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2.
Emerg Med Clin North Am ; 38(1): 207-222, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757251

RESUMO

A systematic approach is required for patients with a suspected concussion. Although standardized tools can aid in assessment, the diagnosis of concussion remains a clinical one. At the time of diagnosis, patients should be given both verbal and written review of the common symptoms of concussion, expected course of recovery, as well as strategies to manage symptoms. Most patients benefit from a brief period of rest, followed by a gradual reintroduction of activities, and a graduated return-to-sport protocol. Patients with prolonged recovery from a concussion may benefit from exercise, vestibular, and cognitive rehabilitation programs.


Assuntos
Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Diagnóstico por Imagem/métodos , Gerenciamento Clínico , Emergências , Medicina Esportiva/métodos , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Concussão Encefálica/etiologia , Humanos , Índices de Gravidade do Trauma
3.
Scand J Med Sci Sports ; 30(1): 185-192, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31494968

RESUMO

The purpose of this study was to determine the factors related to the occurrence of concussion in rugby tacklers. Match video records showing tackles leading to concussion were used to identify injury-inciting events. Additionally, noninjury tackles by concussed tacklers (prior to concussion) and position-matched tacklers from the same matches were used as a control cohort. All tackles were coded according to the tackling characteristics. The odds ratio (OR) was reported by logistic regression. The results demonstrated that a side step of the ball-carrier reduced the risk of concussion for tacklers (OR = 0.13 [95% CI, 0.03-0.58]; P = .008). Conversely, the tackler's head/neck contacting the ball-carrier (OR = 18.62 [95% CI, 4.59-75.49]; P < .001) and not remaining bound to the ball-carrier since making initial contact (OR = 4.38 [95% CI, 1.69-11.34]; P = .002) were identified as risk factors for the concussion of tacklers. These results suggest that avoidance movements of the ball-carrier prior to tackling reduced the risk of concussion and that incorrect tackling techniques contributed to an increased occurrence of concussion. Furthermore, the probability of concussion for tacklers increased when their head was in front or to one side of the ball-carrier, and the direction of the tackle also affected the risk of concussion, especially from the side. Therefore, it is important to emphasize the tackler's head position in conjunction with the direction of tackle.


Assuntos
Traumatismos em Atletas/etiologia , Concussão Encefálica/etiologia , Futebol Americano/lesões , Atletas , Humanos , Japão , Modelos Logísticos , Razão de Chances , Fatores de Risco , Gravação em Vídeo
4.
Medicine (Baltimore) ; 98(41): e17467, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593106

RESUMO

BACKGROUND: We investigated differences in corpus callosum (CC) injuries between patients with concussion and those with diffuse axonal injury (DAI) by using diffusion tensor tractography (DTT). METHODS: Twenty-nine patients with concussion, 21 patients with DAI, and 25 control subjects were recruited. We reconstructed the whole CC and 5 regions of the CC after applying Hofer classification (I, II, III, IV, and V). The whole CC and each region of the CC were analyzed to measure DTT parameters (fractional anisotropy [FA], apparent diffusion coefficient [ADC], and fiber number [FN]). RESULTS: In the whole CC, significant differences were observed in all DTT parameters between the concussion and control groups and the DAI and control groups (P < .05). Among the 5 regions of the CC, significant differences were observed in FA and ADC between the concussion and control groups and the DAI and control groups (P < .05). Significant differences in FN were observed in CC regions I and II (connected with the prefrontal lobe and secondary motor area) between the concussion and control groups, in CC regions I, II, III, and IV (connected with the frontoparietal lobes) between the DAI and control groups, and in CC regions III, IV (connected with the motor-sensory cortex) between the concussion and DAI groups (P < .05). CONCLUSION: It was observed that both concussion and DAI patients showed diffuse neural injuries in the whole CC and all 5 regions of the CC. Neural FN results revealed that concussion patients appeared to be specifically injured in the anterior part of the CC connected with the frontal lobe, whereas DAI patients were injured in more diffuse regions connected with whole frontoparietal lobes.


