Preliminary Evidence of Orthostatic Intolerance and Altered Cerebral Vascular Control Following Sport-Related Concussion

Worley, Morgan L.; O'Leary, Morgan C.; Sackett, James R.; Schlader, Zachary J.; Willer, Barry; Leddy, John J.; Johnson, Blair D.

doi:10.3389/fneur.2021.620757

Cited by 11 publications

(4 citation statements)

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“…More pronounced reductions in PETCO 2 may have occurred during LBNP if we did not add CO 2 to the inspirate. We previously observed ∼5 mmHg decrease in PETCO 2 during 5 min of LBNP in healthy men and women ( Worley et al, 2021 ). Despite reductions in mean arterial pressure and PETCO 2 , MCAv was maintained throughout LBNP at pre- and post-BRJ ingestion ( Figure 5C ).…”

Section: Discussionmentioning

confidence: 90%

“…To attenuate reductions in PETCO 2 that can be observed during LBNP, participants inhaled a mild hypercapnic gas (FiCO 2 : 0.03, FiO 2 : 0.21, FiN 2 : 0.76) during baseline and throughout the duration of testing. Our lab has previously demonstrated that LBNP set to −40 mmHg for 5 min reduces PETCO 2 by 5 ± 3 mmHg in healthy, young adults ( Worley et al, 2021 ), which likely influences cerebrovascular responses to LBNP. However, elevated FiCO 2 can also impair CA.…”

Section: Methodsmentioning

confidence: 99%

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Acute beetroot juice consumption does not alter cerebral autoregulation or cardiovagal baroreflex sensitivity during lower-body negative pressure in healthy adults

Worley

Reed²,

Chapman³

et al. 2023

Front. Hum. Neurosci.

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IntroductionBeetroot juice (BRJ) improves peripheral endothelial function and vascular compliance, likely due to increased nitric oxide bioavailability. It is unknown if BRJ alters cerebrovascular function and cardiovagal baroreflex control in healthy individuals.PurposeWe tested the hypotheses that BRJ consumption improves cerebral autoregulation (CA) and cardiovagal baroreflex sensitivity (cBRS) during lower-body negative pressure (LBNP).MethodsThirteen healthy adults (age: 26 ± 4 years; 5 women) performed oscillatory (O-LBNP) and static LBNP (S-LBNP) before (PRE) and 3 h after consuming 500 mL of BRJ (POST). Participants inhaled 3% CO2 (21% O2, 76% N2) during a 5 min baseline and throughout LBNP to attenuate reductions in end-tidal CO2 tension (PETCO2). O-LBNP was conducted at ∼0.02 Hz for six cycles (−70 mmHg), followed by a 3-min recovery before S-LBNP (−40 mmHg) for 7 min. Beat-to-beat middle cerebral artery blood velocity (MCAv) (transcranial Doppler) and blood pressure were continuously recorded. CA was assessed using transfer function analysis to calculate coherence, gain, and phase in the very-low-frequency (VLF; 0.020–0.070 Hz) and low-frequency bands (LF; 0.07–0.20 Hz). cBRS was calculated using the sequence method. Comparisons between POST vs. PRE are reported as mean ± SD.ResultsDuring O-LBNP, coherenceVLF was greater at POST (0.55 ± 0.06 vs. 0.46 ± 0.08; P < 0.01), but phaseVLF (P = 0.17) and gainVLF (P = 0.69) were not different. CoherenceLF and phaseLF were not different, but gainLF was lower at POST (1.03 ± 0.20 vs. 1.12 ± 0.30 cm/s/mmHg; P = 0.05). During S-LBNP, CA was not different in the VLF or LF bands (all P > 0.10). Up-cBRS and Down-cBRS were not different during both LBNP protocols.ConclusionThese preliminary data indicate that CA and cBRS during LBNP in healthy, young adults is largely unaffected by an acute bolus of BRJ.

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Section: Discussionmentioning

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Acute beetroot juice consumption does not alter cerebral autoregulation or cardiovagal baroreflex sensitivity during lower-body negative pressure in healthy adults

Worley

Reed²,

Chapman³

et al. 2023

Front. Hum. Neurosci.

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“…Interestingly, a randomised controlled trial found a ∆ HR cut-off metric (<50 bpm) to predict prolonged recovery 109. Pilot studies employing physiological stressors such as lower body negative and positive pressure110 and the Cold Pressure Test111 found group differences in cerebrovascular reactivity (CVR),110 HR and BP 111. One study found a significantly elevated Mayer wave proportion in the concussion group compared with control 112…”

