Repetitive bout of controlled soccer heading does not alter heart rate variability metrics: A preliminary investigation.

Objectives: There is elevated unease regarding how repetitive head impacts, such as those associated with soccer heading, contribute to alterations in brain function. This study examined the extent heart rate variability (HRV) and cardiac baroreceptor sensitivity (BRS) metrics are altered immediately following an acute bout of soccer heading. Methods: Seven male elite soccer players (24.1 ± 1.5 years) completed 40 successful soccer headers in 20-min. The headers were performed under controlled circumstances using a soccer ball launcher located 25 meters away and using an initial ball velocity of 77.5 ± 3.7 km/h (heading condition). An accelerometer (xPatch) on the right mastoid process quantified linear/rotational head accelerations. Participants also completed sham (body contact) and control (non-contact) sessions. A three-lead ECG and finger photoplethysmography characterized short-term spontaneous HRV/cardiac BRS, before and after each condition. The SCAT3 indexed symptom scores pre-post exposures to all three conditions. Results: During the heading condition, cumulative linear and rotational accelerations experienced were 1,574 ± 97.9 g and 313,761 ± 23,966 rad/s2, respectively. Heart rate trended toward an increase from pre- to post-heading (p = 0.063), however HRV metrics in the time-domain (ps > 0.260) and frequency-domain (ps > 0.327) as well as cardiac BRS (ps > 0.144) were not significantly changed following all three conditions. Following the heading condition, SCAT3 symptom severity increased (p = 0.030) with a trend for symptom score augmentation (p = 0.078) compared to control and sham. Conclusion: Whereas, symptoms as measured by the SCAT3 were induced following an acute bout of controlled soccer heading, these preliminary findings indicate they were not accompanied by alterations to autonomic function. Ultimately, this demonstrates further research is needed to understand the physiological underpinnings of alterations in brain function occurring immediately after a bout of soccer heading and how these may, over time, contribute to long-term neurological impairments.

A comparison of monitoring designs to assess wildlife community parameters across spatial scales.

Dedicated long-term monitoring at appropriate spatial and temporal scales is necessary to understand biodiversity losses and develop effective conservation plans. Wildlife monitoring is often achieved by obtaining data at a combination of spatial scales, ranging from local to broad, to understand the status, trends, and drivers of individual species or whole communities and their dynamics. However, limited resources for monitoring necessitates tradeoffs in the scope and scale of data collection. Careful consideration of the spatial and temporal allocation of finite sampling effort is crucial for monitoring programs that span multiple spatial scales. Here we evaluate the ability of five monitoring designs-stratified random, weighted effort, indicator unit, rotating panel, and split panel-to recover parameter values that describe the status (occupancy), trends (change in occupancy), and drivers (spatially varying covariate and an autologistic term) of wildlife communities at two spatial scales. Using an amphibian monitoring program that spans a network of US national parks as a motivating example, we conducted a simulation study for a regional community occupancy sampling program to compare the monitoring designs across varying levels of sampling effort (ranging from 10% to 50%). We found that the stratified random design outperformed the other designs for most parameters of interest at both scales and was thus generally preferable in balancing the estimation of status, trends, and drivers across scales. However, we found that other designs had improved performance in specific situations. For example, the rotating panel design performed best at estimating spatial drivers at a regional level. Thus, our results highlight the nuanced scenarios in which various design strategies may be preferred and offer guidance as to how managers can balance common tradeoffs in large-scale and long-term monitoring programs in terms of the specific knowledge gained. Monitoring designs that improve accuracy in parameter estimates are needed to guide conservation policy and management decisions in the face of broad-scale environmental challenges, but the preferred design is sensitive to the specific objectives of a monitoring program.

An acute bout of controlled subconcussive impacts can alter dynamic cerebral autoregulation indices: a preliminary investigation.