Assuntos
Concussão Encefálica/diagnóstico por imagem , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Corpo Caloso/lesões , Lesão Axonal Difusa/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Adulto , Idoso , Concussão Encefálica/etiologia , Corpo Caloso/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
5.
Int J Sports Med ; 40(13): 825-830, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31574545

RESUMO

Concussion is a frequently occurring injury in rugby which is not usually reported to coaches or medical staff. Recognition and treatment of concussion should be a priority; however, education surrounding concussion knowledge and attitudes of the players have been lacking. The aim of this study was to investigate the knowledge and attitudes toward concussion in Western Province Rugby Union (WPRU) Super League senior club rugby players. This study focused on gathering quantitative information from WPRU club rugby players, using the Rosenbaum Concussion Knowledge and Attitudes Survey-Student Version (RoCKAS-ST). The correlation between the Concussion Attitude Index (CAI) and Concussion Knowledge Index (CKI) was (r=0.14). The CKI average for the players was (16.72±2.96). The participants answered 67% (16.72±2.96) of the CKI questions and 62% (46.54±5.75) of the CAI questions correctly. The participants demonstrated sufficient knowledge of concussion, as well as safe attitudes toward concussion. A small number of players lacked knowledge of symptoms and attitudes toward concussion, which may have been influenced by the importance of games. Overall, the participants in this study demonstrated superior knowledge and safe attitudes compared to other studies. The current study found that the players had good knowledge and safe attitudes regarding the severity of concussion.


Assuntos
Atletas/psicologia , Concussão Encefálica , Futebol Americano/lesões , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Concussão Encefálica/diagnóstico , Concussão Encefálica/etiologia , Humanos , Masculino , África do Sul , Inquéritos e Questionários , Adulto Jovem
6.
Pediatrics ; 144(5)2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31615955

RESUMO

BACKGROUND: Ongoing monitoring of concussion rates and distributions is important in assessing temporal patterns. Examinations of high school sport-related concussions need to be updated. This study describes the epidemiology of concussions in 20 high school sports during the 2013-2014 to 2017-2018 school years. METHODS: In this descriptive epidemiology study, a convenience sample of high school athletic trainers provided injury and athlete exposure (AE) data to the National High School Sports-Related Injury Surveillance Study (High School Reporting Information Online). Concussion rates per 10 000 AEs with 95% confidence intervals (CIs) and distributions were calculated. Injury rate ratios and injury proportion ratios examined sex differences in sex-comparable sports (soccer, basketball, baseball and softball, cross country, track, and swimming). We also assessed temporal trends across the study period. RESULTS: Overall, 9542 concussions were reported for an overall rate of 4.17 per 10 000 AEs (95% CI: 4.09 to 4.26). Football had the highest concussion rate (10.40 per 10 000 AEs). Across the study period, football competition-related concussion rates increased (33.19 to 39.07 per 10 000 AEs); practice-related concussion rates decreased (5.47 to 4.44 per 10 000 AEs). In all sports, recurrent concussion rates decreased (0.47 to 0.28 per 10 000 AEs). Among sex-comparable sports, concussion rates were higher in girls than in boys (3.35 vs 1.51 per 10 000 AEs; injury rate ratio = 2.22; 95% CI: 2.07 to 2.39). Also, among sex-comparable sports, girls had larger proportions of concussions that were recurrent than boys did (9.3% vs 6.4%; injury proportion ratio = 1.44; 95% CI: 1.11 to 1.88). CONCLUSIONS: Rates of football practice-related concussions and recurrent concussions across all sports decreased. Changes in concussion rates may be associated with changes in concussion incidence, diagnosis, and management. Future research should continue to monitor trends and examine the effect of prevention strategies.


Assuntos
Traumatismos em Atletas/epidemiologia , Concussão Encefálica/epidemiologia , Adolescente , Traumatismos em Atletas/etiologia , Concussão Encefálica/etiologia , Feminino , Humanos , Incidência , Masculino , Vigilância da População , Fatores Sexuais , Estados Unidos/epidemiologia
7.
J Athl Train ; 54(8): 852-857, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415183

RESUMO

OBJECTIVE: To assist sideline medical staff and to augment detection of concussion in National Football League (NFL) players during preseason and regular season games via the use of certified athletic trainer (ATC) spotters. BACKGROUND: Detecting concussive injuries in contact-sport athletes can be a challenging task for health care providers on the sideline. Over the past 8 years, professional sport leagues have begun to use additional sets of eyes (medical spotters along with video review) to help identify athletes with possible concussive injuries. DESCRIPTION: The NFL first began a program using spotters in 2011, and the ATC Spotter Program has undergone systematic enhancements each year. This article describes the evolution of the ATC Spotter Program, the requirements and training of its participants, and the program data available to date. Directions for future improvement and research are addressed. CLINICAL ADVANTAGES: The use of ATC spotters stationed in the broadcast booth has enhanced the real-time detection of concussed players in the NFL.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Futebol Americano/lesões , Gestão da Segurança , Traumatismos em Atletas/etiologia , Concussão Encefálica/etiologia , Humanos , Desenvolvimento de Programas , Melhoria de Qualidade , Segurança , Gestão da Segurança/métodos , Gestão da Segurança/organização & administração , Estados Unidos
8.
Rev Med Suisse ; 15(658): 1390-1392, 2019 Aug 14.
Artigo em Francês | MEDLINE | ID: mdl-31411828

