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PubMed1995

The assessment of orientation following concussion in athletes.

The purpose of this study was to investigate the sensitivity of orientation and recent memory questions in the diagnosis of concussion. In a prospective study over 7 consecutive years (1985-1991), all players at a professional Australian Rules Football club who sustained a concussive injury (n = 28) were administered a set of questions evaluating orientation and recent memory. Concussion was diagnosed independently on the basis of loss or disturbance of consciousness and clinical symptoms. A control group of age-matched nonconcussed players was administered the same set of questions. The results showed that items evaluating recently acquired information were more sensitive in the assessment of concussion than standard orientation items. The relative sensitivity of orientation questions must be considered when they are used in the clinical diagnosis of concussion in sport.

Australia↗

PubMed2001

Postural stability assessment following concussion: one piece of the puzzle.

Clinicians regularly assess concussion according to the symptoms that an athlete manifests at the time of injury, as well as during subsequent evaluations. The subjectivity involved with symptom assessment, however, often leaves the clinician without a clear picture of the athlete's true mental status. Neuropsychologic testing has become very popular in the sports medicine community for assessing the cognitive domain of neurologic functioning, and postural stability testing is gaining credence for assessing the motor domain. The objective of this review was to determine the efficacy of postural stability testing as an adjunct to concussion assessment of athletes. Multiple studies, using both sophisticated force plate technology, as well as those using less sophisticated clinical balance tests, have identified postural stability deficits lasting several days following sport-related concussion. It appears that postural stability testing provides a useful tool for objectively assessing the motor domain of neurologic functioning, and should be considered a reliable and valid adjunct to the assessment of athletes suffering from concussion. Although symptom severity, neurocognitive function, and postural stability are often affected initially following concussion, they are not necessarily related or even affected to the same degree.

Athletic Injuries↗

PubMed2006

Sideline management of sport-related concussions.

Concussions remain one of the most troublesome injuries sports physicians face. Studies suggest recovery takes hours to weeks, but at what point is the concussed brain no longer at increased risk for reinjury is unknown. Physicians must be alert to the symptoms of concussion and be familiar with the available tools to assess neurocognitive dysfunction. Prospectively validated signs and symptoms include amnesia, loss of consciousness, headache, dizziness, blurred vision, attention deficit, memory, postural instability, and nausea. A player with any signs or symptoms of a concussion should not be allowed to return to the current game or practice and should be monitored closely for deterioration of symptoms. Return-to-play should be individually based and proceed in a step-wise manner. The ongoing risk-benefit analysis of return-to-play must currently be based on experience, corollary data from traumatic brain injuries in animals and humans, and limited prospective data with sports-related concussions.

Athletic Injuries↗

PubMed2005

A comparison of a preparticipation evaluation history form and a symptom-based concussion survey in the identification of previous head injury in collegiate athletes.

OBJECTIVE: The purpose of this study was to compare the incidence of prior head injury reported on preparticipation physical evaluation (PPE) history forms with a retrospective symptom-based survey. DESIGN: A comparison of 2 retrospective survey instruments. SETTING: NCAA Division I varsity athletic program. PARTICIPANTS: A total of 93 male and 79 female athletes participating in intercollegiate contact/collision sports. MAIN OUTCOME MEASURES: Athletes were administered a concussion symptom survey (CSS) with questions about symptom incidence after head injury. These responses were compared with answers given about previous concussion/head injury on the university's PPE history form. The numbers of positive responses were analyzed using descriptive statistics, and differences between the PPE medical history form and the concussion symptom survey were assessed using chi analysis. Factor analysis was performed to assess for possible variance structure between reported symptoms. RESULTS: Seventy-one percent of athletes reporting symptoms consistent with concussion were not identified as having a history of head injury on the PPE medical history form. The most common symptom on the CSS was headache, which accounted for 46 (56.1%) positive responses. CONCLUSIONS: The CSS revealed greater numbers of athletes experiencing symptomatic head injuries than the screening questions on the PPE history form. Screening for signs and symptoms of concussion may enhance the sensitivity of the PPE in detecting a prior history of concussion.

Adolescent↗

PubMed2006

Neuropsychological dysfunction following repeat concussions in jockeys.

BACKGROUND: Single and repeat concussions have a high prevalence in sport. However, there is limited research into longterm risks associated with single and repeat concussions. OBJECTIVES: To determine the effects of single and repeat historical concussions on the neuropsychological functioning and neurological reports of licensed jockeys. METHODS: Six hundred and ninety eight licensed jockeys in the UK were assessed for neurological and neuropsychological symptoms of concussion at least three months after potential episodes. RESULTS: Jockeys reporting multiple historical injuries versus a single injury showed reliable decrements on a measure of response inhibition and, to a less robust degree, on divided attention. Younger adults showed greater vulnerability. CONCLUSIONS: Repeated concussion is associated with reliable decrements in cognitive performance--even after a three month window for recent recovery.

