Recovery from sports-related concussion: Days to return to neurocognitive baseline in adolescents versus young adults

Zuckerman, Scott L.; Lee, Young M.; Odom, Mitchell; Solomon, Gary S.; Forbes, Jonathan A.; Sills, Allen K.

doi:10.4103/2152-7806.102945

Cited by 103 publications

(74 citation statements)

References 25 publications

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“…The history group showed a larger increase in arousal, as reflected by a greater EDA response relative to the no-history group, without a decrement in task performance. Our results are similar to those of researchers [4][5][6][7] who noted that participants with PFC hyperactivation achieved similar behavioral outcomes on a working-memory task.…”

Section: Discussionsupporting

confidence: 91%

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Phasic Electrodermal Activity During the Standardized Assessment of Concussion (SAC)

Raikes

Schaefer

2016

Journal of Athletic Training

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Context: The long-term effects of concussion on brain function during cognitive tasks are not fully understood and neuroimaging findings are equivocal. Some images show hyperactivation of prefrontal brain regions in previously concussed individuals relative to controls, suggesting increased cognitive resource allocation. Others show prefrontal hypoactivation and hyperactivation in other regions as a presumed compensatory mechanism. Given the relationship between sympathetic arousal and neural activation, physiologic measures of arousal, such as electrodermal activity, may provide additional insight into the brain's functional changes in those with a history of concussion.Objective: To quantify differences in electrodermal activity during a commonly used standardized neurocognitive assessment between individuals with or without a history of concussion.Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: Seven asymptomatic individuals with a self-reported history of physician-diagnosed, sport-related concussion (number of previous concussions ¼ 1.43 6 0.53; time since most recent concussion ¼ 0.75 to 6 years, median ¼ 3 years) and 10 individuals without a history of concussion participated in this study.Main Outcome Measure(s): All participants wore bilateral wrist electrodermal activity sensors during the Standardized Assessment of Concussion. We measured normalized phasic (reactive) electrodermal activity during each test element (orientation, immediate recall, concentration, delayed recall).Results: A significant group-by-test element interaction was present (P ¼ .003). Individuals with a history of concussion had greater phasic activity during delayed recall (P , .001). Delayed-recall phasic activity was greater in both groups relative to the other elements.Conclusions: Delayed recall resulted in greater physiologic arousal in previously concussed individuals relative to healthy control participants, supporting previous neuroimaging findings of increased prefrontal cortex activity during memory tasks after concussion. Given similar task performance and arousal patterns across the test, our results suggest that previously concussed individuals incur additional cognitive demands in a short-delay recall task.Key Words: traumatic brain injuries, memory, wireless technology Key PointsIndividuals with a history of diagnosed concussion displayed an increased physiologic arousal response to the delayed-recall section of the Standardized Assessment of Concussion. Increases in physiologic arousal may reflect alterations in how individuals with a history of concussion deal with the cognitive demands of short-term memory tasks. Therefore, short-term memory processes may not fully recover by 6 months after a concussion.

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Section: Discussionsupporting

confidence: 91%

“…Therefore, short-term memory processes may not fully recover by 6 months after a concussion. N umerous authors [1][2][3][4][5] have identified short-term cognitive impairments resulting from concussion. Affected cognitive processes include attention, memory, and executive function.…”

mentioning

confidence: 99%

Phasic Electrodermal Activity During the Standardized Assessment of Concussion (SAC)

Raikes

Schaefer

2016

Journal of Athletic Training

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“…These studies, relating neurocognitive deficits and return to neurocognitive baseline scores, have provided some of the only age-related data on SRC outcome and have produced inconsistent results regarding time to return to neurocognitive baseline. 4,16,32,34 Due to conflicting findings, further categorization is needed to stratify the effect of age on SRC. Our study aimed to further elucidate age disparities in concussion management by analyzing symptoms post-SRC.…”

