Graded Symptom Checklist Research Articles

Improvement in symptom severity, processing speed and visual acuity in a patient with a history of multiple concussions and anxiety, with neurological rehabilitation and pulsed magnetic frequency therapy

Event Abstract Back to Event Improvement in symptom severity, processing speed and visual acuity in a patient with a history of multiple concussions and anxiety, with neurological rehabilitation and pulsed magnetic frequency therapy Matthew M. Antonucci1, 2, 3* and Frederick R. Carrick1, 4 1 Carrick Institute, Clinical Neuroscience, United States 2 Plasticity Brain Centers, Neurorehabilitation, United States 3 NeuroSynergy Associates, PA, Neurorehabilitation, United States 4 Harvard Medical School and Harvard-Macy MGH Institute of Health Professions, Medical Education, United States Background: A 21-year-old, Mexican, male, student with a history of 5 concussions presented with headache, feeling of being in a “fog”, frequent urination up to 6x per day, and anxiety. Graded Symptom Checklist (GSC) severity was 41/162. Trails A (TA) and Trails B (TB) times were 22 and 40.5 seconds respectively. Processing Speed (PS) coding score was 71 correctly matched symbols in 2 minutes. Visual Acuity (VA) line difference was 1. Methods: A five-day, multimodal program of receptor based neurological rehabilitation was administered three times per day, one hour per session. Each session consisted of electrical somatosensory stimulation, vision therapy exercises, therapeutic exercises, off-vertical axis rotations, and 1 hour in a Magneceutical Health™ Magnesphere™ (30 minutes parasympathetic program, 30 minutes anxiety setting). Results: Following conclusion of five days of treatment there were improvements in GSC (-51.3%), TA (-47.3%), TB (-42.8%), PS (+7.8%) and VA (-20%). Conclusion: Short duration, multimodal, intensive programs of receptor-based neurological rehabilitation combined with pulsed magnetic frequencies may be a viable method to improve neurological integrity and performance in individuals with Post-Concussive Syndrome. The authors suggest further investigation into short duration, multi-modal, intensive approaches to restoring neurological function in individuals suffering from mild traumatic brain injury (mTBI) Acknowledgements The authors and clinicians would like to acknowledge and thank Magneceutical Health for the provision of the Magnesphere which was utilized in this patient's case. Keywords: PMF, Anxiety, concussion, concussion rehabilitation, Vestibular Rehabilitation Conference: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016. Presentation Type: Poster Presentation Topic: Abstracts ISCN 2016 Citation: Antonucci MM and Carrick FR (2016). Improvement in symptom severity, processing speed and visual acuity in a patient with a history of multiple concussions and anxiety, with neurological rehabilitation and pulsed magnetic frequency therapy . Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00060 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Sep 2016; Published Online: 07 Sep 2016. * Correspondence: Dr. Matthew M Antonucci, Carrick Institute, Clinical Neuroscience, Cape Canaveral, United States, drnucci@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Matthew M Antonucci Frederick R Carrick Google Matthew M Antonucci Frederick R Carrick Google Scholar Matthew M Antonucci Frederick R Carrick PubMed Matthew M Antonucci Frederick R Carrick Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Improvement in symptom severity, cognitive assessment, and choice reaction time in a college professor with post-concussive syndrome.

Event Abstract Back to Event Improvement in symptom severity, cognitive assessment, and choice reaction time in a college professor with post-concussive syndrome. Matthew M. Antonucci1, 2, 3*, Paul E. Link2, 3, Derek A. Barton2, 3 and Frederick R. Carrick1, 4 1 Carrick Institute, Clinical Neuroscience, United States 2 Plasticity Brain Centers, Neurorehabilitation, United States 3 NeuroSynergy Associates, PA, Neurorehabilitation, United States 4 Harvard Medical School and Harvard-Macy MGH Institute of Health Professions, Medical Education, United States Background: A 42-year-old, college professor, with a history of concussion following a motor vehicle accident, presented with symptoms of headache, neck pain, balance problems, fatigue, low energy and trouble driving. Graded Symptom Checklist (GSC) severity was 33/162. Trails A (TA) and Trails B (TB) had scores of 27.0 seconds and 32.9 seconds respectively. Choice Reaction Time (cRT) latency was 424 milliseconds. Methods: A five-day, multimodal program of receptor based neurological rehabilitation was administered three times per day, one hour per session. Each session consisted of electrical somatosensory stimulation, vestibular rehabilitation exercises, neuromuscular reeducation exercises, hand-eye coordination exercises, vision therapy exercises and off-vertical axis rotations. Results: Following conclusion of five days of treatment there were improvements in GSC (-75%), decreased TA (-37%) and TB (-10%), and cRT latency (-15.8%). Conclusion: Short duration, multimodal, intensive programs of receptor based neurological rehabilitation may be a viable method to improve neurological integrity and performance in individuals with Post-Concussive Syndrome. The authors suggest further investigation into short duration, multi-modal, intensive approaches to restoring neurological function in individuals suffering from mild traumatic brain injury (mTBI) Keywords: concussion rehabilitation, Off-vertical axis rotation, cognitive processing, Trail Making Test (TMT), MTBI, Vestibular Rehabilitation Conference: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016. Presentation Type: Poster Presentation Topic: Abstracts ISCN 2016 Citation: Antonucci MM, Link PE, Barton DA and Carrick FR (2016). Improvement in symptom severity, cognitive assessment, and choice reaction time in a college professor with post-concussive syndrome.. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00095 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Sep 2016; Published Online: 07 Sep 2016. * Correspondence: Dr. Matthew M Antonucci, Carrick Institute, Clinical Neuroscience, Cape Canaveral, United States, drnucci@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Matthew M Antonucci Paul E Link Derek A Barton Frederick R Carrick Google Matthew M Antonucci Paul E Link Derek A Barton Frederick R Carrick Google Scholar Matthew M Antonucci Paul E Link Derek A Barton Frederick R Carrick PubMed Matthew M Antonucci Paul E Link Derek A Barton Frederick R Carrick Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Improvement in symptoms, processing speed and cognition in a 59-year-old stroke patient with Wernicke's aphasia

