Name: an investigation of the effects of sports-related concussion in youth using functional magnetic resonance imaging and the head impact telemetry system
Uploaded: 2011-01-12T22:30:00
Description: Watch this Scientific Journal Video about An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System at JoVE

We would like to thank the Canadian Institutes of Health Research (CIHR) and the Ontario Neurotrauma Foundation (ONF) who have provided funding for this research.

1. Obtaining Pre-injury Neuropsychological Baseline Profile on Subject
<ol>
	<li>Prior to subject arriving for testing, ensure all equipment is functioning properly and ready for testing and that the room is free from unnecessary distractions.</li>
	<li>After reviewing parental and subject consent, measure and record subject's height, weight and head circumference.</li>
	<li>Administer balance assessment while subject is standing on force plate in the following order of conditions: A1 - on force plate, eyes open; ...

<ol>
	<li>Browne, G. J., Lam, L. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Concussive+head+injury+in+children+and+adolescents+related+to+sports+and+other+leisure+physical+activities.">Concussive head injury in children and adolescents related to sports and other leisure physical activities.</a> Br. J .Sports Med. 40, 163-168 (2006).</li><li>McCrory, P., Collie, A., Anderson, V., Davis, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Can+we+manage+sport+related+concussion+in+children+the+same+as+in+adults.">Can we manage sport related concussion in children the same as in adults.</a> Br. J .Sports Med. 38, 516-519 (2004).</li><li>Brolinson, P. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+of+linear+head+accelerations+from+collegiate+football+impacts.">Analysis of linear head accelerations from collegiate football impacts.</a> Curr. Sports Med. Rep. 5, 23-28 (2006).</li><li>Duma, S. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+of+real-time+head+accelerations+in+collegiate+football+players.">Analysis of real-time head accelerations in collegiate football players.</a> Clin. J. Sport Med. 15, 3-8 (2005).</li><li>Schnebel, B., Gwin, J. T., Anderson, S., Gatlin, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+vivo+study+of+head+impacts+in+football:+a+comparison+of+National+Collegiate+Athletic+Association+Division+I+versus+high+school+impacts.">In vivo study of head impacts in football: a comparison of National Collegiate Athletic Association Division I versus high school impacts.</a> Neurosurgery. 60, 490-495 (2007).</li><li>Chen, J. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+abnormalities+in+symptomatic+concussed+athletes:+an+fMRI+study.">Functional abnormalities in symptomatic concussed athletes: an fMRI study.</a> Neuroimage. 22, 68-82 (2004).</li><li>Glover, G. H., Law, C. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spiral-in/out+BOLD+fMRI+for+increased+SNR+and+reduced+susceptibility+artifacts.">Spiral-in/out BOLD fMRI for increased SNR and reduced susceptibility artifacts.</a> Magn. Reson. Med. 46, 515-522 (2001).</li><li>Smith, S. M., Jenkinson, M., Johansen-Berg, H., Rueckert, D., Nichols, T. E., Mackay, C. E., Watkins, K. E., Ciccarelli, O., Cader, M. Z., Matthews, P. M., Behrens, T. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tract-based+spatial+statistics:+voxelwise+analysis+of+multi-subject+diffusion+data.">Tract-based spatial statistics: voxelwise analysis of multi-subject diffusion data.</a> Neuroimage. 31, 1487-1505 (2006).</li><li>Gibson, E., Gao, F., Black, S. E., Lobaugh, N. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Automatic+Segmentation+of+White+Matter+Hyperintensities+in+FLAIR+images+at+3T.">Automatic Segmentation of White Matter Hyperintensities in FLAIR images at 3T.</a> J. Magn. Reson. Imaging. , (2009).</li><li>McIntosh, A. R., Bookstein, F. L., Haxby, J. V., Grady, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spatial+pattern+analysis+of+functional+brain+images+using+Partial+Least+Squares.">Spatial pattern analysis of functional brain images using Partial Least Squares.</a> NeuroImage. 3, 143-157 (1996).</li><li>McIntosh, A., Gonzalez-Lima, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Network+interactions+among+limbic+cortices,+basal+forebrain+and+cerebellum+differentiate+a+tone+conditioned+as+a+Pavlovian+excitor+or+inhibitor:+fluorodeoxyglucose+and+covariance+structural+modeling.">Network interactions among limbic cortices, basal forebrain and cerebellum differentiate a tone conditioned as a Pavlovian excitor or inhibitor: fluorodeoxyglucose and covariance structural modeling.</a> J. Neurophysiol. 72, 1717-1733 (1994).</li><li>McIntosh, A., Lobaugh, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Partial+least+squares+analysis+of+neuroimaging+data:+applications+and+advances.">Partial least squares analysis of neuroimaging data: applications and advances.</a> Neuroimage. 23, 250-263 (2004).</li><li>Frackowiack, R. S. J., Frith, C. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Human Brain Function. , (2003).</li></ol>

We predict that those youths who show the greatest impact on brain white matter will show the greatest reorganization of brain activity, and the longest behavioural and neural recovery periods. This research will provide a better understanding of pediatric post-concussion events and have a significant impact on medical care, as it will allow us to establish a recovery protocol based on research evidence that is specific to children and youth. Such a protocol can then be translated to stakeholders, including parents, co...

