Rates of Invalid Baseline Concussion Testing May Be Alarmingly High

MedicalResearch.com Interview with:

Christopher Abeare, Ph.D. Associate Professor Clinical Neuropsychology Department of Psychology University of Windsor Windsor, Ontario

Dr. Christopher Abeare

Christopher Abeare, Ph.D.
Associate Professor
Clinical Neuropsychology
Department of Psychology
University of Windsor
Windsor, Ontario

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: In this study, we examined the prevalence of invalid performance on baseline neurocognitive testing in sport concussion. Baseline testing is a commonly employed practice in which the cognitive abilities of athletes are assessed pre-season. These baseline test results are then used as a point of comparison against which post-injury neurocognitive test results can be compared, thereby creating a more individualized approach to the assessment of neurocognitive functioning.

However, there has been growing concern about the validity of baseline test results, meaning that there is concern over the degree to which the scores on these baseline tests actually reflect an athlete’s true cognitive ability. There are many reasons why their test scores might not reflect their actual ability, ranging from inattentiveness during testing and lack of appreciation of the importance of doing their best on testing to intentional underperformance (aka “sandbagging” or malingering).

As a result of these concerns, 4 different validity measures have been developed. We compared these 4 validity measures, head to head, in a sample of 7897 athletes aged 10 to 21 years.

We found that 56% of athletes failed at least 1 of these validity measures, suggesting that as many as 56% of  athletes have scores that may not reflect their true ability level. We then tested the hypothesis that age would be related to the proportion of athletes with invalid performance. Our findings supported this hypothesis in that nearly 84% of 10-year-olds failed at least one validity measure and 29% of 21-year-olds failed at least one.  Continue reading

Pre-Clinical Study of Tbit™ System for Detection of Traumatic Brain Injury

MedicalResearch.com Interview with:

Sergey A. Dryga, PhD, MBA Chief Scientific Officer BioDirection, Inc.

Dr. Sergey Dryga

Sergey A. Dryga, PhD, MBA
Chief Scientific Officer
BioDirection, Inc. 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: When patients have suffered a head injury, they typically undergo a series of subjective cognitive tests to confirm a diagnosis of a concussion or other traumatic brain injury. In many cases these tests are inaccurate and inconsistent, increasing the risk of misdiagnosis. In other cases, patients may undergo an unnecessary CT scan, which is costly and exposes them to radiation. Early, objective diagnostic testing of patients who have experienced a head injury can support more rapid and appropriate treatment decisions while potentially reducing the use of unnecessary CT scans or other forms of intervention.

We know that protein biomarkers, including S100 calcium binding protein beta (S100β) and glial fibrillary acidic protein (GFAP), are released from the brain into the bloodstream immediately following a concussion or other traumatic brain injury. The Tbit™ System is a new medical device based on a nanotechnology biosensor that rapidly detects and accurately measures these protein biomarkers. The system includes a disposable cartridge and portable analyzer designed for testing using a single drop of blood at the earliest stages of a concussion.

This pre-clinical study was designed to evaluate the ability of the Tbit System to screen traumatic brain injury patients for a CT positive or CT negative test. Frozen plasma samples were collected from a total of 100 patients who had undergone CT scans post hospital admission. The Tbit System demonstrated 100% sensitivity with no false negative results, and a 41% specificity level.

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White Matter Trajectories Diverge In Children After Traumatic Brain Injury

MedicalResearch.com Interview with:

Emily Dennis Postdoctoral Scholar Imaging Genetics Center Mark and Mary Stevens Neuroimaging and Informatics Institute USC

Emily Dennis

Emily Dennis PhD
Postdoctoral Scholar
Imaging Genetics Center
Mark and Mary Stevens Neuroimaging and Informatics Institute
USC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know that there is heterogeneity in outcome post-traumatic brain injury (TBI), but we generally think of this as a continuous variable – with most patients falling in the middle and only a few at the extremes in terms of recovery process and outcome.

Our main finding was that interhemispheric transfer time (IHTT – the time it takes for information to move from one hemisphere of the brain to the other) identified 2 subgroups of TBI patients – those with slow IHTT and those with normal IHTT. These two groups show differences in cognitive function and brain structure, with the IHTT slow group showing structural disruptions that become progressively worse while the IHTT normal group seems to be recovering from the injury.

