Consideration of a Neuromotor Concussion Subtype

A recent Consensus Conference proposed subtyping concussive injuries into 5 categories. We propose adding a neuromotor subtype. Abnormal motion is a key feature of brain injury, as concussions can impact the neurological systems controlling gait. Neuromotor function can remain abnormal after symptom resolution and may be superior to self-report for tracking recovery. Neuromotor function can also define co-occurring orthopedic injuries and reveal vulnerabilities which could reduce injury risk

Diagnosed and Nondisclosed Sport-Related Concussion: An Exploratory Comparison Study by ADHD Status in Collegiate Athletes

Objective: To determine if ADHD status in collegiate athletes was associated with differences in the number of diagnosed and nondisclosed sport-related concussions, and reasons why suspected concussive injuries were not reported. Method: A cross-sectional survey was completed by 858 collegiate athletes (65 with ADHD; 793 without ADHD). The survey included self-report items regarding ADHD status and histories of diagnosed and nondisclosed sport-related concussions. Groups were matched for gender, age, and sport with a ratio of one participant with ADHD to four without ADHD. Results: Collegiate athletes with ADHD reported significantly more diagnosed sport-related concussions and were more likely to have a history of diagnosis compared to those without ADHD. There were no significant differences between groups regarding sport-related concussion nondisclosure history. Conclusion: Collegiate athletes with ADHD have an increased prevalence rate of diagnosed sport-related concussions compared to those without ADHD; however, this developmental disorder may not influence injury nondisclosure decisions.

Traumatic brain injury risk assessment with smart technology

Mild traumatic brain injuries (mTBIs) continue to burden our warfighters. The high-tech industry has delivered wearable Micro-Electro-Mechanical System (MEMS) head-impact sensors to monitor impact forces. So far, these MEMS sensors have categorically failed to detect mTBIs and are therefore of no clinical utility for diagnosis. Our recent studies have shown that human head kinematics is anisotropic with respect to pitch–roll–yaw degrees of freedom of the head and neck. In the present project, we generated head acceleration datasets on non-injurious impacts and mTBI events based on mean values from the literature. We then augmented the simulated data with pitch–roll–yaw information followed by machine learning with a Classification and Regression Tree analysis. Our results revealed that head angular acceleration in pitch is the best predictor. More than 81.3 % of concussive injuries had head angular accelerations in pitch exceeding 3527 rad/s2. Out of 18.6% of concussive injuries with head angular accelerations in pitch under 3527 rad/s2, 75% of these cases had head angular accelerations in roll exceeding 1679 rad/s2. This study shows that artificial intelligence and machine learning should be able to provide accurate identification of subject-specific concussive thresholds in real time and in the field, thereby moving concussion diagnosis toward precision medicine.

Engaging Athletic Trainers in Concussion Detection: Overview of the National Football League ATC Spotter Program, 2011–2017

Objective To assist sideline medical staff and to augment detection of concussion in National Football League (NFL) players during preseason and regular season games via the use of certified athletic trainer (ATC) spotters. Background Detecting concussive injuries in contact-sport athletes can be a challenging task for health care providers on the sideline. Over the past 8 years, professional sport leagues have begun to use additional sets of eyes (medical spotters along with video review) to help identify athletes with possible concussive injuries. Description The NFL first began a program using spotters in 2011, and the ATC Spotter Program has undergone systematic enhancements each year. This article describes the evolution of the ATC Spotter Program, the requirements and training of its participants, and the program data available to date. Directions for future improvement and research are addressed. Clinical Advantages The use of ATC spotters stationed in the broadcast booth has enhanced the real-time detection of concussed players in the NFL.