Section: Resultsmentioning

confidence: 99%

Role of biomarkers and emerging technologies in defining and assessing neurobiological recovery after sport-related concussion: a systematic review

et al. 2023

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ObjectiveDetermine the role of fluid-based biomarkers, advanced neuroimaging, genetic testing and emerging technologies in defining and assessing neurobiological recovery after sport-related concussion (SRC).DesignSystematic review.Data sourcesSearches of seven databases from 1 January 2001 through 24 March 2022 using keywords and index terms relevant to concussion, sports and neurobiological recovery. Separate reviews were conducted for studies involving neuroimaging, fluid biomarkers, genetic testing and emerging technologies. A standardised method and data extraction tool was used to document the study design, population, methodology and results. Reviewers also rated the risk of bias and quality of each study.Eligibility criteria for selecting studiesStudies were included if they: (1) were published in English; (2) represented original research; (3) involved human research; (4) pertained only to SRC; (5) included data involving neuroimaging (including electrophysiological testing), fluid biomarkers or genetic testing or other advanced technologies used to assess neurobiological recovery after SRC; (6) had a minimum of one data collection point within 6 months post-SRC; and (7) contained a minimum sample size of 10 participants.ResultsA total of 205 studies met inclusion criteria, including 81 neuroimaging, 50 fluid biomarkers, 5 genetic testing, 73 advanced technologies studies (4 studies overlapped two separate domains). Numerous studies have demonstrated the ability of neuroimaging and fluid-based biomarkers to detect the acute effects of concussion and to track neurobiological recovery after injury. Recent studies have also reported on the diagnostic and prognostic performance of emerging technologies in the assessment of SRC. In sum, the available evidence reinforces the theory that physiological recovery may persist beyond clinical recovery after SRC. The potential role of genetic testing remains unclear based on limited research.ConclusionsAdvanced neuroimaging, fluid-based biomarkers, genetic testing and emerging technologies are valuable research tools for the study of SRC, but there is not sufficient evidence to recommend their use in clinical practice.PROSPERO registration numberCRD42020164558.

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“…58,59 The retention of MBP during the HUT in our final multivariable model supports prior studies suggesting abnormal sympathetic augmentation upon baroreceptor activation in people with post-mTBI dizziness. 60–62 Given that prior studies have reported variable patterns of altered HR and BP control following mTBI, 34,63,64 and the preliminary nature of this study, future studies including HR and BP measures of cardiovascular autonomic function are needed. 37 In the meantime, these data support clinical (bedside) assessment of standard orthostatic vital signs 37,65 , which may provide an informative physiological correlate to symptoms of dizziness, provide an additional objective parameter to follow during rehabilitation, and direct treatment approaches.…”

Section: Discussionmentioning

confidence: 99%

A Multimodal Assessment of the Heterogeneous Nature of Post-mTBI Dizziness

Pelo

Gaudette

Millsap

et al. 2022

Preprint

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Dizziness after mild traumatic brain injury (mTBI) is commonly attributed to impairment within the vestibular system. However, oculomotor, mobility, and autonomic dysfunction can also contribute to patient-reported dizziness. The purpose of this preliminary study was to examine whether a multimodal battery of assessments could help explain patient-reported dizziness after mTBI. Twenty-three participants with concussion-related symptoms completed the Dizziness Handicap Inventory (DHI) to evaluate burden imposed by dizziness on daily activities and a battery of tests designed to incorporate domains that have been shown to contribute to dizziness (e.g., vestibular, oculomotor, balance and mobility, and autonomic dysfunction). Specific outcomes included quantitative variables obtained from: Vestibular Ocular Motor Screening (VOMS); standing for 30 seconds with feet together, eyes closed, with hands on their hips on both firm and foam surfaces; walking for one minute at a comfortable pace; and a Head-up Tilt (HUT) Test. Univariate associations between DHI and individual measures were assessed, and a backwards-stepwise regression model determined the multi-variable association. There were no strong associations and only a few moderate associations between individual functional measure and DHI total score. A total of eight variables had univariate correlation coefficients larger than 0.20 in magnitude. The final model from the backwards-stepwise procedure explained 69% of the variance in DHI and retained only three variables: peak turning speed from the one-minute walk; mean blood pressure (MBP) during the HUT; and the total VOMS score. Isolated assessments of individual domains of function have weak-to-moderate associations with post-mTBI dizziness. Conversely, a multivariable model that contained measures of mobility, autonomic function, and symptomatic complaints to vestibular and ocular provocation explained 69% of the variance in dizziness. These results suggest that dizziness is physiologically heterogeneous in nature and support the use of multi-domain assessments in patients with dizziness after mTBI.

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Preliminary Evidence of Orthostatic Intolerance and Altered Cerebral Vascular Control Following Sport-Related Concussion

Cited by 11 publications

References 74 publications

Acute beetroot juice consumption does not alter cerebral autoregulation or cardiovagal baroreflex sensitivity during lower-body negative pressure in healthy adults

Acute beetroot juice consumption does not alter cerebral autoregulation or cardiovagal baroreflex sensitivity during lower-body negative pressure in healthy adults

Role of biomarkers and emerging technologies in defining and assessing neurobiological recovery after sport-related concussion: a systematic review

A Multimodal Assessment of the Heterogeneous Nature of Post-mTBI Dizziness

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