, David; Wu, Leon; Yelleswarapu, Venkata; Lawrence, Gladys; Pennycooke, Wesley; Singh, Anup; Meaney, Dave F.; Issadore, David

    2016-08-01

    A major impediment to improving the treatment of concussion is our current inability to identify patients that will experience persistent problems after the injury. Recently, brain-derived exosomes, which cross the blood-brain barrier and circulate following injury, have shown great potential as a noninvasive biomarker of brain recovery. However, clinical use of exosomes has been constrained by their small size (30–100 nm) and the extensive sample preparation (>24 hr) needed for traditional exosome measurements. To address these challenges, we developed a smartphone-enabled optofluidic platform to measure brain-derived exosomes. Sample-to-answer on our chip is 1 hour, 10x faster than conventional techniques. The key innovation is an optofluidic device that can detect enzyme amplified exosome biomarkers, and is read out using a smartphone camera. Using this approach, we detected and profiled GluR2+ exosomes in the post-injury state using both in vitro and murine models of concussion.

  11. The effect of coach education on reporting of concussions among high school athletes after passage of a concussion law.

    Science.gov (United States)

    Rivara, Frederick P; Schiff, Melissa A; Chrisman, Sara P; Chung, Shana K; Ellenbogen, Richard G; Herring, Stanley A

    2014-05-01

    Increasing attention has been paid to concussions and especially sports-related concussions in youth. To prevent an inappropriate return to play while symptomatic, nearly all states have now passed legislation on youth sports-related concussions. To determine (1) the incidence of sports-related concussions in high school athletes using a unique system to collect reports on concussions, (2) the proportion of athletes with concussions who play with concussive symptoms, and (3) the effect of the type and modality of coach education on the likelihood of athletes reporting symptoms to the coach or playing with concussive symptoms. Cohort study; Level of evidence, 2. This study was conducted with high school football and girls' soccer athletes playing in fall 2012 and their coaches and parents in 20 urban or rural high schools in Washington State. The main outcome was the incidence of concussions per 1000 athlete-exposures (AEs), the proportion of concussed athletes who played with concussive symptoms, and the association of coach concussion education with coach awareness of athletes with concussive symptoms. Among the 778 athletes, the rate of concussions was 3.6 per 1000 AEs and was identical for the 2 sports studied. The cumulative concussion incidence over the course of the season was similar in girls' soccer (11.1%) and football (10.4%). Sixty-nine percent of concussed athletes reported playing with symptoms, and 40% reported that their coach was not aware of their concussion. Most measures of coach concussion education were not associated with coach awareness of concussions in their athletes, although the modalities of a video and quiz were associated with a lower likelihood of coach awareness. More objective and accurate methods are needed to identify concussions. Changes in athlete attitudes on reporting concussive symptoms will likely not be accomplished through legislation alone.

  12. Repeat stereotactic radiosurgery in the management of brain metastases from NSCLC: A case report and review of the literature.

    Science.gov (United States)

    Marvaso, Giulia; Barone, Agnese; Vaccaro, Caterina; Bruzzaniti, Vicente; Grespi, Silvia; Scotti, Valerio; Bianco, Cataldo

    2013-10-01

    The aims of radiotherapeutic treatment of brain metastases include maintaining neurocognitive function and improvement of survival. Based on these premises, we present a case report in which the role of repeat stereotactic radiosurgery (SRS) was investigated in a patient with a recurrent brain metastasis from non-small cell lung cancer in the same area as previously treated with radiosurgery. A 40-year-old male caucasian patient was diagnosed with brain metastasis from non-small cell lung cancer (NSCLC) and underwent SRS. The patient developed a recurrence of the disease and a second SRS on the same area was performed. After 8 months, tumor restaging demonstrated a lesion compatible with a recurrence and the patient underwent surgery. Histological diagnosis following surgery revealed only the occurrence of radionecrosis. Radiotherapy was well-tolerated and no grade 3/4 neurological toxicity occurred. To date, no consensus exists on the efficacy of retreatment with SRS. Despite the limited number of studies in this field, in the present case report, we outline the outcomes of this unconventional approach.

  13. Expression of neuronal nitric oxide synthase gene in the brain tissue of rats with cerebral concussion%神经元型一氧化氮合酶基因在脑震荡大鼠脑组织中的表达

    Institute of Scientific and Technical Information of China (English)

    彭瑞云; 高亚兵; 王德文; 肖兴义; 杨瑞; 陈浩宇; 吴小红; 刘杰; 胡文华; 马俊杰

    2004-01-01

    BACKGROUND: Cerebral concussion is a mild brain injury. In basic researches, the expression and significance of enkaphalin and dopamine in cerebral concussion remain poorly understood.OBJECTIVE: To observe the expression of neuronal nitric oxide synthase (nNOS) gene in rat models of cerebral concussion and to explore its significance.DESIGN: A randomized controlled trialled study.SETTING and PARTICIPANTS: This study was conducted in the Institute of Radiation Medicine, Academy of Military Medical Sciences. Rat models of cerebral concussion was established in 80 healthy male Wistar rats of clean grade purchased from the Experimental Animal Center of Academy of Military Medical Sciences with free access to food and water. The rats were randomly divided into 4 groups according to the different levels of cerebral impact for model establishment, namely the control group, 50, 100 and 200 g counterweight groups.MAIN OUTCOME MEASURES: Brain tissue samples were taken 1, 3, 7,14 and 30 days after injury respectively, from each group, to examine the changes in the expression of nNOS gene in the course of cerebral concussion by means of immunohistochemistry and in situ hybridization.RESULTS: Rats in 100 g group exhibited typical manifestations of cerebral concussion as seen in the clinical setting. The pathological changes included cerebral vascular dilatation, congestion, edema of the cerebral tissues, neuronal degeneration, necrosis, and decrease or even disappearance of the Nissl bodies. The protein and mRNA of nNOS were increased 3 days after the injury, peaked on the 7th day, and decreased till the 14th days but still remained positive on the 30th day. The positive expression was detected in the plasma of neurons in the cerebral cortex, hippocampus, thalamus and cerebellum.CONCLUSION: Cerebral concussion is pathologically characterized by blood circulation disorder and neural cell degeneration and necrosis. The expression of nNOS gene participates in brain tissue damage

  14. Genetics and Other Risk Factors for Past Concussions in Active-Duty Soldiers.

    Science.gov (United States)

    Dretsch, Michael N; Silverberg, Noah; Gardner, Andrew J; Panenka, William J; Emmerich, Tanja; Crynen, Gogce; Ait-Ghezala, Ghania; Chaytow, Helena; Mathura, Venkat; Crawford, Fiona C; Iverson, Grant L

    2017-02-15

    Risk factors for concussion in active-duty military service members are poorly understood. The present study examined the association between self-reported concussion history and genetics (apolipoprotein E [APOE], brain-derived neurotrophic factor [BDNF], and D2 dopamine receptor genes [DRD2]), trait personality measures (impulsive-sensation seeking and trait aggression-hostility), and current alcohol use. The sample included 458 soldiers who were preparing to deploy for Operation Iraqi Freedom/Operation Enduring Freedom. For those with the BDNF Met/Met genotype, 57.9% (11/19) had a history of one or more prior concussions, compared with 35.6% (154/432) of those with other BDNF genotypes (p = 0.049, odds ratio [OR] = 2.48). APOE and DRD2 genotypes were not associated with risk for past concussions. Those with the BDNF Met/Met genotype also reported greater aggression and hostility personality characteristics. When combined in a predictive model, prior military deployments, being male, and having the BDNF Met/Met genotype were independently associated with increased lifetime history of concussions in active-duty soldiers. Replication in larger independent samples is necessary to have more confidence in both the positive and negative genetic associations reported in this study.

  15. Threat, Pressure, and Communication About Concussion Safety: Implications for Parent Concussion Education.

    Science.gov (United States)

    Kroshus, Emily; Babkes Stellino, Megan; Chrisman, Sara P D; Rivara, Frederick P

    2017-08-01

    Parental communication about the importance of reporting concussion symptoms can influence a child's attitudes about such reporting, and is likely related to perceived threat of concussion. However, parental investment in child sport achievement might impede this communication. To examine the relationship between perceived threat of concussion and parent-child communication regarding concussion symptom reporting, and the potential interaction with parental pressure regarding child sport achievement. A total of 236 parents of youth soccer players completed an anonymous online survey. There were greater odds of encouraging concussion reporting among parents who perceived that their child had a greater likelihood of sustaining a concussion ( OR = 1.03, 95% CI [1.01, 1.04]) and lower odds among parents who exhibited greater parental sport pressure ( OR = 0.88, 95% CI [0.78, 0.99]). Parents whose child had a prior concussion were much more likely to communicate with their child about concussion reporting ( OR = 7.86, 95% CI [3.00, 20.55]). Initiatives are needed to support healthy sport parenting, particularly focusing on parental encouragement of concussion reporting. Possible directions for concussion education for parents based on the results of this study include providing parents with concrete guidance about the important role they can play in encouraging their child to report symptoms of a concussion, communicating the athletic consequences of continued sport involvement while experiencing symptoms of a concussion, and using narrative messaging with exemplars to personalize the information for parents of youth who have not previously sustained a concussion.

  16. A change of the expression of PLP in the prefrontal cortex of brain after pure cerebral concussion and multiple cerebral concussions in rats%一重和多重脑震荡大鼠前额叶髓鞘脂蛋白(PLP)的变化

    Institute of Scientific and Technical Information of China (English)

    江东; 李坪; 朱乔; 于建云; 张桓; 曹珍珍; 郭泽云

    2012-01-01

    Objective; This study aimed to investigate the distribution and expression changes of the myelin protein lipo-protein ( PLP) in prefrontal-septum areas after pure cerebral concussion ( PCC) and multiple cerebral concussions ( MCC). Methods:PCC and MCC rat models were created by using a metallic pendulum-striker concussive device. The rats were randomly divided into PCC 1,2,4,8 and 16 d (n = 6 for each time point) and MCC 1,2,4,8 and 16 d ( n = 6 for each time point) groups after injury. One control (normal) group (n =6) was used. The distribution and immno-expression changes of the PLP were observed by S-P immuno-histochemical staining in the prefrontal-septum areas after injury. Results: The results showed that PLP immunoreactivity was localized in the white matter and was widely associated with the nerve fibers in the molecular and granular layer of cerebral cortex and prefrontal-septum areas including medial forebrain bundle (Mfb) , vertical diagonal band (VDB) , lateral septal nucleus, intermediate part (LSI) , amygdaloid nucleus, corpus callosum (cc) , caudate putamen (Cpu) and anterior commissure (ac) in the control rats. Following PCC, the expression level of PLP in most areas was remained unaltered (P > 0. 05 ) compared to that of the control groups. However, in MCC groups, PLP expression was reduced significantly (P<0.05) in the molecular layer of pre-frontal cortex, VDB as well as the Cpu when compared with the control and PCC rats. Conclusion:The present results suggest that MCC may have cumalative effects on the injury, thus aggravating the damage to the nerve fibers of the pre-frontal-septum.%目的:为探索一重(pure cerebral concussion,PCC)和多重脑震荡(multiple cerebral concussion,MCC)后大鼠前额叶中隔断面髓鞘脂蛋白(myelin protein lipoprotein,PLP)分布与表达变化规律.方法:采用自制单摆式机械打击装置复制PCC和MCC大鼠模型,伤后随机分为PCC中1、2、4、8、16和24 d组(n=6),MCC中1、2、4、8、16

  17. Concussion reporting behaviours of community college student-athletes and limits of transferring concussion knowledge during the stress of competition.

    Science.gov (United States)

    Chinn, Nancy Resendes; Porter, Paul

    2016-01-01

    Concussion education for student-athletes is mandated by several states and is becoming an integral component of concussion management programmes; however, little is known about student-athlete concussion knowledge and self-reporting of suspected concussion. This study explored to what extent collegiate student-athletes are knowledgeable on the topic of concussion, the relationship between having concussion knowledge and reporting behaviours, and factors contributing to not reporting when education has been provided. Mixed method explanatory design. The Rosenbaum Concussion Knowledge and Attitudes Survey was administered to 986 community college student-athletes from 6 sports. Follow-up qualitative interviews were conducted using purposive sampling. Concussion knowledge scores positively correlated with number of times concussion education was received, but were not associated with reporting of concussion. Of respondents with a history of concussion, 64% stated that they reported all of their concussions. The highest ranked reason given for not reporting concussion was, "I was into the game/practice and didn't realize I had a concussion at the time." Qualitative analysis revealed physiologically related and attitudinal factors particular to competition that precluded participants' identification and reporting of concussion. Despite receiving concussion education, student-athletes may not be cognizant of a possible concussion particularly during the stress of competition. Results indicate that alternate methods of providing concussion education that can affect knowledge transfer should be explored: providing education in the settings where student-athletes practice and compete, incorporating a kinaesthetic or procedural learning approach to concussion education, and addressing the social and attitudinal aspects of concussion reporting.

  18. [Expression and significance of enkephalin and dopamine in experimental rat cerebral concussion tissue].

    Science.gov (United States)

    Peng, Rui-Yun; Gao, Ya-Bing; Wang, De-Wen; Xiao, Xing-Yi; Chen, Hao-Yu; Wu, Xiao-Hong; Liu, Jie; Xu, Long-He; Hu, Wen-Hua

    2003-05-01

    To explore the expression and significance of enkephalin and dopamine in rat cerebral concussion tissue. 80 Wistar male rats were used to make animal model of cerebral concussion, which were sacrificed on 1,3,7,14 and 30 days after postconcussion and the brain tissues were taken out. The expression patterns of enkephalin and dopamine were studied in the course of cerebral concussion by immunohistochemical staining. The clinical manifestation with typical cerebral concussion character was seen in rat group with 100 g body weight. The mainly pathologic changes were cerebral vascular constriction and dilatation, congestion and edema of cerebral tissue, and neuronal degeneration and necrosis. Expression of enkephalin was increased on day 1 after injury and the enkephalin positive area was in the plasma of endothelial cells in cerebral cortex, hippocamp and cerebellum. The expression of enkephalin reached the peak on day 7 after injury, and the positive area was also seen in the plasma of neurons in cerebral cortex, hippocamp and cerebellum. From 14 days after injury, the expression of enkephalin decreased gradually, but until 30 days after injury it was still higher than that of controls. Expression of dopamine increased in 7 days after injury and the positive area was seen in the plasma of endothelial cells and in the vessel wall in cerebral cortex, hippocamp, thalamus and cerebellum, and had no notable changes at other time points. The mainly pathologic changes after cerebral concussion were blood circulatory disorder and denaturation and necrosis of parenchymal cells. Enkephalin and dopamine may participate in the pathophysiological course of cerebral injury after cerebral concussion, and play an important role in the blood vessel injury, regulation of blood-brain barrier and the denaturation and necrosis of nerve cells.

  19. The catechol-O-methyltransferase (COMT val158met polymorphism affects brain responses to repeated painful stimuli.

    Directory of Open Access Journals (Sweden)

    Marco L Loggia

    Full Text Available Despite the explosion of interest in the genetic underpinnings of individual differences in pain sensitivity, conflicting findings have emerged for most of the identified "pain genes". Perhaps the prime example of this inconsistency is represented by catechol-O-methyltransferase (COMT, as its substantial association to pain sensitivity has been reported in various studies, but rejected in several others. In line with findings from behavioral studies, we hypothesized that the effect of COMT on pain processing would become apparent only when the pain system was adequately challenged (i.e., after repeated pain stimulation. In the present study, we used functional Magnetic Resonance Imaging (fMRI to investigate the brain response to heat pain stimuli in 54 subjects genotyped for the common COMT val158met polymorphism (val/val = n 22, val/met = n 20, met/met = n 12. Met/met subjects exhibited stronger pain-related fMRI signals than val/val in several brain structures, including the periaqueductal gray matter, lingual gyrus, cerebellum, hippocampal formation and precuneus. These effects were observed only for high intensity pain stimuli after repeated administration. In spite of our relatively small sample size, our results suggest that COMT appears to affect pain processing. Our data demonstrate that the effect of COMT on pain processing can be detected in presence of 1 a sufficiently robust challenge to the pain system to detect a genotype effect, and/or 2 the recruitment of pain-dampening compensatory mechanisms by the putatively more pain sensitive met homozygotes. These findings may help explain the inconsistencies in reported findings of the impact of COMT in pain regulation.

  20. Repeated diffusion MRI reveals earliest time point for stratification of radiotherapy response in brain metastases

    Science.gov (United States)

    Mahmood, Faisal; Johannesen, Helle H.; Geertsen, Poul; Hansen, Rasmus H.

    2017-04-01

    An imaging biomarker for early prediction of treatment response potentially provides a non-invasive tool for better prognostics and individualized management of the disease. Radiotherapy (RT) response is generally related to changes in gross tumor volume manifesting months later. In this prospective study we investigated the apparent diffusion coefficient (ADC), perfusion fraction and pseudo diffusion coefficient derived from diffusion weighted MRI as potential early biomarkers for radiotherapy response of brain metastases. It was a particular aim to assess the optimal time point for acquiring the DW-MRI scan during the course of treatment, since to our knowledge this important question has not been addressed directly in previous studies. Twenty-nine metastases (N  =  29) from twenty-one patients, treated with whole-brain fractionated external beam RT were analyzed. Patients were scanned with a 1 T MRI system to acquire DW-, T2*W-, T2W- and T1W scans, before start of RT, at each fraction and at follow up two to three months after RT. The DW-MRI parameters were derived using regions of interest based on high b-value images (b  =  800 s mm‑2). Both volumetric and RECIST criteria were applied for response evaluation. It was found that in non-responding metastases the mean ADC decreased and in responding metastases it increased. The volume based response proved to be far more consistently predictable by the ADC change found at fraction number 7 and later, compared to the linear response (RECIST). The perfusion fraction and pseudo diffusion coefficient did not show sufficient prognostic value with either response assessment criteria. In conclusion this study shows that the ADC derived using high b-values may be a reliable biomarker for early assessment of radiotherapy response for brain metastases patients. The earliest response stratification can be achieved using two DW-MRI scans, one pre-treatment and one at treatment day 7–9 (equivalent to 21

  1. Sports-related traumatic brain injury.

    Science.gov (United States)

    Phillips, Shawn; Woessner, Derek

    2015-06-01

    Concussions have garnered more attention in the medical literature, media, and social media. As such, in the nomenclature according to the Centers for Disease Control and Prevention, the term concussion has been supplanted by the term mild traumatic brain injury. Current numbers indicate that 1.7 million TBIs are documented annually, with estimates around 3 million annually (173,285 sports- and recreation-related TBIs among children and adolescents). The Sideline Concussion Assessment Tool 3 and the NFL Sideline Concussion Assessment Tool are commonly used sideline tools.

  2. [Study on the expressions of basic fibroblast growth factor and nervous growth factor genes in rat cerebral concussion].

    Science.gov (United States)

    Peng, Rui-yun; Gao, Ya-bing; Xiao, Xing-yi; Wang, De-wen; Chen, Hao-yu; Wu, Xiao-hong; Liu, Jie; Hu, Wen-hua; Cai, Bao-ren

    2003-04-01

    To study the expressions of basic fibroblast growth factor (bFGF) and nervous growth factor(NGF) genes in rat cerebral concussion. Eighty Wistar male rats were used for animal model of cerebral concussion, which were sacrificed on 1, 3, 7, 14 and 30 days after injury and the brain tissue was taken out. The expressions of bFGF and NGF genes were studied in the course of cerebral concussion by means of immunohistochemistry and in situ hybridization. Rats in 100 g group were seen the clinical manifestation for typical cerebral concussion. The protein and mRNA of bFGF were increased on day 1, obtained at peak on day 3-7, decreased on day 14 and also increased on day 30 compared with controls. The positive area was seen in the plasma of neurons in cerebral cortex, hippocampus, thalamus and cerebellum. NGF protein and mRNA showed strong positive and increased in the plasma of neurons in cerebral cortex, hippocampus, thalamus and cerebellum on day 1, and they were continuously positive but gradually decreased within 30 days after injury. The expression of bFGF gene participates in the course of cerebral concussion, might play an important role in the nervous cells degeneration and necrosis; NGF gene expression participates in the whole course of cerebral concussion, especially in the early phase.

  3. Exposure to sub-concussive head injury in boxing and other sports.

    Science.gov (United States)

    Erlanger, David M

    2015-01-01

    Current characterizations of chronic traumatic brain injury (CTBI) in boxing, football and other sports are reviewed in the context of the history of research on sub-concussive brain trauma in athletes. The utility of exposure models for understanding CTBI in boxers is examined and concerns regarding the paucity of findings supportive of an exposure model for CTBI in football players are discussed. Recommendations for development of exposure models for sport-specific phenotypic characterizations of CTBI are presented.

  4. Acute post-traumatic stress symptoms and age predict outcome in military blast concussion.

    Science.gov (United States)

    Mac Donald, Christine L; Adam, Octavian R; Johnson, Ann M; Nelson, Elliot C; Werner, Nicole J; Rivet, Dennis J; Brody, David L

    2015-05-01

    High rates of adverse outcomes have been reported following blast-related concussive traumatic brain injury in US military personnel, but the extent to which such adverse outcomes can be predicted acutely after injury is unknown. We performed a prospective, observational study of US military personnel with blast-related concussive traumatic brain injury (n = 38) and controls (n = 34) enrolled between March and September 2012. Importantly all subjects returned to duty and did not require evacuation. Subjects were evaluated acutely 0-7 days after injury at two sites in Afghanistan and again 6-12 months later in the United States. Acute assessments revealed heightened post-concussive, post-traumatic stress, and depressive symptoms along with worse cognitive performance in subjects with traumatic brain injury. At 6-12 months follow-up, 63% of subjects with traumatic brain injury and 20% of controls had moderate overall disability. Subjects with traumatic brain injury showed more severe neurobehavioural, post-traumatic stress and depression symptoms along with more frequent cognitive performance deficits and more substantial headache impairment than control subjects. Logistic regression modelling using only acute measures identified that a diagnosis of traumatic brain injury, older age, and more severe post-traumatic stress symptoms provided a good prediction of later adverse global outcomes (area under the receiver-operating characteristic curve = 0.84). Thus, US military personnel with concussive blast-related traumatic brain injury in Afghanistan who returned to duty still fared quite poorly on many clinical outcome measures 6-12 months after injury. Poor global outcome seems to be largely driven by psychological health measures, age, and traumatic brain injury status. The effects of early interventions and longer term implications of these findings are unknown.

  5. Reliability-based automatic repeat request for short code modulation visual evoked potentials in brain computer interfaces.

    Science.gov (United States)

    Sato, Jun-Ichi; Washizawa, Yoshikazu

    2015-08-01

    We propose two methods to improve code modulation visual evoked potential brain computer interfaces (cVEP BCIs). Most of BCIs average brain signals from several trials in order to improve the classification performance. The number of averaging defines the trade-off between input speed and accuracy, and the optimal averaging number depends on individual, signal acquisition system, and so forth. Firstly, we propose a novel dynamic method to estimate the averaging number for cVEP BCIs. The proposed method is based on the automatic repeat request (ARQ) that is used in communication systems. The existing cVEP BCIs employ rather longer code, such as 63-bit M-sequence. The code length also defines the trade-off between input speed and accuracy. Since the reliability of the proposed BCI can be controlled by the proposed ARQ method, we introduce shorter codes, 32-bit M-sequence and the Kasami-sequence. Thanks to combine the dynamic averaging number estimation method and the shorter codes, the proposed system exhibited higher information transfer rate compared to existing cVEP BCIs.

  6. Thinner Cortex in Collegiate Football Players With, but not Without, a Self-Reported History of Concussion.

    Science.gov (United States)

    Meier, Timothy B; Bellgowan, Patrick S F; Bergamino, Maurizio; Ling, Josef M; Mayer, Andrew R

    2016-02-15

    Emerging evidence suggests that a history of sports-related concussions can lead to long-term neuroanatomical changes. The extent to which similar changes are present in young athletes is undetermined at this time. Here, we tested the hypothesis that collegiate football athletes with (n = 25) and without (n = 24) a self-reported history of concussion would have cortical thickness differences and altered white matter integrity relative to healthy controls (n = 27) in fronto-temporal regions that appear particularly susceptible to traumatic brain injury. Freesurfer software was used to estimate cortical thickness, fractional anisotropy was calculated in a priori white matter tracts, and behavior was assessed using a concussion behavioral battery. Groups did not differ in self-reported symptoms (p > 0.10) or cognitive performance (p > 0.10). Healthy controls reported significantly higher happiness levels than both football groups (all p 0.10). However, football athletes with a history of concussion had significantly thinner cortex in the left anterior cingulate cortex, orbital frontal cortex, and medial superior frontal cortex relative to healthy controls (p = 0.02, d = -0.69). Further, football athletes with a history of concussion had significantly thinner cortex in the right central sulcus and precentral gyrus relative to football athletes without a history of concussion (p = 0.03, d = -0.71). No differences were observed between football athletes without a history of concussion and healthy controls. These results suggest that previous concussions, but not necessarily football exposure, may be associated with cortical thickness differences in collegiate football athletes.

  7. Automatic classification of athletes with residual functional deficits following concussion by means of EEG signal using support vector machine.

    Science.gov (United States)

    Cao, Cheng; Tutwiler, Richard Laurence; Slobounov, Semyon

    2008-08-01

    There is a growing body of knowledge indicating long-lasting residual electroencephalography (EEG) abnormalities in concussed athletes that may persist up to 10-year postinjury. Most often, these abnormalities are initially overlooked using traditional concussion assessment tools. Accordingly, premature return to sport participation may lead to recurrent episodes of concussion, increasing the risk of recurrent concussions with more severe consequences. Sixty-one athletes at high risk for concussion (i.e., collegiate rugby and football players) were recruited and underwent EEG baseline assessment. Thirty of these athletes suffered from concussion and were retested at day 30 postinjury. A number of task-related EEG recordings were conducted. A novel classification algorithm, the support vector machine (SVM), was applied as a classifier to identify residual functional abnormalities in athletes suffering from concussion using a multichannel EEG data set. The total accuracy of the classifier using the 10 features was 77.1%. The classifier has a high sensitivity of 96.7% (linear SVM), 80.0% (nonlinear SVM), and a relatively lower but acceptable selectivity of 69.1% (linear SVM) and 75.0% (nonlinear SVM). The major findings of this report are as follows: 1) discriminative features were observed at theta, alpha, and beta frequency bands, 2) the minimal redundancy relevance method was identified as being superior to the univariate t -test method in selecting features for the model calculation, 3) the EEG features selected for the classification model are linked to temporal and occipital areas, and 4) postural parameters influence EEG data set and can be used as discriminative features for the classification model. Overall, this report provides sufficient evidence that 10 EEG features selected for final analysis and SVM may be potentially used in clinical practice for automatic classification of athletes with residual brain functional abnormalities following a concussion

  8. Effect of concussion on clinically measured reaction time in nine NCAA Division I collegiate athletes: a preliminary study

    Science.gov (United States)

    Eckner, James T.; Kutcher, Jeffrey S.; Richardson, James K

    2013-01-01

    Objectives To evaluate the effect of concussion on clinically-measured reaction time (RTclin) with comparison to a computerized reaction time measure (RTcomp). Design Prospective, repeated measures observational study. Setting Athletic training clinic at an NCAA Division I university. Participants Data are reported for 9 collegiate athletes with acute concussion who were part of a larger cohort of 209 athletes recruited from the university’s football, women’s soccer, and wrestling teams prior to the start of their respective athletic seasons. Methods Baseline RTclin and RTcomp were measured during pre-participation physical examinations. RTclin measured the time required to catch a suspended vertical shaft by hand closure after its release by the examiner. RTcomp was derived from the simple reaction time component of the CogState-Sport computerized neurocognitive test battery. Athletes who subsequently sustained a physician-diagnosed concussion underwent repeat RTclin and RTcomp testing within 72 hours of injury. A Wilcoxon signed rank test was used to compare baseline and after-injury reaction times. Main Outcome Measurements After-injury changes in RTclin and RTcomp calculated with respect to each athlete’s own pre-season baseline value. Results After-injury RTclin was prolonged in 8 of the 9 concussed athletes, while RTcomp was prolonged in 5 of the 9 concussed athletes. Mean RTclin increased from 193 ± 21 ms to 219 ± 31 ms (p = 0.050), and mean RTcomp increased from 247 ± 75 to 462 ± 120 ms (p = 0.214). Conclusions We conclude that RTclin appears to be sensitive to the known prolongation of reaction time following concussion, and compares favorably to an accepted computerized reaction time measure. This study supports the potential utility of RTclin as part of a multi-faceted concussion assessment battery. PMID:21402367

  9. The effects of repeat testing, malingering, and traumatic brain injury on visuospatial memory span

    Directory of Open Access Journals (Sweden)

    David L Woods

    2016-01-01

    Full Text Available Spatial span tests such as the Corsi Block Test (CBT and the spatial span test of the Wechsler Memory Scale are widely used to assess deficits in spatial working memory. We conducted three experiments to evaluate the test-retest reliability and clinical sensitivity of a new computerized spatial span test (C-SST that incorporates psychophysical methods to improve the precision of spatial span measurement. In Experiment 1, we analyzed C-SST test-retest reliability in 49 participants who underwent three test sessions at weekly intervals. Intraclass correlation coefficients (ICC were higher for a psychophysically derived mean span (MnS metric (0.83 than for the maximal span and total correct metrics used in traditional spatial-span tests. Response times (ReTs also showed high ICCs (0.93 that correlated negatively with MnS scores and correlated positively with response-time latencies from other tests of processing speed. Learning effects were insignificant. Experiment 2 examined the performance of Experiment 1 participants when instructed to feign symptoms of traumatic brain injury: 57% showed abnormal MnS z-scores. A MnS z-score cutoff of 3.0 correctly classified 36% of simulated malingerers and 91% of the subgroup of 11 control participants with abnormal spans. Malingerers also made more substitution errors than control participants with abnormal spans (sensitivity = 43%, specificity = 91%. In addition, malingerers showed no evidence of ReT slowing, in contrast to significant abnormalities seen on other malingered tests of processing speed. As a result, differences between ReT z-scores and z-scores on other processing speed tests showed very high sensitivity and specificity in distinguishing malingering and control participants with either normal or abnormal spans. Experiment 3 examined C-SST performance in a group of patients with predominantly mild traumatic brain injury (TBI: neither MnS nor ReT z-scores showed significant group

  10. Altered Neurochemistry in Former Professional Soccer Players without a History of Concussion.

    Science.gov (United States)

    Koerte, Inga K; Lin, Alexander P; Muehlmann, Marc; Merugumala, Sai; Liao, Huijun; Starr, Tyler; Kaufmann, David; Mayinger, Michael; Steffinger, Denise; Fisch, Barbara; Karch, Susanne; Heinen, Florian; Ertl-Wagner, Birgit; Reiser, Maximilian; Stern, Robert A; Zafonte, Ross; Shenton, Martha E

    2015-09-01

    Soccer is played by more than 250 million people worldwide. Repeatedly heading the ball may place soccer players at high risk for repetitive subconcussive head impacts (RSHI). This study evaluates the long-term effects of RSHI on neurochemistry in athletes without a history of clinically diagnosed concussion, but with a high exposure to RSHI. Eleven former professional soccer players (mean age 52.0±6.8 years) and a comparison cohort of 14 age- and gender-matched, former non-contact sport athletes (mean age 46.9±7.9 years) underwent 3T magnetic resonance spectroscopy (MRS) and neurocognitive evaluation. In the soccer players a significant increase was observed in both choline (Cho), a membrane marker, and myo-inositol (ml), a marker of glial activation, compared with control athletes. Additionally, ml and glutathione (GSH) were significantly correlated with lifetime estimate of RSHI within the soccer group. There was no significant difference in neurocognitive tests between groups. Results of this study suggest an association between RSHI in soccer players and MRS markers of neuroinflammation, suggesting that even subconcussive head impacts affect the neurochemistry of the brain and may precede neurocognitive changes. Future studies will need to determine the role of neuroinflammation in RSHI and the effect on neurocognitive function.

