scispace - formally typeset

Journal ArticleDOI

Recovery of cognitive and dynamic motor function following concussion

01 Dec 2007-British Journal of Sports Medicine (BMJ Publishing Group)-Vol. 41, Iss: 12, pp 868-873

TL;DR: In order to fully examine the effects of concussion and determine the optimal time for a safe return to activity, a multi-factorial approach, including both cognitive and motor tasks, should be employed.

AbstractObjective: Neuropsychological testing has been advocated as an important tool of proper post-concussion management. Although these measures provide information that can be used in the decision of when to return an individual to previous levels of physical activity, they provide little data on motor performance following injury. The purpose of this investigation was to examine the relationship between measures of dynamic motor performance and neuropsychological function following concussion over the course of 28 days. Methods: Participants completed two experimental protocols: gait stability and neuropsychological testing. The gait stability protocol measured whole-body centre of mass motion as subjects walked under conditions of divided and undivided attention. Neuropsychological testing consisted of a computerised battery of tests designed to assess memory, reaction time, processing speed and concussion symptoms. Correlation coefficients were computed between all neuropsychological and gait variables and comparisons of neuropsychological and gait stability post-concussion recovery curves were assessed. Results: Dynamic motor tasks, such as walking under varying conditions of attention, are complex and demanding undertakings, which require a longer recovery time following a concussion than cognitive measures. Little statistical relationship was found between the neuropsychological and gait variables, and the recovery curves of neuropsychological and gait domains were observed to be independent. Conclusions: In order to fully examine the effects of concussion and determine the optimal time for a safe return to activity, a multi-factorial approach, including both cognitive and motor tasks, should be employed.

Topics: Concussion (55%), Gait (human) (53%), Poison control (51%)

...read more

Content maybe subject to copyright    Report

Citations
More filters

Journal ArticleDOI
TL;DR: The focus of this review is on the current status of PPCS as a clinical entity from the perspective of recent advances in the biomechanical modeling of concussion in human and animal studies, particularly directed at a better understanding of the neuropathology associated with concussion.
Abstract: On the mild end of the acquired brain injury spectrum, the terms concussion and mild traumatic brain injury (mTBI) have been used interchangeably, where persistent post-concussive syndrome (PPCS) has been a label given when symptoms persist for more than three months post-concussion. Whereas a brief history of concussion research is overviewed, the focus of this review is on the current status of PPCS as a clinical entity from the perspective of recent advances in the biomechanical modeling of concussion in human and animal studies, particularly directed at a better understanding of the neuropathology associated with concussion. These studies implicate common regions of injury, including the upper brainstem, base of the frontal lobe, hypothalamic-pituitary axis, medial temporal lobe, fornix, and corpus callosum. Limitations of current neuropsychological techniques for the clinical assessment of memory and executive function are explored and recommendations for improved research designs offered, that may enhance the study of long-term neuropsychological sequelae of concussion. (JINS, 2008, 14, 1–22.)

382 citations


Cites background or methods from "Recovery of cognitive and dynamic m..."

  • ..., & Povlishock, J.T. (2005). Myelinated and unmyelinated axons of the corpus callosum differ in vulnerability and functional recovery following traumatic brain injury. Experimental Neurology, 196, 126–137. Ropper, A.H. & Gorson, K.C. (2007). Clinical practice. Concussion. New England Journal of Medicine, 356, 166–172. Ross, S.R., Putnam, S.H., & Adams, K.M. (2006a). Psychological disturbance, incomplete effort, and compensation-seeking status as predictors of neuropsychological test performance in head injury....

    [...]

  • ..., & Povlishock, J.T. (2005). Myelinated and unmyelinated axons of the corpus callosum differ in vulnerability and functional recovery following traumatic brain injury....

    [...]

