Sport-related Concussion In Athletes Research Articles

A-59 Sport-related concussion in para athletes: A scoping review of concussion assessment and management

Abstract Purpose Current guidelines have lagged in addressing sport-related concussion (SRC) in athletes with disabilities, or para athletes. Concussion assessments may not accurately capture symptoms in para athletes or be appropriately accessible, resulting in challenges managing SRCs in these athletes. The objective of this scoping review was to summarize the current literature on SRC in para athletes, including assessment procedures and management of SRC. Data Selection This review was registered with Open Science Framework and adhered to PRISMA-ScR guidelines. Searches of electronic databases (CINAHL, Google Scholar, MEDLINE, SPORTDiscus, and Web of Science) were conducted from database inception to 02/01/2023. Articles selected examined SRC assessment and management in adaptive sports. Data Synthesis Reviewers screened 202 title-abstracts and 32 articles qualified for full-text review, with 9 articles qualifying for data extraction for information on SRC assessment and management. Most articles addressed baseline assessment (N=6), some addressed both assessment and management (N=2), and only one article addressed SRC management (N=1). Results identified discrepancies in the results of baseline data in para athletes. Differences in baseline composite scores and symptom reporting in para vs. non-adaptive athletes were also found. The literature acknowledged lack of validated assessment tools and SRC management guidelines for para athletes. Conclusions There is limited literature on the assessment and management of SRC in para athletes at both elite and non-elite levels, indicating a lag in research on para athletes as compared to non-adaptive athletes. Development or standardization of current baseline assessment procedures for SRC and subsequent management guidelines for para athletes is needed.

Epidemiological Characteristics of Sport-Related Concussion in Athletes of Brazilian Jiu-Jitsu and Muay Thai

To evaluate the self-reported history of concussion in athletes of both Brazilian Jiu-Jitsu (BJJ) and Muay Thai. Combat sports are widely practiced around the world. They include modalities that involves punches or kicks directed at the opponent's head (Striking sports) or that consists of grabbing an opponent and taking him to the ground (Grappling sports). Due to the objectives and close contact in combat sports, the risk of concussion is significant. This was a cross-sectional study involving a Brazilian sample of BJJ athletes (n-18) and Muay Thai athletes (n-22). The sample was consisted of both professional and amateur athletes (Women constituted 20% of sample). Through individual interviews with a researcher the following data were collected: self-report of concussion and the moment of the injury (whether in practice or in the fight). The Post-Concussion Symptoms Scale (PCSS) was also applied. In the present study, a concussion was considered as a direct impact on the head followed by symptoms. This study was approved by a local Ethics Committee. Among BJJ athletes, 61% reported a history of concussion, while among Muay Thai athletes the percentage was more higher (86%). The main mechanisms of head impact were the throw/takedown and elbow-hits to the head in BJJ and punches and knee-hits to the head in Muay Thai. There was no difference in the symptom score between BJJ and Muay Thai concussed athletes (average of 11 vs 10.7, respectively). The most common symptoms were dizziness, headache and nausea in BJJ athletes, and headache, nausea, drowsiness and brain fogginess in Muay Thai ones. The results presented herein suggest that concussions in Muay Thai and BJJ occur through different mechanisms. The clinical profile of post-concussion symptoms appears to be different between BJJ and Muay Thai athletes.

An investigation of plasma interleukin-6 in sport-related concussion.

Increasing evidence suggests inflammation is an important component of concussion pathophysiology. However, its etiology, restitution, and potential clinical repercussions remain unknown. The purpose of the current study was to compare the blood concentrations of interleukin (IL) -6, a prominent inflammatory cytokine, between healthy athletes and athletes with a sport-related concussion (SRC), while addressing the potential confounds of sex, recent physical activity, and the interacting effect of concussion history. A prospective, observational cohort study was conducted on athletes at a single academic institute participating across 13 interuniversity sports. Follow-up of 96 athletes who agreed to provide a blood sample was completed: 41 athletes with a physician diagnosed SRC, and 55 healthy athletes. Ella™, the high sensitivity immunoassay system by ProteinSimple was used to measure peripheral plasma concentrations of IL-6 within the first week (median = 4 days, range = 2-7) following injury. A resampled ordinary least squares regression was used to evaluate the relationship between IL-6 concentrations and concussion status, while partial least squares regression was used to evaluate the relationship between IL-6 and both symptom burden and time to clinical recovery. Regression analysis identified a negative relationship between plasma IL-6 concentrations and the interaction between an acute SRC and a history of concussion (β = -0.29, p = 0.029). IL-6 did not differ between healthy athletes and those with an acute SRC independent of concussion history, and was not correlated with either recovery time or symptom burden in athletes with SRC. Perturbations to circulating IL-6 concentrations, a key inflammatory cytokine, may be more pronounced following SRC in athletes who have a history of concussion. These results add to a growing body of evidence supporting the involvement of inflammation at all phases of recovery following SRC, and potentially support a concomitant effect of prior concussion on acute SRC pathophysiology.

