Buffalo Concussion Treadmill Test Research Articles

Use of the Buffalo Concussion Treadmill Test in community adult patients with mild traumatic brain injury.

The Buffalo Concussion Treadmill Test (BCTT) is used to establish exercise tolerance for rehabilitation and identify injury subtypes for youth athletes after mild traumatic brain injury (mTBI). Its utility in adult community members is unknown. Primary: To describe how adults with and without mTBI tolerate the BCTT. Secondary: To explore relationships between baseline factors, mTBI-related symptoms, and BCTT duration. Prospective, observational, longitudinal. Academic medical center. Thirty-seven adults treated in a level 1 trauma center emergency department with mTBI;  24 uninjured controls (UC). N/A. Participants completed two visits 3 weeks apart (1 week and 1 month after mTBI) including a 15-minute BCTT, the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and preinjury International Physical Activity Questionnaire. Analyses characterized BCTT response and associations between baseline factors, RPQ scores, and BCTT duration. Persons with mTBI discontinued earlier than UC at 1-week postinjury using standard discontinuation criteria for exercise intolerance. The percentage of mTBI participants with signs of possible mTBI-related intolerance was 55.6% at 1 week (36.1% for mTBI-related symptom exacerbation, 19.4% for exertion/fatigue before reaching 85% of one's age-predicted maximum heart rate [HR]) and 48.0% at 1 month (40.0% mTBI-related symptom exacerbation, 8.0% exertion without reaching the target HR). Thirty percent of UCs completed the BCTT at both assessments. UCs met discontinuation criteria for increased nonspecific symptoms (eg, pain/general discomfort and increased Visual Analog Scale ratings; 39-61%) and physical exertion (9-26%). Shorter duration was associated with higher body mass index (r = -0.42 - -0.45), shorter height (r = 0.22-0.29), female gender (r = -0.26 - -0.27), and greater RPQ symptoms (r = -0.28 - -0.47). The BCTT exacerbates mTBI-related symptoms in adult community members. Participant characteristics and noninjury factors influence performance. The findings imply the BCTT could be useful in clinical assessments of adults with mTBI. Interpretation should account for the unique characteristics of nonathletes.

Utility of Structured Oculomotor, Balance, and Exercise Testing in Civilian Adults with Mild Traumatic Brain Injury (mTBI).

Assessments of oculomotor, balance, and exercise function detect different responses to mild traumatic brain injury (mTBI) in sport-related mTBI. These assessments are understudied in the adult community mTBI population. We evaluated level 1 trauma center patients with non-sports related mTBI on oculomotor functioning (near point of convergence [NPC] and accommodation [NPA]), balance (Balance Error Scoring System [BESS]), and exercise tolerance (Buffalo Concussion Treadmill Test [BCTT]). A prospective, cohort study of adults with mTBI (N = 36) were assessed at 1 week and (N = 26) 1 month post-mTBI using NPC, NPA, BESS, BCTT, and the Rivermead Post Concussion Symptoms Questionnaire [RPQ]. Prevalence of test impairment and association between performance and mTBI-related symptom burden (RPQ scores) were characterized. Participants demonstrated varying levels of impairment (e.g., 33.3% oculomotor, 44.1% balance, and 55.6% exercise impairment at 1 week). Participants displayed diverse impairment profiles across assessments. We observed medium-to-large correlations between poorer NPC and BCTT performance and greater mTBI symptom burden. Clinical examinations of oculomotor function, balance, and exercise adopted from sport-related concussion assessments detect impairment in adult community members with mTBI. While findings warrant larger-scale replication, they imply that incorporating these simple, structured exams into the assessment of mTBI may facilitate more personalized management strategies.

Comparison of the Buffalo Concussion Treadmill Test With a Physiologically Informed Cycle Test: Calgary Concussion Cycle Test.