  • ..., & Povlishock, J.T. (2005). Myelinated and unmyelinated axons of the corpus callosum differ in vulnerability and functional recovery following traumatic brain injury. Experimental Neurology, 196, 126–137. Ropper, A.H. & Gorson, K.C. (2007). Clinical practice. Concussion. New England Journal of Medicine, 356, 166–172. Ross, S.R., Putnam, S.H., & Adams, K.M. (2006a). Psychological disturbance, incomplete effort, and compensation-seeking status as predictors of neuropsychological test performance in head injury. Journal of Clinical Experimental Neuropsychology, 28, 111–125. Ross, S.R., Putnam, S.H., Millis, S.R., Adams, K.M., & Krukowski, R.A. (2006b). Detecting insufficient effort using the Seashore Rhythm and Speech-Sounds Perception Tests in head injury. Clinical Neuropsychology, 20, 798–815. Roy, K., Murtie, J.C., El-Khodor, B.F., Edgar, N., Sardi, S.P., Hooks, B.M., Benoit-Marand, M., Chen, C., Moore, H., O’Donnell, P., Brunner, D., & Corfas, G. (2007). Loss of erbB signaling in oligodendrocytes alters myelin and dopaminergic function, a potential mechanism for neuropsychiatric disorders....

    [...]

  • ..., & Povlishock, J.T. (2005). Myelinated and unmyelinated axons of the corpus callosum differ in vulnerability and functional recovery following traumatic brain injury. Experimental Neurology, 196, 126–137. Ropper, A.H. & Gorson, K.C. (2007). Clinical practice. Concussion. New England Journal of Medicine, 356, 166–172. Ross, S.R., Putnam, S.H., & Adams, K.M. (2006a). Psychological disturbance, incomplete effort, and compensation-seeking status as predictors of neuropsychological test performance in head injury. Journal of Clinical Experimental Neuropsychology, 28, 111–125. Ross, S.R., Putnam, S.H., Millis, S.R., Adams, K.M., & Krukowski, R.A. (2006b). Detecting insufficient effort using the Seashore Rhythm and Speech-Sounds Perception Tests in head injury....

    [...]

  • ...Assessment in sports concussion has recognized the need to move beyond traditional neuropsychological assessment with the development of more tailored assessment tools in the athlete with concussion (Broglio et al., 2007; Parker et al., 2007)....

    [...]


Journal ArticleDOI
TL;DR: Vestibular rehabilitation should be considered in the management of individuals post concussion who have dizziness and gait and balance dysfunction that do not resolve with rest, indicating that vestibular Rehabilitation may equally benefit both children and adults.
Abstract: Background and Purpose: Management of dizziness and balance dysfunction is a major challenge after concussion. The purpose of this study was to examine the effect of vestibular rehabilitation in reducing dizziness and to improve gait and balance function in people after concussion. Methods: A retrospective chart review of 114 patients (67 children aged 18 years and younger [mean, 16 years; range, 8 –18 years]; 47 adults older than 18 years [mean, 41 years; range, 19 –73 years]) referred for vestibular rehabilitation after concussion was performed. At the time of initial evaluation and discharge, recordings were made of outcome measures of self-report (eg, dizziness severity, Activities-specific Balance Confidence Scale, and Dizziness Handicap Inventory) and gait and balance performance (eg, Dynamic Gait Index, gait speed, and the Sensory Organization Test). A mixed-factor repeated-measures analysis of variance was used to test whether there was an effect of vestibular rehabilitation therapy and age on the outcome measures. Results: The median length of time between concussion and initial evaluation was 61 days. Of the 114 patients who were referred, 84 returned for at least 1 visit. In these patients, improvements were observed in all self-report, gait, and balance performance measures at the time of discharge (P .05). Children improved by a greater amount in dizziness severity (P .005) and conditions 1 (eyes open, fixed support) and 2 (eyes closed, fixed support) of the Sensory Organization Test (P .025). Discussion: Vestibular rehabilitation may reduce dizziness and improve gait and balance function after concussion. For most measures, the improvement did not depend on age, indicating that vestibular rehabilitation may equally benefit both children and adults.

