Rehabilitation of Persistent Symptoms and Neurocognitive Deficits Following Sports-Related Concussion in a Professional Hockey Player: Case Study

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S26-S26
Author(s):  
Shaun Kornfeld ◽  
Emily Kalambaheti ◽  
Matthew Michael Antonucci
Keyword(s):  
Reaction Time ◽  
Simple Reaction Time ◽  
Trail Making Test ◽  
Neurocognitive Performance ◽  
Test Part ◽  
Hockey Player ◽  
Trail Making ◽  
Professional Hockey ◽  
Functional Neurology

ObjectiveTo demonstrate decreased post-concussive symptomatology and neurocognitive improvements in a professional hockey player following a multimodal, functional neurology approach to neurorehabilitation.BackgroundHockey is one of the top 3 sports in which concussions occur and has one of the top 10 highest participation numbers of sports in the northern hemisphere. The investigation of treatment modalities is warranted given the prevalence of hockey throughout society. This case study presents a 31-year-old male professional hockey athlete who had sustained 5 diagnosed concussions with additional suspected concussions throughout his career. His symptoms remained after independently receiving physical therapy and vestibular rehabilitation, causing an inability to continue playing hockey at a professional level.Design/MethodsThe patient was prescribed 10 treatment sessions over 5 contiguous days at an outpatient neurorehabilitation center specializing in functional neurology. The C3Logix neurocognitive assessment and graded symptom checklist were utilized at intake and discharge. Multimodal treatment interventions included transcranial photobiomodulation, non-invasive neuromodulation of the lingual branch of the trigeminal nerve, hand-eye coordination training, vestibular rehabilitation utilizing a three-axis whole-body off-axis rotational device, and cognitive training.ResultsOn intake, their composite symptom score was reported as 16/162, Trail Making Test Part B was 24.1 seconds, Simple Reaction Time was 274 milliseconds, and Choice Reaction Time was 496 milliseconds. On discharge, the patient experienced an 81% in self-reported symptoms, Trail Making Test Part B improved to 17 seconds (+29.46%), Simple Reaction Time was 252 milliseconds (8% faster), and Choice Reaction Time was 465 milliseconds (24% faster).ConclusionsThe present case study results demonstrated meaningful improvements in both self-rated concussion symptoms and neurocognitive performance for this patient. The Press suggest further investigation into functional neurology-based, multimodal, intensive approaches to decrease chronic post-concussion symptoms and improve neurocognitive performance in athletes that engage in hockey.

scholarly journals Symptom recovery and the relationship between post-injury symptom scores and neurocognitive performance in athletes with sport-related concussion

2021 ◽  
Vol 5 ◽  
pp. 205970022110180
Author(s):  
Susan M Linder ◽  
Aaron Lear ◽  
Joseph Linder ◽  
Adam Lake ◽  
Corey Brier ◽  
...  
Keyword(s):  
Reaction Time ◽  
Symptom Score ◽  
Symptom Severity ◽  
Neurocognitive Function ◽  
Trail Making Test ◽  
Neurocognitive Performance ◽  
Post Injury ◽  
Mixed Effect ◽  
Trail Making ◽  
The Relationship

