Concussions in Ice Hockey — Moving Toward Objective Diagnoses and Point-of-care Treatment: A Review

Abstract

The incidence of sport-related concussion coupled with a doubling of the participation rate in youth hockey over the past two decades provides impetus for the review of the most promising concussion treatment options. This narrative review summarizes the future treatment options for sport-related concussions in ice hockey, while acknowledging their generalizability to concussion in all sports. Symptom assessment, sign observation, as well as cognitive and balance testing, have historically been used to diagnose a concussion. These methods continue to improve, but the need for effective treatments is clear. Pharmacologic, transcranial light, and nutritional supplement treatment options for concussion warranting further investigation have been identified. Dimethyl fumarate is an immunomodulatory compound thought to trigger antioxidant gene expression. Memantine reduces apoptosis and astrogliosis by inhibiting the calcium influx into cells normally caused by glutamate's activation of N-methyl-d-aspartate receptors. Thioredoxin-mimetic peptides and transcranial photobiomodulation temper the effects of the energy crisis by acting as free radical scavengers. In addition, seven neuroprotective nutritional supplements have been identified: berberine, creatine, curcumin, melatonin, omega-3 fatty acids, resveratrol, and vitamins. An estimated US $1.1 billion has been spent on unsuccessful traumatic brain injury clinical trials. As our ability to accurately diagnose concussion improves, dimethyl fumarate, memantine, thioredoxin-mimetic peptides, transcranial photobiomodulation, and nutritional supplements (berberine, creatine, curcumin, melatonin, omega-3 fatty acids, resveratrol, and vitamins) warrant further preclinical and clinical examination in advancing the treatment of sport-related concussions.

Effects of Creatine Supplementation on Brain Function and Health

“…Although the current body of research is limited, the utilization of creatine in the protection and management of concussion and mild traumatic brain injury (mTBI) has been noted as a particular area of interest [ 5 , 11 , 18 , 132 , 133 , 134 , 135 , 136 ]. The current treatment options to address physiological dysfunction following concussion and mTBI is limited to aerobic exercise treatment; however, creatine is postulated to be another option which could address aspects of the neurometabolic cascade associated with a concussion or mTBI [ 137 , 138 ].…”

Reducing the Sports Injury Through Function Movement Biological Image Data Screening

“…Before the test, we explained to the athletes FMS TM seven test action requirements in detail and performed action demonstrations so that all athletes are familiar with the action's essentials. 3 Except for the password, there was no test-related feedback (score and deduction points) during the two tests. Three attempts are allowed for each test action, with about 10s between each attempt and an interval of about 60s between each test action.…”

Brain Vital Signs in Elite Ice Hockey: Towards Characterizing Objective and Specific Neurophysiological Reference Values for Concussion Management

“…Subjective symptom assessment remains important and can play a major role in treatment programs such as those that incorporate exercise as medicine ( Leddy et al, 2018 ). However, there is an increasing movement to combine these assessments with objective, neurophysiological measures of concussion in order to better quantify injury severity and monitor change over time ( Smith et al, 2017 ; Pender et al, 2020 ). Recently, studies have demonstrated the ability of rapid objective assessments based on electroencephalography (EEG) that show high sensitivity and specificity to detecting concussion and concussion-related neurological changes ( Boshra et al, 2019 ; Fickling et al, 2019b ; Bazarian et al, 2021 ).…”