Brain Vital Signs in Elite Ice Hockey: Towards Characterizing Objective and Specific Neurophysiological Reference Values for Concussion Management

Abstract

Background: Prior concussion studies have shown that objective neurophysiological measures are sensitive to detecting concussive and subconcussive impairments in youth ice-hockey. These studies monitored brain vital signs at rink-side using a within-subjects design to demonstrate significant changes from pre-season baseline scans. However, practical clinical implementation must overcome inherent challenges related to any dependence on a baseline. This requires establishing the start of normative reference data sets.Methods: The current study collected specific reference data for N = 58 elite, youth, male ice-hockey players and compared these with a general reference dataset from N = 135 of males and females across the lifespan. The elite hockey players were recruited to a select training camp through CAA Hockey, a management agency for players drafted to leagues such as the National Hockey League (NHL). The statistical analysis included a test-retest comparison to establish reliability, and a multivariate analysis of covariance to evaluate differences in brain vital signs between groups with age as a covariate.Findings: Test-retest assessments for brain vital signs evoked potentials showed moderate-to-good reliability (Cronbach’s Alpha > 0.7, Intraclass correlation coefficient > 0.5) in five out of six measures. The multivariate analysis of covariance showed no overall effect for group (p = 0.105), and a significant effect of age as a covariate was observed (p < 0.001). Adjusting for the effect of age, a significant difference was observed in the measure of N100 latency (p = 0.022) between elite hockey players and the heterogeneous control group.Interpretation: The findings support the concept that normative physiological data can be used in brain vital signs evaluation in athletes, and should additionally be stratified for age, skill level, and experience. These can be combined with general norms and/or individual baseline assessments where appropriate and/or possible. The current results allow for brain vital sign evaluation independent of baseline assessment, therefore enabling objective neurophysiological evaluation of concussion management and cognitive performance optimization in ice-hockey.

Effectiveness of Personalized Rehabilitation in Adults Suffering from Persistent Concussion Symptoms as Compared to Usual Care: A Randomized Control Trial Protocol

“…They are sensitive to cognitive dysfunction and have a well-established test-retest reliability making it a valid and sensitive measure of concussion-related impairments. Three ERPs (brain vital sign), auditory N100 (auditory sensation); auditory oddball P300 (basic attention); and auditory speech processing N400 (cognitive processing) will be evaluated (22,23).…”

Monitoring the Impact of Spaceflight on the Human Brain

“…Many microgravity- and isolation-related afflictions can be diagnosed and therefore treated early using brain monitoring. Brain health monitoring using EEG can establish longitudinal baselines for astronauts in various health metrics and even vital signs [ 37 , 38 ]. Cognitive functions and mood states are also affected in microgravity environments and their analogs, and these effects can be monitored using EEG [ 36 ].…”

“…Monitoring technologies have been made available to support EEG in real-time longitudinal monitoring of both brain health and vital signs (i.e., NeuroCatch™ platform). The existence of monitoring platforms for EEG greatly widens the ability for its use as a medical tool as well as a research technology [ 37 , 38 ]. Among its diagnostic capabilities, EEG can support the detection of brain tumors, and in-flight brain injury during long flights with exposure to high LET radiation [ 10 , 24 , 25 ].…”

Brain vital sign monitoring of sleep deprivation detects situational cognitive impairment

“…In 2016, we developed a brain vital sign framework that incorporates the N100, P300, and N400 into a rapid, standardized, intuitive, and easy to use approach to evaluate cognitive brain function ( Ghosh Hajra et al, 2016 ). The brain vital sign framework has since been validated increasingly in both health individuals as well as individuals with brain injury (including concussion) and brain disease ( Ghosh Hajra et al, 2018 ; Fickling et al, 2019b , Smith et al, 2020 ; Carrick et al, 2021 ; Fickling et al, 2021 ; Kirby et al, 2023 ). Sleep deprivation can lead to a wide decline across domains of cognitive performance, such as response speed, attention, memory, verbal comprehension, mood, et cetera ( Pilcher and Huffcutt, 1996 ; Kim et al, 2001 ; Philibert, 2005 ; Walker, 2008 ).…”