The Dynamics of Concussion: Mapping Pathophysiology, Persistence, and Recovery With Causal-Loop Diagramming

Abstract

Despite increasing public awareness and a growing body of literature on the subject of concussion, or mild traumatic brain injury, an urgent need still exists for reliable diagnostic measures, clinical care guidelines, and effective treatments for the condition. Complexity and heterogeneity complicate research efforts and indicate the need for innovative approaches to synthesize current knowledge in order to improve clinical outcomes. Methods from the interdisciplinary field of systems science, including models of complex systems, have been increasingly applied to biomedical applications and show promise for generating insight for traumatic brain injury. The current study uses causal-loop diagramming to visualize relationships between factors influencing the pathophysiology and recovery trajectories of concussive injury, including persistence of symptoms and deficits. The primary output is a series of preliminary systems maps detailing feedback loops, intrinsic dynamics, exogenous drivers, and hubs across several scales, from micro-level cellular processes to social influences. Key system features, such as the role of specific restorative feedback processes and cross-scale connections, are examined and discussed in the context of recovery trajectories. This systems approach integrates research findings across disciplines and allows components to be considered in relation to larger system influences, which enables the identification of research gaps, supports classification efforts, and provides a framework for interdisciplinary collaboration and communication—all strides that would benefit diagnosis, prognosis, and treatment in the clinic.

Diverse Autonomic Nervous System Stress Response Patterns in Childhood Sensory Modulation

“…Thus, non-linear dynamical models are most appropriate for managing the varying temporal dynamics related to ANS-HPA axis systems. Complex systems modeling, which strives to portray causal interrelationships within a system, has been used to generate insight into a wide range of biomedical applications (Wittenborn et al, 2016;Kenzie et al, 2018) and could be advantageous. Finally, automatic and deliberate processes from dual-tiered models inform effective treatment planning by supporting the alignment of treatment approaches across distributed systems.…”

System Dynamics Applications to Injury and Violence Prevention: a Systematic Review

“…After excluding articles that did not involve an actual SDrelated application and were not injury-related, 62 articles remained. Two members of the research team conducted a thorough text review of these 62 and determined that 18 [50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] had a direct and specific link to an injury outcome and utilized a SD-related method or tool (e.g., CLD, SD simulation model). These 18 studies were included in the review (Table 1).…”

“…Since 2009, one to three applications have been published each year. Topic areas included youth violence [50], domestic violence [55,56], community violence [51]; suicide [63]; drug overdose [54,[64][65][66][67]; occupational injury [53]; road traffic injury [52,[58][59][60][61][62]; and traumatic brain injury [57]. Studies were conducted within a variety of geographic contexts and scales.…”

Mapping the multicausality of Alzheimer’s disease through group model building

“…This could lead to circadian misalignment when it includes damage to melanopsin-expressing retinal ganglion cells (Feng et al 2016) and could thereby result in exacerbated oxidative stress (Musiek and Holtzman 2016). Loops with more than three variables also exist and, although they are sometimes difficult to recognize, they may have important effects on the system (Kenzie et al 2018). These loops can often exist between variables at multiple spatial or temporal scales and may be related to various scientific domains.…”