bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of multiple sub-concussive blows on brain structural and functional integrity: combined virtual reality and neuroimaging study
Authors: Slobounov Semyon , Sebastianelli Wayne 
Published: March 2013

ObjectiveTo determine the differential sensitivity of subjects, with and without prior history of concussion, towards multiple sub-concussive impacts. We hypothesised that previous concussions may increase the athletes' vulnerability to repetitive blows leading to brain metabolic, structural and/or functional compromised integrity.DesignA set of Virtual Reality (VR) tests and MRI scans (fMRI, DTI, MRS) before and within 3 h after a competition was implemented. The number and type of sub-concussive blows was documented via observational charts incorporated with reconstruction of impacts captured on video.SettingSubjects were recruited from Penn State collegiate football and rugby teams.Subjects12 football and rugby players (with n=6 and without n=6 history of concussion) often experiencing multiple blows during practices and games were recruited for this study.Outcome MeasuresSpatial working memory, balance, and speed of information processing were assessed by VR testing using Head Mounted Display. Brain metabolic profile (MRS NAA/Cho; NAA/CR of the corpus callosum), functional connectivity (DMN during rs-fMRI) and white matter tracks integrity (DTI, FA) were the primary neuroimaging measures.ResultsWe observed decreased interhemispheric functional connectivity (rs-fMRI, left-right hippocampus; r=0.82/0.55), reduced FA (DTI in Genu, 0.7/0.4), and reduced NAA/Cho ratio (MRS measures) at frontal (2.21/1.72) ROI after the competition only in subjects with prior history of concussion. These subjects also experienced deficient balance and spatial memory problems assessed by VR.ConclusionsThis study provides a solid foundation to begin improving the current understanding of the neural substrate(s) differential response(s) to sub-concussive blows occurring in athletics.Competing interestsNone.
Do family physicans, emergency physicians and paediatricians give consistent sport-related concussion management advice?
Authors: Stoller Jacqueline , Carson James , Purcell Laura , Davidson Bruce , Garel Alisha , Bell Margaret , Snow Catherine , Law Marcus 
Published: March 2013

ObjectiveTo identify differences and gaps in the recommendations to patients for the management of sport-related concussion among family physicians (FPs), emergency physicians (ERs) and paediatricians (Peds).DesignA self-administered multiple-choice survey, which had been validated for content validity.SettingToronto East General Hospital and Markham Stouffville Hospital, both in Ontario, Canada.Subjects270 physicians were invited to participate; 104 surveys were completed (39%).InterventionThe survey link was emailed to FPs, ERs and Peds from the above hospitals. Data were analysed using SPSS. Frequencies and percentages were calculated with cross-tabulation of data by specialty.Outcome MeasuresKey survey questions identified sources of concussion management information, usefulness of concussion diagnosis strategies, and whether physicians use common terminology when explaining cognitive rest strategies to patients after a sport-related concussion.ResultsFor making a diagnosis of concussion, 54% of FPs, 86% of ERs and 78% of Peds never used the SCAT2; 49% of FPs, 57% of ERs and 36% of Peds always advised cognitive rest, the mainstay of early management for post-concussion symptoms; 65% of FPs, 71% of ERs and 55% of Peds always advised physical rest; and 49% of FPs, 52% of ERs and 27% of Peds reported no knowledge of any consensus statements on concussion in sport.ConclusionsWe identified large gaps in the implementation of recommendations for sport-related concussion patients. Although some physicians are recommending physical and cognitive rest, a large proportion fail to consistently advise this strategy. Better knowledge translation efforts should target all three groups of physicians.AcknowledgementsThank you to Babak Aliarzadeh for the statistical analysis. Special thanks go to Paul Krueger, Leigh Hayden and the other 18 participants in the validation of our survey.Competing interestsNone.
Academic accommodation for post concussion student athletes: can physicians do better?
Authors: Carson James , Snow Catherine , Lawrence David , Kraft Sari , Chatterjee Ananda , MacKenzie Heather , Moineddin Rahim , Frémont Pierre 
Published: March 2013