Sport-related concussions are a complex injury requiring multifaceted assessment, including physical exertion. Currently, concussion testing relies primarily on a treadmill-based protocol for assessing exertion-related symptoms in persons after concussion. This study compared a modified cycle protocol (Calgary Concussion Cycle Test [CCCT]) with the clinically adopted standard, the Buffalo Concussion Treadmill Test (BCTT), across multiple physiological parameters. Treadmill and cycle matched workload protocols would produce similar results for cerebral blood velocity, mean arterial pressure (MAP), and end-tidal carbon dioxide partial pressure (PETCO2), but heart rate (HR) and oxygen consumption (VO2) would be higher on the treadmill than the cycle modality. Crossover study design. Level 3. A total of 17 healthy adults (8 men, 9 women; age, 26 ± 3 years; body mass index, 23.8 ± 2.7 kg/m2) completed the BCTT and CCCT protocols, 7 days apart in a randomized order. During both exertional protocols, the physiological parameters measured were middle cerebral artery mean blood velocity (MCAv), MAP, PETCO2, VO2, and HR. Analysis of variance with effect size computations, coefficient of variation, and Bland-Altman plots with 95% limits of agreement were used to compare exercise tests. The BCTT and CCCT produced comparable results for both male and female participants with no significant differences for average MCAv, MAP, and PETCO2 (all P > 0.05; all generalized eta squared [η2G] < 0.02 [negligible]; P value range, 0.29-0.99) between stages. When accounting for exercise stage and modality, VO2 (P < 0.01) and HR (P < 0.01) were higher on the treadmill compared with the cycle. Aside from the final few stages, all physiology measures displayed good-to-excellent agreeability/variability. The CCCT was physiologically similar to the BCTT in terms of MCAv, PETCO2, and MAP; however, HR and VO2 differed between modalities. Providing a cycle-based modality to exertional testing after injury mayincrease accessibility to determine symptom thresholds in the future.

Exercise Intolerance After Mild Traumatic Brain Injury Occurs in All Subtypes in the Adult Population.

Thematically grouped symptom clusters are present during the acute timeline of post-mild traumatic brain injuries (mTBI), representing clinical profiles called subtypes. Exercise intolerance has not been evaluated within the subtype classifications and, because guidelines support early submaximal aerobic exercise, further knowledge is required in regard to the exercise capabilities among the concussion subtypes. This cross-sectional study (n = 78) aimed to characterize the presence of exercise intolerance within the clinical subtypes and to explore performance on the Buffalo Concussion Treadmill Test (BCTT) in the adult subacute (2-12 weeks post-injury) mTBI population. All participants were evaluated using the BCTT to determine exercise tolerance. We first used the Neurobehavioral Symptom Inventory (NSI) questionnaire to assign each participant a primary subtype(s). To further explore all five subtypes (headache, cognitive, vestibular, ocular motor, and mood), participants were assessed using a multitude of thematically grouped assessments including self-reported questionnaires, clinical tests of vestibular and ocular motor function, balance function, and computerized cognitive testing. Thirty-seven (47%) subjects were exercise tolerant and 41 (53%) were exercise intolerant. There was no difference in the distribution of primary subtypes between the exercise tolerant and exercise intolerant groups. In addition, no significant differences were found between the exercise tolerant and exercise intolerant groups on other thematically grouped subtype assessments. The exercise intolerant group had a significantly higher resting heart rate (HR), lower percentage of age-predicted maximum HR achieved, lower Borg Rate of Perceived Exertion (RPE), and could walk on the treadmill for less time (lower duration) compared with the exercise tolerant group. The current findings suggest that exercise intolerance is common and pervasive across all five mTBI subtypes. A comprehensive mTBI assessment should include evaluation for exercise intolerance regardless of the primary clustering of symptoms and across patient populations. Therefore, early referral to physical therapists, athletic trainers, or medical clinics that can perform the BCTT may be helpful to initiate appropriate exercise prescriptions for patients with mTBI.

Flexion And Extension Is Reduced Immediately Following Sport-related Concussion During The Buffalo Concussion Treadmill Test

Flexion And Extension Is Reduced Immediately Following Sport-related Concussion During The Buffalo Concussion Treadmill Test

Combined Neurocognitive and Exercise Tolerance Testing Improves Objectivity of Buffalo Concussion Treadmill Test.

