Race and Concussion: An Emerging Relationship

Wagner, Ryan J; Zach, Karie N.; Kobayashi, Yohnosuke; Gottschalk, Andrew W.

doi:10.31486/toj.20.0145

Cited by 6 publications

(5 citation statements)

References 8 publications

(6 reference statements)

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“…We emphasize that mobile EEG testing, especially when combined with community-engaged methods, provides an opportunity to improve the representation of underrepresented populations. Predominantly Black high schools, as identified in our population here, are more often Title I schools that face resource limitations, commonly lacking access to healthcare professionals ( 8 ), education about brain injuries ( 10 , 68 , 69 ) and diagnostic tools used for concussion and treatment ( 68 , 70 ). As a result of historical systemic racism, poverty disproportionately affects Black people compared to White people in the U.S. ( 71 ).…”

Section: Discussionmentioning

confidence: 99%

Dynamic cognitive inhibition in the context of frustration: Increasing racial representation of adolescent athletes using mobile community-engaged EEG methods

et al. 2022

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IntroductionConcussive events and other brain injuries are known to reduce cognitive inhibition, a key aspect of cognition that supports ones' behaviors and impacts regulation of mood or affect. Our primary objective is to investigate how induction of negative affect (such as frustration) impacts cognitive inhibition and the dynamic process by which youth athletes modulate responses. Secondary objective is to address the lack of Black representation in the scientific literature that promotes brain health and investigates pediatric sports-related brain injury. In particular, neuroscience studies predominantly include White participants despite broad racial representation in sport, in part due to technological hurdles and other obstacles that challenge research access for Black participants.MethodsUsing electroencephalography (EEG), we evaluate the dynamic brain processes associated with cognitive inhibition in the context of frustration induction in adolescent athletes during pre-season conditioning (i.e., prior to contact; N = 23) and a subset during post-season (n = 17).ResultsThe N2 component was sensitive to frustration induction (decreased N2 amplitude, slower N2 latency), although effects were less robust at postseason. Trial-by-trial changes indicated a steady decrease of the N2 amplitude during the frustration block during the preseason visit, suggesting that affective interference had a dynamic effect on cognitive inhibition. Lastly, exploratory analyses provide preliminary evidence that frustration induction was less effective for athletes with a previous history of concussion or migraines (trending result) yet more effective for athletes endorsing a history with mental health disorders.DiscussionWe emphasize the urgent need to improve representation in cognitive neuroscience, particularly as it pertains to brain health. Importantly, we provide detailed guides to our methodological framework and practical suggestions to improve representative participation in studies utilizing high-density mobile EEG.

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Section: Discussionmentioning

confidence: 99%

Dynamic cognitive inhibition in the context of frustration: Increasing racial representation of adolescent athletes using mobile community-engaged EEG methods

et al. 2022

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“…The reported incidence of concussion has been increasing, which has been attributed to increasing awareness and education among coaches, medical professionals, and the lay public 3,6,13 . Despite better awareness and education, some populations of patients continue to receive disparate care 14 . For example, Black adolescents have reportedly higher concussion rates than White adolescents but lower diagnosis, health care utilization, and follow‐up rates in addition to worse clinical outcomes after concussion 15,16 .…”

Section: Introductionmentioning

confidence: 99%

“…3,6,13 Despite better awareness and education, some populations of patients continue to receive disparate care. 14 For example, Black adolescents have reportedly higher concussion rates than White adolescents but lower diagnosis, health care utilization, and follow-up rates in addition to worse clinical outcomes after concussion. 15,16 Among high school athletes, Black athletes have also been reported to be less knowledgeable about concussion signs and symptoms than White athletes, 16 which may prevent them from seeking assessment and care.…”

Section: Introductionmentioning

confidence: 99%

Consensus statement: An evidence‐based review of exercise, rehabilitation, rest, and return to activity protocols for the treatment of concussion and mild traumatic brain injury

