Rehabilitation of Persistent Post-Concussion Symptoms in Retired and Active NHL Players: Clinical Case Series

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S23.3-S24
Author(s):  
Matthew Michael Antonucci ◽  
Emily Kalambaheti ◽  
Derek Barton ◽  
Shaun Kornfeld ◽  
Kenneth Jay
Keyword(s):  
Reaction Time ◽  
Choice Reaction Time ◽  
Case Series ◽  
Effect Sizes ◽  
Return To Play ◽  
Whole Body ◽  
Symptom Duration ◽  
Digit Symbol ◽  
Persistent Symptoms ◽  
Functional Neurology

ObjectiveTo present the evaluation of 12 rehabilitation cases as a case series in sports-related concussion.BackgroundSport-related concussion is a common injury in the NHL. While most athletes recover within few weeks of sustaining a mild head injury, some still experience persistent symptoms for months or years after following recommended recovery and return to play guidelines.Design/MethodsTwelve male NHL athletes (6/6 active/retired; mean age/height/weight/symptom duration/#concussions [SD]: 33.4 years [7.9]: 185.8 cm [5.1]: 94.8 kg [14.6]; 121 wks: [156]; 4.3 [2.3]) with persistent but mild post-concussion symptoms were treated for 10 sessions at an outpatient neurorehabilitation center specializing in functional neurology. The athletes were evaluated before- and after treatment utilizing the C3 Logix platform. The interventions included joint manipulation, neuromuscular re-education, vestibular rehabilitation in a whole-body off-axis rotational device, orthoptic exercises, and cognitive training. Graded Symptoms Checklist (0–162), Digit-Symbol Coding, Simple- and Choice Reaction Time, and Trail Making Test A/B were analyzed in Graphpad PRISM. 9.1.0 by multiple paired t-tests with Holm-Šídák corrections. Results are reported as differences-of-means pre- to post-treatment (SE) with Cohen's d effect sizes [ES] (0.2, 0.5, 0.8 represents small, medium, and large effect sizes, respectively). p-values <0.05 were considered significant.ResultsGraded Symptom Checklist score (p < 0.001): −25.1 (4.0) [1.83]; Digit-Symbol Matching speed (#symbols) (p = 0.03): 6.2 (1.9) [0.92]; Simple reaction time (ms) (p = 0.03): −74.7 (22.9) [0.94]; Choice reaction time (ms) (p = 0.009): −106.1 (26.0) [1.18]; Trails A (s) (p = 0.04) [0.80]: −2.6 (0.9); and Trails B (s) (p = 0.04): −6.0 (2.2) [0.79].ConclusionsThe present case series shows that a functional neurology approach of multimodal short duration intensive therapies can produce clinically meaningful improvements with large and very large effect sizes, in both the concussion symptoms and neurocognitive performance, of 12 professional NHL players experiencing symptom stagnation.

Rehabilitation of Persistent Neurocognitive Deficits Following Sports-Related Concussion in an Amateur Football Athlete: Case Study

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S25.2-S25
Author(s):  
Shaun Kornfeld ◽  
Emily Kalambaheti ◽  
Matthew Michael Antonucci
Keyword(s):  
Reaction Time ◽  
Choice Reaction Time ◽  
Simple Reaction Time ◽  
American Football ◽  
Whole Body ◽  
Meaningful Improvement ◽  
Contact Sports ◽  
Simple Reaction ◽  
Functional Neurology