329 citations


Journal ArticleDOI
TL;DR: Assessment of neurocognitive function and balance can provide clinicians with an additional piece of the concussion puzzle, remove some of the guesswork in uncovering less obvious symptoms, and assist in determining readiness to return safely to participation.
Abstract: Although neuropsychological testing has proven to be a valuable tool in concussion management, it is most useful when administered as part of a comprehensive assessment battery that includes grading of symptoms and clinical balance tests. A thorough sideline and clinical examination by the certified athletic trainer and team physician is considered an important first step in the management of concussion. The evaluation should be conducted in a systematic manner, whether on the field or in the clinical setting. The evaluation should include obtaining a history for specific details about the injury (eg, mechanism, symptomatology, concussion history), followed by assessing neurocognitive function and balance, which is the focus of this article. The objective measures from balance testing can provide clinicians with an additional piece of the concussion puzzle, remove some of the guesswork in uncovering less obvious symptoms, and assist in determining readiness to return safely to participation.

229 citations


Journal ArticleDOI
TL;DR: There is evidence to suggest that cognitive or motor-cognitive methods positively affects physical functioning, such as postural control, walking abilities and general functions of the upper and lower extremities, respectively, in older adults over the age of 65.
Abstract: Several types of cognitive or combined cognitive-motor intervention types that might influence physical functions have been proposed in the past: training of dual-tasking abilities, and improving cognitive function through behavioral interventions or the use of computer games. The objective of this systematic review was to examine the literature regarding the use of cognitive and cognitive-motor interventions to improve physical functioning in older adults or people with neurological impairments that are similar to cognitive impairments seen in aging. The aim was to identify potentially promising methods that might be used in future intervention type studies for older adults. A systematic search was conducted for the Medline/Premedline, PsycINFO, CINAHL and EMBASE databases. The search was focused on older adults over the age of 65. To increase the number of articles for review, we also included those discussing adult patients with neurological impairments due to trauma, as these cognitive impairments are similar to those seen in the aging population. The search was restricted to English, German and French language literature without any limitation of publication date or restriction by study design. Cognitive or cognitive-motor interventions were defined as dual-tasking, virtual reality exercise, cognitive exercise, or a combination of these. 28 articles met our inclusion criteria. Three articles used an isolated cognitive rehabilitation intervention, seven articles used a dual-task intervention and 19 applied a computerized intervention. There is evidence to suggest that cognitive or motor-cognitive methods positively affects physical functioning, such as postural control, walking abilities and general functions of the upper and lower extremities, respectively. The majority of the included studies resulted in improvements of the assessed functional outcome measures. The current evidence on the effectiveness of cognitive or motor-cognitive interventions to improve physical functioning in older adults or people with neurological impairments is limited. The heterogeneity of the studies published so far does not allow defining the training methodology with the greatest effectiveness. This review nevertheless provides important foundational information in order to encourage further development of novel cognitive or cognitive-motor interventions, preferably with a randomized control design. Future research that aims to examine the relation between improvements in cognitive skills and the translation to better performance on selected physical tasks should explicitly take the relation between the cognitive and physical skills into account.

147 citations


Cites background from "Recovery of cognitive and dynamic m..."

  • ...The patterns of cognitive decline observed in patients after traumatic brain injury resembles that of classic aging processes [35,39,40]....

    [...]