OBJECTIVES: There is growing concern repetitive head contacts sustained by soccer players may lead to long-term health ramifications. Therefore, this preliminary investigation examined the impact an acute soccer heading bout has on dynamic cerebral autoregulation (dCA) metrics. METHODS: In this preliminary investigation, 40 successful soccer headers were performed in 20 min by 7 male elite soccer players (24.1 ± 1.5 years). Soccer balls were launched at 77.5 ± 3.7 km/h from JUGS soccer machine, located 35 m away from participants. Linear and rotational head accelerations impacts were measured using an accelerometer (xPatch). The SCAT3 indexed concussion symptom score and severity before and after: soccer headers, sham (body contact only), and control conditions. Squat-stand maneuvers were performed at 0.05 Hz and 0.10 Hz to quantity dCA through measures of coherence, phase, and gain. RESULTS: Cumulative linear and rotational accelerations during soccer headers were 1574 ± 97.9 g and 313,761 ± 23,966 rads/s2, respectively. SCAT3 symptom severity was elevated after the soccer heading bout (pre 3.7 ± 3.6, post 9.4 ± 7.6: p = 0.030) and five of the seven participants reported an increase in concussion-like symptoms (pre: 2.6 ± 3.0, post: 6.7 ± 6.2; p = 0.078). Phase at 0.10 Hz was elevated following soccer heading (p = 0.008). No other dCA metric differed following the three conditions. CONCLUSION: These preliminary results indicate an acute bout of soccer heading resulted in alterations to dCA metrics. Therefore, future research with larger sample sizes is warranted to fully comprehend short- and long-term physiological changes related to soccer heading.

Effect of losartan on performance and physiological responses to exercise at high altitude (5035 m).

OBJECTIVE: Altitude-related and exercise-related elevations in blood pressure (BP) increase the likelihood of developing pulmonary hypertension and high-altitude illness during high-altitude sojourn. This study examined the antihypertensive effect and potential exercise benefit of the angiotensin II receptor antagonist losartan when taken at altitude. METHODS: Twenty participants, paired for age and ACE genotype status, completed a double-blinded, randomised study, where participants took either losartan (100 mg/day) or placebo for 21 days prior to arrival at 5035 m (Whymper Hut, Mt Chimborazo, Ecuador). Participants completed a maximal exercise test on a supine cycle ergometer at sea level (4 weeks prior) and within 48 hours of arrival to 5035 m (10-day ascent). Power output, beat-to-beat BP, oxygen saturation (SpO2) and heart rate (HR) were recorded during exercise, with resting BP collected from daily medicals during ascent. Before and immediately following exercise at 5035 m, extravascular lung water prevalence was assessed with ultrasound (quantified via B-line count). RESULTS: At altitude, peak power was reduced relative to sea level (p<0.01) in both groups (losartan vs placebo: down 100±29 vs 91±28 W, p=0.55), while SpO2 (70±6 vs 70±5%, p=0.96) and HR (146±21 vs 149±24 bpm, p=0.78) were similar between groups at peak power, as was the increase in systolic BP from rest to peak power (up 80±37 vs 69±33 mm Hg, p=0.56). Exercise increased B-line count (p<0.05), but not differently between groups (up 5±5 vs 8±10, p=0.44). CONCLUSION: Losartan had no observable effect on resting or exercising BP, exercise-induced symptomology of pulmonary hypertension or performance at 5035 m.

An Acute Bout of Soccer Heading Subtly Alters Neurovascular Coupling Metrics.

Objective: The current investigation examined how a bout of soccer heading may impact brain function. Design: Semi-randomized crossover cohort. Setting: Controlled soccer heading. Participants: Seven male soccer players (24.1 ± 1.5 years). Intervention: 40 successful soccer headers were performed in 20 min (25 m, launch velocity ~80 km/h). X2 xPatch recorded linear and rotational head accelerations during each impact. A contact control "sham" condition - ball made body contact, but not by the head; and a no activity time "control" condition were also completed. Main Outcome Measures: Posterior and middle cerebral artery (PCA and MCA, respectively), cerebral blood velocity (CBV) was recorded during a visual task (neurovascular coupling: NVC) alongside SCAT3 symptoms scores pre/post a controlled bout of soccer heading. Results: Cumulative linear and rotational accelerations were 1,574 ± 97.9 g and 313,761 ± 23,966 rads/s2, respectively, during heading and changes in SCAT3 symptom number (pre: 2.6 ± 3.0; post: 6.7 ± 6.2, p = 0.13) and severity (pre: 3.7 ± 3.6, post: 9.4 ± 7.6, p = 0.11) were unchanged. In the PCA, no NVC differences were observed, including: relative CBV increase (28.0 ± 7.6%, p = 0.71) and total activation (188.7 ± 68.1 cm, p = 0.93). However, MCA-derived NVC metrics were blunted following heading, demonstrating decreased relative CBV increase (7.8 ± 3.1%, p = 0.03) and decreased total activation (26.7 ± 45.3 cm, p = 0.04). Conclusion: Although an acute bout of soccer heading did not result in an increase of concussion-like symptoms, there were alterations in NVC responses within the MCA during a visual task. This suggests an acute bout of repetitive soccer heading can alter CBV regulation within the region of the brain associated with the header impacts.