ObjectiveTo determine the barriers and facilitators to the implementation of concussion related medical recommendations in a sport and school environment.DesignRetrospective longitudinal chart review and structured telephone interviews.SettingA sport medicine physician's office in Ontario, Canada.Subjects159 students with a sport-related concussion.InterventionThe data collection involved a review of 170 charts of patients seen for concussion over a 5-year period (2006–2010). Two blinded authors independently reviewed each chart and SCAT or SCAT2 symptom self report form. In situations where there was discrepancy between the two reviewers results, a third author reviewed the charts. The telephone interviews supported the data collection.Outcome MeasuresOur primary outcome measures were (1) whether the patient returned to their sport too soon, or before they had fully recovered, and (2) whether the patient returned to school too soon, or before they had adequately recovered. The phone interview was structured to collect outcome measures providing insight into the patients' post-concussion course and recovery process. This will assist in determining what factors they believe improved their condition, or what slowed the recovery process.ResultsIn terms of the primary outcomes, 43.53% of students returned to sport too soon and 44.71% returned to school too soon.ConclusionsCurrently, physicians advise restricted mental and physical activity, but no clear guideline exists explaining exactly what cognitive rest entails for post-concussion student athletes. Efforts are needed to find the best method of implementing a coordinated plan for the post-concussion athlete who is returning to school.Competing interestsNone.
Diffusion tensor and susceptibility-weighted imaging in concussion assessment of national football league players
Authors: Luther Neal , Niogi Sumit , Kutner Kenneth , Rodeo Scott , Shetty Teena , Warren Russell , Weiss Leigh , Barnes Ronnie , Zimmerman Robert , Tsiouris Apostolos , Hartl Roger 
Published: March 2013

IntroductionStandard MRI is normal following the vast majority of concussions. Diffusion tensor imaging (DTI) and susceptibility-weighted imaging (SWI) are advanced MRI techniques hypothesized to be more sensitive in detecting subtle evidence of structural brain injury. Using DTI and SWI in National Football League (NFL) players, we aim to elucidate and localise the presence of such injury following concussions.MethodsThis ongoing prospective study has recruited active NFL players with and without history of concussion within 6 months prior to entry. Neurological and neurocognitive examination, DTI, and SWI were performed on each subject. Blinded neuroradiologists performed radiographic analysis. Fractional anisotropy (FA) values were measured for 11 distinct white matter tracts on DTI. A global FA value was calculated. SWI was utilised to assess for microhemorrhage. Statistical comparisons between players with and without recent concussion, and to civilian controls, were made.ResultsSeven of eighteen evaluated players to date had a concussion within 6 months of entry. On DTI, of the 11 tracts evaluated, a significant decrease in FA for concussed players was seen in one tract. There was no significant difference in global FA assessment between players with and without recent concussions. Civilian control comparisons are ongoing. SWI was negative in all players.ConclusionsTo our knowledge this is the largest prospective brain imaging study, and the first utilising DTI and SWI to assess anatomical injury secondary to concussion, in NFL players. Minimal changes have been observed in players with recent concussion. The clinical significance of these findings remains under investigation.Learning ObjectivesBy the conclusion of the session, participants should be able to (1) understand the role of DTI and SWI in the evaluation of mild traumatic brain injury (2) discuss to what degree long-term football play poses risk in terms of structural brain injury.ReferencesConcussion, football, MRI, NFL.How will your Research Improve Patient CareThere is no reliable objective test to evaluate the severity of brain injury suffered secondary to concussion, and concussion is a growing area of concern in football and other contact sports. This study evaluates to what degree brain injury as detected by highly sensitive MR technologies (DTI and SWI) is suffered by those who have had long-term, high-level participation in football and now play at the professional level. Information from this study could play an important role in establishing neurological risks of football.
Effects of exercise on symptoms, cognitive and motor performance tasks using the sport concussion assessment tool (SCAT2) in healthy young adults and children
Authors: Boutros Nour , Norcia Mary Catherine , Sammouda Jamila , Tran Chi-Lan , Pearson Isabelle , Gagnon Isabelle 
Published: March 2013