Event Abstract Back to Event Improvement in symptoms, processing speed and cognition in a 59-year-old stroke patient with Wernicke's aphasia Matthew M. Antonucci1, 2, 3* and Freddys X. Garcia1, 3 1 Carrick Institute, Clinical Neuroscience, United States 2 Plasticity Brain Centers, Neurorehabilitation, United States 3 NeuroSynergy Associates, PA, Neurorehabilitation, United States Background: A 59-year-old, male, with a history of a left-sided MCA stroke, presented with right hand and face numbness, right hand weakness, incomplete Wernicke's receptive aphasia, and confusion. His Graded Symptom Checklist (GSC) severity was 78/162. Standard Assessment of Cognition (SAC) was 0/30. Trails A (TA) was unable to be completed within the two-minute time deadline. Processing Speed (PS) coding test was unable to be performed due to delays between each symbol. Methods: A five-day multimodal program of receptor based neurological rehabilitation was administered three times per day, one hour per session. Each session consisted of electrical somatosensory stimulation on the second branch of his trigeminal nerve on the right and bilaterally on the third branch of his trigeminal nerve, vestibular rehabilitation exercises, therapeutic exercises, hand-eye coordination exercises, Carrick eye exercises, and off-vertical axis rotations. Results: At the end of five days of treatment there were significant resolutions in GSC (-92.3%), improvement of SAC from 0/30 to 4/30, TA time from unable to be performed to completion in 69.4 seconds and processing speed of 15 symbols matched correctly from being unable to perform. Conclusion: Short duration, multimodal, intensive programs of receptor based neurological rehabilitation may be a viable method to improve neurological integrity and performance in individuals with Stroke. The authors suggest further investigation into short duration, multi-modal, intensive approaches to restoring neurological function in individuals suffering from acquired brain injuries, such as stroke. Keywords: Stroke, Aphasia, Wernicke’s aphasia, vestibular rehabilitaiton, non-invasive nerve stimulation, Off-vertical axis rotation Conference: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016. Presentation Type: Poster Presentation Topic: Abstracts ISCN 2016 Citation: Antonucci MM and Garcia FX (2016). Improvement in symptoms, processing speed and cognition in a 59-year-old stroke patient with Wernicke's aphasia. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00075 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Sep 2016; Published Online: 07 Sep 2016. * Correspondence: Dr. Matthew M Antonucci, Carrick Institute, Clinical Neuroscience, Cape Canaveral, United States, drnucci@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Matthew M Antonucci Freddys X Garcia Google Matthew M Antonucci Freddys X Garcia Google Scholar Matthew M Antonucci Freddys X Garcia PubMed Matthew M Antonucci Freddys X Garcia Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Baseline Neurocognition and Balance do not Influence Head Impact Severity in High School Football Players

