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The preliminary evidence reported in the current pilot study is clinically relevant as our findings suggest exercise-based treatments may improve PCS outcomes in a more favourable manner than rest-based treatment.

Mild traumatic brain injury (mTBI), commonly known as concussion, is a complex neurobehavioral phenomenon affecting six in 1000 people globally each year. Symptoms last between days and years as microstructural damage to axons and neurometabolic changes result in brain network disruption. There is no clinically available objective biomarker to diagnose the severity of injury or monitor recovery. However, emerging evidence suggests eye movement dysfunction (e.g., saccades and smooth pursuits) in patients with mTBI. Patients with a higher symptom burden and prolonged recovery time following injury may show higher degrees of eye movement dysfunction. Likewise, recent advances in magnetic resonance imaging (MRI) have revealed both white matter tract damage and functional network alterations in mTBI patients, which involve areas responsible for the ocular motor control. This scoping review is presented in three sections: Section 1 explores the anatomical control of eye movements to aid the reader with interpreting the discussion in subsequent sections. Section 2 examines the relationship between abnormal MRI findings and eye tracking after mTBI based on the available evidence. Finally, Section 3 communicates gaps in our knowledge about MRI and eye tracking, which should be addressed in order to substantiate this emerging field.

Traumatic brain injury (TBI) accounts for significant global health burden. Effects of TBI can become chronic even following mild injury. There is a need to develop effective therapies to attenuate the damaging effects of TBI and improve recovery outcomes. This literature review using a priori criteria (PROSPERO; CRD42018100623) summarized 43 studies between January 1998 and July 2019 that investigated nutritional interventions (NUT) delivered with the objective of altering neurophysiological (NP) outcomes following TBI. Risk of bias was assessed for included studies, and NP outcomes recorded. The systematic search resulted in 43 of 3,748 identified studies met inclusion criteria. No studies evaluated the effect of a NUT on NP outcomes of TBI in humans. Biomarkers of morphological changes and apoptosis, oxidative stress, and plasticity, neurogenesis, and neurotransmission were the most evaluated NP outcomes across the 43 studies that used 2,897 animals. The risk of bias was unclear in all reviewed studies due to poorly detailed methodology sections. Taking these limitations into account, anti-oxidants, branched chain amino acids, and ω-3 polyunsaturated fatty acids have shown the most promising pre-clinical results for altering NP outcomes following TBI. Refinement of pre-clinical methodologies used to evaluate effects of interventions on secondary damage of TBI would improve the likelihood of translation to clinical populations.

Background Within the last two decades, attitudes have shifted from considering sports-related concussion as an insignificant minor injury with no long-term repercussions to a potentially serious brain injury garnering attention from media, clinicians, researchers, and the general public. Objectives To conduct a case study to determine the underlying cause of persistent issues suspected to be associated with a history of sports-related concussion. Protocol Participant A underwent neurophysiological testing following the Neary protocol (assessment of cerebrovascular and cardiovascular variables), comprehensive concussion assessment at a dedicated sports concussion clinic (history, neurological assessment, cervical spine screening, vestibulo-ocular screening, SCAT-5, and exercise testing), referral to a neurologist, structural MRI scan, and referral for specialised assessment at a dedicated dizziness and balance centre. Results Despite a history of multiple sports-related concussions, Participant A’s persistent symptom reports were associated with peripheral vestibular dysfunction and otolithic dysfunction seemingly unrelated to his concussion history. Discussion Lessons from Participant A’s case study showed that on-going symptoms that patients may associate with the effects of concussions may instead be due to unrelated causes that share similar symptomology. Conclusion This research exemplifies the importance of a multi-disciplinary assessment using a repeated testing protocol.

Although injury mechanisms of mild traumatic brain injury (mTBI) may be similar across patients, it is becoming increasingly clear that patients cannot be treated as one homogenous group. Several predominant symptom clusters (PSC) have been identified, each requiring specific and individualised treatment plans. However, objective methods to support these clinical decisions are lacking. This pilot study explored whether wearable sensor data collected during the Buffalo Concussion Treadmill Test (BCTT) combined with a deep learning approach could accurately classify mTBI patients with physiological PSC versus vestibulo-ocular PSC. A cross-sectional design evaluated a convolutional neural network model trained with electrocardiography (ECG) and accelerometry data. With a leave-one-out approach, this model classified 11 of 12 (92%) patients with physiological PSC and 3 of 5 (60%) patients with vestibulo-ocular PSC. The same classification accuracy was observed in a model only using accelerometry data. Our pilot results suggest that adding wearable sensors during clinical tests like the BCTT, combined with deep learning models, may have the utility to assist management decisions for mTBI patients in the future. We reiterate that more validation is needed to replicate the current results.

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We conducted a multimodal MRI study on high school rugby players with bespoke kinematic mouthguard sensors to investigate the correlation between the cumulative effects of subconcussive head impact exposure and any change in the structure of the brain. Despite being underpowered, the study found that the volume of the corpus callosum changed the most over a season of rugby (PCA); Axial Diffusivity of the UF and ILF tracts negatively correlated with the cumulative impact sustained by the athletes. Further investigation of the cumulative effect of playing high-contact sports over an extended period is required, especially for children with developing brains.