ObjectiveDemonstrate neurocognitive improvements in an inactive, amateur football athlete following a functional neurology approach to multimodal neurorehabilitation.BackgroundAmerican Football has been reported to have one of the highest incidences of concussion in all contact sports. Given the high rate of concussive blows during play, the investigation of treatment modalities is warranted. This case study presents a 23-year-old male amateur football player who has sustained 3 diagnosed concussions with additional suspected concussions throughout his time participating in football. In addition, his symptoms persisted years after ceasing participation in all contact sports.Design/MethodsThe athlete was prescribed 10 treatment sessions over 5 consecutive days at an outpatient neurorehabilitation center specializing in functional neurology. The C3Logix neurocognitive assessment and Graded Symptom Checklist were utilized on intake and discharge. Multimodal treatment interventions included transcranial photobiomodulation, non-invasive neuromodulation of the lingual branch of the trigeminal nerve, neuromuscular reeducation of the limbs bilaterally, hand-eye coordination training, vestibular rehabilitation utilizing a three-axis whole-body off-axis rotational device, and cognitive training.ResultsOn intake, composite symptom score was reported as 10/162, Trails Making Test Part A was 20.8 seconds, Part B was 41.9 seconds, Digit Symbol Matching score was 53, Simple Reaction Time was 277 milliseconds, and Choice Reaction Time was 412 milliseconds. On discharge, the patient experienced a 70% in self-reported symptoms, Trails A improved to 14.8 seconds (+29%), Trails B improved to 30.3 seconds (+28%), Simple Reaction Time was 248 milliseconds (10% faster), and Choice Reaction Time was 340 milliseconds (17% faster).ConclusionsThe present case study demonstrates a meaningful improvement in symptoms and neurocognitive performance of a patient with multiple sports-related concussions. Therefore, the Press suggest further investigation into a functional neurology approach to multi-modal, intensive care to improve neurocognitive impairment in athletes that sustained concussions participating in footballs.

Central and Peripheral Visual Choice-Reaction Time under Conditions of Induced Cortical Hyperthermia

1982 ◽  
Vol 54 (2) ◽  
pp. 395-402 ◽  
Author(s):  
P. A. Hancock ◽  
G. R. Dirkin
Keyword(s):  
Reaction Time ◽  
Choice Reaction Time ◽  
External Auditory Meatus ◽  
Whole Body ◽  
Placebo Condition ◽  
Heat Condition ◽  
Cortical Temperature ◽  
Whole Body Heat Stress ◽  
Male Subjects ◽  
Body Heat

Six right-handed male subjects performed a central and peripheral visual choice-reaction time (RT) task. After two initial practice periods, subjects performed counterbalanced manipulations of control, placebo, and heat conditions. In the heat condition, a helmet selectively raised cortical temperature, measured in the external auditory meatus, by 7°F while the placebo condition utilized the helmet with no external heat applied. Analysis indicated that the elevation of cortical temperature caused an increase in RT and decreased rate of errors. This conservatism in subjects' response under induced cortical hyperthermia is contrasted with previous accounts of visual RT performance under manipulations of whole-body heat stress.

Information Processing Components of Digit Symbol Performance in Schizophrenia

1976 ◽  
Vol 42 (3_suppl) ◽  
pp. 1329-1330
Author(s):  
D. R. Hemsley
Keyword(s):  
Information Processing ◽  
Reaction Time ◽  
Choice Reaction Time ◽  
Present Report ◽  
Visual Stimuli ◽  
Reaction Time Task ◽  
Choice Reaction Time Task ◽  
Digit Symbol ◽  
Time Task ◽  
The Relationship

The present report is of the relationship between digit symbol performance in schizophrenia and measures derived from a visual choice reaction-time task. The ability to ignore irrelevant visual stimuli was most closely related to digit symbol performance, other measures adding little to the predicted variance.