Athletes with better neurocognitive and balance performance may have heightened field awareness allowing sufficient time to prepare for collision. Identifying football players who are at risk for sustaining high severity head impacts using baseline neurocognitive, balance, and symptom severity values could be a valuable concussion prevention strategy. PURPOSE: To compare head impact severity between football players with higher and lower baseline neurocognitive, balance, and symptoms. METHODS: Thirty-seven high school football players (height = 180.6±6.5 cm, mass = 87.3±18.6 kg, age = 16.6±0.9 years) completed a baseline evaluation including a computerized neurocognitive assessment (CNS Vital Signs), balance assessment (Balance Error Scoring System - BESS), and graded symptom checklist. Higher and lower performance groups were created using a median split for BESS total errors, total symptom scores, and the following neurocognitive measures: composite memory, psychomotor speed, reaction time, complex attention, cognitive flexibility, processing speed, executive function. The Head Impact Telemetry System was used to capture measures of severity for 16,066 head impacts (>10g): linear acceleration (g), rotational acceleration (rad/s2), and Head Impact Technology severity profile (HITsp - unitless). Random intercepts general linear models were used to compare head impact severity between higher and lower performers for each outcome measure (α = 0.05). RESULTS: Head impact severity did not differ between players with higher and lower neurocognitive and balance performance (p>0.05). Players reporting higher total symptom scores sustained higher linear acceleration (higher: 22.6g, 95%CI: 21.5, 23.7 vs. lower: 21.2g, 95%CI: 20.5, 21.9; F1,37= 5.10, p=0.030) and HITsp (higher: 14.2, 95%CI: 13.5, 14.9 vs. lower:13.3, 95%CI: 12.9, 13.8; F1,37= 4.24, p=0.046) compared to players reporting lower symptoms. CONCLUSION: Our results suggest that baseline neurocognitive and balance measures do not influence the risk of sustaining severe head impacts. Baseline symptoms may influence head impact severity, however, differences observed are not likely clinically meaningful. Researchers should continue to identify multidimensional factors associated with lessening concussion injury risk.

ABSTRACT: IMPROVEMENT IN SYMPTOMS AND COGNITIVE PERFORMANCE IN A HIGH SCHOOL FOOTBALL PLAYER WITH MULTIPLE CONCUSSIONS

Event Abstract Back to Event ABSTRACT: IMPROVEMENT IN SYMPTOMS AND COGNITIVE PERFORMANCE IN A HIGH SCHOOL FOOTBALL PLAYER WITH MULTIPLE CONCUSSIONS Matthew Antonucci1, 2*, Chris M. Sass1, 2 and Brian J. Sass1, 2 1 Plasticity Brain Centers, United States 2 Carrick Institute for Graduate Studies, United States Background: A 20 year old, male, former high school football player, with a history of 3 concussions, presented with fogginess, sluggishness, light sensitivity, blurred vision, head pressure, and headache of 2-year duration. Graded Symptom Checklist (GSC) severity score was 31/138. Standard Assessment of Cognition (SAC) was scored at 27/30. Trails A (TA) and Trails B (TB) had scores of 22.7 sec and 40.3 seconds respectively; Trails B-A Difference (TB-A) was 17.6 sec. Simple Reaction Time (sRT) and Choice Reaction Time (cRT) latencies were 290 and 366 milliseconds respectively. Static (SVA) and Dynamic (DVA) Visual Acuity was -0.26 LogMAR and -0.06 respectively. Methods: A five-day, multi-modal program of neurological rehabilitation was administered three times per day, for 45 minutes per session. Each session consisted of electrical somatosensory stimulation, neuromuscular reeducation exercises, vestibular rehabilitation, off-vertical axis rotation, and eye exercises. Results: Following the course of treatment, the patient had an overall decrease in GSC severity (-77.4%), increased SAC score (+11.1%), decreased TA time (- 4%), decreased TB time (-15.9%), decreased TB-A time (-31.3%), decreased sRT latency and cRT latency (-5.5% ,-5.5%), and increased SVA and DVA (+38.5%, +400%). Conclusion: Short duration, multi-modal, intensive programs of neurological rehabilitation may be a viable method to improve neurological function, and reduce symptoms in patients with protracted post-concussive disorders. Further investigation in this area is warranted. Keywords: Cognition, Vestibular Rehabilitation, Neurorehabilitation, concussion, TBI Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: Antonucci M, Sass CM and Sass BJ (2015). ABSTRACT: IMPROVEMENT IN SYMPTOMS AND COGNITIVE PERFORMANCE IN A HIGH SCHOOL FOOTBALL PLAYER WITH MULTIPLE CONCUSSIONS. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00051 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 30 Oct 2015; Published Online: 02 Nov 2015. * Correspondence: Dr. Matthew Antonucci, Plasticity Brain Centers, Orlando, Florida, United States, mantonucci@carrickinstitute.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Matthew Antonucci Chris M Sass Brian J Sass Google Matthew Antonucci Chris M Sass Brian J Sass Google Scholar Matthew Antonucci Chris M Sass Brian J Sass PubMed Matthew Antonucci Chris M Sass Brian J Sass Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

A CASE OF COMPLETE SYMPTOM RESOLUTION AND IMPROVEMENT IN COGNITION IN A 71 YEAR OLD MALE WITH COGNITIVE DECLINE FOLLOWING A 1-WEEK MULTI-MODAL NEURO-REHABILITATION PROGRAM

