Sports psychiatry and medical views on mild traumatic brain injury in competitive sport: a current review and recommendations

Head injuries are common in competitive and recreational sport. Nomenclature, though inconsistent, identifies mild traumatic brain injury (mTBI) based on acute diagnostic criteria, whereas a sport-related concussion (SRC) is event-related and specific to mTBI experienced while participating in athletic activity. The effects of SRC are often neurological, neuropsychological and/or psychiatric with a variety of symptoms. Different organizations categorize these symptoms differently and this variance demonstrates that no uniform clinical classification system has been agreed upon. Diagnosis of SRC is based on clinical examination. Numerous symptom checklists and assessments are available for clinical diagnosis, but their validity is somewhat limited. There is increasing awareness regarding the psychiatric deficits associated with SRC and the potential for developing post-concussion syndrome (PCS). In addition to complex, causal SRC-associated symptoms, reactive psychological complaints may also occur, as well as social mistreatment on recovery from SRC. Pre-existing mental health conditions are associated with an increased risk for developing PCS. This often necessitates the implementation of psychiatric or psychotherapeutic care after SRC. As with mTBI and SRC, no standardized classification has been established for PCS. Multi-stage rehabilitation strategies can help injured athletes navigate a successful recovery and prevent premature return to play. Further research on the utility of psychotherapy, psychopharmacotherapy, and exercise therapy of PCS is needed. Key Words: Concussion, Mental Health, Post-Concussion Syndrome, Interdisciplinarity

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Identifying Frequency of Mild Traumatic Brain Injury in Firefighters

Workplace Health & Safety ◽

10.1177/2165079920922576 ◽

2020 ◽

Vol 68 (10) ◽

pp. 468-475 ◽

Cited By ~ 1

Author(s):

Victoria A. Torres ◽

Jordan E. Strack ◽

Sara Dolan ◽

Marc I. Kruse ◽

Michelle L. Pennington ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Assessment Tool ◽

Head Injuries ◽

Cross Sectional Study ◽

Depression Symptoms ◽

State University ◽

Cross Sectional ◽

Increased Risk

Background: Mild traumatic brain injury (mTBI) is a nationwide problem; yet, no firefighter mTBI data are available. Methods: In this cross-sectional study, we assessed retrospective head injuries using WHO guidelines. We captured mTBI frequency and examined firefighters’ symptoms (e.g., using Ohio State University Traumatic Brain Injury Identification method, Brief Traumatic Brain Injury Screen, Warrior Administered Retrospective Causality Assessment Tool). Findings: Of 1,112 firefighters contacted, 60 responses were included. Most participants were White (80%), male (90%), former athletes (75%). 62% met mTBI symptom criteria. 75% reported at least one lifetime head injury. Number of head injuries and depression symptoms were associated (r = .36, p < .05). Conclusion/application to practice: Overall, it appears most firefighters have sustained at least one lifetime mTBI. Those with multiple head injuries may be at increased risk of depression. Occupational health professionals should be aware of firefighters’ mTBI risk. Further research is warranted given findings.

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Concussion and Mild-Traumatic Brain Injury in Rural Settings: Epidemiology and Specific Health Care Considerations

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0039-3402581 ◽

2020 ◽

Vol 11 (01) ◽

pp. 023-033 ◽

Cited By ~ 2

Author(s):

John K. Yue ◽

Pavan S. Upadhyayula ◽

Lauro N. Avalos ◽

Ryan R L. Phelps ◽

Catherine G. Suen ◽

...

Keyword(s):

Health Care ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Health Care Disparities ◽

Return To Play ◽

Pubmed Database ◽

Increased Risk ◽

Rural Patients ◽

Specific Health

Abstract Background Mild-traumatic brain injury (mTBI) and concussions cause significant morbidity. To date, synthesis of specific health care disparities and gaps in care for rural mTBI/concussion patients remains needed. Methods A comprehensive literature search was performed using PubMed database for English articles with keywords “rural” and (“concussion” or “mild traumatic brain injury”) from 1991 to 2019. Eighteen articles focusing on rural epidemiology (n = 5), management/cost (n = 5), military (n = 2), and concussion prevention/return to play (n = 6) were included. Results mTBI/concussion incidence was higher in rural compared with urban areas. Compared with urban patients, rural patients were at increased risk for vehicular injuries, lifetime number of concussions, admissions for observation without neuroimaging, and injury-related costs. Rural patients were less likely to utilize ambulatory and mental health services following mTBI/concussion. Rural secondary schools had decreased access to certified personnel for concussion evaluation, and decreased use of standardized assessment instruments/neurocognitive testing. While school coaches were aware of return-to-play laws, mTBI/concussion education rates for athletes and parents were suboptimal in both settings. Rural veterans were at increased risk for postconcussive symptoms and posttraumatic stress. Telemedicine in rural/low-resource areas is an emerging tool for rapid evaluation, triage, and follow-up. Conclusions Rural patients are at unique risk for mTBI/concussions and health care costs. Barriers to care include lower socioeconomic status, longer distances to regional medical center, and decreased availability of neuroimaging and consultants. Due to socioeconomic and distance barriers, rural schools are less able to recruit personnel certified for concussion evaluation. Telemedicine is an emerging tool for remote triage and evaluation.

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Hyperbaric oxygen therapy for persistent post-concussion syndrome following mild traumatic brain injury

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd012727 ◽

2017 ◽

Author(s):

Yusuke Tsutsumi ◽

Ikuyo Tsutsumi ◽

Yasushi Tsujimoto ◽

Sei Takahashi ◽

Asuka Tsuchiya ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hyperbaric Oxygen ◽

Mild Traumatic Brain Injury ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Post Concussion Syndrome

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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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Incidence of head injury and traumatic brain injury among people with Alzheimer’s disease

Journal of Epidemiology & Community Health ◽

10.1136/jech-2018-211960 ◽

2019 ◽

Vol 73 (5) ◽

pp. 451-454 ◽

Cited By ~ 4

Author(s):

Sarianna Ilmaniemi ◽

Heidi Taipale ◽

Antti Tanskanen ◽

Jari Tiihonen ◽

Sirpa Hartikainen ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Head Injuries ◽

Community Dwelling ◽

University Hospital ◽

Health Concern ◽

Increased Risk

BackgroundInjuries caused by falling are a major health concern among older population. For older people, falls are the leading cause of head injuries; especially, persons with cognitive disorders have an increased risk of falling.ObjectiveTo compare the incidence of head injury and traumatic brain injury (TBI) among persons with Alzheimer’s disease (AD) with persons without AD.MethodsThis register-based study was conducted on a nationwide cohort, which includes all community-dwelling persons diagnosed with AD in Finland in 2005–2011. Persons with previous head injuries were excluded, leaving 67 172 persons with AD. For each person with AD, a matching person without AD and previous head injury were identified with respect to age, sex and university hospital district. The Cox proportional hazard model and competing risk analyses were used to estimate HR for head injury and TBI.ResultsPersons with AD had 1.34-fold (95% CI 1.29 to 1.40) risk of head injuries and 1.49-fold (95% CI 1.40 to 1.59) risk of TBIs after accounting for competing risks of death and full adjustment by socioeconomic status, drug use and comorbidities.ConclusionPersons with AD are more likely to have a head injury or TBI incident than persons without AD.

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