Concussions in Athletics: From Brain to Behavior

✍ Scribed by Semyon M. Slobounov (editor), Wayne J. Sebastianelli (editor)

• Publisher: Springer
• Year: 2021
• Tongue: English
• Leaves: 463
• Category: Library

✦ Synopsis

Now in a fully revised and expanded second edition, this comprehensive text remains a timely and major contribution to the literature that addresses the neuromechanisms, predispositions, and latest developments in the evaluation and management of concussive injuries. Concussion, also known as mild traumatic brain injury, continues to be a significant public health concern with increased attention focusing on treatment and management of this puzzling epidemic as well as controversies within the field. The book is comprised of five thematic sections: current developments in evaluation; biomechanical mechanisms; neural substrates, biomarkers, genetics and brain imaging; pediatric considerations; and clinical management and rehabilitation.

Since the publication of the original edition in 2014, much has changed regarding the current understanding of mild traumatic brain injury including development of more precise imaging modalities, development and classification of new biomarkers, and updates to clinical treatment and management of athletic concussion. This new edition will include new chapters targeting the influence of genetics on concussive injury, as well as an expansion on the knowledge of pediatric response to concussion and the influence of repetitive subconcussive impacts on athlete health.

An invaluable contribution to the literature, Concussions in Athletics: From Brain to Behavior reestablishes itself as a state-of-the-art reference that will be of significant interest to a wide range of clinicians, researchers, administrators, and policy makers, and this updated version aims to narrow the gap between research findings and clinical management of sports-related concussion and other mild traumatic brain injury. The second edition also attempts to broaden the scope of the knowledge to apply to more professionals and pre-professionals in the fields of neuroscience, neuropsychology, and other allied health professionals that closely work with athletes and sports medicine professionals.

