Name: a neuroscientific approach to the examination of concussions in student-athletes
Uploaded: 2014-12-08T14:00:00.000+00:00
Duration: 11 min 32 s
Description: Watch this Scientific Journal Video about A Neuroscientific Approach to the Examination of Concussions in Student-Athletes at JoVE.com

This study was supported by grants from the American Medical Society for Sports Medicine. The authors would like to acknowledge and show our appreciation for our undergraduate research students including David Lawton, Drew Gardner, Mark Sundman, Kelsey Evans, Graham Cochrane, Jordan Cottle and Jack Halligan for their assistance in data collection over the past four years.

아래에 설명 된 모든 절차는 엘론의 임상 시험 심사위원회의 승인되었습니다. 1. 전산화 신경인지 검사 <ol><li> 질문 참가자는 컴퓨터 앞에 앉아있다. 시스템에 참가자를 기록하고 인구 통계 학적 및 배경 정보 섹션,자가보고 증상 체크리스트, 6 모듈 (워드 차별, 디자인 메모리, X의와 O의 기호 매칭, 색상 일치로 구성 전산화 신경 심리 테스트를 완료하도록 지시하고, 세 글자). </li><li> 요약 보고서를 다운로드 및 언어 적 기억, 시각 기억, 반응 시간 및 모터 처리 속도에 대한 네 가지 복합 점수를 입력합니다. </li></ol> 2. 이벤트 관련 전위 <ol><li> EEG 그물의 크기는 사용되는 결정하기 위해 측정하는 테이프를 사용하여 둘레 머리를 측정합니다. 해부학 적 랜드 마크를 측정하여 EEG 그물의 위치를​​ 결정합니다. </li><li> 그래서에서 EEG 그물을 적시염화나트륨과 5 분 아기 샴푸의 기술인 것. </li><li> 참가자의 머리에 뇌파 그물을 놓습니다. 우리가 사용하는 시스템은 32 개 채널을 포함한다. </li><li> 컴퓨터에서 사이트의 임피던스 수준을 확인합니다. 우리의 시스템의 경우, 100 킬로 오옴 이하 임피던스는 허용되는 것으로 간주된다. </li><li> 인지 적 작업을 설명하고 참가자가 각 작업을 연습 할 수 있습니다. <ol><li> 청각 괴짜 작업 : 헤드폰에 넣고 테이블에 편안하게 앉아있는 참가자를 지시한다. 그들은 낮은과 높은 톤의 시리즈를들을 수 고주파 청각 톤 버튼을 클릭하여 신속하고 가능한 한 정확하게 응답 할 것을 그들에게 알려주십시오. </li><li> 측면에 붙인 작업 : 그들이 화면에 영사 화살표의 시리즈를 제공 할 위치를 컴퓨터 화면 앞에 앉아 참가자를 지시합니다. 이 왼쪽을 가리키는 경우 마우스 왼쪽 버튼을 클릭하거나 장비를 가리키는 경우 마우스 오른쪽 버튼을 클릭하여 중간 화살표 방향에 대응하는 참가자 지시신속하고 정확하게 가능한 HT. </li></ol></li><li> 청각 괴짜 작업과 우 측면에 작업 모두 두 가지 시험을 완료하기 위해 참가자를 지시한다. </li><li> 참가자 EEG 그물을 제거하고 10 분 동안 살균제 소독제에 몸을 담글하여 EEG 그물을 청소합니다. </li></ol> 3. 