  11. Near Point of Convergence After a Sport-Related Concussion

    Science.gov (United States)

    Pearce, Kelly L.; Sufrinko, Alicia; Lau, Brian C.; Henry, Luke; Collins, Michael W.; Kontos, Anthony P.

    2016-01-01

    Background Convergence insufficiency (CI) is a common binocular vision deficit after a sport-related concussion (SRC). CI may result in visual discomfort and vision-mediated functional difficulties such as slowed reading and compromised attention, leading to impaired academic, work, and sport performance. Purpose To test the reliability of repeated near point of convergence (NPC) measurements in a sample of athletes after an SRC; compare the symptoms and cognitive impairment of athletes with normal NPC to those with CI after an SRC; and explore the relationship among age, sex, learning disability, migraine history, and CI. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 78 athletes (mean age, 14.31 ± 2.77 years) who were seen a mean 5.79 ± 5.63 days after an SRC were administered 3 trials of an NPC assessment, along with neurocognitive (Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT]) and symptom assessments. Patients were divided into normal NPC (NPC ≤5 cm; n = 45) and CI (NPC >5 cm; n = 33) groups. Intraclass correlation coefficients (ICCs) and repeated-measures analyses of variance (ANOVAs) assessed the consistency of NPC across the 3 trials. The ANOVAs were employed to examine differences on neurocognitive composites and symptoms between the normal NPC and CI groups. Stepwise regressions (controlling for age and symptom scores on the Post-Concussion Symptom Scale [PCSS]) were conducted to evaluate the predictive utility of the NPC distance for neurocognitive impairment. Results Groups did not differ on demographic or injury characteristics. NPC differed between trial 1 and trials 2 (P = .02) and 3 (P = .01) for the CI group but not the normal NPC group. Internal consistency was high across NPC measurements (ICC range, 0.95–0.98). Patients with CI performed worse on verbal memory (P = .02), visual motor speed (P = .02), and reaction time (P = .001, η2 = .13) and had greater total symptom scores (P = .02

  12. The Acute Management of Sport Concussion in Pediatric Athletes.

    Science.gov (United States)

    Resch, Jacob E; Kutcher, Jeffrey S

    2015-10-01

    During the past two decades the focus on sport concussion has increased significantly. Young athletes represent the most vulnerable population to sustain a sport concussion yet receive the least amount of attention. Specifically, young athletes who sustain a sport concussion can go unrecognized and continue to participate in sport putting them at an increased risk for a more significant injury. The purpose of this review is to provide a clinical framework for the evaluation and management of sport concussion. In addition, this review provides considerations for health care professionals in regard to clinical measures and follow-up strategies during the acute phase following concussion in young concussed athletes following injury.

  13. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... Fact Sheet Download a Fact Sheet on Overall Sports Safety: Protect the Ones You Love For parents ... Exit Disclaimer] Concussion Educational Materials for all NCAA Sports Download Materials [Exit Disclaimer] Watch a Video or ...

  14. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... Matthew Alan Gfeller Sport-Related TBI Research Center, University of North Carolina at Chapel Hill May Clinic ... of Health, Physical Education & Recreation Sports Legacy Institute University of Pittsburgh Medical Center, Sports Medicine Concussion Program ...

  15. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... Testing FAQs on Baseline Testing Fact Sheet Download a Fact Sheet on Overall Sports Safety: Protect the ... all NCAA Sports Download Materials [Exit Disclaimer] Watch a Video or PSA on Concussion NFL PSA on ...

  16. Interprofessional management of concussion in sport.

    Science.gov (United States)

    Pabian, Patrick S; Oliveira, Leonardo; Tucker, Jennifer; Beato, Morris; Gual, Carlos

    2017-01-01

    Due to the high incidence of sports concussion, various health and medical providers are likely to encounter athletes who have sustained such an injury. Management of concussion necessitates coordinated care by the members of the sports medicine team due to its pathophysiology and complexity of management during recovery. All members of the sports medicine team must possess contemporary knowledge of concussion management as well as strong interprofessional communication skills to ensure effective care and safe return to sports participation. Therefore, the aim of this manuscript is to review the current best practices in interdisciplinary management of sports concussion with a special emphasis on the required interprofessional communication among the sports medicine team. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... have symptoms that last for days, or even weeks. A more serious concussion can last for months ... is slowly increased over a period of days, weeks, or months depending on the athlete’s response to ...

  18. Link Seen Between Concussions and Alzheimer's

    Science.gov (United States)

    ... fullstory_163025.html Link Seen Between Concussions and Alzheimer's But study didn't prove head injuries cause ... mental decline of people already at risk for Alzheimer's disease? In a new study, researchers examined 160 ...

  19. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... Search The CDC Cancel Submit Search The CDC Injury Prevention & Control: Concussion Note: Javascript is disabled or is ... Disease Control and Prevention , Â National Center for Injury Prevention and Control , Â Division of Unintentional Injury Prevention ...

  20. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... ON Concussion And Traumatic Brian Injury In The USA Communicating Effectively Sports-Specific Information LESSON 1 QUIZ ... Participating Orginizations Amateur Athletic Union Amateur Softball Association/USA Softball American Academy of Neurology American Academy of ...

  1. Sports concussion: management and predictors of outcome.

    Science.gov (United States)

    Reddy, Cara Camiolo; Collins, Michael W

    2009-01-01

    Interest in sports concussion has grown widely in the last two decades among laypersons and medical professionals. Significant contributions of evidence-based research have led to a better understanding of this multifaceted, but still often elusive, injury. This information has transformed all aspects of concussion management, from on-field evaluation through return-to-play guidelines. The aim of this article is to highlight important research regarding predictors of outcome and treatment protocols. This research has been the basis of the paradigm shift from traditional concussion grading scales to individualized care. Today, concussion management requires a patient-centered approach with individualized assessment, including risk factor analysis, neurocognitive testing, and a thorough symptom evaluation.

  2. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... Email Address What's this? Submit What's this? Submit Button Concussion in Youth Sports Training course: This page ... Email Address What's this? Submit What's this? Submit Button Connect with HEADS UP & CDC's Injury Center HEADS ...

  3. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... The CDC Cancel Submit Search The CDC Injury Prevention & Control: Concussion Note: Javascript is disabled or is ... 2017 Content source: Centers for Disease Control and Prevention , Â National Center for Injury Prevention and Control , ...

  4. Heads Up: Concussion in Youth Sports

    Science.gov (United States)

    ... Fact Sheet Download a Fact Sheet on Overall Sports Safety: Protect the Ones You Love For parents ... Exit Disclaimer] Concussion Educational Materials for all NCAA Sports Download Materials [Exit Disclaimer] Watch a Video or ...

  5. Concussion in rugby — an update

    African Journals Online (AJOL)

    to the pre-season baseline value and an exercise rehab- ilitation programme has ... Concussion is a trauma-induced change in mental state that may or may not involve ..... in attention, response strategy or depressed mood. Developmental.

  6. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... Submit What's this? Submit Button Concussion in ... to the course's overview page for more information, including technical requirements: https://www.cdc.gov/headsup/youthsports/training/index. ...

  7. Expression of CRFR1 and Glu5R mRNA in different brain areas following repeated testing in mice that differ in habituation behaviour

    NARCIS (Netherlands)

    Salomons, A.R.; Arndt, S.S.; Lavrijsen, M.; Kirchhoff, S.; Ohl, F.

    2013-01-01

    Our recent studies revealed a profound impairment to habituate in 129P3 mice compared to BALB/c mice after repeated exposure to an initially novel environment. This was accompanied by strain-specific c-Fos expression in the prelimbic cortex, a brain area related to emotional and cognitive processing

  8. Possible Lingering Effects of Multiple Past Concussions

    Directory of Open Access Journals (Sweden)

    Grant L. Iverson

    2012-01-01

    Full Text Available Background. The literature on lingering or “cumulative” effects of multiple concussions is mixed. The purpose of this study was to examine whether athletes with a history of three or more concussions perform more poorly on neuropsychological testing or report more subjective symptoms during a baseline, preseason evaluation. Hypothesis. Athletes reporting three or more past concussions would perform more poorly on preseason neurocognitive testing. Study Design. Case-control study. Methods. An archival database including 786 male athletes who underwent preseason testing with a computerized battery (ImPACT was used to select the participants. Twenty-six athletes, between the ages of 17 and 22 with a history of three or more concussions, were identified. Athletes with no history of concussion were matched, in a case-control fashion, on age, education, self-reported ADHD, school, sport, and, when possible, playing position and self-reported academic problems. Results. The two groups were compared on the four neuropsychological composite scores from ImPACT using multivariate analysis of variance followed by univariate ANOVAs. MANOVA revealed no overall significant effect. Exploratory ANOVAs were conducted using Verbal Memory, Visual Memory, Reaction Time, Processing Speed, and Postconcussion Scale composite scores as dependent variables. There was a significant effect for only the Verbal Memory composite. Conclusions. Although inconclusive, the results suggest that some athletes with multiple concussions could have lingering memory deficits.

  9. Possible lingering effects of multiple past concussions.

    Science.gov (United States)

    Iverson, Grant L; Echemendia, Ruben J; Lamarre, Amanda K; Brooks, Brian L; Gaetz, Michael B

    2012-01-01

    Background. The literature on lingering or "cumulative" effects of multiple concussions is mixed. The purpose of this study was to examine whether athletes with a history of three or more concussions perform more poorly on neuropsychological testing or report more subjective symptoms during a baseline, preseason evaluation. Hypothesis. Athletes reporting three or more past concussions would perform more poorly on preseason neurocognitive testing. Study Design. Case-control study. Methods. An archival database including 786 male athletes who underwent preseason testing with a computerized battery (ImPACT) was used to select the participants. Twenty-six athletes, between the ages of 17 and 22 with a history of three or more concussions, were identified. Athletes with no history of concussion were matched, in a case-control fashion, on age, education, self-reported ADHD, school, sport, and, when possible, playing position and self-reported academic problems. Results. The two groups were compared on the four neuropsychological composite scores from ImPACT using multivariate analysis of variance followed by univariate ANOVAs. MANOVA revealed no overall significant effect. Exploratory ANOVAs were conducted using Verbal Memory, Visual Memory, Reaction Time, Processing Speed, and Postconcussion Scale composite scores as dependent variables. There was a significant effect for only the Verbal Memory composite. Conclusions. Although inconclusive, the results suggest that some athletes with multiple concussions could have lingering memory deficits.

  10. Head Injuries

    Science.gov (United States)

    ... object that's stuck in the wound. previous continue Concussions Concussions — the temporary loss of normal brain function due ... also a type of internal head injury. Repeated concussions can permanently damage the brain. In many cases, ...

  11. The biomechanics of concussion in unhelmeted football players in Australia: a case–control study

    Science.gov (United States)

    McIntosh, Andrew S; Patton, Declan A; Fréchède, Bertrand; Pierré, Paul-André; Ferry, Edouard; Barthels, Tobias

    2014-01-01

    Objective Concussion is a prevalent brain injury in sport and the wider community. Despite this, little research has been conducted investigating the dynamics of impacts to the unprotected human head and injury causation in vivo, in particular the roles of linear and angular head acceleration. Setting Professional contact football in Australia. Participants Adult male professional Australian rules football players participating in 30 games randomly selected from 103 games. Cases selected based on an observable head impact, no observable symptoms (eg, loss-of-consciousness and convulsions), no on-field medical management and no injury recorded at the time. Primary and secondary outcome measures A data set for no-injury head impact cases comprising head impact locations and head impact dynamic parameters estimated through rigid body simulations using the MAthematical DYnamic MOdels (MADYMO) human facet model. This data set was compared to previously reported concussion case data. Results Qualitative analysis showed that the head was more vulnerable to lateral impacts. Logistic regression analyses of head acceleration and velocity components revealed that angular acceleration of the head in the coronal plane had the strongest association with concussion; tentative tolerance levels of 1747 rad/s2 and 2296 rad/s2 were reported for a 50% and 75% likelihood of concussion, respectively. The mean maximum resultant angular accelerations for the concussion and no-injury cases were 7951 rad/s2 (SD 3562 rad/s2) and 4300 rad/s2 (SD 3657 rad/s2), respectively. Linear acceleration is currently used in the assessment of helmets and padded headgear. The 50% and 75% likelihood of concussion values for resultant linear head acceleration in this study were 65.1 and 88.5 g, respectively. Conclusions As hypothesised by Holbourn over 70 years ago, angular acceleration plays an important role in the pathomechanics of concussion, which has major ramifications in terms of

  12. The biomechanics of concussion in unhelmeted football players in Australia: a case-control study.

    Science.gov (United States)

    McIntosh, Andrew S; Patton, Declan A; Fréchède, Bertrand; Pierré, Paul-André; Ferry, Edouard; Barthels, Tobias

    2014-05-20

    Concussion is a prevalent brain injury in sport and the wider community. Despite this, little research has been conducted investigating the dynamics of impacts to the unprotected human head and injury causation in vivo, in particular the roles of linear and angular head acceleration. Professional contact football in Australia. Adult male professional Australian rules football players participating in 30 games randomly selected from 103 games. Cases selected based on an observable head impact, no observable symptoms (eg, loss-of-consciousness and convulsions), no on-field medical management and no injury recorded at the time. A data set for no-injury head impact cases comprising head impact locations and head impact dynamic parameters estimated through rigid body simulations using the MAthematical DYnamic MOdels (MADYMO) human facet model. This data set was compared to previously reported concussion case data. Qualitative analysis showed that the head was more vulnerable to lateral impacts. Logistic regression analyses of head acceleration and velocity components revealed that angular acceleration of the head in the coronal plane had the strongest association with concussion; tentative tolerance levels of 1747 rad/s(2) and 2296 rad/s(2) were reported for a 50% and 75% likelihood of concussion, respectively. The mean maximum resultant angular accelerations for the concussion and no-injury cases were 7951 rad/s(2) (SD 3562 rad/s(2)) and 4300 rad/s(2) (SD 3657 rad/s(2)), respectively. Linear acceleration is currently used in the assessment of helmets and padded headgear. The 50% and 75% likelihood of concussion values for resultant linear head acceleration in this study were 65.1 and 88.5 g, respectively. As hypothesised by Holbourn over 70 years ago, angular acceleration plays an important role in the pathomechanics of concussion, which has major ramifications in terms of helmet design and other efforts to prevent and manage concussion. Published by

  13. Young Football Players Tackle Greatest Concussion Risk At Practice

    Science.gov (United States)

    ... https://medlineplus.gov/news/fullstory_160579.html Young Football Players Tackle Greatest Concussion Risk at Practice But ... Children under the age of 14 who play football are at risk of concussions, and a small ...

  14. Concussion Can Spur Short-Term Change in Women's Periods

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_167006.html Concussion Can Spur Short-Term Change in Women's Periods ... MONDAY, July 3, 2017 (HealthDay News) -- After a concussion, a young woman might notice that her next ...

  15. Engaging Teammates in the Promotion of Concussion Help Seeking

    Science.gov (United States)

    Kroshus, Emily; Garnett, Bernice R.; Baugh, Christine M.; Calzo, Jerel P.

    2016-01-01

    Concussion underreporting contributes to the substantial public health burden of concussions from sport. Teammates may be able to play an important role in encouraging injury identification and help seeking. This study assessed whether there was an association between beliefs about the consequences of continued play with a concussion and…

  16. Concussion in sport: what is known and what is new?

    African Journals Online (AJOL)

    Catharina Grant

    2014-08-20

    Aug 20, 2014 ... ... and made use of the Glasgow. Coma Scale for the definition of mild TBI.2 However, the ... four years to review existing evidence on concussion in sport. Concussion is now ... Keywords: concussion, diagnosis, return to play, signs ... An increased risk of other injuries because of poor decision- making or ...

  17. Management of concussion in disability sport: A different ball game?

    OpenAIRE

    West, L R; Griffin, S.; Weiler, R.; Ahmed, Osman

    2016-01-01

    Concussion management in sport is a serious medical issue. Frequent high-profile incidents coupled with ongoing debate and research surrounding the definition, diagnosis and management of concussion mean that it is likely to remain a hot topic.1 Internationally, concussion has become a key focus for many sporting governing bodies, with a range of educational campaigns aimed at improving recognition and management.

  18. Chronic Exposure to Androgenic-Anabolic Steroids Exacerbates Axonal Injury and Microgliosis in the CHIMERA Mouse Model of Repetitive Concussion.

    Directory of Open Access Journals (Sweden)

    Dhananjay R Namjoshi

    Full Text Available Concussion is a serious health concern. Concussion in athletes is of particular interest with respect to the relationship of concussion exposure to risk of chronic traumatic encephalopathy (CTE, a neurodegenerative condition associated with altered cognitive and psychiatric functions and profound tauopathy. However, much remains to be learned about factors other than cumulative exposure that could influence concussion pathogenesis. Approximately 20% of CTE cases report a history of substance use including androgenic-anabolic steroids (AAS. How acute, chronic, or historical AAS use may affect the vulnerability of the brain to concussion is unknown. We therefore tested whether antecedent AAS exposure in young, male C57Bl/6 mice affects acute behavioral and neuropathological responses to mild traumatic brain injury (TBI induced with the CHIMERA (Closed Head Impact Model of Engineered Rotational Acceleration platform. Male C57Bl/6 mice received either vehicle or a cocktail of three AAS (testosterone, nandrolone and 17α-methyltestosterone from 8-16 weeks of age. At the end of the 7th week of treatment, mice underwent two closed-head TBI or sham procedures spaced 24 h apart using CHIMERA. Post-repetitive TBI (rTBI behavior was assessed for 7 d followed by tissue collection. AAS treatment induced the expected physiological changes including increased body weight, testicular atrophy, aggression and downregulation of brain 5-HT1B receptor expression. rTBI induced behavioral deficits, widespread axonal injury and white matter microgliosis. While AAS treatment did not worsen post-rTBI behavioral changes, AAS-treated mice exhibited significantly exacerbated axonal injury and microgliosis, indicating that AAS exposure can alter neuronal and innate immune responses to concussive TBI.

  19. University Football Players, Postural Stability, and Concussions.

    Science.gov (United States)

    Graves, Barbara Sue

    2016-02-01

    Concussion in football athletes is certainly more prevalent and has potentially serious outcomes. With current concerns and increasing return-to-play issues, additional assessment focus is needed. Division 1 college football athletes, from 18 to 20.9 years (n = 177; age, 19.7 ± 1.2 years; height, 182.3 ± 4.5 cm; weight, 97.3 ± 10.6 kg), before fall practice, over a period of 3 years, underwent baseline postural stability testing (sensory organization test [SOT], NeuroCom). Individuals, who were diagnosed with a concussion (headache, dizziness, fatigue, confusion, or loss of consciousness) during practice or actual competition (n = 15; age, 18.9 ± 0.9 years; height, 181.8 ± 2.5 cm; weight, 86.6 ± 3.6 kg), underwent serial evaluation after injury and 24 hours after concussion. As soon as the player was considered asymptomatic, the test was completed on the first and 14th day. A control group of noninjured male athletes (n = 15; age, 19.1 ± 0.4 years; height, 178.2 ± 3.2 cm; weight, 78.6 ± 2.1 kg) were tested for the same time frame. This particular study was only one part of the total evaluation conducted for the concussed athlete's return to play. Results indicated that the concussion group had a statistically significant (p = 0.037) change from their baseline SOT score and the control group (p = 0.025). This change remained significant until day 14 of posttesting. These data indicate that the SOT, when available, may be a positive additional assessment of concussed college-aged football players. Professionals, when dealing with concussion in competitive sports, do need to continue to work together, but awareness of SOT assessments may also contribute to the return-to-play decisions.

  20. Microstructural changes in memory and reticular formation neural pathway after simple concussion

    Institute of Scientific and Technical Information of China (English)

    Lin Ouyang; Rongyue Shi; Yuhui Xiao; Jiarong Meng; Yihe Guo; Guangming Lu

    2012-01-01

    Patients with concussion often present with temporary disturbance of consciousness.The microstructural and functional changes in the brain associated with concussion,as well as the relationship with transient cognitive disorders,are currently unclear.In the present study,a rabbit model of simple concussion was established.Magnetic resonance-diffusion tensor imaging results revealed that the corona radiata and midbrain exhibited significantly decreased fractional anisotropy values in the neural pathways associated with memory and the reticular formation.In addition,the apparent diffusion coefficient values were significantly increased following injury compared with those before injury.Following a 1-hour period of quiet rest,the fractional anisotropy values significantly increased,and apparent diffusion coefficient values significantly decreased,returning to normal pre-injury levels.In contrast,the fractional anisotropy values and apparent diffusion coefficient values in the corpus callosum,thalamus and hippocampus showed no statistical significant alterations following injury.These findings indicate that the neural pathways associated with memory and the reticular formation pathway exhibit reversible microstructural white matter changes when concussion occurs,and these changes are exhibited to a different extent in different regions.

  1. Post-concussive syndrome in a female basketball player: a case study

    Directory of Open Access Journals (Sweden)

    Str

    2013-05-01

    Full Text Available Sarah L StrandDepartment of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USAAbstract: The objective of this case study was to identify the signs and symptoms of concussion and post-concussive syndrome in a collegiate, female basketball player, as well as her progress to becoming symptom free. The patient, a previously healthy, 21-year-old with no previous head injuries, experienced a concussion and continued to participate in her sport. Even though the athlete knew the risks of playing while symptomatic, she did not report her symptoms, and continued playing until the season ended. This case highlights that even when patients know the risks, they may be willing to overlook them to continue playing and it emphasizes the importance of further education. In addition, it shows that even when following recommended guidelines, and with normal neurocognitive testing, symptoms may come back upon return to play.Keywords: concussion, basketball, mild traumatic brain injury, female athletes

  2. Sports-related concussions: diagnosis, complications, and current management strategies.

    Science.gov (United States)

    Hobbs, Jonathan G; Young, Jacob S; Bailes, Julian E

    2016-04-01

    Sports-related concussions (SRCs) are traumatic events that affect up to 3.8 million athletes per year. The initial diagnosis and management is often instituted on the field of play by coaches, athletic trainers, and team physicians. SRCs are usually transient episodes of neurological dysfunction following a traumatic impact, with most symptoms resolving in 7-10 days; however, a small percentage of patients will suffer protracted symptoms for years after the event and may develop chronic neurodegenerative disease. Rarely, SRCs are associated with complications, such as skull fractures, epidural or subdural hematomas, and edema requiring neurosurgical evaluation. Current standards of care are based on a paradigm of rest and gradual return to play, with decisions driven by subjective and objective information gleaned from a detailed history and physical examination. Advanced imaging techniques such as functional MRI, and detailed understanding of the complex pathophysiological process underlying SRCs and how they affect the athletes acutely and long-term, may change the way physicians treat athletes who suffer a concussion. It is hoped that these advances will allow a more accurate assessment of when an athlete is truly safe to return to play, decreasing the risk of secondary impact injuries, and provide avenues for therapeutic strategies targeting the complex biochemical cascade that results from a traumatic injury to the brain.

  3. Concussion

    Science.gov (United States)

    ... and Sugar Substitutes Exercise and Fitness Exercise Basics Sports Safety Injury Rehabilitation Emotional Well-Being Mental Health ... and Sugar Substitutes Exercise and Fitness Exercise Basics Sports Safety Injury Rehabilitation Emotional Well-Being Mental Health ...

  4. Concussions From 9 Youth Organized Sports

    Science.gov (United States)

    Buzas, David; Jacobson, Nathan A.; Morawa, Lawrence G.

    2014-01-01

    Background: Youth sports programs are extremely popular throughout the United States, with children starting formal sports participation as young as 4 years. This places children at greater risk for concussions and other trauma. Purpose: To describe the epidemiology of concussions sustained during participation in 9 organized sports prior to participation in high school athletics. Methods: Over an 11-year span from January 2002 to December 2012, the authors reviewed the concussions sustained by athletes aged 4 to 13 years while playing basketball, baseball, football, gymnastics, hockey, lacrosse, soccer, softball, and wrestling, as evaluated in emergency departments (EDs) in the United States and captured by the National Electronic Injury Surveillance System (NEISS) database of the US Consumer Product Safety Commission. Study Design: Descriptive epidemiology study. Results: There were 4864 (national estimate [NE] = 117,845) youth athletes evaluated in NEISS EDs as sustaining concussions from 2002 to 2012. Except for the year 2007, concussion frequencies trended upward throughout the 11-year time frame as well as with increasing age. Loss of consciousness (LOC) occurred in 499 cases (NE, 12,129; 10%). Football had the highest frequency of concussions, with 2013 (NE, 51,220; 41%), followed by basketball, with 977 (NE, 22,099; 20%), and soccer, with 801 (NE, 18,916; 17%). The majority of concussions were treated in the outpatient setting, with 4444 (91.4%) patients being treated and released; 412 (9%) patients required admission and were found to have increased frequencies of LOC (n = 17; 18.0%) compared with LOC in the total group (n = 499, 10%). The total number of player-to-player injury mechanisms mirrored the total number of concussions by year, which increased throughout the 11-year span, except for the year 2007. Subgroup analysis of athletes aged 4 to 7 years demonstrated a difference in the mechanism of injury distribution, with a ball-to-head mechanism

  5. Physical exercise affects the epigenetic programming of rat brain and modulates the adaptive response evoked by repeated restraint stress.

    Science.gov (United States)

    Kashimoto, R K; Toffoli, L V; Manfredo, M H F; Volpini, V L; Martins-Pinge, M C; Pelosi, G G; Gomes, M V

    2016-01-01

    Epigenetics has recently been linked to molecular adaptive responses evoked by physical exercise and stress. Herein we evaluated the effects of physical exercise on global DNA methylation and expression of the Dnmt1 gene in the rat brain and also verified its potential to modulate responses evoked by repeated restraint stress (RRS). Wistar rats were classified into the following experimental groups: (1) physically active (EX): animals submitted to swimming during postnatal days 53-78 (PND); (2) stress (ST): animals submitted to RRS during 75-79PND; (3) exercise-stress (EX-ST): animals submitted to swimming during 53-78PND and to RRS during 75-79PND, and (4) control (CTL): animals that were not submitted to intervention. Samples from the hippocampus, cortex and hypothalamus were obtained at 79PND. The global DNA methylation profile was assessed using an ELISA-based method and the expression of Dnmt1 was evaluated by real-time PCR. Significantly increased methylation was observed in the hypothalamus of animals from the EX group in comparison to CTL. Comparative analysis involving the EX-ST and ST groups revealed increased global DNA methylation in the hippocampus, cortex, and hypothalamus of EX-ST, indicating the potential of physical exercise in modulating the responses evoked by RRS. Furthermore, decreased expression of the Dnmt1 gene was observed in the hippocampus and hypothalamus of animals from the EX-ST group. In summary, our data indicate that physical exercise affects DNA methylation of the hypothalamus and might modulate epigenetic responses evoked by RRS in the hippocampus, cortex, and hypothalamus. Copyright © 2015 Elsevier B.V. All rights reserved.

