Abstract
Purpose: Investigate the feasibility of a non-invasive method to evaluate the physical and cognitive repercussions of long-lasting post-concussion effects in professional combat sports athletes. To help athletes return to professional combat, there is a need for unbiased objective tools and techniques used as a prognostic method of recovery after Sport Related Concussion (SRC).Methods: Six mild Traumatic Brain Injury (mTBI) athletes, age 20 ÷ 43 yr (1 female, 5 males) and 7 not concussed (NC) participants (amateur), age 24 ÷ 38 yr (3 females, 4 males), were tested Inspired/expired gas concentration, Cerebral changes in oxygenated hemoglobin (Δ[HbO2]) and deoxygenated hemoglobin (Δ[HHb]) were measured using near infrared spectroscopy (NIRS) with a 3-step protocol: rest before maximal oxygen uptake (VO2max) test, hypercapnia, and recovery after VO2max test. The brain oxygenation and respiratory parameters of both sample sets were calculated using a non-parametric test (Mann-Whitney U test). Aerobic fitness outcome was quantified through mean average using the Bruce test. Participants performed Fitt's test using a laptop and analysis of medio-lateral and anterior-posterior range of oscillation was carried out via a force platform Romberg test.Results: mTBI group showed statistically significant differences in saturated hemoglobin Δ[HbO2] (p < 0.001) during rest and recovery phase after maximal incremental exercise, in medio-lateral sway eyes open (p = 0.008, NC 25.35 ± 4.11 mm and mTBI 17.65 ± 4.79 mm). VO2max revealed no significant differences between the two groups: NC 47.47 ± 4.91 mTBI 49.58 ± 5.19 ml/kg/min−1. The 2 groups didn't differ for maximum power output (NC 220 ± 34, mTBI 255 ± 50 W). End-tidal fractional concentration of O2 (FetO2 NC15.20 ± 0.41, mTBI 16.09 ± 0.68) throughout hypercapnia, saturated blood hemoglobin (Δ[HbO2]) revealed significant differences with the mTBI group. No differences emerged from Fitt's test.Conclusions: It emerges that NIRS is able to reveal differences in long time outcomes of mTBI. The medio-lateral variations cannot be considered as a marker of long-term damage in athletes specifically trained for balance.
Highlights
Traumatic Brain Injuries (TBIs) can be distinguished based on the severity in: mild, moderate, and severe (Kaj, 2016)
A concussion is considered as part of the mild TBI spectrum associated diseases and often the term is used as synonymous of Mild TBIs (mTBIs)
Measurements performed with transcranial ultrasonographic doppler, showed the changes in cerebral circulation occurring in concussed subjects (Len et al, 2011)
Summary
Traumatic Brain Injuries (TBIs) can be distinguished based on the severity in: mild, moderate, and severe (Kaj, 2016). A lower incidence rate of head injuries has been observed in more aerobically trained subjects than in less trained, even if this difference does not change the effects of neuro-cognitive decline given by a possible concussion (Kontos et al, 2006). The limited perfusion of oxygen, determined by the autonomic nervous system, can cause limitations of brain functions or high metabolic demands to an Abbreviations: TBIs, Traumatic Brain Injuries; mTBIs, Mild TBIs; SRC, Sport Related Concussion; LOC, Loss Of Consciousness; AOC, Alteration Of Consciousness; PTA, Post-traumatic amnesia; PCS, Post-Concussion Syndrome; CTE, Chronic traumatic encephalopathy; PPCS, Persistent post-concussive symptoms; MCI, Mild Cognitive Impairment; HIC, Head Injury Criteria; GSI, Gadd Severity Index; SCAT, Sport Concussion Assessment Tool; [HbO2], Oxyhaemoglobin; [HHb], Deoxyhaemoglobin; tHb, Total hemoglobin; Cox, Cerebral Oxygenation; MLroo, Medio-Lateral oscillation; AProo, AnteriorPosterior range of oscillation; FetO2, Fraction End Tidal O2; OEF, Cerebral oxygen extraction fraction; MMA, Mixed Martial Arts; CBF, Cerebral Blood Flow
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