Concussion in Sport

2017 ◽  
Author(s):  
Anthony P. Kontos ◽  
Jamie McAllister-Deitrick
Keyword(s):  
Structural Damage ◽  
Sport Participation ◽  
Chronic Traumatic Encephalopathy ◽  
Ice Hockey ◽  
American Football ◽  
Return To Play ◽  
Cognitive Balance ◽  
History Of ◽  
Clinical Profiles ◽  
Rehabilitation Strategies

Concussions affect millions of athletes of all ages each year in a variety of sports. Athletes in certain sports such as American football, ice hockey, rugby, soccer, and combative sports like boxing are at higher risk for concussion. Direct or indirect mechanical forces acting on the skull and brain cause a concussion, which is a milder form of brain injury. Conventional neuroimaging (e.g., computerized tomography [CT], magnetic resonance imaging [MRI]) for concussion is typically negative. Concussions involve both neurometabolic and subtle structural damage to the brain that results in signs (e.g., loss of consciousness [LOC], amnesia, confusion), symptoms (e.g., headache, dizziness, nausea), and functional impairment (e.g., cognitive, balance, vestibular, oculomotor). Symptoms, impairment, and recovery time following concussion can last from a few days to weeks or months, based on a variety of risk factors, including younger age, female sex, history of concussion, and history of migraine. Following a concussion, athletes may experience one or more clinical profiles, including cognitive fatigue, vestibular, oculomotor, post-traumatic migraine (PTM), mood/anxiety, and/or cervical. The heterogeneous nature of concussion warrants a comprehensive approach to assessment, including a thorough clinical examination and interview; symptom inventories; and cognitive, balance, vestibular, oculomotor, and exertion-based evaluations. Targeted treatment and rehabilitation strategies including behavior management, vestibular, vision, and exertion therapies, and in some cases medication can be effective in treating the various concussion clinical profiles. Some athletes experience persistent post-concussion symptoms (PCS) and/or psychological issues (e.g., depression, anxiety) following concussion. Following appropriate treatment and rehabilitation strategies, determination of safe return to play is predicated on being symptom-free and back to normal levels of function at rest and following exertion. Certain populations, including youth athletes, may be at a higher risk for worse impairment and prolonged recovery following concussion. It has been suggested that some athletes experience long-term effects associated with concussion including chronic traumatic encephalopathy (CTE). However, additional empirical studies on the role of concussion on CTE are needed, as CTE may have multiple causes that are unrelated to sport participation and concussion.

scholarly journals Sex Differences in Time to Return-to-Play Progression After Sport-Related Concussion

2016 ◽  
Vol 9 (1) ◽  
pp. 41-44 ◽  
Author(s):  
Sarah Stone ◽  
Bobby Lee ◽  
J. Craig Garrison ◽  
Damond Blueitt ◽  
Kalyssa Creed
Keyword(s):  
Sex Differences ◽  
Sport Participation ◽  
Clinical Decision Making ◽  
Female Athletes ◽  
Collegiate Athletes ◽  
Sports Participation ◽  
American Football ◽  
Return To Play ◽  
Male Athletes ◽  
History Of

Background: Recently, female sports participation has increased, and there is a tendency for women to experience more symptoms and variable presentation after sport-related concussion (SRC). The purpose of this study was to determine whether sex differences exist in time to begin a return-to-play (RTP) progression after an initial SRC. Hypothesis: After initial SRC, female athletes (11-20 years old) would take longer to begin an RTP progression compared with age-matched male athletes. Study Design: Retrospective cohort study. Level of Evidence: Level 3. Methods: A total of 579 participants (365 males [mean age, 15.0 ± 1.7 years], 214 females [mean age, 15.2 ± 1.5 years]), including middle school, high school, and collegiate athletes who participated in various sports and experienced an initial SRC were included and underwent retrospective chart review. The following information was collected: sex, age at injury, sport, history of prior concussion, date of injury, and date of initiation of RTP progression. Participants with a history of more than 1 concussion or injury sustained from non–sport-related activity were excluded. Results: Despite American football having the greatest percentage (49.2%) of sport participation, female athletes took significantly longer to start an RTP progression after an initial SRC (29.1 ± 26.3 days) compared with age-matched male athletes (22.7 ± 18.3 days; P = 0.002). Conclusion: On average, female athletes took approximately 6 days longer to begin an RTP progression compared with age-matched male athletes. This suggests that sex differences exist between athletes, aged 11 to 20 years, with regard to initiation of an RTP progression after SRC. Clinical Relevance: Female athletes may take longer to recover after an SRC, and therefore, may take longer to return to sport. Sex should be considered as part of the clinical decision-making process when determining plan of care for this population.