  6. Alterations in brain-derived neurotrophic factor in the mouse hippocampus following acute but not repeated benzodiazepine treatment.

    Directory of Open Access Journals (Sweden)

    Stephanie C Licata

    Full Text Available Benzodiazepines (BZs are safe drugs for treating anxiety, sleep, and seizure disorders, but their use also results in unwanted effects including memory impairment, abuse, and dependence. The present study aimed to reveal the molecular mechanisms that may contribute to the effects of BZs in the hippocampus (HIP, an area involved in drug-related plasticity, by investigating the regulation of immediate early genes following BZ administration. Previous studies have demonstrated that both brain derived neurotrophic factor (BDNF and c-Fos contribute to memory- and abuse-related processes that occur within the HIP, and their expression is altered in response to BZ exposure. In the current study, mice received acute or repeated administration of BZs and HIP tissue was analyzed for alterations in BDNF and c-Fos expression. Although no significant changes in BDNF or c-Fos were observed in response to twice-daily intraperitoneal (i.p. injections of diazepam (10 mg/kg + 5 mg/kg or zolpidem (ZP; 2.5 mg/kg + 2.5 mg/kg, acute i.p. administration of both triazolam (0.03 mg/kg and ZP (1.0 mg/kg decreased BDNF protein levels within the HIP relative to vehicle, without any effect on c-Fos. ZP specifically reduced exon IV-containing BDNF transcripts with a concomitant increase in the association of methyl-CpG binding protein 2 (MeCP2 with BDNF promoter IV, suggesting that MeCP2 activity at this promoter may represent a ZP-specific mechanism for reducing BDNF expression. ZP also increased the association of phosphorylated cAMP response element binding protein (pCREB with BDNF promoter I. Future work should examine the interaction between ZP and DNA as the cause for altered gene expression in the HIP, given that BZs can enter the nucleus and intercalate into DNA directly.

  7. Posttraumatic Stress Disorder in Combat Casualties With Burns Sustaining Primary Blast and Concussive Injuries

    Science.gov (United States)

    2009-04-01

    in close proximity to the blast center, can result in eardrum damage (rupture of the tympanic membrane TM), lung damage (pulmonary or alveolar ...rence of psychologic deficit .12,13 The Defense and Veterans Brain Injury Center reports 22% of soldiers returning from OIF/OEF as having evidence of...psychologic deficit , specifically, posttraumatic stress disorder (PTSD).13 This in- creased risk of altered mental status, concussive symptoms, and PTSD

  8. English professional football players concussion knowledge and attitude

    Directory of Open Access Journals (Sweden)

    Joshua M. Williams

    2016-06-01

    Conclusion: The results of this study suggest that Championship Level English footballers have moderate concussion knowledge, safe attitudes, and good concussion symptom recognition when assessed with pen and paper questionnaires. However, within the semi-structured interview many respondents reported unsafe concussion behaviors despite accurately identifying the potential risks. Further, multiple barriers to concussion reporting were identified which included perceived severity of the injury, game situations, and the substitution rule. These findings can help form the foundation of educational interventions to potentially improve concussion reporting behaviors amongst professional footballers.

  9. Effect of an acute bout of soccer heading on postural control and self-reported concussion symptoms.

    Science.gov (United States)

    Schmitt, D M; Hertel, J; Evans, T A; Olmsted, L C; Putukian, M

    2004-07-01

    Our purpose was to determine if an acute bout of heading soccer balls adversely affected postural control and self-reported symptoms of cerebral concussion. Thirty-one college-aged soccer players were randomly placed into either a kicking group or a heading group. Subjects either kicked or headed 18 soccer balls over the course of 40 minutes. Subjects had their postural control assessed while standing on a force plate and completed a concussion symptoms checklist on three separate occasions: prior to, immediately following, and 24 hours after kicking or heading. There were no significant differences between the heading and kicking groups on the postural control measures prior to, immediately following, and 24 hours after kicking/heading. The heading group did, however, report significantly more concussion symptoms than the kicking group immediately after heading, but not 24 hours after heading. The number of previous concussions sustained by subjects did not influence the effects of heading. An acute bout of soccer heading appears to cause an increase in self-reported symptoms of cerebral concussion lasting less than 24 hours but no quantifiable deficits in postural control. Further research is needed to investigate the cumulative effects of soccer heading on postural control and other objective measures of brain function.

  10. Neuropsychological Assessment Following Concussion: an Evidence-Based Review of the Role of Neuropsychological Assessment Pre- and Post-Concussion.

    Science.gov (United States)

    Kontos, Anthony P; Sufrinko, Alicia; Womble, Melissa; Kegel, Nathan

    2016-06-01

    Neuropsychological evaluation is one component of a comprehensive and multifaceted assessment following concussion. Although some neuropsychologists use a "hybrid" assessment approach integrating computerized neurocognitive testing batteries with traditional paper and pencil tests, computerized neurocognitive test batteries are the predominant testing modality for assessment of athletes from the youth to professional level. This review summarizes the most recent research supporting the utility of neuropsychological evaluation and highlights the strengths and weaknesses of both computerized and traditional neuropsychological testing approaches. The most up to date research and guidelines on baseline neurocognitive testing is also discussed. This paper addresses concerns regarding reliability of neuropsychological testing while providing an overview of factors that influence test performance, both transient situational factors (e.g., pain level, anxiety) and characteristics of particular subgroups (e.g., age, preexisting learning disabilities), warranting the expertise of an experienced neuropsychologist for interpretation. Currently, research is moving forward by integrating neuropsychological evaluation with emerging assessment approaches for other domains of brain function (e.g., vestibular function) vulnerable to concussion.

  11. Alteration of brain levels of neurotransmitters and amino acids in male F344 rats induced by three-week repeated inhalation exposure to 1-bromopropane.

    Science.gov (United States)

    Suda, Megumi; Honma, Takeshi; Miyagawa, Muneyuki; Wang, Rui-Sheng

    2008-08-01

    The present study investigated the effects of 1-bromopropane (1BP) on brain neuroactive substances of rats to determine the extent of its toxicity to the central nervous system (CNS). We measured the changes in neurotransmitters (acetylcholine, catecholamine, serotonin and amino acids) and their metabolites or precursors in eight brain regions after inhalation exposure to 1BP at 50 to 1,000 ppm for 8 h per day for 7 d per week for 3 wk. Rats were sacrificed at 2 h (Case 1), or at 19 h (Case 2) after the end of exposure. In Case 1, the level of 5-hydroxyindoleacetic acid (5HIAA) was lowered in some brain regions by 1BP exposure. The decrease of 5HIAA in the frontal cortex was statistically significant at 50 ppm 1BP exposure. In Case 2, gamma-amino butyric acid (GABA) and taurine were decreased in many brain regions of exposed rats, and a significant decrease of taurine in the midbrain occurred at 50 ppm 1BP exposure. In both cases of 2-h and 19-h intervals from the end of exposure to sacrifice, aspartate and glutamine levels were elevated in many brain regions, but the acetylcholine level did not change in any brain region. Three-week repeated exposure to 1BP produced significantly changes in amino acid contents of rat brains, particularly at 1,000 ppm.

  12. Concussion management in US college football: progress and pitfalls

    Science.gov (United States)

    Kroshus, Emily

    2015-01-01

    Reducing the frequency and severity of concussions from sport is an important issue in public health currently addressed by a multifaceted approach. Given the large number of participants and the comparatively high risk of injury, American football is an important sport to consider when examining concussion management practices. Focusing on American football at the collegiate level, this manuscript describes current research regarding concussion epidemiology, policy, implementation of clinical diagnosis, management and return-to-play standards and athlete concussion education. Although American collegiate sports leagues have put forth concussion-related policies in recent years, the implementation of these policies and related effects on athlete concussion education, clinical management of concussion and ultimately athlete health outcomes are not well understood. Additional research is needed. PMID:27064258

  13. Concussion in Sports: What Do Orthopaedic Surgeons Need to Know?

    Science.gov (United States)

    Cahill, Patrick J; Refakis, Christian; Storey, Eileen; Warner, William C

    2016-12-01

    A concussion is a relatively common sports-related injury that affects athletes of all ages. Although orthopaedic surgeons are not expected to replace sports medicine physicians and neurologists with regard to the management of concussions, orthopaedic surgeons, particularly those who are fellowship-trained in sports medicine, must have a current knowledge base of what a concussion is, how a concussion is diagnosed, and how a concussion should be managed. Orthopaedic surgeons should understand the pathophysiology, assessment, and management of concussion so that they have a basic comprehension of this injury, which is at the forefront of the academic literature and North American media. This understanding will prepare orthopaedic surgeons to work in concert with and assist sports medicine physicians, athletic trainers, and physical therapists in providing comprehensive care for athletes with a concussion.

  14. Update on concussion management for the Rhode Island clinician.

    Science.gov (United States)

    Waryasz, Gregory R; Tambone, Robert; Kriz, Peter

    2014-02-03

    Concussions are common injuries with increasing diagnostic incidence. The 4th International Conference on Concussion in Sport, held in November 2012 in Zurich, revised consensus statements regarding the definition of a concussion, diagnostic criteria, and management. Return-to-play guidelines require a graded return to activity in which concussed athletes remain symptom-free. In order to improve awareness pertaining to concussion diagnosis and management, legislation has now been enacted in all fifty states. Rhode Island enacted into law the School and Youth Programs Concussion Act in 2010, which increases awareness of concussions for athletes, coaches, teachers, school nurses and parents/guardians through written information and mandatory training for coaches. Athletes must be removed from practice/competition and cannot return until a physician has evaluated and cleared them. [Full text available at http://rimed.org/rimedicaljournal-2015-02.asp, free with no login].

  15. Concussion in professional football: comparison with boxing head impacts--part 10.

    Science.gov (United States)

    Viano, David C; Casson, Ira R; Pellman, Elliot J; Bir, Cynthia A; Zhang, Liying; Sherman, Donald C; Boitano, Marilyn A

    2005-12-01

    This study addresses impact biomechanics from boxing punches causing translational and rotational head acceleration. Olympic boxers threw four different punches at an instrumented Hybrid III dummy and responses were compared with laboratory-reconstructed NFL concussions. Eleven Olympic boxers weighing 51 to 130 kg (112-285 lb) delivered 78 blows to the head of the Hybrid III dummy, including hooks, uppercuts and straight punches to the forehead and jaw. Instrumentation included translational and rotational head acceleration and neck loads in the dummy. Biaxial acceleration was measured in the boxer's hand to determine punch force. High-speed video recorded each blow. Hybrid III head responses and finite element (FE) brain modeling were compared to similarly determined responses from reconstructed NFL concussions. The hook produced the highest change in hand velocity (11.0 +/- 3.4 m/s) and greatest punch force (4405 +/- 2318 N) with average neck load of 855 +/- 537 N. It caused head translational and rotational accelerations of 71.2 +/- 32.2 g and 9306 +/- 4485 r/s. These levels are consistent with those causing concussion in NFL impacts. However, the head injury criterion (HIC) for boxing punches was lower than for NFL concussions because of shorter duration acceleration. Boxers deliver punches with proportionately more rotational than translational acceleration than in football concussion. Boxing punches have a 65 mm effective radius from the head cg, which is almost double the 34 mm in football. A smaller radius in football prevents the helmets from sliding off each other in a tackle. Olympic boxers deliver punches with high impact velocity but lower HIC and translational acceleration than in football impacts because of a lower effective punch mass. They cause proportionately more rotational acceleration than in football. Modeling shows that the greatest strain is in the midbrain late in the exposure, after the primary impact acceleration in boxing and football.

  16. CONCUSSION OCCURRENCE AND KNOWLEDGE IN ITALIAN FOOTBALL (SOCCER

    Directory of Open Access Journals (Sweden)

    Steven P. Broglio

    2010-09-01

    Full Text Available The purpose of the study was to investigate concussion history, knowledge, injury identification, and management strategies among athletes, coaches, and medical staff in Italian club level football (soccer clubs. Surveys (N=727 were distributed among Italian football clubs. Athletes' surveys were designed to evaluate athlete knowledge of concussive signs and symptoms and injury reporting. Coaches' surveys explored the understanding of concussive signs and symptoms and management practices. Medical staff surveys explored the standard of care regarding concussions. A total of 342 surveys were returned, for a 47% response rate. Descriptive analyses indicated 10% of athletes sustaining a concussion in the past year and 62% of these injuries were not reported, primarily due to the athletes not thinking the injury was serious enough. Coaches consistently identified non-concussion related symptoms (98.7%, but were unable to identify symptoms associated with concussion (38.9%. Most understood that loss of consciousness is not the sole indicator of injury (82.6%. Medical staff reported a heavy reliance on the clinical exam (92% and athlete symptom reports (92% to make the concussion diagnosis and return to play decision, with little use of neurocognitive (16.7% or balance (0.0% testing. Italian football athletes appear to report concussions at a rate similar to American football players, with a slightly higher rate of unreported injuries. Most of these athletes were aware they were concussed, but did not feel the injury was serious enough to report. Although coaches served as the primary person to whom concussions were reported, the majority of coaches were unable to accurately identify concussion related symptoms. With little use for neurocognitive and postural control assessments, the medical personnel may be missing injuries or returning athletes to play too soon. Collectively, these findings suggest that athletes, coaches, and medical personnel would

  17. In Silico Modeling of Novel Drug Ligands for Treatment of Concussion Associated Tauopathy.

    Science.gov (United States)

    Zhao, Wei; Ho, Lap; Wang, Jun; Bi, Weina; Yemul, Shrishailam; Ward, Libby; Freire, Daniel; Mazzola, Paolo; Brathwaite, Justin; Mezei, Mihaly; Sanchez, Roberto; Elder, Gregory A; Pasinetti, Giulio Maria

    2016-10-01

    The objective of this study was to develop an in silico screening model for characterization of potential novel ligands from commercial drug libraries able to functionally activate certain olfactory receptors (ORs), which are members of the class A rhodopsin-like family of G protein couple receptors (GPCRs), in the brain of murine models of concussion. We previously found that concussions may significantly influence expression of certain ORs, for example, OR4M1 in subjects with a history of concussion/traumatic brain injury (TBI). In this study, we built a 3-D OR4M1 model and used it in in silico screening of potential novel ligands from commercial drug libraries. We report that in vitro activation of OR4M1 with the commercially available ZINC library compound 10915775 led to a significant attenuation of abnormal tau phosphorylation in embryonic cortico-hippocampal neuronal cultures derived from NSE-OR4M1 transgenic mice, possibly through modulation of the JNK signaling pathway. The attenuation of abnormal tau phosphorylation was rather selective since ZINC10915775 significantly decreased tau phosphorylation on tau Ser202/T205 (AT8 epitope) and tau Thr212/Ser214 (AT100 epitope), but not on tau Ser396/404 (PHF-1 epitope). Moreover, no response of ZINC10915775 was found in control hippocampal neuronal cultures derived from wild type littermates. Our in silico model provides novel means to pharmacologically modulate select ubiquitously expressed ORs in the brain through high affinity ligand activation to prevent and eventually to treat concussion induced down regulation of ORs and subsequent cascade of tau pathology. J. Cell. Biochem. 117: 2241-2248, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  18. Loss of possession: concussions, informed consent, and autonomy.

    Science.gov (United States)

    Robeson, Richard; King, Nancy M P

    2014-01-01

    The recent explosion of publicity about the dangers of concussion in contact sports - particularly in football - represents the unraveling of a disinformation campaign by the NFL amid growing public and professional concern about the game's long-term risks of harm. The persistence of controversy and denial reflects a cultural view of football players as serving the needs of the team, a resulting evidentiary skepticism, and resistance to rule changes as excessive or unenforceable. This article considers the cultural context of informed decision making by parents of youth football players and suggests that policy changes designed to lower (although they cannot eliminate) risks of brain injury have the potential to change both the culture of football and the way the benefits and harms of the game are regarded for its players, without loss of its essential excitement and appeal.

  19. [A case of brain metastasis discovered after surgery for lung cancer based on changes in CEA, in which long-term survival was obtained by repeated gammaknife irradiation].

    Science.gov (United States)

    Kakeya, Hiroshi; Inoue, Yuichi; Sawai, Toyomitsu; Ikuta, Yasushi; Ohno, Hideaki; Yanagihara, Katsunori; Higashiyama, Yasuhito; Miyazaki, Yoshitsugu; Soda, Hiroshi; Tashiro, Takayoshi; Kohno, Shigeru

    2005-12-01

    A 58-year-old man underwent right lower lobectomy for lung adenocarcinoma in June 1998. Since a high level of tumor marker CEA persisted after surgery, chemotherapy was additionally performed, and the CEA level subsequently normalized. However, the CEA level increased in April 1999, and brain metastasis was found in the left occipital lobe, and the first gammaknife irradiation was performed. Multiple brain metastases were found when CEA increased again in August 1999, and the second gammaknife irradiation was performed. Moreover, brain metastases were found in the left frontal and occipital lobes in February 2000, and the third gammaknife irradiation was performed. CEA normalized thereafter, but increased in February 2001. Brain metastasis was found in the right occipital lobe, and the fourth gammaknife irradiation was performed. CEA has remained within the normal range for about 4 years thereafter. Long-term survival was possible by repeated gammaknife irradiation for brain metastases. Monitoring of CEA played an important role in finding recurrent brain metastasis in this patient.

  20. The association between white-matter tract abnormalities, and neuropsychiatric and cognitive symptoms in retired professional football players with multiple concussions.

    Science.gov (United States)

    Multani, Namita; Goswami, Ruma; Khodadadi, Mozhgan; Ebraheem, Ahmed; Davis, Karen D; Tator, Charles H; Wennberg, Richard; Mikulis, David J; Ezerins, Leo; Tartaglia, Maria Carmela

    2016-07-01

    Retired professional athletes, who have suffered repetitive concussions, report symptoms of depression, anxiety, and memory impairment over time. Moreover, recent imaging data suggest chronic white-matter tract deterioration in sport-related concussion. The aim of this study is to evaluate the impact of repetitive concussions in retired professional football players on white-matter tracts, and relate these changes to neuropsychological function. All subjects (18 retired professional football players and 17 healthy controls) underwent imaging, neuropsychological assessment, and reported on concussion-related symptoms. Whole brain tract-based spatial statistics analysis revealed increased axial diffusivity in the right hemisphere of retired players in the (1) superior longitudinal fasciculus (SLF), (2) corticospinal tract, and (3) anterior thalamic radiations, suggesting chronic axonal degeneration in these tracts. Moreover, retired players report significantly higher neuropsychiatric and cognitive symptoms than healthy controls, and worsening of these symptoms since their last concussion. Loss of integrity in the right SLF significantly correlated with participants' visual learning ability. In sum, these results suggest that repetitive concussions in retired professional football players are associated with focal white-matter tract abnormalities that could explain some of the neuropsychiatric symptoms and cognitive deficits experienced by these retired athletes.

  1. Sport-related concussions: knowledge translation among minor hockey coaches.

    Science.gov (United States)

    Mrazik, Martin; Bawani, Farzad; Krol, Andrea L

    2011-07-01

    The objective of this study was to investigate minor hockey coaches' knowledge base of sport-related concussions. Cross-sectional survey. Subjects independently completed the written survey at preseason organizational meetings. One hundred seventy-eight active coaches spanning 5 age levels (ages 5-15 years). Coaches reported 2.62 ± 3.73 years of coaching experience. Resources where coaches obtained information about concussions, perceptions of variables associated with concussions, knowledge level of issues associated with concussions, and decision-making practices. Newspapers and magazines were the most frequent source of information regarding concussions, yet were rated as not very helpful. Family physicians were less frequently sought but were rated as most helpful. A majority of coaches reported limited knowledge about concussions but rated this knowledge as being important. There was a significant relationship between head coaching experience and concussion knowledge [R = 0.09, F3,156 = 4.41, P = 0.005]. Most coaches demonstrated a good knowledge base of common issues associated with concussions, and a majority of individuals correctly identified return-to-play practices. A majority of minor hockey coaches correctly recognized and understood issues related to sport-related concussions. Results suggested that knowledge translation through various formal and informal sources has had a positive effect. However, a majority of coaches reported having limited knowledge about concussions yet consider it an important topic.

  2. Exploration of US men's professional sport organization concussion policies.

    Science.gov (United States)

    Cochrane, Graham Dean; Owen, Matthew; Ackerson, Joseph D; Hale, Matthew H; Gould, Sara

    2017-05-01

    Concussion policies are increasingly being developed and adopted among professional sports organizations. We sought to compare the policies of the National Hockey League (NHL), the National Basketball Association (NBA), the National Football League (NFL), and Major League Baseball (MLB). Our objective was to summarize each policy and evaluate the extent to which each policy is organization-specific and/or consistent with medical guidelines. We visited websites for the NHL, NBA, NFL, and MLB. We searched media articles reporting concussion policy. We utilized only publically available data. We collected information on each league's approach to the definition of concussion, education provided about concussion, baseline testing requirements, minimum return to play time and return to play protocol. We found that concussion policies vary across these organizations. Most organizations utilize the Concussion in Sport Group (CISG) definition (2013) to define concussion. The NFL and NBA mandate preseason education. All organizations require some type of baseline testing. All organizations require sideline evaluation after suspected concussion. The NFL and MLB require Sport Concussion Assessment Tool (SCAT) testing for sideline evaluation of suspected concussion. MLB is the only organization to require minimum time before return to play. There is a return to play protocol in place for each organization. The NFL and MLB require independent neurologic consultation as part of their return to play protocol. There is variability in concussion policy among the professional sports organizations. The most pronounced variation from the CISG consensus statement is the variability in the minimum time to return to play. Further, the rules of the individual sports have a role in how concussion policy can be designed and implemented. Professional sports set an example for thousands of recreational sports enthusiasts so their publically available policies on concussion have a large impact.

  3. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... chances for long-term problems. B You can’t see a concussion like you can a broken ... even briefly) Shows behavior or personality changes Can't recall events prior to hit or fall Can' ...

  4. [Evaluation of relevance in concussion and damage of health by monitoring of neuron specific enolase and S-100b protein].

    Science.gov (United States)

    Vajtr, D; Průsa, R; Kukacka, J; Houst'ava, L; Sámal, F; Pelichovská, M; Strejc, P; Toupalík, P

    2007-07-01

    Proteins released to the circulation from affected glial (neuron specific enolasis, NSE) or ganglial cells (S-100b protein) during traumatic brain injury might be used in diagnosis of traumatic brain injury in cases with negative finding on computer tomography scan (concussion) or in patients where the serious clinical status does not corresponde with mild changes on CT scan (diffuse axonal injury, DAI). Classification of DAI according Gennarelli considered the concussion as lower degree of DAI. 15 patients were divided into group I of mild conccussion (n=3) with 1-day duration of hospitalisation, group II of serious concussion (n=4) with more days duration of hospitalisation with negative findings on CT scan and group III of patients with diagnosis of DAI (n=8). Blood samples were investigated by immunoanalysis for NSE and protein S-100b (Elecsys 2010, Roche). Values of NSE (16.30 +/- 2.33 vs. 110.48 +/- 34.99 vs. 24.07 +/- 6.29 microg/l), and protein S-100b (0.207 +/- 0.03 vs. 0.945 +/- 0.69 vs. 0.736 +/- 0.36 microg/l) overdrow the reference value in cases of group I, II, and III. We discuss the biomechanics of trauma and the blood brain barrier damage in comparison with values of NSE and S-100b protein. [corrected] We proved the significantly higher values of the NSE in group of serious concussion compared to group of DAI. We demonstrated that concussions in some cases lead to serious damage of health.

  5. Diet, age, and prior injury status differentially alter behavioral outcomes following concussion in rats.

    Science.gov (United States)

    Mychasiuk, Richelle; Hehar, Harleen; van Waes, Linda; Esser, Michael J

    2015-01-01

    Mild traumatic brain injury (mTBI) or concussion affects a large portion of the population and although many of these individuals recover completely, a small subset of people experience lingering symptomology and poor outcomes. Little is known about the factors that affect individual susceptibility or resilience to poor outcomes after mTBI and there are currently no biomarkers to delineate mTBI diagnosis or prognosis. Based upon the growing literature associated with caloric intake and altered neurological aging and the ambiguous link between repetitive mTBI and progressive neurodegeneration, the current study was designed to examine the effect of a high fat diet (HFD), developmental age, and repetitive mTBI on behavioral outcomes following a mTBI. In addition, telomere length was examined before and after experimental mTBI. Sprague Dawley rats were maintained on a HFD or standard rat chow throughout life (including the prenatal period) and then experienced an mTBI/concussion at P30, P30 and P60, or only at P60. Behavioral outcomes were examined using a test battery that was administered between P61-P80 and included; beam-walking, open field, elevated plus maze, novel context mismatch, Morris water task, and forced swim task. Animals with a P30 mTBI often demonstrated lingering symptomology that was still present during testing at P80. Injuries at P30 and P60 rarely produced cumulative effects, and in some tests (i.e., beam walking), the first injury may have protected the brain from the second injury. Exposure to the high fat diet exacerbated many of the behavioral deficits associated with concussion. Finally, telomere length was shortened following mTBI and was influenced by the animal's dietary intake. Diet, age at the time of injury, and the number of prior concussion incidents differentially contribute to behavioral deficits and may help explain individual variations in susceptibility and resilience to poor outcomes following an mTBI.

  6. Depressive symptoms and concussions in aging retired NFL players.

    Science.gov (United States)

    Didehbani, Nyaz; Munro Cullum, C; Mansinghani, Sethesh; Conover, Heather; Hart, John

    2013-08-01

    We examined the relationship between a remote history of concussions with current symptoms of depression in retired professional athletes. Thirty retired National Football League (NFL) athletes with a history of concussion and 29 age- and IQ-matched controls without a history of concussion were recruited. We found a significant correlation between the number of lifetime concussions and depressive symptom severity using the Beck Depression Inventory II. Upon investigating a three-factor model of depressive symptoms (affective, cognitive, and somatic; Buckley et al., 2001) from the BDI-II, the cognitive factor was the only factor that was significantly related to concussions. In general, NFL players endorsed more symptoms of depression on all three Buckley factors compared with matched controls. Findings suggest that the number of self-reported concussions may be related to later depressive symptomology (particularly cognitive symptoms of depression).

  7. Sports-related concussions — media, science and policy

    Science.gov (United States)

    Mannix, Rebekah; Meehan, William P.; Pascual-Leone, Alvaro

    2017-01-01

    Although growing awareness about the potential long-term deleterious effects of sport-related concussion has led to increased attention to the risks of collision sports, calls to ban these sports, such as American football, might be premature. Collision sports have a relatively high incidence of concussions, but participation in these sports also confers a host of benefits. In addition, the associated risks of participation, including concussion, have not been definitively shown to outweigh the benefits they provide, and the risk–benefit ratio might vary among individuals. The risks of concussion and repetitive concussions associated with collision sports are unknown in the general population and not well characterized even in elite athlete populations. In this article, we discuss current knowledge on sports-related concussion, its neurological consequences, and implications for regulation of the practice of collision sports. PMID:27364748

  8. Sports-related concussions - media, science and policy.

    Science.gov (United States)

    Mannix, Rebekah; Meehan, William P; Pascual-Leone, Alvaro

    2016-08-01

    Although growing awareness about the potential long-term deleterious effects of sport-related concussion has led to increased attention to the risks of collision sports, calls to ban these sports, such as American football, might be premature. Collision sports have a relatively high incidence of concussions, but participation in these sports also confers a host of benefits. In addition, the associated risks of participation, including concussion, have not been definitively shown to outweigh the benefits they provide, and the risk-benefit ratio might vary among individuals. The risks of concussion and repetitive concussions associated with collision sports are unknown in the general population and not well characterized even in elite athlete populations. In this article, we discuss current knowledge on sports-related concussion, its neurological consequences, and implications for regulation of the practice of collision sports.

  9. Depressive Symptoms and Concussions in Aging Retired NFL Players

    Science.gov (United States)

    Didehbani, Nyaz; Munro Cullum, C.; Mansinghani, Sethesh; Conover, Heather; Hart, John

    2013-01-01

    We examined the relationship between a remote history of concussions with current symptoms of depression in retired professional athletes. Thirty retired National Football League (NFL) athletes with a history of concussion and 29 age- and IQ-matched controls without a history of concussion were recruited. We found a significant correlation between the number of lifetime concussions and depressive symptom severity using the Beck Depression Inventory II. Upon investigating a three-factor model of depressive symptoms (affective, cognitive, and somatic; Buckley et al., 2001) from the BDI-II, the cognitive factor was the only factor that was significantly related to concussions. In general, NFL players endorsed more symptoms of depression on all three Buckley factors compared with matched controls. Findings suggest that the number of self-reported concussions may be related to later depressive symptomology (particularly cognitive symptoms of depression). PMID:23644673

  10. In-office management of sport-related concussion.

    Science.gov (United States)

    Reynolds, Erin; Collins, Michael W

    2014-01-01

    The field of sport-related concussion has grown exponentially over the past decade, with more concussion-specific clinics being identified in major hospital systems as well as independent practitioner's offices. To date, there is no standardized in-office protocol for managing ongoing symptoms. The University of Pittsburgh Medical Center (UPMC) Sports Concussion Program, established in 2000, is one of the largest programs in the USA, pioneering the way in clinical management, research, and education of sport-related concussion. This report will outline the essential components of a successful concussion clinic, using the UPMC Sports Concussion Program as a case example of best practice. We will share several case studies illustrating the individualized and complex nature of this injury, as well as review important rehabilitation components.

