Current Issues in the Identification, Assessment, and Management of Concussions in Sports-Related Injuries

Younger athletes (below the collegiate level) appear to be at an increased risk for concussions. One of the possible reasons is that youth athletes are sustaining concussions during critical stages in brain development, especially during a time of increased plasticity.  It has been hypothesized that concussions in the developing brain my ultimately impair this plasticity, however it is not yet clear if this impairment is permanent or temporary. The increase in susceptibility to concussions in children and adolescents, compared to adults has been attributed to decreased myelination, a greater head-to-body ratio, thinner cranial bones, which all provide less protection to the developing brain. In respect to gender differences, it is currently unknown the cause but it has been noted that female athletes have an increase in risk for concussions compared to male athletes participating in the same sport. The authors in this study identified that there is a lack of research in concussions and their recovery in relation to specifically female athletes. In regards to assessment, the sideline assessment of concussions is a good gross assessment tool but it is important to have a more comprehensive baseline assessment to then compare to a comprehensive postconcussion assessment. It is then recommended to use serial assessments to demonstrate gradual improvement or deterioration in mental status over time. The authors conclude with further need for concussion research in youth athletes and female athletes of all ages. They also suggest the implementation of a comprehensive concussion management program and promoting mandatory baseline assessments fro all youth athletes at risk. To see full article.

Alteration of Brain Default Network in Subacute Phase of Injury in Concussed Individuals: Resting-state fMRI study

Currently neuropsychological testing and traditional anatomical imaging are not sufficiently sensitive to detect differences in an individual’s brain less then three weeks post mild traumatic brain injury (mTBI). After a college athlete is cleared post concussion to return to play they may still report physical and emotional symptoms that can persist over one-year post injury. A study was done using 15 student-athletes without a history of mTBI (control) and 14 collegiate athletes who suffered a grade 1 mTBI, diagnosed by a certified athletic trainer at on the field at initial contact. Functional connectivity characteristics were assessed between the control and athletes recovering from mTBI using a resting state function magnetic resonance imaging (rs-fMRI). Major findings include: resting state of default mode network (DMN) in mTBI subjects showed an overall reduced connectivity, specifically connections from the posterior cingulated cortex (PCC) with the anterior cingulated gyrus (ACC) and right supramarginal guyrus  and hyper-connectivity in the medial prefrontal cortex (MPFC). They also found a reduced interhemispheric connectivity which is consistent with previous studies. To see full study

Use of Modified Acute Concussion Evaluation Tools in the Emergency Department in a Pediatric Population

In the pediatric population, mild traumatic brain injuries (concussions) make up 75%-90% of all acquired brain injuries evaluated in emergency departments (ER) in the US.  The Acute Concussion Evaluation (ACE) system published by the Centers for Disease Control and Prevention was developed to assist in identification and diagnosis of concussions. The ACE Care Plan tool was developed to guide management, including individualized recommendations for daily life, school, work and return to play. This tool was originally felt to be too time consuming for ER physicians. For this study a modified version was created and preformed on a patient population between ages 5-21. A primary concern of post ED management of concussions was the importance of ongoing outpatient rehabilitation, in this study it was found that this tool improved reported follow-up post-implementation for all patients. It also found an improvement in parent recall of concussion education. For full study.

Vestibular/Ocular Motor Screening in Assessing Concussions

There has been evidence that the vestibular system is implicated in sports-related concussions. The vestibulospinal tract (ie balance) is most often tested but the vestibulo-ocular system may also be affected but is not as often tested. A study was done using the Vestibular/Ocular Motor Screening (VOMS) assessment, comparing patients with sports-related concussion with a control group of healthy individuals to identify the validity of this screen in identifying vestibular-ocular motor impairments in patients with concussions.  It was shown to be a good predictor of vestibular and ocular motor impairments in post-concussion patients. It may be a useful tool as an adjunct with the current concussion management screening tools. See original study.

Concussion rehab focusing on the inner ear and cervical spine

As the impact of concussions become more known in sports a major factor to look at has been time to return to sport. The researchers at the Sports Injury Prevention Research Center of University of Calgary looked at the effects of rehabilitating the cervical spine and vestibular system in a cohort of post-concussed athletes between the ages of 12-30 and the amount of time until they were medically cleared to return to sport.  18 males and 13 females were randomized between the control group and the intervention group. The intervention group received cervical spine and vestibular rehabilitation for 8-weeks or until they were medically cleared. Of the patients receiving therapy 73% were medically cleared to return to their sport in 8 weeks compared to only 4% of the control group.  An article discussing this study was written in the Globe and Mail or See original study