Variables associated with subjective cognitive change among Iraq and Afghanistan war Veterans with blast-related mild traumatic brain injury

Introduction: This study investigated variables associated with subjective decline in executive function among Veterans of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) following a history of blast-related mild traumatic brain injury (mTBI).

Method: Fifty-six male U.S. Veterans (M_Age = 35.3 ± 8.8 years) with a history of blast-related mTBI (6.6 ± 3.2 years post injury) completed a battery of self-report questionnaires and neuropsychological measures. Participants rated current and retrospectively estimated pre-mTBI executive function difficulties on the Frontal Systems Behavior Scale (FrSBe). A difference score (post- minus pre-mTBI ratings) was the dependent variable (?FrSBe). Linear regression models examined variables predicting ?FrSBe, including: pre-injury characteristics (education, premorbid intelligence), injury-related characteristics (number of blast exposures, losses of consciousness), post-injury clinical symptoms (PTSD Checklist–Military version; Pittsburgh Sleep Quality Index), and post-injury neuropsychological performances on executive function measures (Trail Making Test Part B; Controlled Oral Word Association Test; Auditory Consonant Trigrams; Wisconsin Card Sorting Test).

Results: While 11% of participants had a clinically elevated pre-injury FrSBe total score, 82% had a clinically elevated post-injury FrSBe total score. Only self-reported PTSD symptom severity independently predicted perceived change in executive function.

Conclusions: Many OEF/OIF/OND Veterans with a history of blast-related mTBI experience subjective decline in executive function following injury. Perceived executive function decline was associated with higher PTSD symptom severity, aligning with previous research associating PTSD with cognitive complaints. Results did not support a correspondence between perceived cognitive change and neuropsychological performances.     

大鼠脑震荡c-fos癌基因的表达及其法医病理学意义

目的 探讨原癌基因c-fos的表达和脑震荡性损伤的关系,同时寻找脑震荡后法医病理学的诊断依据。方法 55只实验大鼠随机分为脑震荡组和对照组。c-fos-mRNA表达采用原位杂交法观察。结果 对照组大鼠未见c-fos-mRNA的表达,然而脑震荡组在损伤后15min即可在神经元和胶质细胞观察到c-fos-mRNA的表达,至30min c-fos-mRNA的阳性反应达最高峰,以后逐渐下降。结论 c-fos原癌基因的检测可成为诊断脑震荡和推断脑震荡后经过时间的一项敏感指标。     

脑电图对脑震荡预后的诊断价值

目的:探讨脑电图对脑震荡预后的诊断价值.方法:对86例临床确诊脑震荡的患者常规进行脑电图检查.结果:边缘脑电图3例,轻度异常脑电图42例,中度异常脑电图2例,异常率为54.7%.结论:脑电图应作为脑震荡必备检查方法.有助于客观评估病情,及时指导治疗和法学鉴定.     

Sensitivity to light and sound following minor head injury

9 consecutively referred closed head injury (CHI) patients were assessed for sensitivity to light and sound stimuli, within 7-19 days of injury, on both objective and subjective measures. Patients were matched with controls on age, sex, race, socio-economic status and order of test administration. The mean luminance (1366 lux) tolerated by CHI patients was significantly lower (0.01 level by Student's t-test for related samples) than that tolerated by controls (1783 lux). The mean sound intensity tolerated by CHI patients was also lower (82 db) than for controls (94 db), though this difference was not statistically significant. Subjective ratings of sensitivity made by CHI patients after exposure to intense sound and light stimuli, showed no relationship to objective ratings of tolerance. The results demonstrate an objective basis for complaints of increased sensitivity, at least to light, following CHI. These findings do not support earlier "psychogenic" explanations of post-concussion syndrome (PCS) etiology.     