  11. Repeated head trauma is associated with smaller thalamic volumes and slower processing speed: the Professional Fighters' Brain Health Study.

    Science.gov (United States)

    Bernick, Charles; Banks, Sarah J; Shin, Wanyong; Obuchowski, Nancy; Butler, Sam; Noback, Michael; Phillips, Michael; Lowe, Mark; Jones, Stephen; Modic, Michael

    2015-08-01

    Cumulative head trauma may alter brain structure and function. We explored the relationship between exposure variables, cognition and MRI brain structural measures in a cohort of professional combatants. 224 fighters (131 mixed martial arts fighters and 93 boxers) participating in the Professional Fighters Brain Health Study, a longitudinal cohort study of licensed professional combatants, were recruited, as were 22 controls. Each participant underwent computerised cognitive testing and volumetric brain MRI. Fighting history including years of fighting and fights per year was obtained from self-report and published records. Statistical analyses of the baseline evaluations were applied cross-sectionally to determine the relationship between fight exposure variables and volumes of the hippocampus, amygdala, thalamus, caudate, putamen. Moreover, the relationship between exposure and brain volumes with cognitive function was assessed. Increasing exposure to repetitive head trauma measured by number of professional fights, years of fighting, or a Fight Exposure Score (FES) was associated with lower brain volumes, particularly the thalamus and caudate. In addition, speed of processing decreased with decreased thalamic volumes and with increasing fight exposure. Higher scores on a FES used to reflect exposure to repetitive head trauma were associated with greater likelihood of having cognitive impairment. Greater exposure to repetitive head trauma is associated with lower brain volumes and lower processing speed in active professional fighters. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. Changes of TNF-α in the Cortex of Rat Brain after Pure Cerebral Concussion%TNF-α在单纯性脑震荡大鼠皮质中的表达变化

    Institute of Scientific and Technical Information of China (English)

    李玉环; 吴德野; 董世峰; 唐红丹; 杨晓燕; 左寒东; 于建云; 李坪

    2015-01-01

    目的 观察单纯性脑震荡(pure cerebral concussion,PCC)大鼠前额叶皮质(prefrontal cortex,PC)、颞叶皮质(temporal cortex,TC)和梨状皮质(piriform cortex,Pir)区炎症因子TNF-α(tumor necrosis factor-α,TNF-α)的表达和时程变化规律,探讨TNF-α与脑损伤之间的病理联系.方法 采用“金属单摆闭合式脑损伤打击装置”制备PCC模型,随机分为伤后3h、12h、1d、2d、3d、7d6个时间点的PCC损伤组(n=5),另设正常对照组(n=5).采用兔抗TNF-α进行免疫组织化学SP法染色,观察PCC组和正常对照组大鼠PC、TC和Pir脑区TNF-α的表达变化.结果 正常对照组大鼠PC、TC和Pir内TNF-α免疫阳性表达很弱,损伤后TNF-α的阳性表达和阳性细胞的数量逐渐增加,3d组达高峰,7d组后有下降趋势,但仍高于正常组(P<0.05).结论 PCC损伤早期PC、TC和Pir中TNF-α的表达量出现明显变化,提示TNF-α参与了PCC致伤后的病理变化.

  13. High School Football Players' Knowledge and Attitudes About Concussions.

    Science.gov (United States)

    Anderson, Brit L; Gittelman, Michael A; Mann, Jessica K; Cyriac, RoseAnn L; Pomerantz, Wendy J

    2016-05-01

    To assess high school (HS) football players' knowledge of concussions and to determine whether increased knowledge is correlated with better attitudes toward reporting concussion symptoms and abstaining from play. Two survey tools were used to assess athletes' knowledge and attitudes about concussions. Surveys collected information about demographics, knowledge about concussions, and attitudes about playing sports after a concussion. All athletes present completed one of the 2 surveys. A knowledge and attitude score for each survey was calculated. Frequencies and mean values were used to characterize the population; regression analysis, analysis of variance, and t tests were used to look for associations. A football camp for HS athletes in the Cincinnati area. Male HS football players from competitive football programs in the Cincinnati area. None. Scores on knowledge and attitude sections; responses to individual questions. One hundred twenty (100%) athletes were enrolled although not every athlete responded to every question. Thirty (25%) reported history of a concussion; 82 (70%) reported receiving prior concussion education. More than 75% correctly recognized all concussion symptoms that were asked, except "feeling in a fog" [n = 63 (53%)]. One hundred nine (92%) recognized a risk of serious injury if they return to play too quickly. Sixty-four (54%) athletes would report symptoms of a concussion to their coach; 62 (53%) would continue to play with a headache from an injury. There was no association between knowledge score and attitude score (P = 0.08). Despite having knowledge about the symptoms and danger of concussions, many HS football athletes in our sample did not have a positive attitude toward reporting symptoms or abstaining from play after a concussion. Physicians should be aware that young athletes may not report concussion symptoms.

  14. English professional football players concussion knowledge and attitude

    Institute of Scientific and Technical Information of China (English)

    Joshua M. Williams; Jody L. Langdon; James L. McMillan; Thomas A. Buckley

    2016-01-01

    Background: Concussions are a common pathology in football and multiple misconceptions exist amongst the players and managers. To address these misconceptions, and potentially reduce concussion associated sequela, effective educational interventions need to be developed. However, the current knowledge and attitude status must be ascertained to appropriately develop these interventions. The purpose of this study was to assess the concussion knowledge and attitude of English professional footballers. Methods: Twenty-six participants from one English Football League Championship club completed the study. A mixed methods approach included the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS) and a semi-structured interview. The RoCKAS contains separate knowledge (0–25) and attitude (15–75) scores and was followed by a semi-structured interview consisting of concussion knowledge, attitude, and behavior related questions. Results: The mean score on the RoCKAS knowledge was 16.4 ± 2.9 (range 11–22) and the attitude score was 59.6 ± 8.5 (range 41–71). The interview responses identified inconsistencies between the RoCKAS and the intended behaviors, endorsing multiple concussion misconceptions, and revealed barriers to concussion reporting. Conclusion: The results of this study suggest that Championship Level English footballers have moderate concussion knowledge, safe attitudes, and good concussion symptom recognition when assessed with pen and paper questionnaires. However, within the semi-structured interview many respondents reported unsafe concussion behaviors despite accurately identifying the potential risks. Further, multiple barriers to concussion reporting were identified which included perceived severity of the injury, game situations, and the substitution rule. These findings can help form the foundation of educational interventions to potentially improve concussion reporting behaviors amongst professional footballers.

  15. An epidemiologic profile of pediatric concussions: identifying urban and rural differences.

    Science.gov (United States)

    Stewart, Tanya Charyk; Gilliland, Jason; Fraser, Douglas D

    2014-03-01

    The objective of this study was to describe the epidemiology of concussions presenting to the emergency department (ED). A retrospective cohort of concussions for pediatric (age concussions. Two thirds of the concussions occurred in males (67%), with a median age of 13 years (interquartile range [IQR], 6). Nearly half of the pediatric concussions were sports related (48%); 36% of these concussions were from hockey. Significant differences were found in the distribution of the mechanism of injury across age groups (p concussions, for children 10 years and older. Two fifths of concussions occurred during winter months. Discharge disposition significantly differed by age (p concussions from a motor vehicle crash compared with urban youth patients (p concussions. Concussions are predictable, and their prevention should be targeted based on epidemiologic and environmental data. Epidemiologic, study, level III.

  16. The history of neurosurgical treatment of sports concussion.

    Science.gov (United States)

    Stone, James L; Patel, Vimal; Bailes, Julian E

    2014-10-01

    Concussion has a long and interesting history spanning at least the 5 millennia of written medical record and closely mirrors the development of surgery and neurosurgery. Not surprisingly, much of the past and present experimental head injury and concussion work has been performed within neurosurgically driven laboratories or by several surgically oriented neurologists. This historical review chronicles the key aspects of neurosurgical involvement in sports concussion as related to the diagnosis, treatment, mitigation, and prevention of injury using the example of American football. In addition, we briefly trace the developments that led to our current understanding of the biomechanical and neurophysiological basis of concussion.

  17. Concussions and Osteopathic Manipulative Treatment: An Adolescent Case Presentation.

    Science.gov (United States)

    Castillo, Iris; Wolf, Kimberly; Rakowsky, Alexander

    2016-03-01

    Concussions commonly occur in adolescents. Although the majority of adolescent patients' symptoms resolve, about 11% continue to experience symptoms at 3 months. Standard treatment options for prolonged symptoms are not available, and the role of osteopathic manipulative treatment in the management of adolescent concussions is unclear. The authors describe a case of a 16-year-old girl with a history of 3 head injuries who presented with concussion symptoms. After 6 weekly osteopathic manipulative treatment sessions, the patient was able to return to her normal activities. Further research on the role of osteopathic manipulative treatment to manage concussions is needed.

  18. History of neuropsychological study of sport-related concussion.

    Science.gov (United States)

    Webbe, Frank M; Zimmer, Adam

    2015-01-01

    Although the medical literature has a long history of description and comment on concussion, the occurrence of concussion within the context of sports other than boxing was not judged to be problematic until the 1980s. Neuropsychological assessment played a critical and integral role in identifying the cognitive sequelae of concussion and mapping out the short- and long-term vagaries in recovery. This paper captures that history and expands upon current applications of neuropsychological assessment in the diagnosis and management of sport-related concussion.

  19. The Role of Nutritional Supplements in Sports Concussion Treatment.

    Science.gov (United States)

    Ashbaugh, Andrew; McGrew, Christopher

    2016-01-01

    There has been considerable research conducted in regard to the prevention and treatment of concussions. Numerous supplements and vitamins are being used throughout the country to help patients recover from concussions; however, to date, there are no completed human-based studies specifically examining supplement and vitamin use for the treatment or prevention of concussions. This article examines the most current evidence regarding supplements and vitamins for the treatment and prevention of concussions. The supplements and vitamins reviewed include omega-3 fatty acids, curcumin, resveratrol, melatonin, creatine, and Scutellaria baicalensis.

  20. Repeatability of Brain Volume Measurements Made with the Atlas-based Method from T1-weighted Images Acquired Using a 0.4 Tesla Low Field MR Scanner.

    Science.gov (United States)

    Goto, Masami; Suzuki, Makoto; Mizukami, Shinya; Abe, Osamu; Aoki, Shigeki; Miyati, Tosiaki; Fukuda, Michinari; Gomi, Tsutomu; Takeda, Tohoru

    2016-10-11

    An understanding of the repeatability of measured results is important for both the atlas-based and voxel-based morphometry (VBM) methods of magnetic resonance (MR) brain volumetry. However, many recent studies that have investigated the repeatability of brain volume measurements have been performed using static magnetic fields of 1-4 tesla, and no study has used a low-strength static magnetic field. The aim of this study was to investigate the repeatability of measured volumes using the atlas-based method and a low-strength static magnetic field (0.4 tesla). Ten healthy volunteers participated in this study. Using a 0.4 tesla magnetic resonance imaging (MRI) scanner and a quadrature head coil, three-dimensional T1-weighted images (3D-T1WIs) were obtained from each subject, twice on the same day. VBM8 software was used to construct segmented normalized images [gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) images]. The regions-of-interest (ROIs) of GM, WM, CSF, hippocampus (HC), orbital gyrus (OG), and cerebellum posterior lobe (CPL) were generated using WFU PickAtlas. The percentage change was defined as[100 × (measured volume with first segmented image - mean volume in each subject)/(mean volume in each subject)]The average percentage change was calculated as the percentage change in the 6 ROIs of the 10 subjects. The mean of the average percentage changes for each ROI was as follows: GM, 0.556%; WM, 0.324%; CSF, 0.573%; HC, 0.645%; OG, 1.74%; and CPL, 0.471%. The average percentage change was higher for the orbital gyrus than for the other ROIs. We consider that repeatability of the atlas-based method is similar between 0.4 and 1.5 tesla MR scanners. To our knowledge, this is the first report to show that the level of repeatability with a 0.4 tesla MR scanner is adequate for the estimation of brain volume change by the atlas-based method.

  1. Effects of repeated low-dose exposure of the nerve agent VX on monoamine levels in different brain structures in mice.

    Science.gov (United States)

    Graziani, S; Christin, D; Daulon, S; Breton, P; Perrier, N; Taysse, L

    2014-05-01

    In a previous report, alterations of the serotonin metabolism were previously reported in mice intoxicated with repeated low doses of soman. In order to better understand the effects induced by repeated low-dose exposure to organophosphorus compounds on physiological and behavioural functions, the levels of endogenous monoamines (serotonin and dopamine) in different brain areas in mice intoxicated with sublethal dose of (O-ethyl-S-[2(di-isopropylamino) ethyl] methyl phosphonothioate) (VX) were analysed by HPLC method with electrochemical detection. Animals were injected once a day for three consecutive days with 0.10 LD50 of VX (5 μg/kg, i.p). Neither severe signs of cholinergic toxicity nor pathological changes in brain tissue of exposed animals were observed. Cholinesterase (ChE) activity was only inhibited in plasma (a maximum of 30% inhibition 24 h after the last injection of VX), but remained unchanged in the brain. Serotonin and dopamine (DA) metabolism appeared significantly modified. During the entire period of investigation, at least one of the three parameters investigated (i.e. DA and DOPAC levels and DOPAC/DA ratio) was modified. During the toxic challenge, an increase of the serotonin metabolism was noted in hippocampus (HPC), hypothalamus/thalamus, pons medulla and cerebellum (CER). This increase was maintained 4 weeks after exposure in HPC, pons medulla and CER whereas a decrease in cortex 3 weeks after the toxic challenge was observed. The lack of correlation between brain ChE activity and neurochemical outcomes points out to independent mechanisms. The involvement in possibly long-lasting behavioural disorders is discussed.

  2. Central serotonin depletion modulates the behavioural, endocrine and physiological responses to repeated social stress and subsequent c-fos expression in the brains of male rats.

    Science.gov (United States)

    Chung, K K; Martinez, M; Herbert, J

    1999-01-01

    Intraspecific confrontation has been used to study effect of depleting central serotonin on the adaptation of male rats to repeated social stress (social defeat). Four groups of adult male rats were used (serotonin depletion/sham: stressed; serotonin depletion/sham: non-stressed). Central serotonin was reduced (by 59-97%) by a single infusion of the neurotoxin 5,7-dihydroxtryptamine (150 microg) into the cerebral ventricles; levels of dopamine and noradrenaline were unaltered (rats received appropriate uptake blockers prior to neurotoxic infusions). Sham-operated animals received solute only. Rats were then either exposed daily for 10 days to a second larger aggressive male in the latter's home cage, or simply transferred to an empty cage (control procedure). Rats with reduced serotonin failed to show the increased freezing behaviour during the pre-defeat phase of the social interaction test characteristic of sham animals. There was no change in the residents' behaviour. Core temperature increased during aggressive interaction in sham rats, and this did not adapt with repeated stress. By contrast, stress-induced hyperthermia was accentuated in serotonin-reduced rats as the number of defeat sessions increased. Basal core temperature was unaffected by serotonin depletion. Heart rate increased during social defeat, but this did not adapt with repeated stress; serotonin depletion had no effect on this cardiovascular response. Basal corticosterone was increased in serotonin-depleted rats, but the progressive reduction in stress response over days was not altered. C-fos expression in the brain was not altered in control (non-stressed) rats by serotonin reduction in the areas examined, but there was increased expression after repeated social stress in the medial amygdala of 5-HT depleted rats. These experiments show that reduction of serotonin alters responses to repeated social stress in male rats, and suggests a role for serotonin in the adaptive process.

  3. 'Heading' Soccer Ball Not Smart for The Brain

    Science.gov (United States)

    ... news/fullstory_163363.html 'Heading' Soccer Ball Not Smart for the Brain It's tied to higher concussion ... Albert Einstein College of Medicine in New York City, said in a college news release. "But our ...

  4. 小胶质细胞在单纯性脑震荡大鼠皮质中的变化%Changes of microglia in the cortex of rat brain after pure cerebral concussion

    Institute of Scientific and Technical Information of China (English)

    李晓文; 曾晓锋; 康丽; 吴德野; 郭小兵; 于建云; 李坪

    2014-01-01

    目的:观察单纯性脑震荡(pure cerebral concussion,PCC)大鼠前额叶皮质(prefrontal cortex,PC)、颞叶皮质(temporal cortex,TC)和梨状皮质(piriform cortex,Pir)内小胶质细胞(microglia,MG)的反应和时程变化规律,探讨小胶质细胞与脑损伤之间的病理联系.方法:采用自制金属单摆闭合式脑损伤打击装置制备清醒状态下PCC模型,随机分为伤后3h、12 h、1d、2d、3d、7d六个损伤组(n=5),另设正常对照组(n=5).采用OX-42单克隆抗体(MG特异性标记物)进行免疫组织化学和免疫荧光染色,观察PCC组和正常对照组大鼠PC、TC和Pir中OX-42的表达变化.结果:正常对照组大鼠PC、TC和Pir内OX-42免疫阳性产物的表达很弱,OX-42免疫阳性的小胶质细胞的数量少而轮廓不清.损伤后OX-42免疫阳性产物的表达和阳性细胞的数量逐渐增加,3d时达高峰,7d后有下降趋势,但仍高于正常组(P<0.05).结论:PCC损伤早期PC、TC和Pir中MG出现激活的形态学变化,提示MG可能参与了PCC致伤后的病理变化.

  5. Low risk of concussions in top-level karate competition.

    Science.gov (United States)

    Arriaza, Rafael; Cierna, Dusana; Regueiro, Patricia; Inman, David; Roman, Franco; Abarca, Benjamin; Barrientos, Mercé; Saavedra, Miguel A

    2017-02-01

    Although it is well known that injuries occur in combat sports, the true incidence of concussions is not clearly defined in the literature for karate competition. To determine the incidence of concussions in top-level (World Karate Federation World Championships) karate competition. Injuries that took place in 4 consecutive World Karate Championships (from 2008 to 2014) were prospectively registered. A total of 4625 fights (2916 in the male category and 1709 in the female category) were scrutinised, and concussions were identified and analysed separately for frequency (rate per fight) and injury risk. A total of 4 concussions were diagnosed by the attending physicians after carrying out athlete examinations. Globally, there was 1 concussion in every 1156 fights, or 0.43/1000 athlete-exposures (AE). In male athletes, the rate of concussion was 1/5832 min of fighting, and in female athletes, it was 1/6836 min. OR for concussion in women is 0.57 (95% CI 0.06 to 5.47; z=0.489; p=0.6249) and risk ratio for concussions in men is RR 1.478 (95% CI 0.271 to 8.072), p=0.528, representing a higher risk of definite concussions in men than in women, but not statistically significant. There is not a significantly higher risk of concussions in team competition (no weight limit) when compared with individual competition (held with strict weight limits for each category). The risk of concussions in top-level karate competition is low, with a tendency for an increased risk for men and for competition without weight limits, but not statistically significant with respect to women or individual competition. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  6. Symptom-based assessment of the severity of a concussion.

    Science.gov (United States)

    Erlanger, David; Kaushik, Tanya; Cantu, Robert; Barth, Jeffrey T; Broshek, Donna K; Freeman, Jason R; Webbe, Frank M

    2003-03-01

    Current grading systems of concussion and return-to-play guidelines have little empirical support. The authors therefore examined the relationships of the characteristics and symptoms of concussion and the history of concussion to three indicators of concussion severity-number of immediate symptoms, number of symptoms at the initial follow-up examination, and duration of symptoms--to establish an empirical basis for grading concussions. Forty-seven athletes who sustained concussions were administered alternate forms of an Internet-based neurocognitive test until their performances were within normal limits relative to baseline levels. Assessments of observer-reported and self-reported symptoms at the sideline of the playing field on the day of injury, and at follow-up examinations were also obtained as part of a comprehensive concussion management protocol. Although loss of consciousness (LOC) was a useful indicator of the initial severity of the injury, it did not correlate with other indices of concussion severity, including duration of symptoms. Athletes reporting memory problems at follow-up examinations had significantly more symptoms in general, longer durations of those symptoms, and significant decreases in scores on neurocognitive tests administered approximately 48 hours postinjury. This decline of scores on neurocognitive testing was significantly associated with an increased duration of symptoms. A history of concussion was unrelated to the number and duration of symptoms. This paper represents the first documentation of empirically derived indicators of the clinical course of postconcussion symptom resolution. Self-reported memory problems apparent 24 hours postconcussion were robust indicators of the severity of sports-related concussion and should be a primary consideration in determining an athlete's readiness to return to competition. A decline on neurocognitive testing was the only objective measure significantly related to the duration of

  7. Use of Anisotropy, 3D Segmented Atlas, and Computational Analysis to Identify Gray Matter Subcortical Lesions Common to Concussive Injury from Different Sites on the Cortex.

    Directory of Open Access Journals (Sweden)

    Praveen Kulkarni

    Full Text Available Traumatic brain injury (TBI can occur anywhere along the cortical mantel. While the cortical contusions may be random and disparate in their locations, the clinical outcomes are often similar and difficult to explain. Thus a question that arises is, do concussions at different sites on the cortex affect similar subcortical brain regions? To address this question we used a fluid percussion model to concuss the right caudal or rostral cortices in rats. Five days later, diffusion tensor MRI data were acquired for indices of anisotropy (IA for use in a novel method of analysis to detect changes in gray matter microarchitecture. IA values from over 20,000 voxels were registered into a 3D segmented, annotated rat atlas covering 150 brain areas. Comparisons between left and right hemispheres revealed a small population of subcortical sites with altered IA values. Rostral and caudal concussions were of striking similarity in the impacted subcortical locations, particularly the central nucleus of the amygdala, laterodorsal thalamus, and hippocampal complex. Subsequent immunohistochemical analysis of these sites showed significant neuroinflammation. This study presents three significant findings that advance our understanding and evaluation of TBI: 1 the introduction of a new method to identify highly localized disturbances in discrete gray matter, subcortical brain nuclei without postmortem histology, 2 the use of this method to demonstrate that separate injuries to the rostral and caudal cortex produce the same subcortical, disturbances, and 3 the central nucleus of the amygdala, critical in the regulation of emotion, is vulnerable to concussion.

  8. Detecting cognitive impairment after concussion: sensitivity of change from baseline and normative data methods using the CogSport/Axon cognitive test battery.

    Science.gov (United States)

    Louey, Andrea G; Cromer, Jason A; Schembri, Adrian J; Darby, David G; Maruff, Paul; Makdissi, Michael; Mccrory, Paul

    2014-08-01

    Concussion-related cognitive impairments are typically evaluated with repeated neuropsychological assessments where post-injury performances are compared with pre-injury baseline data (baseline method). Many cases of concussions, however, are evaluated in the absence of baseline data by comparing post-injury performances with normative data (normative method). This study aimed to compare the sensitivity and specificity of these two methods using the CogSport/Axon test battery. Normative data and reliable change indices were computed from a non-injured athlete sample (n = 235). Test-retest data from non-injured (n = 260) and recently concussed (n = 29) athlete samples were then used to compare the two methods. The baseline method was found to be more sensitive than the normative method, and both methods had high specificity and overall correct classification rates. This suggests that while the normative method identifies most cases of recent concussions, the baseline method remains a more precise approach to assessing concussion-related cognitive impairments.

  9. Concussion and the Young Athlete: Critical Management Strategies

    Science.gov (United States)

    Faure, Caroline; Pemberton, Cynthia Lee A.

    2010-01-01

    One in six high school football players in the United States will sustain a concussion at some point during their playing career. The consequences of concussion can be catastrophic, especially since the symptoms are rarely visible and often overlooked. To ensure the safety of athletes in youth and interscholastic sports programs, having Certified…

  10. Caring for Student-Athletes following a Concussion

    Science.gov (United States)

    Piebes, Sarah K.; Gourley, Meganne; Valovich McLeod, Tamara C.

    2009-01-01

    The school nurse plays a dynamic role in the care and treatment of a concussed athlete. Concussions in the adolescent populations are of special concern due to their potential impact on mental development and cognitive function, as well as an increased risk of serious complications including second impact syndrome. The complexity of a concussion…

  11. Concussions--The Role of the School Nurse. Position Statement

    Science.gov (United States)

    Diaz, Anne L.; Wyckoff, Leah J.

    2012-01-01

    It is the position of the National Association of School Nurses that the registered professional school nurse (hereinafter referred to as school nurse) is an essential member of the team addressing concussions. As the school-based clinical professional on the team, the school nurse has the knowledge and skills to provide concussion prevention…

  12. K-12 Students with Concussions: A Legal Perspective

    Science.gov (United States)

    Zirkel, Perry A.; Brown, Brenda Eagan

    2015-01-01

    This article provides a multipart analysis of the public schools' responsibility for students with concussions. The first part provides the prevailing diagnostic definitions of concussions and postconcussive syndrome. The second and central part provides (a) the legal framework of the two overlapping federal laws--the Individuals with Disabilities…

  13. States Address Concerns about Concussions in Youth Sports

    Science.gov (United States)

    Kreck, Carol

    2014-01-01

    Education Commission of the States (ECS) reviewed legislation in the 50 states to see how state leaders are responding to concerns about concussions in youth sports. This report reviews state responses to concussion concerns, and provides examples of provisions put in place by California, Connecticut, and Texas. Three emerging innovations are…

  14. Acute clinical recovery from sport-related concussion.

    Science.gov (United States)

    Nelson, Lindsay D; Janecek, Julie K; McCrea, Michael A

    2013-12-01

    Concussion is a highly prevalent injury in contact and collision sports that has historically been poorly understood. An influx of sport-concussion research in recent years has led to a dramatic improvement in our understanding of the injury's defining characteristics and natural history of recovery. In this review, we discuss the current state of knowledge regarding the characteristic features of concussion and typical acute course of recovery, with an emphasis on the aspects of functioning most commonly assessed by clinicians and researchers (e.g., symptoms, cognitive deficits, postural stability). While prototypical clinical recovery is becoming better understood, questions remain regarding what factors (e.g., injury severity, demographic variables, history of prior concussions, psychological factors) may explain individual variability in recovery. Although research concerning individual differences in response to concussion is relatively new, and in many cases limited methodologically, we discuss the evidence about several potential moderators of concussion recovery and point out areas for future research. Finally, we describe how increased knowledge about the negative effects of and recovery following concussion has been translated into clinical guidelines for managing concussed athletes.

  15. K-12 Students with Concussions: A Legal Perspective

    Science.gov (United States)

    Zirkel, Perry A.; Brown, Brenda Eagan

    2015-01-01

    This article provides a multipart analysis of the public schools' responsibility for students with concussions. The first part provides the prevailing diagnostic definitions of concussions and postconcussive syndrome. The second and central part provides (a) the legal framework of the two overlapping federal laws--the Individuals with Disabilities…

  16. Impulsivity and Concussion in Juvenile Rats: Examining Molecular and Structural Aspects of the Frontostriatal Pathway.

    Directory of Open Access Journals (Sweden)

    Harleen Hehar

    Full Text Available Impulsivity and poor executive control have been implicated in the pathogenesis of many developmental and neuropsychiatric disorders. Similarly, concussions/mild traumatic brain injuries (mTBI have been associated with increased risk for neuropsychiatric disorders and the development of impulsivity and inattention. Researchers and epidemiologists have therefore considered whether or not concussions induce symptoms of attention-deficit/hyperactivity disorder (ADHD, or merely unmask impulsive tendencies that were already present. The purpose of this study was to determine if a single concussion in adolescence could induce ADHD-like impulsivity and impaired response inhibition, and subsequently determine if inherent impulsivity prior to a pediatric mTBI would exacerbate post-concussion symptomology with a specific emphasis on impulsive and inattentive behaviours. As these behaviours are believed to be associated with the frontostriatal circuit involving the nucleus accumbens (NAc and the prefrontal cortex (PFC, the expression patterns of 8 genes (Comt, Drd2, Drd3, Drd4, Maoa, Sert, Tph1, and Tph2 from these two regions were examined. In addition, Golgi-Cox staining of medium spiny neurons in the NAc provided a neuroanatomical examination of mTBI-induced structural changes. The study found that a single early brain injury could induce impulsivity and impairments in response inhibition that were more pronounced in males. Interestingly, when animals with inherent impulsivity experienced mTBI, injury-related deficits were exacerbated in female animals. The single concussion increased dendritic branching, but reduced synaptic density in the NAc, and these changes were likely associated with the increase in impulsivity. Finally, mTBI-induced impulsivity was associated with modifications to gene expression that differed dramatically from the gene expression pattern associated with inherent impulsivity, despite very similar behavioural phenotypes. Our

  17. Direct analysis of tau from PSP brain identifies new phosphorylation sites and a major fragment of N-terminally cleaved tau containing four microtubule-binding repeats.

