Sports-related Concussion Patients Research Articles

Elevated Smooth Pursuit Gain in Collegiate Athletes with Sport-related Concussion Immediately Following Injury

Purpose: Although there is evidence that sport-related concussion (SRC) affects oculomotor function and perceptual ability, experiments are often poorly controlled and are not replicable. This study aims to test the hypothesis that there are decreased values when assessing oculomotor impairment indicating poorer performance in SRC patients. Methods: Fifteen DI athletes presenting with SRC (7 females, 8 males) and 15 student volunteers (CON) (12 females, 3 males) completed a dynamic visual acuity (DVA) task that involved answering the direction of a moving stimulus (Landolt C) while wearing a head-mounted binocular eye tracker. There were 120 trials total with 60 trials presenting at 30º per second and 60 presenting at 90º per second. Various eye movement measurements, including horizontal smooth pursuit eye movements (SPEM) gain and saccadic peak velocity, were analyzed between groups using univariate ANOVAs. Saccade count in SPEM trials, accuracy, and vision were analyzed using Kruskal–Wallis tests. Results: There was no statistical difference in saccadic peak velocity: SRC = 414.7 ± 42º/s, CON = 406.6 ± 40.6º/s. A significant difference was found between SRC patients and healthy controls in horizontal SPEM gain (SRC = 0.9 ± 0.04, CON = 0.86 ± 0.03, F(1,28) = 7.243, P = 0.012) indicating that patients demonstrated compensatory eye movements when tracking the target. There were significantly more saccades in all SPEM trials (P = 0.001). Conclusion: SRC oculomotor deficits manifest as elevated horizontal SPEM gain when assessed within 48 hours of injury and compared to healthy controls within the same age range. SRC demonstrates altered oculomotor ability. While accurate in tracking a stimulus, SRC patients may conduct less controlled eye movements.

Elevated Smooth Pursuit Gain in Collegiate Athletes with Sport-related Concussion Immediately Following Injury

Purpose: Although there is evidence that sport-related concussion (SRC) affects oculomotor function and perceptual ability, experiments are often poorly controlled and are not replicable. This study aims to test the hypothesis that there are decreased values when assessing oculomotor impairment indicating poorer performance in SRC patients. Methods: Fifteen DI athletes presenting with SRC (7 females, 8 males) and 15 student volunteers (CON) (12 females, 3 males) completed a dynamic visual acuity (DVA) task that involved answering the direction of a moving stimulus (Landolt C) while wearing a head-mounted binocular eye tracker. There were 120 trials total with 60 trials presenting at 30º per second and 60 presenting at 90º per second. Various eye movement measurements, including horizontal smooth pursuit eye movements (SPEM) gain and saccadic peak velocity, were analyzed between groups using univariate ANOVAs. Saccade count in SPEM trials, accuracy, and vision were analyzed using Kruskal–Wallis tests. Results: There was no statistical difference in saccadic peak velocity: SRC = 414.7 ± 42º/s, CON = 406.6 ± 40.6º/s. A significant difference was found between SRC patients and healthy controls in horizontal SPEM gain (SRC = 0.9 ± 0.04, CON = 0.86 ± 0.03, F(1,28) = 7.243, P = 0.012) indicating that patients demonstrated compensatory eye movements when tracking the target. There were significantly more saccades in all SPEM trials (P = 0.001). Conclusion: SRC oculomotor deficits manifest as elevated horizontal SPEM gain when assessed within 48 hours of injury and compared to healthy controls within the same age range. SRC demonstrates altered oculomotor ability. While accurate in tracking a stimulus, SRC patients may conduct less controlled eye movements.