Event Abstract Back to Event A CASE OF COMPLETE SYMPTOM RESOLUTION AND IMPROVEMENT IN COGNITION IN A 71 YEAR OLD MALE WITH COGNITIVE DECLINE FOLLOWING A 1-WEEK MULTI-MODAL NEURO-REHABILITATION PROGRAM Matthew Antonucci1, 2*, Chris M. Sass1, 2 and Brian J. Sass1, 2 1 Plasticity Brain Centers, United States 2 Carrick Institute for Graduate Studies, United States Background: A 71-year-old male presented with a gradual decline in ability “to think, reason, do work, and remember names of people”. He had also noticed a heightened sense of emotionality, cognitive decline, headaches, and neck stiffness. Graded Symptom Checklist (GSC) severity score was 59/138. Standard Assessment of Concussion (SAC) was scored at 15/30 including decreased orientation, decreased immediate word recall, and absence of delayed word recall. Trails A (TA) and Trails B (TB) had scores of 39.7 sec and 103.2 seconds respectively. Methods: A five-day, multi-modal program of neurological rehabilitation was administered three times per day, for approximately 45 minutes per session. Each session consisted of electrical somatosensory stimulation, neuromuscular reeducation exercises, vestibular-ocular rehabilitation, off-vertical axis rotation, and eye exercises. Results: Following the course of treatment, the patient had a complete decrease in GSC severity to a 0/138 (-100%); increased SAC score to 23/30 (+34.8%) with improved immediate recall, delayed recall and full orientation; no change in TA time 40.4 sec, and decreased TB time 68.6 sec (-33.5%). Conclusion: Short duration, multi-modal, intensive programs of neurological rehabilitation may effectively reduce symptoms, improve orientation, concentration, speed and fluid attention as well as other cognitive abilities of individuals experiencing cognitive decline in the geriatric population. The SAC may also be an effective way to measure pre and post intervention cognitive function in the geriatric population. Further research into high intensity, short- duration, multi-modal neurological rehabilitation for geriatric cognitive decline is indicated. Keywords: Cognition, Vestibular Rehabilitation, Neurorehabilitation, Geriatrics, Aging Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: Antonucci M, Sass CM and Sass BJ (2015). A CASE OF COMPLETE SYMPTOM RESOLUTION AND IMPROVEMENT IN COGNITION IN A 71 YEAR OLD MALE WITH COGNITIVE DECLINE FOLLOWING A 1-WEEK MULTI-MODAL NEURO-REHABILITATION PROGRAM. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00058 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 30 Oct 2015; Published Online: 02 Nov 2015. * Correspondence: Dr. Matthew Antonucci, Plasticity Brain Centers, Orlando, Florida, United States, mantonucci@carrickinstitute.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Matthew Antonucci Chris M Sass Brian J Sass Google Matthew Antonucci Chris M Sass Brian J Sass Google Scholar Matthew Antonucci Chris M Sass Brian J Sass PubMed Matthew Antonucci Chris M Sass Brian J Sass Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

ABSTRACT: IMPROVEMENT IN SYMPTOMS AND COGNITIVE MEASUREMENTS IN A HIGH SCHOOL HOCKEY PLAYER WITH PRTOTRACTED CONCUSSION SYMPTOMS

Event Abstract Back to Event ABSTRACT: IMPROVEMENT IN SYMPTOMS AND COGNITIVE MEASUREMENTS IN A HIGH SCHOOL HOCKEY PLAYER WITH PRTOTRACTED CONCUSSION SYMPTOMS Matthew Antonucci1, 2*, Chris M. Sass1, 2 and Brian J. Sass1, 2 1 Plasticity Brain Centers, United States 2 Carrick Institute for Graduate Studies, United States Background: An 18 year old, high school, male hockey player, with a history of 7 documented concussions, presented with symptoms of headache, “brain fog”, and sluggishness. Graded Symptom Checklist (GSC) severity was a 14/138. Standard Assessment of Cognition (SAC) was scored at 21/30. Trails A (TA) and Trails B (TB) had scores of 22.3 sec and 51.8 seconds respectively; Trails AB Difference (TB-A) was 29.5 sec. Processing Speed (PS) score was a 52/80. Choice Reaction Time (cRT) latency was 462 milliseconds. Methods: A four-day, multi-modal program of neurological rehabilitation was administered three times per day, for one hour per session. Each session consisted of electrical somatosensory stimulation, neuromuscular reeducation exercises, vestibular rehabilitation exercises, off-vertical axis rotation, and eye exercises. Results: At the end of four days of treatment there was complete resolution of symptoms; GSC severity (-100%). The patient had an increased SAC score (+28.6%), decreased TA time (-19.3%), decreased TB time (-25.3%), TB-A decreased (-29.8%), increased PS score (+21.2%), and decreased cRT latency (-21.2%). Conclusion: Short duration, multi-modal, intensive programs of neurological rehabilitation may be a viable method to improve neurological integrity and performance in individuals with protracted concussive deficits. The authors suggest further investigation into short duration, multi-modal, intensive approaches to restoring neurological function in individuals suffering from mild traumatic brain injury (mTBI). Keywords: Keywords: performance enhancement, Vestibular Rehabilitation, balance, Visual Acuity, Cognition Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: Antonucci M, Sass CM and Sass BJ (2015). ABSTRACT: IMPROVEMENT IN SYMPTOMS AND COGNITIVE MEASUREMENTS IN A HIGH SCHOOL HOCKEY PLAYER WITH PRTOTRACTED CONCUSSION SYMPTOMS. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00046 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 29 Oct 2015; Published Online: 02 Nov 2015. * Correspondence: Dr. Matthew Antonucci, Plasticity Brain Centers, Orlando, United States, mantonucci@carrickinstitute.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Matthew Antonucci Chris M Sass Brian J Sass Google Matthew Antonucci Chris M Sass Brian J Sass Google Scholar Matthew Antonucci Chris M Sass Brian J Sass PubMed Matthew Antonucci Chris M Sass Brian J Sass Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

