Shorter Recovery Time in Concussed Elite Ice Hockey Players by Early Head-and-Neck Cooling: A Clinical Trial

Al-Husseini, Ali; Bakhsheshi, Mohammad Fazel; Gard, Anna; Tegner, Yelverton; Marklund, Niklas

doi:10.1089/neu.2022.0248

Cited by 9 publications

(5 citation statements)

References 57 publications

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“…Some examples in the literature support the former. 8,27,28 Additional comparison of our findings with previous studies is difficult, given the significant differences in study design, outcome measures, and device design/protocols that vary greatly across the literature. In previous studies: (1) the use of treatment protocols where the treatment is delivered once and data are derived from 1 to 2 postintervention time points 8,[25][26][27] and (2) subject cohorts typically comprised older adolescents (.17 years old) or adults.…”

Section: Discussionmentioning

confidence: 81%

Reduced Concussion Symptom Burden in Early Adolescent Athletes Using a Head–Neck Cooling Device

Smith,

McNinch,

Chaney

et al. 2024

Clinical Journal of Sport Medicine

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Objective: To determine whether an investigational head–neck cooling device, Pro2cool, can better reduce symptom severity compared with standard postconcussion care in early adolescent athletes after a sports-related concussion. Design: Prospective, longitudinal, randomized trial design conducted over a 28-day period. Setting: Six pediatric medical centers in Ohio and Michigan. Participants: The study enrolled 167 male and female 12- to 19-year-old athletes who experienced a sports-related concussion within 8 days of study enrollment and registering a Sports Concussion Assessment Tool 5 (SCAT5) composite score >7. Interventions: Pro2cool, an investigational head–neck cooling therapy device, was applied at 2 postinjury time points compared with postconcussion standard of care only. Main Outcome Measures: Baseline SCAT5 composite symptom severity scores were determined for all subjects. Sports Concussion Assessment Tool 5 scores for concussed athletes receiving cooling treatment were analyzed across 6 independent postenrollment time points compared with subjects who did not receive cooling therapy and only standard care. Adverse reactions and participate demographics were also compared. Results: Athletes who received Pro2cool cooling therapy (n = 79) experienced a 14.4% greater reduction in SCAT5 symptom severity scores at the initial visit posttreatment, a 25.5% greater reduction at the 72-hour visit posttreatment, and a 3.4% greater reduction at the 10-day visit compared with subjects receiving only standard care (n = 88). Overall, 36 adverse events (increased blood pressure, decreased pulse, and dizziness) were reported, with 13 events associated with the device, of which 3 were classified as moderate in severity. Conclusions: This study demonstrates the efficacy and safety of head and neck cooling for the management of concussion symptoms in adolescent athletes of an age group for which little to no prior data are available.

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Section: Discussionmentioning

confidence: 81%

Reduced Concussion Symptom Burden in Early Adolescent Athletes Using a Head–Neck Cooling Device

Smith,

McNinch,

Chaney

et al. 2024

Clinical Journal of Sport Medicine

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“…Head-and-neck cooling was shown to decrease brain temperature measured by magnetic resonance imaging (MRI) (19), and improved cognitive outcome when applied acutely post-concussion (20). In a recent clinical trial including 132 concussed ice hockey players, a shorter recovery time was observed after acute selective head-and-neck cooling for at least 45 minutes (12). A shorter recovery also observed when cooling was initiated up to 8 days post-concussion (21).…”

Section: Discussionmentioning

confidence: 96%

“…In sports, the strenuous exercise leads to elevated core body-and brain-temperature (11), which may exacerbate brain injury induced by head impacts. Recently, we showed that selective head-and-neck cooling, aiming to rapidly normalize the elevated brain temperature, applied acutely post-SRC in elite ice hockey players resulted in earlier return-to-play and a smaller proportion of players with prolonged symptoms following the SRC (12). However, there is a lack of objective outcome measures for assessing the effects of head-and-neck cooling in athletes.…”

Section: Background and Rationalementioning

confidence: 99%

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Selective head-and-neck cooling on biomarker levels and symptom rating following a boxing bout- protocol for an exploratory randomized trial

