Recovery of cognitive and dynamic motor function following concussion
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.
Abstract: Objective: 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.
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01 Jan 2014
TL;DR: The results suggest that individuals may be returning to sports participation prior to complete concussion recovery and could be a mechanism for the high recurrent concussion rate as well as recent speculation associating concussions and other sports-related injuries.
Abstract: The fourth International Consensus Statement on Concussion in Sport reports that 80–90 % of concussions recover in 7–10 days. Impairments in postural control are a cardinal symptom following a sports-related concussion; however, many studies suggest that these impairments resolve within 3–5 days post-injury. Multiple recent studies, utilizing diverse and sophisticated research paradigms, are suggesting that this may be premature and that prolonged recovery could be normal. Therefore, the overarching purpose of the studies reported herein is to investigate impairments in postural control following a concussion and to identify recovery. We investigated the efficacy of “non-novel” tasks including gait initiation, gait variability, gait termination, and static stance and track the individual’s performance across time to identify residual impairments compared to performance on the standard clinical assessment battery. In the acute aftermath of a concussion, the subjects demonstrated substantial impairments in postural control across all tasks which are consistent with a multiple previous investigations. However, the novel findings were the identification of persistent and lingering impairments in postural control which were present despite apparent full recovery on all clinical measures. Specifically, the impairments were more apparent when evaluating central control mechanisms (e.g., movement strategies and anticipatory postural adjustments) as standard kinematic variables returned to premorbid values in a timelier manner. These results suggest that individuals may be returning to sports participation prior to complete concussion recovery and could be a mechanism for the high recurrent concussion rate as well as recent speculation associating concussions and other sports-related injuries.
4 citations
01 Jan 2014
3 citations
01 May 2016
3 citations
Cites background from "Recovery of cognitive and dynamic m..."
...0%) -Days Since Concussion 126 (28-432) -- b -Total Concussions 1 (1-3) 0 (0-2) b -All variables are represented by the mean (SD) unless otherwise noted....
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TL;DR: Differences in inter-limb postural stability were found in subjects post-concussion, and impairments were detected that otherwise would have likely gone undiagnosed using the BESS test alone.
Abstract: Introduction Impairments in postural stability have been identified following sports-related concussion. CaneSense™ is a recently developed mobile lower limb motion capture system and mobile application for movement assessment which provides an objective measure of postural stability. One of the components within CaneSense™ is the Post-Concussive Excursion Index (PCEI), a measure of postural stability expressed as a percentage of symmetry between lower limbs. Purpose The purpose of this case series is to examine pre- and post-concussion differences using two separate measures, CaneSense™, and a known test, the Balance Error Scoring System (BESS), in Division I collegiate football players. Methods A convenience sample of eight football players diagnosed with a concussion, were the subjects in this case series. All subjects underwent baseline testing prior to the start of pre-season camp consisting of the single limb stance (SLS) test with CaneSense™ and the BESS test. Twenty-four to 72 hours following their concussion, SLS with CaneSense™ test and the BESS test, were administered. Segmental excursions for the thigh and shank segments for each lower limb were combined into the Post-Concussion Excursion Profile (PCEP), which represents each segment's maximum excursion in the medial-lateral and anterior-posterior direction. The PCEI is a single metric generated to quantify differences within subjects by comparing the PCEP value between lower limbs during SLS where 100% suggests absolute symmetry. Results The PCEI value decreased significantly post-concussion (41.43 ± 15.53% vs. 87.41 ± 6.05%, p < 0.001) demonstrating a 52.6% decrease in inter-limb symmetry when compared to baseline values. There was an unanticipated 36.36% improvement in composite BESS performance post-concussion (10.5 ± 4.87 errors vs. 16.5 ± 8.49 errors, p = 0.10). Conclusions Differences in inter-limb postural stability were found in subjects post-concussion. By assessing postural stability in both lower limbs individually, using the PCEI, impairments were detected that otherwise would have likely gone undiagnosed using the BESS test alone. Levels of Evidence Therapy, Level 4.
3 citations
TL;DR: This instrument may be used for assessment of service members who have experienced mTBI to help identify environmental factors, functional activities, and body functions that may reduce the safe and efficient fulfillment of their duties and determine their ability to return-to-duty.
Abstract: Purpose The objective of this study was to develop and establish content validity of a new instrument titled the Military Concussion Readiness Inventory for Dizziness and Balance (MCRI-DB). The MCRI-DB was intended to recognize functional impairments and predict readiness for return-to-duty in service members who experienced mild traumatic brain injury (mTBI). Methods Nineteen male service members were included in a nominal group technique (NGT) process to produce items for the MCRI-DB. Items were categorized according to the International Classification of Functioning, Disability and Health (ICF) and were sent to 13 physical therapy experts through a Delphi survey to determine content validity. The consensus to include an item was defined as an agreement of at least 70% of the participants. Results The NGT produced 222 items with 108 duplicates removed. The ICF categorization linked 84 of the items to 36 unique ICF Codes, 9 items were not linkable to the ICF due to the complex nature of the activity, and 21 items were removed. After three rounds of the Delphi survey, 68 items were included in this instrument. Conclusion In this study, we successfully combined the use of service members' experiences with expert opinion to determine content validity of the MCRI-DB. This instrument may be used for assessment of service members who have experienced mTBI to help identify environmental factors, functional activities, and body functions that may reduce the safe and efficient fulfillment of their duties and determine their ability to return-to-duty. Further research is needed to develop the psychometric properties of the instrument fully.
3 citations
References
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01 May 1990TL;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.
9,092 citations
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.
3,166 citations
TL;DR: In this paper, a study of 1631 football players from 15 US colleges found that players with concussions exhibited more severe symptoms (mean GSC score 20.93 [95% confidence interval {CI, 15.65-26.21] points higher than that of controls), cognitive impairments (mean SAC score 2.94 [ 95% CI, 1.41 to 2.06], cognitive functioning improved to baseline levels within 5 to 7 days (day 7 SAC mean difference, −0.33;
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.
1,484 citations
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 ...
1,026 citations
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.
987 citations