Return to play following sports-related concussion

Lovell, Mark R.; Collins, Michael James; Bradley, James P.

doi:10.1016/j.csm.2004.04.001

Cited by 123 publications

(71 citation statements)

References 33 publications

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“…Relative NAA levels were calculated as the ratio of the peak area of NAA with that of Despite hundreds of studies and decades of research, there is currently no universally accepted definition of mild traumatic brain injury (mTBI) or concussion (3,12,15,17,18,46,53), even though it is often described as a traumatically induced alteration in mental status, not necessarily with loss of consciousness. As a direct consequence, diagnosis and management of mTBI represent a dilemma of inestimable proportion, considering that more than 75% of all TBIs are suspected to be mild and the majority of these are going unreported and unassessed by medical professionals.…”

Section: Mri and 1 H-mr Spectroscopy Acquisition Techniquesmentioning

confidence: 99%

“…In rats, two consecutive mTBIs occurring within the shortest time interval considered (3 d after the first concussion) produced biochemical damages typical of severe TBI (78), in believe these data are valuable in helping to manage the postinjury period, when the sports medicine physician is faced with the challenging decision of when the athlete is safely able to return to play (16,25,41,46,49), especially considering the facts that the concussive symptoms reported are probably underappreciated, are frequently unrecognized by the athletes, and are difficult to document without standardized, sensitive, objective diagnostic tests (15,46). Given the importance of accurately detecting concussions in athletes, it has been pointed out that multimodal appraisal is necessary (5).…”

Section: Second Impact Syndrome: a Concept To Broaden?mentioning

confidence: 99%

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Temporal Window of Metabolic Brain Vulnerability to Concussion

et al. 2008

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OBJECTIVE:In the present study, the occurrence of the temporal window of brain vulnerability was evaluated in concussed athletes by measuring N-acetylaspartate (NAA) using proton magnetic resonance ( 1 H-MR) spectroscopy. METHODS: Thirteen nonprofessional athletes who had a sport-related concussive head injury were examined for NAA determination by means of 1 H-MR spectroscopy at 3, 15, and 30 days postinjury. All athletes but three suspended their physical activity. Those who continued their training had a second concussive event and underwent further examination at 45 days from the initial injury. The single case of one professional boxer, who was studied before the match and 4, 7, 15, and 30 days after a knockout, is also presented. Before each magnetic resonance examination, patients were asked for symptoms of mild traumatic brain injury, including physical, cognitive, emotional, and sleep disturbances. Data for 1 H-MR spectroscopy recorded in five normal, age-matched, control volunteers, who were previously screened to exclude previous head injuries, were used for comparison. Semiquantitative analysis of NAA relative to creatine (Cr)-and choline (Cho)-containing compounds was performed from proton spectra obtained with a 3-T magnetic resonance system. RESULTS: Regarding the values of the NAA-to-Cr ratio (2.21 Ϯ 0.11) recorded in control patients, singly concussed athletes, at 3 days after the concussion, showed a decrease of 18.5% (1.80 Ϯ 0.04; P Ͻ 0.001). Only a modest 3% recovery was observed at 15 days (1.88 Ϯ 0.1; P Ͻ 0.001); at 30 days postinjury, the NAA-to-Cr ratio was 2.15 Ϯ 0.1, revealing full metabolic recovery with values not significantly different from those of control patients. These patients declared complete resolution of symptoms at the time of the 3-day study. The three patients who had a second concussive injury before the 15-day study showed an identical decrease of the NAA-to-Cr ratio at 3 days (1.78 Ϯ 0.08); however, at 15 days after the second injury, a further diminution of the NAA-to-Cr ratio occurred (1.72 Ϯ 0.07; P Ͻ 0.05 with respect to singly concussed athletes). At 30 days, the NAAto-Cr ratio was 1.82 Ϯ 0.1, and at 45 days postinjury, the NAA-to-Cr ratio showed complete recovery (2.07 Ϯ 0.1; not significant with respect to control patients). This group of patients declared a complete resolution of symptoms at the time of the 30-day study. CONCLUSION: Results of this pilot study carried out in a cohort of singly and doubly concussed athletes, examined by 1 H-MR spectroscopy for their NAA cerebral content at different time points after concussive events, demonstrate that also in humans, concussion opens a temporal window of brain metabolic imbalance, the closure of which does not coincide with resolution of clinical symptoms. The recovery of brain metabolism is not linearly related to time. A second concussive event prolonged the time of NAA normalization by 15 days. Although needing confirmation in a larger group of patients, these results show that NAA measurement by 1 H-MR spe...