Introduction A multi-domain approach to concussion assessment has been recommended that includes self-reported symptom severity in addition to neurocognitive tests and measures of postural stability. The relationship between subjective self-reported symptoms and objective measures of cognitive function in the post-injury state is not well understood. The aims of the study were to determine symptom severity throughout the post-injury continuum of care and the association between symptom severity and performance on measures of neurocognitive function. Methods An observational cohort study was conducted on 1257 high school and collegiate athletes (67% male and 33% female) who had sustained a concussion. Student-athletes were included in the study if they had a healthy baseline assessment and at least one follow-up injury assessment utilizing the Cleveland Clinic Concussion Application (C3 App). Symptom severity was assessed during the acute (0–7 days post-injury), subacute (8–20 days post-injury), and post-concussive (≥21 days post-injury) phases. Neurocognitive performance was assessed using the following measures: Simple Reaction Time (SRT), Choice Reaction Time (CRT), Processing Speed Test (PST), Trail Making Test A (TMT-A), and Trail Making Test B (TMT-B). To determine the relationship between symptom severity and neurocognitive test performance, athletes were stratified into two groups for comparison: symptom score ≤7 or >7, utilizing the 27-item graded symptom checklist within the C3 App. Neurocognitive performance was analyzed with separate linear mixed effect models for each module to compare within-phase differences. Significance for each module at each phase was tested at P < .05 and adjusted for multiple comparisons. Results Median symptom severity during the acute post-injury phase was 10 declining to 2 during the subacute and post-concussive phases. Performance on each of the C3 App modules (SRT, CRT, PST, Trails A, and Trails B) were significantly better in athletes reporting a symptom score of ≤7 compared to those reporting a symptom score >7 at each of the post-injury phases (P < 0.05 on all comparisons). Conclusions Symptomatic athletes performed worse on all measures of neurocognitive function, regardless of time from injury. While symptoms alone should not be used to determine recovery, our data indicate that symptom severity may aide in deciding when to initiate post-injury neurocognitive testing to determine readiness for treatment progression.

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.

scholarly journals A-166 The Role of Apathy on Executive Functioning After Stroke

2020 ◽  
Vol 35 (6) ◽  
pp. 960-960
Author(s):  
Lopez A ◽  
Lopez Palacios D ◽  
Quintana A ◽  
Gibson D ◽  
Arguelles-Borge S
Keyword(s):  
Executive Functioning ◽  
Cognitive Performance ◽  
Verbal Learning ◽  
Depression Scale ◽  
Trail Making Test ◽  
Stroke Patients ◽  
Data Set ◽  
Test Part ◽  
Trail Making

Abstract Objective This study examined the role of apathy on performance of an executive functioning task. Method The data for this study was derived from the National Alzheimer’s Coordinating Center’s Uniform Data Set containing neuropsychological information for stroke patients (n = 317) who completed the Neuropsychiatric Inventory-Questionnaire (NPI-Q) and the Trail Making Test (Part B). The sample was divided into two groups. One which endorsed feelings of apathy in the last month (n = 102; mean age = 84,SD = 8.33) and a second group which denied feelings of apathy within the last month (n = 215; mean age = 86, SD = 8.02). Results After controlling for depression [as measured by the Geriatric Depression Scale (GDS)], age, gender, and motor impairment, the results of an ANCOVA showed that those who reported apathy performed significantly slower on the Trail Making Test—Part B than those who did not report it [F(1,312 = 6.01, p = .02]. Conclusions It has previously been found that cognitive performance can be impacted by depression on stroke patients. However, recently, it has been identified that apathy specifically, can have an effect on cognitive domains such as verbal learning, short-term, and long-term memory. The present study further supports that apathy may play a role in overall cognitive performance. Therefore, even if patients do not meet criteria for depression, the presence of apathy should still be taken into account. Future research should examine other possible contributing factors such as processing speed should be taken into account as they could be affecting the scores. Finally, researchers should utilize additional measures of executive functioning as only one was available for this study.

scholarly journals S47. A MULTICENTER STUDY OF COGNITIVE RESERVE IN FIRST-EPISODE PYCHOSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S50-S50
Author(s):  
Silvia Amoretti ◽  
Gerard Anmella ◽  
Ana Meseguer ◽  
Cristina Saiz ◽  
Sonia Canals ◽  
...  
Keyword(s):  
Working Memory ◽  
Executive Function ◽  
Processing Speed ◽  
Cognitive Reserve ◽  
Leisure Activities ◽  
First Episode ◽  
Trail Making Test ◽  
Neurocognitive Performance ◽  
Adult Intelligence Scale ◽  
Trail Making