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Female Soccer Players Have High Risk of Concussion

MedicalResearch.com Interview with:

Wellington K. Hsu, MD Clifford C. Raisbeck, MD, Professor of Orthopaedic Surgery Associate Professor of Orthopaedic Surgery Northwestern University Chicago, IL

Dr. Hsu

Wellington K. Hsu, MD
Clifford C. Raisbeck, MD, Professor of Orthopaedic Surgery
Associate Professor of Orthopaedic Surgery
Northwestern University
Chicago, IL

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Concussions remains a significant problem in youth sports. The recent enactment of Traumatic brain injury laws have certainly heightened awareness regarding this problem. Our study looked at publicly available data regarding diagnosis of concussion in high school athletes. We found that females are more likely to be diagnosed with a concussion than males. We also concluded that girl soccer players and boys football players are at highest risk for a diagnosis of concussion. Since the neck meant of the Traumatic brain injury state laws, the diagnosis of concussion in this patient group increased significantly past decade.

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When Is It Safe To Drive After a Concussion?

MedicalResearch.com Interview with:

Julianne Schmidt, PhD, ATC Assistant Professor Department of Kinesiology The University of Georgia Athens GA

Dr. Julianne Schmidt

Julianne Schmidt, PhD, ATC
Assistant Professor
Department of Kinesiology
The University of Georgia
Athens GA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Less than half of all people with a concussion intend to reduce their driving at any point.

Current recommendations surrounding concussion focus on when it is safe to return to sport or return to the classroom, but return to driving is usually ignored and has not been studied.
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Early Participation in Physical Activity Following Acute Concussion in Children

MedicalResearch.com Interview with:

Roger Zemek, MD, FRCPC Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa Director, Clinical Research Unit, Children’s Hospital of Eastern Ontario Ottawa, ON

Dr. Roger Zemek

Roger Zemek, MD, FRCPC
Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa
Director, Clinical Research Unit,
Children’s Hospital of Eastern Ontario
Ottawa, ON

MedicalResearch.com: What is the background for this study?

Response: While current concussion protocols endorse the conservative view that children should avoid physical activity until completely symptom-free, there is little evidence beyond expert opinion regarding the ideal timing of physical activity re-introduction. In fact, while rest does play a role in concussion recovery, protracted physical rest may actually negatively impact concussion recovery. Further, physiological, psychological, and functional benefits of early physical rehabilitation are observed in other disease processes such as stroke (which is an example of a severe traumatic brain injury). Therefore, our objective was to investigate the relationship between early physical activity (defined within 7 days of the concussion) and the eventual development of persistent post-concussion symptoms at one month.

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Longitudinal Study of Post-Concussion Syndrome: Not Everyone Recovers

MedicalResearch.com Interview with:
Dr. Charles Tator, Neurosurgeon

Toronto Western Hospital and Director
Canadian Concussion Centre 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The main findings of this study are that the number of symptoms of post-concussion syndrome (PCS) are related to how long PCS lasts. Furthermore, physicians need to be more vigorous in their treatment of PCS symptoms and use the treatments that exist for each symptom where possible such as headache, vertigo, anxiety. The sooner sufferers of PCS receive treatment for their symptoms, the better.

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Postconcussion Symptoms Negatively Impact Pediatric Quality of Life

MedicalResearch.com Interview with:

Roger Zemek, MD, FRCPC Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa Director, Clinical Research Unit, Children’s Hospital of Eastern Ontario Ottawa, ON

Dr. Roger Zemek

Roger Zemek, MD, FRCPC
Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion
University of Ottawa
Director, Clinical Research Unit
Children’s Hospital of Eastern Ontario
Ottawa, ON

MedicalResearch.com: What is the background for this study?

Response: Concussion remains a major public health concern in children. Approximately 30% of affected children experience persistent post-concussive symptoms (PPCS) for at least one month post-injury. These symptoms may negatively impact their health related quality of life. Examples may include cognition, memory and attention affecting school attendance and performance, mood and social engagement, as well as physical performance. Prior to this study, there was little evidence that examined the relationship between PPCS and quality of life following concussion. This was important to better understand in order to provide appropriate interventions, expectation management and ultimately a better standard of care to affected patients and their families.