    Science.gov (United States)

    Wray, Selina; Saxton, Malcolm; Anderton, Brian H; Hanger, Diane P

    2008-06-01

    Tangles containing hyperphosphorylated aggregates of insoluble tau are a pathological hallmark of progressive supranuclear palsy (PSP). Several phosphorylation sites on tau in PSP have been identified using phospho-specific antibodies, but no sites have been determined by direct sequencing due to the difficulty in enriching insoluble tau from PSP brain. We describe a new method to enrich insoluble PSP-tau and report eight phosphorylation sites [Ser46, Thr181, Ser202, Thr217, Thr231, Ser235, Ser396/Ser400 (one site) and Thr403/Ser404 (one site)] identified by mass spectrometry. We also describe a 35 kDa C-terminal tau fragment (tau35), lacking the N-terminus of tau but containing four microtubule-binding repeats (4R), that is present only in neurodegenerative disorders in which 4R tau is over-represented. Tau35 was readily detectable in PSP, corticobasal degeneration and 4R forms of fronto-temporal dementia with parkinsonism linked to chromosome 17, but was absent from control, Alzheimer's disease and Pick's disease brain. Our findings suggest the aggregatory characteristics of PSP-tau differ from those of insoluble tau in Alzheimer's disease brain and this might be related to the presence of a C-terminal cleavage product of tau.

  18. Effects of multiple concussions on retired national hockey league players.

    Science.gov (United States)

    Caron, Jeffrey G; Bloom, Gordon A; Johnston, Karen M; Sabiston, Catherine M

    2013-04-01

    The purpose of this study was to understand the meanings and lived experiences of multiple concussions in professional hockey players using hermeneutic, idiographic, and inductive approaches within an interpretative phenomenological analysis. The interviewer was an athlete who had suffered multiple concussions, and the interviewees were five former National Hockey League athletes who had retired due to medically diagnosed concussions suffered during their careers. The men discussed the physical and psychological symptoms they experienced as a result of their concussions and how the symptoms affected their professional careers, personal relationships, and quality of life. The former professional athletes related these symptoms to the turmoil that is ever present in their lives. These findings are of interest to athletes, coaches, sport administrators, family members, sport psychology practitioners, and medical professionals, as they highlight the severity of short- and long-term effects of concussions.

  19. Educating Coaches about Concussion in Sports: Evaluation of the CDC's "Heads Up: Concussion in Youth Sports" Initiative

    Science.gov (United States)

    Covassin, Tracey; Elbin, R. J.; Sarmiento, Kelly

    2012-01-01

    Background: Concussions remain a serious public health concern. It is important that persons involved in youth sports, particularly coaches, be made aware and educated on the signs and symptoms of concussion. This study assessed the perceptions of youth sport coaches who have received the Centers for Disease Control and Prevention's…

  20. Educating Coaches about Concussion in Sports: Evaluation of the CDC's "Heads Up: Concussion in Youth Sports" Initiative

    Science.gov (United States)

    Covassin, Tracey; Elbin, R. J.; Sarmiento, Kelly

    2012-01-01

    Background: Concussions remain a serious public health concern. It is important that persons involved in youth sports, particularly coaches, be made aware and educated on the signs and symptoms of concussion. This study assessed the perceptions of youth sport coaches who have received the Centers for Disease Control and Prevention's…

  1. Concussions in Community-Level Rugby: Risk, Knowledge, and Attitudes.

    Science.gov (United States)

    Martin, R Kyle; Hrubeniuk, Travis J; Witiw, Christopher D; MacDonald, Peter; Leiter, Jeff

    Rugby is a popular collision sport where participants are at risk of sustaining concussions. Most research focuses on elite-level or youth divisions. Comparatively, little is known about adult community rugby. The aim of this research was to estimate the risk of sustaining a concussion during participation in community-level rugby and summarize the collective knowledge and attitudes toward concussions. Concussion symptoms will be reported frequently among community-level rugby players and a substantial proportion will report a willingness to continue participation despite the risk. Cross-sectional analysis. Level 3. An anonymous, voluntary survey was administered to all 464 senior rugby players registered in the province of Manitoba in 2015. Two primary domains were assessed: (1) concussion history from the preceding season including occurrence, symptomatology, and impact on daily activities and (2) knowledge and attitudes toward concussion risks and management. In total, 284 (61.2%) rugby players responded. Concussive symptoms were reported by 106 (37.3%). Of those, 87% were formally diagnosed with a concussion and 27% missed school and/or work as a result. The danger of playing while symptomatic was recognized by 93.7% of participants, yet 29% indicated they would continue while symptomatic. Furthermore, 39% felt they were letting others down if they stopped playing due to a concussion. Concussive symptoms were common among the study cohort and had a notable impact on daily activities. A high proportion of players were willing to continue while experiencing symptoms despite recognizing the danger. The observed discord between knowledge and attitudes implicates a culture of "playing injured." Understanding the risk of injury may affect an individual's decision to participate in community-level rugby. Moreover, evidence of discord between the knowledge and attitudes of players may direct future research initiatives and league governance.

  2. Brain distribution of dipeptide repeat proteins in frontotemporal lobar degeneration and motor neurone disease associated with expansions in C9ORF72.

    Science.gov (United States)

    Davidson, Yvonne S; Barker, Holly; Robinson, Andrew C; Thompson, Jennifer C; Harris, Jenny; Troakes, Claire; Smith, Bradley; Al-Saraj, Safa; Shaw, Chris; Rollinson, Sara; Masuda-Suzukake, Masami; Hasegawa, Masato; Pickering-Brown, Stuart; Snowden, Julie S; Mann, David M

    2014-06-20

    A hexanucleotide (GGGGCC) expansion in C9ORF72 gene is the most common genetic change seen in familial Frontotemporal Lobar Degeneration (FTLD) and familial Motor Neurone Disease (MND). Pathologically, expansion bearers show characteristic p62 positive, TDP-43 negative inclusion bodies within cerebellar and hippocampal neurons which also contain dipeptide repeat proteins (DPR) formed from sense and antisense RAN (repeat associated non ATG-initiated) translation of the expanded repeat region itself. 'Inappropriate' formation, and aggregation, of DPR might therefore confer neurotoxicity and influence clinical phenotype. Consequently, we compared the topographic brain distribution of DPR in 8 patients with Frontotemporal dementia (FTD), 6 with FTD + MND and 7 with MND alone (all 21 patients bearing expansions in C9ORF72) using a polyclonal antibody to poly-GA, and related this to the extent of TDP-43 pathology in key regions of cerebral cortex and hippocampus. There were no significant differences in either the pattern or severity of brain distribution of DPR between FTD, FTD + MND and MND groups, nor was there any relationship between the distribution of DPR and TDP-43 pathologies in expansion bearers. Likewise, there were no significant differences in the extent of TDP-43 pathology between FTLD patients bearing an expansion in C9ORF72 and non-bearers of the expansion. There were no association between the extent of DPR pathology and TMEM106B or APOE genotypes. However, there was a negative correlation between the extent of DPR pathology and age at onset. Present findings therefore suggest that although the presence and topographic distribution of DPR may be of diagnostic relevance in patients bearing expansion in C9ORF72 this has no bearing on the determination of clinical phenotype. Because TDP-43 pathologies are similar in bearers and non-bearers of the expansion, the expansion may act as a major genetic risk factor for FTLD and MND by rendering the brain

  3. New Repeat Polymorphism in the AKT1 Gene Predicts Striatal Dopamine D2/D3 Receptor Availability and Stimulant-Induced Dopamine Release in the Healthy Human Brain.

    Science.gov (United States)

    Shumay, Elena; Wiers, Corinde E; Shokri-Kojori, Ehsan; Kim, Sung Won; Hodgkinson, Colin A; Sun, Hui; Tomasi, Dardo; Wong, Christopher T; Weinberger, Daniel R; Wang, Gene-Jack; Fowler, Joanna S; Volkow, Nora D

    2017-05-10

    The role of the protein kinase Akt1 in dopamine neurotransmission is well recognized and has been implicated in schizophrenia and psychosis. However, the extent to which variants in the AKT1 gene influence dopamine neurotransmission is not well understood. Here we investigated the effect of a newly characterized variant number tandem repeat (VNTR) polymorphism in AKT1 [major alleles: L- (eight repeats) and H- (nine repeats)] on striatal dopamine D2/D3 receptor (DRD2) availability and on dopamine release in healthy volunteers. We used PET and [(11)C]raclopride to assess baseline DRD2 availability in 91 participants. In 54 of these participants, we also measured intravenous methylphenidate-induced dopamine release to measure dopamine release. Dopamine release was quantified as the difference in specific binding of [(11)C]raclopride (nondisplaceable binding potential) between baseline values and values following methylphenidate injection. There was an effect of AKT1 genotype on DRD2 availability at baseline for the caudate (F(2,90) = 8.2, p = 0.001) and putamen (F(2,90) = 6.6, p = 0.002), but not the ventral striatum (p = 0.3). For the caudate and putamen, LL showed higher DRD2 availability than HH; HL were in between. There was also a significant effect of AKT1 genotype on dopamine increases in the ventral striatum (F(2,53) = 5.3, p = 0.009), with increases being stronger in HH > HL > LL. However, no dopamine increases were observed in the caudate (p = 0.1) or putamen (p = 0.8) following methylphenidate injection. Our results provide evidence that the AKT1 gene modulates both striatal DRD2 availability and dopamine release in the human brain, which could account for its association with schizophrenia and psychosis. The clinical relevance of the newly characterized AKT1 VNTR merits investigation.SIGNIFICANCE STATEMENT The AKT1 gene has been implicated in schizophrenia and psychosis. This association is likely to reflect modulation of dopamine signaling by Akt1 kinase

  4. Depletion and time-course of recovery of brain serotonin after repeated subcutaneous dexfenfluramine in the mouse. A comparison with the rat.

    Science.gov (United States)

    Fracasso, C; Guiso, G; Confalonieri, S; Bergami, A; Garattini, S; Caccia, S

    1995-12-01

    The indole-depleting effects of repeated subcutaneous doses of dexfenfluramine (D-F) (2.5, 5, 10, 20 and 40 mg/kg/day, for four days) in mice were examined with regard to the initial response and time-course of recovery and related to the pharmacokinetics of D-F and its active metabolite dexnorfenfluramine (D-NF). Steady-state plasma and brain concentrations of D-F rose dose-dependently with a metabolite-to-drug ratio averaging 0.4 in brain. This confirmed that in mice D-NF contributes less than in other species to the effects of D-F. Regional serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) contents were decreased dose-dependently 4 hr after the last injection of D-F. However, two weeks after D-F (2.5-10 mg/kg/day) brain indoles had almost totally recovered, and the long-term effects of the 20 mg/kg/day dose were completely reversed by six weeks, when significant effects are still observable in rats. Although substantial recovery was evident even at 40 mg/kg/day, 5-HT but not 5-HIAA was still slightly reduced nine weeks later. Comparative studies in rats given 2.5-20 mg/kg/day D-F indicated much more severe initial indole depletions than in mice. Brain levels of D-F and D-NF were much higher in rats than in mice. The total active drug brain concentration (D-F + D-NF) was significantly correlated with 5-HT content in both species, with approx 20 nmol/g of total drug causing 50% reduction. These findings point to species differences in D-F kinetics as a main reason for differences in the neurochemical response, supporting the view that the recovery of indoles over time is related to the extent of initial depletion, which in turn depends on critical drug brain concentrations. In view of the qualitative and quantitative species differences in the pharmacodynamics and pharmacokinetics of D-F neither of these rodent species is a suitable model for predicting potential drug toxicity in humans.

  5. Long-Term Safety of Repeated Blood-Brain Barrier Opening via Focused Ultrasound with Microbubbles in Non-Human Primates Performing a Cognitive Task.

    Directory of Open Access Journals (Sweden)

    Matthew E Downs

    Full Text Available Focused Ultrasound (FUS coupled with intravenous administration of microbubbles (MB is a non-invasive technique that has been shown to reliably open (increase the permeability of the blood-brain barrier (BBB in multiple in vivo models including non-human primates (NHP. This procedure has shown promise for clinical and basic science applications, yet the safety and potential neurological effects of long term application in NHP requires further investigation under parameters shown to be efficacious in that species (500 kHz, 200-400 kPa, 4-5 μm MB, 2 minute sonication. In this study, we repeatedly opened the BBB in the caudate and putamen regions of the basal ganglia of 4 NHP using FUS with systemically-administered MB over 4-20 months. We assessed the safety of the FUS with MB procedure using MRI to detect edema or hemorrhaging in the brain. Contrast enhanced T1-weighted MRI sequences showed a 98% success rate for openings in the targeted regions. T2-weighted and SWI sequences indicated a lack edema in the majority of the cases. We investigated potential neurological effects of the FUS with MB procedure through quantitative cognitive testing of' visual, cognitive, motivational, and motor function using a random dot motion task with reward magnitude bias presented on a touchpanel display. Reaction times during the task significantly increased on the day of the FUS with MB procedure. This increase returned to baseline within 4-5 days after the procedure. Visual motion discrimination thresholds were unaffected. Our results indicate FUS with MB can be a safe method for repeated opening of the BBB at the basal ganglia in NHP for up to 20 months without any long-term negative physiological or neurological effects with the parameters used.

  6. The King-Devick test and sports-related concussion: study of a rapid visual screening tool in a collegiate cohort.

    Science.gov (United States)

    Galetta, Kristin M; Brandes, Lauren E; Maki, Karl; Dziemianowicz, Mark S; Laudano, Eric; Allen, Megan; Lawler, Kathy; Sennett, Brian; Wiebe, Douglas; Devick, Steve; Messner, Leonard V; Galetta, Steven L; Balcer, Laura J

    2011-10-15

    Concussion, defined as an impulse blow to the head or body resulting in transient neurologic signs or symptoms, has received increasing attention in sports at all levels. The King-Devick (K-D) test is based on the time to perform rapid number naming and captures eye movements and other correlates of suboptimal brain function. In a study of boxers and mixed martial arts (MMA) fighters, the K-D test was shown to have high degrees of test-retest and inter-rater reliability and to be an accurate method for rapidly identifying boxers and mixed martial arts fighters with concussion. We performed a study of the K-D test as a rapid sideline screening tool in collegiate athletes to determine the effect of concussion on K-D scores compared to a pre-season baseline. In this longitudinal study, athletes from the University of Pennsylvania varsity football, sprint football, and women's and men's soccer and basketball teams underwent baseline K-D testing prior to the start of the 2010-11 playing season. Post-season testing was also performed. For athletes who had concussions during the season, K-D testing was administered immediately on the sidelines and changes in score from baseline were determined. Among 219 athletes tested at baseline, post-season K-D scores were lower (better) than the best pre-season scores (35.1 vs. 37.9s, P=0.03, Wilcoxon signed-rank test), reflecting mild learning effects in the absence of concussion. For the 10 athletes who had concussions, K-D testing on the sidelines showed significant worsening from baseline (46.9 vs. 37.0s, P=0.009), with all except one athlete demonstrating worsening from baseline (median 5.9s). This study of collegiate athletes provides initial evidence in support of the K-D test as a strong candidate rapid sideline visual screening tool for concussion. Data show worsening of scores following concussion, and ongoing follow-up in this study with additional concussion events and different athlete populations will further examine

  7. Early symptom burden predicts recovery after sport-related concussion

    Science.gov (United States)

    Mannix, Rebekah; Monuteaux, Michael C.; Stein, Cynthia J.; Bachur, Richard G.

    2014-01-01

    Objective: To identify independent predictors of and use recursive partitioning to develop a multivariate regression tree predicting symptom duration greater than 28 days after a sport-related concussion. Methods: We conducted a prospective cohort study of patients in a sports concussion clinic. Participants completed questionnaires that included the Post-Concussion Symptom Scale (PCSS). Participants were asked to record the date on which they last experienced symptoms. Potential predictor variables included age, sex, score on symptom inventories, history of prior concussions, performance on computerized neurocognitive assessments, loss of consciousness and amnesia at the time of injury, history of prior medical treatment for headaches, history of migraines, and family history of concussion. We used recursive partitioning analysis to develop a multivariate prediction model for identifying athletes at risk for a prolonged recovery from concussion. Results: A total of 531 patients ranged in age from 7 to 26 years (mean 14.6 ± 2.9 years). The mean PCSS score at the initial visit was 26 ± 26; mean time to presentation was 12 ± 5 days. Only total score on symptom inventory was independently associated with symptoms lasting longer than 28 days (adjusted odds ratio 1.044; 95% confidence interval [CI] 1.034, 1.054 for PCSS). No other potential predictor variables were independently associated with symptom duration or useful in developing the optimal regression decision tree. Most participants (86%; 95% CI 80%, 90%) with an initial PCSS score of concussion is overall symptom burden. PMID:25381296

  8. Can helmet design reduce the risk of concussion in football?

    Science.gov (United States)

    Rowson, Steven; Duma, Stefan M; Greenwald, Richard M; Beckwith, Jonathan G; Chu, Jeffrey J; Guskiewicz, Kevin M; Mihalik, Jason P; Crisco, Joseph J; Wilcox, Bethany J; McAllister, Thomas W; Maerlender, Arthur C; Broglio, Steven P; Schnebel, Brock; Anderson, Scott; Brolinson, P Gunnar

    2014-04-01

    Of all sports, football accounts for the highest incidence of concussion in the US due to the large number of athletes participating and the nature of the sport. While there is general agreement that concussion incidence can be reduced through rule changes and teaching proper tackling technique, there remains debate as to whether helmet design may also reduce the incidence of concussion. A retrospective analysis was performed of head impact data collected from 1833 collegiate football players who were instrumented with helmet-mounted accelerometer arrays for games and practices. Data were collected between 2005 and 2010 from 8 collegiate football teams: Virginia Tech, University of North Carolina, University of Oklahoma, Dartmouth College, Brown University, University of Minnesota, Indiana University, and University of Illinois. Concussion rates were compared between players wearing Riddell VSR4 and Riddell Revolution helmets while controlling for the head impact exposure of each player. A total of 1,281,444 head impacts were recorded, from which 64 concussions were diagnosed. The relative risk of sustaining a concussion in a Revolution helmet compared with a VSR4 helmet was 46.1% (95% CI 28.1%-75.8%). When controlling for each player's exposure to head impact, a significant difference was found between concussion rates for players in VSR4 and Revolution helmets (χ(2) = 4.68, p = 0.0305). This study illustrates that differences in the ability to reduce concussion risk exist between helmet models in football. Although helmet design may never prevent all concussions from occurring in football, evidence illustrates that it can reduce the incidence of this injury.

  9. Using video analysis for concussion surveillance in Australian football.

    Science.gov (United States)

    Makdissi, Michael; Davis, Gavin

    2016-12-01

    The objectives of the study were to assess the relationship between various player and game factors and risk of concussion; and to assess the reliability of video analysis for mechanistic assessment of concussion in Australian football. Prospective cohort study. All impacts and collisions resulting in concussion were identified during the 2011 Australian Football League season. An extensive list of factors for assessment was created based upon previous analysis of concussion in Australian Football League and expert opinions. The authors independently reviewed the video clips and correlation for each factor was examined. A total of 82 concussions were reported in 194 games (rate: 8.7 concussions per 1000 match hours; 95% confidence interval: 6.9-10.5). Player demographics and game variables such as venue, timing of the game (day, night or twilight), quarter, travel status (home or interstate) or score margin did not demonstrate a significant relationship with risk of concussion; although a higher percentage of concussions occurred in the first 5min of game time of the quarter (36.6%), when compared to the last 5min (20.7%). Variables with good inter-rater agreement included position on the ground, circumstances of the injury and cause of the impact. The remainder of the variables assessed had fair-poor inter-rater agreement. Common problems included insufficient or poor quality video and interpretation issues related to the definitions used. Clear definitions and good quality video from multiple camera angles are required to improve the utility of video analysis for concussion surveillance in Australian football. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  10. Epidemiology of concussion in sport: a literature review.

    Science.gov (United States)

    Clay, Michael B; Glover, Kari L; Lowe, Duane T

    2013-12-01

    The purpose of this study was to summarize sport concussion incidence data, identify sports that present higher injury frequency, reveal the degree of risk in some lesser-known sports, and outline specific details within the sports literature that raise additional concerns, such as helmet-to-helmet contact and player positions that experience frequent impact. A systematic literature review of Pub Med using keyword search on injury, concussion, and sports was performed through May 2012. Abstracts were identified, selections were made based upon inclusion criteria, and full-length articles were obtained. Additional articles were considered following review of reference sections. Articles were reviewed and tabulated according to sport. Two hundred eighty-nine articles were screened, and 62 articles were reviewed. The overall incidence of concussion in sport ranged from 0.1 to 21.5 per 1000 athletic exposures. The lowest incidence was reported in swimming and diving. Concussion incidence was highest in Canadian junior ice hockey, but elevated incidence in American football remains a concern because of the large number of participants. The literature reviewed included incidence of concussion on the field of play under real-world conditions and influenced by the current culture of sport. The studies examined in this article show that there is risk of concussion in nearly every sport. Some sports have higher concussion frequency than others, which may depend upon the forces and roles of the positions played in these sports. Younger athletes have a higher incidence of concussion, and female incidence is greater than male in many comparable sports. Headgear may reduce concussion in some sports but may also give athletes a false sense of protection.

  11. Concussion symptoms in youth motocross riders: a prospective, observational study.

    Science.gov (United States)

    Luo, T David; Clarke, Michelle J; Zimmerman, Amy K; Quinn, Michael; Daniels, David J; McIntosh, Amy L

    2015-03-01

    Action motorsports, including motocross, have been gaining popularity among children and adolescents, raising concerns for increased risk of concussions in participating youth. The authors undertook this study to test the following hypotheses: 1) that there is a high rate of concussion symptoms associated with a number of preventable or adjustable risk factors, and 2) that a high percentage of these symptoms are not be reported to adults and medical personnel. The authors identified all motocross riders under the age of 18 at a regional racetrack during the riding season between May and October 2010. The participants completed questionnaires pertaining to demographic characteristics and variables associated with motocross. The questionnaire results were compared with the incidence of self-reported concussion symptoms. Two hundred two riders were identified who met the criteria for participation in the study, and 139 of them completed the study questionnaire. Of these 139 riders, 67 (48%) reported at least 1 concussion symptom during the season. The majority of riders (98%) reported "always" wearing a helmet, and 72% received professional help with fitting of their helmets. Proper helmet fitting was associated with a 41% decreased risk of concussion symptoms (RR 0.59, 95% CI 0.44-0.81, p motocross participation. Sponsor support conferred a relative risk for concussion symptoms of 1.48 (95% CI 1.05-2.08, p = 0.02). Nearly half of all motocross competitors under the age of 18 reported concussion symptoms. Preventive measures are necessary to limit the negative impact from concussions. The risk of concussive injury can be decreased for pediatric motocross riders if they receive professional help with proper helmet fitting and through implementation of stricter guidelines regarding sponsorship.

  12. Concussion Incidence and Recurrence in Professional Australian Football Match-Play: A 14-Year Analysis

    Directory of Open Access Journals (Sweden)

    Nathan Gibbs

    2017-01-01

    Full Text Available Background. Concussion incidence rates in professional Australian football may be underreported due to the injury classification definition. A myriad of factors contribute to concussion risk; however, there is limited long-term surveillance in Australian football. This study analysed concussion in one Australian football team over an extended period. Method. Match-play concussion injuries in one team (n=116 participants were diagnosed and treated by the team physician over 14 years. Analysis of factors related to concussion including matches played, time of day and season, and return to play provided an insight into occurrence and recurrence rates. Results. 140 concussions were recorded (17.6 per 1000 player match hours. A strong relationship was evident between matches played and concussion incidence (r=0.70 and match conditions did not negatively affect the concussion rate. Whether an athlete returned to play in the same match or suffered a loss-of-consciousness concussion (p=0.84, their ensuing rate of concussion was not affected. Conclusion. Concussion in professional Australian football was related to the number of matches played. Further, neither previous incidence nor loss of consciousness affected future concussion risk. This study provides ecologically valid evidence of the concussion incidence rate in professional Australian football and has implications for the management of athletes sustaining concussion injuries.

  13. Heads Up! Play it Safe When it Comes to Concussions

    Centers for Disease Control (CDC) Podcasts

    2007-05-21

    As many as 3.8 million sports- and recreation-related concussions are estimated to occur in the United States each year. This podcast is a radio interview with CDC's Dr. Julie Gilchrist on the newly available “Heads Up: Concussion in Youth Sports" tool kit, which was developed to provide information to coaches, parents, and athletes involved in youth sports on preventing, recognizing, and responding to a concussion.  Created: 5/21/2007 by National Center for Injury Prevention and Control, Division of Injury Response.   Date Released: 10/31/2007.

  14. Individual Variability and Test-Retest Reliability Revealed by Ten Repeated Resting-State Brain Scans over One Month.

    Directory of Open Access Journals (Sweden)

    Bing Chen

    Full Text Available Individual differences in mind and behavior are believed to reflect the functional variability of the human brain. Due to the lack of a large-scale longitudinal dataset, the full landscape of variability within and between individual functional connectomes is largely unknown. We collected 300 resting-state functional magnetic resonance imaging (rfMRI datasets from 30 healthy participants who were scanned every three days for one month. With these data, both intra- and inter-individual variability of six common rfMRI metrics, as well as their test-retest reliability, were estimated across multiple spatial scales. Global metrics were more dynamic than local regional metrics. Cognitive components involving working memory, inhibition, attention, language and related neural networks exhibited high intra-individual variability. In contrast, inter-individual variability demonstrated a more complex picture across the multiple scales of metrics. Limbic, default, frontoparietal and visual networks and their related cognitive components were more differentiable than somatomotor and attention networks across the participants. Analyzing both intra- and inter-individual variability revealed a set of high-resolution maps on test-retest reliability of the multi-scale connectomic metrics. These findings represent the first collection of individual differences in multi-scale and multi-metric characterization of the human functional connectomes in-vivo, serving as normal references for the field to guide the use of common functional metrics in rfMRI-based applications.

  15. Repeated administration of alpha7 nicotinic acetylcholine receptor (nAChR) agonists, but not positive allosteric modulators, increases alpha7 nAChR levels in the brain

    DEFF Research Database (Denmark)

    Christensen, Ditte Z; Mikkelsen, Jens D; Hansen, Henrik H;

    2010-01-01

    -induced phosphorylation of Erk2 in the prefrontal cortex occurs following acute, but not repeated administration. Our results demonstrate that repeated agonist administration increases the number of alpha7 nAChRs in the brain, and leads to coupling versus uncoupling of specific intracellular signaling....... Here we investigate the effects of repeated agonism on alpha7 nAChR receptor levels and responsiveness in vivo in rats. Using [(125)I]-alpha-bungarotoxin (BTX) autoradiography we show that acute or repeated administration with the selective alpha7 nAChR agonist A-582941 increases the number of alpha7 n......-120596 and NS1738 do not increase [(125)I]-BTX binding. Furthermore, A-582941-induced increase in Arc and c-fos mRNA expression in the prefrontal cortex is enhanced and unaltered, respectively, after repeated administration, demonstrating that the alpha7 nAChRs remain responsive. Contrarily, A-582941...

  16. Routine Repeat Head CT may not be Indicated in Patients on Anticoagulant/Antiplatelet Therapy Following Mild Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    McCammack, Kevin C.

    2014-12-01

    Full Text Available Introduction: Evaluation recommendations for patients on anticoagulant and antiplatelet (ACAP therapy that present after mild traumatic brain injury (TBI are controversial. At our institution, an initial noncontrast head computed tomography (HCT is performed, with a subsequent HCT performed six hours later to exclude delayed intracranial hemorrhage (ICH. This study was performed to evaluate the yield and advisability of this approach. Methods: We performed a retrospective review of subjects undergoing evaluation for ICH after mild TBI in patients on ACAP therapy between January of 2012 and April of 2013. We assessed for the frequency of ICH on both the initial noncontrast HCT and on the routine six-hour follow-up HCT. Additionally, chart review was performed to evaluate the clinical implications of ICH, when present, and to interrogate whether pertinent clinical and laboratory data may predict the presence of ICH prior to imaging. We used multivariate generalized linear models to assess whether presenting Glasgow Coma Score (GCS, loss of consciousness (LOC, neurological or physical examination findings, international normalized ratio, prothrombin time, partial thromboplastin time, platelet count, or specific ACAP regimen predicted ICH. Results: 144 patients satisfied inclusion criteria. Ten patients demonstrated initial HCT positive for ICH, with only one demonstrating delayed ICH on the six-hour follow-up HCT. This patient was discharged without any intervention required or functional impairment. Presenting GCS deviation (p<0.001, LOC (p=0.04, neurological examination findings (p<0.001, clopidogrel (p=0.003, aspirin (p=0.03 or combination regimen (p=0.004 use were more commonly seen in patients with ICH. Conclusion: Routine six-hour follow-up HCT is likely not indicated in patients on ACAP therapy, as our study suggests clinically significant delayed ICH does not occur. Additionally, presenting GCS deviation, LOC, neurological examination

  17. The Effects of Repeat Testing, Malingering, and Traumatic Brain Injury on Computerized Measures of Visuospatial Memory Span.