A-41 The Use of Virtual Reality for the Diagnosis of Pediatric Sports-Related Concussion: A Feasibility Study

Abstract Purpose Virtual Reality (VR) based concussion software has shown potential in diagnosing sports-related concussion (SRC). The purpose of this study was to explore potential symptom provocation when using a VR based diagnostic concussion software among SRC patients. Methods Pediatric SRC patients aged 12-18 and within 72 hours from injury to initial visit were recruited. While wearing the VR device, patients were instructed to fixate gaze on various targets to track eye movements in a gamified manner. The Post-Concussive Symptom Scale (PCSS) and Virtual Reality Sickness Questionnaire (VRSQ) were administered on a scale of 0 (none) to 3 (severe). Results A total of 21 patients were eligible (Age=14.9±1.7; Female 57.1%; White 61.9%). Patients noted minimal to no symptoms in terms of discomfort (.48±.60), fatigue (.48±.68), headache (1.48±.60), eye strain (.90±.77), inattention (.38±.59), blurred vision (.29±.64), and dizziness (.71±.56) while completing the VR task. Conclusions Compared to other studies using VRSQ among healthy subjects, our sample of acutely injured children with SRC reported minimally provoked symptoms that were below empirically established limits. Specifically, both components of the VRSQ (ocular component MOcu=3.24, SD=1.89; disorientation component MDis=2.59, SD=2.27) ranked below the average limit compared to other studies using VRSQ (MOcu=6.7; MDis=5.8). Future research should gather validity and reliability data to establish the clinical environment in which to diagnose pediatric SRC.

A-42 Patient Perspectives and Attitudes Toward the Use of Virtual Reality in Pediatric Sports-Related Concussion

Abstract Purpose Virtual reality (VR) has garnered increased attention as a modality to evaluate sports-related concussion (SRC). The purpose of this study was to better understand patient perspectives and attitudes towards VR while in the acute phase of injury. Methods Pediatric SRC patients aged 12-18 and within 72 hours from injury to initial visit were recruited. After completion of a VR task, patients were asked to rate their attitudes and perceptions on a custom VR user experience survey, on a scale of 0 (strongly disagree) to 4 (strongly agree). Results A total of 21 patients were eligible (Age=14.9±1.7; Female 57.1%; White 61.9%). Patients reported that the VR task involved mental focus (3.14±.57), required eye movements in all directions (3.33±.97), and motivated them to “finish and win” (3.38±2.11). Patients were neutral in their evaluation of the strategic component of the VR task (2.48±.93). They denied any difficulties understanding task instructions (.67±.96). Conclusions Overall, VR may be a promising avenue of research to evaluate SRC in pediatric patients given the level of engagement, ease of administration, and rich data captured by the VR device. Future research should determine whether VR can be used to accurately diagnose SRC and gather user information about ways to amplify the game-like and strategic nature of the task.

Prospective evaluation of 24-hour movement behaviors among adolescents recovering from a sport-related concussion

This study aimed to describe the 24-hour composition of movement behaviors, including sleep, sedentary behavior, and physical activity (PA), among pediatric sports-related concussion (SRC) patients over their recovery period, assess the association between movement compositions and recovery time, and understand feasibility of 24-hour accelerometry in the study population. A cohort of 50 pediatric SRC patients were asked to wear a wrist-worn accelerometer continuously for the duration of their recovery. Among all enrolled participants, the sample was primarily 14 or 15 years of age (65%), female (55%), and recovered in under 28 days (88%). Accelerometer compliance was moderate; 35 participants (70%) were compliant with the protocol. Compositional analysis was used to address time-use objectives in 33 participants who provided adequate data for inclusion. Overall, participants spent an average of 50% of their 24-hour day sedentary, 33% sleeping, 11% in light intensity PA, and 6% in moderate or vigorous intensity PA. The 24-hour composition of movement behaviors was not associated with recovery time (p = .09–.99). However, the limited sample size may have contributed to null findings. Given recent evidence supporting the effects of sedentary behavior and PA on concussion recovery, future studies should aim to further validate these findings in a larger sample.

Preliminary Evaluation of a Novel Point of Care Diagnostic Device for Sports-Related Concussion.