IMPROVEMENT IN SYMPTOMS AND COGNITIVE MEASUREMENTS IN A HIGH SCHOOL HOCKEY PLAYER WITH PROTRACTED CONCUSSION SYMPTOMS

Event Abstract Back to Event IMPROVEMENT IN SYMPTOMS AND COGNITIVE MEASUREMENTS IN A HIGH SCHOOL HOCKEY PLAYER WITH PROTRACTED CONCUSSION SYMPTOMS Matthew Antonucci1, 2*, Chris M. Sass1, 2 and Brian J. Sass1, 2 1 Plasticity Brain Centers, United States 2 Carrick Institute for Graduate Studies, United States Background: An 18 year old, high school, male hockey player, with a history of 7 documented concussions, presented with symptoms of headache, “brain fog”, and sluggishness. Graded Symptom Checklist (GSC) severity was a 14/138. Standard Assessment of Cognition (SAC) was scored at 21/30. Trails A (TA) and Trails B (TB) had scores of 22.3 sec and 51.8 seconds respectively; Trails AB Difference (TB-A) was 29.5 sec. Processing Speed (PS) score was a 52/80. Choice Reaction Time (cRT) latency was 462 milliseconds. Methods: A four-day, multi-modal program of neurological rehabilitation was administered three times per day, for one hour per session. Each session consisted of electrical somatosensory stimulation, neuromuscular reeducation exercises, vestibular rehabilitation exercises, off-vertical axis rotation, and eye exercises. Results: At the end of four days of treatment there was complete resolution of symptoms; GSC severity (-100%). The patient had an increased SAC score (+28.6%), decreased TA time (-19.3%), decreased TB time (-25.3%), TB-A decreased (-29.8%), increased PS score (+21.2%), and decreased cRT latency (-21.2%). Conclusion: Short duration, multi-modal, intensive programs of neurological rehabilitation may be a viable method to improve neurological integrity and performance in individuals with protracted concussive deficits. The authors suggest further investigation into short duration, multi-modal, intensive approaches to restoring neurological function in individuals suffering from mild traumatic brain injury (mTBI). Keywords: performance enhancement, Vestibular Rehabilitation, balance, Visual Acuity, Cognition Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: Antonucci M, Sass CM and Sass BJ (2015). IMPROVEMENT IN SYMPTOMS AND COGNITIVE MEASUREMENTS IN A HIGH SCHOOL HOCKEY PLAYER WITH PROTRACTED CONCUSSION SYMPTOMS. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00059 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 30 Oct 2015; Published Online: 02 Nov 2015. * Correspondence: Dr. Matthew Antonucci, Plasticity Brain Centers, Orlando, Florida, United States, mantonucci@carrickinstitute.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Matthew Antonucci Chris M Sass Brian J Sass Google Matthew Antonucci Chris M Sass Brian J Sass Google Scholar Matthew Antonucci Chris M Sass Brian J Sass PubMed Matthew Antonucci Chris M Sass Brian J Sass Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Changes in ImPACT and Graded Symptom Checklist Scores During a Division I Football Season

Changes in ImPACT and Graded Symptom Checklist Scores During a Division I Football Season

The Graded Symptom Checklist as a Pre-Participation Screening Instrument for Concussion

The Graded Symptom Checklist as a Pre-Participation Screening Instrument for Concussion

The Effects of Sleep Quality and Sleep Quantity on Concussion Baseline Assessment