A Prospective Transcranial Doppler Ultrasound-Based Evaluation of the Effects of Repetitive Subconcussive Head Trauma on Neurovascular Coupling Dynamics.

OBJECTIVE: To determine the effects of repetitive subconcussive head trauma on neurovascular coupling (NVC) responses. DESIGN: Prospective cohort study collected between September 2013 and December 2016. SETTING: University laboratory. PARTICIPANTS: One hundred seventy-nine elite, junior-level (age, 19.6 ± 1.5 years) contact sport (ice hockey, American football) athletes recruited for preseason testing. Fifty-two nonconcussed athletes returned for postseason testing. Fifteen noncontact sport athletes (age, 20.4 ± 2.2 years) also completed preseason and postseason testing. EXPOSURE(S): Subconcussive sport-related head trauma. MAIN OUTCOME MEASURES: Dynamics of NVC were estimated during cycles of 20 seconds eyes closed and 40 seconds eyes open to a visual stimulus (reading) by measuring cerebral blood flow (CBF) velocity in the posterior (PCA) and middle (MCA) cerebral arteries via transcranial Doppler ultrasound. RESULTS: Both athlete groups demonstrated no significant differences in PCA or MCA NVC dynamics between preseason and postseason, despite exposure to a median of 353.5 (range, 295.0-587.3) head impacts (>2g) over the course of the season for contact sport athletes. CONCLUSIONS: Within the context of growing concern over detrimental effects of repetitive subconcussive trauma, the current results encouragingly suggest that the dynamics of NVC responses are not affected by 1 season of participation in junior-level ice hockey or American football. This is an important finding because it indicates an appropriate postseason CBF response to elevated metabolic demand with increases in neural activity.

Dynamic cerebral autoregulation across the cardiac cycle during 8 hr of recovery from acute exercise.

Current protocols examining cerebral autoregulation (CA) parameters require participants to refrain from exercise for 12-24 hr, however there is sparse objective evidence examining the recovery trajectory of these measures following exercise across the cardiac cycle (diastole, mean, and systole). Therefore, this study sought to determine the duration acute exercise impacts CA and the within-day reproducibility of these measures. Nine participants performed squat-stand maneuvers at 0.05 and 0.10 Hz at baseline before three interventions: 45-min moderate-continuous exercise (at 50% heart-rate reserve), 30-min high-intensity intervals (ten, 1-min at 85% heart-rate reserve), and a control day (30-min quiet rest). Squat-stands were repeated at hours zero, one, two, four, six, and eight after each condition. Transcranial doppler ultrasound of the middle cerebral artery (MCA) and the posterior cerebral artery (PCA) was used to characterize CA parameters across the cardiac cycle. At baseline, the systolic CA parameters were different than mean and diastolic components (ps < 0.015), however following both exercise protocols in both frequencies this disappeared until hour four within the MCA (ps > 0.079). In the PCA, phase values were affected only following high-intensity intervals until hour four (ps > 0.055). Normalized gain in all cardiac cycle domains remained different following both exercise protocols (ps < 0.005) and across the control day (p < .050). All systolic differences returned by hour six across all measures (ps < 0.034). Future CA studies may use squat-stand maneuvers to assess the cerebral pressure-flow relationship 6 hr after exercise. Finally, CA measures under this paradigm appear to have negligible within-day variation, allowing for reproducible interpretations to be drawn.

Disentangling data discrepancies with integrated population models.

