NeuroRehabilitation - Volume 22, issue 3

Authors: Willer, Barry | Leddy, John J.

Article Type: Editorial

DOI: 10.3233/NRE-2007-22301

Citation: NeuroRehabilitation, vol. 22, no. 3, pp. 159-160, 2007

Authors: Shapcott, Erin J.B. | Bloom, Gordon A. | Johnston, Karen M. | Loughead, Todd M. | Delaney, J. Scott

Article Type: Research Article

Abstract: Individuals with an optimistic explanatory style have generally been linked with improved mental and physical health across a variety of chronic and serious conditions. The purpose of the current study was to examine the effects of explanatory style on recovery time and number of sport-related concussions suffered in the last 12 months. University varsity athletes (n = 170) suffering from at least one concussion over the last 12 months from six contact or collision team sports completed both the Attributional Style Questionnaire and the Sport History Questionnaire. The results indicated that athletes with an optimistic explanatory style took longer …to recover than athletes with a pessimistic or average explanatory style. More specifically, optimistic athletes who suffered a complex concussion (requiring more than 7 days to recover) took significantly longer to return to play. However, the results showed that explanatory style did not influence whether an athlete suffered subsequent concussions. Overall, the current results can be used to better understand the psychology of concussions, as well as concussion prevention efforts and management strategies. Show more

Keywords: Concussion, explanatory style, sport psychology

DOI: 10.3233/NRE-2007-22302

Citation: NeuroRehabilitation, vol. 22, no. 3, pp. 161-167, 2007

Authors: Brooks, David A.

Article Type: Research Article

Abstract: Concussion is a potentially serious injury for athletes. Recent statistics suggest that approximately 300 000 sports-related traumatic brain injuries occur annually in the United States. Soccer, rugby, football, and ice hockey are all considered high-risk team sports for concussion. Hockey-related concussions are of particular concern in Canada, where over 500 000 players compete annually in ice hockey. The United States is now registering similar numbers of players. Return to play issues are one of the most difficult issues for physicians caring for concussed athletes. The advent of computerized neuropsychological testing adds another tool to assist in this process. It also …appears to enhance the education process for players, coaches, and parents on the potential seriousness of concussion for these young athletes. Show more

Keywords: Concussion, athletes, ice hockey, youth sports, postconcussion syndrome, head injury, neuropsychological testing

DOI: 10.3233/NRE-2007-22303

Citation: NeuroRehabilitation, vol. 22, no. 3, pp. 169-179, 2007

Authors: Gianotti, Simon | Hume, Patria A.

Article Type: Research Article

Abstract: The effectiveness of a concussion management education programme (CMEP) in rugby in reducing the number and cost of concussion/brain injury (CBI) moderate to serious claims (MSC) was assessed. A RugbySmart™ educational video and a sideline concussion check (SCC) tool comprised the CMEP. Over 30,000 SCC, providing information on management of suspected concussion among community level rugby players prior to seeking medical treatment, were distributed from July 2003 to June 2005. Each year approximately 10,000 coaches and 2,000 referees participated in RugbySmart™. From 2003 to 2005 new rugby CBI MSC reduced by 10.7% (actual) and 58.2% (forecast). Rugby player numbers, new …non-sport CBI MSC and new sport MSC all increased by 13.6%, 16.9% and 24.6% respectively in the same period. The median number of days between CBI injury and the player seeking medical treatment decreased from six days to four days. Cost savings after CMEP were $USD690,690 (actual) to $USD3,354,780 (forecast). The two-year cost of CMEP was $USD54,810 returning $USD12.60 (actual) and $USD61.21 (forecast) for every $USD1 invested (ROI). CMEP provided community coaches and managers with education on minimum best practice for managing suspected concussion, contributed towards ROI and savings for CBI MSC in rugby. Show more

Keywords: Concussion, injury prevention intervention, concussion management, community, rugby, return on investment, education

DOI: 10.3233/NRE-2007-22304

Citation: NeuroRehabilitation, vol. 22, no. 3, pp. 181-189, 2007

Authors: Kozlowski, Karl F. | Leddy, John J. | Tomita, Machiko | Bergen, Anne | Willer, Barry S.