RESUMO

Sports and hobbies are important cause of accident and the incidence of reported traumatic brain injury is about 10 000 case/years in Switzerland. Hockey and handball are very high-risk contact sports. The term «â€…mild traumatic brain injury ¼ (mTBI) involves a patient with an initial Glasgow coma scale between 13 and 15. Signs and symptoms are variable and non-specific. They extend to loss of consciousness to neurocognitive disorders. TBI are potentially life threatening. Therefore, their management must be fast and effective in the emergency department. Long-term complications are also frequent and caregivers have to identify and support the patients who are at risk to develop post-concussion syndrome. Multidisciplinary supportive care and decision-making related to return to sport are necessary.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Síndrome Pós-Concussão , Esportes , Traumatismos em Atletas/terapia , Concussão Encefálica/etiologia , Concussão Encefálica/terapia , Humanos , Síndrome Pós-Concussão/etiologia , Síndrome Pós-Concussão/terapia , Suíça
9.
J Athl Train ; 54(5): 534-540, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31084502

RESUMO

CONTEXT: Concussions elicit changes in brain function that may extend well beyond clinical symptom recovery. Whether these changes produce meaningful deficits outside the laboratory environment is unclear. The results of player performance postconcussion within professional sports have been mixed. OBJECTIVE: To determine whether National Hockey League (NHL) players with concussions performed worse after returning to sport than players with lower body injuries or uninjured players. DESIGN: Cohort study. SETTING: Publicly available Web sites that compiled injury and player statistics of NHL players. PATIENTS OR OTHER PARTICIPANTS: Male NHL players who missed games due to a concussion (n = 22), lower body injury (n = 21), or noninjury (ie, personal reason or season break; n = 13) during the 2013-2014 and 2014-2015 regular seasons. Data on concussed athletes were used to identify similar players with lower body injury and noninjury based on (1) position, (2) time loss, (3) time on the ice, and (4) team. MAIN OUTCOME MEASURE(S): The primary performance metric was a modified plus-minus statistic calculated by weighting the players' plus-minus metric by their team's simple rating system to account for varying team performances. Linear mixed models assessed the relationship between injury type (concussion, lower body, or noninjury) and performance (plus-minus score). RESULTS: We observed a quadratic effect for a time2 × group interaction ( \upchi _2^2 = 8.85, P = .01). This interaction revealed that the concussion and lower body injury groups had similar patterns of an initial decrease (ie, 2 weeks after return to play), followed by an increase in performance compared with the uninjured group in weeks 5 and 6. Meanwhile, the uninjured group had an initial increase in performance. We observed no group × linear time interaction (P = .47) or overall group effect (P = .57). CONCLUSIONS: The NHL players in the concussion and lower body injury groups displayed similar performance impairments. Both injured cohorts experienced an initial decrease in performance at weeks 1 to 2 after return to play, followed by improved performance at weeks 5 to 6 after return to play, suggesting that the performance implications of concussion may be short lived.


Assuntos
Traumatismos em Atletas , Desempenho Atlético , Concussão Encefálica , Hóquei/lesões , Extremidade Inferior/lesões , Volta ao Esporte , Adulto , Traumatismos em Atletas/classificação , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/psicologia , Desempenho Atlético/fisiologia , Desempenho Atlético/psicologia , Concussão Encefálica/diagnóstico , Concussão Encefálica/etiologia , Concussão Encefálica/fisiopatologia , Concussão Encefálica/psicologia , Estudos de Coortes , Humanos , Modelos Lineares , Masculino , Recuperação de Função Fisiológica , Volta ao Esporte/fisiologia , Volta ao Esporte/psicologia , Volta ao Esporte/normas
10.
J Athl Train ; 54(5): 527-533, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30933609

