Concussion Monthly Select- March 2020

Concussion Monthly Select- March 2020

Author:

Doug Van Pelt, PhD

3/22/2020

Below are highlighted recently published concussion research articles with a brief summary and takeaway points.

Effect of Diagnosed Sleep Disorders on Baseline Concussion Symptom, Cognitive, and Balance Assessments in Collegiate Athletes

McAllister-Deitrick J, Trbovich AM, Broglio SP, McCrea M, McAllister TW, Kontos AP

https://journals.sagepub.com/doi/abs/10.1177/0363546520902701?journalCode=ajsb

Summary:

Certain individual demographics or medical history can influence performance on concussion assessments (e.g. BESS, SAC, SCAT5 symptoms). While previous studies have examined sex, ADD/ADHD, previous concussion, education levels, or primary language, we know little about whether diagnosed sleep disorders can influence baseline concussion test performance. Roughly 27% of college students have a sleep disorder (Gaultney et al 2010) and many collegiate athletes do not get the recommended amount of sleep (Brauer et al 2019). The current study examined NCAA varsity athletes with and without a diagnosed sleep disorder. Those with a diagnosed sleep disorder performed significantly worse on the SAC, endorsed more anxiety, depression, and somatization symptoms, and had more symptoms and to a greater severity as measured by the SCAT symptom or post-concussion symptom checklist. On the BESS, athletes with a sleep disorder performed better than those without a sleep disorder. Having a sleep disorder was not associated with ImPACT performance.

Takeaway:

Diagnosed sleep disorder can influence baseline concussion scores. However, this effect was observed predominately on symptom checklists, increasing the number of symptoms for athletes with a diagnosed sleep disorder. There was limited to no impact of a sleep disorder on ImPACT and was associated with better balance performance. 



The Association Between Persistent White-Matter Abnormalities and Repeat Injury After Sport-Related Concussion

Benjamin L Brett, Yu-Chien Wu, Sourajit M Mustafi, Andrew J Saykin, Kevin M Koch, Andrew S Nencka, Christopher C Giza, Joshua Goldman, Kevin M Guskiewicz, Jason P Mihalik, Stefan M Duma, Steven P Broglio, Thomas W McAllister, Michael A McCrea, Timothy B Meier

https://pubmed.ncbi.nlm.nih.gov/32038451/

Summary: 

After a concussion, the brain needs time to recover after a cascade of physiological events and regain homeostasis (see Giza et al 2014 for review; or video). During this recovery period, the brain may be more susceptible to injury because it is in a vulnerable state. Since we cannot easily measure this brain physiology so we rely on clinical symptoms to determine recovery. However, there is growing research showing that the brain is still recovering even after symptoms resolve. The researchers wanted to see athletes who returned to play (RTP) when their brain was still recovering would be more likely to sustain another concussion. The athletes who sustained a second concussion within the same year showed impaired white matter in the brain at 7 days post-RTP.

Takeaway:

A portion of athletes may have persistent changes in white matter integrity that reflect on ongoing recovery process. Notably, these athletes appear to have an increased risk for another concussion. 


Return to Play and Risk of Repeat Concussion in Collegiate Football Players: Comparative Analysis From the NCAA Concussion Study (1999-2001) and CARE Consortium (2014-2017)

Michael McCrea, Steven Broglio, Thomas McAllister, Wenxian Zhou, Shi Zhao, Barry Katz, Maria Kudela, Jaroslaw Harezlak, Lindsay Nelson, Timothy Meier, Stephen William Marshall, Kevin M Guskiewicz, CARE Consortium Investigators

https://pubmed.ncbi.nlm.nih.gov/31036562/

Summary:

The previous study showed us that there is a period of time post-concussion where an athlete’s brain may be more susceptible repeat concussion. But what can be done clinically? The authors of the current study compared concussion management in 1999-2001 to 2014-2017 football seasons. In 2014-2017 versus 1999-2001, we observe long symptom durations, symptom-free waiting periods (the time between when the athlete became asymptomatic to when they began the RTP protocol), and total time removed from play. This more conservative management drastically reduced the likelihood of a repeat concussion within 10 days of the initial concussion and if a repeat concussion occurred it happed at 56 days versus 6 days after the initial concussion.

Takeaway:

More conservative concussion management in football has greatly reduced secondary injuries during the time the brain is the most vulnerable. 




Academic Outcomes Following Adolescent Sport-Related Concussion or Fracture Injury: A Prospective Cohort Study

Kelly Russell, Erin Selci, Brian Black, Karis Cochrane, Michael Ellis

https://pubmed.ncbi.nlm.nih.gov/31022262/

Summary: 

While concussion care initially focused on returning the athlete to play there is growing concern on how to return the athlete to learn. Returning to school post-concussion can be difficult for students, causing symptoms to return or create a period of stress or concern on how the concussion is impacting their academic performance. To evaluate whether a concussion has a different impact on academic performance the researchers compared the academic performance of high school athletes after a concussion or fracture. Despite concussed athletes missing more days of school, there was no difference in grades between the concussed or fracture injury groups. 

Takeaway:

Reassuringly, there was no significant pre/post-injury difference in academic performance for athletes with a concussion versus those with a fracture. A concussion does not appear to impact academic performance for high school athletes.



Examination of Reaction Time Deficits Following Concussion: A Systematic Review and Meta-analysis

Landon B Lempke, David R Howell, James T Eckner, Robert C Lynall

https://pubmed.ncbi.nlm.nih.gov/32162242/


Summary: 

Reaction time slowing is a common symptom after a concussion. Processing information and responding quickly is necessary for many activities, including athletics or driving. To determine how large of an effect concussion has on reaction time and for how long, researchers reviewed the studies on reaction time and summarized their findings. Large impairments in reaction time were observed 0-3 post-concussion but may persist for 59 days after a concussion. 

Takeaway:

While athletes exhibit the greatest impairment in reaction time acutely post-concussion, they may have slow reaction time well after they have returned to play. 






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