✦ Table of Contents

Foreword
Athletics Foreword
Introduction
Concussion in Athletics: Current Understanding from Basic Brain Science to Clinical Research
Introduction
Clinical Research of Sports-Related Concussion
EEG Research
Advanced Neuroimaging Research
Biomarkers and Genetic Basis of SRC Research
Concluding Statement
Contents
Contributors
About the Editors
Part I: Evaluation of Concussion
1: Consequences of Ignorance and Arrogance for Mismanagement of Sports-Related Concussions: Short- and Long-Term Complications
Short-Term Risks of Concussion Mismanagement
So, What Are the Short-Term Risks of Mismanaging a Concussion?
Concussions: Structural Versus Functional Brain Disorder
Subjects’ Reports Versus Pure Evaluation
Coaching Preventive Strategies
Second Impact Syndrome
Long-Term Risks of Mismanaging Multiple Concussions
Historical Perspective
Boston University School of Medicine Chronic Traumatic Encephalopathy Center
Doctor, Do I Have CTE?
In Summary: 10 Myths About Concussion
Myth Number One: You Have to Be Hit in the Head to Have a Concussion
Myth Number Two: You Have to Be Rendered Unconscious to Sustain a Concussion
Myth Number Three: Helmets Prevent Concussions
Myth Number Four: Mouth Guards Prevent Concussions
Myth Number Five: You Can Always See a Concussion
Myth Number Six: Your Next Concussion Will Be Worse Than Your Last
Myth Number Seven: Three Concussions and You Are Out
Myth Number Eight: Signs and Symptoms Occur Immediately
Myth Number Nine: Boys Suffer More Concussions Than Girls
Myth Number Ten: Concussions Determine Risk of CTE
References
2: Neuropsychological Testing in Sports Concussion Management: Test of an Evidence-Based Model When Baseline Is Unavailable
Introduction
Summary of Literature Recommendations for the Use of Neuropsychological Testing in Sports Concussion
Use of Baseline Testing
Timing of Post-concussion Testing
The “Value-Added” of Neuropsychological Tests in a Sports Concussion Framework
A Proposed Evidence-Based Model for Neurocognitive Concussion Management When No Baseline Is Available
Measures
Algorithm of Decision Rules
Why Recommend Testing During the Acute Concussion Phase?
Limitations
Testing the Model
Method
Participants
Recovered Versus Not Recovered Participants Using Base Rate of Impairment at Baseline Algorithm
Measures
Post-Concussion Cognitive Outcome Variables Not Included in the Algorithm
Results
Preliminary Analyses: Recovered Versus Not Recovered Participants Using Combined Algorithm
Hypothesis Testing Analyses on Recovered Versus Not Recovered Participants Using Combined Algorithm
Post Hoc Analyses
Discussion of Model Test
Future Directions
References
3: Feasibility of Virtual Reality for Assessment of Neurocognitive, Executive, and Motor Functions in Concussion
Introduction
Virtual Reality Applications, Methods, and Procedures
VR Visual Spatial Memory Test
VR Recognition “A” Test
VR Recognition “B” Test
VR Assessment of Sustained Attention
VR Assessment of Balance
Normalized Assessment of Postural Stability
VR Assessment of Executive Function (Reaction Time)
Assessment of Sense of Presence and Practice Effect
Assessment of Fatigue Induced by Full Contact Football Practices
Validation of Virtual Reality Modalities
Overall Application of Virtual Reality as a Research and Clinical Tool
References
4: Feasibility of Electroencephalography for Direct Assessment of Concussion
Introduction
Need for Physiologic Measurement in Clinical Concussion Diagnosis/Management
The Nature of EEG
EEG Frequency Bands
EEG and Concussion
Current Work from Our Lab
Compensatory Approach During Concussion Assessment Batteries
“Return to Play” and EEG Concussion Research
Brain Lateralization Analysis, Psychological Symptoms, and the Evaluation of Both Using EEG
References
Part II: Biomechanics and Motor Control Mechanisms of Concussion
5: Biomechanical Studies of Impact and Helmet Protection
Introduction
Epidemiological Approaches – Effectiveness and Efficacy
Helmet Characteristics
Performance Requirements and Standards
How Well Do Helmets Perform?
Future Development
References
6: Acute and Lingering Impairments in Post-Concussion Postural Control
Postural Control as a Concussion Biomarker
Postural Control and Concussion
Clinical Post-Concussion Postural Control Assessment Battery
Instrumented Postural Control During Motor Tasks Post-Concussion
Single-Task Gait
Dual-Task Gait
Gait Initiation
Gait Termination
Conclusion
References
7: The Role of the Playing Surface in Mitigating the Deleterious Effects of Head Impacts in Field Sports
Motivation
Quantifying Head Injury Severity
Wayne State Tolerance Curve
Gadd Severity Index
Head Injury Criterion
Testing Standards for Sport Surfaces
Limitations of Current Indices
Modeling a Head Impact
Single Particle Model
One-Link Model
Two-Link Model
Hertz Contact Theory
Model Comparison
Determination of Input Parameters
Sensitivity Analysis
Results
Summary
References
Part III: Physiology of Concussion and Subconcussive Injuries
8: Neuropathology of Mild Traumatic Brain Injury: Relationship to Structural Neuroimaging Findings
Introduction
Heterogeneity of mTBI
Time Sequence of Neuropathology Associated with mTBI
Computed Tomography in mTBI
Visible Macroscopic Abnormalities
Empirically Derived Quantitative MR Abnormalities
Heterogeneity Visible mTBI Lesions
Cellular Basis of mTBI Neuropathology
Deformation Biomechanics and the Most Vulnerable Areas for Brain Injury
Volumetry Findings in mTBI
Conclusion
References
9: Advanced Neuroimaging of Mild Traumatic Brain Injury
Introduction
Imaging Traumatic Vascular Injury
Susceptibility-Weighted Imaging of Hemorrhagic Lesions
Quantitative Susceptibility Mapping of Bleeding and Blood Oxygenation
Diffusion Tensor Imaging (DTI) of Axonal Injury
