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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.
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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Citations
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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.)

401 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....

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

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  • ..., & 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....

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  • ..., & 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....

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  • ...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)....

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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.

387 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.

252 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.

167 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]....

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Journal ArticleDOI
TL;DR: Sport concussions were associated with pervasive changes in postural control and more M1 intracortical inhibition, providing neurophysiologic and behavioral evidence of lasting, subclinical changes in motor system integrity in concussed athletes.
Abstract: Context: The known detrimental effects of sport concussions on motor system function include balance problems, slowed motor execution, and abnormal motor cortex excitability. Objective: To assess whether these concussion-related alterations of motor system function are still evident in collegiate football players who sustained concussions but returned to competition more than 9 months before testing. Design: Case-control study. Setting: University laboratory. Patients or Other Participants: A group of 21 active, university-level football players who had experienced concussions was compared with 15 university football players who had not sustained concussions. Intervention(s): A force platform was used to assess center-of-pressure (COP) displacement and COP oscillation regularity (approximate entropy) as measures of postural stability in the upright position. A rapid alternating-movement task was also used to assess motor execution speed. Transcranial magnetic stimulation over the motor cortex was used to ...

164 citations

References
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Reference EntryDOI
14 Jun 2015
TL;DR: The mental status exam as mentioned in this paper is the equivalent of the physical exam for mental health practitioners and contains both objective observations and subjective reporting from the patient and allows the evaluee's mental state at the time of evaluation to be documented and preserved.
Abstract: The mental status exam is the equivalent of the physical exam for mental health practitioners. It contains both objective observations and subjective reporting from the patient. It allows the evaluee's mental state at the time of evaluation to be documented and preserved. The mental status is generally reported in the order of physical/superficial observations to more detailed internal thought process and capabilities. Multiple tests, screens, or scales can be used to assist the evaluator in determining a person's mental status. The mental status can be used for a variety of purposes such as formulating a diagnosis, accessing malingering, determining violence risk to self or others, and justifying a billing code. It needs to be remembered though that a mental status is just one part of a comprehensive examination or clinical encounter and there can be variation in the information noted depending on the context of the evaluation. Keywords: interview; mental status; clock drawing; mini mental status exam; billing; suicide; malingering; capacity; tattoo

112 citations

Journal ArticleDOI
TL;DR: Injured athletes experiencing symptoms of concussion displayed impaired motor function and attention, although their learning and memory were preserved, in contrast with the improvement observed in asymptomatic and non-injured athletes.
Abstract: BACKGROUND Concussion is a common neurological injury occurring during contact sport. Current guidelines recommend that no athlete should return to play while symptomatic or displaying cognitive dysfunction. This study compared post-concussion cognitive function in recently concussed athletes who were symptomatic/asymptomatic at the time of assessment with that of non-injured (control) athletes. METHODS Prospective study of 615 male Australian Rules footballers. Before the season, all participants (while healthy) completed a battery of baseline computerised (CogSport) and paper and pencil cognitive tasks. Sixty one injured athletes (symptomatic = 25 and asymptomatic = 36) were reassessed within 11 days of being concussed; 84 controls were also reassessed. The serial cognitive function of the three groups was compared using analysis of variance. RESULTS The performance of the symptomatic group declined at the post-concussion assessment on computerised tests of simple, choice, and complex reaction times compared with the asymptomatic and control groups. The magnitude of changes was large according to conventional statistical criteria. On paper and pencil tests, the symptomatic group displayed no change at reassessment, whereas large improvements were seen in the other two groups. CONCLUSION Injured athletes experiencing symptoms of concussion displayed impaired motor function and attention, although their learning and memory were preserved. These athletes displayed no change in performance on paper and pencil tests in contrast with the improvement observed in asymptomatic and non-injured athletes. Athletes experiencing symptoms of concussion should be withheld from training and competition until both symptoms and cognitive dysfunction have resolved.

64 citations

Journal ArticleDOI
TL;DR: Despite their good recovery of locomotor function, subjects with moderate and severe TBI showed residual deficits in relation to greater difficulties in dealing with environments that challenge their locomotor and attentional abilities.

60 citations

Journal Article
TL;DR: The mental status examination evaluates appearance and behavior, attitude, perception, orientation, judgment, cognition, abstraction and insight to substantiate clinical decisions on competance, potential for danger and hospitalization.
Abstract: The mental status examination evaluates appearance and behavior, attitude, perception, orientation, judgment, cognition, abstraction and insight. It can be administered quickly and repetitively. This examination provides information to distinguish organic from "functional" illnesses and also provides objective data regarding the patient's improving or deteriorating sensorium. It helps substantiate clinical decisions on competance, potential for danger and hospitalization.

57 citations

Journal ArticleDOI
TL;DR: The results suggest that measures of executive functioning and attention may be associated to locomotor behaviour in complex environments following a moderate to severe TBI.
Abstract: Primary objective: To determine the relationships between clinical measures of executive function and attention, and laboratory measures of anticipatory locomotor adaptations with dual tasks following a TBI.Methods and procedures: Ten people with moderate or severe TBI were compared to 10 healthy subjects for neuropsychological measures in the clinic, as well as locomotor patterns and reading time in the laboratory for adapted Stroop tasks (Bar and Word) during unobstructed and obstructed walking.Main outcomes and results: As previously found (Vallee M, McFadyen BJ, Swaine B, Doyon J, Cantin JF, Dumas D. Effects of environmental demands on locomotion after traumatic brain injury. Archives of Physical Medicine Rehabilitation 2006;87:806--813) during the locomotor activities, subjects with TBI walked slower, had higher clearance margins and took longer to read during the Stroop tasks than healthy subjects. In general, subjects with TBI also showed deficits in executive functions and attention. Significant r...

48 citations

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