bluuebunny/crossref_metadata_2025_split huggingface dataset:
Botulinum toxin a for adolescents with persisting post-concussion headaches: a case series
Authors: Purtzki Jacqueline , Chan Catherine 
Published: November 2017

ObjectiveTo present safety and tolerability of treating persistent post-concussive headaches with botulinum toxin A (Botox) in adolescents.DesignRetrospective case series.SettingA tertiary rehabilitation hospital interdisciplinary outpatient concussion clinic for adolescents aged 12–18 years.ParticipantsSeven patients ages 15–18 with persistent post-concussion headaches.Interventions1. Comprehensive assessment by an interdisciplinary rehab team. 2. Establishing the diagnosis of chronic daily headache disorder with 15 headaches per month, 8 of them meeting pediatric migraine criteria. Headache treatment included neck exercises, physiotherapy, CBT, mindfulness, oral prophylactic and abortive migraine medications as well as Botox. Patients selected had prolonged debilitating headaches, had failed other treatment options, and/or had specific circumstances precluding use of other treatment options, were unable to attend school, tolerate daily activities. 3. Discussion of potential side effects of Botox, complications of injection, review of current literature evidence. Verbal consent obtained.Clinical monitoring of adverse events of injection, side effects of Botox, effect on daily activities and headaches.Main resultsThere were no adverse events related to the injection of Botox. Some patients experienced a transient flare up of headaches after injection. All patients reported that injections and post-injection side effects were tolerable. Reduction in headaches was variable.ConclusionsBased on this small clinical sample of adolescents with severe persistent post-concussion headaches, Botox appears to be a well-tolerated and safe treatment option. Prospective, RCT studies are required to confirm this preliminary clinical impression.Competing interestsNone.
Efficiency of an active rehabilitation intervention in a slow-to-recover paediatric population following a sport-related concussion
Authors: Fait Phil , Imhoff Sarah , Carrier-Toutant Frédérike , Geneviève Boulard 
Published: November 2017

ObjectiveThe aim of this study was to identify whether the addition of an individualised Active Rehabilitation Intervention to standard care influences recovery of young patients who are slow to recover following a sport-related concussion and remain symptomatic at rest.DesignQuasi-experimental, prospective study Setting: Interdisciplinary private concussion clinicSubjectsFifteen participants aged 15±2 years.InterventionStandard care and an individualised Active Rehabilitation Intervention which included: 1) low- to high-intensity aerobic training; 2) specific coordination exercises; and, 3) balance exercises.Outcome measuresList of symptoms before and after the intervention, duration of symptoms, adherence to the individualised exercice program.ResultsThe Active Rehabilitation Intervention lasted 49 (SD=17 days) days. The duration of the intervention was correlated to self-reported adherence (x=84.64 19.63%, r=−0.792, p<0.001). The average postconcussion symptom inventory (PCSI) score went from a total of 36.85±23.21 points to 4.31±5.04 points after the intervention (Z=−3.18, p=0.001).ConclusionsA progressive sub-maximal Active Rehabilitation Intervention may represent an important asset in the recovery of young patients who are slow to recover following a sport-related concussion.Competing interestsPhil Fait: Co-owner of the Cortex Mdecine et Radaptation clinic Sarah Imhoff, Frdrike Carrier-Toutant, Genevive Boulard: None.
Serum neurofilament light concentration increases following a season of american football
Authors: Wallace Colin , Henrik Zetterberg , Kim Henriksen , Paul van Donkelaar 
Published: November 2017