Abstract Background The cognitive reserve (CR) refers to the brain’s capacity to cope with pathology in order to minimize the symptoms. In the field of first episode psychosis (FEP), the CR was able to predict functional and neurocognitive performance. Nevertheless, CR has been estimated using heterogeneous methods, which, in term, difficult to compare studies. Therefore, there is a need to create a specific scale for the assessment of this relevant construct. The Cognitive Reserve Assessment Scale in Health (CRASH) is the first measure developed specifically for patients with severe mental illness with optimal psychometric properties, facilitating reliable and valid measurement of CR. The study of the internal structure of the CRASH determined a four-factor structure (Education, Occupation, Leisure activities and Sociability) that can be analyzed separately to know what kind of relationship they might have with other variables. The aim of this study was to analyze the effects of CR measured with CRASH scale on functioning and neurocognitive performance and to explore the relationship of each factor with the outcome in an adult sample of subjects with FEP. Methods The sample of this study came from a multicentre, naturalistic and longitudinal research project financed by a catalan grant (“Pla Estratègic de Recerca i Innovació en Salut” - PERIS 2016–2018). Expedient Nº: SLT006/17/00345; entitled “Identificación y caracterización del valor predictivo de la reserva cognitiva en el curso evolutivo y respuesta en terapéutica en personas con un primer episodio psicótico”. 23 FEP patients and 72 healthy control (HC) were enrolled. The premorbid IQ was estimated with the Wechsler Adult Intelligence Scale (WAIS-IV) vocabulary subtest. To assess processing speed, Trail Making Test-part A was used. Sustained attention was tested with the Continuous Performance Test–II. The working memory was assessed with the Letters and Numbers Subtest of the WAIS-IV. Finally, the executive functions tested set shifting, planning and cognitive flexibility using the Tower of London task and the Trail Making Test (TMT) part B. Results Significant differences between the total CRASH score of patients and HC groups have been found. The patient group obtained lower scores compared to the HC group (36.66±16.01 vs 49.83±11.08, p&lt;0.001). After performing a logistic regression to assess the predictive power of CRASH for each group, the model correctly classified 83.2% of the cases (B=0.091; p&lt;0.001; Exp(B)=1.095). In FEP patients, the CRASH score was associated with premorbid IQ (p&lt;0.001), processing speed (p=0.005), executive function (TMT-B, p=0.005; London Tower task, p=0.039) and attention (CPT Hit SE ISI change, p=0.004). Specifically, the Education factor was associated with premorbid IQ, processing speed, working memory and executive function. The Occupation was only associated with executive function. Leisure activities factor was correlated with premorbid IQ and functioning. Finally, Sociability was correlated with psychosocial functioning and duration of untreated psychosis. In HC, CRASH was associated with premorbid IQ (p&lt;0.001) and attention (p=0.015). Education and Occupation factors were associated with premorbid IQ and attention; Leisure activities with processing speed; and sociability with attention. Discussion FEP patients were shown to have lower CR than HC, and CRASH correctly classified 83.2% of the sample. Each CRASH factor was associated with different outcome, which is why it can be interesting to analyze the total CRASH score and each factor separately. Patients with higher CR showed a better cognitive performance. Therefore, enhancing each factor involved in cognitive reserve may improve outcomes in FEP.

Neuropsychological Features of Asymptomatic c.709-1G>A Progranulin Mutation Carriers

2012 ◽  
Vol 18 (6) ◽  
pp. 1086-1090 ◽  
Author(s):  
Myriam Barandiaran ◽  
Ainara Estanga ◽  
Fermín Moreno ◽  
Begoña Indakoetxea ◽  
Ainhoa Alzualde ◽  
...  
Keyword(s):  
Trail Making Test ◽  
Neuropsychological Battery ◽  
Boston Naming Test ◽  
Prodromal Phase ◽  
Test Part ◽  
Mutation Carriers ◽  
Trail Making ◽  
Clinically Significant ◽  
Study Participants ◽  
Naming Test