체성 지각 응답 <ol><li> 감각 자극 장치에 쉬고 복와 그들의 왼손으로 편안 참가자 시트와 그들의 손가락 자극 프로브와 접촉하여 배치 숫자 (2) 및 (3)의 패딩 팁 장치의 윤곽을 따라 위치. 23 </li><li> 컴퓨터 모니터에 작업 관련 지침과 단서를 확인하고 두 버튼 컴퓨터 마우스를 사용하여 응답을 입력 할 참가자를 요청합니다. 프로젝트 5 가지 시험 :이 단순한 단일 부위 반응 시간 작업 현장 듀얼 진폭 차별, 단일 사이트 자극, 24과 24 적응 듀얼 사이트 진폭 태스크시간적 순서 판단 작업. (25) </li><li> 전에 각 테스트 실행의 시작에, 컴퓨터의 큐는 작업에 익숙해 연습 시험을 완료하기 위해 참가자를 지시합니다. 컴퓨터 (; 잘못된 예 올바른) 각 시험 후 참가자 성능 피드백을 제공 할 것입니다. </li></ol> 4. 균형 프로토콜 <ol><li> 미끄럼 방지 양말에 넣어 참가자를 지시 한 다음 장비에 익숙해되기 위해 균형 시스템에 서있다. </li><li> 화면의 중앙 점과 압력 점의 중심을 일치, 편안한 자세로 서서 참가자를 지시한다. 연구진은 장치에 서있는 동안 모든 테스트가 동일한 발 위치에 자리를 차지할 있도록이 편안하게 시작 위치를 기록합니다. </li><li> 네 가지 조건 각각에 대해 30 초 동안 서 참가자에게 질문 (오픈 눈 / 회사 표면, 눈은 거품 표면 / 눈을 감 으면, / 회사 표면을 눈을 감고 열기 / 거품면). 참가자들에게 각 조건 및 각 기록의 시작하기 전에 3 초 카운트 다운 사이에 10 초 휴식을 제공합니다. </li><li> 보조 작업을 완료하는 동안 각 조건을 반복합니다. 그들 (예를 들어, 843)에 주어진 임의의 3 자리 숫자에서 7 시작하여 거꾸로 계산하도록 지시합니다. </li><li> 흔들림 지수를, 추가 분석을 위해 나중에 사용하기 위해 각 압력 조건과 데이터 센터를위한 흔들림 량의 표준 편차의 측정 값을 기록한다. </li></ol> 5. 보행 평가 <ol><li> 참가자의 footfalls를 감지 카펫의 길이에 걸쳐 현재의 압력 센서와 긴 카펫 계측 보행 분석 시스템 &#39;휴대용 15 사용하여 보행&#39;을 참가자를 평가합니다. </li><li> 매트를 떠난 후 &#39;매트의 시작과 3 전&#39;3의 거리에서 시작하여 편안한 속도로 매트 맨발에 걸쳐 다섯 번 걸어 참가자를 요청합니다. </li><li> participa 지시동시인지 이중 작업으로 임의의 3 자리 숫자에서 일곱에 의해 거꾸로 계산하는 동안 국세청은 추가로 5 도보 시험을 완료합니다. </li><li> 보행 분석에서 출력으로 얻은 종속 변수는 속도, 케이던스 단계 길이 등 여러 시공간 매개 변수의 절대 및 변동성 조치를 포함한다. </li></ol> 6. 유전학 <ol><li> (단 면봉 스틱의 스틱 끝을 터치에주의하면서), 조심스럽게 무균 용기에있는 면봉 스틱을 제거하는 참가자에게 물어 자신의 입으로 면봉을 이동하고, 적극적으로 20 초 총 두 뺨의 안쪽에 면봉을 문질러 . </li><li> 라텍스 또는 니트릴 장갑을 착용 기술자에 면봉 스틱을 손입니다. 만 스틱 끝을 잡고 즉시 얼음에 배치, (식별 번호 만 표지) 멸균 1.7 ML 튜브에 면봉 팁을 배치합니다. </li><li> 24 시간 전송 내에서 시료는 -20 ° C 냉장고에 있습니다. </li><li> DNA를 사용하여 추출제조사의 프로토콜에 따라 표준 DNA 정제 키트. 농축 된 샘플을 얻기 위해, 추출 후, 이소프로판올 침전 단계를 수행하고 EDTA 완충액 (pH 8.0) 20 μL에 DNA를 재수. </li><li> 형광 태그 표준 폴리머 라제 연쇄 반응 (PCR) 분석을 이용하여 유전자형을 분석 할 때까지 -80 ° C에서 추출 된 DNA를 저장한다. </li><li> PCR 소프트웨어에 의한 유전자형을 &quot;전화&quot;다음 PCR 증폭 플롯을 확인하여 수동으로 확인합니다. </li></ol>