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Return to Normal Activity After Concussion Does Not Worsen Symptoms For Most Patients

MedicalResearch.com Interview with:

Danny G. Thomas, MD, MPH Department of Pediatrics, Emergency Medicine Children’s Hospital of Wisconsin Corporate Center Milwaukee, WI

Dr. Danny Thomas

Danny G. Thomas, MD, MPH
Department of Pediatrics, Emergency Medicine
Children’s Hospital of Wisconsin Corporate Center
Milwaukee, WI

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This was a secondary analysis of a randomized controlled trial of strict rest after concussion published last year. We wanted to find out how mental and physical activity levels related to symptom spikes or sudden increases in concussion symptoms. We found that one in three patients had symptoms spikes in recovery. Patients who had symptom spikes tended to have higher symptoms in the emergency department and throughout recovery. Most symptom spikes were not associated with an increase in physical and mental activity level the day prior. We did find that a sudden increase in activity like returning to school did increase the risk of having a symptom spike, but the good news is these symptom spikes seemed to resolve the following day and did not impact recovery by 10 days.

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Does Complete Rest In a Dark Room Help or Hurt Concussion Recovery?

MedicalResearch.com Interview with:

Thomas A. Buckley Ed.D Assistant Professor Kinesiology & Applied Physiology 144 Human Performance Lab College of Health Sciences University of Delaware

Dr. Thomas Buckley

Thomas A. Buckley Ed.D
Assistant Professor
Kinesiology & Applied Physiology
144 Human Performance Lab
College of Health Sciences
University of Delaware

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Buckley: The most recent international consensus statement recommends 24 – 48 hours of cognitive and physical rest in the immediate aftermath of a concussion; however, our clinical experience was that patients who were “shut down” for a few days did worse than patients who were allowed to be out and about as tolerated by symptoms.  This was a retrospective study (chart review) comparing symptom reporting among patients who were shut down for 24 hours and those who were not.

The main finding of the study was the addition of a day of cognitive and physical rest (i.e., ‘shut down”) did not improve symptom recovery recovery.  In fact, we were surprised to see that the non-rest group was symptom free 1.3 days sooner than the rest group and this was statistically significant.

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NFL Players: Concussions With Loss Of Consciousness Linked To Later Memory Problems and Brain Changes

C. Munro Cullum, PhD, ABPP Professor of Psychiatry and Neurology & Neurotherapeutics Pamela Blumenthal Distinguished Professor of Clinical Psychology Chief of Psychology Director of Neuropsychology Univ. of Texas Southwestern Medical Center Dallas, TX  75390-9044 MedicalResearch.com Interview with:
C. Munro Cullum, PhD, ABPP
Professor of Psychiatry and Neurology & Neurotherapeutics
Pamela Blumenthal Distinguished Professor of Clinical Psychology
Chief of Psychology , Director of Neuropsychology
Univ. of Texas Southwestern Medical Center Dallas, TX

Medical Research: What is the background for this study? What are the main findings?

Dr. Cullum: My colleague and principal investigator of the study, Dr. John Hart and I have been interested in the acute and longer-term effects of traumatic brain injury for years, and because of my roles in the Alzheimer’s Disease Center and the Texas Institute for Brain Injury and Repair at the University of Texas Southwestern Medical Center, it seemed like a natural to begin studying older individuals with and without cognitive disorder who have a history of traumatic brain injury.  Our main findings are two-fold:

First, we demonstrated that a history of concussion with loss of consciousness (which make up only about 10% of all concussions) was associated with smaller memory centers in the brain (the hippocampus) and lower memory results in our sample of retired professional football players. Concussions that did not result in loss of consciousness did not show that same strong association.

Second, our data suggest that patients with a clinical diagnosis of mild cognitive impairment (ie a memory disorder that does not grossly impair overall functioning but may lead to dementia) who also have a history of concussion with loss of consciousness show worse memory results and more brain atrophy than similar individuals diagnosed with mild cognitive impairment in the absence of a history of concussion.

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Post Concussion: Returning To Activity Brings Variable Risks

Li-Shan Chou, Ph.D Professor and Department Head Department of Human Physiology University of Oregon Eugene, OR 97403-124MedicalResearch.com Interview with:
Li-Shan Chou, Ph.D
Professor and Department Head Department of Human Physiology
University of Oregon Eugene, OR 97403-1240

Medical Research: What are the main findings of the study?