    Science.gov (United States)

    Woods, David L; Wyma, John M; Herron, Timothy J; Yund, E W

    2015-01-01

    Spatial span tests (SSTs) such as the Corsi Block Test (CBT) and the SST of the Wechsler Memory Scale are widely used to assess deficits in spatial working memory. We conducted three experiments to evaluate the test-retest reliability and clinical sensitivity of a new computerized spatial span test (C-SST) that incorporates psychophysical methods to improve the precision of spatial span measurement. In Experiment 1, we analyzed C-SST test-retest reliability in 49 participants who underwent three test sessions at weekly intervals. Intraclass correlation coefficients (ICC) were higher for a psychophysically derived mean span (MnS) metric (0.83) than for the maximal span and total correct metrics used in traditional spatial-span tests. Response times (ReTs) also showed high ICCs (0.93) that correlated negatively with MnS scores and correlated positively with response-time latencies from other tests of processing speed. Learning effects were insignificant. Experiment 2 examined the performance of Experiment 1 participants when instructed to feign symptoms of traumatic brain injury (TBI): 57% showed abnormal MnS z-scores. A MnS z-score cutoff of 3.0 correctly classified 36% of simulated malingerers and 91% of the subgroup of 11 control participants with abnormal spans. Malingerers also made more substitution errors than control participants with abnormal spans (sensitivity = 43%, specificity = 91%). In addition, malingerers showed no evidence of ReT slowing, in contrast to significant abnormalities seen on other malingered tests of processing speed. As a result, differences between ReT z-scores and z-scores on other processing speed tests showed very high sensitivity and specificity in distinguishing malingering and control participants with either normal or abnormal spans. Experiment 3 examined C-SST performance in a group of patients with predominantly mild TBI: neither MnS nor ReT z-scores showed significant group-level abnormalities. The C-SST improves the

  18. Concussions in the NHL: A narrative review of the literature

    Science.gov (United States)

    Izraelski, Jason

    2014-01-01

    Ice hockey has been identified as a sport with a high risk for concussions. Given the health sequelae associated with the injury, a great deal of attention has been placed on its diagnosis, management and return-to-play protocols. The highest level of ice hockey in North America is played in the National Hockey League (NHL), and concussions pose a serious threat to the health of the players and the game itself. Unfortunately, the scientific literature on concussions in ice hockey is derived mostly from research conducted on youth and amateur levels of play, leaving a gap in our knowledge at the professional level. This narrative review attempts to summarize what is known about concussion incidence, mechanisms of injury and risk factors in the NHL. PMID:25550658

  19. Can a Dietary Supplement Treat a Concussion? No!

    Science.gov (United States)

    ... For Consumers Home For Consumers Consumer Updates Can a Dietary Supplement Treat a Concussion? No! Share Tweet Linkedin Pin it More ... practice for football, soccer and other sports. It’s a time when parents may be thinking about sport ...

  20. Concussion knowledge and return-to-play attitudes among subelite ...

    African Journals Online (AJOL)

    constituting 4.8% of injuries reported across the same season of. English Premiership Rugby. ... Effective concussion prevention and management has been highlighted as a priority in contact sports in general, and particularly in rugby union.

  1. Boys More Likely to Hide a Concussion Than Girls

    Science.gov (United States)

    ... Scientists are beginning to tease out the potential long-term health consequences of concussions. They're focusing on professional athletes who went on to suffer memory loss, erratic behavior and depression, among other effects, after ...

  2. Concussions in the NHL: A narrative review of the literature.

    Science.gov (United States)

    Izraelski, Jason

    2014-12-01

    Ice hockey has been identified as a sport with a high risk for concussions. Given the health sequelae associated with the injury, a great deal of attention has been placed on its diagnosis, management and return-to-play protocols. The highest level of ice hockey in North America is played in the National Hockey League (NHL), and concussions pose a serious threat to the health of the players and the game itself. Unfortunately, the scientific literature on concussions in ice hockey is derived mostly from research conducted on youth and amateur levels of play, leaving a gap in our knowledge at the professional level. This narrative review attempts to summarize what is known about concussion incidence, mechanisms of injury and risk factors in the NHL.

  3. Driving Skills May Suffer Even After Concussion Symptoms Subside

    Science.gov (United States)

    ... try to determine when concussion patients' driving abilities improve, and to develop guidelines to help recommend when driving should be restricted. The study was published online recently in the Journal of Neurotrauma . SOURCE: University of Georgia, news release, ...

  4. Neuropsychological factors related to college ice hockey concussions.

    Science.gov (United States)

    Pedersen, Heather A; Ferraro, F Richard; Himle, Michael; Schultz, Caitlin; Poolman, Mark

    2014-05-01

    We analyzed data from 74 male collegiate hockey players. Each athlete's season began with a baseline administration of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) neuropsychology test battery. Fourteen athletes sustained a sport-related head injury and were readministered the test to assess the impact of the injury. A significant decrease in performance (compared to baseline) on immediate and delayed word recall and designs followed the first concussion. Following a second sport-related concussion, the 4 affected athletes showed significant decrease in visual motor speed. Performance improved on 2 response speed measures (Ps life concussions and head injury on late-life consequences, such as chronic traumatic encephalopathy, and more immediate issues such as return-to-play decisions for athletes.

  5. Sports-related concussion: the role of the headache specialist.

    Science.gov (United States)

    Conidi, Francis X

    2012-05-01

    Over the past few years, sports-related concussion has received significant media attention making it one of the most, if not highest profile neurological disorder. Thirty-one states now have passed sports concussion laws, with 14 states pending legislation. Most concussions are managed by primary care physicians, ie, family practice trained sports medicine physicians and pediatricians. Symptoms are usually short lived and do not require treatment. The one exception is headache, which is usually present from onset and is often the last symptom to resolve. Headache is the most common reason for referral to a specialist, and therefore it is imperative that the headache specialist have at least a basic understanding of all aspects of sports concussion as they are likely going to be called upon to evaluate these athletes, especially the more refractory cases.

  6. Concussion among female middle-school soccer players.

    Science.gov (United States)

    O'Kane, John W; Spieker, Amy; Levy, Marni R; Neradilek, Moni; Polissar, Nayak L; Schiff, Melissa A

    2014-03-01

    Despite recent increased awareness about sports concussions, little research has evaluated concussions among middle-school athletes. To evaluate the frequency and duration of concussions in female youth soccer players and to determine if concussions result in stopping play and seeking medical care. Prospective cohort study from March 2008 through May 2012 among 4 soccer clubs from the Puget Sound region of Washington State, involving 351 elite female soccer players, aged 11 to 14 years, from 33 randomly selected youth soccer teams. Of the players contacted, 83.1% participated and 92.4% completed the study. Concussion cumulative incidence, incidence rate, and description of the number, type, and duration of symptoms. We inquired weekly about concussion symptoms and, if present, the symptom type and duration, the event resulting in symptom onset, and whether the player sought medical attention or played while symptomatic. Among the 351 soccer players, there were 59 concussions with 43 742 athletic exposure hours. Cumulative concussion incidence was 13.0% per season, and the incidence rate was 1.2 per 1000 athletic exposure hours (95% CI, 0.9-1.6). Symptoms lasted a median of 4.0 days (mean, 9.4 days). Heading the ball accounted for 30.5% of concussions. Players with the following symptoms had a longer recover time than players without these symptoms: light sensitivity (16.0 vs 3.0 days, P = .001), emotional lability (15.0 vs 3.5 days, P = .002), noise sensitivity (12.0 vs 3.0 days, P = .004), memory loss (9.0 vs 4.0 days, P = .04), nausea (9.0 vs 3.0 days, P = .02), and concentration problems (7.0 vs 2.0 days, P = .02). Most players (58.6%) continued to play with symptoms, with almost half (44.1%) seeking medical attention. Concussion rates in young female soccer players are greater than those reported in older age groups, and most of those concussed report playing with symptoms. Heading the ball is a frequent precipitating event. Awareness

  7. Brain network activation as a novel biomarker for the return-to-play pathway following sport-related brain injury: A prospective case study

    Directory of Open Access Journals (Sweden)

    Adam W Kiefer

    2015-11-01

    Full Text Available Children and adolescent athletes are at a higher risk for concussion than adults, and also experience longer recovery times and increased associated symptoms. It has also recently been demonstrated that multiple, seemingly mild concussions may result in exacerbated and prolonged neurologic deficits. Objective assessments and return to play criteria are needed to reduce risk and morbidity associated with concussive events in these populations. Recent research has pushed to study the use of electroencephalography as an objective measure of brain injury. In the present case study, we present a novel approach that examines event related potentials via a brain network activation (BNA analysis as a biomarker of concussion and recovery. Specifically, changes in BNA scores as indexed through this approach, offer a potential indicator of neurological health as the BNA assessment qualitatively and quantitatively indexes the network dynamics associated with brain injury. Objective tools such as these support accurate and efficient assessment of brain injury and may offer a useful step in categorizing the temporal and spatial changes in brain activity following concussive blows, as well as the functional connectivity of brain networks, associated with concussion.

  8. Do self-reported concussions have cumulative or enduring effects on drivers' anticipation of traffic hazards?

    Science.gov (United States)

    Preece, Megan H W; Horswill, Mark S; Ownsworth, Tamara

    2016-01-01

    To investigate the cumulative effect of multiple self-reported concussions and the enduring effect of concussion on drivers' hazard perception ability. It was hypothesized: (1) that individuals reporting multiple previous concussions would be slower to anticipate traffic hazards than individuals reporting either one previous concussion or none; and (2) that individuals reporting a concussion within the past 3 months would be slower to anticipate traffic hazards than individuals reporting either an earlier concussion or no prior concussion. Two hundred and eighty-two predominantly young drivers (nconcussed = 68, Mage = 21.57 years, SDage = 6.99 years, 66% female) completed a validated hazard perception test (HPT) and measures of emotional, cognitive, health and driving status. A one-way analysis of variance showed that there was no significant effect of concussion number on HPT response times. Similarly, pairwise comparisons showed no significant differences between the HPT response times of individuals reporting a concussion within the previous 3 months, individuals reporting an earlier concussion and the never concussed group. The findings suggest that previous concussions do not adversely affect young drivers' ability to anticipate traffic hazards; however, due to reliance on self-reports of concussion history, further prospective longitudinal research is needed.

  9. Sex Differences and the Incidence of Concussions Among Collegiate Athletes

    Science.gov (United States)

    Swanik, C. Buz; Sachs, Michael L.

    2003-01-01

    Objective: To compare sex differences regarding the incidence of concussions among collegiate athletes during the 1997–1998, 1998–1999, and 1999–2000 seasons. Design and Setting: A cohort study of collegiate athletes using the National Collegiate Athletic Association (NCAA) Injury Surveillance System; certified athletic trainers recorded data during the 1997–2000 academic years. Subjects: Collegiate athletes participating in men's and women's soccer, lacrosse, basketball, softball, baseball, and gymnastics. Measurements: Certified athletic trainers from participating NCAA institutions recorded weekly injury and athlete-exposure data from the first day of preseason practice to the final postseason game. Injury rates and incidence density ratios were computed. Incidence density ratio is an estimate of the relative risk based on injury rates per 1000 athlete-exposures. Results: Of 14 591 reported injuries, 5.9% were classified as concussions. During the 3-year study, female athletes sustained 167 (3.6%) concussions during practices and 304 (9.5%) concussions during games, compared with male athletes, who sustained 148 (5.2%) concussions during practices and 254 (6.4%) concussions during games. Chi-square analysis revealed significant differences between male and female soccer players (χ21 = 12.99, P = .05) and basketball players (χ21 = 5.14, P = .05). Conclusions: Female athletes sustained a higher percentage of concussions during games than male athletes. Of all the sports, women's soccer and men's lacrosse were found to have the highest injury rate of concussions. Incidence density ratio was greatest for male and female soccer players. PMID:14608434

  10. Video incident analysis of concussions in boys' high school lacrosse.

    Science.gov (United States)

    Lincoln, Andrew E; Caswell, Shane V; Almquist, Jon L; Dunn, Reginald E; Hinton, Richard Y

    2013-04-01

    Boys' lacrosse has one of the highest rates of concussion among boys' high school sports. A thorough understanding of injury mechanisms and game situations associated with concussions in boys' high school lacrosse is necessary to target injury prevention efforts. To characterize common game-play scenarios and mechanisms of injury associated with concussions in boys' high school lacrosse using game video. Descriptive epidemiological study. In 25 public high schools of a single school system, 518 boys' lacrosse games were videotaped by trained videographers during the 2008 and 2009 seasons. Video of concussion incidents was examined to identify game characteristics and injury mechanisms using a lacrosse-specific coding instrument. A total of 34 concussions were captured on video. All concussions resulted from player-to-player bodily contact. Players were most often injured when contact was unanticipated or players were defenseless (n = 19; 56%), attempting to pick up a loose ball (n = 16; 47%), and/or ball handling (n = 14; 41%). Most frequently, the striking player's head (n = 27; 79%) was involved in the collision, and the struck player's head was the initial point of impact in 20 incidents (59%). In 68% (n = 23) of cases, a subsequent impact with the playing surface occurred immediately after the initial impact. A penalty was called in 26% (n = 9) of collisions. Player-to-player contact was the mechanism for all concussions. Most commonly, injured players were unaware of the pending contact, and the striking player used his head to initiate contact. Further investigation of preventive measures such as education of coaches and officials and enforcement of rules designed to prevent intentional head-to-head contact is warranted to reduce the incidence of concussions in boys' lacrosse.

  11. Influence of the severity and location of bodily injuries on post-concussive and combat stress symptom reporting after military-related concurrent mild traumatic brain injuries and polytrauma.

    Science.gov (United States)

    French, Louis M; Lange, Rael T; Marshall, Kathryn; Prokhorenko, Olga; Brickell, Tracey A; Bailie, Jason M; Asmussen, Sarah B; Ivins, Brian; Cooper, Douglas B; Kennedy, Jan E

    2014-10-01

    Traumatic brain injuries (TBI) sustained in combat frequently co-occur with significant bodily injuries. Intuitively, more extensive bodily injuries might be associated with increased symptom reporting. In 2012, however, French et al. demonstrated an inverse relation between bodily injury severity and symptom reporting. This study expands on that work by examining the influence of location and severity of bodily injuries on symptom reporting after mild TBI. Participants were 579 US military service members who sustained an uncomplicated mild TBI with concurrent bodily injuries and who were evaluated at two military medical centers. Bodily injury severity was quantified using a modified Injury Severity Score (ISSmod). Participants completed the Neurobehavioral Symptom Inventory (NSI) and the Posttraumatic Stress Disorder Checklist (PCL-C), on average, 2.5 months post-injury. There was a significant negative association between ISSmod scores and NSI (r=-0.267, pinverse relation between bodily injury severity and symptom reporting in this sample. Hypothesized explanations include underreporting of symptoms, increased peer support, disruption of fear conditioning because of acute morphine use, or delayed expression of symptoms.

  12. Relative risk for concussions in young female soccer players.

    Science.gov (United States)

    Strand, Sarah; Lechuga, David; Zachariah, Thomas; Beaulieu, Kathryn

    2015-01-01

    The objective of this study was to determine the relative risk and reported symptoms of concussions in 11- to 13-year-old, female soccer players. For this, a survey to compare the reported incidence of concussion in age-matched female soccer players to nonsoccer players was performed. The survey included 342 girls between the ages of 11 and 13: 195 were involved in an organized soccer team and 147 were not involved in organized soccer but were allowed to participate in any other sport or activity. A total of 94 of the 195 soccer players, or 48%, reported at least one symptom consistent with a concussion. The most prevalent symptom for these girls was headache (84%). A total of 34 of the 147 nonsoccer players, or 23%, reported at least one symptom consistent with a concussion in the previous six months. These results determined that the relative risk of probable concussions among 11- to 13-year-old, female soccer players is 2.09 (p concussions in young female soccer players is significantly higher than in a control group of nonsoccer players of the same sex and age.

  13. Study on expression of endothelin in experimental cerebral concussion in rats%内皮素在大鼠实验性脑震荡脑组织中表达研究

    Institute of Scientific and Technical Information of China (English)

    彭瑞云; 高亚兵; 王德文; 肖兴义; 陈浩宇; 吴小红; 刘杰; 胡文华; 蔡宝仁; 薛官生; 张援平; 尹晓梅

    2002-01-01

    Objective To study changes and significance of endothelin(ET) in rat cerebral concussion.Methods 80 Wistar male rats were used for animal model of cerebral concussion,which were sacrificed on 1,3,7,14 and 30 days after injury and the brain tissue were taken off. The expression of ET was studied in the course of cerebral concussion by means of immunohistochemistry.Results Typical clinical manifestation was observed in the 100 g group in which the pathological changes included cerebral vascular constriction and dilatation,congestion and edema of cerebral tissue,neuronal degeneration,necrosis,and obviously decreased even disappeared Nissl bodies.Increased expression of ET was observed on the first day,the positive area was seen in the plasma of endothelial cells in cerebral cortex,hippocampus,cerebellum and thalamus.ET expression peak occurred on the 7th day,the positive area was also found in the plasma of Purkinje cells in the cerebellum.Decreased ET expression was found on 14th day and returned to normal level on the 30th day.Conclusion The main pathological changes of cerebral concussion contained blood circulation disorder,and degeneration and necrosis of substantial cells.ET was involved in the brain tissue injury during the pathological process of cerebral concussion and might be related to regulation of cerebral vascular reaction,and neuron degeneration and necrosis.

  14. A systematic video analysis of National Hockey League (NHL) concussions, part II: how concussions occur in the NHL.

    Science.gov (United States)

    Hutchison, Michael G; Comper, Paul; Meeuwisse, Willem H; Echemendia, Ruben J

    2015-04-01

    Concussions in sports are a growing cause of concern, as these injuries can have debilitating short-term effects and little is known about the potential long-term consequences. This work aims to describe how concussions occur in the National Hockey League. Case series of medically diagnosed concussions for regular season games over a 3.5-year period during the 2006-2010 seasons. Digital video records were coded and analysed using a standardised protocol. 88% (n=174/197) of concussions involved player-to-opponent contact. 16 diagnosed concussions were a result of fighting. Of the 158 concussions that involved player-to-opponent body contact, the most common mechanisms were direct contact to the head initiated by the shoulder 42% of the time (n=66/158), by the elbow 15% (n=24/158) and by gloves in 5% of cases (n=8/158). When the results of anatomical location are combined with initial contact, almost half of these events (n=74/158) were classified as direct contact to the lateral aspect of the head. The predominant mechanism of concussion was consistently characterised by player-to-opponent contact, typically directed to the head by the shoulder, elbow or gloves. Also, several important characteristics were apparent: (1) contact was often to the lateral aspect of the head; (2) the player who suffered a concussion was often not in possession of the puck and (3) no penalty was called on the play. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. The effect of days since last concussion and number of concussions on cognitive functioning in Division I athletes.

    Science.gov (United States)

    Thoma, Robert J; Cook, Julia A; McGrew, Christopher; King, John H; Mayer, Andrew R; Lewine, Jeffrey D; Yeo, Ronald A; Campbell, Richard

    2015-01-01

    Cognitive recovery from sports concussion may be incomplete after resolution of other symptoms. It was hypothesized that independent effects of the number of days since last concussion (Days) and total number of concussions (Number) would predict poorer cognitive functioning. Cognition was assessed in an NCAA Division I student-athlete population (n = 87) using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery. In a MANOVA, the five ImPACT Composite scores were dependent variables, with Group (Concussion, Unaffected) as the independent variable and prior number of concussions (Number) and days since last concussion (Days; 68-2495 days) entered as covariates. The hypothesis that Days and Number would each independently affect cognitive functioning (as assessed by ImPACT Composite scores) was only partly supported. A significant, multivariate, main effect of Days (p = 0.01) indicated that more Days predicted better cognitive functioning overall (p = 0.01). Univariate effects emerged such that more Days specifically predicted better visual memory (p = 0.004) and faster reaction times (p = 0.02). A trend toward a Group*Days*Number three-way interaction for reaction time emerged (p = 0.06), such that smaller Number and more Days each predicted slower reaction time. Cognitive recovery following sports concussion may take far longer than was previously thought, the aetiology of cognitive reductions may be very complex and the ImPACT appears to be sensitive to subtle changes in cognition across time.

  16. Factors Influencing the Risk and Recovery from Sport-Related Concussion

    Institute of Scientific and Technical Information of China (English)

    R.J.Elbin; Tracey Covassin

    2011-01-01

    @@ Sport-related concussion remains a hot topic in the field of sport medicine as recent estimates indicate approximately 1.6 to 3 million concussions occur in sport and recreation every year in the United States[1].

  17. Rest and Return to Activity After Sport-Related Concussion: A Systematic Review of the Literature.

    Science.gov (United States)

    McLeod, Tamara C Valovich; Lewis, Joy H; Whelihan, Kate; Bacon, Cailee E Welch

    2017-03-01

    To systematically review the literature regarding rest and return to activity after sport-related concussion. The search was conducted in the Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, Educational Resources Information Center, Ovid MEDLINE, and PubMed using terms related to concussion, mild traumatic brain injury, physical and cognitive rest, and return to activity. Studies were included if they were published in English; were original research; and evaluated the use of, compliance with, or effectiveness of physical or cognitive rest or provided empirical evidence supporting the graded return-to-activity progression. The study design, patient or participant sample, interventions used, outcome measures, main results, and conclusions were extracted, as appropriate, from each article. Articles were categorized into groups based on their ability to address one of the primary clinical questions of interest: use of rest, rest effectiveness, compliance with recommendations, or outcome after graded return-to-activity progression. A qualitative synthesis of the results was provided, along with summary tables. Our main findings suggest that rest is underused by health care providers, recommendations for rest are broad and not specific to individual patients, an initial period of moderate physical and cognitive rest (eg, limited physical activity and light mental activity) may improve outcomes during the acute postinjury phase, significant variability in the use of assessment tools and compliance with recommended return-to-activity guidelines exists, and additional research is needed to empirically evaluate the effectiveness of graded return-to-activity progressions. Furthermore, there is a significant need to translate knowledge of best practices in concussion management to primary care providers.

  18. A Mechanistic End-to-End Concussion Model That Translates Head Kinematics to Neurologic Injury

    Directory of Open Access Journals (Sweden)

    Laurel J. Ng

    2017-06-01

    Full Text Available Past concussion studies have focused on understanding the injury processes occurring on discrete length scales (e.g., tissue-level stresses and strains, cell-level stresses and strains, or injury-induced cellular pathology. A comprehensive approach that connects all length scales and relates measurable macroscopic parameters to neurological outcomes is the first step toward rationally unraveling the complexity of this multi-scale system, for better guidance of future research. This paper describes the development of the first quantitative end-to-end (E2E multi-scale model that links gross head motion to neurological injury by integrating fundamental elements of tissue and cellular mechanical response with axonal dysfunction. The model quantifies axonal stretch (i.e., tension injury in the corpus callosum, with axonal functionality parameterized in terms of axonal signaling. An internal injury correlate is obtained by calculating a neurological injury measure (the average reduction in the axonal signal amplitude over the corpus callosum. By using a neurologically based quantity rather than externally measured head kinematics, the E2E model is able to unify concussion data across a range of exposure conditions and species with greater sensitivity and specificity than correlates based on external measures. In addition, this model quantitatively links injury of the corpus callosum to observed specific neurobehavioral outcomes that reflect clinical measures of mild traumatic brain injury. This comprehensive modeling framework provides a basis for the systematic improvement and expansion of this mechanistic-based understanding, including widening the range of neurological injury estimation, improving concussion risk correlates, guiding the design of protective equipment, and setting safety standards.

  19. The Sport Concussion Assessment Tool: a systematic review.

    Science.gov (United States)

    Yengo-Kahn, Aaron M; Hale, Andrew T; Zalneraitis, Brian H; Zuckerman, Scott L; Sills, Allen K; Solomon, Gary S

    2016-04-01

    OBJECTIVE Over the last 2 decades, sport-related concussion (SRC) has garnered significant attention. Even with increased awareness and athlete education, sideline recognition and real-time diagnosis remain crucial. The need for an objective and standardized assessment of concussion led to the eventual development of the Sport Concussion Assessment Tool (SCAT) during the Second International Conference on Concussion in Sport in 2004, which is now in its third iteration (SCAT3). In an effort to update our understanding of the most well-known sideline concussion assessment, the authors conducted a systematic review of the SCAT and the evidence supporting its use to date. METHODS English-language titles and abstracts published between 1995 and October 2015 were searched systematically across 4 electronic databases and a review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines adapted for the review of a heterogeneous collection of study designs. Peer-reviewed journal articles were included if they reported quantitative data on any iteration of the SCAT, Standardized Assessment of Concussion (SAC), or modified Balance Error Scoring System (mBESS) data at baseline or following concussion in an exclusively athlete population with any portion older than 13 years of age. Studies that included nonathletes, only children less than 13 years old, exclusively BESS data, exclusively symptom scale data, or a non-SCAT-related assessment were excluded. RESULTS The database search process yielded 549 abstracts, and 105 full-text articles were reviewed with 36 meeting criteria for inclusion. Nineteen studies were associated with the SAC, 1 was associated with the mBESS exclusively, and 16 studies were associated with a full iteration of the SCAT. The majority of these studies (56%) were prospective cohort studies. Male football players were the most common athletes studied. An analysis of the studies focused on

  20. Rugby headgear and concussion prevention: misconceptions could increase aggressive play.

    Science.gov (United States)

    Menger, Richard; Menger, Austin; Nanda, Anil

    2016-04-01

    OBJECTIVE Multiple studies have illustrated that rugby headgear offers no statistically significant protection against concussions. However, there remains concern that many players believe rugby headgear in fact does prevent concussions. Further investigation was undertaken to illustrate that misconceptions about concussion prevention and rugby headgear may lead to an increase in aggressive play. METHODS Data were constructed by Internet survey solicitation among United States collegiate rugby players across 19 teams. Initial information given was related to club, age, experience, use of headgear, playing time, whether the rugger played football or wrestling in high school, and whether the player believed headgear prevented concussion. Data were then constructed as to whether wearing headgear would increase aggressive playing style secondary to a false sense of protection. RESULTS A total of 122 players responded. All players were male. The average player was 19.5 years old and had 2.7 years of experience. Twenty-three of 122 players (18.9%) wore protective headgear; 55.4% of players listed forward as their primary position. Overall, 45.8% (55/120) of players played 70-80 minutes per game, 44.6% (54/121) played football or wrestled in high school, 38.1% (45/118) believed headgear prevented concussions, and 42.2% (51/121) stated that if they were using headgear they would be more aggressive with their play in terms of running or tackling. Regression analysis illustrated that those who believed headgear prevented concussions were or would be more likely to engage in aggressive play (p = 0.001). CONCLUSIONS Nearly 40% of collegiate rugby players surveyed believed headgear helped to prevent concussions despite no scientific evidence that it does. This misconception about rugby headgear could increase aggressive play. Those who believed headgear prevented concussion were, on average, 4 times more likely to play with increased aggressive form than those who believed

  1. A retrospective clinical analysis of moderate to severe athletic concussions.

    Science.gov (United States)

    Cantu, Robert C; Guskiewicz, Kevin; Register-Mihalik, Johna K

    2010-12-01

    To investigate differences in clinical outcomes on the basis of gender and age after a moderate or severe concussion in a cohort of physically active subjects examined by a single clinician. A descriptive, cross-sectional, retrospective chart review of consecutive patients. Outpatient assessments by a single clinician with expertise in sports concussion. Physically active subjects seen for evaluation after a concussion experienced while participating in sports (N = 194; 215 concussions; age mean ± standard deviation = 19.19 ± 8.53 years) were included. INTERVENTIONS (INDEPENDENT VARIABLES): Intergroup differences and associations were examined by gender, age group (grade for all outcome measures. Separate χ² tests were used to assess associations between gender, age group, and symptom duration group (≤ 7 days, 8-90 days, > 90 days), the presence of depression, the presence of loss of consciousness, altered school or work, and concussion grade. Separate independent samples t-tests was used to examine differences in symptom reporting and time to recovery. No association was observed between gender and any measured characteristics (P > .05). Subjects 18 years or older took longer to recover (315.77 days), compared with younger subjects (91.31 days) (t₂₁₃ = -2.01, P = .049). Older subjects also reported more concussions than did younger ones, 4.33 and 2.37, respectively (t₂₁₃ = -3.77, P < .001). All concussions included in this study were moderate to severe in nature as defined by the Revised Cantu Grading Scale. Contrary to existing literature regarding gender differences in concussion of a lesser severity, no gender differences were observed in this sample. Age differences were observed, with the population of subjects who were 18 years and older experiencing a greater number and duration of concussion symptoms than the younger group. Developing evidence-based return-to-play progressions and rehabilitation strategies in this population is the next

  2. Concussion Management in Community College Athletics: Revealing and Understanding the Gap between Knowledge and Practice

    Science.gov (United States)

    Chinn, Nancy Resendes; Porter, Paul

    2013-01-01

    The seriousness of concussions in athletics is only recently becoming fully understood and appreciated. There are significant implications for the concussed student-athlete both in returning to the playing field and the classroom. Although practices are now in place to improve identification and management of concussions in professional sports,…

  3. Decreased microvascular cerebral blood flow assessed by diffuse correlation spectroscopy after repetitive concussions in mice.