The Buffalo Concussion Treadmill Test (BCTT) is a standard assessment of exercise tolerance utilized for exercise prescription following concussion and to inform decisions regarding return to play. One limitation of the BCTT is that interpretation of test results is dependent on individuals' self-report of symptom exacerbation with exertion. Symptoms following concussion are significantly underreported or unreported. Combining objective neurocognitive assessment with exercise tolerance testing may enable clinicians to objectively identify those requiring further assessment or rehabilitation before return to play. The purpose of this study was to investigate how performance on a neurocognitive assessment battery is affected by provocative exercise testing. Prospective cohort study, pretest/posttest. A total of 30 participants included 13 women (43.3%), age 23.4 (1.93)years, height 173.56 (10)cm, weight 77.35 (16.3)kg, and 11 (36.7%) with history of concussion. All participants completed a neurocognitive assessment battery, including the Stroop Test and standardized assessments of working memory, attention, and information processing speed/accuracy in single-task (seated position) and dual-task conditions (walking on a treadmill at 2.0 miles per hour). The neurocognitive assessment battery was performed at baseline and after the standard BCTT test protocol. BCTT: Average percentage of heart rate maximum (%HRmax) = 93.97% (4.8%); average maximum rating of perceived exertion = 18.6 (1.5). Time-based performance in single-task and dual-task conditions significantly improved from baseline (P < .05) following maximal exercise testing on the BCTT for the following neurocognitive assessments: concentration-reverse digits, Stroop congruent, and Stroop incongruent. Healthy participants demonstrated improvements across multiple domains of neurocognitive performance following the exercise tolerance testing on the BCTT. Understanding normal responses in neurocognitive performance for healthy individuals following exercise tolerance testing may allow clinicians to more objectively monitor the trajectory of recovery following sports-related concussion.

Can the Buffalo Concussion Treadmill Test Be Used as a Prognostic Indicator for Patients With Sport-Related Mild Traumatic Brain Injury?

To establish whether time to exercise cessation using the Buffalo Concussion Treadmill Test (BCTT) protocol can be used as a prognostic indicator of recovery after sport-related mild traumatic brain injury (SR-mTBI). Retrospective analysis of prospectively collected data. Specialist Concussion Clinic. Three hundred and twenty one patients presenting between 2017 and 2019 who underwent BCTT for SR-mTBI. Participants who remained symptomatic at a 2-week follow-up appointment after SR-mTBI underwent BCTT to develop a progressive subsymptom threshold exercise program with fortnightly follow-up until clinical recovery. Clinical recovery was the primary outcome measure. A total of 321 participants were eligible to participate in this study (mean age 22.94% and 46% female). The BCTT test duration was divided into 4-minute intervals and those who completed full 20 minutes. There was higher probability of clinical recovery in those who finished the entire 20-minute BCTT protocol compared with those who managed 17-<20 minutes (Hazard Ratio, HR 0.57), 13 to 16 minutes (HR 0.53), 9 to 12 minutes (HR 0.6), 5 to 8 minutes (HR 0.4), and 1 to 4 minutes (HR 0.7), respectively. Those seen earlier after injury ( P = 0.009), male patients ( P = 0.116), younger patients ( P = 0.0003), and those with physiological or cervical dominant ( P = 0.416) symptom clusters were more likely to achieve clinical recovery. Fifty percent of those who completed the full BCTT protocol achieved clinical recovery at day 19 post-injury. The group completing full 20 minutes of BCTT achieved clinical recovery more quickly than those who did not complete full BCTT.

An at-home, virtually administered graded exertion protocol for use in concussion management: Preliminary evaluation of safety and feasibility in healthy youth and children with subacute concussion.