scholarly journals In vivo characterization of chronic traumatic encephalopathy using [F-18]FDDNP PET brain imaging

2015 ◽  
Vol 112 (16) ◽  
pp. E2039-E2047 ◽  
Author(s):  
Jorge R. Barrio ◽  
Gary W. Small ◽  
Koon-Pong Wong ◽  
Sung-Cheng Huang ◽  
Jie Liu ◽  
...  
Keyword(s):  
Pet Imaging ◽  
Medial Temporal Lobe ◽  
Chronic Traumatic Encephalopathy ◽  
Amyloid Β ◽  
American Football ◽  
Subcortical Structures ◽  
Imaging Results ◽  
History Of ◽  
In Vivo Characterization

Chronic traumatic encephalopathy (CTE) is an acquired primary tauopathy with a variety of cognitive, behavioral, and motor symptoms linked to cumulative brain damage sustained from single, episodic, or repetitive traumatic brain injury (TBI). No definitive clinical diagnosis for this condition exists. In this work, we used [F-18]FDDNP PET to detect brain patterns of neuropathology distribution in retired professional American football players with suspected CTE (n = 14) and compared results with those of cognitively intact controls (n = 28) and patients with Alzheimer’s dementia (AD) (n = 24), a disease that has been cognitively associated with CTE. [F-18]FDDNP PET imaging results in the retired players suggested the presence of neuropathological patterns consistent with models of concussion wherein brainstem white matter tracts undergo early axonal damage and cumulative axonal injuries along subcortical, limbic, and cortical brain circuitries supporting mood, emotions, and behavior. This deposition pattern is distinctively different from the progressive pattern of neuropathology [paired helical filament (PHF)-tau and amyloid-β] in AD, which typically begins in the medial temporal lobe progressing along the cortical default mode network, with no or minimal involvement of subcortical structures. This particular [F-18]FDDNP PET imaging pattern in cases of suspected CTE also is primarily consistent with PHF-tau distribution observed at autopsy in subjects with a history of mild TBI and autopsy-confirmed diagnosis of CTE.

An Exploration of Experiences of Female Participants in Power and Performance Sports

2016 ◽  
Vol 24 (1) ◽  
pp. 35-42
Author(s):  
Stacia Ming ◽  
Duncan Simpson ◽  
Daniel Rosenberg
Keyword(s):  
Lived Experience ◽  
Sport Participation ◽  
Female Athletes ◽  
Ice Hockey ◽  
Women's Sport ◽  
Leading Role ◽  
Societal Norms ◽  
History Of ◽  
And Performance ◽  
Personal Accounts

Throughout the history of sport, men have played a leading role in its organization, function, purpose, and exposition (Hargreaves, 2000). Women’s sport participation has drastically risen over the past 40 years and ample new opportunities have emerged within the sport realm for women, which are attributed to a collection of incentives, but chiefly resulting from the passage of Title IX (Coakley, 2009). Women are allowed to participate in physically intense, aggressive, and violent sports, often referred to as power and performance sports (Coakley, 2014), however, the occurrence of this form of sport involvement appears to run counterintuitive to traditionally accepted societal norms. Consequently, the intent of this research was to explore how female athletes experience, interpret, accept, tolerate, and or resist the presumed contradictory role adopted through participation in power and performance sports. For the purpose of this study, existential phenomenological interviews were conducted that yielded in-depth personal accounts of the lived experience of 12 female athletes ranging in age from 21 to 50, representing a variety of power and performance sports (i.e., rugby, ice hockey, jiu-jitsu, kenpo, muay thai, kendo, boxing, and mixed martial arts). Analysis of the transcripts revealed a total of 381 meaning units that were further grouped into subthemes and major themes. This led to the development of a final thematic structure revealing four major dimensions that characterized these athletes’ experiences of power and performance sports: Physicality, Mentality, Opportunity, and Attraction & Alliance.

