Mind the gaps—advancing research into short-term and long-term neuropsychological outcomes of youth sports-related concussions

Carman, Aaron J.; Ferguson, Rennie W.; Cantu, Robert C.; Comstock, R. Dawn; Dacks, Penny A.; DeKosky, Steven T.; Gandy, Sam; Gilbert, James E.; Gilliland, Chad; Gioia, Gérard A.; Giza, Christopher C.; Greicius, Michael D.; Hainline, Brian; Hayes, Ronald L.; Hendrix, James A.; Jordan, Barry; Kovach, James; Lane, Rachel; Mannix, Rebekah; Murray, Thomas H.; Seifert, Tad; Shineman, Diana W.; Warren, Eric; Wilde, Elisabeth A.; Willard, Huntington F.; Fillit, Howard

doi:10.1038/nrneurol.2015.30

Cited by 70 publications

(53 citation statements)

References 218 publications

(216 reference statements)

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“…These findings hint at the biological mechanisms underlying this observation. These findings are also consistent with the broader idea that concussions disrupt sensory processing (including in the auditory, visual, and somatosensory systems) concomitant to cognitive deficits32.…”

Section: Discussionsupporting

confidence: 88%

“…Temporal and frontal cortices are thought to be the areas of neocortex most susceptible to injury in concussions32, and mTBI may cause abnormal gain mechanisms for subcortical neural coding. Given links between F 0 strength and attention skills39, this may contribute to the poor pitch processing we observe and the broader phenotype of poor auditory processing in individuals with mTBI.…”

Section: Discussionmentioning

confidence: 99%

“…A concussion is a clinical diagnosis that requires a physician to evaluate a constellation of potential symptoms across multiple organ systems32. It is nearly impossible to predict how long a patient will suffer from a concussion—although many cases resolve within a few days, others last from months to years40.…”

Section: Discussionmentioning

confidence: 99%

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Auditory biological marker of concussion in children

Kraus

Thompson

Krizman

et al. 2016

Sci Rep

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Concussions carry devastating potential for cognitive, neurologic, and socio-emotional disease, but no objective test reliably identifies a concussion and its severity. A variety of neurological insults compromise sound processing, particularly in complex listening environments that place high demands on brain processing. The frequency-following response captures the high computational demands of sound processing with extreme granularity and reliably reveals individual differences. We hypothesize that concussions disrupt these auditory processes, and that the frequency-following response indicates concussion occurrence and severity. Specifically, we hypothesize that concussions disrupt the processing of the fundamental frequency, a key acoustic cue for identifying and tracking sounds and talkers, and, consequently, understanding speech in noise. Here we show that children who sustained a concussion exhibit a signature neural profile. They have worse representation of the fundamental frequency, and smaller and more sluggish neural responses. Neurophysiological responses to the fundamental frequency partially recover to control levels as concussion symptoms abate, suggesting a gain in biological processing following partial recovery. Neural processing of sound correctly identifies 90% of concussion cases and clears 95% of control cases, suggesting this approach has practical potential as a scalable biological marker for sports-related concussion and other types of mild traumatic brain injuries.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Auditory biological marker of concussion in children

Kraus

Thompson

Krizman

et al. 2016

Sci Rep

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show abstract

“…Similarly, mild traumatic brain injury (mTBI) was thought to result in only transient symptoms from single head exposure. However, several recent clinical studies have shown that even in the absence of diagnosed concussion, repeated 'mild' head exposures could lead to long-term progressive changes in white matter structure and abnormalities in functional magnetic resonance imaging (MRI) activation patterns [5][6][7][8][9]. It is known that the brain enters a state of metabolic depression after an injury [10].…”

Section: Introductionmentioning

confidence: 99%

Resonance of human brain under head acceleration

Laksari

Kurt

et al. 2015

J. R. Soc. Interface.

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Although safety standards have reduced fatal head trauma due to single severe head impacts, mild trauma from repeated head exposures may carry risks of long-term chronic changes in the brain's function and structure. To study the physical sensitivities of the brain to mild head impacts, we developed the first dynamic model of the skull-brain based on in vivo MRI data. We showed that the motion of the brain can be described by a rigid-body with constrained kinematics. We further demonstrated that skull-brain dynamics can be approximated by an under-damped system with a low-frequency resonance at around 15 Hz. Furthermore, from our previous field measurements, we found that head motions in a variety of activities, including contact sports, show a primary frequency of less than 20 Hz. This implies that typical head exposures may drive the brain dangerously close to its mechanical resonance and lead to amplified brain-skull relative motions. Our results suggest a possible cause for mild brain trauma, which could occur due to repetitive low-acceleration head oscillations in a variety of recreational and occupational activities.

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“…In the United States, there are an estimated 1.1 to 1.9 million sports-and recreation-related concussions among children ≤ 18 years old [1]. Children and adolescents appear more vulnerable to concussion than older athletes [2,3], and even mild injuries can affect the thinking, learning, behavior, and emotions of a child's developing brain [4,5].…”

Section: Introductionmentioning

confidence: 99%

Parents Take-On Concussion: Advances in Sideline Research and Culture in Youth Sports

Johnson¹

2017

J Sports Med Ther

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Identifying concussion and initiating removal from play is challenging for even the most diligent youth sports organizations. Empowering parents to implement removal from play protocols and sideline testing may be the most practical plan at community levels to protect young athletes. We developed paradigms for community-based youth sports teams that incorporated both standard concussion protocols and research investigations. The research studies were designed to determine how sideline tests of vision, cognition and balance augment the capacity for parents and other responsible adults to identify youth athletes with concussion in ice hockey, football, lacrosse and cheerleading. Research-based sideline tests were performed at pre-season baseline sessions and during the season at the time of injury or as soon as symptoms were recognized by trained volunteer parent team testers. The combination of standard concussion protocols and research studies were performed for 510 athletes, aged 5-17 years, over 2.5 years through 5 athletic seasons. To implement the protocols and studies, approximately 80 student volunteers and parents were educated and trained on early concussion recognition and on baseline and sideline test administration. Over 80% of parent-identifi ed head injuries were physician-confi rmed concussions. Of the sideline tests performed, over two-thirds were administered within 24 hours of injury; the rest were performed within an average of 2.6 days post-injury since some athletes had delayed development of symptoms. Removal from play guidelines and standard concussion evaluation protocols were maintained in the context of the sideline testing research investigations. Based on this observational study, parents of youth athletes can be successfully empowered to perform rapid sideline tests in the context of existing concussion protocols. Implementation of objective testing may improve concussion identifi cation and shift the culture of advocacy and responsibility towards parent groups to promote safety of young athletes. Ongoing investigations will further examine the impact of these programs on concussion management in youth sports.

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Mind the gaps—advancing research into short-term and long-term neuropsychological outcomes of youth sports-related concussions

Cited by 70 publications

References 218 publications

Auditory biological marker of concussion in children

Auditory biological marker of concussion in children

Resonance of human brain under head acceleration

Parents Take-On Concussion: Advances in Sideline Research and Culture in Youth Sports

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