Section: Discussionmentioning

confidence: 99%

Does age affect symptom recovery after sports-related concussion? A study of high school and college athletes

Lee

Odom

Zuckerman

et al. 2013

PED

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Object Sport-related concussions (SRCs) in high school and college athletes represent a significant public health concern. Research suggests that younger athletes fare worse symptomatically than older athletes after an SRC. Using reliable change index (RCI) methodology, the authors conducted a study to determine if there are age-related differences in number, severity, and resolution of postconcussion symptoms. Methods Between 2009 and 2011, baseline measures of neurocognitive functions and symptoms in high school and college athletes were entered into a regional database. Seven hundred forty of these athletes later sustained an SRC. Ninety-two athletes in the 13- to 16-year-old group and 92 athletes in the 18- to 22-year-old group were matched for number of prior concussions, sex, biopsychosocial variables, and days to first postconcussion testing and symptom assessment. A nonparametric Mann-Whitney U-test was used to compare the severity of each of 22 symptoms comprising the Total Symptom Scale (TSS) at baseline and first postconcussion test. To obtain a family-wise p value of 0.05 for each test, the significance level for each symptom comparison was set at an alpha of 0.05/22 = 0.0023. The number of days to return to baseline TSS score was compared using the RCI methodology, set at the 80% confidence interval, equal to a change in raw score of 9.18 points on the TSS. Results There was no statistically significant difference in symptom presence, symptom severity, and total symptoms between the age groups at baseline or at postconcussion testing. There was no statistically significant difference in return to baseline symptom scores between the age groups. Conclusions Using RCI methodology, there was no statistically significant difference between younger and older athletes in return to baseline symptoms postconcussion.

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“…20 More recent evidence suggests that children and adolescents are more likely to endure prolonged symptom recovery [21][22][23] and are more vulnerable to poor outcomes. 24,25 Moreover, neuroimaging studies show persistent structural and functional changes in the brain following mild TBI in children.…”

Section: Introductionmentioning

confidence: 99%

Age at First Exposure to Football Is Associated with Altered Corpus Callosum White Matter Microstructure in Former Professional Football Players

Stamm

Koerte

Muehlmann

et al. 2015

Journal of Neurotrauma

156

131

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Youth football players may incur hundreds of repetitive head impacts (RHI) in one season. Our recent research suggests that exposure to RHI during a critical neurodevelopmental period prior to age 12 may lead to greater later-life mood, behavioral, and cognitive impairments. Here, we examine the relationship between age of first exposure (AFE) to RHI through tackle football and later-life corpus callosum (CC) microstructure using magnetic resonance diffusion tensor imaging (DTI). Forty retired National Football League (NFL) players, ages 40-65, were matched by age and divided into two groups based on their AFE to tackle football: before age 12 or at age 12 or older. Participants underwent DTI on a 3 Tesla Siemens (TIM-Verio) magnet. The whole CC and five subregions were defined and seeded using deterministic tractography. Dependent measures were fractional anisotropy (FA), trace, axial diffusivity, and radial diffusivity. Results showed that former NFL players in the AFE <12 group had significantly lower FA in anterior three CC regions and higher radial diffusivity in the most anterior CC region than those in the AFE ‡12 group. This is the first study to find a relationship between AFE to RHI and later-life CC microstructure. These results suggest that incurring RHI during critical periods of CC development may disrupt neurodevelopmental processes, including myelination, resulting in altered CC microstructure.

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Recovery from sports-related concussion: Days to return to neurocognitive baseline in adolescents versus young adults

Cited by 103 publications

References 25 publications

Phasic Electrodermal Activity During the Standardized Assessment of Concussion (SAC)

Phasic Electrodermal Activity During the Standardized Assessment of Concussion (SAC)

Does age affect symptom recovery after sports-related concussion? A study of high school and college athletes

Age at First Exposure to Football Is Associated with Altered Corpus Callosum White Matter Microstructure in Former Professional Football Players

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