ObjectiveTo document the effect of high intensity exercise on the Sport Concussion Assessment Tool 2 (SCAT2) scores in healthy young adults and children.DesignRepeated measures design.SettingMcGill University Athletics Department (adults) and Elementary School in the Montreal area (children).ParticipantsSeventy six healthy young adults (45 women and 31 men, mean age 22.5±1.9 years) and 13 children (6 girls and 7 boys, mean age 10.7±0.4 years) participated in this study.InterventionParticipants performed the Léger Test, a maximal multistage 20 m shuttle run test, to their perceived volitional exhaustion.Main Outcome MeasurementsThe SCAT2 was used to evaluate participants at rest, 2 min and 25 min post-exercise.ResultsIn adults, total SCAT2 scores were significantly decreased immediately after high intensity exercise (p<0.001) and returned to baseline after the allocated rest period (p=0.350). Individual components of the SCAT2 also reflected this for symptom severity (p<0.001), and total balance score (p<0.001). High intensity exercise had no effect on delayed recall memory (p=0.242). Children in our small sample revealed a tendency for a similar impact of high intensity exercise on SCAT2 scores although statistical significance was not reached.ConclusionsHigh intensity exercise, such as that achieved during a sporting event, has an impact on aspects of functioning assessed by the SCAT2.Clinical RelevanceIn order to eliminate the effects of exercise when testing individuals on the field immediately post-injury, professionals should allow for proper rest before using the SCAT2.AcknowledgementsParticipants and their families, Gardenview Elementary School for allowing testing within their institutions, Fonds de recherche du Québec-Santé, School of Physical and Occupational Therapy McGill University.Competing interestsNone.
Persistent differences in patterns of brain activation after sports- related concussion: a longitudinal fMRI study
Authors: Dettwiler Annegret , Murugavel Murali , Putukian Margot , Echemendia Ruben , Cubon Valerie , Furtado John , Osherson Daniel 
Published: March 2013

ObjectiveTo define neural correlates of SRC during the 2 month post-injury period using a working memory (WM) task and fMRI and correlate these to clinical measures.DesignLongitudinal fMRI study assessing subject's brain activation as they perform a N-back task (N=1 to 3) consisting of 30 randomised blocks.SettingVarsity collegiate athletes were recruited from high-risk sports teams. Images were acquired on a 3T Siemens Skyra scanner.SubjectsAll athletes were evaluated prospectively within 48 h, 2, 8 weeks postinjury on SCAT2 and hybrid NP battery (ImPACT, paper and pencil tests). 15 right-handed, varsity contact sport athletes who sustained a SRC were scanned at 72 h, 2 and 8 weeks post injury. 15 uninjured control athletes were scanned at baseline and 2 weeks.Outcome MeasuresPost-hoc, whole brain t tests of the 2–1 contrast were performed using FSL-FEAT (mixed effects modelling, z>2.3, corrected p=0.05).ResultsAcross all 3 sessions, concussed athletes demonstrated significantly increased activation in the right dorsolateral prefrontal cortex (DLPFC). In session 1, concussed subjects demonstrated increased activation in additional areas: left DLPFC and bilateral inferior parietal. In all 3 sessions, no significant between group differences were observed in subjects performance for all 3 N-back task conditions.ConclusionsFunctional brain activation differences persist at 8 weeks post injury in concussed athletes, despite the fact that their performance on a WM task is comparable to normal controls and normalisation of clinical/hybrid NP tests. These results might indicate a delay between neural and behaviorally-assessed recovery.AcknowledgementsThis research was supported by NJBIR Grant 10-3217-BIR-E-0 AMSSM Grant 005548 Goldstein Family Fund.
Another look at active rehabilitation for slow-to-recover sport-related concussion in children and adolescents: further evidence to support its effectiveness
Authors: Gagnon Isabelle 
Published: March 2013