A common challenge for studying wildlife populations occurs when different survey methods provide inconsistent or incomplete inference on the trend, dynamics, or viability of a population. A potential solution to the challenge of conflicting or piecemeal data relies on the integration of multiple data types into a unified modeling framework, such as integrated population models (IPMs). IPMs are a powerful approach for species that inhabit spatially and seasonally complex environments. We provide guidance on exploiting the capabilities of IPMs to address inferential discrepancies that stem from spatiotemporal data mismatches. We illustrate this issue with analysis of a migratory species, the American Woodcock (Scolopax minor), in which individual monitoring programs suggest differing population trends. To address this discrepancy, we synthesized several long-term data sets (1963-2015) within an IPM to estimate continental-scale population trends, and link dynamic drivers across the full annual cycle and complete extent of the woodcock's geographic range in eastern North America. Our analysis reveals the limiting portions of the life cycle by identifying time periods and regions where vital rates are lowest and most variable, as well as which demographic parameters constitute the main drivers of population change. We conclude by providing recommendations for resolving conflicting population estimates within an integrated modeling approach, and discuss how strategies (e.g., data thinning, expert opinion elicitation) from other disciplines could be incorporated into ecological analyses when attempting to combine multiple, incongruent data types.

Cross-sectional comparison of spiral versus block integrated curriculums in preparing medical students to diagnose and manage concussions.

BACKGROUND: An integrated curriculum is designed to be repetitive yet progressive and the concept has rapidly established itself within medical education. National organizations have recommended a shift to a spiral curriculum design, which uses both vertical and horizontal integration. This study examined differences between the recently implemented integrated spiral (class of 2019) and conventional block (classes of 2016-2018) MD curricula at the University of British Columbia (UBC) with respect to knowledge of concussion. METHODS: Cross-sectional online survey (FluidSurveys: Fluidware, Ottawa, ON), distributed via email to UBC medical students during the 2015-2016 academic year. Questions focused on demographic data, knowledge of concussion definition, and management considerations. Differences in responses across the two groups were assessed using chi-square tests. Ordinal Likert-scale data were analyzed using Mann-Whitney U-Tests. Statistical significance was determined a priori at p < 0.05. RESULTS: One hundred forty eight medical students (57% female) responded with 78 students in the spiral curriculum and 70 students the block curriculum. Important differences between responses from spiral versus block curricula students included: formal exposure to concussion-related educational material (10.8 h spiral vs. 3.95 h block), understanding concussions can occur without direct head impacts (90% spiral vs. 70% block, X21,148 = 9.41, p = 0.002) and identifying long-term consequences (dementia: 90% spiral vs. 66% block, X21,148 = 12.57, p < 0.0001; second impact syndrome: 80% spiral vs. 57% block, X21,148 = 8.60, p = 0.003; Parkinsonism: 47% spiral vs. 17% block, X21,148 = 14.87, p < 0.001). Block students identified the need for a full neurological exam (X21,148 = 17.63, p < 0.001) and had greater clinical exposure to acute concussion (47% block vs. 14% spiral, X21,148 = 19.27, p < 0.001) and post-concussion syndrome (37% block vs. 19% spiral, X21,148 = 5.91, p = 0.015). CONCLUSIONS: The findings from this preliminary study suggest the spiral curriculum design, which emphasizes and revisits clinical competencies, promotes a strong understanding and retention of knowledge in highly prevalent clinical conditions such as concussion.

Cerebral Autoregulation Is Disrupted Following a Season of Contact Sports Participation.

Repetitive subconcussive head impacts across a season of contact sports participation are associated with a number of deficits in brain function. To date, no research has investigated the effect of such head impact exposure on dynamic cerebral autoregulation (dCA). To address this issue, 179 elite, junior-level (age 19.6 ± 1.5 years) contact sport (ice hockey, American football) athletes were recruited for pre-season testing. Fifty-two non-concussed athletes returned for post-season testing. Fifteen non-contact sport athletes (age 20.4 ± 2.2) also completed pre- and postseason testing. dCA was assessed via recordings of beat-by-beat mean arterial pressure (MAP) and middle cerebral artery blood velocity (MCAv) using finger photoplethysmography and transcranial Doppler ultrasound, respectively, during repetitive squat-stand maneuvers at 0.05 and 0.10 Hz. Transfer function analysis was used to determine Coherence (correlation), Gain (response amplitude), and Phase (response latency) of the MAP-MCAv relationship. Results showed that in contact sport athletes, Phase was reduced (p = 0.027) and Gain increased (p < 0.001) at post-season compared to pre-season during the 0.10 Hz squat-stand maneuvers, indicating cerebral autoregulatory impairment in both the latency and magnitude of the response. Changes in Phase were greater in athletes experiencing higher numbers and severity of head impacts. By contrast, no changes in dCA were observed in non-contact sport controls. Taken together, these results demonstrate that repetitive subconcussive head impacts occurring across a season of contact sports participation are associated with exposure-dependent impairments in the cerebrovascular pressure-buffering system capacity. It is unknown how long these deficits persist or if they accumulate year-over-year.

