Evidence of altered interhemispheric communication after pediatric concussion

Background: Dizziness after concussion is primarily attributed to effects on the brain, but traumatic inner ear disorders can also contribute. Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder that can result from minor head trauma and can be easily diagnosed and rapidly treated in an office setting. The role of BPPV in pediatric postconcussive dizziness has not been well-studied. Purpose: To evaluate the prevalence and clinical features of BPPV in a group of pediatric patients with concussion and prolonged dizziness after concussion. Study Design: Case-control study. Level of Evidence: Level 3. Methods: Retrospective review of 102 patients seen within the past 3 years in a pediatric multidisciplinary concussion clinic for evaluation of postconcussive dizziness. Results: BPPV was diagnosed in 29.4% (30/102) of patients with postconcussion syndrome and dizziness. All patients with BPPV were treated with repositioning maneuvers, except for 5 patients who had spontaneous resolution of symptoms. Patients were evaluated at an average of 18.8 weeks (SD, 16.4 weeks) after the injury. BPPV was diagnosed at similar rates regardless of gender or age group (children vs adolescents). The mean Post-Concussion Symptom Scale (PCSS) score did not differ significantly between patients with (58.3 [SD, 22.5]) or without BPPV (55.8 [SD, 29.4]; P = 0.39). The PCSS “balance problems or dizziness” subscore also did not differ between patients with (3.3 [SD, 1.7]) or without BPPV (2.8 [SD, 1.6]; P = 0.13). Conclusion: BPPV is fairly common in pediatric concussion, occurring in one-third of the patients studied. BPPV is often not diagnosed and treated until many weeks after the injury. Increased awareness of the evaluation and management of BPPV among pediatric concussion providers may help expedite resolution of dizziness and hasten overall recovery in affected patients. Clinical Relevance: BPPV is a treatable cause of dizziness caused by minor head injuries and is more common than previously reported in pediatric patients with concussion. Improved awareness of BPPV by concussion providers may expedite recovery.

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“What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

BMC Health Services Research ◽

10.1186/s12913-021-06110-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anh Ly ◽

Roger Zemek ◽

Bruce Wright ◽

Jennifer Zwicker ◽

Kathryn Schneider ◽

...

Keyword(s):

Emergency Department ◽

Health Care Providers ◽

Clinical Pathways ◽

Theoretical Domains Framework ◽

Local Context ◽

Emergency Department Physician ◽

Evidence Based ◽

Care Providers ◽

Structured Interviews ◽

Pediatric Concussion

Abstract Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.

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Interhemispheric communication of abstract and specific visual-form information

Neuropsychologia ◽

10.1016/s0028-3932(02)00065-9 ◽

2002 ◽

Vol 40 (12) ◽

pp. 1983-1999 ◽

Cited By ~ 20

Author(s):

Chad J Marsolek ◽

Christopher D Nicholas ◽

David R Andresen

Keyword(s):

Interhemispheric Communication ◽

Visual Form ◽

Form Information

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Variations in Time to Recovery from Pediatric Concussion Based on Differing Outcomes of Interest

Neurology ◽

10.1212/01.wnl.0000801828.94648.3d ◽

2021 ◽

Vol 98 (1 Supplement 1) ◽

pp. S10.2-S11

Author(s):

Christina Master ◽

Kristi Metzger ◽

Mr. Daniel Corwin ◽

Catherine McDonald ◽

Melissa Pfeiffer ◽

...

Keyword(s):