RESUMO

CONTEXT: Postconcussion deficits in neurocognitive performance and postural control may persist at the time of return to sport participation. How these deficits, if present, affect athletic performance is largely unknown, with prior studies showing mixed results. OBJECTIVE: To evaluate postconcussion National Hockey League player performance using advanced hockey metrics over short- (5 games), medium- (10 games), and long-term (remainder of the season) seasonal performance. DESIGN: Retrospective cohort study. PATIENTS OR OTHER PARTICIPANTS: National Hockey League players who sustained a sport-related concussion (SRC; n = 93) and returned during the same season and players (n = 51) who missed time for non-injury-related reasons. MAIN OUTCOME MEASURE(S): Six performance metrics were used: (1) points per 60 minutes, (2) Corsi percentage, (3) personal Fenwick shooting percentage, (4) scoring chances per 60 minutes, (5) penalty difference, and (6) PDO (not an acronym but sometimes referred to as SVSP% [save percentage shooting percentage]). Performance was compared using 2 (group) × 2 (time) repeated-measures analyses of variance for 3 time windows: (1) ±5 games, (2) ±10 games, and (3) the remainder of the season postconcussion. Alpha values were set at a conservative .01 to account for the lack of independence among dependent variables. RESULTS: No significant interactions were present for any of the 6 dependent variables at any of the 3 time windows. Overall, none of the secondary variables differed. CONCLUSIONS: Using advanced, sport-specific metrics, we found that National Hockey League players did not display worse seasonal performance during 3 postinjury time frames after they sustained an SRC. Whereas laboratory studies have identified lingering neurologic deficits after concussion, our results suggest that these deficits, if present, either do not translate to worse athletic performance or were not captured by these 44 metrics. Further, prospective efforts are needed to accurately quantify performance after SRC among professional hockey players.


Assuntos
Traumatismos em Atletas , Desempenho Atlético , Concussão Encefálica , Hóquei/lesões , Volta ao Esporte , Adulto , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/psicologia , Desempenho Atlético/fisiologia , Desempenho Atlético/psicologia , Concussão Encefálica/etiologia , Concussão Encefálica/fisiopatologia , Concussão Encefálica/psicologia , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Equilíbrio Postural , Estudos Retrospectivos , Volta ao Esporte/fisiologia , Volta ao Esporte/psicologia , Volta ao Esporte/normas
11.
Neuroimage Clin ; 22: 101793, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30939340

RESUMO

In the military, explosive blasts are a significant cause of mild traumatic brain injuries (mTBIs). The symptoms associated with blast mTBIs causes significant economic burdens and a diminished quality of life for many service members. At present, the distinction of the injury mechanism (blast versus non-blast) may not influence TBI diagnosis. However, using noninvasive imaging, this study reveals significant distinctions between the blast and non-blast TBI mechanisms. A cortical whole-brain thickness analysis was performed using structural high-resolution T1-weighted MRI to identify the effects of blasts in persistent mTBI (pmTBI) subjects. A total of 41 blast pmTBI subjects were individually age- and gender-matched to 41 non-blast pmTBI subjects. Using FreeSurfer, cortical thickness was quantified for the blast group, relative to the non-blast group. Cortical thinning was identified within the blast mTBI group, in two clusters bilaterally. In the left hemisphere, the cluster overlapped with the lateral orbitofrontal, rostral middle frontal, medial orbitofrontal, superior frontal, rostral anterior cingulate and frontal pole cortices (p < 0.02, two-tailed, size = 1680 mm2). In the right hemisphere, the cluster overlapped with the lateral orbitofrontal, rostral middle frontal, medial orbitofrontal, pars orbitalis, pars triangularis and insula cortices (p < 0.002, two-tailed, cluster size = 2453 mm2). Self-report assessments suggest significant differences in the Post-Traumatic Stress Disorder Checklist-Civilian Version (p < 0.05, Bonferroni-corrected) and the Neurobehavioral Symptom Inventory (p < 0.01, uncorrected) between the blast and non-blast mTBI groups. These results suggest that blast may cause a unique injury pattern related to a reduction in cortical thickness within specific brain regions which could affect symptoms. No other study has found cortical thickness difference between blast and non-blast mTBI groups and further replication is needed to confirm these initial observations.