Repetitive Head Trauma Induces Chronic Traumatic Encephalopathy by Multiple Mechanisms

2020 ◽  
Vol 40 (04) ◽  
pp. 430-438 ◽  
Author(s):  
Jonathan D. Cherry ◽  
Katharine J. Babcock ◽  
Lee E. Goldstein
Keyword(s):  
Cognitive Deficits ◽  
Tau Protein ◽  
Chronic Traumatic Encephalopathy ◽  
Biomechanical Properties ◽  
Ice Hockey ◽  
American Football ◽  
Head Impacts ◽  
Blast Exposure ◽  
Hyperphosphorylated Tau Protein ◽  
The Brain

AbstractExposure to repetitive neurotrauma increases lifetime risk for developing progressive cognitive deficits, neurobehavioral abnormalities, and chronic traumatic encephalopathy (CTE). CTE is a tau protein neurodegenerative disease first identified in boxers and recently described in athletes participating in other contact sports (notably American football, ice hockey, rugby, and wrestling) and in military veterans with blast exposure. Currently, CTE can only be diagnosed by neuropathological examination of the brain after death. The defining diagnostic lesion of CTE consists of patchy perivascular accumulations of hyperphosphorylated tau protein that localize in the sulcal depths of the cerebral cortex. Neuronal abnormalities, axonopathy, neurovascular dysfunction, and neuroinflammation are triggered by repetitive head impacts (RHIs) and likely act as catalysts for CTE pathogenesis and progression. However, the specific mechanisms that link RHI to CTE are unknown. This review will explore two important areas of CTE pathobiology. First, we will review what is known about the biomechanical properties of RHI that initiate CTE-related pathologies. Second, we will provide an overview of key features of CTE neuropathology and how these contribute to abnormal tau hyperphosphorylation, accumulation, and spread.

scholarly journals Concussion in Sports

2019 ◽  
Vol 4 (2) ◽  
pp. 37 ◽  
Author(s):  
Giuseppe Musumeci ◽  
Silvia Ravalli ◽  
Angela Maria Amorini ◽  
Giuseppe Lazzarino
Keyword(s):  
Sports Medicine ◽  
Clinical Symptoms ◽  
Research Work ◽  
Ice Hockey ◽  
American Football ◽  
Return To Play ◽  
Energy Deficit ◽  
Horse Riding ◽  
Gene And Protein Expression ◽  
Wide Range

Concussion, a peculiar type of mild traumatic brain injury (mTBI), is an injury frequently encountered in various contact and noncontact sports, such as boxing, martial arts, American football, rugby, soccer, ice hockey, horse riding, and alpine skiing. Concussion occurs anytime external forces of specific intensities provoke acceleration–deceleration of the brain, and it is characterized by the rapid onset of short-lived impairment of neurologic functions, spontaneously resolving within weeks, persisting for longer times only in a small percentage of cases. A wide range of molecular alterations, including mitochondrial dysfunction, energy deficit, and gene and protein expression changes, is triggered by concussion and lasts longer than clinical symptoms. In recent years, concussion has become a primary issue of discussion among sports medicine professionals, athletes, media, and sports sponsors in relation to athletes’ return to play, after a concussion. Continued improvement in prevention and management of concussed athletes requires extensive research from different disciplines. Research work needs to focus on both prevention and management. Researchers and clinicians’ efforts should be dedicated to a better understanding of the molecular changes occurring in the post-concussed brain and to clearly define healing after concussion for a safe return of athletes to play. It is essential for sports medicine professionals to stay informed about the advances in understanding concussions and how to rehabilitate each single player who sustained a concussion.

scholarly journals Chronic traumatic encephalopathy – current state of knowledge

2021 ◽  
Vol 11 (8) ◽  
pp. 86-100
Author(s):  
Łukasz Bryliński ◽  
Paulina Drożak ◽  
Martyna Drożak ◽  
Katarzyna Augustowska ◽  
Piotr Duda ◽  
...  
Keyword(s):  
Tau Protein ◽  
Behavioral Problems ◽  
Current Knowledge ◽  
Chronic Traumatic Encephalopathy ◽  
Imaging Techniques ◽  
Head Injuries ◽  
Memory Loss ◽  
Ice Hockey ◽  
Diagnostic Methods ◽  
American Football

