Dynamic Visual Stimulations Produced in a Controlled Virtual Reality Environment Reveals Long-Lasting Postural Deficits in Children With Mild Traumatic Brain Injury

Motor control deficits outlasting self-reported symptoms are often reported following mild traumatic brain injury (mTBI). The exact duration and nature of these deficits remains unknown. The current study aimed to compare postural responses to static or dynamic virtual visual inputs and during standard clinical tests of balance in 38 children between 9 and 18 years-of-age, at 2 weeks, 3 and 12 months post-concussion. Body sway amplitude (BSA) and postural instability (vRMS) were measured in a 3D virtual reality (VR) tunnel (i.e., optic flow) moving in the antero-posterior direction in different conditions. Measures derived from standard clinical balance evaluations (BOT-2, Timed tasks) and post-concussion symptoms (PCSS-R) were also assessed. Results were compared to those of 38 healthy non-injured children following a similar testing schedule and matched according to age, gender, and premorbid level of physical activity. Results highlighted greater postural response with BSA and vRMS measures at 3 months post-mTBI, but not at 12 months when compared to controls, whereas no differences were observed in post-concussion symptoms between mTBI and controls at 3 and 12 months. These deficits were specifically identified using measures of postural response in reaction to 3D dynamic visual inputs in the VR paradigm, while items from the BOT-2 and the 3 timed tasks did not reveal deficits at any of the test sessions. PCSS-R scores correlated between sessions and with the most challenging condition of the BOT-2 and as well as with the timed tasks, but not with BSA and vRMS. Scores obtained in the most challenging conditions of clinical balance tests also correlated weakly with BSA and vRMS measures in the dynamic conditions. These preliminary findings suggest that using 3D dynamic visual inputs such as optic flow in a controlled VR environment could help detect subtle postural impairments and inspire the development of clinical tools to guide rehabilitation and return to play recommendations.

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Reactive balance responses after mild traumatic brain injury (mTBI): a scoping review

10.1101/2020.12.17.20248433 ◽

2020 ◽

Author(s):

Amanda Morris ◽

Tallie Casucci ◽

Mary M. McFarland ◽

Ben Cassidy ◽

Ryan Pelo ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Scoping Review ◽

Quantitative Measure ◽

Cognitive Testing ◽

Cochrane Library ◽

Future Research ◽

Postural Response ◽

Postural Responses

AbstractBackgroundBalance testing after concussion or mild traumatic brain injury (mTBI) can be useful in determining acute and chronic neuromuscular deficits that are unapparent from symptom scores or cognitive testing alone. However, current assessments of balance do not comprehensively evaluate all three classes of balance: maintaining a posture, voluntary movement, and reactive postural response. Despite the utility of reactive postural responses in predicting fall risk in other balance impaired populations, the effect of mTBI on reactive postural responses remains unclear.PurposeTo (1) examine the extent and range of available research on reactive postural responses in people post-mTBI and (2) determine if reactive postural responses (balance recovery) are affected by mTBI.Study DesignScoping review.MethodsStudies were identified using Medline, Embase, CINAHL, Cochrane Library, Dissertations and Theses Global, PsycINFO, SportDiscus, and Web of Science. Inclusion criteria were: injury classified as mTBI with no confounding central or peripheral nervous system dysfunction beyond those stemming from the mTBI, quantitative measure of reactive postural response, and a discrete, externally driven perturbation was used to test reactive postural response.ResultsA total of 4,247 publications were identified and a total of two studies (4 publications) were included in the review.ConclusionThe limited number of studies available on this topic highlight the lack of knowledge on reactive postural responses after mTBI. This review provides a new direction for balance assessments after mTBI and recommends incorporating all three classes of postural control in future research.