Assuntos
Traumatismos por Explosões/patologia , Concussão Encefálica/patologia , Córtex Cerebral/patologia , Neuroimagem/métodos , Transtornos de Estresse Pós-Traumáticos/patologia , Adulto , Traumatismos por Explosões/diagnóstico por imagem , Concussão Encefálica/diagnóstico por imagem , Concussão Encefálica/etiologia , Córtex Cerebral/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Militares , Transtornos de Estresse Pós-Traumáticos/diagnóstico por imagem , Transtornos de Estresse Pós-Traumáticos/fisiopatologia
12.
Am Fam Physician ; 99(7): 426-434, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30932451

RESUMO

Mild traumatic brain injury, also known as concussion, is common in adults and youth and is a major health concern. Concussion is caused by direct or indirect external trauma to the head resulting in shear stress to brain tissue from rotational or angular forces. Concussion can affect a variety of clinical domains: physical, cognitive, and emotional or behavioral. Signs and symptoms are nonspecific; therefore, a temporal relationship between an appropriate mechanism of injury and symptom onset must be determined. Headache is the most common symptom. Initial evaluation involves eliminating concern for cervical spine injury and more serious traumatic brain injury before diagnosis is established. Tools to aid diagnosis and monitor recovery include symptom checklists, neuropsychological tests, postural stability tests, and sideline assessment tools. If concussion is suspected in an athlete, the athlete should not return to play until medically cleared. Brief cognitive and physical rest are key components of initial management. Initial management also involves patient education and reassurance and symptom management. Individuals recover from concussion differently; therefore, rigid guidelines have been abandoned in favor of an individualized approach. As symptoms resolve, patients may gradually return to activity as tolerated. Those with risk factors, such as more severe symptoms immediately after injury, may require longer recovery periods. There is limited research in the younger population; however, given concern for potential consequences of injury to the developing brain, a more conservative approach to management is warranted.


Assuntos
Traumatismos em Atletas/complicações , Concussão Encefálica/diagnóstico , Gerenciamento Clínico , Exame Neurológico/métodos , Medicina Esportiva/métodos , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/etiologia , Concussão Encefálica/terapia , Humanos
13.
Clin Pediatr (Phila) ; 58(5): 547-554, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30788982

RESUMO

The preparticipation sports examination (PPE) is required for US high school athletes. We queried members of the Illinois Chapter of the American Academy of Pediatrics (ICAAP) about what they actually include in a PPE, allotted PPE time, and counseling about full contact sports participation. Of 2300 ICAAP members contacted electronically, 228 (10%) responded, yielding 205 usable surveys. When performing a PPE, 34 (25%) always complete all of 6 selected AAP-recommended PPE components and 102 (74%) always get a concussion history. In contrast, 29 (21%) always complete all of the 6 selected AAP PPE components and 70 (49%) always get a concussion history as part of well-child checkup. Main interferences with clinician proficiency are lack of time and training cited by 49% and 37%, respectively. Pediatricians were evenly divided about whether or not to counsel against full contact sports, but were more likely to do so after the athlete sustained a first concussion.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Anamnese/métodos , Pediatras/estatística & dados numéricos , Exame Físico/métodos , Padrões de Prática Médica/estatística & dados numéricos , Esportes Juvenis , Adolescente , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/prevenção & controle , Atitude do Pessoal de Saúde , Concussão Encefálica/diagnóstico , Concussão Encefálica/etiologia , Concussão Encefálica/prevenção & controle , Criança , Aconselhamento Diretivo/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Illinois , Masculino , Anamnese/normas , Anamnese/estatística & dados numéricos , Pediatras/normas , Exame Físico/normas , Exame Físico/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Medição de Risco , Esportes Juvenis/lesões
14.
Musculoskelet Sci Pract ; 40: 53-57, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30708266

RESUMO

PURPOSE: This study quantified the linear and angular kinematics that result from purposeful heading during youth soccer games, and the influence of game scenario and head impact location on these magnitudes. METHOD: This observational study recruited thirty-six female soccer players (13.4 ±â€¯0.9 years old) from three elite youth soccer teams (U13, U14, U15) and followed for an entire soccer season. Players wore wireless sensors during each game to quantify head impact magnitudes. A total of 60 regular season games (20 games per team) were video recorded, and purposeful heading events were categorized by game scenario (e.g. throw in), and head impact location (e.g. front of head). RESULTS: Game scenario had a statistically significant effect on the linear head acceleration, and rotational head velocity, that resulted from purposeful headers. Rotational velocity from purposeful headers varied significantly between head impact locations, with impacts to the top of the head (improper technique) resulting in larger peak rotational velocities than impacts to the front of the head (proper technique); this was also the case for the linear acceleration for punts. CONCLUSION: Our findings suggest that the magnitude for both linear and angular head impact kinematics depend on the game scenario and head impact location. Headers performed with the top of the head (improper technique) result in larger rotational velocities compared to the front of the head (proper technique). Accordingly, youth players should be educated on how to execute proper heading technique to reduce head impact accelerations.