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The authors declare that they have no competing financial interests.

기준선 진동 시험이 다차원 접근법의 목적은 두 가지이다 : 1) 더 신경근 시스템 뇌진탕 (급성 및 장기)의 영향을 이해하기 위해; 2) 스포츠 의학 직원 메이크업 복귀 결정 (맥 크로 리에서 제시 한 바와 같이 그들은 주로 신경인지 검사를 사용한다). (26) 평가 뇌진탕의 원인, 기능 변경 및 복구에 관한 유용한 정보를 제공 뇌진탕 할 수있는 이러한 다각적 인 접근 방식을 재생할 수 있도록 도?...

진탕 미국에서 놀라운 속도로 발생하고 공중 보건 문제로 주목 꽤 많이 얻고있다. 질병 통제 및 예방 (CDC) 1-3 미국 센터 1.6-3800000 뇌진탕 스포츠 및 레크리에이션 활동에서 발생하는 것으로 추정 매년. 2013 뇌진탕 합의 문 (2)에 의해 정의 된 4,5 뇌진탕은 &quot;하나의 머리에 전달 &#39;충동&#39;힘으로 몸에 다른 곳에서 머리, 얼굴, 목, 또는에 직접 타격에 의해 발생할 수 있습니다.&quot;뇌진탕 월 기능 장애 발생할 수 있습니다 신경 병리학 및 / 또는 substructural 변화의 결과입니다. 이러한 적자는 몇 주 동안 지속 할 수있다 2. 운동 선수가 초기 부상 다음과 같은 자세 제어에 증가자가보고 증상 감소를 경험, 심지어 십사일 신경인지 기능이 감소하는 것은 드문 일이 아니다. 6 증상의 장기간 자연에게,에일관된 뇌진탕의 식별 및 preinjury 능력의 변화는 종종 의사, 불확실한 복구 시간, 그리고 아마도 장기 후유증으로 복잡하고 비 표준화 복귀에 플레이 의사 결정으로 이어질. 7-9 뇌진탕 후, 각각의 단기 및 장기 효과 모두를 경험할 수있다. 스포츠 관련 뇌진탕의 단기 효과는 반응 시간이 느려지 능력, 착란, 기억 장애, 의식 상실 재생의 변화, 조정, 두통, 현기증, 구토, 수면 패턴 및 기분 변화의 변화를 포함 할 수있다. 이러한 현상은 일반적으로 일 만에 해결. 2,10을하지만, 어떤 사람들은 오히려 빨리 하나의 충격에서 부상 다음 몇 주 또는 몇 달 동안 지속 할 수있는 많은 경험 느린 효과를 복구합니다. 10, 11, 12이 증상 교란을 매일 기능은인지 및 성능과 관련하여 정량화 할 수있다D 테스트합니다. 어떤 하나의 시험은 뇌진탕, 테스트 배터리의 진단을 결정 안 및 테스트 사이에 알려진 관계는 진단을 만드는 의료진 도움을 교실로 돌아가, 의사 결정을 재생 반환 할 수있다. (2) 뇌진탕에 대한 개인의 위험과 대응 복구에 큰 변화가있다. 감수성 및 복구 시간 코스를 진동 관련 (11) 요인은 잘 알려져 또는 이해되지 않습니다. 여러 가지 요인은 개인의 뇌진탕 감수성 및 복구에 영향을 미칠 수있는이 제안되었다. 이러한 요인들은 개인의 뇌진탕 역사, 초기 부상의 심각도, 편두통의 역사, 학습 장애의 역사, 정신 동반 질환의 역사, 그리고 아마도 유전 적 요인. 7, 9, 13, 14을 포함 많은 연구는 각각의 단기 및 장기 효과를 위해 특정 요소를 조사 하였다뇌진탕의 요인으로 뇌진탕, 복구 시간 코스, 유전학. 4,8,15-17 명확하게 설정되지 않은 어떤 효과적인 다각적 인 원인, 기능 변경에 관한 유용한 정보를 얻을 것입니다 평가를 충격하는 방법 및 복구입니다 변화로부터. 때문에 증상의 다양성과 회복의 불확실한 시간 코스로, 뇌진탕 평가에 대한 다각적 인 접근 방식은 보증이 사전 연습과 경쟁에 참여하는 모든 선수의 기본 테스트뿐만 아니라 적시에 평가 후 부상을 포함해야한다. 최근 리뷰는 신경인지 평가 혼자 증상을 모니터링보다 뇌진탕 회복에 더 민감 할 수 있음을 시사한다. (18)이 충격에서 회복의 좋은 지표가 될 수있는 다른 객관적인 측정이 있다는 것을있을 수 있습니다. 이 프로토콜을 위해, 우리는 그들이 얼마나 영향 b를보고 시스템의 다양한 구성 요소를 평가하기 위해 여러 작업을 사용나중에 뇌진탕. 전산화 신경인지 시험은 메모리, 처리 속도, 문제 해결 능력,인지 효율과 충동 조절을 평가할 수있다.도 6 EEG을 청각 및 시각 처리 태스크 이벤트와 관련된 전위의 시험을 통해 neuroefficiency을 평가하는데 사용될 수있다. 19 체성 차별 태스크가 될 수있다 말초 및 중앙 감각 처리 능력을 평가하기 위해 사용된다. (20)과 균형 보용 대책 기능적 성능을 평가하기 위해 사용될 수있다. 6,21 또, 역사, 뇌진탕 복구 및인지 기능을 충격하는 관계를 가질 수있는 다양한 유전자형을 평가. (22)에게 우리를 기준선은 시험이 배터리에 우리 학교 대표 학생 운동 선수를 테스트하고 무증상 때 충격이 발생할 경우 테스트를 반복합니다. 이 프로젝트의 목적은 유전, neuroc 진탕을 사용의 결과로서 성능의 잠재적 장단기 감소를 평가하는 것이다ognitive, 전기 생리, 행동, 감각, 균형과 보행 측정합니다. 충격에 대한 우리의 지식을 발전에 중요하다 뇌진탕 발생하는 다양한 증상과 장애와 관련 될 수있는 잠재적 메커니즘을 이해. 큰 뇌진탕 진단의 미래 원조 이러한 변화는 약 knowledgle뿐만 아니라 뇌진탕 관리는 재생 및 학계로 돌아가려면 복귀 관련하여. 아래에 설명 된 모든 조치 기준에서 촬영 (스포츠 학생 선수 참여 전). 우리의 현재 프로토콜은 우리가이 복구 가​​능한 리턴 투 플레이와 리턴 투 학자에 관한 유용한 정보를 제공하고 있다고 생각하기 때문에 균형 프로토콜과 함께 48 시간의 전산화 신경인지 테스트를 완료하는 것입니다. 학생 운동 선수는 증상이보고하면 그들은 다시 모든 기본 조치가 다시 유전자 검사를 제외하고, 실시하고 실험실로 돌아갑니다. 전체 프로토콜, BASeline과 증상은, 하나의 시험 기간에 완료하는 데 약 90 분 소요됩니다.

