Consensus Statement on Concussion in Sport: The 4th International Conference on Concussion in Sport Held in Zurich, November 2012

Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia. Electronic address: .
Journal of the American College of Surgeons (Impact Factor: 5.12). 04/2013; 47(5). DOI: 10.1016/j.jamcollsurg.2013.02.020
Source: PubMed
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Available from: Ruben J Echemendia,
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    • "It is the “Mild” group that is the primary focus of this article, as these are the athletes and soldiers that most often will be seen clinically and who may have cardiac correlates of concussion sufficient to interfere with cognitive and cardiovascular resources needed for athletic and military performance. Generally, patients with a GCS in the 13–15 range will not have LOC, but may have episodic cognitive confusion, transient amnesia, dizziness, slow reaction time, and balance problems (McCrory et al., 2013). When assessed in the Emergency Room, the traditional physical neurologic exam will be negative and non-focal for pathology, as will the Head CT. "
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    ABSTRACT: The study of heart rate variability (HRV) has emerged as an essential component of cardiovascular health, as well as a physiological mechanism by which one can increase the interactive communication between the cardiac and the neurocognitive systems (i.e., the body and the brain). It is well-established that lack of HRV implies cardiopathology, morbidity, reduced quality-of-life, and precipitous mortality. On the positive, optimal HRV has been associated with good cardiovascular health, autonomic nervous system (ANS) control, emotional regulation, and enhanced neurocognitive processing. In addition to health benefits, optimal HRV has been shown to improve neurocognitive performance by enhancing focus, visual acuity and readiness, and by promoting emotional regulation needed for peak performance. In concussed athletes and soldiers, concussions not only alter brain connectivity, but also alter cardiac functioning and impair cardiovascular performance upon exertion. Altered sympathetic and parasympathetic balance in the ANS has been postulated as a critical factor in refractory post concussive syndrome (PCS). This article will review both the pathological aspects of reduced HRV on athletic performance, as well as the cardiovascular and cerebrovascular components of concussion and PCS. Additionally, this article will review interventions with HRV biofeedback (HRV BFB) training as a promising and underutilized treatment for sports and military-related concussion. Finally, this article will review research and promising case studies pertaining to use of HRV BFB for enhancement of cognition and performance, with applicability to concussion rehabilitation.
    Frontiers in Psychology 08/2014; 5:890. DOI:10.3389/fpsyg.2014.00890 · 2.80 Impact Factor
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    • "A detailed history and neurological exam therefore form the core of a concussion diagnosis (McCrory et al. 2013). However, several additional investigations can be utilized: neurocognitive (neuropsychological) testing, while not necessary for a concussion diagnosis, may be employed to evaluate memory, attention and concentration, problem solving , and other higher-order cognitive functioning (Grindel et al. 2001; McCrory et al. 2013). Although neurocognitive testing has been shown to readily detect differences between recently-concussed (less than 1 week after concussion) and healthy patients in studies of collegiate athletes (Echemendia et al. 2001; Schatz and Sandel 2013), there are several challenges when using neurocognitive testing as an aide for tracking the recovery of brain function from a concussion. "
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    ABSTRACT: Sports-related concussions are currently diagnosed through multi-domain assessment by a medical professional and may utilize neurocognitive testing as an aid. However, these tests have only been able to detect differences in the days to week post-concussion. Here, we investigate a measure of brain function, namely resting state functional connectivity, which may detect residual brain differences in the weeks to months after concussion. Twenty-one student athletes (9 concussed within 6 months of enrollment; 12 non-concussed; between ages 18 and 22 years) were recruited for this study. All participants completed the Wisconsin Card Sorting Task and the Color-Word Interference Test. Neuroimaging data, specifically resting state functional Magnetic Resonance Imaging data, were acquired to examine resting state functional connectivity. Two sample t-tests were used to compare the neurocognitive scores and resting state functional connectivity patterns among concussed and non-concussed participants. Correlations between neurocognitive scores and resting state functional connectivity measures were also determined across all subjects. There were no significant differences in neurocognitive performance between concussed and non-concussed groups. Concussed subjects had significantly increased connections between areas of the brain that underlie executive function. Across all subjects, better neurocognitive performance corresponded to stronger brain connectivity. Even at rest, brains of concussed athletes may have to 'work harder' than their healthy peers to achieve similar neurocognitive results. Resting state brain connectivity may be able to detect prolonged brain differences in concussed athletes in a more quantitative manner than neurocognitive test scores.
    Brain Imaging and Behavior 08/2014; 9(2). DOI:10.1007/s11682-014-9312-1 · 4.60 Impact Factor
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    • "[2] [3] [4] In recent years, physician management of concussion has benefitted from the development of standardized concussion symptom inventories and computerized neuro-cognitive testing tools. [5] [6] [7] [8] None of these tools provide a window into the pathophysiology of concussion. In contrast, functional magnetic resonance imaging (fMRI) with blood oxygen level-dependent (BOLD) echo-planar imaging (EPI) has revolutionized our understanding of the brain at ‘work’ and at ‘rest’. "
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    ABSTRACT: Background There is a real need for quantifiable neuro-imaging biomarkers in concussion. Here we outline a brain BOLD-MRI CO2 stress test to assess the condition. Methods This study was approved by the REB at the University of Manitoba. A group of volunteers without prior concussion were compared to post-concussion syndrome (PCS) patients – both symptomatic and recovered asymptomatic. Five 3-minute periods of BOLD imaging at 3.0 T were studied – baseline 1 (BL1– at basal CO2 tension), hypocapnia (CO2 decreased ∼5 mmHg), BL2, hypercapnia (CO2 increased ∼10 mmHg) and BL3. Data were processed using statistical parametric mapping (SPM) for 1st level analysis to compare each subject’s response to the CO2 stress at the p = 0.001 level. A 2nd level analysis compared each PCS patient’s response to the mean response of the control subjects at the p = 0.05 level. Results We report on 5 control subjects, 8 symptomatic and 4 asymptomatic PCS patients. Both increased and decreased response to CO2 was seen in all PCS patients in the 2nd level analysis. The responses were quantified as reactive voxel counts: whole brain voxel counts (2.0±1.6%, p = 0.012 for symptomatic patients for CO2 response < controls and 3.0±5.1%, p = 0.139 for CO2 response > controls: 0.49±0.31%, p = 0.053 for asymptomatic patients for CO2 response < controls and 4.4±6.8%, p = 0.281 for CO2 response > controls). Conclusions Quantifiable alterations in regional cerebrovascular responsiveness are present in concussion patients during provocative CO2 challenge and BOLD MRI and not in healthy controls. Future longitudinal studies must aim to clarify the relationship between CO2 responsiveness and individual patient symptoms and outcomes.
    PLoS ONE 07/2014; 9(7):e102181. DOI:10.1371/journal.pone.0102181 · 3.23 Impact Factor
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