Article Type: Research Article

Abstract: The purpose of this study was to identify the most common causes of head injury and associated symptoms of concussion in a population of school children (n = 1,372,979). Using standardized injury report forms, we identified the mechanisms of head injury associated with various sports/recreation activities and assessed each injury for the presence of concussion symptoms. Head injury reports (n = 7,765) were coded using the WHO's ICECI and ICD-10 E-codes. 1,338 Cases reported symptoms of concussion. The majority of head injuries occurred during School Free-Play/Recess (59.8%). Combative Sports and Wheeled Non-Motored Sports were the activities most often …associated with concussion symptoms (rate of concussion (RC ): 48.3% and 44.4%, respectively, p < 0.001). School Free-Play/Recess and Physical Education Classes were significantly less likely to have head injuries associated with concussion (RC: 16.0%, p < 0.001, and 12.4%, p = 0.034, respectively). The most common causes of head injury were (1) Struck by an Object (24.9%) and (2) Falling on the Same Level (22.8%). Falling from a Transport was the only etiological code significantly associated with concussion symptoms after head injury (RC: 28.7%, p<.001). Results were similar when using the two coding structures in combination. Prevention efforts should focus on activities where children are moving at high speeds since these are more likely to cause a concussion when a head injury occurs. Show more

Keywords: Concussion, sports, ICECI, ICD-10

DOI: 10.3233/NRE-2007-22305

Citation: NeuroRehabilitation, vol. 22, no. 3, pp. 191-198, 2007

Authors: Leddy, John J. | Kozlowski, Karl | Fung, Michael | Pendergast, David R. | Willer, Barry

Article Type: Research Article

Abstract: Although most patients with concussion recover within days to weeks, a small but significant minority develop persistent signs and symptoms of post-concussion syndrome (PCS). The standard treatments of PCS, rest and cognitive adaptation, have limited effectiveness. PCS patients are advised not to exercise because of the concern for symptom exacerbation. Prolonged rest, however, leads to deconditioning (especially in athletes) and may cause secondary effects including depressive symptoms. Concussion is associated with metabolic and physiological changes in the brain and in other organ systems (for example, autonomic function of the heart and altered cerebral autoregulation, sleep, and circadian rhythms). We propose …that PCS results from ongoing central and systemic physiologic regulatory dysfunction after traumatic brain injury (TBI) and we further propose that this physiologic dysfunction may be reduced or alleviated by individualized controlled sub-symptom threshold aerobic exercise rehabilitation. Show more

DOI: 10.3233/NRE-2007-22306

Citation: NeuroRehabilitation, vol. 22, no. 3, pp. 199-205, 2007

Authors: Fazio, Vanessa C. | Lovell, Mark R. | Pardini, Jamie E. | Collins, Michael W.

Article Type: Research Article

Abstract: The objective of this study was to examine differences in neurocognitive performance between symptomatic concussed athletes, a group of concussed athletes with no subjective symptoms, and a non-concussed control group of athletes. All concussed athletes were evaluated within one week of injury using the ImPACT computerized test battery. Results indicate that concussed athletes who denied subjective symptoms demonstrated poorer performance than control subjects on all four composite scores of the ImPACT test batters (Verbal Memory, Visual Memory, Reaction Time and Processing Speed However, the concussed but asymptomatic group demonstrated significantly better performance than did the concussed and symptomatic group. …Thus, concussed athletes who did not report subjective symptoms were not fully recovered based on neurocognitive testing. This study underscores the importance of neurocognitive testing in the assessment of concussion sequelae and recovery. Show more

Keywords: Concussion, mTBI, symptoms

DOI: 10.3233/NRE-2007-22307

Citation: NeuroRehabilitation, vol. 22, no. 3, pp. 207-216, 2007

Authors: Ptito, Alain | Chen, Jen-Kai | Johnston, Karen M.