Visinin-like protein 1 (VILIP-1) is a neuron-specific calcium sensor protein rapidly released into blood after mild traumatic brain injury (mTBI) and may be a suitable biomarker for identification of sports-related concussion (SRC). The objective of the study is to test if quantification of a specific post-translationally modified (ubiquitinated) form of VILIP-1 (ubVILIP-1) from a fingerstick blood sample using a point of care (POC) lateral flow device (LFD) can be used to rapidly identify athletes with SRC. Prospective cohort study. Side-line blood collection at football, soccer, and volleyball games/practices. Division I athletes with/without SRC. Blood ubVILIP-1 concentrations. Data collected over 2 athletic seasons from non-SRC athletes (controls) show a small but statistically significant elevation of ubVILIP-1 over an individual season for male athletes (P = 0.02) dependent on sport (P = 0.014) and no significant changes in ubVILIP-1 levels between seasons. For SRC athletes, the data show ubVILIP-1 levels substantially increase above baseline as soon as 30 minutes postdiagnosis with peak concentrations and times postinjury that vary based on injury severity. Results of the study suggest quantification of blood ubVILIP-1 levels measured using an LFD may provide an objective identification of athletes with SRC, setting the stage for further study with a larger number of SRC patients.

Prevalence of Acute Neck Pain Following Sports-Related Concussion in High School Athletes.

To explore the prevalence of acute neck pain in high school athletes following sports-related concussion (SRC) and to examine the role of acute neck pain in modifying or amplifying concurrent concussive symptoms. Retrospective observational. High school sporting events. High school athletes who suffered a sports-related concussion between the 2011 and 2019 academic years academic years from the National Athletic Treatment, Injury and Outcomes Network (NATION) Study. Not applicable. Prevalence of neck pain (yes/no) along with 33 other commonly reported concussion symptoms, number of symptoms reported, mechanism of injury (contact with person/surface or object), sport type (contact/noncontact), and injury history (first time/repeated injury). One hundred thirty-eight of 401 athletes (33.9%) indicated acute neck pain following SRC. Those with neck pain reported significantly more symptoms overall (M = 13.53, SD = 6.89) relative to their non-neck pain counterparts (M = 8.46, SD = 5.68; t [191.35] = 7.11, P < 0.001). Athletes with SRC due to contact with a surface were significantly less likely to report neck pain than those reported contact with a person. Neck pain, repeated injury, and female sex were significantly associated with a greater number of concussion symptoms in the acute phase. Our data suggest that acute neck pain is a frequent acute symptom following SRC and signals the necessity for additional screening to seek and identify comorbid cervical pathology. Prospective studies should seek to access the benefit of cervical therapy in the early stages in SRC patients with neck pain to reduce the risk of persistent postconcussion symptoms.

Compromised Resting Cerebral Metabolism After Sport-Related Concussion: A Calibrated MRI Study

Use calibrated MRI to model baseline cerebrovascular physiology parameters and investigate whether changes in resting cerebral blood flow (CBF0) following sport-related concussion (SRC) are concordant with changes in resting and dynamic cerebral physiologic markers, within two weeks of the injury. Altered CBF0 in the acute phase post-concussion may contribute to neurobehavioral deficiencies, often reported weeks after the injury. However, in addition to changes in CBF0, little is known about other physiologic mechanisms that may be disturbed within the cerebrovasculature. The aim of this study was to assess whether changes in baseline perfusion following SRC were co-localized with changes in cerebral metabolic demand. Forty-two subjects (15 SRC patients 8.0 ± 4.6 days post-injury and 27 age-matched healthy control athletes) were studied cross-sectionally. CBF0, cerebrovascular reactivity (CVR), resting oxygen extraction (OEF0) and cerebral metabolic rate of oxygen consumption (CMRO2|0) were measured using a combination of hypercapnic and hyperoxic breathing protocols, and the biophysical model developed in calibrated MRI. Blood Oxygenation Level Dependent and Arterial Spin Labelling data were acquired simultaneously using a dual-echo arterial spin labelling sequence. SRC patients showed significant decreases in CBF0 spread across the grey-matter (p < 0.05, corrected), and these differences were also confounded by the effects of baseline end-tidal CO2 (p < 0.0001). Lower perfusion was co-localized with reductions in regional CMRO2|0 (p = 0.006) post-SRC, despite finding no group-differences in OEF0 (p = 0.800). Higher CVR within voxels showing differences in CBF0 was also observed in the SRC group (p = 0.001), compared to controls. Reductions in metabolic demand despite no significant changes in OEF0 suggests that hypoperfusion post-SRC may reflect compromised metabolic function after the injury. These results provide novel insight about the possible pathophysiologic mechanisms underlying concussion that may affect the clinical recovery of athletes after sport-related head injuries.

