Is balance performance reduced after mild traumatic brain injury?: Interim analysis from chronic effects of neurotrauma consortium (CENC) multi-centre study

Walker, William C.; Nowak, Kayla; Kenney, Kimbra; Franke, Laura Manning; Eapen, Blessen C.; Skop, Karen; Levin, Harvey S.; Agyemang, Amma A.; Tate, David F.; Wilde, Elisabeth A.; Hinds, Sidney; Nolen, Tracy L.

doi:10.1080/02699052.2018.1483529

Cited by 16 publications

(18 citation statements)

References 50 publications

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“…The relationship between concussion and lower extremity injury has been extensively studied in the sports medicine literature, 10 , 15 , 16 with a number of hypotheses for the underlying mechanism, including resultant deficiencies in dynamic balance, neuromuscular control, cognitive accuracy, and gait performance. 4 , 14 , 27 , 31 , 40 This observation is corroborated by our study, which identified a concussion history as a significant risk factor in both the multivariate logistic regression and the machine learning models. Finally, an interesting protective correlation was identified between 3-point attempt rate and risk of lower extremity injury.…”

Section: Discussionsupporting

confidence: 84%

Machine Learning for Predicting Lower Extremity Muscle Strain in National Basketball Association Athletes

Pareek

Lavoie-Gagne

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: In professional sports, injuries resulting in loss of playing time have serious implications for both the athlete and the organization. Efforts to quantify injury probability utilizing machine learning have been met with renewed interest, and the development of effective models has the potential to supplement the decision-making process of team physicians. Purpose/Hypothesis: The purpose of this study was to (1) characterize the epidemiology of time-loss lower extremity muscle strains (LEMSs) in the National Basketball Association (NBA) from 1999 to 2019 and (2) determine the validity of a machine-learning model in predicting injury risk. It was hypothesized that time-loss LEMSs would be infrequent in this cohort and that a machine-learning model would outperform conventional methods in the prediction of injury risk. Study Design: Case-control study; Level of evidence, 3. Methods: Performance data and rates of the 4 major muscle strain injury types (hamstring, quadriceps, calf, and groin) were compiled from the 1999 to 2019 NBA seasons. Injuries included all publicly reported injuries that resulted in lost playing time. Models to predict the occurrence of a LEMS were generated using random forest, extreme gradient boosting (XGBoost), neural network, support vector machines, elastic net penalized logistic regression, and generalized logistic regression. Performance was compared utilizing discrimination, calibration, decision curve analysis, and the Brier score. Results: A total of 736 LEMSs resulting in lost playing time occurred among 2103 athletes. Important variables for predicting LEMS included previous number of lower extremity injuries; age; recent history of injuries to the ankle, hamstring, or groin; and recent history of concussion as well as 3-point attempt rate and free throw attempt rate. The XGBoost machine achieved the best performance based on discrimination assessed via internal validation (area under the receiver operating characteristic curve, 0.840), calibration, and decision curve analysis. Conclusion: Machine learning algorithms such as XGBoost outperformed logistic regression in the prediction of a LEMS that will result in lost time. Several variables increased the risk of LEMS, including a history of various lower extremity injuries, recent concussion, and total number of previous injuries.

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Section: Discussionsupporting

confidence: 84%

Machine Learning for Predicting Lower Extremity Muscle Strain in National Basketball Association Athletes

Pareek

Lavoie-Gagne

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…Worsened visuomotor integration (by Trail Making Test TMT-B) has been reported in Service members and Veterans with mTBI (24). A separate study, using the Sensory Organization Test, reported chronic development of balance deficits and projected more frequent or severe deficits in Veterans with repetitive mTBI, as compared to those with single mTBI exposure (79). Some preclinical studies using the staircase test and neurological severity score failed to find motor deficits after LIB-induced mTBI (52,80).…”