Article Type: Research Article

Abstract: Mild traumatic brain injury (mTBI) in contact sport is a problem of such magnitude that improved approaches to diagnosis, investigation and management are urgent. Concussion has traditionally been described as a transient, fully reversible, cerebral dysfunction. However, this seemingly ‘mild’ injury sometimes results in long-lasting and disabling post-concussion symptoms (PCS) and abnormal neuropsychological profiles characteristic of frontal and/or temporal lobe dysfunction. At present, the pathological changes following concussion remain unclear, but it is now widely accepted that concussion results mainly in functional disturbance rather than structural damage. Therefore, functional imaging techniques can help in demonstrating brain abnormalities undetectable by …structural imaging methods. This paper will review the use of functional magnetic resonance imaging (fMRI) in studies of concussion. Our existing and ongoing fMRI studies will be described as examples to highlight the potential and contribution of this non-invasive functional neuroimaging technique in the assessment of sports-related concussion and its management. Show more

Keywords: Concussion, functional Magnetic Resonance Imaging (fMRI), post-concussive symptoms, depression

DOI: 10.3233/NRE-2007-22308

Citation: NeuroRehabilitation, vol. 22, no. 3, pp. 217-227, 2007

Authors: Rees, Roger J. | Bellon, Michelle L.

Article Type: Research Article

Abstract: This research identified persistent post concussion symptoms (PCS) in a group of 20 adult subjects. PCS generally lasted for two years with a mean of 3.35 years. Typical symptoms included physical and cognitive fatigue, depressive behaviors, sensitivity to noise, social withdrawal, irritability, concentration and problem solving difficulties, loss of libido and much difficulty making decisions at even the simplest strategic level. They represented a hard core group for whom the original symptoms persisted well beyond the 6 month period. Participants identified their PCS according to sensory, somatic affective and cognitive items immediately following their trauma (01) and two years later …(02). Counseling and psychotherapy intervention took place between 01 and 02. Items on the PCS schedules and the Beck Depression Inventory (II) demonstrated significant decline in the presence of overall symptoms most noticeably in reduction of agitation, irritability and suicidal wishes. However, subjects throughout generally experienced the feeling that they were being punished which equated with behaviors comparable with learned helplessness. The PCS group considered themselves to be different people after trauma. They had different goals, changing lifestyle, relationships and employment and were more often in a dependent state. Comparability with other conditions such as PTSD and chronic fatigue syndrome (CFS) was demonstrated by individuals who experienced persistent and invasive post concussion symptoms. Show more

Keywords: Concussion, post concussion syndrome, minimal brain damage, psychological difficulties, neurological impairment

DOI: 10.3233/NRE-2007-22309

Citation: NeuroRehabilitation, vol. 22, no. 3, pp. 229-242, 2007

Authors: Segalowitz, Sidney J. | Mahaney, Patrick | Santesso, Diane L. | MacGregor, Leslie | Dywan, Jane | Willer, Barry

Article Type: Research Article

Abstract: We examined in a group of 15-year-old adolescents the retest reliability over one week of 7 subscales of the Automated Neuropsychological Metrics (ANAM), a computerized battery based on standard neuropsychological test measures that is one of several such batteries available to assess concussion effects. Since the principle behind these computerized batteries is to assess athletes before injury and after injury to determine the level of deficit and whether the individual is safe to return to play, it is critical that such batteries have excellent retest reliability. Retest reliability of the ANAM was good, especially for the aggregate of throughput scores, …reaching 0.87, but lower for individual subtests, especially for those measuring only speed of processing. Thus, the ANAM aggregated score appears to have robust reliability for cognitive measures involving memory and attention in 15-year-olds. Limitations related to assessing return-to-baseline after concussion in adolescents are discussed. Show more

DOI: 10.3233/NRE-2007-22310

Citation: NeuroRehabilitation, vol. 22, no. 3, pp. 243-251, 2007