<table><tbody><tr><td>ImPACT</td><td>ImPACT, Pittsburgh, PA</td><td></td><td>Neurocognitive concussion testing</td></tr><tr><td>EEG</td><td>EGI, Eugene, OR</td><td></td><td>EEG 32-channel system</td></tr><tr><td>Stim2</td><td>Compumedics Neuroscan, Charlotte, NC</td><td></td><td>Software for task presentation for flanker task and auditory oddball</td></tr><tr><td>NetStation</td><td>EGI, Eugene, OR</td><td></td><td>Software for data collection and analysis of EEG</td></tr><tr><td>Sensory Device</td><td>Cortical Metrics</td><td></td><td>Sensory testing</td></tr><tr><td>Balance System SD</td><td>Biodex Medical Systems, Inc., Shirley, NY</td><td></td><td>balance testing</td></tr><tr><td>GAITRite&amp;nbsp;</td><td>CIR systems, Inc., Sparta, NJ, USA</td><td></td><td>Gait analysis</td></tr><tr><td>PCR</td><td>Applied Biosystems, Foster City, CA</td><td></td><td>Genetic Analysis</td></tr><tr><td>Matlab</td><td>Mathworks, Natick, MA, USA</td><td></td><td>Gait and balance analysis</td></tr></tbody></table>

a neuroscientific approach to the examination of concussions in student-athletes

진탕는 미국에서 놀라운 속도로 발생하는 심각한 공중 보건 문제가되고있다. CDC는 1.6-3800000 뇌진탕 매년 스포츠와 레크리에이션 활동에서 발생하는 것으로 추정하고있다. 2013 뇌진탕 합의 문에 의해 정의 된 뇌진탕은 &quot;하나의 머리에 전달 &#39;충동&#39;힘으로 몸의 다른 부분에 머리, 얼굴, 목, 또는에 직접 타격에 의해 발생할 수 있습니다.&quot;진탕은 단기 모두 개인을 떠나 장기 효과. 스포츠 관련 뇌진탕의 단기 효과는 반응 시간이 느려지 능력, 착란, 기억 장애, 의식 상실 재생의 변화, 조정, 두통, 현기증, 구토, 수면 패턴 및 기분 변화의 변화를 포함 할 수있다. 이러한 현상은 일반적으로 일 만에 해결. 어떤 사람들은 오히려 빨리 하나의 충격에서 회복하는 동안 그러나, 많은 경험으로는, 할 수있는 효과를 느린몇 주 또는 몇 달 동안 지속. 요인 감수성 뇌진탕 관련 및 후속 복구 시간은 잘이 시간에 알려 지거나 이해되지 않습니다. 여러 가지 요인이 제시되었다 그들은 개인의 뇌진탕 역사, 초기 부상의 심각도, 편두통의 역사, 학습 장애의 역사, 정신 동반 질환의 역사, 아마도 유전 적 요인을 포함한다. 많은 연구는 개별적으로 특정 요인 모두 뇌진탕, 복구 시간 코스, 감수성 및 복구의 단기 및 장기 효과를 조사 하였다. 무엇을 명확하게 설정되지 않은 것은 원인, 기능 변경 및 복구에 관한 유용한 정보를 얻을 것이다 뇌진탕 평가에 효과적인 다각적 인 접근 방법이다. 이 논문의 목적은 하나의 전산화 신경인지 검사, 사건 관련 전위, 감각 지각 응답을 사용하여 뇌진탕을 검사하는 접근, 균형다면 엉덩이를 보여주는 것입니다sment, 보행 평가와 유전자 검사.

전산화 신경인지 검사 전산화 신경인지 검사에 대한 결과의 예는 그림 1에서 볼 수 있습니다. 컴퓨터 프로그램은 언어 적 기억, 시각 기억, 시각 모터 속도와 자주 복귀에 플레이하고 복귀하는 데 사용되는 반응 시간에 복합 점수를 이끌어 법이나 배워 뇌진탕 관리 프로토콜. 언어 적 및 시각적 메모리 복합 주의력 프로세스, 학습과 기억을 평가. 카?...

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A Neuroscientific Approach to the Examination of Concussions in Student-Athletes

뇌진탕에 대한 개인의 위험과 대응 복구에 큰 변화가있다. 뇌진탕 평가에 대한 다각적 인 접근 방식은 보증; 스포츠 및 적시에 평가 후 부상에 참여하기 전에 운동 선수의 기본 테스트를 포함. 이 프로토콜의 목적은 진탕을 조사하기 적합한 다각적 접근법을 제공하는 것이다.

학생 운동 선수에 진탕의 시험에 대한 신경 과학적 접근

Concussions are occurring at alarming rates in the United States and have become a serious public health concern. The CDC estimates that 1.6 to 3.8 ...