Assuntos
Traumatismos em Atletas/complicações , Concussão Encefálica/etiologia , Concussão Encefálica/fisiopatologia , Transtornos Traumáticos Cumulativos/fisiopatologia , Futebol , Esportes/estatística & dados numéricos , Adolescente , Fenômenos Biomecânicos , Feminino , Humanos
15.
Artigo em Inglês | MEDLINE | ID: mdl-30658408

RESUMO

Chronic traumatic encephalopathy (CTE) was first discovered in professional boxers after they exhibited memory impairments, mood and behavioral changes after years of boxing. However, there is now a growing acceptance that CTE can develop in athletes of other sports due to the repetitive head trauma they receive. We present a case of a middle-aged male who presented with worsening memory, poor concentration, and behavioral changes for a year. On further cognitive testing, it was revealed that he had difficulties with short-term memory and processing speed as well as difficulties in organizing and multitasking. He had been practicing mixed martial arts (MMA) for 10 years, and later was an instructor of the sport. Through a detailed examination of his history, it was discovered that he sustained recurrent minor head concussions due to his line of work. To date, there has been limited large-scale research on head trauma in MMA. There is thus an urgent need for more studies in this area as CTE can be a chronic and debilitating illness with incapacitating neuropsychiatric sequelae. This case highlights the importance of public awareness of the risks of MMA and the dangers it poses to the brain, especially with more young people being attracted to this sport.


Assuntos
Concussão Encefálica/patologia , Encefalopatia Traumática Crônica/patologia , Artes Marciais , Adulto , Concussão Encefálica/etiologia , Concussão Encefálica/fisiopatologia , Encefalopatia Traumática Crônica/etiologia , Encefalopatia Traumática Crônica/fisiopatologia , Humanos , Masculino
16.
J Neurosurg Pediatr ; 23(4): 455-464, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30660131

RESUMO

OBJECTIVE: The longitudinal effects of sports-related concussion (SRC) in adolescents on health-related quality of life (HRQOL) remain poorly understood. Hence, the authors established two objectives of this study: 1) compare HRQOL outcomes among adolescents with an acute SRC or a sports-related extremity fracture (SREF) who were followed up until physician-documented clinical recovery; and 2) identify the clinical variables associated with worse HRQOL among adolescent SRC patients. METHODS: The authors conducted a prospective cohort study of adolescents with acute SRC and those with acute SREF who underwent clinical assessment and follow-up at tertiary subspecialty clinics. Longitudinal patient-reported HRQOL was measured at the time of initial assessment and at each follow-up appointment by using the adolescent version (age 13-18 years) of the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale and Cognitive Functioning Scale. RESULTS: A total of 135 patients with SRC (60.0% male; mean age 14.7 years; time from injury to initial assessment 6 days) and 96 patients with SREF (59.4% male; mean age 14.1 years; time from injury to initial assessment 8 days) participated in the study. At the initial assessment, the SRC patients demonstrated significantly worse cognitive HRQOL and clinically meaningful impairments in school and overall HRQOL compared to the SREF patients. Clinical variables associated with a worse HRQOL among SRC patients differed by domain but were significantly affected by the patients' initial symptom burden and the development of delayed physician-documented clinical recovery (> 28 days postinjury). No persistent impairments in HRQOL were observed among SRC patients who were followed up until physician-documented clinical recovery. CONCLUSIONS: Adolescent SRC is associated with temporary impairments in HRQOL that have been shown to resolve in patients who are followed up until physician-documented clinical recovery. Future studies are needed to identify the clinicopathological features that are associated with impaired HRQOL and to assess whether the initiation of multidisciplinary, targeted rehabilitation strategies would lead to an improvement in HRQOL.


Assuntos
Traumatismos em Atletas/complicações , Concussão Encefálica/etiologia , Concussão Encefálica/psicologia , Fraturas Ósseas/etiologia , Qualidade de Vida/psicologia , Adolescente , Transtornos Cognitivos/etiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Fatores de Risco
17.
Brain ; 142(2): 255-262, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30649205

RESUMO

There is a growing demand for objective evaluations of concussion. We developed a portable evoked potential framework to extract 'brain vital signs' using electroencephalography. Brain vital signs were derived from well established evoked responses representing auditory sensation (N100), basic attention (P300), and cognitive processing (N400) amplitudes and latencies, converted to normative metrics (six total). The study evaluated whether concussion-related neurophysiological impairments were detected over the duration of ice hockey seasons using brain vital signs. Forty-seven Tier III, Junior A, male ice hockey players were monitored over two seasons. Twelve sustained concussions after baseline testing then completed post-injury and return-to-play assessments. Twenty-three were not diagnosed with a concussion during the season and completed both baseline and post-season testing. Scores were evaluated using a repeated-measures analysis of variance with post hoc two-tailed paired t-tests. Concussion resulted in significantly increased amplitude and delayed latency scores for all six brain vital signs (P < 0.0001). Importantly, significant changes at return-to-play were also detected in basic attention (P300) amplitude, indicating persistent subclinical impairment. In the non-concussed group, there was also a significant change between baseline and post-season (P = 0.0047), with specific decreases in cognitive processing (N400) speed (P = 0.011) and overall total score (P = 0.002).