Tomographic Task-Related Functional Near-Infrared Spectroscopy in Acute Sport-Related Concussion: An Observational Case Study.

Making decisions regarding return-to-play after sport-related concussion (SRC) based on resolution of symptoms alone can expose contact-sport athletes to further injury before their recovery is complete. Task-related functional near-infrared spectroscopy (fNIRS) could be used to scan for abnormalities in the brain activation patterns of SRC athletes and help clinicians to manage their return-to-play. This study aims to show a proof of concept of mapping brain activation, using tomographic task-related fNIRS, as part of the clinical assessment of acute SRC patients. A high-density frequency-domain optical device was used to scan 2 SRC patients, within 72 h from injury, during the execution of 3 neurocognitive tests used in clinical practice. The optical data were resolved into a tomographic reconstruction of the brain functional activation pattern, using diffuse optical tomography. Moreover, brain activity was inferred using single-subject statistical analyses. The advantages and limitations of the introduction of this optical technique into the clinical assessment of acute SRC patients are discussed.

Oculomotor Fatigue Is Present In Some Adolescent Student-athletes Following Sport-related Concussion

Upwards of 70% of adolescent concussion patients present with visual dysfunction. Total time on the King-Devick (K-D) Test or average distance on the near point of convergence (NPC) test contributes to clinical decision-making. However, performance deterioration across multiple trials or cards has not been previously reported and may require consideration for a targeted rehabilitation program. PURPOSE: To determine if oculomotor fatigue (OMF) was present following a sport-related concussion (SRC) in adolescents. METHODS: 121 Student-athletes (15.3 ± 1.4 years; 51 Female/70 Male) were administered Cards 1-3 of the K-D and then three trials of the NPC during their initial concussion evaluation (3.6 ± 1.8 days post-injury). OMF was defined as exceeding the sample mean difference from Trial 1 to Trial 3 for the NPC and Card 1 to Card 3 for the K-D. Descriptive statistics, Mann-Whitney U tests, Independent-samples Median Tests, and Cronbach’s α were performed using SPSS 25. RESULTS: 33% and 26% of the cohort presented with OMF on the NPC and K-D, respectively. The sample mean difference from Trial 1 to 3 for the NPC was 4.33cm and 4.72s for K-D Card 1 to 3. Using the cutoff of 4.33cm on the NPC, the OMF group exhibited worse median performance for all NPC trials (p ≤ 0.002) and all K-D cards (p ≤ 0.029), except Card 1 (p = 0.52). Internal consistency was high for the OMF group on the NPC (Cronbach’s α = 0.967) and K-D (Cronbach’s α = 0.860) and non-fatigue group for NPC (Cronbach’s α = 0.987) and K-D (Cronbach’s α = 0.960). CONCLUSIONS: It appears that there was a decline in performance on the NPC (33%) and K-D (26%) in a subset of our cohort. Interestingly, internal consistency remained high for the measures, even when OMF group performance was significantly worse. Future research is warranted to determine if OMF is a clinical biomarker for underlying attentional, cortical, cerebellar, or vestibular disorders. Our findings are specific to adolescent, sport-related concussion patients seen within a week of their injury using clinician-administered NPC and version 1 of the K-D plastic cards and should not be generalized.

Benign Paroxysmal Positional Vertigo After Pediatric Sports-Related Concussion.

Report the clinical findings and outcomes among pediatric patients diagnosed with benign paroxysmal positional vertigo (BPPV) after sports-related concussion (SRC). Retrospective case series. Multidisciplinary pediatric concussion program. Patients younger than 19 years with a sport or recreation activity-related concussion referred for comprehensive vestibular physiotherapy assessment. Symptom resolution after targeted particle repositioning (PR). During the study period, 115 pediatric SRC patients underwent vestibular physiotherapy assessment including 12 (10.4%) who were diagnosed with BPPV. Unilateral posterior semicircular canal (SCC) BPPV was diagnosed in 8/12 (75%) patients, and unilateral anterior SCC BPPV diagnosed in 4/12 (25%) patients. Benign paroxysmal positional vertigo was successfully treated in all patients with a mean of 1.58 targeted PR maneuvers (range = 1-4). Comprehensive management of pediatric SRC requires a multidisciplinary approach to address the heterogeneous pathophysiology of persistent postconcussion symptoms. Pediatric SRC patients with coexisting BPPV should be considered for targeted PR.