De Luigi,

Bell,

Bramhall

et al. 2023

PM&R

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ObjectiveEarly diagnosis and appropriate management of concussion/mild traumatic brain injury (mTBI) is critical for preventing poor outcomes and minimizing healthcare burden. Current clinical guidelines for concussion management focus mostly on diagnosis and return to cognitive and physical activity but provide limited guidance on the use of specific therapeutic interventions.ObjectiveTo systematically review the available evidence on therapeutic interventions for concussion/mTBI and develop an evidence‐based consensus statement on the use of these interventions in clinical practice.Literature SurveyA systematic literature search was performed first in 2018 and 2019, and again in 2022, to identify relevant original research on these interventions. A total of 6303 articles were retrieved through the systematic literature search and screened for inclusion. Eighty articles met inclusion criteria and were included in this review and consensus process.MethodologyA multispecialty panel was convened to explore management of concussion/mTBI. Interventions evaluated included rest, exercise, rehabilitation, and return to activity (RTA) protocols. Studies were assessed for relevance and methodologic quality and were voted upon to develop an evidence‐based consensus statement on the therapeutic appropriateness of these interventions for concussion/mTBI. A meta‐analysis was not performed.SynthesisThere was sufficient evidence to recommend exercise as an appropriate therapy for adolescents with acute concussion/mTBI. In other age groups and for other therapeutic modalities, while some studies demonstrated benefits for some of the interventions, mixed results and study limitations prevented the panel from drawing firm conclusions on the efficacy of those interventions. The panel found evidence of detrimental effects from strict rest and high‐intensity physical activity.ConclusionsThe panel recommended exercise as an appropriate therapy for acute concussion in adolescents. The evidence on other therapeutic interventions for concussion/mTBI remains limited to small randomized controlled trials and observational studies of moderate to low quality. The panel found no strong evidence to support or recommend against the other evaluated interventions but found most interventions to be safe when used judiciously and in consideration of individual patient needs. High‐quality randomized studies with sufficient power are needed to evaluate the effects of rest, rehabilitation, and RTA protocols for the management of concussion/mTBI.This article is protected by copyright. All rights reserved.

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“…Sportrelated concussions in youth are generally thought to have adverse long-term effects on a variety of health outcomes, including: changes in brain structure and function; poorer memory, executive functioning, and motor control; more frequent mood disorders; and poorer academic performance [7]. The risk for sport-related concussion has been shown to vary with personal characteristics, including age, race, ethnicity, prior mental health problems, and prior history of concussions [8][9][10], suggesting the possibility of identifying youth who may benefit from specific strategies to mitigate the risk for sport-related concussions.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal, prospective study of head impacts in male high school football players

McAlister,

Mack,

Bir

et al. 2023

PLoS ONE

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Introduction Repetitive, subconcussive events may adversely affect the brain and cognition during sensitive periods of development. Prevention of neurocognitive consequences of concussion in high school football is therefore an important public health priority. We aimed to identify the player positions and demographic, behavioral, cognitive, and impact characteristics that predict the frequency and acceleration of head impacts in high school football players. Methods In this prospective study, three cohorts of adolescent male athletes (N = 53, 28.3% Hispanic) were recruited over three successive seasons in a high school American football program. Demographic and cognitive functioning were assessed at baseline prior to participating in football. Helmet sensors recorded impact frequency and acceleration. Each head impact was captured on film from five different angles. Research staff verified and characterized on-field impacts. Player-level Poisson regressions and year-level and impact-level linear mixed-effect models were used to determine demographic, behavioral, cognitive, and impact characteristics as predictors of impact frequency and acceleration. Results 4,678 valid impacts were recorded. Impact frequency positively associated with baseline symptoms of hyperactivity-impulsivity [β(SE) = 1.05 impacts per year per unit of symptom severity (1.00), p = 0.01] and inattentiveness [β(SE) = 1.003 impacts per year per T-score unit (1.001), p = 0.01]. Compared to quarterbacks, the highest acceleration impacts were sustained by kickers/punters [β(SE) = 21.5 g’s higher (7.1), p = 0.002], kick/punt returners [β(SE) = 9.3 g’s higher (4.4), p = 0.03], and defensive backs [β(SE) = 4.9 g’s higher (2.5), p = 0.05]. Impacts were more frequent in the second [β(SE) = 33.4 impacts (14.2), p = 0.02)] and third [β(SE) = 50.9 impacts (20.1), p = 0.01] year of play. Acceleration was highest in top-of-the-head impacts [β(SE) = 4.4 g’s higher (0.8), p<0.001]. Conclusion Including screening questions for Attention-Deficit/Hyperactivity Disorder in pre-participation evaluations can help identify a subset of prospective football players who may be at risk for increased head impacts. Position-specific strategies to modify kickoffs and correct tackling and blocking may also reduce impact burden.

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Race and Concussion: An Emerging Relationship

Cited by 6 publications

References 8 publications

Dynamic cognitive inhibition in the context of frustration: Increasing racial representation of adolescent athletes using mobile community-engaged EEG methods

Dynamic cognitive inhibition in the context of frustration: Increasing racial representation of adolescent athletes using mobile community-engaged EEG methods

Consensus statement: An evidence‐based review of exercise, rehabilitation, rest, and return to activity protocols for the treatment of concussion and mild traumatic brain injury

Longitudinal, prospective study of head impacts in male high school football players

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