Browsing by Subject "Brain Concussion"
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Item A Comparison of Post-Injury Symptomatology and Recovery Following Concussion Versus Orthopedic Injury(August 2021) Allen, Tahnae Tarkenton; Cullum, C. Munro; Didehbani, Nyaz; Hynan, Linda S.; Silver, Cheryl H.; Miller, ShaneOBJECTIVE: Concussion research has utilized orthopedic injury (OI) comparison groups to examine outcomes specific to concussion versus physical injury in general, due to the suggestion that preexisting, comorbid, and other injury-related factors influence post-concussion symptom reporting and recovery. The first aim of this dissertation (Study 1) was to conduct a review of the literature on post-injury symptoms and outcomes following concussion versus OI in children and adolescents, focusing on study design and synthesizing conclusions about concussion versus OI in youth populations. Incorporating findings from the review, the second objective of this dissertation (Study 2) was to collect original data from concussed youth and a carefully selected OI control group to compare symptomatology and recovery at initial presentation and 3-months post-injury to examine whether concussion outcomes are unique to a brain injury or more related to response to injury in general. METHODS: A scoping review using MEDLINE and PubMed to query databases from 2000 to 2020 was performed. Studies were included if they reported children, adolescents, or young adults with mild traumatic brain injury (mTBI)/concussion, used an orthopedic control group, and compared post-injury outcomes, which resulted in a total of 52 articles out of the 526 initially identified. For the second study, participants age 12-18 who sustained a concussion (n = 50) were matched by sex, age, and days since injury to an OI group (n = 50). Repeated measure analyses of covariance (ANCOVAs) were used to compare post-concussion symptoms, emotional symptoms, and recovery outcomes between injury groups at initial and 3 months post-injury. Binary logistic regression analyses were used to determine predictors of prolonged recovery separately in concussion and OI groups. RESULTS: Study 1: sixty-nine percent of the studies included in the scoping review reported differences between concussion and OI outcomes during at least one assessment time point during the recovery period, with higher and more persistent symptomatology in the concussion group. Study 2: the repeated measure ANCOVAs indicated that concussion participants reported significantly higher post-injury symptomatology and psychological sequelae within the first week of injury compared to OI subjects, but by 3 months, the groups showed no differences. Within the concussion group, females reported significantly higher symptoms compared to males, but this pattern was not observed in the OI group. Significant predictors for prolonged recovery also differed between injury groups. For the concussion group, previous concussion was the only significant predictor in our model for prolonged recovery. In the OI group, time since injury and functional impairment rating scores predicted prolonged recovery. CONCLUSIONS: Overall, findings suggest concussion results in a unique expression of symptoms, and recovery following concussion is influenced by a specific set of concussion-related factors that are not commonly seen in OI. Clinically, a unique presentation and recovery course following concussion versus OI supports the utility of specialized concussion treatment and clinical protocols, and may help identify individuals at greater risk of prolonged recovery.Item Do Concussion History and Gender Influence Neurocognitive Testing Performance(2016-11-21) Borque, Brandy; Silver, Cheryl H.; Cullum, C. Munro; Resch, JacobBACKGROUND: To date, the literature regarding sport concussion (SC) has concentrated primarily on male athletes. Generally, as research on female athletics has increased, there is an overall agreement that female athletes show more impairment post-injury than males. However, more data are needed to determine how SC impacts the female athlete and if that impact is influenced by factors such as age or history of prior concussion. SUBJECTS: Subjects with and without a previous history of concussion at the high school and college level were included and carefully matched for age, gender, height, and weight. After careful matching, five high school athletes with a history of prior SC were compared with five high school athletes without a concussion history, and 14 college athletes with a history of prior SC were compared with 14 matched college athletes without a concussion history. METHOD: Data for this study were acquired from a larger study conducted at the University of Texas at Arlington that examined sport concussion in high school and college athletes. Variables included previous concussion history and baseline scores from the ImPACT test. It was hypothesized that female athletes with a previous SC would show more impairment on baseline neurocognitive measures and would report greater symptom severity at baseline testing compared to athletes without a prior SC. In addition, it was hypothesized that female athletes with a previous SC at the high school level would show more impairment on baseline neurocognitive measures than college athletes with prior SC and that high school players would show greater symptom severity compared to college athletes at baseline. RESULTS: No significant differences were seen on any ImPACT baseline composite scores between athletes with and without a reported history of prior concussion. Similarly, no differences on ImPACT baseline total symptom scores were seen between athletes with concussion versus without a history of prior concussion. Finally, there were no differences on ImPACT composite or total symptom scores between college and high school athletes.Item Elucidating the Impact of Previous Head Injury on Cognition, Brain Structure, and Pathophysiology in Cognitively Normal Individuals Across the Adult Lifespan(2020-08-01T05:00:00.000Z) Munro, Catherine Elizabeth; Cullum, C. Munro; Park, Denise C.; Davenport, Elizabeth; Didehbani, Nyaz; Rodrigue, KarenMild traumatic brain injury (mTBI), or concussion, is a common experience and awareness of mTBI has been increasing. There has been growing concern regarding potential long-term effects of concussion on cognition and risk for neurodegenerative disorders. This concern is heightened for athletic populations, particularly in high-contact sports, at risk for repetitive mTBI. Short-term effects of mTBI are heterogeneous, but well-documented, and the majority of individuals recover from post-concussive symptoms within several months. However, long-term effects of mTBI on