The Effect of Concussions on the Emotion Regulation Processes of Martial Arts Athletes

Purpose To identify differences in the use of cognitive emotion regulation strategies between martial artists who sustained concussive injuries and their control teammates. Methods Athletes (9 concussed, 10 controls) from martial arts teams completed the cognitive emotion regulation questionnaire (CERQ) and rated pictures from the International Affective Pictures System (IAPS) using the self-assessment manikin (SAM). Athletes actively participating in martial arts were recruited directly from their team 9 months (280.67±85.59 days) following a concussion. Athletes with a diagnosis of neurologic disorder were excluded form the analysis. Results Athletes with a history of concussion reported catastrophizing (p=.007) significantly less often and reported putting things in perspective (p=.04) more often than controls when faced with a negative event. While viewing neutral (p=.05) and negative (p=.03) pictures, athletes with a history of concussion rated pictures as more positive than controls did. They also felt more in control than non-concussed athletes while viewing positive (p=.008), neutral (p=.01), and negative (p=.05) pictures. Conclusion Martial artists reporting concussive injuries appear to diverge from non-concussed teammates in their emotion regulation processes. This group difference could be explained by greater affect intensity and surgency for the concussed group and greater emotional control and leveling of positive affect for the control group. Altered affective report following concussion may be related to more general impairments in socio-emotional functioning. Additional research is necessary to better understand how those alterations evolve over time and in relation with subsequent concussive injuries.

Abnormal Motor Response Associated With Concussive Injuries: Biomechanical Comparison Between Impact Seizures and Loss of Consciousness

Context Loss of consciousness (LOC) and impact seizures associated with concussion represent different clinical presentations of concussion; however, they are often investigated and treated similarly. The biomechanical parameters differentiating these 2 distinct signs of injury are poorly described. Objective To differentiate between cases of concussions with LOC and those with impact seizures by comparing the impact velocity, peak linear and peak rotational acceleration, as well as brain tissue deformation in the cerebral cortex, white matter, brainstem, cerebellum, thalamus, and corpus callosum. Design Descriptive laboratory study. Patients or Other Participants Elite American football players who sustained an LOC (n = 20) or impact seizures (n = 21). Main Outcome Measure(s) Impact velocity, peak linear and peak rotational acceleration, maximum principal strain, cumulative strain damage measure at 10%, and strain rate (SR). Results The SR in the cerebral white matter was greater in the LOC group than in the impact-seizure group. Similar trends were observed for SRs in the cerebral cortex, brainstem, and corpus callosum. No differences were present between groups for the other variables in this study. Conclusions A lower SR in certain brain regions helps to explain why motor function is preserved and can be observed in patients with impact seizures versus LOC from concussive injuries.

The Role of Speech-Language Pathology in an Interdisciplinary Care Model for Persistent Symptomatology of Mild Traumatic Brain Injury

The Marcus Institute for Brain Health (MIBH) provides interdisciplinary care for adults struggling with persistent effects of mild traumatic brain injury and accompanying changes in behavioral health, with specific emphases on Veterans and retired elite athletes. The cognitive, physical, and behavioral symptoms associated with mild traumatic brain injury are interrelated, with neurobiopsychosocial modeling encompassing the factors related to recovery from a traumatic brain injury. The diffuse impacts of chronic concussive injuries require multiple clinical providers to address the breadth of symptoms, facilitating both interdisciplinary and transdisciplinary care models. By implementing integrated practice units, patients receive advanced medical care, imaging, speech-language pathology, physical therapy, behavioral health, neuropsychology, and clinical pharmacy for a cohesive diagnostic and intervention plan. Nationally, speech-language pathologists report challenges with best-practice options for concussion, particularly in the domain of assessment practices. At the MIBH, speech-language pathologists begin their assessment with a structured clinical interview that focuses on patients' needs and concerns. Evaluation modalities focus on hearing, communication, and functional cognition to guide therapeutic treatment planning. The intensive outpatient care program at MIBH incorporates both individual sessions targeting patient-centered goals and group care, where speech-language pathologists work transdisciplinarily to generalize care from all disciplines out into the community. Care practices for concussive injuries continue to evolve rapidly; speech-language pathology at the MIBH offers one such vision for excellence in clinical care.