Graded exertion testing (GXT) is an important tool for concussion management, as it is used to personalize post-concussion exercise prescription and return athletes to sport. However, most GXT requires expensive equipment and in-person supervision. Our objective was to assess the safety and feasibility of the Montreal Virtual Exertion (MOVE) protocol, a no-equipment, virtually compatible GXT, in healthy children and children with subacute concussion. Cross-sectional. The MOVE protocol consists of seven stages of bodyweight and plyometric exercises performed for 60 seconds each. Twenty healthy (i.e., non-concussed) children completed the MOVE protocol virtually over Zoom Enterprise. Next, thirty children with subacute concussion (median: 31.5 days post-injury) were randomized to the MOVE protocol or Buffalo Concussion Treadmill Test (BCTT), which increases the incline or speed of the treadmill every minute until maximum exertion. Out of an abundance of caution, all concussed participants completed the MOVE protocol in an in-person clinical space. However, the test evaluator was stationed in a different room within the clinic and administered the MOVE protocol using Zoom Enterprise software to mimic telehealth conditions. Safety and feasibility outcomes were recorded throughout GXT, including heart rate, rate of perceived exertion (RPE), and symptom outcomes. No adverse events were recorded, and all feasibility criteria were successfully met in healthy youth and youth with concussion. Among concussed youth, increases in heart rate (MOVE: 82.4  17.9 bpm, BCTT: 72.1  23.0 bpm; t(28)=1.36, p=0.18), RPE (MOVE: 5.87  1.92, BCTT: 5.07  2.34, t(28)=1.02, p=0.32), and overall symptom presentation were similar between the MOVE and BCTT protocols. The MOVE protocol is a safe and feasible GXT that in healthy youth and youth with subacute concussion. Future studies should assess the fully virtual administration of the MOVE in children with concussion, MOVE protocol tolerability in children with acute concussion, and whether the MOVE protocol can be used to guide individualized exercise prescription.

A Novel Method to Assist Clinical Management of Mild Traumatic Brain Injury by Classifying Patient Subgroups Using Wearable Sensors and Exertion Testing: A Pilot Study

Although injury mechanisms of mild traumatic brain injury (mTBI) may be similar across patients, it is becoming increasingly clear that patients cannot be treated as one homogenous group. Several predominant symptom clusters (PSC) have been identified, each requiring specific and individualised treatment plans. However, objective methods to support these clinical decisions are lacking. This pilot study explored whether wearable sensor data collected during the Buffalo Concussion Treadmill Test (BCTT) combined with a deep learning approach could accurately classify mTBI patients with physiological PSC versus vestibulo-ocular PSC. A cross-sectional design evaluated a convolutional neural network model trained with electrocardiography (ECG) and accelerometry data. With a leave-one-out approach, this model classified 11 of 12 (92%) patients with physiological PSC and 3 of 5 (60%) patients with vestibulo-ocular PSC. The same classification accuracy was observed in a model only using accelerometry data. Our pilot results suggest that adding wearable sensors during clinical tests like the BCTT, combined with deep learning models, may have the utility to assist management decisions for mTBI patients in the future. We reiterate that more validation is needed to replicate the current results.

Sub-symptom threshold aerobic exercise for patients with persisting post-concussion symptoms and exercise intolerance after mild traumatic brain injury – a study protocol with a nested feasibility study for a randomized controlled trial

BackgroundPersistent post-concussion symptoms (PPCS) affect between 34 and 46% after a mild traumatic brain injury (mTBI). Many also experience exercise intolerance. Sub-symptom threshold aerobic exercise, SSTAE (exercise at an intensity level that does not increase symptoms) is proposed as a treatment to both reduce the symptom burden and increase the exercise tolerance after the injury. It is unclear if this also applies in a more chronic phase after mTBI.Main purposeThe main purpose of this study is to evaluate whether SSTAE in addition to ordinary rehabilitation will lead to clinically meaningful improvement of symptom burden, normalize exercise tolerance, increase physical activity, improve health-related quality of life, and reduce patient-specific activity limitations compared to a control group that only receives ordinary rehabilitation.DesignRandomized, controlled, single-blind parallel-group study with three measurement times; T0 at baseline, T1 after the intervention and T2 six months after T1.MethodsPatients between the ages of 18 and 60 with exercise intolerance and persistent PPCS (> 3 months) will be recruited to the study and randomized to two groups. All patients will receive follow-up at the outpatient TBI clinic. The intervention group will in addition receive SSTAE for 12 weeks with exercise diaries and a retest every 3 weeks for optimal dosage and progression. The Rivermead post-concussion symptoms questionnaire will be the main outcome measure. The secondary outcome measure will be a test of exercise tolerance—the Buffalo Concussion Treadmill Test. Other outcome measures include the patient-specific functional scale that measures patient-specific activity limitations, as well as outcome measures for diagnosis-specific health-related quality of life, anxiety and depression, specific symptoms such as dizziness, headache and fatigue, and physical activity.DiscussionThis study will add knowledge about the effect of SSTAE and whether it should be implemented in rehabilitation for the adult population with persistent PPCS after mTBI. The nested feasibility trial showed that the SSTAE intervention was safe and that the study procedures and delivery of the intervention overall were feasible. However, minor amendments to the study protocol were made prior to the commencement of the RCT.Trial registrationClinical Trials.gov, NCT05086419. Registered on September 5th, 2021.