Adolescent↗

PubMed2004

The usefulness of quantitative EEG (QEEG) and neurotherapy in the assessment and treatment of post-concussion syndrome.

Mild traumatic brain injury (TBI) is associated with damage to frontal, temporal and parietal lobes. Post-concussion syndrome has been used to describe a range of residual symptoms that persist 12 months or more after the injury, often despite a lack of evidence of brain abnormalities on MRI and CT scans. The core deficits of post-concussion syndrome are similar to those of ADHD and mood disorders, and sufferers often report memory, socialization problems and frequent headaches. While cognitive rehabilitation and psychological support are widely used, neither has been shown to be effective in redressing the core deficits of post-concussion syndrome. On the other hand, quantitative EEG has been shown to be highly sensitive (96%) in identifying post-concussion syndrome, and neurotherapy has been shown in a number of studies to be effective in significantly improving or redressing the symptoms of post-concussion syndrome, as well as improving similar symptoms in non-TBI patients.

Electroencephalography↗

PubMed2003

Current issues in the identification, assessment, and management of concussions in sports-related injuries.

The recent literature has focused on the need for appropriate identification, assessment, and management of sports-related concussion. This article addresses current issues in the prevalence and assessment of sports-related concussion. Despite a paucity of research on female athletes and youth athletes, there is evidence that female athletes are at higher risk for injury than males and that concussions may affect children and young adolescents differently than older adolescents and adults. Sideline, baseline, and postconcussion assessments have become prevalent in documenting preinjury and postinjury performance, tracking recovery rates, and assisting return-to-play decisions. New computerized assessment procedures are growing in popularity and use. Future directions in the assessment and management of sports-related concussion include increased research on prevalence rates and effects of concussions for females and youth athletes, educating parents of youth athletes as well as family physicians on the importance of baseline and postconcussion cognitive assessments, and further validation of computerized assessment measures.

Athletic Injuries↗

PubMed2005

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

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Acceleration↗

PubMed2006

Structural validity of a self-report concussion-related symptom scale.

PURPOSE: This study evaluated the factorial validity of a self-report measure of concussion-related symptom severity among a large sample of male, high-school athletes. METHODS: Participants (N = 1089) were nonconcussed, male, high-school football players. All participants completed a single baseline self-report measure of concussion-related symptom severity, namely the graded symptom checklist (GSC). We tested the factorial validity of the measure with confirmatory factor analysis using LISREL 8.50. RESULTS: The analysis indicated that a theoretically derived, three-factor model provided a good, but not excellent, fit for the 16-item GSC. Excellent model-data fit was demonstrated for the three-factor model for a 9-item version of the GSC. In both instances, the three factors were best described by a single second-order factor, namely concussion symptomatology. CONCLUSIONS: This study provides additional evidence for the factorial validity of a summative self-reported measure of concussion-related symptoms. The factor structure represents a cohesive group of nine symptoms that can be explained by three underlying latent variables, namely somatic symptoms, neurobehavioral symptoms, and "cognitive" symptoms, subsumed under a single higher-order factor, namely concussion symptoms.

Adolescent↗

PubMedDate not supplied

Coma associated with flaccidity produced by fluid-percussion concussion in the cat. II: Contribution of activity in the pontine inhibitory system.

In the preceding paper we reported that concussive levels of fluid-percussion head injury can produce transient flaccidity of postural muscles associated with other indices of coma. This reversible coma associated with flaccidity follows an initial period of generalized areflexia and occurs in the absence of EEG slow waves. The present study investigated the physiological mechanisms underlying the flaccidity following concussive head injury be recording dorsal and ventral root potentials of the spinal cord. Studies indicated that, during the initial period of generalized areflexia, afferent input transmission was depressed although the excitability of motoneuronal pools was increased. In contrast, during periods of flaccidity, spinal cord somatomotor functions were depressed while transmission of afferent inputs was recovering. Systematic transection of the brain stem showed that activity within structures lying between collicular and midpontine levels is necessary to produce this latter condition. Cholinergic activation of pontine inhibitory areas within this same region of the rostral pons can produce profound descending inhibitory influences on postural somatomotor function in conjunction with other features of coma including suppression of eye-opening responses. Such effects occur without EEG slow waves. Moreover, other data indicate that local rates of glucose utilization within this pontine inhibitory area increase following concussive head injury. Thus, it is possible that a predominance of activity within the pontine inhibitory area could provide at least one neural basis for the reversible comatose state following concussive head injury characterized by close association between flaccidity and other indices of coma. Possible relationships of these data to clinically observed features of concussion are discussed.