Introduction and purpose. Chronic traumatic encephalopathy (CTE) is a tauopathy caused by repetitive, mild head injuries. It is characterized by perivascular accumulation of hyperphosphorylated tau protein in the neurons and astrocytes. CTE leads to changes in central nervous system, both on microscopic and macroscopic level. The aim of the study was to present the current knowledge on chronic traumatic encephalopathy among athletes, its predisposing factors, symptoms and consequences, as well as diagnostic methods and treatment.Description. CTE occurs among contact sport players, such as American football, ice hockey, soccer, baseball, box and MMA (mixed martial arts), as well as among soldiers and victims of domestic violence. Repetitive head injuries and long career duration increase the risk of CTE. Symptoms of chronic traumatic encephalopathy include a commonly occurring triad: cognitive disturbances, behavioral problems and mood disturbances. Other symptoms include memory loss, parkinsonism, headaches, speech and walking problems. Currently, the only diagnostic method of CTE is a posthumous detection of neuropathological markers. Methods such as detection of exosomal tau protein in plasma and imaging techniques give hope to diagnose CTE in alive patients. Treatment methods of CTE, such as LIPUS (low intensity pulsed ultrasound) therapy are currently being developed.Conclusions. Chronic traumatic encephalopathy among athletes is a serious problem that affects multiple people due to the popularity of contact sports. Thus, an emphasis should be put on prevention, raising awareness and appropriate protection of athletes through changes in regulations and improvement of protective equipment.

scholarly journals Top Ten Reasons Why All Athletes Need to have Neuropsychological Testing

2019 ◽  
pp. 1-2
Author(s):  
Michael F Shaughnessy ◽  
Keyword(s):  
Chronic Traumatic Encephalopathy ◽  
Neuropsychological Testing ◽  
Head Injuries ◽  
Return To Play ◽  
Research Journal ◽  
Post Test ◽  
Control And Prevention ◽  
History Of ◽  
Tackle Football

Currently, we are more and more aware of head injuries, concussion and the risks and dangers of athletes being exposed to long term risk and injury.Twenty years or so ago, coaches relied on side line assessment to decide as to whether an athlete who“has had his/her bells rung” should return to play. Currently however, there is much more sophisticated sideline assessment (such as Impact) and other laptop instruments. There are many, many reasons why athletes should undergo pre-and post-test assessment as well as sideline assessment. These will be summarily discussed. These issues have also been discussed by:Arginteanu (2019) and others have clearly specified the need to be concerned and observant regardingthe concept of return to play and even return to the classroom. Hernandez, Giordano, Goubran, Parivash, Grant, Zeineh and Camarillo (2019) have discussed sports related concussions and Corman, Adame, Tsa, Ruston, Beaumont, Kamrath, Liu, Posteher, Tremblayand van Raalt, (2019) have published on sports related concussions. Rose, Yeates, Nguyen, McCarthy, Ercole, Pizzimenti, (2019)have written on youth tackle football. Engleman (2013) writing in The Rotarian pp 27-30 suggests that “youth football leagues should require coaches and encourage all parents, to take the “Heads IUP” training course available at www.cdc.gov. The web site of the U.S. Centers for Disease Control and Prevention” There is much concern about CTE (Chronic traumatic encephalopathy- which is a progressive degenerative disease of the brain. This is usually discerned in individuals who have some type of history of repetitive brain trauma or injury. This could include soccer, basketball, baseball, softball (at least many players DO wear helmets) and wrestling (in terms of wrestling, players do wear protective devices for their ears, but still may suffer concussions and head injuries. Shaughnessy and Laman (2012) have provided an excellent review of evidence based intervention and treatment/rehabilitation of traumatic brain injury. This was published in the Research Journal in Organizational Psychology and Educational Studies and is a serious review of the literature in this realm.

scholarly journals Developing methods to detect and diagnose chronic traumatic encephalopathy during life: rationale, design, and methodology for the DIAGNOSE CTE Research Project

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Michael L. Alosco ◽  
Megan L. Mariani ◽  
Charles H. Adler ◽  
Laura J. Balcer ◽  
Charles Bernick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diagnostic Criteria ◽  
Chronic Traumatic Encephalopathy ◽  
Ice Hockey ◽  
Self Report ◽  
American Football ◽  
Football Players ◽  
Blood Draw ◽  
Research Project