Journal ArticleDOI
TL;DR: It is suggested that concussion affects the ability of adolescents to control body posture during gait up to 2 months after injury and dual-task paradigms may provide additional useful information in the clinical assessment and recovery of concussion.
Abstract: Objective To prospectively and longitudinally examine how concussion affects gait balance control in adolescents during single- and dual-task walking. Design Cohort, prospective, repeated-measures design. Setting Motion analysis laboratory. Participants Adolescents (N=20) identified as suffering a concussion were matched with healthy control subjects (N=20) and tested 5 times across a 2-month period after injury. Interventions Not applicable. Main Outcome Measures Gait temporal-distance parameters included average walking speed, step length, and step width; whole body center of mass (COM) parameters included medial/lateral displacement and peak COM medial/lateral and anterior velocities; dual-task cost, which was defined as percent change from single- to dual-task conditions; and Stroop test accuracy. Results No between-group differences were observed for step length and step width. The dual-task cost for average walking speed for subjects with concussion was greater than control subjects across the 2-month testing period (main effect of group P =.019), as was the dual-task costs for peak anterior COM velocity (main effect of group P =.017) and total COM medial/lateral displacement (main effect of group P =.013). The total COM medial/lateral displacement (group × task interaction P =.006) and peak COM medial/lateral velocity (main effect of group P =.027; main effect of task P =.01) were significantly greater in subjects with concussion compared with control subjects during dual-task walking. Subjects with concussion were significantly less accurate than controls on the Stroop test (main effect of group P =.004). Conclusions The findings suggest that concussion affects the ability of adolescents to control body posture during gait up to 2 months after injury. Furthermore, dual-task paradigms may provide additional useful information in the clinical assessment and recovery of concussion.

146 citations


Cites background or result from "Recovery of cognitive and dynamic m..."

  • ...Furthermore, other work has identified disruptions to dynamic balance control during dual-task walking for up to 28 days after injury in young adults.(14) Because these reports have elucidated information regarding recovery from concussion in the adult population, no studies, to our knowledge, have examined recovery of gait balance parameters specifically in the adolescent population....

    [...]

  • ...This impairment is consistent with the literature, which has described balance deficits in those suffering from a single concussion in young adult populations.(12,14) The Stroop test, when performed in conjunction with another task, such as walking, has been shown to activate the prefrontal cortex, which has been postulated to be crucial for the coordination of mental operations(38) and has been reported to be affected by concussion for up to 1 month after injury....

    [...]