The Effect of Physical Exertional Testing on Postconcussion Symptom Scale Scores in Male and Female High School Students.

Symptom scores commonly measured following concussion were compared between male and female adolescents with (Hx+) and without (Hx-) a history of concussion, pre and post physical exertion testing. Eighty (males [n = 60; Hx+ = 19], female [n = 20; Hx+ = 5]) high school students (ages 15-17y) completed the Buffalo Concussion Treadmill Test once and the modified shuttle run test twice. Symptom scores were collected using the 22-point Symptom Evaluation Scale on the Sport Concussion Assessment Tool (version 5) immediately pre and post physical exertion testing. The symptoms most reported during preexertional testing were fatigue/low energy, feeling slowed down, and nervous/anxious, whereas feeling slowed down, fatigue/low energy, "pressure in head" (males only), and headache (females only) were most frequently reported during postexertion testing. An understanding of the common exertion-related symptoms at baseline in a laboratory or field-based setting in adolescents may be advantageous for clinicians as they manage individual recovery postconcussion. This is particularly important during an adolescent's recovery and return to play when exertional testing may be implemented, especially since symptoms were reported pre and post exertional testing in both males and females regardless of concussion history.

The Buffalo Concussion Treadmill and Bike Tests in People With Mild-to-Moderate Traumatic Brain Injury: An Exploratory Clinical Audit.

To assess the performance on the Buffalo Concussion Treadmill and Bike Tests in nonathletic people following a mild-to-moderate traumatic brain injury. An outpatient rehabilitation clinic. Forty-nine patients with mild-to-moderate traumatic brain injury who underwent the Buffalo Concussion Treadmill or Bike Test as usual clinical care. A retrospective clinical audit. Demographics and brain injury-specific clinical data, Depression Anxiety Stress Scale; Rivermead Post-Concussion Symptom Questionnaire, and performance outcomes on the Buffalo Concussion Treadmill or Bike Test. Forty-nine patients (mean age: 33.7 ± 13.0 years), on average 56.2 ± 36.4 days post-injury, completed the Buffalo Concussion Treadmill or Bike Test. Fourteen patients stopped the test due to symptom exacerbation with a mean test duration of 8.1 ± 4.5 minutes, reaching an age-predicted maximum heart rate of 72.9% ± 12.4% and reporting a rating of perceived exertion of 13.4 ± 2.2. Those who terminated the test for other reasons had a significantly longer test duration (14.0 ± 4.7 minutes, P = .01), with a higher age-predicted maximum heart rate (83.3% ± 12.8%, P = .01) and rating of perceived exertion (17.0 ± 2.5, P = .01). Within the group who stopped for other reasons, 10 were due to symptoms deemed unrelated to the injury at the time of the test and 2 were stopped by the therapist for safety reasons. A significant but weak correlation between heart rate and rating of perceived exertion existed only for those who terminated the test for other reasons ( r = 0.38, P = .02). Overall, a shorter test duration was associated with higher scores of both self-reported depression ( r = -0.41, P < .01) and late postconcussion symptoms ( r = -0.40, P < .01). The Buffalo Concussion Treadmill or Bike Test can be used in the nonathletic mild-to-moderate traumatic brain injury population to differentiate between those who experience symptom exacerbation during exercise and those who do not based on symptom exacerbation, test duration, and poor perception of exertion. Further research is required to determine whether other reasons for test termination are related to the injury.

Exercise-Induced Vision Dysfunction Early After Sport-Related Concussion Is Associated With Persistent Postconcussive Symptoms.