ObjectiveTo examine neurofilament light (NF-L), a microtubule-associated protein widely regarded to be central nervous system (CNS) specific, concentrations in serum prior to and following a season of contact (American football) and non-contact (cross-country running) in elite, collegiate-aged athletes.DesignProspective cohort.SettingLaboratory.Participants13 male American football athletes (19±1.2 years) and 11 cross-country runners (20±1.9 years).InterventionPre- and post-season blood samples were obtained from all participants and spun at 2000 g for 10 minutes to extract serum. NF-L was detected through the isolation of individual immunocomplexes on pragmatic beads using standard ELISA reagents. The beads were then trapped in single-molecule, femtolitre-sized wells, allowing for a digital readout of each individual bead. The digital nature of this technique allows an average of 1000x sensitivity increase over conventional assays.Outcome measuresAnalysis of pre- and post-season serum samples provide NF-L concentrations.ResultsSerum samples from American football players showed a significant increase (p=0.04) from pre-season NF-L serum concentrations (95% CI: 6.51 – 9.19 pg/mL) to post-season (95% CI: 7.08 – 11.70 pg/mL). Serum NF-L concentrations in cross-country runners showed no change (p=0.57) from pre-season (95% CI: 5.05 – 6.94 pg/mL) to post-season (95% CI: 5.05 – 6.88 pg/mL).ConclusionsExperiencing repetitive subconcussive head-trauma throughout a season of American football elevates serum NF-L concentrations. This finding indicates multiple head-impacts may lead to CNS axonal damage.Competing interestsNone.
Spinal control is related to concussion in professional footballers
Authors: Leung Felix , Hides Julie A , Franettovich Smith Melinda M , Mendis Dilani M , Smith Nigel A , Cooper Andrew J , Treleaven Julia , Choy Nancy Low 
Published: November 2017

ObjectiveTo examine whether physical measurements of the sensorimotor system predict concussion incurred by footballers.DesignProspective cohort study.SettingAustralian professional sport setting.ParticipantsFifty-three rugby union and rugby league players.Assessment of risk factorsPhysical measurements including balance (sway across six test conditions), vestibular function (assessments of oculo-motor and vestibular ocular reflex) and spinal control (cervical joint position error and trunk muscle size and contraction ability) were performed during the preseason.Outcome measuresConcussion injuries during the season were diagnosed and recorded by club medical staff.ResultsAge, height, weight, and years playing football were not associated with concussion in the season (p=0.43, 0.43, 0.19, 0.25). Preseason cross-sectional area of the multifidus muscle at the L5 vertebral level was 10% smaller in players who went on to sustain a season concussion compared to those who did not: mean difference (95% confidence interval) 1.0 cm2(0.1 cm2to 1.9 cm2), p=0.031. This difference in size was moderate (effect size 0.7) and exceeds the minimal detectable change of 0.4 cm2. There were no significant differences observed for the other measures, p>0.05.ConclusionsOptimal spinal control is likely to be a key requirement in a physically demanding sport such as football. The multifidus is one of the muscles crucial for spinal control, and our findings report this measure to be predictive of footballers sustaining a concussion. This novel finding provides preliminary evidence that warrants further investigation as to the possible importance of spinal control in prevention programsCompeting interestsNone.
Association between concussion history and knowledge among italian youth soccer athletes
Authors: Filali Naji , McLeod Tamara Valovich , Bacon Cailee Welch , Bellini Gianandrea , Amaddeo Paolo , Cornali Claudio 
Published: November 2017

ObjectiveTo compare concussion-based knowledge between Italian youth soccer athletes who reported a previously diagnosed concussion or concussion-like symptoms and those without prior concussion history.DesignCross sectional.SettingSelf-reported survey.SubjectsMale soccer athletes (n=766, age=16.9 ± 1.3 years, experience=6.6 ± 3.9 years) from 25 club teams across three professional leagues in Italy.InterventionThe independent variables studied were diagnosed concussion group (prior diagnosed concussion vs. no diagnosed concussion) and self-reported concussion symptom group (experienced concussion-like symptoms vs. no concussion-like symptoms).Outcome measuresThe dependent variables were total knowledge scores, measured through accurate endorsement of symptoms and responses to true and false prompts. Independent t-tests were used to determine group differences.Results45 (6%) respondents indicated they sustained a physician-diagnosed concussion. The mean number of diagnosed concussions was 0.065±0.3 (range 0–3). 198 (26.2%) respondents indicated they had experienced concussion-like symptoms. The mean frequency of self-reported concussion-like symptoms was 0.54±1.3 (range: 0–15). There were no significant differences in concussion symptom knowledge (P=0.616, 13.9±2.0 vs. 14.1±2.2) or true and false knowledge (P=0.390, 10.7±1.8 vs. 10.4±1.7) between the group with a previously diagnosed concussion compared to the one without. There were also no significant differences in concussion symptom knowledge (P=0.499, 14.2±2.1 vs 14.1±2.2) or true and false knowledge (P=0.256, 10.5±1.6 vs. 10.4±1.8) between the group that had experienced concussion-like symptoms compared to the group that had not.ConclusionsThese results suggest the necessity for targeted knowledge-based interventions for youth athletes, especially for those who sustain and report concussions.Competing interestsNone.
Circulating microrna as novel early biomarker of concussion in elite athletes
Authors: SU Zhangjie , Di pietro Valentina , Davies David , Wang Michael , Evans Shaun , Hill Lisa , Grey Michael , Belli Antonio 
Published: November 2017