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Elevated levels of serum, but not salivary, brain-derived neurotrophic factor following mild traumatic brain injury in collegiate athletes post return-to-play

Journal of Concussion ◽

10.1177/2059700219894108 ◽

2019 ◽

Vol 3 ◽

pp. 205970021989410

Author(s):

Taylor R Susa ◽

Ryan D Brandt ◽

Keara J Kangas ◽

Catherine E Bammert ◽

Erich N Ottem ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Neurotrophic Factor ◽

Collegiate Athletes ◽

Brain Derived Neurotrophic Factor ◽

Return To Play ◽

Control Group ◽

The Relationship ◽

Serum Bdnf

Brain-derived neurotrophic factor (BDNF) helps restore neuronal function following mild traumatic brain injury. BDNF levels can be obtained in blood serum and more recently in saliva. However, the relationship between serum and salivary BDNF is poorly understood—especially in relation to alterations in BDNF levels following mild traumatic brain injury. In this study, serum and salivary BDNF were collected from a sample of 42 collegiate student athletes. Half of the participants were recently cleared by a physician and/or an athletic trainer to return-to-play after experiencing a sports-related concussion. The other half had not experienced a concussion within the past year and were matched by age, sex, sport, and time of sample. Results suggest that incidences of depression, anxiety, and stress were all elevated in the concussion group, relative to the control participants. When controlling for stress-related negative affect, serum BDNF was elevated in the concussion group. However, there was no difference in salivary BDNF. Serum and salivary BDNF were uncorrelated across the entire sample. Yet, these measures of BDNF were correlated in the concussion group, but not the control group. In sum, serum BDNF is elevated in concussion post return-to-play; however, further research is needed to explore the utility of salivary BDNF following concussion.

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Developing return-to-play guidelines following mild traumatic brain injury

Journal of Science and Medicine in Sport ◽

10.1016/s1440-2440(03)80277-3 ◽

2003 ◽

Vol 6 (4) ◽

pp. 519-520

Author(s):

M Stevenson

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Return To Play

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Virtual reality treatment for complicated mild traumatic brain injury: A case study

2017 International Conference on Virtual Rehabilitation (ICVR) ◽

10.1109/icvr.2017.8007475 ◽

2017 ◽

Author(s):

Anne-Marie Lambert ◽

Emily H. Sinitski ◽

Courtney Bridgewater

Keyword(s):

Traumatic Brain Injury ◽

Virtual Reality ◽

Brain Injury ◽

Mild Traumatic Brain Injury

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TEMPORAL WINDOW OF METABOLIC BRAIN VULNERABILITY TO CONCUSSION

Neurosurgery ◽

10.1227/01.neu.0000316421.58568.ad ◽

2008 ◽

Vol 62 (6) ◽

pp. 1286-1296 ◽

Cited By ~ 79

Author(s):

Roberto Vagnozzi ◽

Stefano Signoretti ◽

Barbara Tavazzi ◽

Roberto Floris ◽

Andrea Ludovici ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Magnetic Resonance ◽