Prof. Li-Shan Chou: The findings from this study indicate that pre return-to-activity (RTA), the adolescents with concussion reduced their medial/lateral displacement and velocity during dual-task walking, suggesting an improvement in gait balance control, while significantly increasing these frontal plane motion variables during dual-task walking post RTA, suggesting a worsening of frontal plane COM control following RTA. These data suggest that frontal plane motion during dual-task walking are sensitive to the effects of return to activity following concussion and may reveal a possible regression in gait stability following return to activity.
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Post-Concussion Symptoms Mimic Post Traumatic Stress Syndrome

MedicalResearch.com Interview with: Emmanuel Lagarde Director of Research at INSERM, France  Medical Research: What are the main findings of the study?  Dr. Lagarde: Concussion accounts for more than 90 percent of all traumatic brain injuries, although little is known about prognosis for the injury. The symptoms cited as potentially being part of post concussion syndrome fall into three areas: cognitive, somatic and emotional. But the interpretation of symptoms after concussion should also take into account that injuries are often sustained during psychologically distressing events which can lead to Posttraumatic Stress Disorder.    Medical Research: Were any of the findings unexpected?  Dr. Lagarde: Yes, as we were expecting to observe long term (3-month) symptoms following brain injury, but few were found to be specific : most of them were as frequent among patients with other injuries.  Medical Research: What should clinicians and patients take away from your report?  Dr. Lagarde: It seems as if there is little evidence of the existence of a specific syndrome following mild traumatic brain injury. However, patients who experienced a concussion are at risk of  another well-known syndrome called Posttraumatic Stress Disorder, which is associated with the distressing event that led to the injury.  Medical Research: What recommendations do you have for future research as a result of this study?  Dr. Lagarde: The classification system of symptoms following mild brain injury should be revisited as our results are challenging the very relevance of the DSM-V post concussion syndrome.  Citation: Association of Symptoms Following Mild Traumatic Brain Injury With Posttraumatic Stress Disorder vs Postconcussion SyndromeMedicalResearch.com Interview with:
Emmanuel Lagarde
Director of Research at INSERM, France

Medical Research: What are the main findings of the study?

Dr. Lagarde: Concussion accounts for more than 90 percent of all traumatic brain injuries, although little is known about prognosis for the injury. The symptoms cited as potentially being part of post concussion syndrome fall into three areas: cognitive, somatic and emotional. But the interpretation of symptoms after concussion should also take into account that injuries are often sustained during psychologically distressing events which can lead to Posttraumatic Stress Disorder.

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Tackle Football Linked to Smaller Hippocampal Volume and Slower Reaction Times

Patrick S. F. Bellgowan, PhD Laureate Institute for Brain Research Faculty of Community Medicine, The University of Tulsa, Tulsa, OklahomaMedicalResearch Interview with:
Patrick S. F. Bellgowan, PhD
Laureate Institute for Brain Research
Faculty of Community Medicine, The University of Tulsa,
Tulsa, Oklahoma


MedicalResearch: What are the main findings of the study?

Dr. Bellgowan: These results demonstrate 14% and 24% smaller hippocampal volumes in collegiate football players with and without a history of concussion relative to education-, sex- and age-matched controls participants.  Further, the number of years of tackle football experience was correlated with smaller hippocampi and slower baseline reaction times.  The hippocampus plays a key role in memory and emotional regulation.  Volumetrics of other medial temporal lobe structures (I.e. The amygdala) did NOT show differences among groups suggesting that this effect is localized to the hippocampus.
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Sports-Related Concussion Diagnosis Using Blood Biomarker Tau

Pashtun Shahim, MD Clinical Neurochemistry Laboratory Institute of Neuroscience and Physiology Department of Neurochemistry Sahlgrenska University Hospital, Mölndal SwedenMedicalResearch.com Interview with:
Pashtun Shahim, MD
Clinical Neurochemistry Laboratory
Institute of Neuroscience and Physiology
Department of Neurochemistry
Sahlgrenska University Hospital, Mölndal
Sweden

MedicalResearch.com: What are the main findings of the study?

