A Neuroscientific Approach to the Examination of Concussions in Student-Athletes

Summary

There is great variability in an individual’s risk for concussion and their corresponding recovery. A multifaceted approach to concussion evaluation is warranted; including baseline testing of athletes before participation in sport and timely evaluation post injury. The goal of this protocol is to provide an appropriate multifaceted approach to examine concussions.

Abstract

Concussions are occurring at alarming rates in the United States and have become a serious public health concern. The CDC estimates that 1.6 to 3.8 million concussions occur in sports and recreational activities annually. Concussion as defined by the 2013 Concussion Consensus Statement “may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an ‘impulsive’ force transmitted to the head.” Concussions leave the individual with both short- and long-term effects. The short-term effects of sport related concussions may include changes in playing ability, confusion, memory disturbance, the loss of consciousness, slowing of reaction time, loss of coordination, headaches, dizziness, vomiting, changes in sleep patterns and mood changes. These symptoms typically resolve in a matter of days. However, while some individuals recover from a single concussion rather quickly, many experience lingering effects that can last for weeks or months. The factors related to concussion susceptibility and the subsequent recovery times are not well known or understood at this time. Several factors have been suggested and they include the individual’s concussion history, the severity of the initial injury, history of migraines, history of learning disabilities, history of psychiatric comorbidities, and possibly, genetic factors. Many studies have individually investigated certain factors both the short-term and long-term effects of concussions, recovery time course, susceptibility and recovery. What has not been clearly established is an effective multifaceted approach to concussion evaluation that would yield valuable information related to the etiology, functional changes, and recovery. The purpose of this manuscript is to show one such multifaceted approached which examines concussions using computerized neurocognitive testing, event related potentials, somatosensory perceptual responses, balance assessment, gait assessment and genetic testing.

Introduction

Concussions are occurring at alarming rates in the United States and have garnered quite a lot of attention as a public health concern.^1-3 US Centers for Disease Control and Prevention (CDC) estimates that 1.6 to 3.8 million concussions occur in sports and recreational activities annually.^4,5 Concussion as defined by the 2013 Concussion Consensus Statement² “may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an ‘impulsive’ force transmitted to the head.” Concussion may result in neuropathological and/or substructural changes that may result in functional disturbances.

Protocol

All the procedures described below have been approved by the Elon’s Institutional Review Board.

1. Computerized Neurocognitive Testing

1. Ask the participants to be seated in front of the computer. Log participants on to system and instruct them to complete the computerized neuropsychological test which consists a demographic and background information section, self-reported symptom checklist, and 6 modules (word discrimination, design memory, X’s and O’s, symbol matching, color match, and three letters).
2. Download summary report and enter four composite scores for verbal memory, visual memory, reaction t....

Results

Computerized Neurocognitive Testing

An example of results for the computerized neurocognitive test can be seen in Figure 1. The computer program elicits composite scores on Verbal Memory, Visual Memory, Visual Motor Speed and Reaction Time which are often used to make return-to-play and return-to-learn concussion management protocols. The verbal and visual memory composites evaluate attentional processes, learning and memory. Visual motor speed measures visual.......

Discussion

The goal of this multidimensional approach to baseline concussion testing is twofold: 1) to better understand the impact of a concussion (acute and long term) on the neuromuscular system; 2) to help the sports medicine staff make return to play decisions (they primarily use neurocognitive testing as has been suggested by McCrory).²⁶ This multifaceted approach to concussion evaluation provides valuable information related to the etiology, functional changes, and recovery from concussion. Little is understood ab.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
ImPACT	ImPACT, Pittsburgh, PA		Neurocognitive concussion testing
EEG	EGI, Eugene, OR		EEG 32-channel system
Stim2	Compumedics Neuroscan, Charlotte, NC		Software for task presentation for flanker task and auditory oddball
NetStation	EGI, Eugene, OR		Software for data collection and analysis of EEG
Sensory Device	Cortical Metrics		Sensory testing
Balance System SD	Biodex Medical Systems, Inc., Shirley, NY		balance testing
GAITRite	CIR systems, Inc., Sparta, NJ, USA		Gait analysis
PCR	Applied Biosystems, Foster City, CA		Genetic Analysis
Matlab	Mathworks, Natick, MA, USA		Gait and balance analysis