AbstractMutations in the progranulin (PGRN) gene have been identified as a cause of frontotemporal dementia (FTD). However, little is known about the neuropsychological abilities of asymptomatic carriers of these mutations. The aim of the study was to assess cognitive functioning in asymptomatic c.709-1G>A PGRN mutation carriers. We hypothesized that poorer neuropsychological performance could be present before the development of clinically significant FTD symptoms. Thirty-two asymptomatic first-degree relatives of FTD patients carrying the c.709-1G>A mutation served as study participants, including 13 PGRN mutation carriers (A-PGRN+) and 19 non-carriers (PGRN-). A neuropsychological battery was administered. We found that the A-PGRN+ participants obtained significantly poorer scores than PGRN- individuals on tests of attention (Trail-Making Test Part A), mental flexibility (Trail-Making Test Part B), and language (Boston Naming Test). Poorer performance on these tests in asymptomatic PGRN mutation carriers may reflect a prodromal phase preceding the onset of clinically significant symptoms of FTD. (JINS, 2012, 18, 1086–1090)

Neuropsychological performance changes following subthalamic versus pallidal deep brain stimulation in Parkinson’s disease: a systematic review and metaanalysis

CNS Spectrums ◽  
2017 ◽  
Vol 23 (1) ◽  
pp. 10-23 ◽  
Author(s):  
Ahmed Elgebaly ◽  
Mohamed Elfil ◽  
Attia Attia ◽  
Mayar Magdy ◽  
Ahmed Negida
Keyword(s):  
Systematic Review ◽  
Deep Brain Stimulation ◽  
Verbal Fluency ◽  
Neuropsychological Performance ◽  
Trail Making Test ◽  
Test Part ◽  
Trail Making ◽  
Neuropsychological Outcomes ◽  
Naming Test ◽  
Deep Brain

BackgroundStudies comparing subthalamus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) for the management of Parkinson’s disease in terms of neuropsychological performance are scarce and heterogeneous. Therefore, we performed a systematic review and metaanalysis to compare neuropsychological outcomes following STN DBS versus GPi DBS.MethodsA computer literature search of PubMed, the Web of Science, and Cochrane Central was conducted. Records were screened for eligible studies, and data were extracted and synthesized using Review Manager (v. 5.3 for Windows).ResultsSeven studies were included in the qualitative synthesis. Of them, four randomized controlled trials (n=345 patients) were pooled in the metaanalysis models. The standardized mean difference (SMD) of change in the Stroop color-naming test favored the GPi DBS group (SMD=–0.31,p=0.009). However, other neuropsychological outcomes did not favor either of the two groups (Stroop word-reading:SMD=–0.21,p=0.08; the Wechsler Adult Intelligence Scale (WAIS) digits forward:SMD=0.08,p=0.47; Trail Making Test Part A:SMD=–0.05,p=0.65; WAIS–R digit symbol:SMD=–0.16,p=0.29; Trail Making Test Part B:SMD=–0.14,p=0.23; Stroop color–word interference:SMD=–0.16,p=0.18; phonemic verbal fluency: bilateral DBSSMD=–0.04,p=0.73, and unilateral DBSSMD=–0.05,p=0.83; semantic verbal fluency: bilateral DBSSMD=–0.09,p=0.37, and unilateral DBSSMD=–0.29,p=0.22; Boston Naming Test:SMD=–0.11,p=0.33; Beck Depression Inventory: bilateral DBSSMD=0.15,p=0.31, and unilateral DBSSMD=0.36,p=0.11).ConclusionsThere was no statistically significant difference in most of the neuropsychological outcomes. The present evidence does not favor any of the targets in terms of neuropsychological performance.

scholarly journals A-029 The Clinical Utility of the Trail Making Test- Part B Efficiency Score in a Memory Disorder Clinic

2020 ◽  
Vol 35 (6) ◽  
pp. 819-819
Author(s):  
Grueninger K ◽  
Yousif M ◽  
Denny A ◽  
Sohoni R ◽  
Webbe F ◽  
...  
Keyword(s):  
Clinical Utility ◽  
Clinical Information ◽  
Efficiency Score ◽  
Trail Making Test ◽  
Scoring Method ◽  
Memory Disorder ◽  
Test Part ◽  
Trail Making ◽  
Normal Cognition ◽  
B Efficiency

