Foreword
Preface
Contributors
Contents
Chapter 1: Introduction
Clinical Research of Sports-Related Concussion
EEG Research in Concussion
Functional Magnetic Resonance Imaging and Concussion
Resting-State Functional Connectivity from fMRI
Default Mode Network
Diffusion Tensor Imaging and Concussion
Magnetic Resonance Spectroscopy and Concussion
Concluding Statement
References
Evaluation of Concussions—Current Development
Chapter 2: 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 Mismanagement of Concussion
Concluding Statement: 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’re 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
Chapter 3: Neuropsychological Testing in Sports Concussion Management: 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
Future Directions
References
Chapter 4: 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
Assessment of “Sense of Presence” and Success Rate
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)
Experimental Procedure: Effect of Practice
Experimental Procedure: Effect of Fatigue Induced by Full Contact Football Practices
Results
Sense of Presence and Subjective Reports
Effect of Practice
Effect of Fatigue
Discussion
Conclusion
References
Chapter 5: 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
References
Chapter 6: The Relevance of Assessing Cerebral Metabolic Recovery for a Safe Return to Play Following Concussion
Introduction
Energy Metabolism and Gene Modulation: Crucial Issues of Concussion-Induced Brain Vulnerability
A Surrogate Marker of the Post-concussive Brain Damage: N -acetylaspartate
Post-concussion Brain Vulnerability
“Imaging” the Brain’s Biochemistry: The Role of Proton Magnetic Resonance Spectroscopy ( 1 H-MRS)
Conclusions
References
Biomechanical Mechanisms of Concussion and Helmets
Chapter 7: The Biomechanics of Concussion: 60 Years of Experimental Research
Introduction
Cadaver Data
Animal Data
NFL Data
Volunteer Data
Concussion Injury Criteria
Helmet Performance
Clinical Validation of Helmet Performance
Future Testing and Dummy Head Forms
References
Chapter 8: Acute and Lingering Impairments in Post-
Introduction
Postural Control and Concussion
Post-concussion Postural Control Assessment Battery
Postural Control During Motor Tasks Post-concussion
Experimental Post-concussion Postural Control
Acute Concussion Response
Postural Control and Recovery
Conclusion
References
Chapter 9: 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
Neural Substrates, Biomarkers, and Brain Imaging of Concussion Research
Chapter 10: 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
Volumetry Findings in MTBI
Conclusion
References
Chapter 11: Metabolic Dysfunction Following Traumatic Brain Injury
What Is so Mild About Mild Traumatic Brain Injury?
Biomechanics and Pathophysiology of Concussion
Transient CNS Disorders Versus Permanent Brain Lesions: Diaschisis
Energy Crisis After Concussive Blows
Evaluation of Energy Crisis via Neuroimaging Tools
Concluding Statement
References
Chapter 12: 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 of Axonal Injury
Imaging at Different Pathological Stages
Acute Stage
Subacute Stage
Chronic Stage
Longitudinal Studies
Correlation Between DTI-Derived WM Injury Topography and Neuropsychological Deficits
Deliver the Impact to mTBI Care
Conclusions
References
Chapter 13: Biomarkers for Concussion
Introduction
Need for Serum Biomarkers for Concussion
Biofluid Biomarkers of Astroglial Injury
S100β[Beta]
Glial Fibrillary Acid Protein
Biofluid Biomarkers of Neuronal Injury
Neuron-Specific Enolase
Ubiquitin C-Terminal Hydrolase (UCH-L1)
Biofluid Biomarkers of Axonal Injury
Alpha-II-Spectrin Breakdown Products
TAU Protein
Neurofilaments
Conclusion
References
Chapter 14: Functional Magnetic Resonance Imaging in Mild Traumatic Brain Injury
Introduction
Review of Current Findings from the Literature
Overarching Issues in FMRI Research Following mTBI
Psychiatric Sequelae and mTBI
fMRI Physiology and Trauma
fMRI Analyses
Conclusions
References
Pediatric Sport-Related Concussions
Chapter 15: Predicting Postconcussive Symptoms After Mild Traumatic Brain Injury in Children and Adolescents
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
Alternative Explanations
Timing of Outcome Assessment
Prediction of Individual Outcomes
Building Prognostic Models and Decision Rules
Future Directions
References
Chapter 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 Alterations
Post-concussion Recovery and Assessment Challenges
Conclusion
References
Chapter 17: Neuropsychological Assessment of Sports-
Introduction
Recovery After Concussion
Brief Walk Through Testing
Looking Back on Concussion Management
Concussion Treatment
Case Study
Conclusion
References
Clinical Management and Rehabilitation of Concussions
Chapter 18: Management of Collegiate Sport-Related Concussions
Introduction
Emergency Action Planning and Establishing a Concussion Policy
Injury Identification
The On-Field/Sideline Assessment
Primary Survey
Secondary Survey
Conclusion
References
Chapter 19: 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
Chapter 20: The Role of the Quantitative EEG in the Diagnosis and Rehabilitation of the Traumatic Brain Injured Patients
Introduction
The TBI Problem
Sports
Emergency Departments
The Biological Effects of a TBI
Non-brainstem Neuroanatomical Effects in TBI
Prognostic Issues for the TBI Patient
Spontaneous Cure Myth vs. Compensation
Diagnostic Issues
Electrophysiological Effects
The Multiple Cognitive Discriminant Approach
Participants
EEG Recording
Measures
Tasks
Results
QEEG and Rehabilitation
Other Reported Relations Between QEEG Measures and Rehabilitation Outcomes
The Coordinated Allocation of Resource Model of Brain Functioning
Conclusion
References
Chapter 21: Current Understanding of Concussion: Treatment Perspectives
Introduction
Definition of Concussion
Definition of Post-concussion Syndrome
Biomechanics of Concussion
Neurophysiologic Cascade of Injury
Metabolic Dysregulation
Oxidative Damage and Apoptosis
Inflammation and Concussion
Cerebrovascular Response to Concussive Injury
Animal Studies: Acute/Subacute Injury
Hypothermia Treatment (Posttraumatic Cooling)
Donepezil
Dehydroepiandrosterone Sulfate
MK-801 and Scopolamine
Excitotoxicity and Antioxidant Mechanism (Bacalein and Bacalin)
Cytokine Intervention (Proinflammatory Inhibitors: Minocycline)
Cytokine Intervention (TNF-alpha)
Cytokine Intervention (GSK-3)
Antioxidant and Neurometabolic Intervention
Antioxidant and Anti-inflammatory Intervention
Omega-3 Fatty Acids
Vitamin E
Hydrogen-Rich Saline
N -Acetylcysteine
Antioxidant Intervention (PEG-HCC: Nanoparticles)
Apoptotic Inhibition (pHBSP)
PCS/Chronic mTBI
Exercise: Benefits and Neuroprotection
Hyperbaric Oxygen
Symptom Management: Naltrexone
Symptom Management: Dihydroergotamine and Metoclopramide
Cognitive Treatment (Postsynaptic Enhancement)
PCS: Posttraumatic Headaches
Divalproex
PCS: Depression Management
Sertraline
PCS: Psychological/Psychosocial
Education
Cognitive Behavioral Therapy
Mindfulness-Based Stress Reduction
Cognitive Rehabilitation
References
Chapter 22: Post-concussion Syndrome, Persistent Symptomatic Concussion, Related Sequelae, and Treatment of Mild Closed Head Injury
Introduction
Historical Perspective
Definition
Pathophysiology
Predictor of Disease
Treatment
Overall Strategy
Summary
Corresponding Author’s Disclaimer
References
Index