The Clinical Utility of a Novel Multi-Modal Assessment Battery for Acute Sport-Related Concussion
Creators: name: Bertagnolli, Jalena Ashley
Publisher: name: Graduate Studies
Year: 2024
Subjects: subject: Concussion
subject: Sport-Related Concussion
subject: EEG
subject: Balance
subject: Exercise
subject: Autonomic Nervous System
subject: Neuroscience

description: Objective: To determine the clinical utility of a novel, multimodal, assessment battery in detecting acute post-concussion impairment relative to baseline performance. Study Design: Prospective observational cohort study. Subjects: Four hundred thirty-one elite ice hockey, alpine and freestyle ski, artistic swimming and luge athletes (mean age: 15.7 years (range: 14-36 years), male: 349, female: 82) over one athletic season (2022-2023). Observation Technique: Standardized multimodal baseline assessments including electroencephalography (EEG) utilizing the NeuroCatch® 1.0 device, postural sway using the tri-axial accelerometer Protxx® device, cardiovascular exercise from a bicycle ergometer and sustained handgrip strength were completed in the pre-season and then repeated for any athlete sustaining a sport-related concussion within seven days of injury. Outcome Measures: Directional bootstrap paired t-tests and binomial tests adjusting for multiplicity using Bonferroni correction were used to assess changes in performance between baseline and post-concussion test results for the following four primary assessments of interest: 1) quantitative EEG event-related potentials (N100, P300, and N400 amplitude and latency) (NeuroCatch), 2) quantitative assessment of postural sway with eyes open and eyes closed using a physiological vibration acceleration (phybrata) sensor (Protxx), 3) concussion symptom exacerbation (≥1 on a 10-point visual analogue rating scale) during a submaximal bicycle ergometer assessment, and 4) change in heart rate during a 30-second, 30% maximal handgrip strength contraction. Results: Forty-six athletes were diagnosed with a concussion by a sport medicine physician during the study period. Neither amplitude nor latency for N100, P300 or N400 event-related potentials demonstrated a significant group difference between baseline and post-concussion assessments. Athletes demonstrated a significant group difference in postural sway between baseline and post-concussion timepoints using the phybrata sensor for sway power ratio, with a moderate effect size (dav= 0.491) (baseline: 1.4 ±0.5W, post-concussion: 1.9 ±1.4W, p=0.005). Fifteen (68.2%) of the 22 athletes completing post-concussion exercise assessments experienced worsening symptoms, with two additional athletes unable to initiate exercise due to significant symptom burden (p&lt;0.001, large effect size PR= 0.972). Furthermore, no significant difference was observed for change in heart rate during the handgrip strength task. Conclusions: A novel phybrata motion sensor objectively evaluating postural sway and standardized submaximal cardiovascular assessment evaluating symptom exacerbation demonstrated significant clinical utility in detecting impairment within seven days of an acute sport-related concussion, while event-related potentials (N100, P300, N400) and heart rate change during a sustained handgrip task did not.