Anticipatory postural adjustments as a function of response complexity in simple reaction time tasks.

The central nervous system preplans postural responses to successfully perform complex multi-joint movements. These responses have been termed anticipatory postural adjustments (APAs), and they constitute a general type of response to stabilize posture prior to movement initiation. APA sequences are elicited with shorter latency when a startling acoustic stimulus is applied, demonstrating their preplanned nature. Increasing task complexity using a simple reaction time (RT) paradigm has been shown to delay limb movement RT as a result of additional planning or sequencing requirements; however, the effect of task complexity on APA dynamics is unclear. The purpose of the present study was to investigate if task complexity modulates APA onset in a manner analogous to that observed in the primary effector. 13 participants completed 150 trials of simple (1-target) and complex (2- or 3-target) arm movements while standing on a force plate. Results indicated participants had significantly faster arm movement RTs in the simple versus the most complex condition. Similar to the primary effector, APA RTs were longer in the most complex (3-target) movement compared to both the 1-target and 2-target movements. Furthermore, APA excursion velocities were scaled to the complexity of the upcoming movement: the rate of APAs increased from simplest to most complex movements. These findings clearly demonstrate APAs are sensitive to task complexity, further elucidating their preplanned role in stabilizing posture which enables the successful completion of intended movements.

Sport-Related Concussion Alters Indices of Dynamic Cerebral Autoregulation.

Sport-related concussion is known to affect a variety of brain functions. However, the impact of this brain injury on cerebral autoregulation (CA) is poorly understood. Thus, the goal of the current study was to determine the acute and cumulative effects of sport-related concussion on indices of dynamic CA. Toward this end, 179 elite, junior-level (age 19.6 ± 1.5 years) contact sport (ice hockey, American football) athletes were recruited for preseason testing, 42 with zero prior concussions and 31 with three or more previous concussions. Eighteen athletes sustained a concussion during that competitive season and completed follow-up testing at 72 h, 2 weeks, and 1 month post injury. Beat-by-beat arterial blood pressure (BP) and middle cerebral artery blood velocity (MCAv) were recorded using finger photoplethysmography and transcranial Doppler ultrasound, respectively. Five minutes of repetitive squat-stand maneuvers induced BP oscillations at 0.05 and 0.10 Hz (20- and 10-s cycles, respectively). The BP-MCAv relationship was quantified using transfer function analysis to estimate Coherence (correlation), Gain (amplitude ratio), and Phase (timing offset). At a group level, repeated-measures ANOVA indicated that 0.10 Hz Phase was significantly reduced following an acute concussion, compared to preseason, by 23% (-0.136 ± 0.033 rads) at 72 h and by 18% (-0.105 ± 0.029 rads) at 2 weeks post injury, indicating impaired autoregulatory functioning; recovery to preseason values occurred by 1 month. Athletes were cleared to return to competition after a median of 14 days (range 7-35), implying that physiologic dysfunction persisted beyond clinical recovery in many cases. When comparing dynamic pressure buffering between athletes with zero prior concussions and those with three or more, no differences were observed. Sustaining an acute sport-related concussion induces transient impairments in the capabilities of the cerebrovascular pressure-buffering system that may persist beyond 2 weeks and may be due to a period of autonomic dysregulation. Athletes with a history of three or more concussions did not exhibit impairments relative to those with zero prior concussions, suggesting recovery of function over time. Findings from this study support the potential need to consider physiological recovery in deciding when patients should return to play following a concussion.

Differential Systolic and Diastolic Regulation of the Cerebral Pressure-Flow Relationship During Squat-Stand Manoeuvres.