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12.7K 조회수.  Elon University.  뇌진탕에 대한 개인의 위험과 대응 복구에 큰 변화가있다. 뇌진탕 평가에 대한 다각적 인 접근 방식은 보증; 스포츠 및 적시에 평가 후 부상에 참여하기 전에 운동 선수의 기본 테스트를 포함. 이 프로토콜의 목적은 진탕을 조사하기 적합한 다각적 접근법을 제공하는 것이다. 

비디오: A Neuroscientific Approach to the Examination of Concussions in Student-Athletes

An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System

One of the most commonly reported injuries in children who participate in sports is concussion or mild traumatic brain injury (mTBI)1. Children and youth involved in organized sports such as competitive hockey are nearly six times more likely to suffer a severe concussion compared to children involved in other leisure physical activities2. While the most common cognitive sequelae of mTBI appear similar for children and adults, the recovery profile and breadth of consequences in children remains largely unknown2, as does the influence of pre-injury characteristics (e.g. gender) and injury details (e.g. magnitude and direction of impact) on long-term outcomes. Competitive sports, such as hockey, allow the rare opportunity to utilize a pre-post design to obtain pre-injury data before concussion occurs on youth characteristics and functioning and to relate this to outcome following injury. Our primary goals are to refine pediatric concussion diagnosis and management based on research evidence that is specific to children and youth. To do this we use new, multi-modal and integrative approaches that will:
 1.Evaluate the immediate effects of head trauma in youth 
2.Monitor the resolution of post-concussion symptoms (PCS) and cognitive performance during recovery 
3.Utilize new methods to verify brain injury and recovery
To achieve our goals, we have implemented the Head Impact Telemetry (HIT) System. (Simbex; Lebanon, NH, USA). This system equips commercially available Easton S9 hockey helmets (Easton-Bell Sports; Van Nuys, CA, USA) with single-axis accelerometers designed to measure real-time head accelerations during contact sport participation 3 - 5. By using telemetric technology, the magnitude of acceleration and location of all head impacts during sport participation can be objectively detected and recorded. We also use functional magnetic resonance imaging (fMRI) to localize and assess changes in neural activity specifically in the medial temporal and frontal lobes during the performance of cognitive tasks, since those are the cerebral regions most sensitive to concussive head injury 6. Finally, we are acquiring structural imaging data sensitive to damage in brain white matter.

This article provides an overview of a multi-modal approach to mild traumatic brain injury diagnosis and recovery in youth. This approach combines neuropsychological testing with functional magnetic resonance imaging and the Head Impact Telemetry System to monitor the relationship between head impacts and brain activity during cognitive testing.

기능성 자기 공명 이미징 및 머리 충격 텔레 메 트리 시스템을 사용하는 청소년의 스포츠 관련 뇌진탕의 효과 조사

One of the most commonly reported injuries in children who participate in sports is concussion or mild traumatic brain injury (mTBI)1. Children and youth ...

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Bronchial Thermoplasty:  A Novel Therapeutic Approach to Severe Asthma

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled manner to reduce excessive airway smooth muscle. Reducing airway smooth muscle decreases the ability of the airways to constrict, thereby reducing the frequency of asthma attacks. Bronchial thermoplasty is delivered by the Alair System and is performed in three outpatient procedure visits, each scheduled approximately three weeks apart. The first procedure treats the airways of the right lower lobe, the second treats the airways of the left lower lobe and the third and final procedure treats the airways in both upper lobes. After all three procedures are performed the bronchial thermoplasty treatment is complete.
Bronchial thermoplasty is performed during bronchoscopy with the patient under moderate sedation. All accessible airways distal to the mainstem bronchi between 3 and 10 mm in diameter, with the exception of the right middle lobe, are treated under bronchoscopic visualization. Contiguous and non-overlapping activations of the device are used, moving from distal to proximal along the length of the airway, and systematically from airway to airway as described previously. Although conceptually straightforward, the actual execution of bronchial thermoplasty is quite intricate and procedural duration for the treatment of a single lobe is often substantially longer than encountered during routine bronchoscopy. As such, bronchial thermoplasty should be considered a complex interventional bronchoscopy and is intended for the experienced bronchoscopist. Optimal patient management is critical in any such complex and longer duration bronchoscopic procedure. This article discusses the importance of careful patient selection, patient preparation, patient management, procedure duration, postoperative care and follow-up to ensure that bronchial thermoplasty is performed safely.
Bronchial thermoplasty is expected to complement asthma maintenance medications by providing long-lasting asthma control and improving asthma-related quality of life of patients with severe asthma. In addition, bronchial thermoplasty has been demonstrated to reduce severe exacerbations (asthma attacks) emergency rooms visits for respiratory symptoms, and time lost from work, school and other daily activities due to asthma.

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled manner to reduce excessive airway smooth muscle. Reducing airway smooth muscle decreases the ability of the airways to constrict, thereby reducing the frequency of asthma attacks.

기관지 Thermoplasty : 심한 천식에 소설 치료 접근

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled ...