<table border="1">
 <tbody>
 <tr>
 <td>Name</td>
 <td>Company</td>
 <td>Comments</td>
 </tr>
 <tr>
 <td>AccuGait Portable Gait and Balance Platform 
 (Balance Assessment)</td>
 <td>AMTI</td>
 <td><a href="http://www.amti.biz/">www.amti.biz</a></td>
 </tr>
 <tr>
 <td>NetForce Balance Data Acquisition Software</td>
 <td>AMTI</td>
 <td><a href="http://www.amti.biz/">www.amti.biz</a></td>
 </tr>
 <tr>
 <td>Visual Conflict Dome</td>
 <td>&nbsp;</td>
 <td>Fabricated by researchers; modeled after: Lovell MR, Collins MW. Neuropsychological assessment of the college 					football player. J Head Trauma Rehabil. 1998;13(2):9-26.</td>
 </tr>
 <tr>
 <td>Airex Balance Pad</td>
 <td>Airex</td>
 <td><a href="http://www.bebalanced.net/">www.bebalanced.net</a></td>
 </tr>
 <tr>
 <td>Smedlay's Dynamometer, 100 kg(Grip Strength)</td>
 <td>TTM, Tokyo</td>
 <td>&nbsp;</td>
 </tr>
 <tr>
 <td>Grooved Pegboard Test</td>
 <td>Lafayette Instrument Company</td>
 <td><a href="http://www.lafayetteinstrument.com/">www.lafayetteinstrument.com</a></td>
 </tr>
 <tr>
 <td>Axon Jump Mat</td>
 <td>Vacumed</td>
 <td><a href="http://www.vacumed.com/">www.vacumed.com</a></td>
 </tr>
 <tr>
 <td>Strength Bar</td>
 <td>&nbsp;</td>
 <td>Fabricated by researchers: 
 <ul>
 <li>31" titanium lacrosse handle</li>
 <li>Two 40" utility chains</li>
 <li>24" x 26" plywood platform</li>
 <li>Two dock ring fasteners</li>
 <li>Two U-bolts (1" width)</li>
 </ul></td>
 </tr>
 <tr>
 <td>Head Impact Telemetry (HIT) System</td>
 <td>Simbex</td>
 <td><a href="http://www.simbex.com/">www.simbex.com</a></td>
 </tr>
 <tr>
 <td>Post-Concussion Symptoms Scale Revised (PCS-R)</td>
 <td>&nbsp;</td>
 <td>Adapted from: 
 Lovell MR, Collins MW. Neuropsychological assessment of the college football player. J Head Trauma Rehabil. 1998;13(2):9-26.</td>
 </tr>
 <tr>
 <td>GE Discovery&trade; MR750 3.0T MRI Scanner</td>
 <td>GE</td>
 <td><a href="http://www.gehealthcare.com/">www.gehealthcare.com</a></td>
 </tr>
 <tr>
 <td>GE 8 channel head coil</td>
 <td>GE</td>
 <td><a href="http://www.gehealthcare.com/">www.gehealthcare.com</a></td>
 </tr>
 <tr>
 <td>Lumitouch Reply System</td>
 <td>Lightwave Medical Industries</td>
 <td>Vancouver, BC 1-(604)-875-4529</td>
 </tr>
 <tr>
 <td>Back projection screen (for presenting fMRI stimuli)</td>
 <td>Unknown</td>
 <td>&nbsp;</td>
 </tr>
 <tr>
 <td>Disposable foam ear plugs</td>
 <td>PAR Inc.</td>
 <td><a href="http://www.parinc.com/">www.parinc.com</a></td>
 </tr>
 <tr>
 <td>Neuropsychological Tests</td>
 <td>Pearson Assessments</td>
 <td><a href="http://www.pearsonassessments.com/">www.pearsonassessments.com</a></td>
 </tr>
 </tbody>
</table>

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.

Watch this Scientific Journal Video about An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System at JoVE

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

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.

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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