ObjectiveTo explore and impact of a previously developed active rehabilitation intervention for children who are slow-to-recover after concussion.DesignProspective repeated measures design.SettingThe Montreal Children's Hospital Concussion Clinic.ParticipantsTen children (three girls and seven boys, mean age 14.4±1.3 years) participated in this study.InterventionParticipants who were still symptomatic 4 weeks after the injury were involved in the active rehabilitation intervention (mean time since injury=47 days). It involves gradual, closely monitored light aerobic exercise, general coordination exercises, mental imagery, as well as reassurance and stress/anxiety reduction strategies. The program continued until complete symptom resolution at rest, at which time children and adolescents were eligible to resume the standard return to sports protocol.Main Outcome MeasurementsPrimary outcome was evolution of post-concussion symptoms. Secondary outcomes included mood and energy level as well as balance and cognitive function. Those were assessed at initiation and at the end of the rehabilitation.ResultsChange in functioning was found in all domains assessed including Symptoms, Balance, Fatigue and Depressive Symptoms. Cognitive function was within normal limits at the initiation of the intervention and remained unchanged. Average duration of the intervention was 45 days (range 14–72 days).ConclusionsAlthough no control group was used in this pilot study, children's functioning is improved after participation in the active rehabilitation intervention.Clinical RelevanceThe introduction of graded light intensity exercise in the post-acute period post-concussion is feasible and appears to have benefits on children's functioning.AcknowledgementsParticipants and their families, Trauma Programs of the Montreal Children's Hospital-McGill University Health Center, Fonds de la recherche du Québec-Santé; Réseau provincial de recherche en adaptation-réadaptation.Competing interestsNone.
Concussion education and awareness support group: the value of a pilot clinical program as an essential Knowledge Transfer and Exchange (KTE) strategy
Authors: Provvidenza Christine , Kissick James , Purcell Laura , Johnston Karen 
Published: March 2013

ObjectiveTo pilot test a concussion education and support workshop as a Knowledge Transfer and Exchange (KTE) intervention for enhancing knowledge and education post-concussion.DesignProspective, pre-post design to pilot test a KTE intervention.SettingSport Concussion Clinic patients and their parents.SubjectsFive concussed athletes (4 males; 1 female) ages 10–39 years (mean=29±10 years) and their parents (N=4).InterventionAn education presentation based on 2008 Concussion in Sport Meeting content (Zurich, Switzerland) consisting of case studies, discussion questions and a workbook.Outcome MeasuresA survey was designed to examine baseline and changes in concussion knowledge and attitudes, and was administered pre and post intervention. A workshop evaluation assessed preferred learning methods and workshop satisfaction.ResultsKnowledge improvements regarding the return-to-play protocol (RTP; 22%), when to RTP (11%) and start rehabilitation (45%) were seen. Knowledge gaps were associated with the role of CT/MRI and protective equipment. Athletes acknowledged the seriousness of concussion and felt relief that they were not alone. The workshop was considered a successful form of peer support for the athletes and overall support for the parents.ConclusionsThis intervention is a potentially effective KTE strategy for optimising concussion knowledge and education post-injury, and providing support throughout the concussion recovery process. Participants indicated they wanted to learn more about recovery techniques and coping, and would like to receive information electronically. The limited sample size reinforces the need to continue examining the role of such workshops using a larger group design. Establishing online peer support and education workshops in a webinar format would be an appropriate next step.AcknowledgementsAlternative Funding Program Innovation Funds, Ontario Ministry of Health and Long-Term Care.Competing interestsNone.
A sample of headache incidence in post concussive patients
Authors: Ouchterlony Donna , Johnson Patricia , Wong Amy , Michalak Alicja , Topolovec-Vranic Jane , Masanic Cheryl , Waseem Zeesham 
Published: March 2013