In Vivo Protocol of Controlled Subconcussive Head Impacts for the Validation of Field Study Data

Subconcussive hits pose a threat to neuronal health as they have shown to induce neuronal structural damage and functional impairment without causing outward symptomology and appear to be a key contributor to an irreversible neurodegenerative disease, chronic traumatic encephalopathy (CTE). In addition, athletes can incur more than 1,000 of these hits per season. The subconcussive soccer heading model (SSHM) is a relevant, reproducible, and leading method of isolating and examining the effects of these subconcussive head impacts. By controlling variables such as ball traveling speed, the frequency of impacts, interval, ball placement to the head, as well as by measuring head impact magnitude, the SSHM provides the scientific community with a superior avenue of investigating the acute subconcussive effects on neuronal health. In this paper, we demonstrate the utility of SSHM in studying a time-course expression of neurofilament-light polypeptide (NF-L) in plasma in a repeated measures fashion. NF-L is an axonal injury marker that has previously been shown to be elevated in boxers and football players following subconcussive head trauma. Thirty-four adult aged soccer players were recruited and randomly assigned to either a soccer heading (n = 18) or kicking (n = 16) group. The heading group executed 10 headers with soccer balls projected at a velocity of 25 mph over 10 min. The kicking group followed the same protocol with 10 kicks. Plasma samples were obtained before and at 0 h, 2 h, and 24 h after heading/kicking and assessed for NF-L expressions. The heading group showed a gradual increase in plasma NF-L expression and peaked at 24 h after the heading protocol, whereas the kicking group remained consistent across the time points. These results confirmed the NF-L data from clinical field studies, encouraging the use of SSHM to validate clinical subconcussion data.

The subconcussive soccer heading model is a safe and concise methodological approach to isolate and measure the effects of subconcussive head impacts.

필드 연구 데이터의 유효성 검사에 대 한 제어 Subconcussive 머리 영향의 비보 프로토콜에

Subconcussive hits pose a threat to neuronal health as they have shown to induce neuronal structural damage and functional impairment without causing ...

행동분석학

Modified Drop Tower Impact Tests for American Football Helmets

A modified National Operating Committee on Standards for Athletic Equipment (NOCSAE) test method for American football helmet drop impact test standards is presented that would provide better assessment of a helmet's on-field impact performance by including a faceguard on the helmet. In this study, a merger of faceguard and helmet test standards is proposed. The need for a more robust systematic approach to football helmet testing procedures is emphasized by comparing representative results of the Head Injury Criterion (HIC), Severity Index (SI), and peak acceleration values for different helmets at different helmet locations under modified NOCSAE standard drop tower tests. Essentially, these comparative drop test results revealed that the faceguard adds a stiffening kinematic constraint to the shell that lessens total energy absorption. The current NOCSAE standard test methods can be improved to represent on-field helmet hits by attaching the faceguards to helmets and by including two new helmet impact locations (Front Top and Front Top Boss). The reported football helmet test method gives a more accurate representation of a helmet's performance and its ability to mitigate on-field impacts while promoting safer football helmets.

This article provides a novel technique to assess the performance characteristics of American football helmets by inclusion of faceguards during NOCSAE Standard drop tests. Additionally, two more impact locations are proposed to be added to the NOCSAE certification.

미식 축구 헬멧에 대한 수정 드롭 탑 충격 테스트

A modified National Operating Committee on Standards for Athletic Equipment (NOCSAE) test method for American football helmet drop impact test standards ...

생체공학

Revised and Neuroimaging-Compatible Versions of the Dual Task Screen

Dual task paradigms simultaneously assess motor and cognitive abilities, and they can detect subtle, residual impairments in athletes with recent mild traumatic brain injury (mTBI). However, past dual task paradigms have focused solely on lower extremity skills and have relied on cumbersome, expensive laboratory equipment - thus limiting their practicality for everyday mTBI evaluation. Subsequently, we developed the Dual Task Screen (DTS), which takes &#60;10 minutes to administer and score, uses low-cost portable equipment, and includes lower extremity (LE) and upper extremity (UE) subtasks. The purpose of this manuscript was twofold. First, we describe the administration protocol for the revised DTS, which we revised to address the limitations of the original DTS. Specifically, the revisions included additions of smart devices to acquire more detailed gait data and inclusion of single cognitive conditions to test for disrupted cognitive performance under dual task conditions. Importantly, the revised DTS is a measure intended for future clinical use, and we present representative results from three male athletes to illustrate the type of clinical data that can be acquired from the measure. Importantly, we have yet to evaluate the sensitivity and specificity of the revised DTS in athletes with mTBI, which is the next research initiative. The second purpose of this manuscript is to describe a neuroimaging-compatible version of the DTS. We developed this version so we could evaluate the neural underpinnings of single and dual task performance, for a better empirical understanding of the behavioral deficits associated with mTBI. Thus, this manuscript also describes the steps we took to enable simultaneous functional near-infrared spectroscopy (fNIRS) measurement during the DTS, along with how we acquired and completed first-level processing of the fNIRS data.

We developed the original Dual Task Screen (DTS) as a portable, low-cost measure that can evaluate athletes with sports-induced mild traumatic brain injury. We revised the original DTS for future clinical use and developed a neuroimaging-compatible version of the DTS to measure neural underpinnings of single and dual task performance.