Compromised resting cerebral metabolism after sport-related concussion: A calibrated MRI study

Altered resting cerebral blood flow (CBF0) in the acute phase post-concussion may contribute to neurobehavioral deficiencies, often reported weeks after the injury. However, in addition to changes in CBF0, little is known about other physiological mechanisms that may be disturbed within the cerebrovasculature. The aim of this study was to assess whether changes in baseline perfusion following sport-related concussion (SRC) were co-localized with changes in cerebral metabolic demand. Forty-two subjects (15 SRC patients 8.0 ± 4.6days post-injury and 27 age-matched healthy control athletes) were studied cross-sectionally. CBF0, cerebrovascular reactivity (CVR), resting oxygen extraction (OEF0) and cerebral metabolic rate of oxygen consumption (CMRO2|0) were measured using a combination of hypercapnic and hyperoxic breathing protocols, and the biophysical model developed in calibrated MRI. Blood oxygenation level dependent and perfusion data were acquired simultaneously using a dual-echo arterial spin labelling sequence. SRC patients showed significant decreases in CBF0 spread across the grey-matter (P < 0.05, corrected), and these differences were also confounded by the effects of baseline end-tidal CO2 (P < 0.0001). Lower perfusion was co-localized with reductions in regional CMRO2|0 (P = 0.006) post-SRC, despite finding no group-differences in OEF0 (P = 0.800). Higher CVR within voxels showing differences in CBF was also observed in the SRC group (P = 0.001), compared to controls. Reductions in metabolic demand despite no significant changes in OEF0 suggests that hypoperfusion post-SRC may reflect compromised metabolic function after the injury. These results provide novel insight about the possible pathophysiological mechanisms underlying concussion that may affect the clinical recovery of athletes after sport-related head injuries.

Delayed Symptom Onset Following Pediatric Sport-Related Concussion.

Objective: (1) To examine the prevalence of delayed symptom onset (DSO) among pediatric sport-related concussion (SRC) patients as well as the effect of symptom onset on initial symptom severity, length of recovery, and development of delayed recovery; (2) to evaluate the impact of symptom onset on sideline management.Methods: We conducted a prospective study of pediatric SRC patients (<20 years of age) evaluated at a multi-disciplinary concussion program. Patients underwent initial medical assessment by a single neurosurgeon and a structured interview by a research assistant. Patients were classified as experiencing early symptom onset (symptom onset <15 min from the time of the suspected injury; ESO) or DSO (≥15 min from the time of the suspected injury).Results: A total of 144 SRC patients (61.1% male; mean age 14.6 years, SD 1.8) evaluated a median of 5.0 days (IQR 4.0, 9.0) post-injury were included in the study. Among these patients, 120 (83.3%) reported experiencing ESO while 24 (16.7%) experienced DSO following injury. Among those that experienced DSO the median length of time from the suspected injury to symptom onset was 60.0 min (IQR 20.0, 720.0). No significant differences were observed in symptom severity at initial medical assessment (median Post-Concussion Symptom Scale score 20.0 vs. 18.0, p = 0.35), length of physician-document clinical recovery (median 22.0 vs. 24.0 days; p = 0.46) or the proportion of those who developed delayed physician-documented clinical recovery (34.4 vs. 42.1%, p = 0.52) among patients with ESO or DSO. Patients who reported experiencing ESO were significantly more likely to be immediately removed from play at the time of their suspected injury compared to those who experienced DSO (71.6% vs. 29.2%; p < 0.0001).Conclusions: This study suggests that an important proportion of children and adolescents who sustain an acute SRC experience DSO. DSO is associated with lower rates of immediate removal from play at the time of suspected injury. Secondary study findings highlight the need for improved sport stakeholder concussion education and standardized concussion protocols that mandate the immediate and permanent removal of all youth with a suspected concussion until they undergo medical assessment.