OBJECTIVE: Cerebral pressure-flow dynamics are typically reported between mean arterial pressure and mean cerebral blood velocity. However, by reporting only mean responses, potential differential regulatory properties associated with systole and diastole may have been overlooked. MATERIALS AND METHODS: Twenty young adults (16 male, age: 26.7 ± 6.6 years, BMI: 24.9 ± 3.0 kg/m2) were recruited for this study. Middle cerebral artery velocity was indexed via transcranial Doppler. Cerebral pressure-flow dynamics were assessed using transfer function analysis at both 0.05 and 0.10 Hz using squat-stand manoeuvres. This method provides robust and reliable measures for coherence (correlation index), phase (timing buffer) and gain (amplitude buffer) metrics. RESULTS: There were main effects for both cardiac cycle and frequency for phase and gain metrics (p < 0.001). The systolic phase (mean ± SD) was elevated at 0.05 (1.07 ± 0.51 radians) and 0.10 Hz (0.70 ± 0.46 radians) compared to the diastolic phase (0.05 Hz: 0.59 ± 0.14 radians; 0.10 Hz: 0.33 ± 0.11 radians). Conversely, the systolic normalized gain was reduced (0.05 Hz: 0.49 ± 0.12%/%; 0.10 Hz: 0.66 ± 0.20%/%) compared to the diastolic normalized gain (0.05 Hz: 1.46 ± 0.43%/%; 0.10 Hz: 1.97 ± 0.48%/%). CONCLUSIONS: These findings indicate there are differential systolic and diastolic aspects of the cerebral pressure-flow relationship. The oscillations associated with systole are extensively buffered within the cerebrovasculature, whereas diastolic oscillations are relatively unaltered. This indicates that the brain is adapted to protect itself against large increases in systolic blood pressure, likely as a mechanism to prevent cerebral haemorrhages.

Systolic and Diastolic Regulation of the Cerebral Pressure-Flow Relationship Differentially Affected by Acute Sport-Related Concussion.

OBJECTIVE: To determine whether acute sports-related concussion (SRC) exerts differential effects on cerebral autoregulatory properties during systole versus diastole. MATERIALS AND METHODS: One hundred and thirty-six contact-sport athletes tested preseason; 14 sustained a concussion and completed follow-up testing at 72 hours, 2 weeks, and 1 month post-injury. Five minutes of repetitive squat-stand maneuvers induced blood pressure (BP) oscillations at both 0.05 and 0.10 Hz. Beat-by-beat peak-systolic and end-diastolic BP (sysBP/ diasBP) and middle cerebral artery blood velocity (sysMCAv/diasMCAv) were recorded using finger photoplethysmography and transcranial Doppler ultrasound, respectively. Relationships between sysBP-sysMCAv and diasBP-diasMCAv were quantified using transfer function analysis to estimate coherence (correlation), gain (response magnitude), and phase (response latency). RESULTS: Significant main effects of the cardiac cycle were observed across all outcome metrics. A significant main effect of SRC was observed for 0.10 Hz phase: systolic and diastolic phases were reduced at 72 h (21.8 ± 5.2%) and 2 weeks (22.7 ± 7.1%) compared to preseason but recovered by 1 month. Concussion significantly impaired diastolic, but not systolic, gain: 0.10 Hz diastolic gain was increased (27.2 ± 7.7%) at 2 weeks, recovering by 1 month. CONCLUSIONS: Impairments in autoregulatory capacity, observed for a transient period following SRC that persist beyond symptom resolution and clinical recovery, appear to be differentially affected across the cardiac cycle. Similar patterns of impairment were observed for systolic and diastolic phases (response latency); however, normalized gain (response magnitude) impairments were identified only in diastole. These findings may explain the increased cerebral vulnerability as well as exercise-induced symptom exacerbation observed post-SRC.

A Prospective Transcranial Doppler Ultrasound-Based Evaluation of the Acute and Cumulative Effects of Sport-Related Concussion on Neurovascular Coupling Response Dynamics.

