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

The overall goal of the following experiment is to establish an effective multifaceted approach to concussion evaluation that would yield valuable information related to the etiology, functional changes and recovery from concussion. This is achieved by baseline testing student athletes when they begin their collegiate career and conducting follow-up testing if they incur a concussion. Computer testing includes neurocognitive assessment, recording event related potentials during the auditory oddball task and the flaker task, and a somatosensory discrimination task balance is measured to calculate the sway index score and gait is measured using an instrumented gait analysis system.

The results show a multifaceted team-based approach to concussion assessment.Assessment. The main advantage of the Elon Brain Care approach is that multiple perspectives are focused on student athlete wellbeing. This method can help assist sports medicine staff in return to play decisions while expanding our understanding of concussions.

The implications of Elon Brain Care extend toward improved proactive assessment of concussions. Because multidisciplinary baseline measures and education are at the core. Though this method can be useful for collegiate athletes, it can also be applied to high school athletes and the greater community as concussion.

Education and assessment are key to prevention and recovery Generally. The difficulty of this program is coordinating the baseline and follow up assessments to meet the needs of the researchers, athletes, and sports medicine staff. We first had the idea for this method when faculty from exercise science, physical therapy education, and the sports medicine staff saw an opportunity to make an impact in the community.

Visual demonstration of this method is critical. As the scope of testing can seem overwhelming, but the multidisciplinary approach is valuable, The entire protocol or specific parts can be implemented at multiple sites to increase impact. All of our research assistants Are completing projects as part of the undergraduate research program, which a large focus of our education piece demonstrating the procedure will be Jordan Coddle and Kayla Harvey.

Current undergraduate students in exercise science. To begin, ask the participant to be seated in front of the computer, log them onto the system, and instruct them to complete the computerized neuropsychological test, which consists of a demographic and background information section, a self-reported symptom checklist, and six modules. Afterwards, download a summary report and enter four composite scores for verbal memory, visual memory, reaction time, and motor processing speed for each participant.

When ready, measure the participant's head circumference. To determine the size of EEG net needed, determine the placement of the net by measuring anatomical landmarks. Soak the EEG net in a solution of sodium chloride and baby shampoo for five minutes.

After this time, place the net on the participant's head. Check the impedance levels of each site on the computer for this system. An impedance below 100 kilo ohms is deemed acceptable.

Next, explain the cognitive tasks and let the participant practice each of them. For the auditory oddball task. Instruct the participant to put on headphones and sit comfortably at a table.

Inform them that they will hear a series of low and high tones and that they should respond as quickly and accurately as possible by clicking a button to a high frequency auditory tone. For the flanker task, instruct the participant to sit in front of a computer screen where they will be given a series of arrows projected onto a screen. Instruct participants to respond to the direction of the middle arrow by clicking the left mouse button if it was pointing left, or clicking the right mouse button if it was pointing right as quickly and accurately as possible.

Instruct the participant to complete two trials of both the auditory oddball task and the flaker task afterwards. Remove the EEG net from the participant and clean it by soaking in germicide disinfectant for 10 minutes. To test for somatosensory perceptual responses, seat the participant comfortably with their left hand in a prone position, resting on the sensory stimulus device and their fingers positioned along the contour of the device with a padded tips of two digits placed in contact with the stimulus probes.

Ask the participant to view task related instructions and cues on a computer Monitor and enter responses using a two button computer mouse project. Five different tests. Two simple single site reaction time tasks, a dual site amplitude discrimination, a dual site amplitude task with a single site adapting stimulus and a temporal order judgment task.

Prior to the start of each test, run the cues on the computer will instruct the participant to complete practice trials to familiarize themselves with the task. The computer will give the participants performance feedback. After each test, instruct the participant to put on slip resistant socks and then stand on the balance system to become acquainted with the instrument.

The participant should stand in a comfortable position matching the center of the pressure dot with the center dot on the screen. Record this starting position such that all tests take place with the same foot position. Ask the participant to stand for 30 seconds for each of four conditions, eyes open on a firm surface, eyes closed on a firm surface, eyes open on a foam surface and eyes closed on a foam surface.

Provide the participants a ten second rest between each condition and a three second countdown before the beginning of each recording. Next, repeat each of the conditions while completing a secondary task. Instruct the participant to count backwards by seven, starting from a provided random three digit number.

After testing, record the sway index score. This is a measure of the standard deviation of position from the center. For each condition and center of pressure data, assess the participant's gait using a portable 15 foot long carpet instrumented gate analysis system with pressure sensors present throughout the length of the carpet.

To detect the participant's footfalls, ask the participants to walk across the mat barefoot at a comfortable speed, starting from a distance of three feet before the mat and three feet after leaving the mat to perform the concurrent cognitive dual task, instruct the participants to complete five additional walking trials while counting backwards by seven from a random three digit number. The dependent variables obtained as output from gait analysis include absolute and variability measures of several spatial temporal parameters. For sample collection, ask the participant to carefully remove the swab.

Stick from its sterile container and vigorously rub the swab inside of both cheeks for a total of 20 seconds. While wearing sterile gloves, collect the stick and place the swab tip into a sterile 1.7 milliliter tube and immediately place on ice. Within 24 hours, transfer the samples to a negative 20 degrees Celsius freezer.

When ready, extract the DNA using a standard DNA purification kit. Store the extracted DNA at negative 80 degrees Celsius until genotyping analysis using standard PCR assays. This is an example of results from the computerized neurocognitive test.

The computer program elicits composite scores, which are used to help make return to play and return to learn concussion management protocols. These preliminary results show differences in amplitude and latency for P three associated with the flankers task and the auditory oddball task across several regions of the brain. During the amplitude discrimination task, post-concussion performance with a single site adapting stimulus is similar to the performance without a conditioning stimulus.

However, in normal control subjects, the presence of a single site adapting stimulus leads to a decrease in performance similar to the recovery performance. This is a representative example of the results from the balance protocol. The sway index and center of pressure data is used for further analysis.

This illustrates the data output of a single subject during gait analysis. Gait parameters can help us understand how velocity and walking kinematics change after a concussion and how they recover. Once mastered.

This technique can be done in approximately 90 minutes While attempting this procedure, it's important to remember our focus is on student athlete wellbeing and supporting the sports medicine staff. We collect a large amount of data that will not serve as diagnostic at the time of testing, but can be further analyzed to understand how changes on measures are related to concussion risk and recovery After its development. This technique paved the way for researchers in multiple fields to explore common and practical questions from various levels of analysis.

After watching this video, you should have a good understanding of how a multidisciplinary concussion assessment is employed to proactively assess student athletes at baseline and follow up if a concussion occurs. This protocol works because we have the support of many constituencies in our community that focus on the multidisciplinary team approach to supporting student athlete wellbeing.