Health-related quality of life following adolescent sports-related concussion or fracture: a prospective cohort study.

The longitudinal effects of sports-related concussion (SRC) in adolescents on health-related quality of life (HRQOL) remain poorly understood. Hence, the authors established two objectives of this study: 1) compare HRQOL outcomes among adolescents with an acute SRC or a sports-related extremity fracture (SREF) who were followed up until physician-documented clinical recovery; and 2) identify the clinical variables associated with worse HRQOL among adolescent SRC patients. The authors conducted a prospective cohort study of adolescents with acute SRC and those with acute SREF who underwent clinical assessment and follow-up at tertiary subspecialty clinics. Longitudinal patient-reported HRQOL was measured at the time of initial assessment and at each follow-up appointment by using the adolescent version (age 13-18 years) of the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale and Cognitive Functioning Scale. A total of 135 patients with SRC (60.0% male; mean age 14.7 years; time from injury to initial assessment 6 days) and 96 patients with SREF (59.4% male; mean age 14.1 years; time from injury to initial assessment 8 days) participated in the study. At the initial assessment, the SRC patients demonstrated significantly worse cognitive HRQOL and clinically meaningful impairments in school and overall HRQOL compared to the SREF patients. Clinical variables associated with a worse HRQOL among SRC patients differed by domain but were significantly affected by the patients' initial symptom burden and the development of delayed physician-documented clinical recovery (> 28 days postinjury). No persistent impairments in HRQOL were observed among SRC patients who were followed up until physician-documented clinical recovery. Adolescent SRC is associated with temporary impairments in HRQOL that have been shown to resolve in patients who are followed up until physician-documented clinical recovery. Future studies are needed to identify the clinicopathological features that are associated with impaired HRQOL and to assess whether the initiation of multidisciplinary, targeted rehabilitation strategies would lead to an improvement in HRQOL.

Treatment of Acute Sports-Related Concussion.

Here, we summarize the current scientific literature on the management of sports-related concussion (SRC) in the acute period (< 6weeks post-injury) with a focus on rest, return to learn, return to play, and emerging treatments. While relative rest is recommended for the first 24-48h following acute SRC, the most recent guidelines highlight the lack of evidence for complete rest and in fact show that prolonged cognitive and physical rest can be detrimental. Gradual return to learn and play is recommended. Return to sport should only occur once the patient is symptom free. While there are no FDA-approved medications for acute treatment of concussion, there is preclinical data for the benefit of omega 3 fatty acids. Evidence is limited around the benefits of treating sleep disorders, vestibular-ocular dysfunction, and neck pain in the acute period. After 24-48h of rest, SRC patients may gradually resume cognitive and physical activity. More research is needed to determine if any supplements, medications, and/or physical therapy are indicated in the management in acute SRC.

