Category: Concussion research

American Medical Society for Sports Medicine position statement: concussion in sport

Posted 22 May 2018 by prehab



A concussion is considered a subset of a mild traumatic brain injury. Research has found that a second hit to the brain before it has had adequate time to heal may result in worsening of metabolic changes within the cells of the brain. Research has also found that an early return to increased cognitive or physical load may cause the brain to be vulnerable to prolonged dysfunctions. Short-term risks for premature return to play include decreased reaction time and an increased risk of a repeat concussion or injury. Long-term effects include secondary neurological conditions. There is currently no validated return to play guidelines for concussions. It is found that athlete diagnosed with a concussion should never return the same day or should return to sport if they are still symptomatic. It is concluded that treating concussions requires a multifaceted approach. It is important for the athlete to be honest with their symptoms and for all parties involved to be able to recognize signs and symptoms of the injury.  It is then recommended that a healthcare provider that is familiar with the athlete and knowledgeable in recognition and evaluation of concussions be used to properly diagnose a concussion. To see full article and a list of signs and symptoms of a concussion

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Impacts post concussion with dual-task gait balance control

Posted 27 April 2015 by prehab

As there is a continuation of recognition of concussions in the adolescent populations there is still not current agreed upon regulations for return to activity post concussion. It has previously been hypothesized that gait stability during dual-task walking may be particularly sensitive to long-term disruptions after concussions. This study looked at a cohort of adolescents who returned to activity within 2 months of their injury. The participant’s cognition, symptom severity, and balance control during single-task and dual-task walking was observed before and after returning to pre-injury activities. In regards to balance, this study found the participants to have an increased medial/lateral center of mass displacement and velocity during dual-task walking after they returned to their pre-injury activities. See full study

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Diagnostic Tests for Concussions: Is Vision Part of the Puzzle?

Posted 28 February 2015 by prehab

The Centers for Disease Control and Prevention have estimated that 1.4- 3.8 million sports-related mild traumatic brain injures (mTBI) annually in the United States. Not including mTBI not reported or ones seen in the out-patient setting. Sustaining one concussion during a sports season gives an athlete a 3 times greater risk for a second concussion. This article seeks to look at the visual impairments associated with concussions. This can help both with screening and monitoring the recovery of mTBI. In summary concussions and mTBI can have multiple of effects on the visual system. The authors of this article suggest adding a visual component to the current sideline tests in identifying sports-related concussions. See full article 

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

Posted 1 October 2014 by prehab

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.

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Concussion rehab focusing on the inner ear and cervical spine

Posted 6 August 2014 by prehab

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

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Oculomotor Control and Balance Post-Concussion

Posted 2 July 2014 by prehab

Vestibular dysfunction post-concussion could be a major cause of balance disturbances. This study compares athletes post-concussion, athletes without a history of concussions and their oculomotor control during postural control. Athletes post-concussion had a reduced ability to stabilize a fixed eye position during balance testing. See attached study

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High-altitude induced haemodynamic effects

Posted 5 June 2014 by prehab

The change in pressure of being in high-altitude has traditionally had a hypoxic effect. A study was done to look at the physiological effects of high elevation over a three-day period. The decrease in oxygen was found to lead to a significant increase in diastolic blood pressure (DBP) and mean arterial blood pressure that persisted from immediate exposure and continued over three days. See attached study. The altitude-induced haemodynamic changes on high-altitude UT pilots could also possibly be linked to the presence of white matter hyperintensities (WMHs) or unspecified brain lesions.  See attached study.

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Current state of diagnostic testing in concussion management

Posted 2 February 2014 by prehab

Returning an athlete to the game should imply that who ever made the decision fully understands the nuances of the concussion. 

There are many ways we collect quantitative information that gets us closer to understanding the areas affected after brain injury. The information however needs to be interpreted and understood well to determine the type of rehabilitation that well assists injured individuals on returning their brain to pre injury state. In this attached manuscript, we are reviewing the state of concussion testing, diagnostic rating scales and tools available to identify the nuances of concussions. At Concussion Management of New York we are clinician rather than test centered. We utilize these tools collectively or individually when most appropriate.

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Lasting effects after mild concussions

Posted 22 November 2013 by prehab

Abnormal brain structural patterns persist months after clinical symptoms had resolved from a mild concussion researchers found at the Lovelace Biomedical and Environmental Research Institute in Albuquerque, N.M.

Dr. Mayer and colleagues examined the underlying pathophysiology of mild traumatic brain injury through changes in gray matter diffusion and atrophy during the semiacute stage and found evidence that structural changes persist long past the improvement in neuropsychological tests. In a study that involved 50 participants, 26 patients showed evidence of increased cortical gray matter anisotropic diffusion 4 months post injury.

See full study

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Traumatic-Triggered Migraines vs Concussions

Posted 17 November 2013 by prehab

Family history of migraines is a precursor to headaches in children and as per studies cited bellow, head trauma and concussions may increase the length of headaches and complicate treatment. The question is: are Traumatic-Triggered Migraines (TTM’s) different than headaches as a concussive characteristic? and should they be treated differently? The case study referenced by Lords, Q reported in Sports Health Multidisciplinary App.(Traumatic Migraine Versus Concussion: A Case Report.)   presented a different look at their diagnosis and treatment approach.  This report instead of actually  separating them apart it may be pointing out how related they are or that one is part of the other. Headaches post injury may be more or less severe, longer lasting and have a genetic component but should be dealt with in the contest of brain injury. The word “Concussion” can at this time, after it became a popular word in sports, complicate how we deal with it. Because concussions have the sports connotation is easy to fall into the trap of making us follow the light path others have taken and skip important steps toward treatment. In the brain injury world, per say, I can relate to the stance of wanting to distance ourselves from what the word “concussion” is becoming and try to separate its components, such as headaches, and give it another name as it clearly happens in the cited article. For example in this study the author seem to attempt to separate the diagnosis between what a concussion is and what traumatic related headaches or migraines are. Headaches and migraines most times are components of a concussion were its nature, historic and genetic component challenges current diagnosis and treatment methods.

Have you dealt with headaches and/or migraines pre and post injury? Can you separate them and what approaches have you tried with or without success?

Click for referenced studies here…

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