ObjectiveThis study aims to investigate the role of microRNAs in early and late assessments of concussed athletes. Our hypothesis is that expression of certain microRNAs is altered following concussion, and these microRNAs have the potential to become novel biomarkers for early detection and monitoring of concussion.DesignProspective observational case control study.SettingUniversity research centre, single centre.Participants15 concussed athletes divided into 2 groups: Group A (n=9, assessed within a week post-concussion, median 4 days) and B (n=6, assessed over 2 weeks, median 31 days); and 8 age-matched healthy volunteers. Inclusion criteria: male/female elite athletes in contact sports (aged 18-40) who suffered concussion(s) in the games, and being symptomatic with normal neuro-radiological findings at enrolment.Outcome measuresLevels of microRNAs (miR-21, miR-335, miR-425-5p, and miR-502) were measured in blood samples obtained from all participants.Main resultsmiR425-5p was significantly down-regulated in Group A compared with Group B and healthy volunteers (grouping effect p=0.014; post hoc tests p=0.009 and 0.028, respectively). The level of miR425-5p correlated with the interval between assessment and concussion (r2=0.88, p<0.001). No differences were found in other microRNA assessed between the groups.ConclusionsmiR-425-5p is down-regulated in the early phase following sport concussion, and reaches normal levels in the late period, suggesting that it may be a unique microRNA signature for concussion. This makes miR-435-5p a promising candidate biomarker for early evaluation of concussion and monitoring of its recovery. Further longitudinal studies are on-going to establish the time course of miR-425-5p normalisation after concussion.Competing interestsNone.Abstract 5 Figure 1
Concussion and mild traumatic brain injury (mtbi): towards a better integration of the two constructs
Authors: Frémont Pierre , Truchon Catherine 
Published: November 2017

ObjectiveTo analyse the potential ways to reunite the mTBI and concussion constructs in order to harmonise screening, diagnosis and management.DesignNarrative review.SettingIn Quebec, the initial management of concussions sustained in a sport or school-based setting falls under the authority of the Ministry of education and sports whereas the Ministry of health governs the clinical management of mTBI. The recent work of a task force on concussions in Quebec has emphasised the need to achieve a unified understanding and operationalization of the two constructs so that persons affected receive consistent information and care.Main resultsSport and school-based concussion management is generally based on the Concussion In Sport Group definition whereas the Quebec health care system relies on the 5 diagnostic criteria proposed by the WHO task force in 2004. Although the 5 classification criteria of mTBI include normal values, the actual definition requires the presence of one or more abnormal criteria. In a public health care system, such a definition structures access to limited public resources. However unfavourable evolution can occur in the absence of phenomena such as LOC or PTA. Yet these cases represent a potentially serious health condition if proper identification and management is not initiated.ConclusionSo far, sport, education and health care stakeholders in Quebec have agreed that the constructs of concussion and TBI must be revisited and better integrated. This process raises challenges and opportunities in terms of operationalization and management. Studies on prognostic indicators should guide this analysis.ConclusionCompeting interests Pierre Frémont is chair of the Canadian Concussion Collaborative.None.
Effect of a history of 3+ previous concussions on centre of pressure variables during quiet stance
Authors: Dierijck Jill K , Wright Alexander D , Bryk Kelsey , Smirl Jonathan D , Donkelaar Paul van 
Published: November 2017