HEALTH-RELATED QUALITY OF LIFE FOLLOWING ADOLESCENT SPORTS-RELATED CONCUSSION OR FRACTURE: A PROSPECTIVE COHORT STUDY

Background: Sport-related concussion is a form of traumatic brain injury that often presents with a combination of symptoms that reflect disturbances in physical, cognitive, sleep, and emotional functioning. The longitudinal effects of adolescent sports-related concussion (SRC) on health-related quality of life (HRQOL) remain poorly understood. The objectives of this study were to 1) compare HRQOL outcomes among adolescents with an acute SRC or sports-related extremity fracture (SRF) who were followed until physician-documented clinical recovery and 2) to identify the clinical variables associated with worse HRQOL among adolescent SRC patients. Methods: We conducted a prospective cohort study of adolescents with acute isolated SRC or SRF who underwent clinical assessment within 30 days post injury and follow-up at tertiary sub-specialty clinics. Longitudinal patient-reported HRQOL was measured at initial assessment and at each follow-up appointment using the adolescent version (age 13-18) Pediatric Quality of Life Inventory generic core scale and Cognitive Functioning scale. Demographic characteristics were collected from the medical charts. Results: Participants in this study included 135 patients with SRC (60.0% male; mean age 14.7 years; time from injury to initial assessment 6 days) and 96 with SRF (59.4% male, mean age 14.1 years; time from injury to initial assessment 8 days). At initial assessment, SRC patients reported significantly worse cognitive, school and overall HRQOL compared to SRF patients with no differences in physical, emotional and social HRQOL. Clinical variables associated with worse HRQOL among SRC patients differed by domain but were significantly impacted by initial symptom burden and the development of delayed physician-documented clinical recovery (&gt; 28 days post-injury). Overall, 132 (97.8%) SRC patients and all SRF patients achieved physician-documented clinical recovery during the study period. The median days until physician-documented clinical recovery for the SRC patients was 26 days (IQR: 17, 49) and this was not significantly different than SRF patients (31 days, IQR: 23, 42; p=0.12). At the time of physician-documented clinical recovery, patients with SRC did not have persistent impairments in HRQOL. Conclusions: Adolescent SRC is associated with temporary impairments in HRQOL that resolve in patients followed until physician-documented clinical recovery. Compared to SRF, adolescent SRC patients experience significantly greater impairments in cognitive, school, and overall HRQOL. The degree of impairment experienced by adolescent SRC patients across HRQOL domains is impacted by initial symptom burden and length of clinical recovery. Future studies are needed to identify the clinico-pathological features associated with impaired HRQOL and assess whether the initiation of multi-disciplinary targeted rehabilitation strategies lead to an improvement in HRQOL in acute SRC patients.

A Preliminary Investigation of Accelerometer-Derived Sleep and Physical Activity Following Sport-Related Concussion.

Describe changes in postconcussion activity levels and sleep throughout recovery in a sample of pediatric sport-related concussion (SRC) patients, and examine the predictive value of accelerometer-derived activity and sleep on subsequent clinical outcomes at a follow-up clinic visit. Outpatient concussion clinic. Twenty athletes aged 12 to 19 years with diagnosed SRC. Prospective study including visit 1 (<72 hours postinjury) and visit 2 (6-18 days postinjury). Linear regressions used to predict scores (ie, neurocognitive, vestibular/oculomotor) at visit 2 from accelerometer-derived data collected 0 to 6 days postinjury. Linear mixed models evaluated changes in activity and sleep across recovery. Symptom, neurocognitive, and vestibular/oculomotor scores; sleep and activity data (Actigraph GT3x+) RESULTS:: The maximum intensity of physical activity increased (P = .009) and time in bed decreased throughout recovery (P = .026). Several physical activity metrics from 0 to 6 days postinjury were predictive of worse vestibular/oculomotor scores at visit 2 (P < .05). Metrics indicative of poor sleep 0 to 6 days postinjury were associated with worse reaction time at visit 2 (P < .05). This exploratory study suggests physical activity and sleep change from the acute to subacute postinjury time period in adolescent SRC patients. In our small sample, excess physical activity and poor sleep the first week postinjury may be associated with worse outcomes at follow-up in the subacute stage of recovery. This study further supported the feasibility of research utilizing wearable technology in concussion patients, and future research in a large, diverse sample of concussion patients examined at concise time intervals postinjury is needed.

Cerebral blood flow in acute concussion: preliminary ASL findings from the NCAA-DoD CARE consortium.

Sport-related concussion (SRC) has become a major health problem, affecting millions of athletes each year. Despite the increasing occurrence and prevalence of SRC, its underlying mechanism and recovery course have yet to be fully elucidated. The National Collegiate Athletic Association-Department of Defense Grand Alliance: Concussion Assessment, Research and Education (CARE) Consortium is a large-scale, multisite study of the natural history of concussion across multiple sports. The Advanced Research Core (ARC) of CARE is focused on the advanced biomarker assessment of a reduced subject cohort. This paper reports findings from two ARC sites to evaluate cerebral blood flow (CBF) changes in acute SRC, as measured using advanced arterial spin labeling (ASL) magnetic resonance imaging (MRI). We compared relative CBF maps assessed in 24 concussed contact sport athletes obtained at 24-48h after injury to those of a control group of 24 matched contact sport players. Significantly less CBF was detected in several brain regions in concussed athletes, while clinical assessments also indicated clinical symptom and performance impairments in SRC patients. Correlations were found between decreased CBF in acute SRC and clinical assessments, including Balance Error Scoring System total score and Immediate Post-Concussion Assessment and Cognitive Test memory composite and impulse control composite scores, as well as days from injury to asymptomatic. Although using different ASL MRI sequences, our preliminary results from two sites are consistent with previous reports and suggest that advanced ASL MRI methods might be useful for detecting acute neurobiological changes in acute SRC.

