Consensus Statement on Concussion in Sport—the 4th International Conference on Concussion in Sport Held in Zurich, November 2012

McCrory, Paul; Meeuwisse, Willem; Johnston, Karen; Dvořák, Jiří; Aubry, Mark; Molloy, Mick; Cantu, Robert C.

doi:10.1097/jsm.0b013e31828b67cf

Cited by 642 publications

(744 citation statements)

References 124 publications

Supporting

Mentioning

723

Contrasting

Unclassified

Order By: Relevance

“…In striking contrast to our previous findings in a CCI model, 13 the data suggest a protective role for Akt and mTOR pathways after concussive TBI. Closed head injury used herein models specific features of human concussion, including impact and rotational accelerationdeceleration forces, loss of consciousness, neuroinflammation, and cognitive deficits; 24,25 however, this model does not induce detectable acute cell death or chronic brain tissue loss. 21 Although Akt and mTOR activation have been noted in a number of TBI models, 13,15,16 the current study is the first to our knowledge to examine Akt/mTOR in a concussion model devoid of neuronal cell death.…”

Section: Discussionmentioning

confidence: 99%

Role of Akt and Mammalian Target of Rapamycin in Functional Outcome after Concussive Brain Injury in Mice

Zhu

Park

Golinski

et al. 2014

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

Akt (protein kinase B) and mammalian target of rapamycin (mTOR) have been implicated in the pathogenesis of cell death and cognitive outcome after cerebral contusion in mice; however, a role for Akt/mTOR in concussive brain injury has not been well characterized. In a mouse closed head injury (CHI) concussion traumatic brain injury (TBI) model, phosphorylation of Akt (p-Akt), mTOR (p-mTOR), and S6RP (p-S6RP) was increased by 24 hours in cortical and hippocampal brain homogenates (Po0.05 versus sham for each), and p-S6RP was robustly induced in IBA-1 þ microglia and glial fibrillary acidic protein-positive (GFAP þ ) astrocytes. Pretreatment with inhibitors of Akt or mTOR individually by the intracerebroventricular route reduced phosphorylation of their respective direct substrates FOXO1 (Po0.05) or S6RP (Po0.05) after CHI, confirming the activity of inhibitors. Rapamycin pretreatment significantly worsened hidden platform (Po0.01) and probe trial (Po0.05) performance in CHI mice. Intracerebroventricular administration of necrostatin-1 (Nec-1) before CHI increased hippocampal Akt and S6RP phosphorylation and improved place learning (probe trials, Po0.001 versus vehicle), whereas co-administration of rapamycin or Akt inhibitor with Nec-1 eliminated improved probe trial performance. These data suggest a beneficial role for Akt/mTOR signaling after concussion TBI independent of cell death that may contribute to improved outcome by Nec-1.

show abstract

Section: Discussionmentioning

confidence: 99%

Role of Akt and Mammalian Target of Rapamycin in Functional Outcome after Concussive Brain Injury in Mice

Zhu

Park

Golinski

et al. 2014

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

show abstract

“…43,44 Further research is needed to test the safety and efficacy of active rehabilitation in the acute postinjury period. Given the heterogeneity of mTBI, this question can only be answered with a large randomized controlled trial powered to detect effects on subgroups (eg, athletes, patients with previous concussions or migraines, mechanism of injury) using patient-centered outcome measures and objective neurocognitive assessments.…”