References
More filters

Book
01 May 1990
TL;DR: The Fourth Edition of Biomechanics as an Interdiscipline: A Review of the Fourth Edition focuses on biomechanical Electromyography, with a focus on the relationship between Electromyogram and Biomechinical Variables.
Abstract: Preface to the Fourth Edition. 1 Biomechanics as an Interdiscipline. 1.0 Introduction. 1.1 Measurement, Description, Analysis, and Assessment. 1.2 Biomechanics and its Relationship with Physiology and Anatomy. 1.3 Scope of the Textbook. 1.4 References. 2 Signal Processing. 2.0 Introduction. 2.1 Auto- and Cross-Correlation Analyses. 2.2 Frequency Analysis. 2.3 Ensemble Averaging of Repetitive Waveforms. 2.4 References. 3 Kinematics. 3.0 Historical Development and Complexity of Problem. 3.1 Kinematic Conventions. 3.2 Direct Measurement Techniques. 3.3 Imaging Measurement Techniques. 3.4 Processing of Raw Kinematic Data. 3.5 Calculation of Other Kinematic Variables. 3.6 Problems Based on Kinematic Data. 3.7 References. 4 Anthropometry. 4.0 Scope of Anthropometry in Movement Biomechanics. 4.1 Density, Mass, and Inertial Properties. 4.2 Direct Experimental Measures. 4.3 Muscle Anthropometry. 4.4 Problems Based on Anthropometric Data. 4.5 References. 5 Kinetics: Forces and Moments of Force. 5.0 Biomechanical Models. 5.1 Basic Link-Segment Equations-the Free-Body Diagram. 5.2 Force Transducers and Force Plates. 5.3 Bone-on-Bone Forces During Dynamic Conditions. 5.4 Problems Based on Kinetic and Kinematic Data. 5.5 References. 6 Mechanical Work, Energy, and Power. 6.0 Introduction. 6.1 Efficiency. 6.2 Forms of Energy Storage. 6.3 Calculation of Internal and External Work. 6.4 Power Balances at Joints and Within Segments. 6.5 Problems Based on Kinetic and Kinematic Data. 6.6 References. 7 Three-Dimensional Kinematics and Kinetics. 7.0 Introduction. 7.1 Axes Systems. 7.2 Marker and Anatomical Axes Systems. 7.3 Determination of Segment Angular Velocities and Accelerations. 7.4 Kinetic Analysis of Reaction Forces and Moments. 7.5 Suggested Further Reading. 7.6 References. 8 Synthesis of Human Movement-Forward Solutions. 8.0 Introduction. 8.1 Review of Forward Solution Models. 8.2 Mathematical Formulation. 8.3 System Energy. 8.4 External Forces and Torques. 8.5 Designation of Joints. 8.6 Illustrative Example. 8.7 Conclusions. 8.8 References. 9 Muscle Mechanics. 9.0 Introduction. 9.1 Force-Length Characteristics of Muscles. 9.2 Force-Velocity Characteristics. 9.3 Muscle Modeling. 9.4 References. 10 Kinesiological Electromyography. 10.0 Introduction. 10.1 Electrophysiology of Muscle Contraction. 10.2 Recording of the Electromyogram. 10.3 Processing of the Electromyogram,. 10.4 Relationship between Electromyogram and Biomechanical Variables. 10.5 References. 11 Biomechanical Movement Synergies. 11.0 Introduction. 11.1 The Support Moment Synergy. 11.2 Medial/Lateral and Anterior/Posterior Balance in Standing. 11.3 Dynamic Balance during Walking. 11.4 References. APPENDICES. A. Kinematic, Kinetic, and Energy Data. Figure A.1 Walking Trial-Marker Locations and Mass and Frame Rate Information. Table A.1 Raw Coordinate Data (cm). Table A.2( a ) Filtered Marker Kinematics-Rib Cage and Greater Trochanter (Hip). Table A.2( b ) Filtered Marker Kinematics-Femoral Lateral Epicondyle (Knee) and Head of Fibula. Table A.2( c ) Filtered Marker Kinematics-Lateral Malleolus (Ankle) and Heel. Table A.2( d ) Filtered Marker Kinematics-Fifth Metatarsal and Toe. Table A.3( a ) Linear and Angular Kinematics-Foot. Table A.3( b ) Linear and Angular Kinematics-Leg. Table A.3( c ) Linear and Angular Kinematics-Thigh. Table A.3( d ) Linear and Angular Kinematics-1/2 HAT. Table A.4 Relative Joint Angular Kinematics-Ankle, Knee, and Hip. Table A.5( a ) Reaction Forces and Moments of Force-Ankle and Knee. Table A.5( b ) Reaction Forces and Moments of Force-Hip. Table A.6 Segment Potential, Kinetic, and Total Energies-Foot, Leg, Thigh, and1/2 HAT. Table A.7 Power Generation/Absorption and Transfer-Ankle, Knee, and Hip. B. Units and Definitions Related to Biomechanical and Electromyographical Measurements. Table B.1 Base SI Units. Table B.2 Derived SI Units. Index.

8,766 citations


Journal ArticleDOI
Jin Fan1, Bruce D. McCandliss1, Tobias Sommer1, Amir Raz1, Michael I. Posner1 
TL;DR: A study with 40 normal adult subjects indicates that the ANT produces reliable single subject estimates of alerting, orienting, and executive function, and further suggests that the efficiencies of these three networks are uncorrelated.
Abstract: In recent years, three attentional networks have been defined in anatomical and functional terms. These functions involve alerting, orienting, and executive attention. Reaction time measures can be used to quantify the processing efficiency within each of these three networks. The Attention Network Test (ANT) is designed to evaluate alerting, orienting, and executive attention within a single 30-min testing session that can be easily performed by children, patients, and monkeys. A study with 40 normal adult subjects indicates that the ANT produces reliable single subject estimates of alerting, orienting, and executive function, and further suggests that the efficiencies of these three networks are uncorrelated. There are, however, some interactions in which alerting and orienting can modulate the degree of interference from flankers. This procedure may prove to be convenient and useful in evaluating attentional abnormalities associated with cases of brain injury, stroke, schizophrenia, and attention-deficit disorder. The ANT may also serve as an activation task for neuroimaging studies and as a phenotype for the study of the influence of genes on attentional networks.