Patient-Specific Alterations in CO2 Cerebrovascular Responsiveness in Acute and Sub-Acute Sports-Related Concussion.

Preliminary studies suggest that sports-related concussion (SRC) is associated with alterations in cerebral blood flow (CBF) regulation. Here, we use advanced magnetic resonance imaging (MRI) techniques to measure CBF and cerebrovascular responsiveness (CVR) in individual SRC patients and healthy control subjects. 15 SRC patients (mean age = 16.3, range 14-20 years) and 27 healthy control subjects (mean age = 17.6, range 13-21 years) underwent anatomical MRI, pseudo-continuous arterial spin labeling (pCASL) MRI and model-based prospective end-tidal targeting (MPET) of CO2 during blood oxygenation level-dependent (BOLD) MRI. Group differences in global mean resting CBF were examined. Voxel-by-voxel group and individual differences in regional CVR were examined using statistical parametric mapping (SPM). Leave-one-out receiver operating characteristic curve analysis was used to evaluate the utility of brain MRI CO2 stress testing biomarkers to correctly discriminate between SRC patients and healthy control subjects. All studies were tolerated with no complications. Traumatic structural findings were identified in one SRC patient. No significant group differences in global mean resting CBF were observed. There were no significant differences in the CO2 stimulus and O2 targeting during BOLD MRI. Significant group and patient-specific differences in CVR were observed with SRC patients demonstrating a predominant pattern of increased CVR. Leave-one-out ROC analysis for voxels demonstrating a significant increase in CVR was found to reliably discriminate between SRC patients and healthy control subjects (AUC of 0.879, p = 0.0001). The optimal cutoff for increased CVR declarative for SRC was 1,899 voxels resulting in a sensitivity of 0.867 and a specificity of 0.778 for this specific ROC analysis. There was no correlation between abnormal voxel counts and Postconcussion Symptom Scale scores among SRC patients. Acute and subacute SRCs are associated with alterations in CVR that can be reliably detected by brain MRI CO2 stress testing in individual patients.

Longitudinal Assessment of Health-Related Quality of Life following Adolescent Sports-Related Concussion

To examine initial and longitudinal health-related quality of life (HRQOL) in adolescent sports-related concussion (SRC) patients, a prospective observational case-series study was conducted among adolescent SRC patients who were evaluated at a multi-disciplinary pediatric concussion program. Health-related quality of life was measured using the child self-report Pediatric Quality of Life Inventory (PedsQL) generic score scale (age 13-18 version) and the PedsQL Cognitive Functioning scale. Initial and longitudinal HRQOL outcomes were compared between patients who did and did not develop post-concussion syndrome (PCS). A total of 63 patients met the inclusion criteria during the study period. The mean age of the cohort was 14.57 years (standard deviation, 1.17) and 61.9% were male. The median time from injury to initial consultation was 6.5 days (interquartile range, 5, 11). At initial consultation, impairments in physical and cognitive HRQOL but not social or emotional HRQOL were observed. Initial symptom burden and length of recovery were associated with greater impairment in physical and cognitive HRQOL. Patients who went on to develop PCS had significantly worse physical and cognitive HRQOL at initial consultation and demonstrated a slower rate of recovery in these domains, compared with those who recovered in less than 30 days. Adolescent SRC was associated with HRQOL impairments that correlated with clinical outcomes. No persistent impairments in HRQOL were detected among patients who achieved physician-documented clinical recovery. Future studies are needed to evaluate the clinical utility of HRQOL measurement in the longitudinal management of adolescent SRC and PCS patients.