The purpose of this study was to determine if exercise-induced vision dysfunction [reduced performance and/or symptom exacerbation on a post-exercise King-Devick (KD) test] in adolescents early after sport-related concussion was associated with increased risk of persistent post-concussive symptoms (PPCS, recovery >28 days). We used exercise as a provocative maneuver before the KD test, hypothesizing that concussed adolescents with exercise-induced vision dysfunction would be more likely to develop PPCS. Secondary analysis of data from a multi-center, randomized clinical trial comparing KD test performance before and after the Buffalo Concussion Treadmill Test in adolescents within 10 days of sport-related concussion who were randomized to aerobic exercise or placebo stretching program. Three university-associated sports medicine clinical programs. Ninety-nine adolescents with sport-related concussion (exercise group: n = 50, 15.3 ± 1 years, 60% M, 22% with PPCS; stretching group: n = 49, 15.9 ± 1 years, 65% M, 35% with PPCS) tested a mean of 6 ± 2 days from injury. King-Devick test performed immediately before and 2 minutes after Buffalo Concussion Treadmill Test. Persistent post-concussive symptoms. Adolescents who demonstrated exercise-induced vision dysfunction upon initial evaluation developed PPCS at a significantly greater rate when compared with adolescents who did not (71% vs 34%, P < 0.001). Exercise-induced vision dysfunction corresponded to a relative risk of 3.13 for PPCS. Adolescents with exercise-induced vision dysfunction had a 3-fold greater relative risk of developing PPCS than those without exercise-induced vision dysfunction.

Association Between First Attempt Buffalo Concussion Treadmill Test and Days to Recovery in 855 Children With Sport-Related Concussion: A Historical Cohort Study and Prognostic Factors Analysis.

Little is known about the prognostic value of the Buffalo Concussion Treadmill Test (BCTT) after the acute phase of sport-related concussion (SRC). We examined the added prognostic value of the BCTT performed 10 to 21 days after SRC in children, in addition to participant, injury, and clinical process characteristics on days to recovery. Historical clinical cohort study. Network of approximately 150 Canadian multidisciplinary primary-care clinics. 855 children (mean age 14 years, range 6-17 years, 44% female) who presented between January 2016, and April 2019 with SRC. Participant, injury, and clinical process characteristics, with focus on BCTT exercise intolerance assessed 10 to 21 days after injury. Days to clinical recovery. Children who were exercise intolerant experienced an increase of 13 days to recovery (95% CI, 9-18 days). Each additional day between SRC and first BCTT was associated with a recovery delay of 1 day (95% CI, 1-2 days), and prior history of concussion was associated with a recovery delay of 3 days (95% CI, 1-5 days). Participant, injury, and clinical process characteristics, and the first attempt BCTT result explained 11% of the variation in recovery time, with 4% accounted for by the BCTT. Exercise-intolerance assessed 10 to 21 days after SRC was associated with delayed recovery. However, this was not a strong prognostic factor for days to recovery.

Salivary Cortisol Dynamics After Mild Traumatic Brain Injury.

To assess mild traumatic brain injury (mTBI)-related alterations in baseline (resting) salivary cortisol and cortisol reactivity to cognitive and exercise stressors, which are frequently encountered during mTBI rehabilitation and recovery. Persons with mTBI were recruited from a level 1 trauma center emergency department. Uninjured controls (UCs) were recruited from the community. Participants were 37 individuals with mTBI and 24 UCs. All patients with mTBI were enrolled at 7 ± 3 days post-injury, met the American Congress of Rehabilitation Medicine definition of mTBI, and had no acute intracranial findings on clinical neuroimaging (if performed). A prospective cohort study design was used. All participants provided saliva samples 10 times during each of 2 visits spaced 3 weeks apart (1 week and 1 month post-injury for the mTBI group). Each visit included baseline saliva sampling and sampling to evaluate reactivity to a cognitive stressor (Paced Auditory Serial Addition Test) and physical stressor (Buffalo Concussion Treadmill Test [BCTT]). Natural log-transformed salivary cortisol was measured by enzyme immunoassay. Cortisol was predicted using a linear mixed-effects model by group (mTBI and UC), visit (1 week and 1 month), and saliva sample. Mean salivary cortisol was higher in the mTBI group (1.67 nmol/L [95% CI 1.42-1.72]) than in controls (1.30 nmol/L [1.12-1.47]), without an mTBI × time interaction. At 1 week, the mTBI group had greater cortisol reactivity in response to the BCTT. Higher cortisol in individuals with mTBI at 1 week and 1 month post-injury extends previous findings into the subacute recovery period. Furthermore, the mTBI group demonstrated a greater cortisol response to mild-to-moderate aerobic exercise (BCTT) at 1 week post-injury. Given the increasing role of exercise in mTBI rehabilitation, further research is warranted to replicate these findings and identify the clinical implications, if any, of enhanced hypothalamic-pituitary-adrenal axis responses to exercise in civilians with recent mTBI.