Section: Motor Functionsmentioning

confidence: 99%

Perspectives on Primary Blast Injury of the Brain: Translational Insights Into Non-inertial Low-Intensity Blast Injury

et al. 2022

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Most traumatic brain injuries (TBIs) during military deployment or training are clinically “mild” and frequently caused by non-impact blast exposures. Experimental models were developed to reproduce the biological consequences of high-intensity blasts causing moderate to severe brain injuries. However, the pathophysiological mechanisms of low-intensity blast (LIB)-induced neurological deficits have been understudied. This review provides perspectives on primary blast-induced mild TBI models and discusses translational aspects of LIB exposures as defined by standardized physical parameters including overpressure, impulse, and shock wave velocity. Our mouse LIB-exposure model, which reproduces deployment-related scenarios of open-field blast (OFB), caused neurobehavioral changes, including reduced exploratory activities, elevated anxiety-like levels, impaired nesting behavior, and compromised spatial reference learning and memory. These functional impairments associate with subcellular and ultrastructural neuropathological changes, such as myelinated axonal damage, synaptic alterations, and mitochondrial abnormalities occurring in the absence of gross- or cellular damage. Biochemically, we observed dysfunctional mitochondrial pathways that led to elevated oxidative stress, impaired fission-fusion dynamics, diminished mitophagy, decreased oxidative phosphorylation, and compensated cell respiration-relevant enzyme activity. LIB also induced increased levels of total tau, phosphorylated tau, and amyloid β peptide, suggesting initiation of signaling cascades leading to neurodegeneration. We also compare translational aspects of OFB findings to alternative blast injury models. By scoping relevant recent research findings, we provide recommendations for future preclinical studies to better reflect military-operational and clinical realities. Overall, better alignment of preclinical models with clinical observations and experience related to military injuries will facilitate development of more precise diagnosis, clinical evaluation, treatment, and rehabilitation.

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“…Multiple cohort and case-control studies and systematic reviews of moderate-quality evidence found potential motor function impairments that may be present after a concussive event, including impairments in static and dynamic balance, dual-task/multitasking gait activities, and motor coordination with complex movement tasks, which may or may not correlate with symptom reports. 11,13,20,21,44,49,58,59,68,86,89,90,[93][94][95]100,144,154,183,190,195,218,221,223…”

Section: IIImentioning

confidence: 99%

“…Multiple case series and retrospective analyses indicate that subtle, subclinical motor function impairments (eg, postural control/sway metrics or sensory integration ability) may persist beyond the presence of easily observable and detectable impairments (eg, balance tests). 28,180,200,207,221…”

Section: IVmentioning

confidence: 99%

Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury

Quatman‐Yates¹,

Hunter‐Giordano²,

Shimamura³

et al. 2020

Journal of Orthopaedic & Sports Physical Therapy

108

100

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Physical therapists must screen all individuals who have experienced a potential concussive event and document the presence or absence of symptoms, impairments, and functional limitations that may relate to a concussive event. Screening for Indicators of Emergency ConditionsA Physical therapists must screen patients who have experienced a recent potential concussive event for signs of medical emergency or severe pathology (eg, more serious brain injury, medical conditions, or cervical spine injury) that warrant further evaluation by other health care providers. Referral for further evaluation should be made as indicated (FIGURE 1). Differential DiagnosisA Physical therapists must evaluate for potential signs and symptoms of an undiagnosed concussion in patients who have experienced a concussive event but have not been diagnosed with concussion. Evaluation should include triangulation of information from patient/family/witness reports, the patient's past medical history, physical observation/examination, and the use of an age-appropriate symptom scale/checklist (see FIGURE 1 for diagnostic criteria).

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Is balance performance reduced after mild traumatic brain injury?: Interim analysis from chronic effects of neurotrauma consortium (CENC) multi-centre study

Abstract: These findings show that repeated mTBI, partially mediated by pain, may lead to later balance disturbances among military combatants. Further study of CDP outcomes within this accruing cohort is warranted.

Cited by 16 publications

References 50 publications

Machine Learning for Predicting Lower Extremity Muscle Strain in National Basketball Association Athletes

Machine Learning for Predicting Lower Extremity Muscle Strain in National Basketball Association Athletes

Perspectives on Primary Blast Injury of the Brain: Translational Insights Into Non-inertial Low-Intensity Blast Injury

Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury

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