The Effects of Whole Body Exercise on Choice-Reaction Time Performance

1974 ◽  
Vol 18 (4) ◽  
pp. 476-479
Author(s):  
Alan B. Dechovitz ◽  
Rodney K. Schutz ◽  
Thomas L. Sadosky
Keyword(s):  
Reaction Time ◽  
Physical Exercise ◽  
Cognitive Performance ◽  
Choice Reaction Time ◽  
Error Rate ◽  
Reaction Time Task ◽  
Work Load ◽  
Bicycle Ergometer ◽  
Practical Significance ◽  
Whole Body

A study which investigates how cognitive performance is affected by simultaneous, physical exercise is reported. Whole body exercise on a bicycle ergometer at four work loads (30, 60, 120 and 180 watts) and four rates (30, 40, 60 and 90 rpm) for durations of from 5 to 25 minutes were investigated. A two-stage choice reaction time task was performed at one minute intervals prior to, during and after exercise. Psychomotor performance was measured by reaction time and error rate. Although the subjects were fully trained, very pronounced subject differences were noted. The psychomotor response did not vary with work load (watts) or work rate (rpm), and in addition, was not related to the physiological measurements recorded for heart rate and oxygen consumption. Nominal differences in reaction time and error rate were detected during and after exercise; but it was concluded that physical exercise, even if strenuous, does not cause a modification in cognitive performance of practical significance.

scholarly journals Clinical and biomechanical outcomes of rehabilitation targeting intersegmental control in athletic groin pain: prospective cohort of 205 patients

2018 ◽  
Vol 52 (16) ◽  
pp. 1054-1062 ◽  
Author(s):  
Enda King ◽  
Andrew Franklyn-Miller ◽  
Chris Richter ◽  
Eamon O’Reilly ◽  
Mark Doolan ◽  
...  
Keyword(s):  
Groin Pain ◽  
Body Movement ◽  
Three Dimensional ◽  
Case Series ◽  
Cutting Performance ◽  
Biomechanical Analysis ◽  
Return To Play ◽  
Whole Body ◽  
3D Analysis ◽  
Pain Provocation

BackgroundClinical assessments and rehabilitation in athletic groin pain (AGP) have focused on specific anatomical structures and uniplanar impairments rather than whole body movement.ObjectiveTo examine the effectiveness of rehabilitation that targeted intersegmental control in patients with AGP and to investigate post rehabilitation changes in cutting biomechanics.MethodsTwo hundred and five patients with AGP were rehabilitated focusing on clinical assessment of intersegmental control, linear running and change of direction mechanics in this prospective case series. Hip and Groin Outcome Score (HAGOS) was the primary outcome measure. Secondary measures included pain-free return to play rates and times, pain provocation on squeeze tests and three-dimensional (3D) biomechanical analysis during a 110° cutting manoeuvre.ResultsFollowing rehabilitation, patients demonstrated clinically relevant improvements in HAGOS scores (effect size (ES): 0.6–1.7). 73% of patients returned to play pain-free at a mean of 9.9 weeks (±3.5). Squeeze test values also improved (ES: 0.49–0.68). Repeat 3D analysis of the cutting movement demonstrated reductions in ipsilateral trunk side flexion (ES: 0.79) and increased pelvic rotation in the direction of travel (ES: 0.76). Changes to variables associated with improved cutting performance: greater centre of mass translation in the direction of travel relative to centre of pressure (ES: 0.4), reduced knee flexion angle (ES: 0.3) and increased ankle plantar flexor moment (ES: 0.48) were also noted.ConclusionsRehabilitation focused on intersegmental control was associated with improved HAGOS scores, high rates of pain-free return to sporting participation and biomechanical changes associated with improved cutting performance across a range of anatomical diagnoses seen in AGP.

scholarly journals Detection of Persisting Concussion Effects on Measures of Neuromechanical Responsiveness

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Chad J Prusmack
Keyword(s):  
Reaction Time ◽  
Dual Task ◽  
Predictive Value ◽  
Sport Participation ◽  
Elite Athletes ◽  
Recursive Partitioning ◽  
Critical Role ◽  
Return To Sport ◽  
Return To Play ◽  
Whole Body