Dr. Shahim: Sports-related concussion in professional ice hockey players is associated with acute axonal and astroglial injury. Plasma total tau, which is a highly central nervous system-specific protein, is a promising biomarker to be used both in the diagnosis of concussion and in the decision-making when an athlete can be declared fit to return to play.
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Football Helmet Types: Large Differences in Concussion Risk

Steven Rowson, Ph.D. Research Assistant Professor Virginia Tech Wake Forest UniversityMedicalResearch.com Interview with:
Steven Rowson, Ph.D.
Research Assistant Professor
Virginia Tech
Wake Forest University

 

A significant difference in concussion risk was found between these two helmet designs Riddell Revolution (left) and the Riddell VSR4 (right).  Virginia Tech

A significant difference in concussion risk was found between these two helmet designs Riddell Revolution (left) and the Riddell VSR4 (right).
Virginia Tech

MedicalResearch.com: What are the main findings of the study?

Dr. Rowson: We found that there were large differences in concussion risk between football helmet types.  This is the first study to address this question while controlling for the number of times each helmet type was impacted.

This allowed us to compare apples to apples.  For example, we’re not comparing starters who frequently get hit in one helmet type to second string players who don’t get hit as much.
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Post Concussion: Cognitive Rest Beneficial for Recovery

William P. Meehan III, MD Director, Micheli Center for Sports Injury Prevention Director, Sports Concussion Clinic, Boston Children?s Hospital 9 Hope Avenue, Suite 100 Waltham, MA 02453MedicalResearch.com Interview with:
William P. Meehan III, MD
Director, Micheli Center for Sports Injury Prevention
Director, Sports Concussion Clinic, Boston Children?s Hospital
Waltham, MA 02453

MedicalResearch.com: What are the main findings of this study?

Dr. Meehan: The study has 2 findings that I believe are the most worthy of attention.  First, although cognitive rest has been recommended as a therapy for concussion for several years now, there has been little data showing its effect. This lack of data has led to variability in the recommendations for cognitive rest, with some experts not recommending it all, and others recommending athletes avoid all cognitive activity, lying alone in a dark room even, until they are completely recovered.  As you can imaging, this has generated controversy.  We believe this is the first study showing the independent, beneficial effect of limiting cognitive activity on recovery from concussion.
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Concussion: Gray Matter Abnormalities vs Self-Reported Symptoms

Dr. Andrew R.  Mayer, PhD The Mind Research Network Lovelace Biomedical and Environmental Research InstituteMedicalResearch.com Interview with:
Dr. Andrew R.  Mayer, PhD

The Mind Research Network Lovelace Biomedical and Environmental Research Institute

 

MedicalResearch.com: What are the main findings of the study?

Dr. Mayer:

a)     Just because mTBI patients self-report reduced and/or no post-concussive symptoms does not mean that they have completed the healing process.
b)     Current gold-standards in the clinical world (CT scans and self-report) may not be accurately capturing brain health after injury.
c)     Diffusion imaging shows promise for being a more sensitive biomarker for measuring recovery than currently used techniques.
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Depressive symptoms and white matter dysfunction in retired NFL players with concussion history

MedicalResearch.com eInterview with:

John Hart, M.D. Medical Science Director at the Center for BrainHealth Jane and Bud Smith Distinguished Chair Cecil Green Distinguished Chair The University of Texas at DallasJohn Hart, M.D.
Medical Science Director at the Center for BrainHealth
Jane and Bud Smith Distinguished Chair
Cecil Green Distinguished Chair
The University of Texas at Dallas

MedicalResearch.com: What are the main findings of the study?

Dr. Hart: Football players often sustain numerous concussive and subconcussive impacts—head impacts that do not elicit neurologic symptoms that may lead to white matter damage. We evaluated a population of retired NFL players in order to study the relationship between white matter integrity and the manifestation of depressive symptoms. We identified, for the first time, a correlation between depression and white matter abnormalities in former players with a remote history of concussion using diffusion tensor imaging (DTI).

Our data demonstrated a significant association between white matter integrity, as measured by DTI Fractional Anisotropy (FA), and the presence as well as severity of depressive symptoms in retired NFL athletes with a history of concussive or subconcussive impacts. We also found that dysfunction of the anterior aspect of the corpus callosum (forceps minor) and its projections to the frontal lobe can identify those with depression with 100% sensitivity and 95% specificity.

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