Ранні діагностичні показники повернення до тренувально- змагальної діяльності у хокеїстів після черепно-мозкових травм

В дослідженні приймали участь 30 професійних гравців у хокей з шайбоюу віці від 17 до 30 років (середній вік склав 22,7±0,8) із струсом головного мозку у спорті.Спортсменам у день отримання струсу головного мозку у спорті призначали фізичний такогнітивний спокій. На наступний день спортсмени проходили огляд в об’ємі:соматоскопія та соматометрія, оцінку тонусу вегетативної нервової системи, оцінкуваріабельності серцевого ритму, оцінку відхилень балансу (BESS тест). Buffalo concussiontreadmill test, який є найбільш вживаним тестом з дозованим фізичним навантаженням, щовстановлює порогову частоту серцевих скорочень проводили на 3 день та 4 день.Результати проведеного дослідження показали зв’язок між струсом головного мозку успорті та змінами вегетативної регуляції у бік переважання симпатикотонії. Крім того,було показано динаміку стану вегетативної рівноваги протягом раннього періодувідновлення після струсу головного мозку. Також вдалося встановити покращеннярухових функцій після струсу головного мозку у динаміці з 1 візиту по 4. Проте, недивлячись на існуючі рекомендації щодо початку ранньої активної реабілітації на третійдень після струсу, не врахування стану вегетативної регуляції може призвести дофізичного перенапруження регулюючих систем. Це потребує врахування станувегетативної регуляції під час планування та виконання як реабілітаційних, так йспортивних навантажень у хокеїстів після струсу головного мозку у спорті.

Identifying Trends of Dysautonomia Signs and Symptoms Associated with Protracted Concussion Recovery during the Buffalo Concussion Treadmill Test: A Retrospective Study

Abstract Objective: To identify trends of provoked dysautonomia signs and symptoms during the Buffalo Concussion Treadmill Test (BCTT). Subjects: This is a retrospective cohort study of 101 patient charts post-concussion who were screened for suspected dysautonomia. Methods: Patients with suspected dysautonomia were assessed for exercise intolerance using a BCTT. Symptoms and rate of perceived exertion were recorded on a standardized form. Digital pulse oximetry was used to collect heart rate (HR) and oxygen saturation. Descriptive analyses were conducted on BCTT results. Results: Of 101 patient charts, 57 were excluded from analysis, including four patients who completed the BCTT by asymptomatically reaching the target HR zone for their estimated HR max. The remaining 44 patients demonstrated: 35 (79.5%) poor HR stabilization defined as a drop or plateau in HR during exercise, 28 (63.8%) exacerbated concussion symptoms, 13 (29.5%) autonomic nervous system response such as hot flushed sensation, 12 (27.3%) rebound symptoms during recovery phases, and 8 (18.2%) desaturation of 90% or below. The mean delta (80% expected HR max – 80% achieved HR max) on the initial test was 80.66 (± 23.08) beats per minute. Conclusions: This study is the first to identify trends of signs and symptoms during the BCTT in an expanded population with suspected dysautonomia after concussion. Future studies are indicated to validate these findings and contribute to development of modified termination criteria for the BCTT in individuals with suspected dysautonomia associated with protracted concussion recovery.

