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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TL;DR: Clinical balance assessments may need to include static and dynamic measures, to capture possible performance difficulties in children recovered from a mild Traumatic Brain Injury, to enhance clinical decision making and prevent premature return to physical activities in children with mTBI.
Abstract: PURPOSE: To compare the ability of clinical balance measures to detect differences between children recovered from a mild Traumatic Brain Injury (mTBI) and healthy controls. METHODS: A cross-sectional study, with twenty-six children with mTBI and twenty-two age-matched controls was conducted. Balance was evaluated on three scales: Bruininks- Osteresky Test-second edition; Balance Error Scoring System and Community Balance and Mobility Scale, along with gait analysis of three paradigms (self-selected paced walking, obstacle crossing and tandem walking), under single and dual-task conditions, using GAITRitescriptsize® walkway. Independent sample t-tests (α = 0.05) were used to identify group differences. Dual-Task Cost (DTC) was analyzed using repeated measures ANOVA and t-tests. Discriminant analysis predicted which balance measure best identified the groups. RESULTS: Children with mTBI performed worse on all balance scales (pCONCLUSION: Clinical balance assessments may need to include static and dynamic measures, to capture possible performance difficulties. The inclusion of these measures will enhance clinical decision making and prevent premature return to physical activities in children with mTBI. Language: en
31 citations
Cites result from "Recovery of cognitive and dynamic m..."
...Our results contradict studies that have found individuals with mTBI to have greater balance deficits under dual-task conditions 28 days after injury, compared to healthy controls [9,46,47]....
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TL;DR: It is demonstrated that persistence of sensorimotor and physiological changes beyond expected recovery times following subacute mTBI in an adult population is possible and has implications for post-injury assessment and management.
Abstract: Objective. To systematically review the literature with meta-analysis to determine whether persistence of sensorimotor or physiological impairment exists between 4 weeks to 6 months post mild traum...
31 citations
Cites background from "Recovery of cognitive and dynamic m..."
...Six studies assessed sagittal and frontal plane center of motion (COM) and pressure (COP) variables.(8,33,34,42,47,48) Additional measures included variability of distance of trail and lead foot clearance during obstacle crossing,(42,43) as well as obstacle avoidance patterns in relation to shoulder diameter versus obstacle breadth ratios....
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...05), whereas in the control group it was not.(47) Increased ML displacement (P < ....
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...Eight studies (all AAN evidence level 3) using motion analysis technology to assess gait under varying conditions were identified.(8,33,34,41-43,47,48) Six studies assessed sagittal and frontal plane center of motion (COM) and pressure (COP) variables....
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TL;DR: This review summarizes the current state-of-the-art concussion evaluation instruments, ranging from the Sports Concussion Assessment Tool (SCAT) and tools that may enhance concussion detection, to near-term blood-based biomarkers and emerging technology (eg, head impact sensors, vestibulo-ocular/eye-tracking, and mobile applications).
Abstract: More than 200 million American adults and children participate in organized physical activity. Growing awareness has highlighted that concussion, especially when repeated, may be associated with prolonged neurological, cognitive, and/or neuropsychiatric sequelae. Objective diagnosis of concussion remains challenging. Although some concussion symptoms may be apparent even to nonmedical observers, diagnosis and removal from play for evaluation depend on validated assessment tools and trained, vigilant healthcare personnel. Over the past 2 decades, sideline concussion measures have undergone significant revision and augmentation to become more comprehensive batteries in order to detect a wide spectrum of symptomatology, eg, neurocognitive function, postconcussive symptoms, gait/balance, and saccadic eye movements. This review summarizes the current state-of-the-art concussion evaluation instruments, ranging from the Sports Concussion Assessment Tool (SCAT) and tools that may enhance concussion detection, to near-term blood-based biomarkers and emerging technology (eg, head impact sensors, vestibulo-ocular/eye-tracking, and mobile applications). Special focus is directed at feasibility, utility, generalizability, and challenges to implementation of each measure on-field and on the sidelines. This review finds that few instruments beyond the SCAT provide guidance for removal from play, and establishing thresholds for concussion detection and removal from play in qualification/validation of future instruments is of high importance. Integration of emerging sideline concussion evaluation tools should be supported by resources and education to athletes, caregivers, athletic staff, and medical professionals for standardized administration as well as triage, referral, and prevention strategies. It should be noted that concussion evaluation instruments are used to assist the clinician in sideline diagnosis, and no single test can diagnose concussion as a standalone investigation.
30 citations
TL;DR: To evaluate the recovery of balance and gait in concussed athletes using a novel linear mixed-model design that allows an inflection point to account for changes in trend that may occur after RTP, changes in the rate of recovery were coincident with the timing of RTP.
Abstract: Context In longitudinal studies tracking recovery after concussion, researchers often have not considered the timing of return to play (RTP) as a factor in their designs, which can limit the unders...
29 citations
TL;DR: Subtle balance and gait alterations were observed after two weeks following a concussion, which may allow clinicians to improve concussion diagnosis and prevent subsequent injury.
Abstract: ObjectiveThe aim of the study was to systematically review and quantitatively synthesize the existing evidence of balance and gait alterations lasting more than 2 wks after concussion in adults.DesignA systematic review was conducted through PubMed, CINAHL, SPORTDiscus, and Web of Science. Investiga
29 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