Sport-related concussion has been shown to alter cerebral blood flow (CBF) both acutely and chronically, and may exert cumulative effects across multiple injuries. Such dysfunction may be mediated by trauma-induced deficits to CBF control mechanisms, though our understanding of these effects is limited, including dynamics of neurovascular coupling (NVC) responses (i.e., CBF responses to neurologic demand). A total of 179 junior-level contact sport athletes completed preseason testing; 42 reported never having experienced a concussion (Hx-) while 31 had endured three or more (Hx3+). A total of 18 athletes suffered concussions during the study period and were re-tested 3 days, 2 weeks, and 1 month post-injury. NVC dynamics were indexed via CBF velocity in the posterior (PCAv) and middle (MCAv) cerebral arteries during cycles of 20 sec eyes closed and 40 sec eyes open to a visual stimulus (reading). Acutely following concussion, peak rate of PCAv increase during the activation phase was delayed by over 50% and PCAv response magnitude was elevated by over 30%, compared with preseason. Response magnitude remained elevated at 2 weeks despite symptom resolution. Independent medical clearance for full return-to-play was inversely related to the magnitude of increase in the NVC response at 3 days post-injury. No post-injury changes were observed in MCAv, blood pressure, or end-tidal carbon dioxide levels during visual stimulation. No NVC metric differences were observed between the Hx- and Hx3+ groups at preseason. Via multiple potential mechanisms, acute sport-related concussion may induce compensatory alterations in NVC response dynamics that may be related to clinical recovery. Such effects do not appear to be persistent across multiple injuries.

Where's Waldo? The utility of a complicated visual search paradigm for transcranial Doppler-based assessments of neurovascular coupling.

BACKGROUND: The concept of neurovascular coupling has been postulated since the late 1800s and has been demonstrated most commonly in humans using visual stimuli (e.g. reading, checkerboards). These traditional paradigms evoke only a moderate cerebral blood flow response due to the relative simplicity of the visual stimuli. NEW METHOD: Forty subjects completed three visual paradigms each challenging the visual processing areas to a different extent: reading text, complicated visual searching (new method: Where's Waldo) and viewing coloured dots. Posterior and middle cerebral artery (PCA, MCA) velocities were recorded using transcranial Doppler ultrasound during each visual paradigm. RESULTS: Prior to the presentation of the visual stimuli there were no differences in mean arterial pressure, or PCA or MCA velocities for the three paradigms. All three paradigms led to an elevation in PCA and MCA velocities after a delay (∼1.1s). Whereas velocity elevation was consistent across the three paradigms in the MCA, it was markedly larger during the Where's Waldo task in the PCA. Thus, although the onset of the neurovascular coupling response was similar across the three visual paradigms, its overall magnitude was stimulus-dependent. COMPARISON WITH EXISTING METHODS: Given that PCA velocity can be affected by blood pressure or carbon dioxide alterations, traditional neurovascular coupling paradigms (e.g. reading, checkerboards) appear to have a lower signal-to-noise ratio than that observed in complicated visual search tasks such as Where's Waldo. CONCLUSIONS: We recommend complicated visual search paradigms such as Where's Waldo be considered for future transcranial Doppler-based neurovascular coupling studies.

Myelin Water Fraction Is Transiently Reduced after a Single Mild Traumatic Brain Injury--A Prospective Cohort Study in Collegiate Hockey Players.

Impact-related mild traumatic brain injuries (mTBI) are a major public health concern, and remain as one of the most poorly understood injuries in the field of neuroscience. Currently, the diagnosis and management of such injuries are based largely on patient-reported symptoms. An improved understanding of the underlying pathophysiology of mTBI is urgently needed in order to develop better diagnostic and management protocols. Specifically, dynamic post-injury changes to the myelin sheath in the human brain have not been examined, despite 'compromised white matter integrity' often being described as a consequence of mTBI. In this preliminary cohort study, myelin water imaging was used to prospectively evaluate changes in myelin water fraction, derived from the T2 decay signal, in two varsity hockey teams (45 players) over one season of athletic competition. 11 players sustained a concussion during competition, and were scanned at 72 hours, 2 weeks, and 2 months post-injury. Results demonstrated a reduction in myelin water fraction at 2 weeks post-injury in several brain areas relative to preseason scans, including the splenium of the corpus callosum, right posterior thalamic radiation, left superior corona radiata, left superior longitudinal fasciculus, and left posterior limb of the internal capsule. Myelin water fraction recovered to pre-season values by 2 months post-injury. These results may indicate transient myelin disruption following a single mTBI, with subsequent remyelination of affected neurons. Myelin disruption was not apparent in the athletes who did not experience a concussion, despite exposure to repetitive subconcussive trauma over a season of collegiate hockey. These findings may help to explain many of the metabolic and neurological deficits observed clinically following mTBI.