Mild Traumatic Brain Injury ◽

Mr Spectroscopy ◽

Complete Resolution ◽

Return To Play ◽

Temporal Window ◽

1H Mr Spectroscopy ◽

Metabolic Recovery

ABSTRACT OBJECTIVE In the present study, the occurrence of the temporal window of brain vulnerability was evaluated in concussed athletes by measuring N-acetylaspartate (NAA) using proton magnetic resonance (1H-MR) spectroscopy. METHODS Thirteen nonprofessional athletes who had a sport-related concussive head injury were examined for NAA determination by means of 1H-MR spectroscopy at 3, 15, and 30 days postinjury. All athletes but three suspended their physical activity. Those who continued their training had a second concussive event and underwent further examination at 45 days from the initial injury. The single case of one professional boxer, who was studied before the match and 4, 7, 15, and 30 days after a knockout, is also presented. Before each magnetic resonance examination, patients were asked for symptoms of mild traumatic brain injury, including physical, cognitive, emotional, and sleep disturbances. Data for 1H-MR spectroscopy recorded in five normal, age-matched, control volunteers, who were previously screened to exclude previous head injuries, were used for comparison. Semiquantitative analysis of NAA relative to creatine (Cr)- and choline (Cho)-containing compounds was performed from proton spectra obtained with a 3-T magnetic resonance system. RESULTS Regarding the values of the NAA-to-Cr ratio (2.21 ± 0.11) recorded in control patients, singly concussed athletes, at 3 days after the concussion, showed a decrease of 18.5% (1.80 ± 0.04; P < 0.001). Only a modest 3% recovery was observed at 15 days (1.88 ± 0.1; P < 0.001); at 30 days postinjury, the NAA-to-Cr ratio was 2.15 ± 0.1, revealing full metabolic recovery with values not significantly different from those of control patients. These patients declared complete resolution of symptoms at the time of the 3-day study. The three patients who had a second concussive injury before the 15-day study showed an identical decrease of the NAA-to-Cr ratio at 3 days (1.78 ± 0.08); however, at 15 days after the second injury, a further diminution of the NAA-to-Cr ratio occurred (1.72 ± 0.07; P < 0.05 with respect to singly concussed athletes). At 30 days, the NAA-to-Cr ratio was 1.82 ± 0.1, and at 45 days postinjury, the NAA-to-Cr ratio showed complete recovery (2.07 ± 0.1; not significant with respect to control patients). This group of patients declared a complete resolution of symptoms at the time of the 30-day study. CONCLUSION Results of this pilot study carried out in a cohort of singly and doubly concussed athletes, examined by 1H-MR spectroscopy for their NAA cerebral content at different time points after concussive events, demonstrate that also in humans, concussion opens a temporal window of brain metabolic imbalance, the closure of which does not coincide with resolution of clinical symptoms. The recovery of brain metabolism is not linearly related to time. A second concussive event prolonged the time of NAA normalization by 15 days. Although needing confirmation in a larger group of patients, these results show that NAA measurement by 1H-MR spectroscopy is a valid tool in assessing the full cerebral metabolic recovery after concussion, thereby suggesting its use in helping to decide when to allow athletes to return to play after a mild traumatic brain injury.

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Physical Therapy Management of Adults with Mild Traumatic Brain Injury

Seminars in Speech and Language ◽

10.1055/s-0038-1676652 ◽

2019 ◽

Vol 40 (01) ◽

pp. 036-047 ◽

Cited By ~ 2

Author(s):

Deborah Diaz ◽

Carolyn Moore ◽

Ashley Kane

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Physical Therapists ◽

Physical Therapist ◽

Exercise Program ◽

Semicircular Canals ◽

Return To Play ◽

Home Exercise ◽

Motion Sensitivity

AbstractRehabilitation for individuals after mild traumatic brain injury (mTBI) or concussion requires emphasis on both cognitive and physical rest, with a gradual return to activity including sports. As the client becomes more active, the rehabilitation professional should pay close attention to symptoms associated with mTBI, such as headache, dizziness, nausea, and difficulty concentrating. The systematic approach to return to play provided by the Berlin Consensus Statement on Concussion in Sport can apply to adults with mTBI. This protocol calls for gradually increasing the intensity of physical activity while attending to postconcussion symptoms. During the incident that led to an mTBI, the injured individual may incur injuries to the vestibular and balance system that are best addressed by professionals with specific training in vestibular rehabilitation, most commonly physical therapists. Benign paroxysmal positional vertigo is a condition in which otoconia particles in the inner ear dislodge into the semicircular canals, resulting in severe vertigo and imbalance. This condition frequently resolves in a few sessions with a vestibular physical therapist. In conditions such as gaze instability, motion sensitivity, impaired postural control, and cervicogenic dizziness, improvement is more gradual and requires longer follow-up with a physical therapist and a home exercise program. In all of the above-stated conditions, it is essential to consider that a patient with protracted symptoms of mTBI or postconcussion syndrome will recover more slowly than others and should be monitored for symptoms throughout the intervention.

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