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Prog Neurol Surg [journal]
- Future directions in brain injury research. [Journal Article]
- Prog Neurol Surg 2014.:243-50.
This paper reviews the potential future directions that are important for brain injury research, especially with regard to concussion. The avenues of proposed research are categorized according to current concepts of concussion, types of concussion, and a global schema for globally reducing the burden of concussion.
- Neurodegenerative changes after mild traumatic brain injury. [Journal Article]
- Prog Neurol Surg 2014.:234-42.
A link between mild traumatic brain injury (mTBI) and neurodegenerative diseases, specifically Alzheimer's disease and chronic traumatic encephalopathy (CTE), has long been suspected. Shared clinical symptomology - most notably the prominent role of central auditory dysfunction and sleep-wake disturbances in both disease states - and similar findings on postmortem pathological examination has further reinforced suspected commonality between these seemingly disparate entities. However, conventional imaging techniques, including computed tomography and anatomic magnetic resonance, are unable to detect the symptomatic injuries in mTBI patients and therefore detection of neurodegenerative changes in vivo has previously not been reported. Recent research using diffusion tensor imaging, a novel imaging technique, and focused on patient-reported symptoms has for the first time demonstrated imaging findings in mTBI patients in vivo that are strikingly similar to Alzheimer's dementia and CTE. Moving forward, research will focus on identifying what renders certain patients with mTBI susceptible to developing full-fledged Alzheimer's disease and CTE later in life.
- Detecting eye movement abnormalities from concussion. [Journal Article]
- Prog Neurol Surg 2014.:226-33.
An attention-based biomarker may be useful for concussion screening. A key role of attention is to generate time-based expectancies of specific sensory information, and it is postulated that postconcussion cognitive impairments and symptoms may stem from a primary deficit in this predictive timing mechanism. There is a close relationship between gaze and attention, but in addressing predictive timing, there is a need for an appropriate testing paradigm and methods to quantify oculomotor anomalies. We have utilized a continuous predictive visual tracking paradigm because human visual tracking requires predicting the temporal course of a stimulus and dynamically synchronizing the required action with the stimulus. We have shown that concussion patients often show disrupted gaze-target synchronization characterized by large gaze position error variability and overall phase advancement. Various attention components interact with visual tracking, and thus there is a possibility that different neurological and physiological conditions produce identifiable visual tracking characteristics. Analyzing neuromotor functions, specifically oculomotor synchronization, can provide a fast, accurate, and reliable assessment of cognitive functions.
- Vulnerability in speed of visuomotor ability. [Journal Article]
- Prog Neurol Surg 2014.:213-25.
The aim of this report is to illustrate the utility of neurocognitive testing as an investigative method to establish the presence of persistent effects of concussive brain injury amongst players of a contact sport with high risk of such injury. The report reviews the outcomes of three previously published neuropsychological studies on South African Rugby Union (hereafter 'rugby') from school through to the national adult level. The diagnostic utility of differential effects per se, as well as differential practice effects on visuomotor function, as a means of distinguishing poorer neurocognitive outcome for rugby versus demographically equivalent noncontact sports players, is described. From various methodological angles, at each level of play, the reviewed studies attest to the presence of long-term vulnerability in visuomotor speed in association with participation in rugby, in turn implicating diffuse frontotemporal dysfunction due to repetitive concussive and subconcussive injury amongst rugby players. As visuomotor speed is a prime function called upon for optimal scholastic and occupational performance, the robustly demonstrated decrement is of immediate clinical importance. Of critical heuristic relevance, however, is evidence of residual brain dysfunction in association with rugby as early as school level, which may ultimately be the precursor of chronic traumatic encephalopathy.
- The multidisciplinary concussion management program. [Journal Article]
- Prog Neurol Surg 2014.:195-212.
Over the past decade, research has increased scientific and public knowledge about the importance of identification and proper management of concussion. These concerns have prompted many state, regional, and private organizations to mandate the creation of, and strict adherence to, concussion management protocols, particularly with regard to sport-related concussion and subsequent return to play. Because of the individualized nature of the concussive injury and its recovery, a multidisciplinary approach provides comprehensive patient care that best addresses treatment and management of changing symptoms and their impact on multiple aspects of a patient's life and overall function. The current report will explore a model of multidisciplinary concussion management from program establishment and baseline testing to recovery from chronic postconcussion symptoms.