Assuntos
Concussão Encefálica/diagnóstico , Concussão Encefálica/fisiopatologia , Encéfalo/fisiopatologia , Hóquei/lesões , Sinais Vitais/fisiologia , Adolescente , Concussão Encefálica/etiologia , Eletroencefalografia/métodos , Potencial Evocado P300/fisiologia , Hóquei/fisiologia , Humanos , Masculino , Adulto Jovem
18.
JAMA Netw Open ; 2(1): e186676, 2019 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-30646193

RESUMO

Importance: Although previous work has examined clinical outcomes in combat-deployed veterans, questions remain regarding how symptoms evolve or resolve following mild blast traumatic brain injury (TBI) treated in theater and their association with long-term outcomes. Objective: To characterize 5-year outcome in patients with nonmedically evacuated blast concussion compared with combat-deployed controls and understand what clinical measures collected acutely in theater are associated with 5-year outcome. Design, Setting, and Participants: A prospective, longitudinal cohort study including 45 service members with mild blast TBI within 7 days of injury (mean 4 days) and 45 combat deployed nonconcussed controls was carried out. Enrollment occurred in Afghanistan at the point of injury with evaluation of 5-year outcome in the United States. The enrollment occurred from March to September 2012 with 5-year follow up completed from April 2017 to May 2018. Data analysis was completed from June to July 2018. Exposures: Concussive blast TBI. All patients were treated in theater, and none required medical evacuation. Main Outcomes and Measures: Clinical measures collected in theater included measures for concussion symptoms, posttraumatic stress disorder (PTSD) symptoms, depression symptoms, balance performance, combat exposure intensity, cognitive performance, and demographics. Five-year outcome evaluation included measures for global disability, neurobehavioral impairment, PTSD symptoms, depression symptoms, and 10 domains of cognitive function. Forward selection multivariate regression was used to determine predictors of 5-year outcome for global disability, neurobehavior impairment, PTSD, and cognitive function. Results: Nonmedically evacuated patients with concussive blast injury (n = 45; 44 men, mean [SD] age, 31 [5] years) fared poorly at 5-year follow-up compared with combat-deployed controls (n = 45; 35 men; mean [SD] age, 34 [7] years) on global disability, neurobehavioral impairment, and psychiatric symptoms, whereas cognitive changes were unremarkable. Acute predictors of 5-year outcome consistently identified TBI diagnosis with contribution from acute concussion and mental health symptoms and select measures of cognitive performance depending on the model for 5-year global disability (area under the curve following bootstrap validation [AUCBV] = 0.79), neurobehavioral impairment (correlation following bootstrap validation [RBV] = 0.60), PTSD severity (RBV = 0.36), or cognitive performance (RBV = 0.34). Conclusions and Relevance: Service members with concussive blast injuries fared poorly at 5-year outcome. The results support a more focused acute screening of mental health following TBI diagnosis as strong indicators of poor long-term outcome. This extends prior work examining outcome in patients with concussive blast injury to the larger nonmedically evacuated population.


Assuntos
Traumatismos por Explosões , Concussão Encefálica , Cognição , Depressão , Equilíbrio Postural , Transtornos de Estresse Pós-Traumáticos , Adulto , Campanha Afegã de 2001- , Traumatismos por Explosões/complicações , Traumatismos por Explosões/diagnóstico , Concussão Encefálica/complicações , Concussão Encefálica/diagnóstico , Concussão Encefálica/etiologia , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/etiologia , Avaliação da Deficiência , Humanos , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/epidemiologia , Efeitos Adversos de Longa Duração/etiologia , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Estudos Prospectivos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Triagem/estatística & dados numéricos , Estados Unidos/epidemiologia
19.
Acta Neurochir (Wien) ; 161(3): 425-433, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30687899