Section: Future Directionsmentioning

confidence: 99%

Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial

et al. 2015

View full text Add to dashboard Cite

OBJECTIVES: To determine if recommending strict rest improved concussion recovery and outcome after discharge from the pediatric emergency department (ED).METHODS: Patients aged 11 to 22 years presenting to a pediatric ED within 24 hours of concussion were recruited. Participants underwent neurocognitive, balance, and symptom assessment in the ED and were randomized to strict rest for 5 days versus usual care (1-2 days rest, followed by stepwise return to activity). Patients completed a diary used to record physical and mental activity level, calculate energy exertion, and record daily postconcussive symptoms. Neurocognitive and balance assessments were performed at 3 and 10 days postinjury. Sample size calculations were powered to detect clinically meaningful differences in postconcussive symptom, neurocognitive, and balance scores between treatment groups. Linear mixed modeling was used to detect contributions of group assignment to individual recovery trajectory.RESULTS: Ninety-nine patients were enrolled; 88 completed all study procedures (45 intervention, 43 control). Postdischarge, both groups reported a 20% decrease in energy exertion and physical activity levels. As expected, the intervention group reported less school and after-school attendance for days 2 to 5 postconcussion (3.8 vs 6.7 hours total, P , .05). There was no clinically significant difference in neurocognitive or balance outcomes. However, the intervention group reported more daily postconcussive symptoms (total symptom score over 10 days, 187.9 vs 131.9, P , .03) and slower symptom resolution.CONCLUSIONS: Recommending strict rest for adolescents immediately after concussion offered no added benefit over the usual care. Adolescents' symptom reporting was influenced by recommending strict rest. WHAT'S KNOWN ON THIS SUBJECT:Expert consensus recommends rest after concussion with stepwise return to activity. Animal and retrospective human data suggest that early mental and physical activity may worsen outcome. There are no pediatric studies testing the efficacy of recommending strict rest after concussion. WHAT THIS STUDY ADDS:Recommending strict rest postinjury did not improve outcome and may have contributed to increased symptom reporting. Usual care (rest for 1-2 days with stepwise return to activity) is currently the best discharge strategy for pediatric mild traumatic brain injury/concussion. Dr Thomas developed the study concept and design, obtained funding, supervised the study, acquired data, analyzed and interpreted data, and drafted and revised the manuscript; Dr Apps assisted with study concept and design, supervised the study, provided technical support, analyzed and interpreted data, and critically revised the manuscript; Dr Hoffmann assisted with study design, analyzed data, provided statistical expertise, and critically revised the manuscript; Dr McCrea assisted with study design, analyzed and interpreted data, provided technical support, and critically revised the manuscript; Dr Hammeke assisted with study concept and ...

show abstract

“…By understanding the injury mechanism, sports medicine professionals can make more informed decisions on improved equipment 46 and rule changes 91,92,[107][108][109] to reduce concussion incidence. 8 Biomechanical data have effectively improved player safety via protective equipment and rule changes. 26,86,92,95,[110][111][112] For example, the STAR helmet rating was initiated in 2011 at Virginia Tech to identify which helmets have a theoretical reduced concussion risk.…”

Section: Clinical Utilitymentioning

confidence: 99%

“…[5][6][7] Concussion is a brain injury resulting from a direct or indirect blow to the head, typically resulting in transient neurologic impairment and neuropathologic symptoms. 8 After a direct or indirect force to the head, the brain experiences a metabolic crisis due to disrupted ion flow across the neuron membranes and decreased adenosine triphosphate availability to correct the perturbed ion flow. 9 This metabolic disruption lasts about a week, mirroring the timeline of clinical symptom recovery.…”

mentioning

confidence: 99%

Head-Impact–Measurement Devices: A Systematic Review

O’Connor

Rowson

Duma

et al. 2017

Journal of Athletic Training

154

117

View full text Add to dashboard Cite

Context: With an estimated 3.8 million sport-and recreation-related concussions occurring annually, targeted prevention and diagnostic methods are needed. Biomechanical analysis of head impacts may provide quantitative information that can inform both prevention and diagnostic strategies.Objective: To assess available head-impact devices and their clinical utility.Data Sources: We performed a systematic search of the electronic database PubMed for peer-reviewed publications, using the following phrases: accelerometer and concussion, head impact telemetry, head impacts and concussion and sensor, head impacts and sensor, impact sensor and concussion, linear acceleration and concussion, rotational acceleration and concussion, and xpatch concussion. In addition to the literature review, a Google search for head impact monitor and concussion monitor yielded 15 more devices.Study Selection: Included studies were performed in vivo, used commercially available devices, and focused on sportrelated concussion.Data Extraction: One author reviewed the title and abstract of each study for inclusion and exclusion criteria and then reviewed each full-text article to confirm inclusion criteria. Controversial articles were reviewed by all authors to reach consensus.Data Synthesis: In total, 61 peer-reviewed articles involving 4 head-impact devices were included. Participants in boxing, football, ice hockey, soccer, or snow sports ranged in age from 6 to 24 years; 18% (n ¼ 11) of the studies included female athletes. The Head Impact Telemetry System was the most widely used device (n ¼ 53). Fourteen additional commercially available devices were presented.Conclusions: Measurements collected by impact monitors provided real-time data to estimate player exposure but did not have the requisite sensitivity to concussion. Proper interpretation of previously reported head-impact kinematics across age, sport, and position may inform future research and enable staff clinicians working on the sidelines to monitor athletes. However, head-impact-monitoring systems have limited clinical utility due to error rates, designs, and low specificity in predicting concussive injury.

show abstract

Consensus Statement on Concussion in Sport—the 4th International Conference on Concussion in Sport Held in Zurich, November 2012

Cited by 642 publications

References 124 publications

Role of Akt and Mammalian Target of Rapamycin in Functional Outcome after Concussive Brain Injury in Mice

Role of Akt and Mammalian Target of Rapamycin in Functional Outcome after Concussive Brain Injury in Mice

Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial

Head-Impact–Measurement Devices: A Systematic Review

Contact Info

Product

Resources

About