Proper concussion assessment is imperative for properly caring for athletes who sustain traumatic brain injuries. Decreased sleep quality and sleep quantity affect cognition and may threaten the validity of clinical measures often used as a part of the concussion assessment. The purpose of this study was to determine if sleep quality or sleep quantity affects performance on clinical measures of concussion. Prospective cohort design. Clinical research center. One hundred fifty-five college student-athletes (57 females, 98 males; age = 18.8 ± 0.8 years; mass = 78.4 ± 19.6 kg; height = 177.4 ± 12.3 cm). We performed preseason baseline testing by using a well-accepted and multifaceted protocol inclusive of neurocognition, balance performance, and symptom reporting. Information related to sleep quality and sleep quantity was also collected during preseason baseline testing. The CNS Vital Signs battery (computerized neurocognitive test), Sensory Organization Test (computerized dynamic posturography), and a Graded Symptom Checklist (symptom evaluation) were used. Subjects with a low sleep quantity the night before baseline reported both a greater number of symptoms and higher total symptom severity score. No clinically significant effects for sleep quality were observed. Sleep-deprived athletes reporting for baseline testing should be rescheduled for testing after a normal night's sleep.

Recovery of Posttraumatic Migraine Characteristics in Patients After Mild Traumatic Brain Injury

Background: Headache-related symptoms may be predictive of delayed recovery in student athletes after sport-related concussion. Purpose and Hypothesis: To compare balance performance, cognitive function, and symptom recovery in concussed student athletes with no headache, those with posttraumatic headache, and those with characteristics of posttraumatic migraine following a sport-related concussion. It was hypothesized that those with posttraumatic migraine would take longer to recover on all clinical measures. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: A total of 296 student athletes who sustained sport-related concussions (migraine, 52; headache, 176; no headache, 68) were evaluated on measures of balance performance, cognition, and symptoms. Patients were categorized into posttraumatic migraine, posttraumatic headache, and no headache groups based on symptoms reported 1 day after injury. Serial testing was conducted with the Balance Error Scoring System, the Standardized Assessment of Concussion, and a graded symptom checklist to evaluate balance performance, cognition, and symptoms, respectively, at baseline, at the time of injury, after the event, and at days 1, 2, 3, 5, 7, and 90. Results: Student athletes with posttraumatic migraine experienced greater symptom severity scores than did those with posttraumatic headache and no headache at the time of injury, after the event, and through day 7 (P < .001 for all). By day 7, symptom severity scores reported by patients with posttraumatic migraine still demonstrated deficits relative to baseline (Δ = 5.6 ± 1.2) compared with patients with headache (Δ = −0.8 ± 0.7) and those with no headache (Δ = −1.4 ± 1.1). Patients with headache experienced greater symptom severity scores than patients with no headache at the time of injury (P < .001), after the event (P < .001), and at day 1 (P < .001), day 2 (P = .005), and day 3 (P = .038). Much smaller differences were observed between the headache and no headache groups beyond day 3 (P > .05). There were no group differences on balance performance (P = .439) and cognitive testing (P = .200) over time. Female patients were 2.13 times more likely than males to report posttraumatic migraine characteristics after concussion. Conclusion: Posttraumatic migraine characteristics are related to prolonged symptom recovery after sport-related concussion. Clinicians should exercise caution in making decisions about return to participation for athletes with migraine-like symptoms given the increased short-term impairments and delayed symptom recovery we observed.

Dehydration and Performance on Clinical Concussion Measures in Collegiate Wrestlers

The effects of dehydration induced by wrestling-related weight-cutting tactics on clinical concussion outcomes, such as neurocognitive function, balance performance, and symptoms, have not been adequately studied. To evaluate the effects of dehydration on the outcome of clinical concussion measures in National Collegiate Athletic Association Division I collegiate wrestlers. Repeated-measures design. Clinical research laboratory. Thirty-two Division I healthy collegiate male wrestlers (age = 20.0 ± 1.4 years; height = 175.0 ± 7.5 cm; baseline mass = 79.2 ± 12.6 kg). Participants completed preseason concussion baseline testing in early September. Weight and urine samples were also collected at this time. All participants reported to prewrestling practice and postwrestling practice for the same test battery and protocol in mid-October. They had begun practicing weight-cutting tactics a day before prepractice and postpractice testing. Differences between these measures permitted us to evaluate how dehydration and weight-cutting tactics affected concussion measures. Sport Concussion Assessment Tool 2 (SCAT2), Balance Error Scoring System, Graded Symptom Checklist, and Simple Reaction Time scores. The Simple Reaction Time was measured using the Automated Neuropsychological Assessment Metrics. The SCAT2 measurements were lower at prepractice (P = .002) and postpractice (P < .001) when compared with baseline. The BESS error scores were higher at postpractice when compared with baseline (P = .015). The GSC severity scores were higher at prepractice (P = .011) and postpractice (P < .001) than at baseline and at postpractice when than at prepractice (P = .003). The number of Graded Symptom Checklist symptoms reported was also higher at prepractice (P = .036) and postpractice (P < .001) when compared with baseline, and at postpractice when compared with prepractice (P = .003). Our results suggest that it is important for wrestlers to be evaluated in a euhydrated state to ensure that dehydration is not influencing the outcome of the clinical measures.