Abstract Background Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that has been neuropathologically diagnosed in brain donors exposed to repetitive head impacts, including boxers and American football, soccer, ice hockey, and rugby players. CTE cannot yet be diagnosed during life. In December 2015, the National Institute of Neurological Disorders and Stroke awarded a seven-year grant (U01NS093334) to fund the “Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy (DIAGNOSE CTE) Research Project.” The objectives of this multicenter project are to: develop in vivo fluid and neuroimaging biomarkers for CTE; characterize its clinical presentation; refine and validate clinical research diagnostic criteria (i.e., traumatic encephalopathy syndrome [TES]); examine repetitive head impact exposure, genetic, and other risk factors; and provide shared resources of anonymized data and biological samples to the research community. In this paper, we provide a detailed overview of the rationale, design, and methods for the DIAGNOSE CTE Research Project. Methods The targeted sample and sample size was 240 male participants, ages 45–74, including 120 former professional football players, 60 former collegiate football players, and 60 asymptomatic participants without a history of head trauma or participation in organized contact sports. Participants were evaluated at one of four U.S. sites and underwent the following baseline procedures: neurological and neuropsychological examinations; tau and amyloid positron emission tomography; magnetic resonance imaging and spectroscopy; lumbar puncture; blood and saliva collection; and standardized self-report measures of neuropsychiatric, cognitive, and daily functioning. Study partners completed similar informant-report measures. Follow-up evaluations were intended to be in-person and at 3 years post-baseline. Multidisciplinary diagnostic consensus conferences are held, and the reliability and validity of TES diagnostic criteria are examined. Results Participant enrollment and all baseline evaluations were completed in February 2020. Three-year follow-up evaluations began in October 2019. However, in-person evaluation ceased with the COVID-19 pandemic, and resumed as remote, 4-year follow-up evaluations (including telephone-, online-, and videoconference-based cognitive, neuropsychiatric, and neurologic examinations, as well as in-home blood draw) in February 2021. Conclusions Findings from the DIAGNOSE CTE Research Project should facilitate detection and diagnosis of CTE during life, and thereby accelerate research on risk factors, mechanisms, epidemiology, treatment, and prevention of CTE. Trial registration NCT02798185

History of Chronic Traumatic Encephalopathy

2020 ◽  
Vol 40 (04) ◽  
pp. 353-358
Author(s):  
Robert C. Cantu ◽  
Charles Bernick
Keyword(s):  
Chronic Traumatic Encephalopathy ◽  
Neurological Impairment ◽  
American Football ◽  
Football Players ◽  
Long Term Effects ◽  
Public Attention ◽  
Head Impacts ◽  
Repetitive Head Impacts ◽  
History Of ◽  
Initial Description

AbstractThe long-term effects of repetitive head impacts have been recognized for close to a century. What is now referred to as chronic traumatic encephalopathy (CTE) was first described by Martland in 1928 in a series of boxers. Over the years, several important articles were published, including Critchley's 1957 report where he introduced the term “chronic traumatic encephalopathy,” Robert's study in 1969 which provided evidence of the prevalence of neurological impairment in retired fighters, and Corsellis' initial description of the pathology of CTE. However, what brought public attention to the issue of CTE in sports were the postmortem findings of CTE pathology in professional American football players, initially reported by Omalu and subsequently in a large series by McKee. There is now standardization of pathological criteria for CTE and recognition that it can be seen across all activities that involve repetitive head impacts.

Prevalence of Jones Fracture Repair and Impact on Short-Term NFL Participation

2017 ◽  
Vol 39 (1) ◽  
pp. 6-10 ◽  
Author(s):  
Leigh-Anne Tu ◽  
Derrick M. Knapik ◽  
Joseph Sheehan ◽  
Michael J. Salata ◽  
James E. Voos
Keyword(s):  
Significant Risk ◽  
Case Series ◽  
Fracture Repair ◽  
American Football ◽  
Return To Play ◽  
Short Term ◽  
Jones Fracture ◽  
Early Return ◽  
History Of ◽  
The Impact

Background: Elite American football athletes are at high risk for Jones fractures. Fixation is recommended to minimize nonunion and allow early return to play. The purpose of this investigation was to evaluate the prevalence of Jones fracture repair in athletes invited to the National Football League (NFL) Combine and the impact of fracture repair on short-term NFL participation compared to athletes with no history of repair. Methods: A total of 1311 athletes participating in the Combine from 2012 to 2015 were evaluated. Athletes with history of Jones fracture repair were identified. Athlete demographic information was collected while physical examination findings were recorded. Radiographs were evaluated to determine fixation type and the presence of nonunion. Future participation in the NFL was evaluated based on draft status, games played, and games started in the athlete’s first season following the Combine. Results: Fixation was performed for 41 Jones fractures in 40 athletes (3.1%). The highest prevalence was in defensive linemen (n = 10 athletes), with the greatest rate in tight ends (5.1%, n = 4 of 79 athletes). Intramedullary screw fixation was used for all fractures. Incomplete bony union was present in 3 (8%) fractures. Athletes with a history of repair were not at significant risk for going undrafted ( P = .61), playing ( P = .23), or starting ( P = .76) fewer NFL games compared to athletes with no history of repair during athletes’ first NFL season. Conclusion: Athletes with a history of Jones fracture repair were not at significant risk of going undrafted or for diminished participation during their first season in the NFL. Level of Evidence: Level IV, case series.

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