이중 작업 화면의 개정 및 신경 이미징 호환 버전

Dual task paradigms simultaneously assess motor and cognitive abilities, and they can detect subtle, residual impairments in athletes with recent mild ...

A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion

Concussion is one of the most commonly reported injuries amongst children and youth involved in sport participation. Following a concussion, youth can experience a range of short and long term neurobehavioral symptoms (somatic, cognitive and emotional/behavioral) that can have a significant impact on one&#8217;s participation in daily activities and pursuits of interest (e.g., school, sports, work, family/social life, etc.). Despite this, there remains a paucity in clinically driven research aimed specifically at exploring concussion within the youth sport population, and more specifically, multi-modal approaches to measuring recovery. This article provides an overview of a novel and multi-modal approach to measuring recovery amongst youth athletes following concussion. The presented approach involves the use of both pre-injury/baseline testing and post-injury/follow-up testing to assess performance across a wide variety of domains (post-concussion symptoms, cognition, balance, strength, agility/motor skills and resting state heart rate variability). The goal of this research is to gain a more objective and accurate understanding of recovery following concussion in youth athletes (ages 10-18 years). Findings from this research can help to inform the development and use of improved approaches to concussion management and rehabilitation specific to the youth sport community.

This article provides an overview of a multi-modal approach to assessing recovery following concussion in youth athletes. The described protocol uses pre- and post-concussion assessment of performance across a wide variety of domains and can inform the development of improved concussion rehabilitation protocols specific to the youth sport community.

수류탄에 따라 청소년 운동 선수의 평가 복구에 멀티 모달 접근

Concussion is one of the most commonly reported injuries amongst children and youth involved in sport participation. Following a concussion, youth can ...

Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology

Participation in organized sports makes a significant contribution to youth development, but places youth at a higher risk for sustaining a concussion. To date, return-to-activity decision-making has been anchored in the monitoring of self-reported concussion symptoms and neurocognitive testing. However, multi-modal assessments that corroborate objective physiological measures with traditional subjective symptom reporting are needed and can be valuable. Heart rate variability (HRV) is a non-invasive physiological indicator of the autonomic nervous system, capturing the reciprocal interplay between the sympathetic and parasympathetic nervous systems. There is a dearth of literature exploring the effect of concussion on HRV in youth athletes, and developmental differences preclude the application of adult findings to a pediatric population. Further, the current state of HRV methodology has primarily included short-term (5-15 min) recordings, by using resting state or short-term physical exertion testing to elucidate changes following concussion. The novelty in utilizing a 24 h&#160;recording methodology is that it has the potential to capture natural variation in autonomic function, directly related to the activities a youth athlete performs on a regular basis. Within a prospective, longitudinal research setting, this novel approach to quantifying autonomic function can provide important information regarding the recovery trajectory, alongside traditional self-report symptom measures. Our objectives regarding a 24 h recording methodology were to (1) evaluate the physiological effects of a concussion in youth athletes, and (2) describe the trajectory of physiological change, while considering the resolution of self-reported post-concussion symptoms. To achieve these objectives, non-invasive sensor technology was implemented. The raw beat-to-beat time intervals captured can be transformed to derive time domain and frequency domain measures, which reflect an individual&#39;s ability to adapt and be flexible to their ever-changing environment. By using non-invasive heart rate technology, autonomic function can be quantified outside of a traditional controlled research setting.

We demonstrate a 24 h heart rate recording methodology to evaluate the influence of concussion across the recovery trajectory in youth athletes, within an ecologically valid context.

자율 기능 청소년 선수에 뇌 진 탕을 다음: 24 시간 녹화 방법론을 사용 하 여 심장 박동의 변화 탐구

Participation in organized sports makes a significant contribution to youth development, but places youth at a higher risk for sustaining a concussion. To ...

Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion

The evidence-informed standardization of care along disease lines is recommended to improve outcomes and reduce healthcare costs. The aim of this project is to 1) describe the development and implementation of the Concussion Carepath, 2) demonstrate the process of integrating technology in the form of a mobile application to enable the carepath and guide clinical decision-making, and 3) present data on the utility of the C3 app in facilitating decision-making throughout the injury recovery process. A multi-disciplinary team of experts in concussion care was formed to develop an evidence-informed algorithm, outlining best practices for the clinical management of concussion along three phases of recovery &#8211; acute, subacute, and post-concussive. A custom mobile application, the Cleveland Clinic Concussion (C3) app was developed and validated to provide a platform for the systematic collection of objective, biomechanical outcomes and to provide guidance in clinical decision-making in the field and clinical environments. The Cleveland Clinic Concussion app included an electronic incident report, assessment modules to measure important aspects of cognitive and motor function, and a return to play module to systematically document the six phases of post-injury rehabilitation. The assessment modules served as qualifiers within the carepath algorithm, driving referral for specialty services as indicated. Overall, the carepath coupled with the C3 app functioned in unison to facilitate communication among the interdisciplinary team, prevent stagnant care, and drive patients to the right provider at the right time for efficient and effective clinical management.

