Clinical examination factors that predict delayed recovery in individuals with concussion

Martinez, Corina; Christopherson, Zachary; Lake, Ashley Davis; Myers, Heather; Bytomski, Jeffrey R; Butler, Robert J.; Cook, Chad

doi:10.1186/s40945-020-00081-z

Cited by 7 publications

(6 citation statements)

References 36 publications

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“…Our study had a low proportion of participants with a history of depression at 4% ( n = 5), whereas a general population of adults would be expected to be nearer to 10% (DSM-5). This low percentage is supported by a previous study that found that athletes scored higher in the mental toughness category [ 28 ]. Mental toughness is known to be linked to developmental experiences, and sports participation offers challenges and commitment [ 28 ].…”

Section: Discussionsupporting

confidence: 72%

“…This low percentage is supported by a previous study that found that athletes scored higher in the mental toughness category [28]. Mental toughness is known to be linked to developmental experiences, and sports participation offers challenges and commitment [28]. In the scientific literature, mental toughness is evaluated through interviews and mental toughness inventories [28].…”

Section: Discussionmentioning

confidence: 85%

“…Mental toughness is known to be linked to developmental experiences, and sports participation offers challenges and commitment [ 28 ]. In the scientific literature, mental toughness is evaluated through interviews and mental toughness inventories [ 28 ]. Mental toughness includes hope, optimism, perseverance, and resilience [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

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Anxiety and Mood Disruption in Collegiate Athletes Acutely Following Mild Traumatic Brain Injury

Zhang,

Martyna,

Cornwell

et al. 2024

Diagnostics

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Objective: To report the symptom burden of anxiety and mood-related indicators following mTBI in collegiate student-athletes. Study Design: Retrospective cohort study of varsity collegiate athletes. Setting: University sports medicine at a tertiary care center. Patients: Division I college varsity athletes diagnosed with mTBI at a single institution between 2016 and 2019. Independent Variables: Pre- and post-injury. Main Outcome Measures: Comparisons between baseline testing and post-mTBI symptom scale assessments were made to determine changes in scores at the individual and group levels. The primary outcome was the prevalence of post-mTBI symptoms from within 72 h of injury through return to play. Associations with sport, sex, age, and return-to-play time were included. Results: Compared to baseline, mood and anxiety symptom scores were significantly higher acutely following mTBI (2.1 ± 3.3 vs. 14.3 ± 12.2; p < 0.001). A family history of migraine was significantly associated with higher mood and anxiety symptom scores (20.0 ± 14.9 with history vs. 13.3 ± 11.3 without history; p = 0.042). Mood and anxiety symptom scores were highly correlated with non-mood and anxiety symptom scores for all athletes, including the subgroup with prolonged symptoms (r = 0.769; p < 0.001). Conclusions: Symptoms of anxiety or mood disruption are common during the acute period post-injury in varsity college athletes. Risk factors for higher symptom reports immediately following mTBI and for prolonged symptoms (>10 days) included female sex, those with a family history of migraine, and those with an overall higher symptom burden post-injury.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 85%

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Anxiety and Mood Disruption in Collegiate Athletes Acutely Following Mild Traumatic Brain Injury

Zhang,

Martyna,

Cornwell

et al. 2024

Diagnostics

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“…Traumatic Brain Injury (TBI) is estimated to affect 790 per 100,000 New Zealanders every year ( 1 ) and is a leading cause of disability in young adults. Symptoms of dizziness and imbalance are common and are among the risk factors predicting prolonged recovery ( 2 , 3 ). These symptoms are often attributed to dysfunction of the vestibular system ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Patterns of vestibular dysfunction in chronic traumatic brain injury

