Concussion As a Multi-Scale Complex System: An Interdisciplinary Synthesis of Current Knowledge

Abstract

Traumatic brain injury (TBI) has been called “the most complicated disease of the most complex organ of the body” and is an increasingly high-profile public health issue. Many patients report long-term impairments following even “mild” injuries, but reliable criteria for diagnosis and prognosis are lacking. Every clinical trial for TBI treatment to date has failed to demonstrate reliable and safe improvement in outcomes, and the existing body of literature is insufficient to support the creation of a new classification system. Concussion, or mild TBI, is a highly heterogeneous phenomenon, and numerous factors interact dynamically to influence an individual’s recovery trajectory. Many of the obstacles faced in research and clinical practice related to TBI and concussion, including observed heterogeneity, arguably stem from the complexity of the condition itself. To improve understanding of this complexity, we review the current state of research through the lens provided by the interdisciplinary field of systems science, which has been increasingly applied to biomedical issues. The review was conducted iteratively, through multiple phases of literature review, expert interviews, and systems diagramming and represents the first phase in an effort to develop systems models of concussion. The primary focus of this work was to examine concepts and ways of thinking about concussion that currently impede research design and block advancements in care of TBI. Results are presented in the form of a multi-scale conceptual framework intended to synthesize knowledge across disciplines, improve research design, and provide a broader, multi-scale model for understanding concussion pathophysiology, classification, and treatment.

Exploring Sex-Based Differences in Concussion Knowledge, Attitudes and Resources in Young First Nations Hockey Players: A Cross-Sectional Survey from Ontario, Canada

“…Traumatic brain injuries (TBI) are a growing health concern in Canada (Deepa, McFaull, Thompson, & Gayatri, 2018;Karmali et al, 2005). A concussion is also termed a mild TBI; however, it is a complicated syndrome of microsturural injury and functional impairment (Kenzie et al, 2017;Topolovec-Vranic et al, 2015). New animal models and imaging studies are beginning to show that metabolic and neurovascular resolution may actually take longer than symptomatic recovery (Kamins & Giza, 2016).…”

Change, Challenge, and Prospects for a Diversity Paradigm in Social Psychology

“…As Kenzie et al. () explain, “Complex systems often have many interrelated components at multiple scales and demonstrate non‐linearity, feedback, dynamic change, and emergent properties ….To take a systems approach, one must identify all relevant factors or variables in a system, articulate the relationships between those variables, and acknowledge system boundaries” (p. 5). Our current approach to diversity draws upon the work of Plaut () and others (e.g., Apfelbaum, Phillips, & Richeson, ; Galinsky et al., ; Richeson & Sommers, ) and focuses on four key ways a diversity framework should build upon and expand traditional social psychological approaches to intergroup relations.…”

“…A diversity paradigm fundamentally represents a systems view of relations between groups. As Kenzie et al (2017) explain, "Complex systems often have many interrelated components at multiple scales and demonstrate non-linearity, feedback, dynamic change, and emergent properties . .…”

Concussion Evaluation and Management: An Osteopathic Perspective

“…2 Loss of consciousness, once considered a hallmark of concussion, is now found to be featured in less than 14% of cases. 7 Certain factors, such as history of concussion, female gender, younger age, attention-deficit/hyperactivity disorder, psychiatric comorbidity, and prolonged loss of consciousness are associated with prolonged recovery. 8 The sports concussion assessment tool, produced at the international conference on concussion in sport, is sensitive and specific for concussion identification.…”