2,818 citations


Journal ArticleDOI
19 Nov 2003-JAMA
Abstract: ContextLack of empirical data on recovery time following sport-related concussion hampers clinical decision making about return to play after injury.ObjectiveTo prospectively measure immediate effects and natural recovery course relating to symptoms, cognitive functioning, and postural stability following sport-related concussion.Design, Setting, and ParticipantsProspective cohort study of 1631 football players from 15 US colleges. All players underwent preseason baseline testing on concussion assessment measures in 1999, 2000, and 2001. Ninety-four players with concussion (based on American Academy of Neurology criteria) and 56 noninjured controls underwent assessment of symptoms, cognitive functioning, and postural stability immediately, 3 hours, and 1, 2, 3, 5, 7, and 90 days after injury.Main Outcome MeasuresScores on the Graded Symptom Checklist (GSC), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and a neuropsychological test battery.ResultsNo player with concussion was excluded from participation; 79 players with concussion (84%) completed the protocol through day 90. Players with concussion exhibited more severe symptoms (mean GSC score 20.93 [95% confidence interval {CI}, 15.65-26.21] points higher than that of controls), cognitive impairment (mean SAC score 2.94 [95% CI, 1.50-4.38] points lower than that of controls), and balance problems (mean BESS score 5.81 [95% CI, –0.67 to 12.30] points higher than that of controls) immediately after concussion. On average, symptoms gradually resolved by day 7 (GSC mean difference, 0.33; 95% CI, −1.41 to 2.06), cognitive functioning improved to baseline levels within 5 to 7 days (day 7 SAC mean difference, −0.03; 95% CI, −1.33 to 1.26), and balance deficits dissipated within 3 to 5 days after injury (day 5 BESS mean difference, −0.31; 95% CI, −3.02 to 2.40). Mild impairments in cognitive processing and verbal memory evident on neuropsychological testing 2 days after concussion resolved by day 7. There were no significant differences in symptoms or functional impairments in the concussion and control groups 90 days after concussion.ConclusionsCollegiate football players may require several days for recovery of symptoms, cognitive dysfunction, and postural instability after concussion. Further research is required to determine factors that predict variability in recovery time after concussion. Standardized measurement of postconcussive symptoms, cognitive functioning, and postural stability may enhance clinical management of athletes recovering from concussion.

1,407 citations


Journal ArticleDOI
TL;DR: The recommendations for concussion management provided here are based on the most current research and divided into sections on education and prevention, documentation and legal aspects, evaluation and return to play, and other considerations.
Abstract: Objective: To provide athletic trainers, physicians, and other health care professionals with best-practice guidelines for the management of sport-related concussions. Background: An estimated 3.8 ...

951 citations


Journal ArticleDOI
TL;DR: A subroutine package is presented in which the amount of smoothing on a set of n noisy datapoints is determined from the data by means of the Generalized Cross-Validation or predicted Mean-Squared Error criteria of Wahba and her collaborators.
Abstract: Based on the spline software of Lyche et al. , a subroutine package is presented in which the amount of smoothing on a set of n noisy datapoints is determined from the data by means of the Generalized Cross-Validation (GCV) or predicted Mean-Squared Error (MSE) criteria of Wahba and her collaborators. Following an idea of Hutchinson and de Hoog, an efficient O ( m 2 n ) algorithm is used for calculating the criterion functions, where 2 m is the order of the spline function. In this fashion, earlier O ( n 3 ) approaches based on the singular value decomposition can be avoided.

945 citations


Related Papers (5)