Identifying Impairments after Concussion

This study aimed to determine whether agreement exists between baseline comparison (comparison of postconcussion scores to individualized baseline scores) and normative comparison (comparison of postconcussion scores to a normative mean) in identifying impairments after concussion. A total of 1060 collegiate student-athletes completed baseline testing as part of an ongoing clinical program. Gender-specific normative means were obtained from a subset of 673 athletes with no history of self-reported concussion, learning disabilities, or attention-deficit disorders. Concussions were later diagnosed in 258 athletes who had completed baseline testing. The athletes completed their first assessment within 10 d after injury. Athletes completed a computerized neurocognitive test (Automated Neuropsychological Assessment Metrics), postural control assessment (Sensory Organization Test), and a 15-item graded symptom checklist at baseline and again after injury. We computed two postconcussion difference scores for each outcome measure: 1) baseline difference = postconcussion score--individualized baseline score and 2) normative difference = postconcussion score--normative mean. Athletes were considered impaired if postconcussion difference exceeded the reliable change parameters. McNemar tests were used to assess agreement on impairment status (impaired and unimpaired) between comparison methods for each outcome measure. The baseline comparison method identified 2.6 times more impairments than the normative comparison method for the Simple Reaction Time Test 1 (P = 0.043). The normative comparison method identified 7.6 times more impairments than the baseline comparison method for Mathematical Processing (P < 0.001). No other disagreements were observed for postural control or symptom severity. Our findings suggest that, when using these concussion assessment tools, clinicians may consider using normative data in lieu of individualized baseline measures. This may be especially useful to clinicians with limited resources and an inability to capture valid baselines on all athletes.

Psychometric Properties of Self-Report Concussion Scales and Checklists

Reference/Citation: Alla S, Sullivan SJ, Hale L, McCrory P. Self-report scales/checklists for the measurement of concussion symptoms: a systematic review. Br J Sports Med. 2009;43 (suppl 1):i3–i12....

The Relationship Between Subconcussive Impacts and Concussion History on Clinical Measures of Neurologic Function in Collegiate Football Players

Concussions sustained during college and professional football careers have been associated with both acute and chronic neurologic impairment. The contribution of subconcussive impacts to this impairment has not been adequately studied. Therefore, we investigated the relationship between subconcussive impacts and concussion history on clinical measures of neurologic function. Forty-six collegiate football players completed five clinical measures of neurologic function commonly employed in the evaluation of concussion before and after a single season. These tests included the Automated Neuropsychological Assessment Metrics, Sensory Organization Test, Standardized Assessment of Concussion, Balance Error Scoring System, and Graded Symptom Checklist. The Head Impact Telemetry (HIT) System recorded head impact data including the frequency, magnitude, and location of impacts. College football players sustain approximately 1,000 subconcussive impacts to the head over the course of a season, but for the most part, do not demonstrate any clinically meaningful changes from preseason to postseason on measures of neurologic function. Changes in performance were mostly independent of prior concussion history, and the total number, magnitude and location of sustained impacts over one season as observed R(2) values ranged between 0.30 and 0.35. Repetitive subconcussive head impacts over a single season do not appear to result in short-term neurologic impairment, but these relationships should be further investigated for a potential dose-response over a player's career.

Postconcussive Impairment Differences Across a Multifaceted Concussion Assessment Protocol

To examine the proportion of athletes with concussion and with impairment disagreements across various clinical concussion assessment measures. Quasi-experimental repeated measures design. Clinical research laboratory. A sample of 100 collegiate-aged athletes participated in the study (mean [SD] age, 18.5 ± 1.1 years; mean [SD] height, 180.6 ± 9.9 cm; mean [SD] weight, 84.1 ± 20.6 kg). METHODS OR INTERVENTIONS: Participants completed preseason baseline and postconcussive injury assessments on a clinical assessment battery, including a 17-item graded symptom checklist, a computerized neurocognitive assessment, and a balance performance assessment. Symptom severity total score, 8 cognitive domain scores from the Automated Neuropsychological Assessment Metrics, and the composite balance score obtained from the Sensory Organization Test served as outcome measures for the study. McNemar tests of paired proportions were then used to analyze impairment disagreements (where one measure identified impairments not identified by the other) between the study outcome measures. The α level was set to .05 a priori. We observed significant disagreements between symptom severity total scores, and all other measures used in the study in which symptom severity total scores identified more impairments than all other measures. In addition, we observed significant disagreements for half of the clinical measures used in the study, with disagreement proportions that ranged from 22%-52%. Our study underscores the importance of using a multifaceted approach for management of concussion that includes assessment of symptom severity, cognitive function, and balance. Use of this multifaceted approach also can aid clinicians in understanding other comorbidities that may complicate the management of concussion.