The Role of Telehealth in Sideline Management of Sports-Related Injuries

The COVID-19 pandemic has affected the ability of the sports medicine physician to be present to participate in in-person sideline evaluation of the injured athlete. The purpose of this review is to assess existing literature regarding the utilization of telehealth for sideline evaluation and management of the injured athlete, as well as to identify further areas of research. With the rapid incorporation of telehealth visits, the utilization and capabilities of telemedicine continue to expand. A number of evidence-based resources are available to support medical providers to develop and utilize video evaluation for the sideline evaluation of sports-related injuries. Future research, including the development of validated, modified examination techniques and technologies, will allow for improved interactive physical examinations, which may be better utilized for sideline evaluation.     

Prospective study with specific Re-Assessment time points to determine time to recovery following a Sports-Related Concussion in university-aged student-athletes

BackgroundTime to recovery for symptom burden and neurocognition following a Sports-Related Concussion (SRC) has previously been determined by consolidating varying re-assessment time points into a singular point, and has not been established for Vestibular-Ocular-Motor (VOM) function or academic ability.ObjectivesEstablish when recovery of symptom burden, neurocognition, VOM function, and academic ability occurs in university-aged student-athletes.MethodsStudent-athletes completed an assessment battery (Post-Concussion Symptom Scale (PCSS), Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Vestibular Ocular-Motor Screening (VOMS), Perceived Academic Impairment Tool (PAIT)) during pre-season (n = 140), within 48 hours, 4, 8 and 14 days post-SRC and prior to Return To Play (RTP) and were managed according to the Rugby Football Union’ community pathway (n = 42). Student-athletes were deemed recovered or impaired according to Reliable Change Index’ (RCI) or compared to their individual baseline.ResultsSymptom burden recovers by four days post-SRC on RCI and to baseline by eight days. VOM function and academic ability recovers by 8 days. Some student-athletes demonstrated worse performance at RTP on all tests by RCI and to baseline, except for on VOMS score and near point convergence by RCI change.ConclusionsVariation in individual university-aged student-athletes requires a multi-faceted approach to establish what dysfunctions post-SRC exist and when recovery occurs.     

Direct player observation is needed to accurately quantify heading frequency in youth soccer

In soccer, heading may be related to subsequent neurological impairment. Accurate measures of heading exposure are therefore important. This study evaluated whether 12 female youth players accurately recalled their average number of headers over an entire soccer season (20 games total). Their self-reported average number of headers per game was multiplied by the number of games that they participated in, and were compared to actual number of headers extracted from game video. All players overestimated the number of headers compared to game video. Linear regression analysis indicated that self-reported headers overestimated the number of headers by 51%. While self-reports are a convenient way to estimate heading behaviour, they do not accurately represent the number of headers that players perform. Self-reports of heading exposure should be interpreted with caution.     

Understanding Concussion Reporting Using a Model Based on the Theory of Planned Behavior

PurposeAthlete's report of concussion symptoms to coaching or medical personnel is an important component of concussion risk reduction. This study applies a model based on the Theory of Planned Behavior (TPB) to the prediction of concussive symptom underreporting among late adolescent and young adult male ice hockey players.MethodsParticipants were members of an American Tier III Junior A ice hockey league (ages 18–21 years; male; n = 256). Twelve of 14 league teams and 97% of players within these teams agreed to participate. Written survey items assessed symptom reporting behavior, intention, perceived norms, self-efficacy, perceived outcomes of reporting, and concussion knowledge. Structural equation modeling was used to assess the significance of relationships hypothesized by the TPB-based model and the overall model fit. Data were collected in January 2013.ResultsResults supported the fit of the TPB-based model in explaining reporting behavior; all model pathways were significant in the hypothesized direction. Of the perceived reporting outcomes assessed, those related to athletic performance were identified as most strongly associated with reporting intention.ConclusionsResults of this study suggest the importance of considering factors such as perceived outcomes of reporting, perceived norms, and self-efficacy, in addition to knowledge, when analyzing concussion underreporting among adolescent athletes. As concussion education for athletes becomes increasingly mandated, testing and applying psychosocial theories such as TPB may help increase program efficacy.