Al-Husseini,

Tegner,

Blennow

et al. 2024

Preprint

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Background Head impacts are common in contact sports such as boxing and occur at times of elevated core body and brain temperatures induced by the exercise. Following impact, elevated brain temperature may lead to the development of exacerbated brain injury that can be monitored by blood biomarkers. We hypothesized that acute head-and-neck cooling, recently shown to shorten return-to-play in concussed ice hockey players, applied acutely following a boxing bout is associated with an attenuated release of blood biomarkers and improved symptom rating. Methods The trial is academically driven and funded by external and hospital research funds. Young, healthy elite boxers ≥ 18 years old are recruited. Prior to, and immediately after a competitive boxing bout over 3x2 or 3x3 minutes, blood samples are drawn. Boxers are randomized to intervention or control management by 1:1 allocation prior to baseline testing. After the initial post-fight blood sample is drawn and symptom rating using the sports concussion assessment tool-5 (SCAT-5) has been collected, the boxers receive either acute selective head-and-neck cooling for 45 min, or routine post-fight management. The number of head impacts are counted in all boxers on match video recordings. In both groups, blood samples are drawn 45 minutes after the initial post-bout blood sample, as well as 3 and 6 days post-fight. At all time points for blood sampling, the number of symptoms (NOS) and symptom severity score (SSS) are assessed using the symptom rating part of the SCAT-5. The primary endpoint is the difference in biomarker levels (GFAP, NF-L, tau, UCH-L1, neuronal-specific enolase) between immediately post-fight and pre-intervention levels, to those obtained at 6 days post-fight. The post-fight SCAT-5 NOS and SSS are secondary endpoints. Discussion There is no treatment available for boxing-induced brain injury. Biomarkers are surrogate yet objective marker of brain injury, and the head-and-neck cooling treatment may attenuate the release of brain injury-related biomarkers as well as reduce symptoms induced by head impacts attained during a boxing fight. Potentially, head-and-neck cooling is a treatment option acutely following a boxing bout. Trials registration ClinicalTrials.gov, ClinicalTrials.gov Identifier NCT06386484. Registered April 23, 2024.

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“…In the clinical literature, one study found that concussed subjects self-reported temporary relief from physical symptoms after head cooling [91]. In another group of studies, players receiving head-neck cooling have shorter return-to-play times than controls in several studies [71,92].…”

Section: Cold Therapymentioning

confidence: 99%

Conservative Management of Acute Sports-Related Concussions: A Narrative Review

Kureshi,

Mendizabal,

Francis

et al. 2024

Healthcare

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This review explores the application of the conservative management model for pain to sports-related concussions (SRCs), framing concussions as a distinct form of pain syndrome with a pathophysiological foundation in central sensitization. Drawing parallels with proven pain management models, we underscore the significance of a proactive approach to concussion management. Recognizing concussions as a pain syndrome allows for the tailoring of interventions in alignment with conservative principles. This review first covers the epidemiology and controversies surrounding prolonged concussion recovery and persistent post-concussion symptoms (PPCS). Next, the pathophysiology of concussions is presented within the central sensitization framework, emphasizing the need for early intervention to mitigate the neuroplastic changes that lead to heightened pain sensitivity. Five components of the central sensitization process specific to concussion injuries are highlighted as targets for conservative interventions in the acute period: peripheral sensitization, cerebral metabolic dysfunction, neuroinflammation, glymphatic system dysfunction, and pain catastrophizing. These proactive interventions are emphasized as pivotal in accelerating concussion recovery and reducing the risk of prolonged symptoms and PPCS, in line with the philosophy of conservative management.

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Shorter Recovery Time in Concussed Elite Ice Hockey Players by Early Head-and-Neck Cooling: A Clinical Trial

Cited by 9 publications

References 57 publications

Reduced Concussion Symptom Burden in Early Adolescent Athletes Using a Head–Neck Cooling Device

Reduced Concussion Symptom Burden in Early Adolescent Athletes Using a Head–Neck Cooling Device

Selective head-and-neck cooling on biomarker levels and symptom rating following a boxing bout- protocol for an exploratory randomized trial

Conservative Management of Acute Sports-Related Concussions: A Narrative Review

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