    Science.gov (United States)

    Buckley, Erin M; Miller, Benjamin F; Golinski, Julianne M; Sadeghian, Homa; McAllister, Lauren M; Vangel, Mark; Ayata, Cenk; Meehan, William P; Franceschini, Maria Angela; Whalen, Michael J

    2015-12-01

    Repetitive concussions are associated with long-term cognitive dysfunction that can be attenuated by increasing the time intervals between concussions; however, biomarkers of the safest rest interval between injuries remain undefined. We hypothesize that deranged cerebral blood flow (CBF) is a candidate biomarker for vulnerability to repetitive concussions. Using a mouse model of human concussion, we examined the effect of single and repetitive concussions on cognition and on an index of CBF (CBFi) measured with diffuse correlation spectroscopy. After a single mild concussion, CBFi was reduced by 35±4% at 4 hours (Pconcussions spaced 1 day apart, CBFi was also reduced from preinjury levels 4 hours after each concussion but had returned to preinjury levels by 72 hours after the final concussion. Interestingly, in this repetitive concussion model, lower CBFi values measured both preinjury and 4 hours after the third concussion were associated with worse performance on the Morris water maze assessed 72 hours after the final concussion. We conclude that low CBFi measured either before or early on in the evolution of injury caused by repetitive concussions could be a useful predictor of cognitive outcome.

  4. Returning to School after a Concussion: Facilitating Problem Solving through Effective Communication

    Science.gov (United States)

    Bradley-Klug, Kathy L.; Garofano, Jeffrey; Lynn, Courtney; DeLoatche, Kendall Jeffries; Lam, Gary Yu Hin

    2015-01-01

    Concussions are a major public health concern in the United States, especially among children and adolescents. Although there is a growing body of literature regarding the underlying physiologic processes that occur after a concussion, there is no consensus regarding the risk factors for a concussion or the reasons for significant differences in…

  5. Is current medical education adequately preparing future physicians to manage concussion: an initial evaluation.

    Science.gov (United States)

    Donaworth, Michael A; Grandhi, Ravi K; Logan, Kelsey; Gubanich, Paul J; Myer, Gregory D

    2016-01-01

    In 2010, there were 2.5 million hospitalizations, emergency room visits, or deaths associated with concussions in the United States.[1] Knowledge deficits exist among physicians regarding concussion management, which can lead to severe repercussions, including poor patient outcomes, poor patient satisfaction, and potential medical-legal issues. While concussion is a prevalent condition evaluated in the medical field, medical students continue to have a knowledge deficit regarding concussion diagnosis, prognosis, medical management, and return to play guidelines. Medical students from a mid-western medical school completed a survey on concussion diagnosis, prognosis, medical management, and return to play guidelines. The response rate was 40%. The data suggests that the vast majority of medical students are able to define concussion; however, most reported never having a lecture dedicated to concussion during medical school and also lacked clinical experience with acute concussion and post-concussive syndrome. There are clear areas of deficiency as noted by the inability of students to correctly identify symptoms and appropriate management of concussion. The current study indicates that at an individual, mid-western, top 50 medical school, current medical trainees may not be adequately educated to identify and manage concussion. Future research is warranted to determine the optimal guidelines to educate future physicians as it pertains to concussion diagnosis, management, prognosis, and return to play guidelines.

  6. An Evidence-Based Discussion of Heading the Ball and Concussions in High School Soccer.

    Science.gov (United States)

    Comstock, R Dawn; Currie, Dustin W; Pierpoint, Lauren A; Grubenhoff, Joseph A; Fields, Sarah K

    2015-09-01

    Soccer, originally introduced as a safer sport for children and adolescents, has seen a rapid increase in popularity in the United States over the past 3 decades. Recently, concerns have been raised regarding the safety of soccer ball heading (when an athlete attempts to play the ball in the air with his or her head) given the rise in concussion rates, with some calling for a ban on heading among soccer players younger than 14 years. To evaluate trends over time in boys' and girls' soccer concussions, to identify injury mechanisms commonly leading to concussions, to delineate soccer-specific activities during which most concussions occur, to detail heading-related soccer concussion mechanisms, and to compare concussion symptom patterns by injury mechanism. Retrospective analysis of longitudinal surveillance data collected from 2005-2006 through 2013-2014 in a large, nationally representative sample of US high schools. Participants were boys and girls who were high school soccer players. Concussions sustained during high school-sanctioned soccer games and practices. Mechanism and sport-specific activity of concussion. Overall, 627 concussions were sustained during 1,393,753 athlete exposures (AEs) among girls (4.50 concussions per 10,000 AEs), and 442 concussions were sustained during 1,592,238 AEs among boys (2.78 concussions per 10,000 AEs). For boys (68.8%) and girls (51.3%), contact with another player was the most common concussion mechanism. Heading was the most common soccer-specific activity, responsible for 30.6% of boys' concussions and 25.3% of girls' concussions. Contact with another player was the most common mechanism of injury in heading-related concussions among boys (78.1%) and girls (61.9%). There were few differences in concussion symptom patterns by injury mechanism. Although heading is the most common activity associated with concussions, the most frequent mechanism was athlete-athlete contact. Such information is needed to drive evidence

  7. Evidence of alterations in transcallosal motor inhibition as a possible long-term consequence of concussions in sports: A transcranial magnetic stimulation study.

    Science.gov (United States)

    Davidson, Travis W; Tremblay, François

    2016-10-01

    Growing evidence suggests that long-term structural and physiological alterations are present in the brain of previously concussed athletes. In this study, we sought to further explore the long-term consequences of concussions with transcranial magnetic stimulation (TMS) by examining excitability changes both within and between hemispheres. Participants (32 young adults with and without a history of concussions (HxC)) first underwent testing to assess cognitive and motor performance using standardized tests. Then, the following TMS measures were derived bilaterally: (1) resting motor threshold and motor evoked potentials (MEP), (2) afferent-induced modulation, (3) contralateral silent period (cSP) and MEP facilitation, and, (4) ipsilateral silent period (iSP). Multivariate analyses of performance data revealed no major group differences. For TMS data, no "hemisphere" effects were detected for all measures. Group differences were detected only for iSP derived measures owing to alterations in the onset latency and duration of transcallosal inhibition in the HxC group. While no major asymmetries were found between hemispheres, participants in the HxC group showed evidence of impaired transcallosal inhibition. Results provide one of the first piece of evidence pointing to alterations in transcallosal inhibition as a potential neurophysiological marker of long-term consequences of concussions in sports. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  8. A prospective pilot investigation of brain volume, white matter hyperintensities and haemorrhagic lesions after mild traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Michael eJarrett

    2016-02-01

    Full Text Available Traumatic brain injury (TBI is among the most common neurological disorders. Haemorrhagic lesions and white matter hyperintensities (WMH are radiological features associated with moderate and severe traumatic brain injury TBI. Brain volume reductions have also been observed during the months following injury. In concussion, no signs of injury are observed on conventional MRI, which may be a true feature of concussion or merely due to the limited sensitivity of imaging techniques used so far. Moreover, it is not known whether volume reductions are due to the resolution of trauma related edema or a true volume loss. Forty five collegiate level ice hockey players (20 female and 15 controls (9 female 40 players underwent 3T MRI for haemorrhages (multi echo susceptibility weighted imaging (SWI, WMH (three dimensional FLAIR and brain volume at the beginning and the end of the hockey season. Concussed athletes underwent additional imaging and neuropsychological testing atthree days, two weeks, and two months after injury. At the end of the hockey season, brain volume was reduced compared to controls by 0.32% (p<0.034 in the whole cohort and by 0.26% (p<0.09 in the concussed athletes. Two weeks and two months after concussion, brain volume was reduced by -0.08% (p=0.027 and -0.23% (p=0.035, respectively. In athletes, the WMH were significantly closer to the interface between grey matter and white matter compared to controls. No significant changes in thenumber of WMH over the duration of the study were found in athletes. No microhaemorrhages were detected as a result of concussion or playing a season of ice hockey. We conclude that mild TBI does not lead to transient increases in brain volume and no new microbleeds or WMH are detectable after concussion. Brain volume reductions appear by two weeks after concussion and persist until at least two months after concussion. Brain volume is reduced between the beginning and the end of the icehockey season.

  9. Assessment of parental knowledge and attitudes toward pediatric sports-related concussions.

    Science.gov (United States)

    Lin, Ann C; Salzman, Garrett A; Bachman, Shelby L; Burke, Rita V; Zaslow, Tracy; Piasek, Carolina Z; Edison, Bianca R; Hamilton, Anita; Upperman, Jeffrey S

    2015-03-01

    Parents of young athletes play a major role in the identification and management of sports-related concussions. However, they are often unaware of the consequences of concussions and recommended management techniques. This study quantitatively assessed parental understanding of concussions to identify specific populations in need of additional education. We predicted that parents with increased education and prior sports- and concussion-related experience would have more knowledge and safer attitudes toward concussions. Cross-sectional survey. Level 5. Participants were parents of children brought to a pediatric hospital and 4 satellite clinics for evaluation of orthopaedic injuries. Participants completed a validated questionnaire that assessed knowledge of concussion symptoms, attitudes regarding diagnosis and return-to-play guidelines, and previous sports- and concussion-related experience. Over 8 months, 214 parents completed surveys. Participants scored an average of 18.4 (possible, 0-25) on the Concussion Knowledge Index and 63.1 (possible, 15-75) on the Concussion Attitude Index. Attitudes were safest among white women, and knowledge increased with income and education levels. Previous sports experience did not affect knowledge or attitudes, but parents who reported experiencing an undiagnosed concussion had significantly better concussion knowledge than those who did not. Parents with low income and education levels may benefit from additional concussion-related education. There exist many opportunities for improvement in parental knowledge and attitudes about pediatric sports-related concussions. Ongoing efforts to understand parental knowledge of concussions will inform the development of a strategic and tailored approach to the prevention and management of pediatric concussions.

  10. A prospective study of concussions among National Hockey League players during regular season games: the NHL-NHLPA Concussion Program.

    Science.gov (United States)

    Benson, Brian W; Meeuwisse, Willem H; Rizos, John; Kang, Jian; Burke, Charles J

    2011-05-17

    In 1997, the National Hockey League (NHL) and NHL Players' Association (NHLPA) launched a concussion program to improve the understanding of this injury. We explored initial postconcussion signs, symptoms, physical examination findings and time loss (i.e., time between the injury and medical clearance by the physician to return to competitive play), experienced by male professional ice-hockey players, and assessed the utility of initial postconcussion clinical manifestations in predicting time loss among hockey players. We conducted a prospective case series of concussions over seven NHL regular seasons (1997-2004) using an inclusive cohort of players. The primary outcome was concussion and the secondary outcome was time loss. NHL team physicians documented post-concussion clinical manifestations and recorded the date when a player was medically cleared to return to play. Team physicians reported 559 concussions during regular season games. The estimated incidence was 1.8 concussions per 1000 player-hours. The most common postconcussion symptom was headache (71%). On average, time loss (in days) increased 2.25 times (95% confidence interval [CI] 1.41-3.62) for every subsequent (i.e., recurrent) concussion sustained during the study period. Controlling for age and position, significant predictors of time loss were postconcussion headache (p < 0.001), low energy or fatigue (p = 0.01), amnesia (p = 0.02) and abnormal neurologic examination (p = 0.01). Using a previously suggested time loss cut-point of 10 days, headache (odds ratio [OR] 2.17, 95% CI 1.33-3.54) and low energy or fatigue (OR 1.72, 95% CI 1.04-2.85) were significant predictors of time loss of more than 10 days. Postconcussion headache, low energy or fatigue, amnesia and abnormal neurologic examination were significant predictors of time loss among professional hockey players.

  11. A prospective study of concussions among National Hockey League players during regular season games: the NHL-NHLPA Concussion Program

    Science.gov (United States)

    Benson, Brian W.; Meeuwisse, Willem H.; Rizos, John; Kang, Jian; Burke, Charles J.

    2011-01-01

    Background In 1997, the National Hockey League (NHL) and NHL Players’ Association (NHLPA) launched a concussion program to improve the understanding of this injury. We explored initial postconcussion signs, symptoms, physical examination findings and time loss (i.e., time between the injury and medical clearance by the physician to return to competitive play), experienced by male professional ice-hockey players, and assessed the utility of initial postconcussion clinical manifestations in predicting time loss among hockey players. Methods We conducted a prospective case series of concussions over seven NHL regular seasons (1997–2004) using an inclusive cohort of players. The primary outcome was concussion and the secondary outcome was time loss. NHL team physicians documented post-concussion clinical manifestations and recorded the date when a player was medically cleared to return to play. Results Team physicians reported 559 concussions during regular season games. The estimated incidence was 1.8 concussions per 1000 player-hours. The most common postconcussion symptom was headache (71%). On average, time loss (in days) increased 2.25 times (95% confidence interval [CI] 1.41–3.62) for every subsequent (i.e., recurrent) concussion sustained during the study period. Controlling for age and position, significant predictors of time loss were postconcussion headache (p < 0.001), low energy or fatigue (p = 0.01), amnesia (p = 0.02) and abnormal neurologic examination (p = 0.01). Using a previously suggested time loss cut-point of 10 days, headache (odds ratio [OR] 2.17, 95% CI 1.33–3.54) and low energy or fatigue (OR 1.72, 95% CI 1.04–2.85) were significant predictors of time loss of more than 10 days. Interpretation Postconcussion headache, low energy or fatigue, amnesia and abnormal neurologic examination were significant predictors of time loss among professional hockey players. PMID:21502355

  12. Significance of ubiquitin carboxy-terminal hydrolase L1 elevations in athletes after sub-concussive head hits.

    Directory of Open Access Journals (Sweden)

    Vikram Puvenna

    Full Text Available The impact of sub-concussive head hits (sub-CHIs has been recently investigated in American football players, a population at risk for varying degrees of post-traumatic sequelae. Results show how sub-CHIs in athletes translate in serum as the appearance of reporters of blood-brain barrier disruption (BBBD, how the number and severity of sub-CHIs correlate with elevations of putative markers of brain injury is unknown. Serum brain injury markers such as UCH-L1 depend on BBBD. We investigated the effects of sub-CHIs in collegiate football players on markers of BBBD, markers of cerebrospinal fluid leakage (serum beta 2-transferrin and markers of brain damage. Emergency room patients admitted for a clinically-diagnosed mild traumatic brain injury (mTBI were used as positive controls. Healthy volunteers were used as negative controls. Specifically this study was designed to determine the use of UCH-L1 as an aid in the diagnosis of sub-concussive head injury in athletes. The extent and intensity of head impacts and serum values of S100B, UCH-L1, and beta-2 transferrin were measured pre- and post-game from 15 college football players who did not experience a concussion after a game. S100B was elevated in players experiencing the most sub-CHIs; UCH-L1 levels were also elevated but did not correlate with S100B or sub-CHIs. Beta-2 transferrin levels remained unchanged. No correlation between UCH-L1 levels and mTBI were measured in patients. Low levels of S100B were able to rule out mTBI and high S100B levels correlated with TBI severity. UCH-L1 did not display any interpretable change in football players or in individuals with mild TBI. The significance of UCH-L1 changes in sub-concussions or mTBI needs to be further elucidated.

  13. High School Concussions in the 2008–2009 Academic Year

    Science.gov (United States)

    Meehan, William P.; d’Hemecourt, Pierre; Comstock, R. Dawn

    2011-01-01

    Background An estimated 136 000 concussions occur per academic year in high schools alone. The effects of repetitive concussions and the potential for catastrophic injury have made concussion an injury of significant concern for young athletes. Purpose The objective of this study was to describe the mechanism of injury, symptoms, and management of sport-related concussions using the High School Reporting Information Online (HS RIO) surveillance system. Study Design Descriptive epidemiology study. Methods All concussions recorded by HS RIO during the 2008–2009 academic year were included. Analyses were performed using SPSS software. Chi-square analysis was performed for all categorical variables. Statistical significance was considered for P concussions were recorded. The most common mechanism (76.2%) was contact with another player, usually a head-to-head collision (52.7%). Headache was experienced in 93.4%; 4.6% lost consciousness. Most (83.4%) had resolution of their symptoms within 1 week. Symptoms lasted longer than 1 month in 1.5%. Computerized neuropsychological testing was used in 25.7% of concussions. When neuropsychological testing was used, athletes were less likely to return to play within 1 week than those for whom it was not used (13.6% vs 32.9%; P < .01). Athletes who had neuropsychological testing appeared less likely to return to play on the same day (0.8% vs 4.2%; P = .056). A greater proportion of injured, nonfootball athletes had computerized neuropsychological testing than injured football players (23% vs 32%; P = .02) Conclusion When computerized neuropsychological testing is used, high school athletes are less likely to be returned to play within 1 week of their injury. Concussed football players are less likely to have computerized neuropsychological testing than those participating in other sports. Loss of consciousness is relatively uncommon among high school athletes who sustain a sport-related concussion. The most common mechanism is

  14. Pediatric Brain: Repeated Exposure to Linear Gadolinium-based Contrast Material Is Associated with Increased Signal Intensity at Unenhanced T1-weighted MR Imaging.

    Science.gov (United States)

    Flood, Thomas F; Stence, Nicholas V; Maloney, John A; Mirsky, David M

    2017-01-01

    Purpose To determine whether repeated exposure of the pediatric brain to a linear gadolinium-based contrast agent (GBCA) is associated with an increase in signal intensity (SI) relative to that in GBCA-naive control subjects at unenhanced T1-weighted magnetic resonance (MR) imaging. Materials and Methods This single-center, retrospective study was approved by the institutional review board and compliant with HIPAA. The authors evaluated 46 pediatric patients who had undergone at least three GBCA-enhanced MR examinations (30 patients for two-group analysis and 16 for pre- and post-GBCA exposure comparisons) and 57 age-matched GBCA-naive control subjects. The SI in the globus pallidus, thalamus, dentate nucleus, and pons was measured at unenhanced T1-weighted MR imaging. Globus pallidus-thalamus and dentate nucleus-pons SI ratios were calculated and compared between groups and relative to total cumulative gadolinium dose, age, sex, and number of and mean time between GBCA-enhanced examinations. Analysis included the Wilcoxon signed rank test, Wilcoxon rank sum test, and Spearman correlation coefficient. Results Patients who underwent multiple GBCA-enhanced examinations had increased SI ratios within the dentate nucleus (mean SI ratio ± standard error of the mean for two-group comparison: 1.007 ± 0.0058 for GBCA-naive group and 1.046 ± 0.0060 for GBCA-exposed group [P mean SI ratio for pre- and post-GBCA comparison: 0.995 ± 0.0062 for pre-GBCA group and 1.035 ± 0.0063 for post-GBCA group [P mean SI ratio for two-group comparison: 1.131 ± 0.0070 for GBCA-naive group and 1.014 ± 0.0091 for GBCA-exposed group [P = .21]; mean SI ratio for pre- and post-GBCA comparison: 1.068 ± 0.0094 for pre-GBCA group and 1.093 ± 0.0134 for post-GBCA group [P = .12]). There was a significant correlation between dentate nucleus SI and total cumulative gadolinium dose (r = 0.4; 95% confidence interval [CI]: 0.03, 0.67; P = .03), but not between dentate nucleus SI and patient age

  15. Neurological consequences of traumatic brain injuries in sports.

    Science.gov (United States)

    Ling, Helen; Hardy, John; Zetterberg, Henrik

    2015-05-01

    Traumatic brain injury (TBI) is common in boxing and other contact sports. The long term irreversible and progressive aftermath of TBI in boxers depicted as punch drunk syndrome was described almost a century ago and is now widely referred as chronic traumatic encephalopathy (CTE). The short term sequelae of acute brain injury including subdural haematoma and catastrophic brain injury may lead to death, whereas mild TBI, or concussion, causes functional disturbance and axonal injury rather than gross structural brain damage. Following concussion, symptoms such as dizziness, nausea, reduced attention, amnesia and headache tend to develop acutely but usually resolve within a week or two. Severe concussion can also lead to loss of consciousness. Despite the transient nature of the clinical symptoms, functional neuroimaging, electrophysiological, neuropsychological and neurochemical assessments indicate that the disturbance of concussion takes over a month to return to baseline and neuropathological evaluation shows that concussion-induced axonopathy may persist for years. The developing brains in children and adolescents are more susceptible to concussion than adult brain. The mechanism by which acute TBI may lead to the neurodegenerative process of CTE associated with tau hyperphosphorylation and the development of neurofibrillary tangles (NFTs) remains speculative. Focal tau-positive NFTs and neurites in close proximity to focal axonal injury and foci of microhaemorrhage and the predilection of CTE-tau pathology for perivascular and subcortical regions suggest that acute TBI-related axonal injury, loss of microvascular integrity, breach of the blood brain barrier, resulting inflammatory cascade and microglia and astrocyte activation are likely to be the basis of the mechanistic link of TBI and CTE. This article provides an overview of the acute and long-term neurological consequences of TBI in sports. Clinical, neuropathological and the possible pathophysiological

  16. A systematic review of diffusion tensor imaging findings in sports-related concussion.

    Science.gov (United States)

    Gardner, Andrew; Kay-Lambkin, Frances; Stanwell, Peter; Donnelly, James; Williams, W Huw; Hiles, Alexandra; Schofield, Peter; Levi, Christopher; Jones, Derek K

    2012-11-01

    Sports-related concussion (SRC) is typically associated with functional, as opposed to structural, injury. The results of traditional structural neuroimaging techniques used to assess SRC tend to be normal in many athletes, and are only clinically helpful in ruling out a more serious injury. Diffusion tensor imaging (DTI) has increasingly been touted as a method offering greater clinical potential in mild traumatic brain injury (mTBI). Despite this, the utility of DTI as a clinical tool for diagnosing and managing SRC has received considerably less attention than it has in the general TBI research literature. The aim of this article is to conduct a systematic review of DTI in SRC, and to provide a focus and overview of research findings using this MRI technique in SRC. A systematic review of articles published in the English language, up to February 2012, was retrieved via PsycINFO(®), MEDLINE(®), EMBASE, SPORTDiscus(™), Scopus, Web of Science, and Informit; using the key search terms: diffusion tensor imaging, diffusion magnetic resonance imaging, diffusion weighted MRI, diffusion MRI, fractional anisotropy, tractography, apparent diffusion coefficient, magnetic resonance imaging, mild traumatic brain injury, mTBI, traumatic brain injury, concussion, sport, athletic and athlete. Observational, cohort, correlation, cross-sectional and longitudinal studies were all included in the current review. Results of the review found eight articles that met inclusion criteria, which included data on 214 athletes and 96 controls. Seven of eight studies reported some type of DTI abnormality, although the neuroanatomical sites involved varied. Although considerable methodological variations exist across studies, the current review suggests that DTI may possess adequate diagnostic sensitivity to detect SRC in affected athletes. Further longitudinal studies are required to demonstrate its discriminate validity and prognostic capacity within this field.

  17. Mechanisms of injury for concussions in university football, ice hockey, and soccer.

    Science.gov (United States)

    Delaney, J Scott; Al-Kashmiri, Ammar; Correa, José A

    2014-05-01

    To examine the mechanisms of injury for concussions in university football, ice hockey, and soccer. Prospective cohort design. McGill University Sport Medicine Clinic. Male and female athletes participating in varsity football, ice hockey, and soccer. Athletes were followed prospectively over a 10-year period to determine the mechanisms of injury for concussions and whether contact with certain areas of the body or individual variables predisposed to longer recovery from concussions. For soccer, data were collected on whether concussions occurred while attempting to head the ball. There were 226 concussions in 170 athletes over the study period. The side/temporal area of the head or helmet was the most common area to be struck resulting in concussion in all 3 sports. Contact from another player's head or helmet was the most probable mechanism in football and soccer. In hockey, concussion impacts were more likely to occur from contact with another body part or object rather than another head/helmet. Differences in mechanisms of injuries were found between males and females in soccer and ice hockey. Athletes with multiple concussions took longer to return to play with each subsequent concussion. Half of the concussions in soccer were related to attempting to head the soccer ball. The side of the head or helmet was the most common area to be struck resulting in concussion in all 3 sports. In ice hockey and soccer, there are differences in the mechanisms of injury for males and females within the same sport.

  18. Early indicators of enduring symptoms in high school athletes with multiple previous concussions.

    Science.gov (United States)

    Schatz, Philip; Moser, Rosemarie Scolaro; Covassin, Tracey; Karpf, Robin

    2011-06-01

    Despite recent findings of cognitive, emotional, physical, and behavioral symptomatology in retired professional athletes with a history of multiple concussions, there is little systematic research examining these symptoms in high school athletes with a history of concussion. To identify cognitive, emotional, and physical symptoms at baseline in nonconcussed high school athletes based on concussion history. A multicenter sample of 616 high school athletes who completed baseline evaluations were assigned to groups based on history of concussion (none, 1, 2, or more previous concussions). The Post-Concussion Symptom Scale was administered as part of a computerized neuropsychological test battery during athletes' preseason baseline evaluations. Cross-sectional analyses were used to examine symptoms reported at the time of baseline neuropsychological testing. High school athletes with a history of 2 or more concussions showed significantly higher ratings of concussion-related symptoms (cognitive, physical, sleep difficulties) than athletes with a history of one or no previous concussions. It appears that youth athletes who sustain multiple concussions experience a variety of subtle effects, which may be possible precursors of the future onset of concussion-related difficulties. Copyright © 2011 by the Congress of Neurological Surgeons

  19. Spreading the word on sports concussion: citation analysis of summary and agreement, position and consensus statements on sports concussion.

    Science.gov (United States)

    Alla, Sridhar; Sullivan, S John; McCrory, Paul; Hale, Leigh

    2011-02-01

    the growing concern over concussion in sports has led to the publication of five major summary and agreement, position and consensus statements since 2000. The dissemination of information from these statements is largely unknown and difficult to quantify, but their impact on the research community can be quantified by analysing the number of citations to these key publications. The purpose of this review is to report the number and pattern of citations to the key published statements on sports concussion. Web of Science, Scopus and PubMed were searched from 2000 to mid-December 2009 using two different search strategies. The first strategy used the search terms 'concussion' and 'first author' of the statement article, while the second used the 'title' of the target article as the key search term. the publications resulting from the three 'Concussion in Sport' (CIS) group conferences were cited by 532 journal articles, while the National Athletic Trainers' Association position statement was cited 123 times. The highest number of citations to each of the five identified statements was seen in 2009. British Journal of Sports Medicine was the most frequently cited journal. the citation analysis of the key statements on sports concussion has shown that the target papers have been widely cited in the research literature, with the highest number of citations being from the publications arising from the CIS group conferences. The authors have shown their preference to cite source articles published in the British Journal of Sports Medicine.

  20. A Paired Comparison of Initial and Recurrent Concussions Sustained by US High School Athletes Within a Single Athletic Season.

    Science.gov (United States)

    Currie, Dustin W; Comstock, R Dawn; Fields, Sarah K; Cantu, Robert C

    To compare initial and recurrent concussions regarding average number of days between concussions, acute concussion symptoms and symptom resolution time, and return to play time. High school athletes sustaining multiple concussions linked within sport seasons drawn from a large sports injury surveillance study. Retrospective analysis of longitudinal surveillance data. Number of days between concussions, number of symptoms endorsed, specific symptoms endorsed, symptom resolution time, return to play time. Median time between initial and recurrent concussions was 21 days (interquartile range = 10-43 days). Loss of consciousness, the only significant symptom difference, occurred more frequently in recurrent (6.8%) than initial (1.7%) concussions (P = .04). No significant difference was found in the number of symptoms (P = .84) or symptom resolution time (P = .74). Recurrent concussions kept athletes from play longer than initial concussions (P concussions were season ending. We found that athletes' initial and recurrent concussions had similar symptom presentations and resolution time. Despite these similarities, athletes were restricted from returning to play for longer periods following a recurrent concussion, indicating clinicians are managing recurrent concussions more conservatively. It is probable that concussion recognition and management are superior now compared with when previous studies were published, possibly improving recurrent concussion outcomes.

  1. Management of Sport-Related Concussion in the Pediatric and Adolescent Population.

    Science.gov (United States)

    Provance, Aaron J; Engelman, Glenn H; Terhune, E Bailey; Coel, Rachel A

    2016-01-01

    Concussions make up nearly 10% of all high school athletic injuries. Recent changes in concussion management guidelines and legislation aim to make concussion care more standardized and safe but simultaneously pose a challenge for the primary care and sports medicine physician. Pediatric and adolescent concussions may cause anxiety for the treating physician due to concerns over return-to-play decisions, academic issues, and the potential for second impact syndrome. Determining when to refer a patient to an emergency department acutely, to an outpatient concussion clinic, or to other subspecialists may be a difficult decision for the primary care physician. The aim of this article is to review current evidence regarding concussion treatment and return-to-school and return-to-play recommendations to provide the primary care and sports medicine physician with practical guidelines for managing concussions.

  2. CHOA concussion consensus: establishing a uniform policy for academic accommodations.

    Science.gov (United States)

    Popoli, David Michael; Burns, Thomas G; Meehan, William P; Reisner, Andrew

    2014-03-01

    Concussion research generally centers on physical challenges, though aspects such as social functioning and returning to school also warrant attention in pediatric populations. Restoring academic performance postconcussion remains a challenge. Here we provide recommendations addressing a uniform policy for pediatric concussion patients in academic institutions. Tools that may minimize difficulty with academic re-entry include independent educational evaluations, individualized educational programs (IEPs), student support teams (SSTs), letters of academic accommodation, time off, and 504 Plans. Recognition and treatment is crucial for symptom relief and prevention of functional disruption, as is specialist referral during the acute window. We recommend early intervention with a letter of academic accommodation and SST and suggest that 504 Plans and IEPs be reserved for protracted or medically complicated cases. Students with concussion should be observed for anxiety and depression because these symptoms can lead to prolonged recovery, decreased quality of life, and other social challenges.

