Quantitative Multimodal Assessment of Concussion Recovery in Youth Athletes

Abstract

Objective: To evaluate recovery trajectories among youth athletes with a concussion and healthy controls across different domains using a quantitative and multifaceted protocol. Study Design: Prospective repeated measures. Participants: Youth athletes diagnosed with a concussion between the ages of 8 and 18 years were evaluated (1) within 10 days after injury, (2) approximately 3 weeks after injury, and (3) after return-to-play clearance. Control participants completed the same protocol. Setting: Sport concussion clinic. Interventions: N/A. Main Outcome Measures: Participants underwent a multifaceted protocol that assessed symptoms (postconcussion symptom scale [PCSS]), dual-task gait, event-related potentials (ERPs), and eye tracking. Results: Sixty-seven athletes participated: 36 after concussion (age = 14.0 ± 2.6 years; 44% female) and 31 controls (age = 14.6 ± 2.2 years; 39% female). Concussion symptoms were higher for the concussion group compared with controls at the first (PCSS = 31.7 ± 18.8 vs 1.9 ± 2.9; P < 0.001) and second time points (PCSS = 10.8 ± 11.2 vs 1.8 ± 3.6; P = 0.001) but resolved by the final assessment (PCSS = 1.7 ± 3.6 vs 2.0 ± 3.8; P = 0.46). The concussion group walked slower during dual-task gait than controls at all 3 tests including after return-to-play clearance (0.83 ± 0.19 vs 0.95 ± 0.15 m/s; P = 0.049). There were no between-group differences for ERP connectivity or eye tracking. Those with concussions had a decrease in ERP connectivity recovery over the 3 time points, whereas control participants' scores increased (concussion Δ = −8.7 ± 28.0; control Δ = 13.9 ± 32.2; χ2 = 14.1, P = 0.001). Conclusions: Concussion is associated with altered dual-task gait speeds after resolution of concussion symptoms, but ERP and eye tracking measures did not demonstrate between-group differences across time. Some objective approaches to concussion monitoring may support with identifying deficits after concussion, but further work is required to delineate the role of gait, electrophysiological, and eye tracking methods for clinical decision-making.

Role of biomarkers and emerging technologies in defining and assessing neurobiological recovery after sport-related concussion: a systematic review

“…Studies have been mixed in whether80 82 or not76 81 ERP latency was associated with SRC. Five studies indexed functional connectivity using various indices extracted from the proprietary brain network algorithm (BNA), all of which reported either significant SRC versus control group differences or different trajectories of BNA scores across groups 83–87…”

Wearables in rugby union: A protocol for multimodal digital sports-related concussion assessment

“…The sample size calculation is based sample sizes from previous paper examining multimodal assessment, ~200 [ 18 , 35 ]. To determine the appropriate sample size (SS) for estimating the proportion of players we used the following formula ( Eq 1 ) as previously described.…”

“…Therefore, significant challenges remain in the monitoring and objective or personalised return to play (RTP) procedures. There is inconsistency in what tests are performed during participants RTP, varying widely from neurocognitive testing to visual assessment [ 17 , 18 ]. Our previous work outlines the deficiencies in current traditional assessment methods [ 19 , 20 ].…”

“…Indeed, viewing SRC impairments in isolation could be futile and ignores the interconnected and related nature of SRC [ 22 ]. Wearables may provide continuous digital outcome measures, which can be easily compared and integrated with other impairments (e.g., cognitive function) [ 18 ]. SRC is considered a complex injury and will likely require a multimodal assessment approach to provide sufficient sensitivity for diagnosis and monitoring and enhanced understanding.…”

Validation of the Gait Disorientation Test in children with concussion

“…Previous studies have found that concussion injuries have a negative impact on cognition, balance, and mobility, which recover at different rates post-concussion (6,7). Utilizing a functional performance test, as a part of a comprehensive examination of a concussion, may enable health clinicians to better determine the trajectory of recovery following a concussion (8)(9)(10)(11). A recent study suggested a new measure, the Gait Disorientation Test (GDT), which is the difference in the time needed to finish a 20-feet walking task between performing the task with eyes open and eyes closed (12).…”