- Developing an interdisciplinary community-based sports concussion management program. [Journal Article]
- Prog Neurol Surg 2014.:184-94.
The increasing incidence and associated consequences of sport-related concussion have been at the forefront of public health concerns in recent years, prompting the need for safe and effective management guidelines and availability of appropriately trained healthcare providers. In this report we provide practical and user-friendly information regarding several important factors to consider when developing a sports concussion program, including how to select relevant team members, assess community needs and available resources, provide concussion education, secure and nurture partnerships with athletic programs, implement management strategies that align with current practice standards, and cater to athletes' unique needs in terms of program accessibility. It is hoped that the knowledge shared and proposed recommendations will be beneficial for guiding both newly developing and established concussion programs alike.
- Management of concussion in the professional football player. [Journal Article]
- Prog Neurol Surg 2014.:171-83.
There is no other sport that has come under greater scrutiny surrounding the incidence and treatment of concussion than football, and there is no other professional sports league that has experienced more intense focus of its handling of concussions than the National Football League (NFL). The NFL has received significant criticism of their management of concussion in players from both the popular press and the medical community. However, those working with active NFL players have changed their assessment and treatment of these injuries as the knowledge of concussions has evolved over time. We review the current approach to the management of concussions in the professional football player.
- Concussion in ice hockey. [Journal Article]
- Prog Neurol Surg 2014.:161-70.
Ice hockey is an aggressive and fast-paced sport which has a high risk of injury, concussions in particular. Although serious head injury has been recognized for nearly 50 years, an increase in mainstream media attention in recent years has led to unprecedented public awareness. As a result, the National Hockey League (NHL) and other professional leagues around the world have initiated concussion protocols in order to better prevent, recognize, and treat concussions. With over 1,000,000 youth hockey participants in Canada and the USA combined, concussion is an issue that reaches beyond the professional level. In this report we review the incidence, evaluation, treatment, return-to-play protocol, and prevention efforts related to concussion in ice hockey.
- Rehabilitation from postconcussion syndrome: nonpharmacological treatment. [Journal Article]
- Prog Neurol Surg 2014.:149-60.
Following mild traumatic brain injury (mTBI), one or more symptoms commonly occur that are known as the postconcussion syndrome (PCS). While PCS typically resolves within a few weeks of injury for most concussed patients, some patients have a more prolonged or otherwise adverse recovery course. There is relatively little systematic research on the treatment of PCS. This report offers strategies for nonpharmacological treatment of PCS during the acute, subacute, and chronic stages of recovery following mTBI. The treatment strategies are supported by clinical consensus and the limited evidence-based research wherever possible. Core treatment strategies emphasize (1) education about mTBI, PCS, and the natural recovery course, (2) reassurance of a good outcome, (3) reduction in activity level and refrain from hazardous behaviors during the acute phase, (4) gradual return to lifestyle activities as symptoms permit, (5) careful monitoring and early intervention for adverse emotional responses, (6) symptom-specific treatment when needed, and (7) ready access to providers during acute and subacute recovery periods.
- Treating prolonged symptoms of mild traumatic brain injury: neuropharmacology. [Journal Article]
- Prog Neurol Surg 2014.:139-48.
The clinical presentation of concussion can vary widely as patients experience any number of symptoms including headache, dizziness, cognitive symptoms of difficulty with concentration and memory, sleep dysregulation, and mood disturbances. The variability in clinical presentation underscores the importance of thorough history-taking to clearly understand the clinical picture and to allow individualization of the treatment plan. Most postconcussive symptoms are transient in nature and respond to conservative measures, including education of the patient and their caregivers. For those individuals whose symptoms persist or significantly impair quality of life, pharmacologic intervention may be warranted. Though few studies have investigated the use of pharmacology for treatment of postconcussion syndrome specifically, targeted treatment of medications known to improve selected symptoms can be considered.