  3. Mild traumatic brain injuries in early adolescent rugby players: Long-term neurocognitive and academic outcomes.

    Science.gov (United States)

    Alexander, D G; Shuttleworth-Edwards, A B; Kidd, M; Malcolm, C M

    2015-01-01

    Information is scant concerning enduring brain injury effects of participation in the contact sport of Rugby Union (hereafter rugby) on early adolescents. The objective was prospectively to investigate differences between young adolescent male rugby players and non-contact sports controls on neurocognitive test performance over 3 years and academic achievement over 6 years. A sample of boys from the same school and grade was divided into three groups: rugby with seasonal concussions (n = 45), rugby no seasonal concussions (n = 21) and non-contact sports controls (n = 30). Baseline neurocognitive testing was conducted pre-season in Grade 7 and post-season in Grades 8 and 9. Year-end academic grades were documented for Grades 6-9 and 12 (pre-high school to year of school leaving). A mixed model repeated measures ANOVA was conducted to investigate comparative neurocognitive and academic outcomes between the three sub-groups. Compared with controls, both rugby groups were significantly lower on the WISC-III Coding Immediate Recall sub-test. There was a significant interaction effect on the academic measure, with improved scores over time for controls, that was not in evidence for either rugby group. Tentatively, the outcome suggests cognitive vulnerability in association with school level participation in rugby.

  4. Sex differences in concussion symptoms of high school athletes.

    Science.gov (United States)

    Frommer, Leah J; Gurka, Kelly K; Cross, Kevin M; Ingersoll, Christopher D; Comstock, R Dawn; Saliba, Susan A

    2011-01-01

    More than 1.6 million sport-related concussions occur every year in the United States, affecting greater than 5% of all high school athletes who participate in contact sports. As more females participate in sports, understanding possible differences in concussion symptoms between sexes becomes more important. To compare symptoms, symptom resolution time, and time to return to sport between males and females with sport-related concussions. Descriptive epidemiology study. Data were collected from 100 high schools via High School RIO (Reporting Information Online). Athletes from participating schools who sustained concussions while involved in interscholastic sports practice or competition in 9 sports (boys' football, soccer, basketball, wrestling, and baseball and girls' soccer, volleyball, basketball, and softball) during the 2005-2006 and 2006-2007 school years. A total of 812 sport concussions were reported (610 males, 202 females). Reported symptoms, symptom resolution time, and return-to-play time. No difference was found between the number of symptoms reported (P  =  .30). However, a difference was seen in the types of symptoms reported. In year 1, males reported amnesia (exact P  =  .03) and confusion/disorientation (exact P  =  .04) more frequently than did females. In year 2, males reported more amnesia (exact P  =  .002) and confusion/disorientation (exact P  =  .002) than did females, whereas females reported more drowsiness (exact P  =  .02) and sensitivity to noise (exact P  =  .002) than did males. No differences were observed for symptom resolution time (P  =  .40) or return-to-play time (P  =  .43) between sexes. The types of symptoms reported differed between sexes after sport-related concussion, but symptom resolution time and return-to-play timelines were similar.

  5. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... Health Association American School Health Association American Sports Education Program Brain Injury Association of America Brain Trauma ... School Principals National Council for Youth Sports National Education Association National Education Association Health Information Network National ...

  6. Heads Up: Concussion in Youth Sports

    Medline Plus

    Full Text Available ... You will need a score of 80% or higher to pass. Please review the lessons and then ... Health Association American School Health Association American Sports Education Program Brain Injury Association of America Brain Trauma ...

  7. Transient suppression of heart rate complexity in concussed athletes.

    Science.gov (United States)

    La Fountaine, Michael F; Heffernan, Kevin S; Gossett, James D; Bauman, William A; De Meersman, Ronald E

    2009-06-15

    Heart rate variability (HRV) and complexity (HRC) were calculated at rest and during an isometric hand grip test (IHGT) within 48-hours (48 h) and two weeks (Week Two) of a concussion in athletes (CG) and control subjects. No differences were present at rest or in HRV during IGHT. HRC was significantly lower in the CG compared to controls at 48 h during IHGT. In CG at Week Two during IHGT, HRC was significantly greater than 48 h observations and not significantly different than controls. The findings suggest that HRC may have utility in detecting efferent cardiac autonomic anomalies within two weeks of concussion.

  8. Multiple Past Concussions Are Associated with Ongoing Post-Concussive Symptoms but Not Cognitive Impairment in Active-Duty Army Soldiers.

    Science.gov (United States)

    Dretsch, Michael N; Silverberg, Noah D; Iverson, Grant L

    2015-09-01

    The extent to which multiple past concussions are associated with lingering symptoms or mental health problems in military service members is not well understood. The purpose of this study was to examine the association between lifetime concussion history, cognitive functioning, general health, and psychological health in a large sample of fit-for-duty U.S. Army soldiers preparing for deployment. Data on 458 active-duty soldiers were collected and analyzed. A computerized cognitive screening battery (CNS-Vital Signs(®)) was used to assess complex attention (CA), reaction time (RT), processing speed (PS), cognitive flexibility (CF), and memory. Health questionnaires included the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist-Military Version (PCL-M), Zung Depression and Anxiety Scales (ZDS; ZAS), Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the Alcohol Use and Dependency Identification Test (AUDIT). Soldiers with a history of multiple concussions (i.e., three or more concussions) had significantly greater post-concussive symptom scores compared with those with zero (d=1.83, large effect), one (d=0.64, medium effect), and two (d=0.64, medium effect) prior concussions. Although the group with three or more concussions also reported more traumatic stress symptoms, the results revealed that traumatic stress was a mediator between concussions and post-concussive symptom severity. There were no significant differences on neurocognitive testing between the number of concussions. These results add to the accumulating evidence suggesting that most individuals recover from one or two prior concussions, but there is a greater risk for ongoing symptoms if one exceeds this number of injuries.

  9. Subjective, but not objective, lingering effects of multiple past concussions in adolescents.

    Science.gov (United States)

    Brooks, Brian L; McKay, Carly D; Mrazik, Martin; Barlow, Karen M; Meeuwisse, Willem H; Emery, Carolyn A

    2013-09-01

    The existing literature on lingering effects from concussions in children and adolescents is limited and mixed, and there are no clear answers for patients, clinicians, researchers, or policy makers. The purpose of this study was to examine whether there are lingering effects of past concussions in adolescent athletes. Participants in this study included 643 competitive Bantam and Midget hockey players (most elite 20% by division of play) between 13 and 17 years of age (mean age=15.5, SD=1.2). Concussion history at baseline assessment was retrospectively documented using a pre-season questionnaire (PSQ), which was completed at home by parents and players in advance of baseline testing. Players with English as a second language, self-reported attention or learning disorders, a concussion within 6 months of baseline, or suspected invalid test profiles were excluded from these analyses. Demographically adjusted standard scores for the five composites/domains and raw symptom ratings from the brief Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computerized battery were analyzed. Adolescent athletes with one or two or more prior concussions did not have significantly worse neurocognitive functioning on ImPACT than did those with no previous concussions. There were significantly more symptoms reported in those with two or more prior concussions than in those with no or one prior concussion. Adolescents with multiple previous concussions had higher levels of baseline symptoms, but there were not group differences in neurocognitive functioning using this brief computerized battery.

  10. Attention deficit hyperactivity disorder as a risk factor for concussions in NCAA division-I athletes.

    Science.gov (United States)

    Alosco, Michael L; Fedor, Andrew F; Gunstad, John

    2014-01-01

    Sports-related concussions are associated with both acute and long-term consequences. Past work has identified novel risk factors and modifiers for concussions, including mood and neuropsychiatric disorders. Attention Deficit Hyperactivity Disorder (ADHD) is a common neuropsychiatric disorder that may also contribute to concussion risk, although no study has examined this possibility. One hundred and thirty-nine NCAA Division-I athletes at Kent State University (KSU) self-reported a history of prior concussion and diagnostic history of ADHD as part of a larger concussion management programme at KSU. ADHD was prevalent (10.1%) and 18.0% of the sample reported a prior history of at least one concussion injury. 50.4% of athletes with ADHD reported a history of at least one prior concussion vs 14.4% of athletes without ADHD, which represented a significant difference (p concussions than those without ADHD (F (1,133) = 4.31, p = 0.04). ADHD is prevalent in NCAA Division-I athletes and associated with history of past concussions. If replicated, these findings could have important implications in the prevention and management of concussions in athletes with ADHD.

  11. Multiple prior concussions are associated with symptoms in high school athletes.

    Science.gov (United States)

    Mannix, Rebekah; Iverson, Grant L; Maxwell, Bruce; Atkins, Joseph E; Zafonte, Ross; Berkner, Paul D

    2014-06-01

    The purpose of this study was to evaluate the association of prior concussion on baseline computerized neurocognitive testing in a large cohort of high school athletes. This is a retrospective cohort study of student athletes from 49 Maine High Schools in 2010 who underwent baseline computerized neurocognitive evaluation with Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®). As part of the ImPACT®, subjects reported a prior history of concussion as well as demographic information and a symptom questionnaire. We used linear regression to evaluate the association of prior concussion with baseline: (1) ImPACT® composite scores; and (2) symptom scores. Six thousand seventy-five subjects were included in the study, of whom 57% were boys. The majority of student athletes (85.3%) reported no prior history of concussion while 4.6% reported having sustained two or more prior concussions. On simple linear regression, increasing number of concussions was related to worse performance in verbal memory (P = 0.039) and greater symptoms scores (P concussions. In this large-scale, retrospective survey study, history of multiple prior concussions was associated with higher symptom burden but not baseline computerized neurocognitive testing. The association between baseline symptom reporting and clinical and demographic factors was greater than the association with a history of multiple concussions.

  12. Sport Concussion Knowledge and Clinical Practices: A Survey of Doctors of Chiropractic With Sports Certification.

    Science.gov (United States)

    Moreau, William J; Nabhan, Dustin C; Walden, Taylor

    2015-09-01

    The purpose of this study is to describe the knowledge base and clinical practices regarding concussion by sports-certified doctors of chiropractic. A 21-item survey was distributed to the 312 attendees of the 2014 American Chiropractic Board of Sports Physicians Sports Sciences Symposium. Results were measured by frequency analysis and descriptive statistics for all surveys completed by sports-certified chiropractors. Seventy-six surveys were returned by sports-certified doctors of chiropractic. All (N = 76) 100% of respondents believe that the evaluation of concussion should be performed by a health care provider with training in concussion. The respondents actively assess and manage concussion in adults (96%), adolescents (95%), and children (75%). A majority (79%) of respondents believe that the Sideline Concussion Assessment Tool-3 represents a current standard of care for the sideline evaluation of the athlete who possibly has sustained a sport concussion. Most respondents agreed or strongly agreed that manual therapies may be appropriate in certain circumstances in adults (80%) and minors (80%). This cross section of certified sports chiropractors strongly believes that the evaluation of concussion should be performed by a health care provider with specific training in concussion. A high percentage of the sports-certified chiropractors who responded assess and manage sport concussion in their practice, and many of them endorse the use of the Sideline Concussion Assessment Tool-3 as a sideline assessment tool.

  13. Chiropractic and concussion in sport: a narrative review of the literature.

    Science.gov (United States)

    Johnson, Claire D; Green, Bart N; Nelson, Robert C; Moreau, Bill; Nabhan, Dustin

    2013-12-01

    Concussion is a common sporting injury that may be seen by doctors of chiropractic and should be managed following current practice guidelines. The purpose of this abstract is to present a literature review on chiropractic management of concussion in sport and to discuss current guidelines. A review of the literature was performed using the PubMed search engine. MeSH terms included chiropractic and concussion. Search dates were the beginning of the record through July 30, 2013. All languages and article types were included in the search. Articles found were retrieved and evaluated for the relevance of chiropractic management of concussion in sport. Five articles were found (1 prospective study, 1 survey, 3 literature reviews) ranging in publication years from 1993 to 2012. No articles reported a position statement, and none provided a review of current concussion management practices related to chiropractic practice. No articles reported adverse outcomes of chiropractic management of an athlete with concussion. Research related to the chiropractic management of concussion in sport is a nascent area of investigation. Although there are few published articles, the articles in this review showed that doctors of chiropractic encounter concussed athletes at events and in clinical practice. It is essential for doctors of chiropractic to understand the importance of using standardized concussion assessment tools and current concussion guidelines.

  14. Concussion history and reporting rates in elite Irish rugby union players.

    Science.gov (United States)

    Fraas, Michael R; Coughlan, Garrett F; Hart, Emily C; McCarthy, Conor

    2014-08-01

    To determine the self-reported, seasonal rates of concussion and the reporting practices among Irish rugby union players. Descriptive epidemiology study. The study was conducted at the training grounds of four professional Irish rugby union clubs. One hundred seventy-two players (24.97 ± 4.11 years of age, 13.49 ± 5.79 years playing experience) gave consent to participate. Number of concussions reported during the 2010-2011 season, reasons for not reporting, and positions of concussed players. Forty-five percent of players reported at least one concussion during the 2010-2011 season, but only 46.6% of these presented to medical staff. The reasons for not reporting their concussions included, not thinking the injury was serious enough, and not wanting to be removed from the game. The relative proportion of concussions was higher for backs than forwards; however, the severity of injury was greater for forwards. Scrum-halves (12.0%) and flankers (10.9%) accounted for the majority of concussions reported. The self-reported rate of concussion in elite rugby union players in Ireland is higher than reported in other countries or other sports. Many concussions remain unreported and, therefore, unmanaged. However, recent changes in concussion management guidelines by the International Rugby Board may impact future reporting practices of players. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Association Between Traumatic Brain Injury and Risk of Posttraumatic Stress Disorder in Active-Duty Marines

    Science.gov (United States)

    2013-01-01

    neuroscience of persistent post-concussive syndrome. J Int Neuropsychol Soc. 2008;14(1):1-22. 3. Iverson GL, Brooks BL, Lovell MR, Collins MW. No cumulative...traumatic brain injury. J Neuropsychiatry Clin Neurosci . 2011;23(1):29-39. 61. Brenner LA, Betthauser LM, Homaifar BY, et al. Posttraumatic stress...4):589-595. 67. Guskiewicz KM, Marshall SW, Bailes J, et al. Recurrent concussion and risk of depression in retired professional football players.Med

  16. Primary Blast Traumatic Brain Injury in the Rat: Relating Diffusion Tensor Imaging and Behavior

    Science.gov (United States)

    2013-10-14

    collegiate football players: the NCAA concussion study. JAMA (2003) 290:2556–63. doi:10.1001/ jama.290.19.2556 6. DePalma RG, Burris DG, Champion HR...Nugent S, et al. Findings of mild traumatic brain injury in combat veterans with PTSD and a history of blast concussion. J Neuropsychiatry Clin Neurosci ...life cognitive impairment in retired professional football players. Neurosurgery (2005) 57:719–26. doi:10.1227/01.NEU.0000175725. 75780.DD discussion

  17. Concussion Management in Your Schools: A Call to Action

    Science.gov (United States)

    Pierson, Eric E.; Canto, Angela I.

    2015-01-01

    School psychologists are key professionals in assessment, intervention, prevention, and consultation across academic, behavioral, and emotional domains. Often, this includes working with injured or ill students. Given the high prevalence of concussions among children and adolescents, knowledgeable school psychologists are needed to work with these…

  18. Court Decisions Specific to Public School Responses to Student Concussions

    Science.gov (United States)

    Zirkel, Perry A.

    2016-01-01

    This article provides an up-to-date and comprehensive canvassing of the judicial case law concerning the responses to students with concussions in the public school context. The two categories of court decisions are (a) those concerning continued participation in interscholastic athletics, referred to under the rubric of "return to play"…

  19. Vision training methods for sports concussion mitigation and management.

    Science.gov (United States)

    Clark, Joseph F; Colosimo, Angelo; Ellis, James K; Mangine, Robert; Bixenmann, Benjamin; Hasselfeld, Kimberly; Graman, Patricia; Elgendy, Hagar; Myer, Gregory; Divine, Jon

    2015-05-05

    There is emerging evidence supporting the use vision training, including light board training tools, as a concussion baseline and neuro-diagnostic tool and potentially as a supportive component to concussion prevention strategies. This paper is focused on providing detailed methods for select vision training tools and reporting normative data for comparison when vision training is a part of a sports management program. The overall program includes standard vision training methods including tachistoscope, Brock's string, and strobe glasses, as well as specialized light board training algorithms. Stereopsis is measured as a means to monitor vision training affects. In addition, quantitative results for vision training methods as well as baseline and post-testing *A and Reaction Test measures with progressive scores are reported. Collegiate athletes consistently improve after six weeks of training in their stereopsis, *A and Reaction Test scores. When vision training is initiated as a team wide exercise, the incidence of concussion decreases in players who participate in training compared to players who do not receive the vision training. Vision training produces functional and performance changes that, when monitored, can be used to assess the success of the vision training and can be initiated as part of a sports medical intervention for concussion prevention.

  20. Concussion knowledge and attitudes among amateur South African ...

    African Journals Online (AJOL)

    Kathryn van Boom

    and schools offer medical assistance – which is limited to matches – mostly due to a lack ... on concussion education among South African rugby players. Only a single study, to date, ..... Kroshus et al.[14] propose adding real life simulation to.

  1. Consensus Statement on Concussion in Sport – the 3rd ...

    African Journals Online (AJOL)

    Centre for Health, Exercise & Sports Medicine. University of ... face, neck or elsewhere on the body with an ''impulsive'' force transmitted to the head. ..... progressive resistance training) Restore. 5. ... influence the investigation and management of concussion and in some cases ..... Video analysis of acute motor and convul-.

  2. Variations in State Laws Governing School Reintegration Following Concussion.

    Science.gov (United States)

    Thompson, Leah L; Lyons, Vivian H; McCart, Melissa; Herring, Stanley A; Rivara, Frederick P; Vavilala, Monica S

    2016-12-01

    We sought to examine the prevalence, scope, and specificity of provisions governing school reintegration in current state concussion laws. State concussion laws as of May 2016 were independently assessed and classified by 2 trained coders. Statutes were classified as "Return-to-Learn" (RTL) laws if they contained language mandating institutional action at the state, district, or school level related to academic reintegration of youth who have sustained a concussion. All statutes classified as RTL laws were further analyzed to determine scope, required actions, and delineation of responsibility. RTL laws were uncommon, present in only 8 states. Most (75%) of these laws held schools responsible for RTL management but mandated RTL education for school personnel was less frequent, present in only one-quarter of the laws. None of the RTL laws provided guidance on support of students with persistent postconcussive symptoms, and only 1 recommended an evidence-based standard for RTL guidelines. Our review of state concussion laws indicates scant and vague legal guidance regarding RTL. These findings suggest an opportunity for legislative action on the issue of RTL, and reveal the need for better integration of laws and research, so that laws reflect existing best-practice recommendations and remain current as the evidence base develops. Copyright © 2016 by the American Academy of Pediatrics.

  3. Sports-related concussion relevant to the South African football ...

    African Journals Online (AJOL)

    Concussion is a trauma-induced change in mental state that may or may not .... ziness, fatigue, sleep disturbances, memory lapses, mood swings, poor concentra- tion or any other ... exercise until re-evaluation by a doctor. • Contact your ...

  4. Evaluation of SPECT with N-isopropyl (I-123)-p-iodoamphetamine (IMP) or technetium-99m ( sup 99m Tc)-d,1-hexamethyl-propyleneamine oxime (d,1-HM-PAO) in cerebral concussion patients

    Energy Technology Data Exchange (ETDEWEB)

    Torigoe, Ryuichiro; Hayashi, Takashi; Anegawa, Shigetaka (Saint Mary' s Hospital, Kurume, Fukuoka (Japan)); Harada, Katsuhiko; Matsuo, Hiromasa; Yoshikawa, Ichiro

    1991-06-01

    {sup 123}I-IMP and Tc-PAO SPECT were performed in 20 cases of cerebral concussion ranging in age from 4 to 20 years old, including six cases of the juvenile head trauma syndrome (JHTS). The SPECT findings were divided into two main types: six cases in the normal group with no blood flow abnormalities, and 14 cases in abnormal group showing reduced blood flow, mainly in cerebellum and occipital lobe except in one case. In 10 cases of reduced blood flow which could be analyzed, calculation of the blood flow ratio in the temporal and occipital lobes and the cerebellum with the frontal lobe taken as 100 showed values of 93.5% for the temporal lobe, 82.7% for the occipital lobe and 76.8% for the cerebellum. A statistically significant reduction in blood flow occurred in the occipital lobe and cerebellum. In blood examination, abnormally high values of white blood cell counts were observed transiently in 94% of cerebral concussion cases. Abnormalities in brain stem and hypothalamus appeared to cause these abnormal WBC values. From these findings, it was suggested that the blood flow regions of the basilar and posterior cerebral arteries, i.e., the brain stem and hypothalamus are closely connected with the lesions responsible for cerebral concussion. It also appeared that the JHTS occurs in cerebral concussion cases where recovery of the abnormal blood flow in these regions in poor. (author).

  5. Effects of soccer heading on brain structure and function

    Directory of Open Access Journals (Sweden)

    Ana Carolina Oliveira Rodrigues

    2016-03-01

    Full Text Available Soccer is the most popular sport in the world, with more than 265 million players worldwide, including professional and amateur ones. Soccer is unique in comparison to other sports, as it is the only sport in which participants purposely use their head to hit the ball. Heading is considered an offensive or defensive move whereby the player’s unprotected head is used to deliberately impact the ball and direct it during play. A soccer player can be subjected to an average of six to twelve incidents of heading the ball per competitive game, where the ball reaches high velocities. Moreover, in practice sessions, heading training, which involves heading the ball repeatedly at low velocities, is common. Although the scientific community, as well as the media, has focused on the effects of concussions in contact sports, the role of subconcussive impacts, as it can occur during heading, has recently gained attention, considering that it may represent an additional mechanism of cumulative brain injury. The purpose of this study is to review the existing literature regarding the effects of soccer heading on brain structure and function. Only in the last years some investigations have addressed the impact of heading on brain structure, by using neuroimaging techniques. Similarly, there have been some recent studies investigating biochemical markers of brain injury in soccer players. There is evidence of association between heading and abnormal brain structure, but the data are still preliminary. Also, some studies have suggested that subconcussive head impacts, as heading, could cause cognitive impairment, whereas others have not corroborated this finding. Questions persist as to whether or not heading is deleterious to cognitive functioning. Further studies, especially with longitudinal designs, are needed to clarify the clinical significance of heading as a cause of brain injury and to identify risk factors. Such investigations might contribute to the

  6. Effects of Soccer Heading on Brain Structure and Function.

    Science.gov (United States)

    Rodrigues, Ana Carolina; Lasmar, Rodrigo Pace; Caramelli, Paulo

    2016-01-01

    Soccer is the most popular sport in the world, with more than 265 million players worldwide, including professional and amateur ones. Soccer is unique in comparison to other sports, as it is the only sport in which participants purposely use their head to hit the ball. Heading is considered as an offensive or defensive move whereby the player's unprotected head is used to deliberately impact the ball and direct it during play. A soccer player can be subjected to an average of 6-12 incidents of heading the ball per competitive game, where the ball reaches high velocities. Moreover, in practice sessions, heading training, which involves heading the ball repeatedly at low velocities, is common. Although the scientific community, as well as the media, has focused on the effects of concussions in contact sports, the role of subconcussive impacts, as it can occur during heading, has recently gained attention, considering that it may represent an additional mechanism of cumulative brain injury. The purpose of this study is to review the existing literature regarding the effects of soccer heading on brain structure and function. Only in the last years, some investigations have addressed the impact of heading on brain structure, by using neuroimaging techniques. Similarly, there have been some recent studies investigating biochemical markers of brain injury in soccer players. There is evidence of association between heading and abnormal brain structure, but the data are still preliminary. Also, some studies have suggested that subconcussive head impacts, as heading, could cause cognitive impairment, whereas others have not corroborated this finding. Questions persist as to whether or not heading is deleterious to cognitive functioning. Further studies, especially with longitudinal designs, are needed to clarify the clinical significance of heading as a cause of brain injury and to identify risk factors. Such investigations might contribute to the establishment of safety

  7. Advances in neuropsychological assessment of sport-related concussion.

    Science.gov (United States)

    Echemendia, Ruben J; Iverson, Grant L; McCrea, Michael; Macciocchi, Stephen N; Gioia, Gerard A; Putukian, Margot; Comper, Paul

    2013-04-01

    To critically review the literature from the past 12 years regarding the following key issues in sports-related neuropsychological assessment: (1) the advantages and disadvantages of different neuropsychological assessment modalities; (2) the evidence for and against the current paradigm of baseline/postinjury testing; (3) the role of psychological factors in the evaluation and management of concussion; (4) advances in the neuropsychological assessment of children; (5) multi-modal assessment paradigms; (6) the role of the neuropsychologist as part of the sports healthcare team and (6) the appropriate administration and interpretation of neuropsychological tests. Targeted computerised literature review (MEDLINE, PubMed, CINAHL and PsychInfo) from 2000 to the present using key words: neuropsychological, neurocognitive, assessment, testing, concussion and sports. More than 2600 articles were identified using key word searches of the databases, including many duplicates. Several books were also reviewed. The articles were pared down for review if they specifically addressed the key areas noted above. Traditional and computerised neuropsychological tests are useful in the evaluation and management of concussion. Brief cognitive evaluation tools are not substitutes for formal neuropsychological assessment. At present, there is insufficient evidence to recommend the widespread routine use of baseline neuropsychological testing. Although scant, research suggests that psychological factors may complicate and prolong recovery from concussion in some athletes. Age-appropriate symptom scales for children have been developed but research into age-appropriate tests of cognitive functions lags behind. Neuropsychologists are uniquely qualified to interpret neuropsychological tests and can play an important role within the context of a multifaceted-multimodal approach to manage sports-related concussions.

  8. Video analysis of concussion injury mechanism in under-18 rugby

    Science.gov (United States)

    Hendricks, Sharief; O'Connor, Sam; Lambert, Michael; Brown, James C; Burger, Nicholas; Mc Fie, Sarah; Readhead, Clint; Viljoen, Wayne

    2016-01-01

    Background Understanding the mechanism of injury is necessary for the development of effective injury prevention strategies. Video analysis of injuries provides valuable information on the playing situation and athlete-movement patterns, which can be used to formulate these strategies. Therefore, we conducted a video analysis of the mechanism of concussion injury in junior-level rugby union and compared it with a representative and matched non-injury sample. Methods Injury reports for 18 concussion events were collected from the 2011 to 2013 under-18 Craven Week tournaments. Also, video footage was recorded for all 3 years. On the basis of the injury events, a representative ‘control’ sample of matched non-injury events in the same players was identified. The video footage, which had been recorded at each tournament, was then retrospectively analysed and coded. 10 injury events (5 tackle, 4 ruck, 1 aerial collision) and 83 non-injury events were analysed. Results All concussions were a result of contact with an opponent and 60% of players were unaware of the impending contact. For the measurement of head position on contact, 43% had a ‘down’ position, 29% the ‘up and forward’ and 29% the ‘away’ position (n=7). The speed of the injured tackler was observed as ‘slow’ in 60% of injurious tackles (n=5). In 3 of the 4 rucks in which injury occurred (75%), the concussed player was acting defensively either in the capacity of ‘support’ (n=2) or as the ‘jackal’ (n=1). Conclusions Training interventions aimed at improving peripheral vision, strengthening of the cervical muscles, targeted conditioning programmes to reduce the effects of fatigue, and emphasising safe and effective playing techniques have the potential to reduce the risk of sustaining a concussion injury. PMID:27900149

  9. Deployment Repeatability

    Science.gov (United States)

    2016-04-01

    controlled to great precision, but in a Cubesat , there may be no attitude determination at all. Such a Cubesat might treat sun angle and tumbling rates as...could be sensitive to small differences in motor controller timing. In these cases, the analyst might choose to model the entire deployment path, with...knowledge of the material damage model or motor controller timing precision. On the other hand, if many repeated and environmentally representative

  10. The impact of an educational intervention on college athletes' knowledge of concussions.

    Science.gov (United States)

    Miyashita, Theresa L; Timpson, William M; Frye, Melinda A; Gloeckner, Gene W

    2013-09-01

    The purpose of this study was to determine college athletes' knowledge regarding concussions and to determine if an educational lecture before their sport season would improve their knowledge and reporting of concussions. Cross-sectional study. University classroom. Seventy National College Athletic Association Division II men's/women's soccer players and men's/women's basketball players. Educational lecture regarding the basics of concussions. Descriptive statistics, ANOVAs, and a paired sample t test determined the athletes' knowledge of concussion before and after the season and the impact of the educational intervention. A paired sample t test indicated that the athletes scored better on the postseason concussion knowledge assessment [t(49) = 10.34, P concussions.

  11. Neuroprotective effect of hyperbaric oxygen therapy in a juvenile rat model of repetitive mild traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Lei Huang

    2016-01-01

    Full Text Available Repetitive mild traumatic brain injury (rmTBI is an important medical concern for adolescent athletes that can lead to long-term disabilities. Multiple mild injuries may exacerbate tissue damage resulting in cumulative brain injury and poor functional recovery. In the present study, we investigated the increased brain vulnerability to rmTBI and the effect of hyperbaric oxygen treatment using a juvenile rat model of rmTBI. Two episodes of mild cortical controlled impact (3 days apart were induced in juvenile rats. Hyperbaric oxygen (HBO was applied 1 hour/day × 3 days at 2 atmosphere absolute consecutively, starting at 1 day after initial mild traumatic brain