Objective. The aim of this study was to identify whether the addition of an individualised Active Rehabilitation Intervention to standard care influences recovery of young patients who are slow-to-recover following a mTBI. Methods. Fifteen participants aged 15 ± 2 years received standard care and an individualised Active Rehabilitation Intervention which included (1) low- to high-intensity aerobic training; (2) sport-specific coordination exercises; and (3) therapeutic balance exercises. The following criteria were used to measure the resolution of signs and symptoms of mTBI: (1) absence of postconcussion symptoms for more than 7 consecutive days; (2) cognitive function corresponding to normative data; and (3) absence of deficits in coordination and balance. Results. The Active Rehabilitation Intervention lasted 49 ± 17 days. The duration of the intervention was correlated with self-reported participation (truex-=84.64±19.63%, r = −0.792, p < 0.001). The average postconcussion symptom inventory (PCSI) score went from a total of 36.85 ± 23.21 points to 4.31 ± 5.04 points after the intervention (Z = −3.18, p = 0.001). Conclusion. A progressive submaximal Active Rehabilitation Intervention may represent an important asset in the recovery of young patients who are slow-to-recover following a mTBI.
Objectives: Concussions affect the processing of emotional stimuli. This study aimed to investigate how sex interacts with concussion effects on early event-related brain potentials (ERP) measures (P1, N1) of emotional facial expressions (EFE) processing in asymptomatic, multi-concussion athletes during an EFE identification task. Methods: Forty control athletes (20 females and 20 males) and 43 multi-concussed athletes (22 females and 21 males), recruited more than 3 months after their last concussion, were tested. Participants completed the Beck Depression Inventory II, the Beck Anxiety Inventory, the Post-Concussion Symptom Scale, and an Emotional Facial Expression Identification Task. Pictures of male and female faces expressing neutral, angry, and happy emotions were randomly presented and the emotion depicted had to be identified as fast as possible during EEG acquisition. Results: Relative to controls, concussed athletes of both sex exhibited a significant suppression of P1 amplitude recorded from the dominant right hemisphere while performing the emotional face expression identification task. The present study also highlighted a sex-specific suppression of the N1 component amplitude after concussion which affected male athletes. Conclusions: These findings suggest that repeated concussions alter the typical pattern of right-hemisphere response dominance to EFE in early stages of EFE processing and that the neurophysiological mechanisms underlying the processing of emotional stimuli are distinctively affected across sex. (JINS, 2018, 24, 673-683)
Abstract. In asymptomatic multiple-concussion athletes, studies evidenced long-term impairments in psychomotor speed, motor sequence learning, and cognitive control processes, as indexed by the Error Negativity (Ne), also commonly referred to as the Error-related Negativity (ERN). In healthy controls, motor sequence learning during a Serial Reaction Time (SRT) task is associated with an increase in Ne/ERN amplitude. The objective of this paper is to investigate whether concussion effects on cognitive control are associated with sequence learning changes in asymptomatic multi-concussion athletes. Thirty-seven athletes (18 nonconcussed; 19 concussed) completed a SRT task during which continuous electroencephalographic (EEG) activity was recorded. Ne/ERN amplitude modulation from early to late learning blocks of the task was measured. Median reaction times (RTs) were computed to assess psychomotor speed and motor sequence learning. Psychomotor speed was significantly reduced in concussed athletes. Accentuated Ne/ERN amplitude from early to late learning blocks significantly correlated with motor sequence learning in nonconcussed athletes. In contrast, Ne/ERN amplitude was found to decrease significantly with task progression in concussed athletes who nonetheless achieved normal motor sequence learning. Multiple concussions detrimentally affect psychomotor speed. Unlike nonconcussed athletes, motor sequence learning in multi-concussion athletes was not associated with Ne/ERN amplitude modulation, indicating that cognitive control processes do not centrally contribute to learning of a motor sequence after repeated concussions.
ObjectiveThe aim of this study was to identify whether the addition of an individualised Active Rehabilitation Intervention to standard care influences recovery of young patients who are slow to recover following a sport-related concussion and remain symptomatic at rest.DesignQuasi-experimental, prospective study Setting: Interdisciplinary private concussion clinicSubjectsFifteen participants aged 15±2 years.InterventionStandard care and an individualised Active Rehabilitation Intervention which included: 1) low- to high-intensity aerobic training; 2) specific coordination exercises; and, 3) balance exercises.Outcome measuresList of symptoms before and after the intervention, duration of symptoms, adherence to the individualised exercice program.ResultsThe Active Rehabilitation Intervention lasted 49 (SD=17 days) days. The duration of the intervention was correlated to self-reported adherence (x=84.64 19.63%, r=−0.792, p<0.001). The average postconcussion symptom inventory (PCSI) score went from a total of 36.85±23.21 points to 4.31±5.04 points after the intervention (Z=−3.18, p=0.001).ConclusionsA progressive sub-maximal Active Rehabilitation Intervention may represent an important asset in the recovery of young patients who are slow to recover following a sport-related concussion.Competing interestsPhil Fait: Co-owner of the Cortex Mdecine et Radaptation clinic Sarah Imhoff, Frdrike Carrier-Toutant, Genevive Boulard: None.
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