ObjectiveTo determine the influence of a history of 3+ previous concussions on quiet stance.DesignRetrospective cohort.SettingLaboratory.ParticipantsEighty-seven male (age range 17–22) contact-sport athletes (football and hockey) entered the study. Participants were recruited from the same sport teams and tested during the pre-season. Exclusion criteria: concussion in the prior 6 months, or history of 1 or 2 concussions. Forty-four met the inclusion criteria: thirty-one had no previous concussions, and thirteen had a history of 3+ concussions.InterventionsParticipants held quiet upright stance on a force plate (NDI True Impulse) with feet hip-width apart and hands on hips with eyes-open (1 min), and closed (1 min). Independent variables included condition (2) and concussion history (2).Outcome measuresRoot-mean-square displacement (RMSd), and mean velocity of centre-of-pressure (COP) in the anterior/posterior (AP) and medial/lateral (ML) directions.Main resultsMixed ANOVA indicated a significant condition effect in ML-RMSd (p=0.015, 95% CI: 0.032–0.277) between eyes-open and eyes-closed conditions. ML mean velocity also displayed a significant condition effect (p=0.025, 95% CI: 0.025–0.358). In contrast to the effect of visual input, there was no main effect of concussion history on these metrics.ConclusionsA history of 3+ concussions does not appear to result in long-term deficits controlling in quiet stance. Those ML variables were sensitive to condition and indicate that frontal plane COP movements may be more sensitive than those in the sagittal plane. These findings are important as a history of concussion does not appear to alter quiet stance balance control mechanisms.Competing interestsNone.
Interrelationships among neuroimaging biomarkers, neuropsychological test data, and symptom reporting in a cohort of retired national football league (nfl) players
Authors: Zuckerman Scott L , Kuhn Andrew W , Solomon Gary S , Sills Allen K , Casson Ira R 
Published: November 2017

ObjectiveTo assess interrelationships among neuroimaging findings with neurocognitive test performance and symptom endorsement in a cohort of retired professional (NFL) football players.DesignProspective cohort study.SettingNeurology clinic.ParticipantsForty-five retired NFL players.InterventionMRI scan assessment of cavum septum pellucidi, global mean score of Fractional Anisotropy (FA), and microhemorrhages.Outcome measuresNine neuropsychological tests and multiple symptom and depression scores. Associations among the three independent neuroimaging results with these outcome measures were assessed utilising Pearson’s, Spearman’s Rank, and Point-Biserial Correlations.ResultsThe retirees reported an average of 6.9 (±6.2) concussions and 13.0 (±7.9) sport-related “dings” in the NFL. Assessment of cavum septum pellucidum yielded a negative finding in 10 subjects (22%), while 32 (71%) had a small, and 3 (7%) had a large one. Four (9%) of the subjects had microhemorrhages present and average FA mean was 0.459 (±0.035). Number of sport-related “dings” was correlated with an increased risk of microhemorrhages (r=0.305, p=0.042). The majority (50.8%) of the correlations obtained among the three neuroimaging parameters and the neurocognitive/symptom scores were below the threshold of a “small” effect size (r<0.10). The remaining (49.2%) correlations fell somewhere between “small” and “medium” effect sizes (0.1< r<0.3). However, all correlations were statistically non-significant.ConclusionsThe current results demonstrate minimal and statistically non-significant correlations among neuroimaging, neurocognitive, and symptom scores examined in a cohort of NFL retirees. While an often-accepted paradigm, certain neuroimaging findings may not relate consistently and directly with neurocognitive test performance and clinical symptom burden.Competing interestsNone.GS Solomon receives consulting fees from the Tennessee Titans (NFL), the Nashville Predators (NHL), and the athletic departments of several universities; all fees paid to institution. In addition he is a member of the ImPACT Scientific Advisory Board and receives reimbursement for expenses to board meetingsAK Sills is a consulting physician to the Nashville Predators (uncompensated) and also serves as an unaffiliated neurotrauma consultant for the NFLExaminations of the NFL retirees were sponsored by the National Football League (NFL) and coordinated with the NFL Players Association (NFLPA). IR Casson served as a member of the NFL MTBI Committee from 1994-2009 and as a co-chair from 2007-2009. He has done consulting for law firms and insurance companies.
Higher head accelerations observed in female athletes than in male athletes across age
Authors: Caccese Jaclyn B , Buckley Thomas A , Tierney Ryan T , Rose William C , Arbogast Kristy B , Glutting Joseph J , Kaminski Thomas W 
Published: November 2017