ObjectiveHeadache is one of the most common and debilitating symptoms after traumatic brain injury (TBI) and may persist months to years after the initial injury. The purpose of this pilot project was to determine the incidence and characteristics of headaches within the TBI population.DesignDescriptive study.SettingData were collected from an out-patient clinic specialising in the management of TBI.Participants42 patients (24 male, 18 female) with headache symptoms.InterventionTreating physicians collected data on only one appointment for each patient. Of the 160 patients visiting the clinic in May 2012, 30% complained of headaches. Headache symptoms were defined by the International Headache Society Classification ICHD-II criteria.Outcome MeasuresMeasures relating to gender, time since head injury, type of headache, severity of headache, frequency of headaches, location of headache and current medication were recorded.ResultsFifty-seven percent of the population was male. Almost 40% of patients had sustained a head injury over a year prior to data collection. Half of the subjects suffered from tension-type headaches, 14% of patients from migraines, and 7% from both migraine and tension-type headaches. One third reported headaches to occur on a daily basis and 81% percent suffered from headaches that were at least moderate in severity. Thirty-six percent of patients were taking either Advil or Tylenol at the time of data collection.ConclusionsThe pilot data confirmed clinical belief of the necessity to conduct large-scale trials to implement and evaluate interventions for the management of headaches in the TBI population.Competing interestsNone.
Acute clinical signs and outcome of concussion in National Hockey League (NHL) players
Authors: Comper Paul , Hutchison Michael 
Published: March 2013

ObjectivesTo describe and quantify the acute clinical signs of concussion in National Hockey League (NHL) players.SettingNational Hockey League (NHL).DesignProspective case series of concussions over a 5 year period of regular season NHL games (2006–2011).SubjectsDigital video images of 341 NHL players diagnosed with concussions.Outcome MeasuresPrimary outcome measures were mechanism of contact (direct vs indirect trauma), observable acute clinical signs (eg, disorientation, loss of consciousness, balance difficulties, ‘slow to get up’), and time loss that is, time between the injury and medical clearance by the physician to return to competitive play).ResultsApproximately 20% of players diagnosed with concussions showed no on-ice clinical signs. Most frequent on-ice clinical signs were: (1) slow to get up; (2) clutching of the head/helmet; and (3) disorientation/dazed. The number of players with observable on-ice clinical signs, particularly for those who either sustained ‘Possible/Probable Loss of Consciousness’ declined following the 2009 season. None of the clinical signs predicted poor outcome (eg, greater than 21 days of time loss).ConclusionsConcussion can produce a spectrum of acute on-ice clinical signs. Most commonly observed with the 5 year sample of NHL players were ‘slow to get up’, ‘clutching of the head/helmet’, and ‘disorientation/dazed’. Length of time to recovery was not predicted on the basis of acute observable signs.Competing interestsOne of the authors (PC) is a paid consultant for the National Hockey League Players' Association (NHLPA).
The University of Toronto Concussion Symptom Scale: do initial symptoms predict outcome?
Authors: Richards Doug , Hutchison Michael , Ekhtiari Seper , Comper Paul 
Published: March 2013

ObjectiveTo explore symptoms during initial physician evaluation and time to return-to-play experienced by university level athletes.DesignProspective case series of concussions during three athletic seasons (2009–2012).SettingUniversity of Toronto, Ontario, Canada.SubjectsAthletes who sustained concussions while involved in inter-university sports (practice or competition) in the following sports: volleyball, fencing, rugby, basketball, track, hockey, soccer, cheerleading, football, lacrosse, field hockey, and figure skating. A total of 85 concussions were reported from 68 athletes (37 males, 31 females)InterventionDavid L. Macintosh Sport Medicine Clinic physicians documented athletes' post-concussion symptoms and recorded the date when a player was medically cleared to return to play.Main Outcome MeasuresSymptoms as measured by the University of Toronto Concussion Symptom Scale (UTCSS) scores, time loss from competition, loss of consciousness, amnesia, and history of concussion.Results90.6% of athletes reported at least one symptom on the UTCSS at the first office-visit, with somatic symptoms most frequently reported. The average UTCSS score at 3 days following injury was 13.1 (range, 0–51), with female athletes reporting significantly more symptoms than males (p<0.01). Time loss was not significantly different between males and females. The only factor that predicted poor outcome (>14 days out) was endorsement of cognitive symptoms of the UTCSS (OR 1.30, 95% CI 1.03 to 1.68).ConclusionsFemale athletes reported significantly more symptoms than male athletes following concussion. Cognitive symptoms of the UTCSS were significant predictors of time loss among university level athletes.AcknowledgementsThe authors wish to acknowledge the David L. Macintosh Sport Medicine Clinic, The University of Toronto Varsity Blues athletes, therapists, and support staff.Competing interestsNone.