Imaging at Different Pathological Stages
Correlation Between DTI-Derived WM Injury Topography and Neuropsychological Deficits
Connectomic Assessment of mTBI
Deliver the Impact to mTBI Care
Conclusions
References
10: Analytical Monitoring of Brain Metabolism: Not a Research Tool for Elite Academy but an Essential Issue for Return to Play Following Concussion
Introduction
Understanding Biomechanics
The Biomolecular Network and the Post-Concussion Brain “Vulnerability”
Clinical Implications: The Return-to-Play Dilemma
Case 1
Case 2
Case 3
From Diagnosis to Prognosis: Magnetic Resonance Applications and “Deep Structural Neuroimaging”
Conclusion
References
11: Functional Magnetic Resonance Imaging in Sport-Related Concussions
Introduction
fMRI Physiology and Putative Effects of SRC
Analytic Considerations for fMRI Studies
Review of the Current Literature on Functional Imaging and SRC
Review of Evoked fMRI Studies
Review of Functional Connectivity Studies
Added Value of Multimodal Imaging
Psychiatric Sequelae of SRC and fMRI
Overarching Issues in fMRI Research in SRC
Conclusion
References
12: Sports-Related Subconcussive Head Trauma
Introduction
Animal Models of Subconcussive Head Trauma
Biomechanical Studies of Subconcussive Head Trauma
Cognitive Assessment of Subconcussive Head Trauma
Neuroimaging of Subconcussive Head Trauma
Conclusion
References
13: Biomarkers for Concussion
Introduction
Path Toward Blood Test for Concussion
Proteomic Biomarkers
Glial Fibrillary Acidic Protein (GFAP) and Ubiquitin C-Terminal Hydrolase (UCH-L1)
GFAP and UCH-L1 for Mild-to-Moderate Traumatic Brain Injury
GFAP and UCH-L1 for Concussion and Subconcussive Brain Injury
Other Potential Proteomic Biofluid Biomarkers of Concussion
S100β
Tau Protein
Neurofilaments
Transcriptomic Biomarkers
MicroRNAs as the Next Generation of Biomarkers for Concussion
Conclusion
References
14: Genetics in Concussion
Concussion and the Role of Genetics
Brief Biology of Genetics
APOE
BDNF
DRD
COMT
Interleukins
Tau
Single Study Genes Examined
Implications and Future Work
References
Part IV: Sport-Related Concussion in Pediatric Populations
15: Predicting Postconcussive Symptoms After Mild Traumatic Brain Injury in Children and Adolescents: 2020 Update
Introduction
A Model for PCS
Predictors of PCS
Injury Factors
Non-injury Factors
Relative Contributions of Injury Versus Non-injury Factors
Research Issues
Definition of Mild TBI
Outcome Measurement
Assessment of Risk Factors
Prediction Versus Moderation
Alternative Explanations
Timing of Outcome Assessment
Prediction of Individual Outcomes
Building Prognostic Models and Decision Rules
Future Directions
References
16: Long-Term Effects of Pediatric Mild Traumatic Brain Injury
Introduction
Short-Term Versus Long-Term Post-Concussion Symptoms
Cognitive Impairment and Structural Abnormalities
Cognitive Impairment and Metabolic Abnormalities
Post-Concussion Recovery and Assessment Challenges
Conclusion
References
17: Multimodal Approaches to Preventing Asymptomatic Repetitive Head Injury in Adolescent Athletes
Introduction
Evidence for Pathophysiology in the Absence of Symptomatology
Contributing Factors to Asymptomatic Injury
Genetics
Sex
Physical Activity/Sport
Competition/Skill Level
Prevention of Asymptomatic Injury
A Framework for Evaluation—Structural Health Monitoring
Intervention—Exposure Monitoring
Intervention—Training and Rules Changes
Intervention—Protection
Future Work—Personalization of Injury Prevention and Treatment
References
Part V: Clinical Management and Rehabilitation of Concussions
18: Management of Collegiate Sport-Related Concussions
Introduction
Concussion Education and Baseline Assessment
NCAA
NATA
Concussion in Sport Group
AMSSM
Summary
Injury Identification
Sideline Assessment
NCAA
NATA
Concussion in Sport Group
AMSSM
Summary
Injury Management
NCAA
NATA
Concussion in Sport Group
AMSSM
Summary
Return to Learn
NCAA
NATA
Concussion in Sport Group
AMSSM
Summary
Return to Sport Participation
NCAA
NATA
Concussion in Sport Group
AMSSM
Summary
Documentation and Legal Aspects
Conclusion
References
19: The Role of the Quantitative EEG (QEEG) in the Assessment and Treatment of the Brain Injured Individual
QEEG Background
Quantitative EEG (QEEG) Measures
Head Injury Discriminant Approaches
Methods
Results
Discriminant Analysis
Classification Matrices
Cognitive and EEG Characteristics of the TBI Population
Gender and Sex Effects: Females More Affected by TBI
The Issue of Determining if Problems Are a Preexisting Learning Disability
Discussion
Theoretical Considerations
Rehabilitation of the Brain Injured Subjects
Possible Placebo Effects
Conclusion
References
20: Treatment of Sports-Related Concussion
Introduction
Definition of Concussion
New Classification of Post-Concussion Syndrome
Biomechanics of Concussion
Neurophysiologic Cascade of Injury
Metabolic Dysregulation
Oxidative Damage and Apoptosis
Inflammation
Cerebrovascular Response
Chronic Traumatic Encephalopathies
Common Treatment Intervention Strategies
Rest for Concussion
Early Activity or Exercise for Concussion
Neurophysiologic Adaptation to Exercise
Neurovascular Response to Exercise in Concussion
Neuroplasticity, Neurogenesis, and Exercise
Mental Illness, Concussion, and Exercise
Exercise, Heat Acclimation, and Neuroprotection
Psychological Treatment of Concussion
Psychoeducation
Cognitive Behavioral Therapy
Mindfulness-Based Stress Reduction
Conclusion
References
21: Narrowing the Knowledge Gap Between Basic Neuroscience Research and Management of Concussive Injury
Current Clinical Practice
Diagnosis/Evaluation Procedures
Return to Participation (RTP) Protocols
Return to Learn Protocols
Referral and Management
Long-Term Follow-Up/Assessment
Issues and Drawbacks from Current Practice
References
Index