RESUMO

BACKGROUND: When participating in contact sports, (mild) head trauma is a common incident-observed in both professional and amateur sports. When head trauma results in transient neurological impairment, a sports-related concussion has occurred. Acute concussion, repetitive concussions, as well as cumulative "sub-concussive" head impacts may increase the risk of developing cognitive and behavioral deficits for athletes, as well as accelerated cerebral degeneration. While this concept has been well established for classic contact sports like American Football, Rugby, or Boxing, there is still an awareness gap for the role of sports-related concussion in the context of the world's most popular sport-Soccer. METHODS: Here, we review the relevance of sport-related concussion for Soccer as well as its diagnosis and management. Finally, we provide insight into future directions for research in this field. RESULTS: Soccer fulfills the criteria of a contact sport and is characterized by a high incidence of concussion. There is ample evidence that these events cause functional and structural cerebral disorders. Furthermore, heading, as a repeat sub-concussive impact, has been linked to structural brain changes and neurocognitive impairment. As a consequence, recommendations for the diagnosis and management of concussion in soccer have been formulated by consensus groups. In order to minimize the risk of repetitive concussion in soccer the rapid and reliable side-line diagnosis of concussion with adoption of a strict remove-from-play protocol is essential, followed by a supervised, graduated return-to-play protocol. Recent studies, however, demonstrate that adherence to these recommendations by players, coaches, clubs, and officials is insufficient, calling for stricter enforcement. In addition, future research to solidify the pathophysiological relevance of concussion for soccer athletes seems to be needed. Advanced neuroimaging and neurochemical biomarker analyses (e.g. S100ß, tau and neurofilament light (NfL)) may assist in detecting concussion-related structural brain changes and selecting athletes at risk for irreversible damage. CONCLUSION: Sports-related concussion represents a genuine neurosurgical field of interest. Given the high socioeconomic relevance, neurosurgeons should get involved in prevention and management of concussion in soccer.


Assuntos
Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/epidemiologia , Concussão Encefálica/diagnóstico , Concussão Encefálica/epidemiologia , Concussão Encefálica/etiologia , Gerenciamento Clínico , Humanos , Futebol/lesões
20.
J Neuroinflammation ; 16(1): 17, 2019 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-30684956

RESUMO

BACKGROUND: Inflammation is considered a hallmark of concussion pathophysiology in experimental models, yet is understudied in human injury. Despite the growing use of blood biomarkers in concussion, inflammatory biomarkers have not been well characterized. Furthermore, it is unclear if the systemic inflammatory response to concussion differs from that of musculoskeletal injury. The purpose of this paper was to characterize systemic inflammation after injury in athletes with sport-related concussion or musculoskeletal injury. METHODS: A prospective, observational cohort study was conducted employing 175 interuniversity athletes (sport-related concussion, n = 43; musculoskeletal injury, n = 30; healthy, n = 102) from 12 sports at a sports medicine clinic at an academic institution. High-sensitivity immunoassay was used to evaluate 20 inflammatory biomarkers in the peripheral blood of athletes within 7 days of injury (subacute) and at medical clearance. Healthy athletes were sampled prior to the start of their competitive season. Partial least squares regression analyses were used to identify salient biomarker contributions to class separation between injured and healthy athletes, as well as to evaluate the relationship between biomarkers and days to recovery in injured athletes. RESULTS: In the subacute period after injury, compared to healthy athletes, athletes with sport-related concussion had higher levels of the chemokines' monocyte chemoattractant protein-4 (p < 0.001) and macrophage inflammatory protein-1ß (p = 0.001); athletes with musculoskeletal injury had higher levels of thymus and activation-regulated chemokine (p = 0.001). No significant differences in biomarker profiles were observed at medical clearance. Furthermore, concentrations of monocyte chemoattractant protein-1 (p = 0.007) and monocyte chemoattractant protein-4 (p < 0.001) at the subacute time point were positively correlated with days to recovery in athletes with sport-related concussion, while thymus and activation-regulated chemokine was (p = 0.001) positively correlated with days to recovery in athletes with musculoskeletal injury. CONCLUSION: Sport-related concussion is associated with perturbations to systemic inflammatory chemokines that differ from those observed in athletes with a musculoskeletal injury. These results support inflammation as an important facet of secondary injury after sport-related concussion that can be measured systemically in a human model of injury.


Assuntos
Concussão Encefálica/complicações , Concussão Encefálica/etiologia , Quimiocina CCL4/sangue , Proteínas Quimioatraentes de Monócitos/sangue , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Traumatismos em Atletas/complicações , Feminino , Humanos , Masculino , Doenças Musculoesqueléticas/sangue , Índice de Gravidade de Doença , Fatores Sexuais , Adulto Jovem
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