et al. 2022

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BackgroundDizziness and imbalance are common following traumatic brain injury (TBI). While these symptoms are often attributed to vestibular dysfunction, the relative contribution of peripheral vs. central mechanisms is unclear. This study investigated the prevalence of semicircular canal and otolith abnormalities in a cohort of patients with chronic TBI and symptoms of dizziness or imbalance. The relationship between vestibular, oculomotor and posturography results was further explored.MethodsClinical records of patients attending the New Zealand Dizziness and Balance Centre from January 2015 to December 2019 were reviewed for consideration in the study. Inclusion required: an age of 18–80 years, a diagnosed TBI, and vestibular assessment using three-dimensional video head impulses (vHIT), cervical and ocular vestibular-evoked myogenic potentials (c and o VEMPs, respectively) and caloric testing. Severe TBI, pre-existing vestibular diagnoses, and incomplete test results were excluded. Rates of abnormalities were determined for each test and compared with results of oculomotor function testing and postural control, measured using the sensory organization test (SOT).ResultsOf 158 reviewed records, 99 patients aged 49 ± 15 years (59 female) fulfilled criteria for inclusion in the study. The median time between the head injury and the clinical assessment was 12 (IQR 6–21) months. Abnormalities involving one or more components of the vestibular labyrinth and/or nerve divisions were identified in 33 of 99 patients (33.3%). The horizontal semicircular canal was most frequently affected (18.2%), followed by the saccule (14.1%), utricle (8.1%), posterior (7.1%) and anterior (2.0%) semicircular canals. Vestibular test abnormalities were associated with skull-base fractures, superior canal dehiscence, and focal ear trauma. Oculomotor dysfunction and postural instability were recorded in 41.1 and 75.5% of patients, respectively. Postural instability correlated with abnormal oculomotor function (p = 0.008) but not peripheral vestibular hypofunction (p = 0.336).ConclusionsDizziness and/or imbalance in chronic TBI was associated with impaired postural stability for tasks requiring high levels of use of vestibular and visual input for balance. Vestibular hypofunction identified through vHIT, VEMP and caloric testing was recorded but was less common, except when the injury involved a fractured skull-base. There was no specific pattern of end-organ or nerve involvement which characterized this group of patients.

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“…Complaints of persistent imbalance are commonly reported after mTBI, with ~28% of people still reporting problems more than a year following their injury ( 4 ). Visual- and vestibular-related symptoms that occur after mTBI and can be predictive of long-lasting persistent symptoms well after the initial injury ( 5 – 7 ). However, recent evidence suggests that those with balance deficits due to a chronic mTBI (persistent mTBI symptoms >3 months after initial injury) have largely normal peripheral vestibular and ocular motor function ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

The effects of augmenting traditional rehabilitation with audio biofeedback in people with persistent imbalance following mild traumatic brain injury

et al. 2022

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Complaints of non-resolving imbalance are common in individuals with chronic mild traumatic brain injury (mTBI). Vestibular rehabilitation therapy may be beneficial for this population. Additionally, wearable sensors can enable biofeedback, specifically audio biofeedback (ABF), and aid in retraining balance control mechanisms in people with balance impairments. In this study, we described the effectiveness of vestibular rehabilitation therapy with and without ABF to improve balance in people with chronic mTBI. Participants (n = 31; females = 22; mean age = 40.9 ± 11 y) with chronic (>3 months) mTBI symptoms of self-reported imbalance were randomized into vestibular rehabilitation with ABF (n = 16) or without ABF (n = 15). The intervention was a standard vestibular rehabilitation, with or without ABF, for 45 min biweekly for 6 weeks. The ABF intervention involved a smartphone that provided auditory feedback when postural sway was outside of predetermined equilibrium parameters. Participant's completed the Post-Concussion Symptom Scale (PCSS). Balance was assessed with the sensory organization test (SOT) and the Central Sensorimotor Integration test which measured sensory weighting, motor activation, and time delay with sway evoked by surface and/or visual surround tilts. Effect sizes (Hedge's G) were calculated on the change between pre-and post-rehabilitation scores. Both groups demonstrated similar medium effect-sized decreases in PCSS and large increases in SOT composite scores after rehabilitation. Effect sizes were minimal for increasing sensory weighting for both groups. The with ABF group showed a trend of larger effect sizes in increasing motor activation (with ABF = 0.75, without ABF = 0.22) and in decreasing time delay (with ABF = −0.77, without ABF = −0.52) relative to the without ABF group. Current clinical practice focuses primarily on sensory weighting. However, the evaluation and utilization of motor activation factors in vestibular rehabilitation, potentially with ABF, may provide a more complete assessment of recovery and improve outcomes.

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Clinical examination factors that predict delayed recovery in individuals with concussion

Cited by 7 publications

References 36 publications

Anxiety and Mood Disruption in Collegiate Athletes Acutely Following Mild Traumatic Brain Injury

Anxiety and Mood Disruption in Collegiate Athletes Acutely Following Mild Traumatic Brain Injury

Patterns of vestibular dysfunction in chronic traumatic brain injury

The effects of augmenting traditional rehabilitation with audio biofeedback in people with persistent imbalance following mild traumatic brain injury

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