ObjectiveTo compare linear and rotational acceleration across age and gender in controlled purposeful soccer heading.DesignProspective study.SettingBiomechanics laboratory.ParticipantsOne-hundred soccer players (42 male, 58 female, 17.1±3.5 years, 168.5±20.3 cm, 61.5±13.7 kg) classified as collegiate, high school (HS), or youth (12–14 years) male (MS) or female (FS) soccer players.Exclusionary criteriahistory of neurologic disorder, cervical spine injury, or head injury in the past 6 months.InterventionsWe implemented a unique soccer heading paradigm that allows for precise control of head impact magnitude, direction, and frequency to model repetitive head impacts in sport. This model consists of controlled soccer heading (12 headers at 11.2 m/s from a JUGS machine) while measuring linear and rotational accelerations using a triaxial accelerometer and gyroscope affixed to the back of the head. Linear accelerations were transformed to the head center-of-gravity using 3D motion capture data and standard rigid body dynamics equations.Outcome measuresLinear and rotational accelerations at the head center-of-gravity.Main results[Average±Standard Deviation (95% Confidence Interval)] Collegiate [42.4±11.5 g (36.8–47.9); 3.35±0.87 krad/s2(2.9–3.8)], HS [38.5±13.1 g (32.2–44.8); 3.16±1.01 krad/s2(2.7–3.7)], and youth [40.5±14.9 g(33.1–47.9); 3.20±1.24 krad/s2(2.6–3.8)] FS produced higher linear and rotational accelerations than both the collegiate [26.1±9.5 g(21.7–30.6); 2.13±1.07 krad/s2(1.6–2.6)] (linear: p<0.001, p?= 0.012, p=0.002; rotational: p=0.002, p=0.015, p=0.011, respectively) and HS [26.7±5.9 g(23.2–30.1); 2.18±0.40 krad/s2(2.0–2.4)] (linear: p=0.002, p=0.045, p?= 0.012; rotational: p=0.011, p=0.052, p=0.040, respectively) MS.ConclusionsCollegiate and HS FS have higher head accelerations than their male counterparts, but at the youth level, there are no differences across gender. These data suggest that FS may be exposed to greater cumulative head accelerations from repeated heading of a soccer ball over a career than MS.Competing interestsNone.
Neurovascular coupling response is maintained despite exposure to repetitive sub-concussive head trauma over the course of one contact-sport season
Authors: Smirl Jonathan D , Wright Alexander D , Bouilane Kevin , Bryk Kelsey , Jakovac Michael , Donkelaar Paul van 
Published: November 2017

ObjectiveTo examine how head-impact exposures affect the elevation in cerebral blood velocity (CBV) in the posterior cerebral artery (PCA) during visual tasks.DesignProspective Cohort.SettingLaboratory.ParticipantsTo date: 40 male contact-sport athletes (19.4±1.2 years) and 3 cross-country athletes (20.0±1.0 years) have completed testing (non-contact controls).InterventionTranscranial Doppler ultrasound indexed PCA CBV during visual tasks. Participants closed their eyes (20-seconds), and when prompted, opened them and completed a visual task (40-seconds). Testing occurred prior-to and upon-completion-of the competitive athletic season. Raw traces from each trial were averaged to enhance the signal-to-noise ratio of outcome measurements. Independent variable tested was time (2).OutcomeEyes-closed CBV (cm/s), peak elevation in CBV (cm/s), relative change in CBV (%) and total activation during the first 30 seconds of the task (indexed via area under the curve-AUC). Head-impact exposure was characterised in a subset of contact-sport athletes (n=29) using the xPatch (X2 Biosystems).Main resultsRM-ANOVA indicated the contact-sport season had no effects on any outcome metrics: Eyes-closed CBV (p=0.181), peak CBV (p=0.117),% CBV elevation (p=0.252) and AUC (p=0.366), despite experiencing cumulative peak linear accelerations of 8147.2±6215.5g, and cumulative peak rotational accelerations of 34.5×106± 59.0×106rad/?s2.ConclusionsThe results from this study suggest neurovascular coupling metrics are maintained throughout a contact-sport season. This indicates nutrient delivery is maintained for neurocognitive challenges despite possible impairments in cerebrovasculature’s ability to buffer blood pressure challenges associated elevations in rotational accelerations experienced during a contact-sport season.Competing interestsNone.