Dynamic cerebral autoregulation in young athletes following concussion.

The purpose of this study was to examine cerebral autoregulation (CA) in young athletes experiencing concussion. The subjects were monitored and repeatedly tested 72 hours, 2 weeks and 1 month post-injury. Mean arterial blood pressure (MABP), end-tidal partial pressure of carbon dioxide (PETCO2) and cerebral blood flow velocity (CBFV) in the middle and posterior cerebral arteries were monitored during mental activation paradigms. In order to characterize CA we employed autoregressive models with exogenous inputs (ARX) and impulse response models based on the Laguerre expansion technique (LET). By extracting gain and phase estimates from the obtained models we were able to detect disruptions in CA 72 hours following concussion and a slow recovery within a time period of one month.

Novel safety floors do not influence early compensatory balance reactions in older adults.

Novel safety flooring systems are a promising approach for reducing fall-related injuries in seniors, as they have been demonstrated to substantially reduce impact severity during falls, while minimally impairing balance control in community-dwelling older women. This pilot study aimed to characterize the potential effects of flooring conditions on dynamic balance control in retirement home-dwellers with more limited mobility. A tether-release paradigm was used to simulate a trip-type perturbation in 15 seniors across five flooring surfaces (three novel safety floors and one carpet compared to institutional-grade resilient rolled-sheeting). Kinetic and kinematic data tracked the displacement profiles of the underfoot centre-of-pressure and whole-body centre-of-mass, which were used to characterize compensatory balance reactions. Difference tests (ANOVA) found that the onset of the compensatory balance reaction was not associated with floor condition, nor were the timing and magnitude of peak centre-of-pressure excursion (minimum margin of safety) and velocity. Accordingly, the minimum margin of safety of the centre-of-mass was not significantly different across floors. Equivalence tests supported these findings. This study provides evidence that the carpet and novel safety floors tested do not negatively influence characteristics of initial dynamic balance responses following a lean-and-release perturbation compared to an institutional-grade resilient rolled-sheeting surface. In combination with reports of substantial force attenuative properties during fall-related impacts, these findings support the promise of novel safety floors as a biomechanically effective strategy for reducing fall-related injuries.

The influence of headform orientation and flooring systems on impact dynamics during simulated fall-related head impacts.

Novel compliant flooring systems are a promising approach for reducing fall-related injuries in seniors, as they may provide up to 50% attenuation in peak force during simulated hip impacts while eliciting only minimal influences on balance. This study aimed to determine the protective capacity of novel compliant floors during simulated 'high severity' head impacts compared to common flooring systems. A headform was impacted onto a common Commercial-Carpet at 1.5, 2.5, and 3.5 m/s in front, back, and side orientations using a mechanical drop tower. Peak impact force applied to the headform (F(max)), peak linear acceleration of the headform (g(max)) and Head Injury Criterion (HIC) were determined. For the 3.5 m/s trials, backwards-oriented impacts were associated with the highest F(max) and HIC values (p<0.001); accordingly, this head orientation was used to complete additional trials on three common floors (Resilient Rubber, Residential-Loop Carpet, Berber Carpet) and six novel compliant floors at each impact velocity. ANOVAs indicated that flooring type was associated with all parameters at each impact velocity (p<0.001). Compared to impacts on the Commercial Carpet, Dunnett's post hoc indicated all variables were smaller (25-80%) for the novel compliant floors (p<0.001), but larger for Resilient Rubber (31-159%, p<0.01). This study demonstrates that during 'high severity' simulated impacts, novel compliant floors can substantially reduce the forces and accelerations applied to a headform compared to common floors including carpet and resilient rubber. In combination with reports of minimal balance impairments, these findings support the promise of novel compliant floors as a biomechanically effective strategy for reducing fall-related injuries including traumatic brain injuries and skull fractures.