Abstract Objective Trail Making Test—Part B (TMTB) is a common neuropsychological instrument measuring aspects of executive functioning such as set shifting and cognitive flexibility. Typically, TMTB is discontinued if not completed within 300 seconds, limiting variability in interpretation for individuals who discontinue. This study aims to alleviate this limitation by examining whether a TMT-B Efficiency (TMT-Be) score can provide useful clinical information in a memory disorder clinic population. Methods TMTB was administered to 167 patients (101 females, 66 males) as part of a neuropsychological evaluation. Diagnostic groups included: Alzheimer’s Disease (AD; N = 83), Mild Cognitive Impairment (MCI; N = 58), and Normal Cognition (N = 26). Ages ranged from 65–94. Participants completed TMTB according to standardized instructions. TMT-Be scores accounted for time, number of errors, and number of incomplete moves. Results TMT-Be scores differed significantly across diagnostic groups (ANOVA, F (2, 164) = 44.81, p &lt; .001). Post-hoc tests using the Bonferroni correction revealed TMT-Be scores in the AD group (M = 17.48, SD = 9.23) were significantly higher than scores of the MCI group (M = 7.91, SD = 5.68) and WNL group (M = 4.65, SD = 1.67). Significant correlations between TMT-Be score and other neuropsychological measures were also found and will be presented and discussed. Conclusion Results support clinical utility of TMT-Be scores for diagnostic purposes, such as differential diagnosis of normal cognition, MCI, and AD. Further research with a larger number of participants and other populations may lend further support to the clinical utility of the TMT-Be scoring method.

A-104 Examining Methods of Executive Ability from Trail Making Test Part B in Retired Football Players

2021 ◽  
Vol 36 (6) ◽  
pp. 1153-1153
Author(s):  
Daniel W Lopez-Hernandez ◽  
Bethany A Nordberg ◽  
Alexis Bueno ◽  
Pavel Y Litvin ◽  
Amy Bichlmeier ◽  
...  
Keyword(s):  
Executive Functioning ◽  
Cognitive Deficits ◽  
Football Player ◽  
Group Differences ◽  
Football Players ◽  
Trail Making Test ◽  
Test Part ◽  
Trail Making ◽  
The Difference ◽  
Executive Ability

Abstract Introduction Repeated sports-related concussions have been associated with cognitive deficits, similar to other forms of traumatic brain injury. We investigated three different measures of executive ability derived from the Trail Making Test part B (TMT-B) in healthy comparison (HC) adults and retired football players. Methods The sample consisted of 32 HC, 15 retired football speed players (FSP; e.g., quarterbacks), and 53 retired football non-speed players (FNP) participants. Participants were administered both TMT part A (TMT-A) and TMT-B, and total time for completion was recorded. A series of ANCOVAs, controlling for age and education were conducted to evaluate group differences in executive abilities. Executive measures included the TMT-B raw score (i.e., seconds to complete TMT-B), the raw score difference (in seconds) between TMT-A and TMT-B (TMT-BA), and the difference between a predicted TMT-B score (TMT-BP) and the obtained TMT-B score (TMT-BBP). Correlations between TMT-B, TMT-BA, and TMT-BBP and other executive functioning tests (i.e., letter fluency and animal naming) were evaluated. Results Results revealed that the HC group outperformed both retired football player groups on all measures of executive ability derived from TMT-B, p’s &lt; 0.05, ηps2 = 0.18–0.45. Furthermore, the retired FNP TMT-B and TMT-BA were significantly correlated with both letter fluency and animal naming, r’s = −0.40 to −0.36, p’s &lt; 0.05. Discussion We found that the HC group outperformed both retired football player groups on all three TMT variables. In our retired FNP sample, more TMT variables correlated with executive functioning measures which suggests that TMT-B and TMT-BA are likely better measures of executive ability than TMT-BBP.

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