Abstract INTRODUCTION Numerous investigations have documented elevated risk for musculoskeletal injury following sport-related concussion, which suggests that an unrecognized vulnerability persists beyond the resolution of symptoms and return to sport participation. Improved clinical testing methods are needed to better assess the interrelated neurocognitive and neuromuscular capabilities of athletes who may have elevated susceptibility to MSK injury, and possible risk for long- term alterations in brain function, despite resolution of overt concussion symptoms. The term “neuromechanics” refers to the study of interactions between neural, biomechanical, and environmental dynamics We use the term “neuromechanical responsiveness” (NMR) to designate the ability to optimally integrate neurocognitive and neuromuscular processes during participation in sport-related activities. NMR testing may play an critical role in optimizing safe return to play circumstances. METHODS A cohort of 48 elite athletes (34 males: 23.8 ± 4.4 yr; 14 females: 25.4 ± 4.5 yr) performed visuomotor reaction time (VMRT) tests involving rapid manual contact with illuminated target buttons that included 2 dual-task conditions: 1) simultaneous oral recitation of scrolling text (VMRT + ST) and 2) simultaneous verbal responses to identify the right or left direction indicated by the center arrow of the Eriksen flanker test (VMRT + FT). A whole-body reactive agility (WBRA) test requiring side-shuffle movements in response to visual targets was used to assess reaction time, speed, acceleration, and deceleration. RESULTS Concussion occurrence at 2.0 ± 2.3 yr prior to testing was reported by 21 athletes. Strong univariable associations were found for VMRT + FT left minus right difference = 15 ms (OR = 7.14), VMRT + ST outer 2-ring to inner 3-ring ratio = 1.28 (OR = 4.58), and WBRA speed asymmetry = 7.7% (OR = 4.67). A large VMRT + FT X VMRT + ST interaction effect was identified (OR = 25.00). Recursive partitioning identified a 3-way VMRT + FT X VMRT + ST X WBRA interaction that had 100% positive predictive value for identification of athletes with concussion history, whereas negative status on all 3 factors provided 90% negative predictive value. CONCLUSION Performance on dual-task VMRT tests and the WBRA test identified NMR deficiencies among elite athletes who reported a history of concussion.

Whole Body Choice Reaction Time (WBCRT-C1) to Detect Cognitive Impairment in Patients with Depressive Disorder (DD): A Case-Control Study

2021 ◽  
Vol 17 ◽  
Author(s):  
Vitthal Khode ◽  
Girish Babu ◽  
Arun Gadad ◽  
Satish Patil ◽  
Komal Ruikar ◽  
...  
Keyword(s):  
Reaction Time ◽  
Depressive Disorder ◽  
Choice Reaction Time ◽  
Case Control Study ◽  
Reaction Times ◽  
Case Control ◽  
Cognitive Testing ◽  
Whole Body ◽  
Central Processing ◽  
Control Study

Background: Depressive disorder (DD) is a state of multiple neuro-psychological deficits. cognitive testing has proven beneficial in guiding treatment of depression. Since these neuro-cognitive testings require great deal of time and skill, measuring Reaction time (RT) can prove an alternative method of measure of cognition. RT is a sensitive tool to measure attention and execution. In our study whole body choice reaction time (WBCRT) is divided in to 2 chronoscopic readings WBCRT-C1and WBCRT-C2. WBCRT-C1 measures time required for central processing in the central nervous system which includes cognition and WBCRT-C2 measures total RT includes central processing and peripheral processing. Objectives: Objective of the study was to measure and compare WBCRT-C1 in DD and controls, and to assess the correlation between WBCRT-C1 with MMSE and HAM-A score. Methods: Hospital based case-control study was conducted on total 68 young subjects, 34 subjects of DD aged between 18-45yrs their reaction times were compared with similar number of age and sex matched controls. Results: WBCRT-C1 was more delayed in patients of DD (807±245 ms) than in controls (579±99ms). A significant correlation was found between WBCRT-C1 and MMSE (r=-0.7371, p=0.0001), HAM-A scores (r=0.3395 p=0.0046). Conclusion: WBCRT-C1 could be a quantitative tool to assess cognitive dysfunction in DD.

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