Clinical application of the Buffalo Concussion Treadmill Test and the Buffalo Concussion Bike Test: A systematic review

Objective To identify and synthesise research evidence regarding psychometric properties and clinical utility of the Buffalo Concussion Treadmill Test (BCTT) and Buffalo Concussion Bike Test (BCBT) for use with patients with acute concussion, post-concussion syndrome (PCS) or physiological post-concussion disorder (PPCD). Data sources ProQuest (ProQuest Central), PEDro, Medline (Ovid), Emcare (Ovid), EBSCOhost (Health collection) and Google Scholar, searched September 8th-12th, 2020. Study selection Two authors independently selected studies that met eligibility criteria. Studies were selected if they were original research of any design, that investigated the properties of the testing protocols in either concussed or uninjured participants. Articles not published in English, that were not original research or that used significantly different testing protocols were excluded. The search yielded 250 articles, 11 of which were eligible and included in this review. Data extraction Included studies were critically appraised independently by two authors, using the Mixed Methods Appraisal Tool (MMAT). Data relating to study characteristics and key findings were extracted from the studies, documented in tables, and used to inform a critical narrative synthesis of findings. Data synthesis To provide recommendations relating to each aim of the review, a strength of evidence scoring system was used. Available evidence supported use of the BCTT, with strong evidence supporting the safety and construct validity of the test and moderate evidence supporting its prognostic value. There has been very limited research investigating use of the BCBT. Conclusion The findings support a recommendation for use of the BCTT in clinical settings for management of acute concussion, PCS and PPCD. There is limited evidence available for the BCBT. Additional studies are needed of both tests to further establish their clinical value.

P.082 The Toronto Concussion Study: The Feasibility and Effects of Early Prescribed Aerobic Exercise on Recovery and Post-Concussive Symptoms in Adults – A Pilot Study

Background: Evidence suggests that aerobic exercise (AE) soon after concussion may facilitate earlier recovery in athletes. The purpose of this pilot study was to investigate the feasibility and effects of early sub-symptom threshold AE on symptom trajectory and recovery time in a heterogeneous adult population. Methods: Adults presenting within 7 days of concussion were randomized to either the experimental group: prescribed AE (90% of symptom-limited heartrate achieved on Buffalo Concussion Treadmill Test [BCTT]), 30 minutes/day, 5 days/week, or the control group: standard of care exercise recommendations. Participants were assigned a heartrate monitor bracelet to track activity. They underwent serial treadmill testing to monitor exercise tolerance, update prescriptions and determine recovery. Results: 20 participants (10 per arm) completed the BCTT protocol within 7 days of injury, with 8/20 demonstrating exercise tolerance at week 1. 66% (4/6) of those in the experimental group were recovered by week 4, compared to only 43% (3/7) in the control group. Average heart rate monitor compliance was 32% of the prescribed time among all participants, and self-reported exercise prescription compliance was 43% in the experimental group. Conclusions: Early post-concussion aerobic exercise in the general adult population is a promising intervention; this study will inform the design of a larger trial.

Sex differences in the Buffalo Concussion Treadmill Test in adolescents with acute sport-related concussion

ObjectivesThe Buffalo Concussion Treadmill Test (BCTT) is a safe and validated tool to assess exercise tolerance after sport-related concussion (SRC). Sex differences may affect the interpretation of this systematic exertion test in the concussed population, which is important for clinicians. The purpose of this study was to examine sex differences in BCTT performance in adolescents with acute SRC. DesignProspective cohort. MethodsMale (n = 103, 15.3 ± 2 years) and female (n = 87, 15.1 ± 2 years) adolescents with SRC performed the BCTT within 10 days of injury. Heart rate (HR), HR threshold (HRt), Delta HR (difference between resting HR and HRt), symptom severity on Visual Analog Scale (VAS) and symptoms exacerbated on the BCTT were collected and compared. ResultsMales had lower resting HR (M: 70.9 ± 12 vs F: 75.7 ± 13 bpm, p < 0.01) and reached a lower HRt than females (M: 134.7 ± 23 vs F: 141.5 ± 25 bpm, p = 0.05). Sexes did not differ on Delta HR (M: 63.8 ± 26 vs F: 65.9 ± 24 bpm, p = 0.57), total treadmill time (M: 9.3 ± 5 vs F: 8.4 ± 4 min, p = 0.20), maximum VAS (M: 5.0 ± 2 vs F: 5.4 ± 2, p = 0.18) or incidence of a change in VAS (M: 91% vs F: 94%, p = 0.43) on the BCTT. ConclusionsAlthough males may reach symptom exacerbation at a slightly lower mean HRt than females on the BCTT within 10 days of SRC, the BCTT provides comparable information and both sexes reach symptom exacerbation at similar Delta HR.