Animals↗

PubMed2002

The implementation and use of the standardized assessment of concussion at the U.S. Naval Academy.

The Standardized Assessment of Concussion (SAC), a sideline mental status assessment tool, was used for the U.S. Naval Academy football team. Baseline SAC data were obtained for 298 subjects; the SAC was also used in immediate assessment and subsequent monitoring of 21 concussed players. Analysis of baseline data revealed no significant difference in SAC score based on position on team, position category (offense, defense, or special team), test form used, graduating class year, or history of prior concussion, nor was there any correlation on the basis of age. Among injured players, there was a significant drop in mean SAC total score from baseline to immediately following concussion. Surveys by athletic trainers and physicians who used the SAC indicated that, despite identifying potential limitations, they considered it to be easy and quick to administer and a useful tool in the assessment, monitoring, and management of concussed athletes at U.S. Naval Academy.

Academies and Institutes↗

PubMed2006

[Expression of c-myc protein on rats' brains after brain concussion].

OBJECTIVE: To study the changes of expression of c-myc protein on rats' brains after brain concussion. METHODS: sixty rats were randomly divided into brain concussion groups and control group. The expression of c-myc protein was microscopically observed by immunohistochemical method. RESULTS: No expression of c-myc protein in control group were observed. However, positive expression of c-myc protein in some neurons was seen at 20 min after brain concussion, and reach to the peak at 8h after brain concussion and then decreased gradually. CONCLUSION: These findings suggest that the detection of c-myc protein could be an index of diagnosis of brain concussion.

Animals↗

PubMed1999

Neuropsychology of sports-related head injury: Dementia Pugilistica to Post Concussion Syndrome.

This article reviews the existing literature in the following areas of sports neuropsychology: Dementia Pugilistica, concussion and Post Concussion Syndrome, Second Impact Syndrome, and the emerging role of the sports neuropsychologist regarding return to play decisions. Dementia Pugilistica is discussed as a condition that exists along a continuum: Although many boxers will develop mild neurocognitive deficits, it is not yet known what percent of these mild presentations will progress to diagnosable Dementia Pugilistica. Factors contributing to both increased and reduced risk are detailed. The role of neuropsychological assessment in research and clinical management is reviewed. Existing studies of concussion incurred during contact sports provide evidence of an important role for neuropsychology in assessment and management of mild head injuries. Issues in clinical assessment of concussion are reviewed. The importance of grading of concussions, monitoring of postconcussive symptom resolution, and the use of neuropsychological test results in return to play decisions is detailed. The Second Impact Syndrome is discussed with regard to return to play decisions. Recommendations are proposed for research and for clinical application of findings in sports neuropsychology.

Athletic Injuries↗

PubMed1990

Spinal cord concussion.

The hallmark of concussion injuries of the nervous system is the rapid and complete resolution of neurological deficits. Cerebral concussion has been well studied, both clinically and experimentally. In comparison, spinal cord concussion (SCC) is poorly understood. The clinical and radiological features of 19 SCC injuries in the general population are presented. Spinal cord injuries were classified as concussions if they met three criteria: 1) spinal trauma immediately preceded the onset of neurological deficits; 2) neurological deficits were consistent with spinal cord involvement at the level of injury; and 3) complete neurological recovery occurred within 72 hours after injury. Most cases involved young males, injured during athletics or due to falls. Concussion occurred at the two most unstable spinal regions, 16 involving the cervical spinal and three the thoracolumbar junction. Fifteen cases presented with combined sensorimotor deficits, while four exhibited only sensory disturbances. Many patients showed signs of recovery with the first few hours after injury and most had completely recovered within 24 hours. Only one case involved an unstable spinal injury. There was no evidence of ligamentous instability, spinal stenosis, or canal encroachment in the remaining 18 cases. Two patients, both children, suffered recurrent SCC injuries. No delayed deterioration or permanent cord injuries occurred. Spinal abnormalities that would predispose the spinal cord to a compressive injury were present in only one of the 19 cases. This suggests that, as opposed to direct cord compression, SCC may be the result of an indirect cord injury. Possible mechanisms are discussed.

Adolescent↗

PubMed2001

Acceleration-Deceleration Sport-Related Concussion: The Gravity of It All.

