Abstract
Introduction: The prevalence and incidence of sport-related concussion have continued to increase over the past decade, and researchers from various backgrounds strive for evidenced-based clinical assessment and management. When diagnosing and managing a concussion, a battery of tests from several domains (e.g., symptom reporting, neurocognitive, physiology) must be used. In this study, we propose and develop an objective, evidence-based protocol to assess the pathophysiology of the brain by using non-invasive methods. Methods: Contact sport athletes (n = 300) will be assessed at the beginning of the season in a healthy state to establish baseline values, and then prospectively followed if a mild traumatic brain injury (mTBI) occurs on approximately days 1–2, 3–5, 7–10, 21, 30, and subsequently thereafter, depending on the severity of injury. The protocol includes spontaneous measurements at rest, during head postural change, controlled breathing maneuvers for cerebrovascular reactivity, a neurovascular coupling stimuli, and a baroreflex/autoregulation maneuver. Physiological data collection will include cerebral blood flow velocity, cerebral oxygenation, respiratory gases for end-tidal oxygen and carbon dioxide, finger photoplethysmography for blood pressure, seismocardiography for cardiac mechanics, and electrocardiography. Conclusion, Limitations, and Ethics: The protocol will provide an objective, physiological evidence-based approach in an attempt to better diagnose concussion to aid in return-to-play or -learn. Ethics approval has been granted by the University Research Ethics Board.
Highlights
The prevalence and incidence of sport-related concussion have continued to increase over the past decade, and researchers from various backgrounds strive for evidenced-based clinical assessment and management
Concussion has been defined as a “complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces . . . ” [6]
The exact pathophysiology of mild traumatic brain injury (mTBI) is not fully understood, but it has been suggested that autonomic dysfunction [2,5] and changes in total blood volume and cerebral blood flow do occur [3,8]
Summary
The prevalence and incidence of sport-related concussion have continued to increase over the past decade, and researchers from various backgrounds strive for evidenced-based clinical assessment and management. Concussion can occur as a result of the rapid acceleration, deceleration, or rotational forces of the head, which cause the brain to elongate and deform, leading to the stretching of individual neurons, glial cells, and small cerebral blood vessels. These affects can in turn distort neuronal membrane permeability [7]. Because there is no single objective test or protocol, symptom-based questionnaires and neuropsychological tests have been relied on historically [10] These tests have not been designed as a tool to diagnose or to return players to school or sport safely [11]. Reflexive physiologic measures (e.g., chemodetection and blood pressure measurements) and/or processes should be used for diagnosis and recovery, but even this approach requires relatively expensive equipment, standardized protocols, and documentation about what condition the body was in during the measurement (e.g., the status of hydration, sleep, medications, etc.) [2]
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