Abstract
A variety of assessment tools are currently available to help clinicians assess Sports Related Concussion (SRC). Currently, the most widely available tools are neither objective nor portable, and are therefore not ideal for assessment at the site and time of a suspected injury. A portable system was developed to deliver a measurement of the steady-state visual-evoked potential (SSVEP). This system involved a smartphone housed in a Google Cardboard frame, which delivered a 15-Hz flicker visual stimulus while an electroencephalography (EEG) headset recorded EEG signals. Sixty-five rugby union players were tested during their regular season and were stratified into healthy, concussed, and recovered groups based on clinical examination. Their SSVEP response was quantified into a signal-to-noise ratio (SNR). The SNRs of players in each study group were summarized. Additionally, the SNRs of individual players who had baseline, post-injury, and post-recovery readings were analyzed. Sixty-five participants completed a baseline evaluation to measure their SSVEP. Twelve of these participants sustained a medically diagnosed concussion and completed SSVEP re-testing within 72 h. Eight concussed players received follow-up SSVEP testing after recovery. Concussed participants had a lower SNR [2.20 (2.04–2.38)] when compared to their baseline [4.54 (3.79–5.10)]. When clinically recovered, participant SNR was not significantly different to their baseline [4.82 (4.13–5.18)]. The baseline SNRs of the players who experienced a concussion during the season were not different to those of players who did not experience a concussion [4.80 (4.07–5.68)]. This is the first study to identify differences in SSVEP responses in male amateur rugby union players with and without concussion. It is also the first SSVEP demonstration for concussion evaluation at point-of-care. SSVEPs are significantly attenuated in the presence of concussion in these male athletes. Individuals returned to their baseline SSVEP following clinical recovery from the concussive injury. The use of SSVEPs has the potential to be a supplemental aid for the assessment and management of concussion.
Highlights
Sports-related concussion (SRC) is defined by the Concussion in Sport Group as “immediate and transient symptoms immediately following a mild traumatic brain injury occasioned during sport” (McCrory et al, 2017)
Through the course of the rugby season, 12 participants sustained a concussion that was diagnosed by the team physician and had a second state visual-evoked potential (SSVEP) assessment
Further research is required to better understand mechanisms underlying our finding that SSVEPs attenuate in concussion, but this study provides pilot evidence for an objective measure of concussion that is able to be delivered expediently on the sideline
Summary
Sports-related concussion (SRC) is defined by the Concussion in Sport Group as “immediate and transient symptoms immediately following a mild traumatic brain injury occasioned during sport” (McCrory et al, 2017). Concussion is a common injury in contact sports, with an incidence rate of approximately 1 per 1,000 athletic exposures in the NFL (Kilcoyne et al, 2014), and up to 4 concussions per 1,000 player-match-hours in elite rugby union (Gardner et al, 2014; Fuller et al, 2015). Athletes may minimize or deny symptoms to avoid a concussion diagnosis and accelerate their return to play, potentially increasing the risk of Second Impact Syndrome (Bey and Ostick, 2009). Over long periods, repeated and inappropriately managed concussion may lead to chronic neurological impairment and the possibility of chronic traumatic encephalopathy (CTE; Arciniegas, 2011; Stern et al, 2011; Weinstein et al, 2013)
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