OBJECTIVE: To discuss a newtonian physics model for understanding and calculating acceleration-deceleration forces found in sport-related cerebral concussions and to describe potential applications of this formula, including (1) an attempt to measure the forces applied to the brain during acceleration-deceleration injuries, (2) a method of accruing objective data regarding these forces, and (3) use of these data to predict functional outcome, such as neurocognitive status, recovery curves, and return to play. BACKGROUND: Mild concussion in sports has gained considerable attention in the last decade. Athletic trainers and team physicians have attempted to limit negative outcomes by gaining a better understanding of the mechanisms and severity of mild head injuries and by developing meaningful return-to-play criteria. Mild head injury in sports has become an even greater area of focus and concern, given the negative neurobehavioral outcomes experienced by several recent high-profile professional athletes who sustained repeated concussions. Applying the principles of physics to characterize injury types, injury severity, and outcomes may further our development of better concussion management techniques and prevention strategies. DESCRIPTION: We describe the search for models to explain neuronal injury secondary to concussion and provide an exploratory method for quantifying acceleration-deceleration forces and their relationship to severity of mild head injury. Implications for injury prevention and reduction of morbidity are also considered.

Journal Article↗

PubMed2026

Near and distance vergence facility provides complementary clinical information in concussion-related convergence insufficiency.

PURPOSE: To compare near and distance vergence facility testing in adolescents and young adults with concussion-related convergence insufficiency and evaluate changes following office-based vergence/accommodative therapy (OBVAM). METHODS: This secondary analysis of the CONCUSS randomized clinical trial evaluated vergence facility at near (40 cm) and distance (4 m) using a 12Δ base out/3Δ base in prism flipper. Participants aged 11-25 years with concussion-related convergence insufficiency were randomized to immediate or 6 weeks delayed OBVAM. Vergence facility was assessed at baseline, outcome time 1 assessment (after 12 therapy sessions for the immediate group and 6 weeks of watchful waiting for the delayed group), and outcome time 2 assessment (after both groups completed 16 therapy sessions). Agreement between near and distance vergence facility classifications was evaluated, and treatment-related changes were compared between groups. RESULTS: Of the 106 enrolled participants, 102 completed all study visits. At baseline, the near and distance vergence facility classifications demonstrated substantial discordance. Among 101 participants with both measures available, 49 demonstrated reduced distance vergence facility despite normal near vergence facility, whereas only two showed the opposite pattern (Cohen's κ = 0.12; p < 0.0001). Vergence facility improved following therapy in both treatment groups, with larger early improvements in the immediate-treatment group. CONCLUSIONS: Near and distance vergence facility testing provided complementary rather than interchangeable clinical information in adolescents and young adults with concussion-related convergence insufficiency. Both measures improved following vergence/accommodative therapy, supporting consideration of both testing distances in clinical assessment.

Humans↗

PubMed2004

Visual p300 effects beyond symptoms in concussed college athletes.

In order to assess whether cerebral anomalies may be observed in the absence of clinical symptoms, the current study compared the effects of concussions on attentional capacities (reaction times, accuracy) and Event-Related Potentials (ERPs) in concussed athletes with (n = 10) or without (n = 10) symptoms as well as in athletes who never had a concussion (n = 10). The P300 response was recorded from 28 electrodes during a modified visual oddball paradigm. Participants were instructed to press a key upon the appearance of the frequent stimuli as well as when a rare nontarget stimulus followed the frequent one. The other key was to be pressed when the subsequent rare stimuli (rare target) appeared until a frequent one reappeared. The symptomatic athletes displayed longer reaction times than the other two groups of athletes. The P300 amplitude to the rare target stimuli was significantly more attenuated in the symptomatic athletes than in the other two groups. Moreover, the P300 amplitude varied inversely with the severity of post-concussion symptoms but was not influenced by time elapsed since injury. Although the clinical significance of the P300 differences shown by the symptomatic athletes is still uncertain, the results do indicate that symptom severity may be a crucial indicator of functional impairments following mild traumatic brain injury.

Adult↗

PubMed1991

Concussion in sports. Guidelines for the prevention of catastrophic outcome.

Concussion (defined as a traumatically induced alteration in mental status, not necessarily with loss of consciousness) is a common form of sports-related injury too often dismissed as trivial by physicians, athletic trainers, coaches, sports reporters, and athletes themselves. While head injuries can occur in virtually any form of athletic activity, they occur most frequently in contact sports, such as football, boxing, and martial arts competition, or from high-velocity collisions or falls in basketball, soccer, and ice hockey. The pathophysiology of concussion is less well understood than that of severe head injury, and it has received less attention as a result. We describe a high school football player who died of diffuse brain swelling after repeated concussions without loss of consciousness. Guidelines have been developed to reduce the risk of such serious catastrophic outcomes after concussion in sports.

Adolescent↗