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Section: Mri and 1 H-mr Spectroscopy Acquisition Techniquesmentioning

confidence: 99%

Section: Second Impact Syndrome: a Concept To Broaden?mentioning

confidence: 99%

Temporal Window of Metabolic Brain Vulnerability to Concussion

et al. 2008

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“…Studies indicate that athletes with TBI may become symptom free in approximately 7 days after an injury [54]. A NCT may indicate deficits still present, but the importance of a positive NCT with no symptoms of TBI is unknown [55,56]. Newer imaging modalities such as functional magnetic resonance imaging (fMRI), positron emission tomography (PET) and single photon emission computed tomography (SPECT) can detect minor structural abnormalities but their clinical relevance is still unclear [57][58][59][60][61] …”

Section: Traumatic Brain Injurymentioning

confidence: 99%

Involvement of the Bufodienolides in the Pathogenesis and Potential Therapy of Preeclampsia, the Acute Respiratory Distress Syndrome and Traumatic Brain Injury

Chen¹,

Abbas²,

Raju³

et al. 2017

Gynecol Obstet

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The purpose of this review is to provide detailed information on the evidence for marinobufagenin (MBG) as a predictive and causative factor in preeclampsia(PE), the acute respiratory distress syndrome(ARDS) and traumatic brain injury(TBI).In addition, evidence is provided that resibufogenin (RBG),the antagonist of MBG is effective in the treatment of all three diseases .Results from experiments conducted on animal models and in human subjects indicate that patients with PE, ARDS and TBI have increased urinary and serum MBG levels. In PE patients, MBG is elevated in the early stages of pregnancy. In ARDS, MBG was elevated in serum samples of hyperoxic rats. MBG levels were also elevated in concussed athletes and in rat studies in which TBI was induced. In the animal models, all three disease processes were prevented/treated by the administration of RBG. Human trials of MBG as a predictor of PE, ARDS and TBI are underway as are studies of RBG as a therapy with respect to its usefulness and safety. Early detection of PE will significantly reduce its effects on pregnancy. ARDS, which has a high mortality rate, would benefit from studies on employing RBG. TBI patients can be diagnosed much more quickly than currently possible utilizing MBG as an early indicator. Furthermore, RBG may serve as a therapy.

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“…4 Common signs and symptoms of concussion include headache, dizziness, mental confusion, disorientation, blurred vision, and balance impairments. 2,5 Concussions are complex to assess, which makes tracking recovery difficult. Currently, few data-derived standards for concussion assessment are accepted.…”

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confidence: 99%

Objective Functional Assessment After a Head Injury Using Movement and Activity in Physical Space Scores: A Case Report

Farnsworth

McElhiney

David

et al. 2014

Journal of Athletic Training

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Objective: To describe the potential benefit of using a global positioning system (GPS) and accelerometry as an objective functional-activity measure after concussion by creating Movement and Activity in Physical Space (MAPS) scores. Background: A 21-year-old female soccer player suffered a blow to the back of the head from an opponent's shoulder during an away match. No athletic trainer was present. She played the remainder of the match and reported to the athletic training facility the next day for evaluation. Differential Diagnosis: Concussion. Treatment: The athlete was removed from all athletic activities. Her symptoms were monitored based on the Zurich guidelines. She was also instructed to wear an accelerometer on her hip and to carry an on-person GPS receiver at all times for 10 days. Her total symptom scores for the 4 symptomatic days were 82, 39, 49, and 36. Her mean MAPS functional score for symptomatic days 3 through 5 was 900.9 and for asymptomatic days 6 through 11 was 2734.9. Uniqueness: We monitored the patient's function during the concussion-recovery process using an on-person GPS receiver and accelerometer to calculate personalized MAPS scores. This novel approach to measuring function after injury may provide a useful complementary tool to help with return-to-play decisions. Conclusions: An on-person GPS receiver and accelerometer were used to observe the patient's physical activity in a free-living environment, allowing for an objective measure of function during recovery. Her MAPS scores were low while she was symptomatic and increased as she became asymptomatic. We saw the expected inverse relationship between symptoms and function. In situations where accuracy of reported symptoms may be a concern, this measure may provide a way to verify the validity of, or raise doubts about, self-reported symptoms.

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Return to play following sports-related concussion

Cited by 123 publications

References 33 publications

Temporal Window of Metabolic Brain Vulnerability to Concussion

Temporal Window of Metabolic Brain Vulnerability to Concussion

Involvement of the Bufodienolides in the Pathogenesis and Potential Therapy of Preeclampsia, the Acute Respiratory Distress Syndrome and Traumatic Brain Injury

Objective Functional Assessment After a Head Injury Using Movement and Activity in Physical Space Scores: A Case Report

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