A multidisciplinary carepath to standardize disparate concussion care was developed and implemented at the Cleveland Clinic. The Cleveland Clinic Concussion (C3) mobile application was used to enable the carepath through biomechanical outcomes characterizing cognitive and motor function. Patient outcomes improved while cost of care was reduced following implementation.

개발 및 멀티-징계 기술의 구현 청소년과 뇌 진 탕과 어른에 대 한 관리 경로 강화

The evidence-informed standardization of care along disease lines is recommended to improve outcomes and reduce healthcare costs. The aim of this project ...

Objectively Assessing Sports Concussion Utilizing Visual Evoked Potentials

A portable system capable of measuring steady-state visual-evoked potentials (SSVEP) was developed to provide an objective, quantifiable method of electroencephalogram (EEG) testing following a traumatic event. In this study, the portable system was used on 65 healthy rugby players throughout a season to determine whether SSVEP are a reliable electrophysiological biomarker for concussion. Preceding the competition season, all players underwent a baseline SSVEP assessment. During the season, players were re-tested within 72 h of a match for either test-retest reliability or post-injury assessment. In the case of a medically diagnosed concussion, players were reassessed again once deemed recovered by a physician. The SSVEP system consisted of a smartphone housed in a VR-frame delivering a 15 Hz flicker stimulus, while a wireless EEG headset recorded occipital activity. Players were instructed to stare at the screen's fixation point while remaining seated and quiet. Electrodes were arranged according to the 10-20 EEG-positioning nomenclature, with O1-O2 being the recording channels while P1-P2 the references and bias, respectively. All EEG data was processed using a Butterworth bandpass filter, Fourier transformation, and normalization to convert data for frequency analysis. Players SSVEP responses were quantified into a signal-to-noise ratio (SNR), with 15 Hz being the desired signal, and summarized into respective study groups for comparison. Concussed players were seen to have a significantly lower SNR compared to their baseline; however, post-recovery, their SNR was not significantly different from the baseline. Test-retest indicated high device reliability for the portable system. An improved portable SSVEP system was also validated against an established EEG amplifier to ensure the investigative design is capable of obtaining research quality EEG measurements. This is the first study to identify differences in SSVEP responses in amateur athletes following a concussion and indicates the potential for SSVEP as an aid in concussion assessment and management.

A portable system capable of measuring steady-state visual-evoked potentials was developed and trialed on 65 amateur rugby players over 18 weeks to investigate SSVEP as a potential electrophysiological biomarker for concussion. Players' baselines were measured pre-season, with retesting for reliability, concussion, and recovery assessment being conducted within controlled time-periods, respectively.

시각적 유발 잠재력을 활용한 스포츠 뇌진탕 객관적 평가

A portable system capable of measuring steady-state visual-evoked potentials (SSVEP) was developed to provide an objective, quantifiable method of ...

신경과학

Assessing Changes in Synaptic Plasticity Using an Awake Closed-Head Injury Model of Mild Traumatic Brain Injury

Mild traumatic brain injuries (mTBIs) are a prevalent health issue in North America. There is increasing pressure to utilize ecologically valid models of closed-head mTBI in the preclinical setting to increase translatability to the clinical population. The awake closed-headed injury (ACHI) model uses a modified controlled cortical impactor to deliver closed-headed injury, inducing clinically relevant behavioral deficits without the need for a craniotomy or the use of an anesthetic.
This technique does not normally induce fatalities, skull fractures, or brain bleeds, and is more consistent with being a mild injury. Indeed, the mild nature of the ACHI procedure makes it ideal for studies investigating repetitive mTBI (r-mTBI). Growing evidence indicates that r-mTBI can result in a cumulative injury that produces behavioral symptoms, neuropathological changes, and neurodegeneration. r-mTBI is common in youths playing sports, and these injuries occur during a period of robust synaptic reorganization and myelination, making the younger population particularly vulnerable to the long-term influences of r-mTBI.
Further, r-mTBI occurs in cases of intimate partner violence, a condition for which there are few objective screening measures. In these experiments, synaptic function was assessed in the hippocampus in juvenile rats that had experienced r-mTBI using the ACHI model. Following the injuries, a tissue slicer was utilized to make hippocampal slices to evaluate bidirectional synaptic plasticity in the hippocampus at either 1 or 7 days following the r-mTBI. Overall, the ACHI model provides researchers with an ecologically valid model to study changes in synaptic plasticity following mTBI and r-mTBI.

Here, it is demonstrated how an awake closed-head injury model can be used for examining the effects of repeated mild traumatic brain injury (r-mTBI) on synaptic plasticity in the hippocampus. The model replicates important features of r-mTBI in patients and is used in conjunction with in vitro electrophysiology.

경미한 외상성 뇌 손상의 깨어 있는 폐쇄 두부 손상 모델을 사용하여 시냅스 가소성의 변화 평가

Mild traumatic brain injuries (mTBIs) are a prevalent health issue in North America. There is increasing pressure to utilize ecologically valid models of ...