Detailed concussion symptom analysis in a paediatric ED population

Primary objective: To examine the frequency of acute mild traumatic brain injury (mTBI) symptoms in children using a concussion symptom inventory and to identify which symptoms are most useful in identifying mTBI. It was hypothesized that symptoms associated with mTBI are more common in children with head injury than orthopaedic injury and certain symptoms are more useful than others in identifying mTBI.Research design: Prospective case-control study conducted in a paediatric trauma centre emergency department.Methods and procedures: Children of 6–18 years old with head injury or a minor extremity injury were enrolled. Symptoms were assessed using a graded symptom checklist. Symptom frequency was compared using a chi-square test. The association between individual symptoms with AMS was evaluated with logistic regression analysis.Main outcomes and results: Children with head injury displayed more frequent symptoms than controls. Head-injured cases with altered mental status (AMS) demonstrated the most frequent and severe symptoms (median symptom scores: control = 1, cases without AMS = 5, cases with AMS = 10; p < 0.001). Headache, nausea, dizziness, blurred/double vision and not feeling ‘sharp’ were associated with AMS.Conclusions: Symptoms associated with mTBI are more frequent in children with head injury. AMS magnifies this effect. A symptom inventory is integral to the evaluation of mTBI in children; a smaller set of dichotomized symptoms may be as useful as and more easily administered than lengthier symptom scales.

Evaluation of the Standardized Assessment of Concussion in a Pediatric Emergency Department

The Standardized Assessment of Concussion (SAC) is a validated tool for identifying the effects of mild traumatic brain injury (mTBI). Previous research focused on sport-related sideline evaluation of adolescents and adults. Our goal was to evaluate performance of the SAC among subjects with and without head injury in a pediatric emergency department (ED). This was an observational study of children 6 to 18 years of age who presented to an ED with blunt head injury (case-patients) or minor extremity injury (controls). SAC and graded-symptom-checklist scores were compared. American Academy of Neurology concussion grades, presence of loss of consciousness and posttraumatic amnesia were also compared with SAC and graded-symptom-checklist scores among case-patients. Three hundred forty-eight children were enrolled. SAC scores trended lower (greater cognitive deficits) for case-patients compared with controls but did not reach significance. Graded-symptom-checklist scores were significantly higher among case-patients. Presence of altered mental status magnified this effect. There was no correlation between SAC scores and other indicators of mTBI. There was a positive correlation between graded-symptom-checklist scores and posttraumatic amnesia and American Academy of Neurology concussion grade. The graded symptom checklist reliably identified mTBI symptoms for all children aged 6 years and older. SAC scores tended to be lower for case-patients compared with controls but did not reach significance. Patients with altered mental status at the time of injury manifest an increased number and severity of symptoms. Additional research into strategies to identify cognitive deficits related to mTBI and classify mTBI severity in children is needed.

Association Between Previous Concussion History and Symptom Endorsement During Preseason Baseline Testing in High School and Collegiate Athletes

Background:A graded symptom checklist is a commonly used concussion evaluation measure. Little is known about preseason baseline symptomatology of high school and college athletes with and without a previous concussion history.Hypothesis:The primary hypothesis investigated was that those individuals with a concussion history would report more symptoms at baseline testing. The effects of sex and age on symptoms were also examined.Study Design:Cross-sectional study.Methods:Subjects included 8930 high school and collegiate athletes (height, 177.79 ± 9.97 cm; mass, 75.20 ± 19.21 kg; age, 16.60 ± 1.64 years). Subjects completed a self-report graded symptom checklist and concussion history questionnaire during a preseason clinical testing session. Symptoms reported (yes or no) on the 18-item graded symptom checklist served as the dependent variables.Results:A significant association was observed between symptoms on the graded symptom checklist and previous concussion history (P ≤ .001). No differences were observed between high school and college athletes regarding symptom endorsement (t8928 = 0.620; P = .535). A statistical but not clinically meaningful difference was observed between the means for males and females symptom endorsement (t8928 = −3.03; P = .002): men endorsed 1.88 ± 2.81 symptoms, and women endorsed 2.09 ± 2.90 symptoms. Headache, sleeping more than usual, difficulty concentrating, drowsiness, difficulty remembering, fatigue, difficulty sleeping, and irritability were reported by more than 10% of athletes.Conclusion:High school and college athletes with a history of multiple concussions may be at risk for experiencing concussion-linked symptoms well beyond the acute stage of injury. Clinicians should be mindful of previous concussion history in athletes with increased presence of base-rate symptoms as they may be predisposed to future injury.