Sports Medicine ◽

Clinical Care ◽

Median Number ◽

Self Report ◽

Return To School ◽

Self Assessment ◽

Concussion Management ◽

Pediatric Concussion ◽

Concussion Recovery ◽

Definition Of

ObjectiveTo quantify variability in pediatric concussion recovery across multiple outcomes of interest.BackgroundPediatric concussion studies are hindered by a common significant limitation: lack of agreement on a standard definition of “recovery.” A variety of clinical outcomes of interest utilized across studies, including symptom self-report, neurocognitive testing results, self-reported return to activity, and physician clearance for activity, leads to challenges for both research, as well as clinical concussion management.Design/MethodsWe enrolled concussed youth, ages 11–18 years, from a specialty sports medicine clinic = 28 days of injury. Patients were followed as part of clinical care for concussion for up to 13 weeks. At each visit, participants completed questionnaires and a battery of clinical measures. From these data, we constructed 10 potential definitions of recovery: 3 based on self-reported symptoms (change from pre-injury, no symptoms, below pre-determined thresholds), 2 based on visio-vestibular examination (VVE) deficits (none, = 1), 2 based on physician clearance (for return to school/sport), and 3 based on self-assessment (“back to normal”, return to school/exercise).ResultsOne hundred seventy-four concussed youth were enrolled (median age: 15 years, 54.6% female) with a median time from injury to initial visit of 12 days (IQR: 7, 20). Median number of visits was 2 (range: 1, 5). We observed a wide variation in the proportion of participants recovered across the 10 definitions. Depending on definition, between 4% and 45% were considered recovered within 4 weeks, and between 10% and 80% were considered recovered at the end of follow-up. The VVE-based definition (=1 deficit) consistently had the highest proportion recovered at all time points, while self-reported return to exercise had the lowest proportion.ConclusionsRecovery from concussion is not a single unitary point in time. These results will provide valuable guidance to clinicians in managing concussion and researchers in designing future observational and interventional trials of pediatric concussion.

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Predicting Psychological Distress after Pediatric Concussion

Journal of Neurotrauma ◽

10.1089/neu.2018.5792 ◽

2019 ◽

Vol 36 (5) ◽

pp. 679-685 ◽

Cited By ~ 8

Author(s):

Brian L. Brooks ◽

Vickie Plourde ◽

Miriam H. Beauchamp ◽

Ken Tang ◽

Keith Owen Yeates ◽

...

Keyword(s):

Psychological Distress ◽

Pediatric Concussion

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The Callosal Relay Model of Interhemispheric Communication: New Evidence from Effective Connectivity Analysis

Brain Topography ◽

10.1007/s10548-017-0583-x ◽

2017 ◽

Vol 31 (2) ◽

pp. 218-226 ◽

Cited By ~ 6

Author(s):

Saskia Steinmann ◽

Jan Meier ◽

Guido Nolte ◽

Andreas K. Engel ◽

Gregor Leicht ◽

...

Keyword(s):

Effective Connectivity ◽

Connectivity Analysis ◽

Interhemispheric Communication ◽

New Evidence

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The corpus callosum in primates: processing speed of axons and the evolution of hemispheric asymmetry

Proceedings of The Royal Society B Biological Sciences ◽

10.1098/rspb.2015.1535 ◽

2015 ◽

Vol 282 (1818) ◽

pp. 20151535 ◽

Cited By ~ 17

Author(s):

Kimberley A. Phillips ◽

Cheryl D. Stimpson ◽

Jeroen B. Smaers ◽

Mary Ann Raghanti ◽

Bob Jacobs ◽

...

Keyword(s):

Corpus Callosum ◽

Conduction Velocity ◽

Processing Speed ◽

Hemispheric Asymmetry ◽

Brain Size ◽

Myelinated Axon ◽

Primate Species ◽

Limiting Factor ◽

Interhemispheric Communication ◽

Transmission Delays

Interhemispheric communication may be constrained as brain size increases because of transmission delays in action potentials over the length of axons. Although one might expect larger brains to have progressively thicker axons to compensate, spatial packing is a limiting factor. Axon size distributions within the primate corpus callosum (CC) may provide insights into how these demands affect conduction velocity. We used electron microscopy to explore phylogenetic variation in myelinated axon density and diameter of the CC from 14 different anthropoid primate species, including humans. The majority of axons were less than 1 µm in diameter across all species, indicating that conduction velocity for most interhemispheric communication is relatively constant regardless of brain size. The largest axons within the upper 95th percentile scaled with a progressively higher exponent than the median axons towards the posterior region of the CC. While brain mass among the primates in our analysis varied by 97-fold, estimates of the fastest cross-brain conduction times, as conveyed by axons at the 95th percentile, varied within a relatively narrow range between 3 and 9 ms across species, whereas cross-brain conduction times for the median axon diameters differed more substantially between 11 and 38 ms. Nonetheless, for both size classes of axons, an increase in diameter does not entirely compensate for the delay in interhemispheric transmission time that accompanies larger brain size. Such biophysical constraints on the processing speed of axons conveyed by the CC may play an important role in the evolution of hemispheric asymmetry.

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