The Association Between Persistent White-Matter Abnormalities and Repeat Injury After Sport-Related Concussion.

Objective: A recent systematic review determined that the physiological effects of concussion may persist beyond clinical recovery. Preclinical models suggest that ongoing physiological effects are accompanied by increased cerebral vulnerability that is associated with risk for subsequent, more severe injury. This study examined the association between signal alterations on diffusion tensor imaging following clinical recovery of sport-related concussion in athletes with and without a subsequent second concussion.Methods: Average mean diffusivity (MD) was calculated in a region of interest (ROI) in which concussed athletes (n = 82) showed significantly elevated MD acutely after injury (<48 h), at an asymptomatic time point, 7 days post-return to play (RTP), and 6 months relative to controls (n = 69). The relationship between MD in the identified ROI and likelihood of sustaining a subsequent concussion over a 1-year period was examined with a binary logistic regression (re-injured, yes/no).Results: Eleven of 82 concussed athletes (13.4%) sustained a second concussion within 12 months of initial injury. Mean MD at 7 days post-RTP was significantly higher in those athletes who went on to sustain a repeat concussion within 1 year of initial injury than those who did not (p = 0.048; d = 0.75). In this underpowered sample, the relationship between MD at 7 days post-RTP and likelihood of sustaining a secondary injury approached significance [χ2(1) = 4.17, p = 0.057; B = 0.03, SE = 0.017; OR = 1.03, CI = 0.99, 1.07].Conclusions: These preliminary findings raise the hypothesis that persistent signal abnormalities in diffusion imaging metrics at RTP following concussion may be predictive of a repeat concussion. This may reflect a window of cerebral vulnerability or increased susceptibility following concussion, though understanding the clinical significance of these findings requires further study.

Systematic Review of Pre-Injury Migraine Disorder as a Risk Factor for Worse Outcome Following Sport-Related Concussion

Abstract Purpose This systematic review examined clinical outcomes (i.e., prognosis) following a sport-related concussion in athletes who have a pre-injury history of migraines. Clinical recovery was defined functionally as recovery from symptoms or full return to activities following injury. Data Selection All studies published prior to February 2019 that addressed pre-injury migraines as a possible predictor of clinical recovery from concussion were included. Broadly, the search included (i) sport/athlete-related terms, (ii) concussion-related terms, and (iii) diverse predictor/modifier terms. The following databases were utilized: PubMed, PsycINFO®, MEDLINE®, CINAHL, Cochrane Library, EMBASE, SPORTDiscus, Scopus, and Web of Science. After removing duplicates from the 9,372 identified articles, 5,888 abstracts were screened, 358 full-text articles were reviewed, and 15 articles examining pre-injury migraines as a predictor of recovery were included. Data Synthesis Most articles examined pre-injury migraines as an exploratory/secondary predictor of concussion outcome. Migraine history was predominantly based on self-report. Studies included minimal other information about this condition (e.g., age of onset, migraine frequency/severity, past treatment). Methodological rigor varied greatly across studies. Most studies did not find pre-injury migraines to be associated with concussion outcome, but several of these studies had small or very small sample sizes. Larger, better-designed studies suggested pre-injury migraines may be a risk factor for worse concussion outcome. Effect sizes were rarely reported or able to be calculated. Conclusion There is some evidence to suggest pre-injury migraines may be a vulnerability factor for a prolonged recovery following concussion. Future studies should focus on improving methodological quality when assessing the relationship between pre-injury migraines and concussion outcome.