brain structure and function are more poorly understood. The current studies sought to determine potential long-term effects of mTBI history and history of sports participation on 1) cognitive performance and change and 2) white matter hyperintensities (WMH) and hyperphosphorylated tau (pTau) burden, a protein associated with neurodegenerative disorders. Participants from the Dallas Lifespan Brain Study (DLBS) (aged 20-90 at baseline) completed two assessments related to head injury: the novel Head Injury Exposure and Assessment Data (HEAD) questionnaire and the current "gold standard," the Ohio State University TBI Identification Method (OSU TBI-ID). MTBI exposure variables were: number of mTBI and HEAD Total Index Score (overall seriousness of mTBI history) from the HEAD questionnaire and history of "concerning" head injury per OSU TBI-ID criteria. The HEAD questionnaire assessed history of participation in sports and average number of years played across no, limited, and high contact sports. Participants underwent longitudinal neuropsychological testing and magnetic resonance imaging, and cross-sectional positron emission tomography. Composite indices were created to represent the domains of Memory, Executive Functioning, and Processing Speed. The results did not find any evidence to suggest mTBI negatively affects cognitive performance, cognitive change, or perceived memory capacity. Longer participation in high-contact sports was not predictive of cognitive performance and there was no difference in mean cognitive index scores across highest level of contact sport played. There was also no evidence to support any relationship between history of mTBI/participation in high-contact sports and increased cerebral WMH volume or regional pTau burden. Thus, prior history of mTBI/participation in high-contact sports does not appear to be related to changes in brain structure or function in these otherwise healthy adults.Item Outcomes Following Sports-Related Concussion in School-Aged Children and Adolescents: The Influence of Psychological Factors(2018-07-30) Wilmoth, Kristin Michelle; Cullum, C. Munro; Bell, Kathleen R.; Hynan, Linda S.; Didehbani, Nyaz; Rossetti, HeidiAlthough neurocognitive performance has been a popular topic of investigation in sports-related concussion, biopsychosocial sequelae have received considerably less attention. We reviewed the literature on emotional and psychosocial functioning in school-aged children and adolescents following concussion. MEDLINE and PsycINFO database queries identified 604 studies examining psychological and/or social outcomes of mild traumatic brain injury in children, 11 of those specific to athletes. This small body of literature and extrapolation from the general pediatric concussion literature indicated behavioral disturbances present at least temporarily following injury. Postconcussive anxiety and depressive symptoms are common, though levels may be subclinical. Social and academic disruption was less clearly documented. To aid clinicians in anticipating the psychosocial needs of concussed student athletes, well-controlled and adequately powered research on emotional and psychosocial outcomes are needed. The impact of post-injury psychological functioning on concussion recovery is poorly understood, particularly in youth. To this end, we explored initial mood and sleep symptoms as predictors of prolonged symptom clearance in a sample of adolescents, controlling for previously established injury-related and demographic risk factors. Student athletes (aged 12-18, N=393, 55% male) evaluated in outpatient concussion clinics completed brief self-report anxiety, depression, sleep, and postconcussive symptom scales 0-2 weeks post-injury. Medical record review at three-month follow-up provided date of symptom clearance. Survival analysis for time to recovery was conducted based on 1) self-reported injury/medical factors: sex, psychiatric history, prior concussion history, loss of consciousness, amnesia, initial symptom severity, and 2) psychological factors: anxiety, depression, and sleep screeners. Having amnesia, greater postconcussive symptoms, and worse sleep quality decreased the odds of recovery across time points (HRs = 0.64-0.99, ps < .05) in the total sample. When separated by sex, only postconcussive symptoms were associated with recovery in females, while amnesia and depressive symptoms were the only significant predictors of recovery for males (HRs = 0.54-0.98, ps < .05). Our findings linked brief psychological screeners to prolonged recovery, even considering injury and medical factors. Assessment of mood and sleep may aid in identification of individuals at risk for worse outcomes, though further exploration of postconcussive psychological issues is warranted before drawing firm conclusions.Item Predictors of Persistent Neurobehavioral Symptoms in Adolescents with Mild Traumatic Brain Injury Using a Novel Clinical Tool(2021-07-23) Wright, Brittany Nicole; Brewer-Mixon, Karen; Cullum, C. Munro; Juengst, Shannon B.; Krumwiede, Kimberly Hoggatt; Terhorst, Lauren; Wilmoth, Kristin MichellePersistent post-concussion symptoms in adolescents are non-specific and poorly understood. A small percentage of adolescents (roughly 20%) will experience persistent symptoms following mTBI that can be disruptive in many areas of daily functioning. Including measures in assessment that are specific to adolescents but capture symptoms beyond injury may lead to more insight as to why some adolescents experience persistent symptoms. Moreover, identifying predictors of persistent symptoms could aid in management and evaluation of symptoms. The current set of studies was designed to validate a measurement tool for adolescents and identify predictors of persistent symptoms in a cohort of adolescents with mTBI. Study 1 was designed to further validate a tool (the BAST-A), which assesses persistent emotional and behavioral symptoms in adolescents. Another aim was to develop ordinal to continuous normed scores to aid in clinical interpretation. When assessing the psychometric indicators of the tool, both the Negative Affect and Fatigue and Executive and Social Function subscales performed well. However, the Risk Behaviors subscale performed poorly in this sample of adolescents with sports-related concussion. Specifically, Risk Behaviors was not able to distinguish different severity levels in the sample. Results from this study suggest further psychometric validation of the BAST-A in adolescents with mTBI. The aim of Study 2 was to utilize the ordinal to continuous normed scores in the first study to assess if a combination of predictors was associated with persistent neurobehavioral symptoms in adolescents with mTBI. A combination of pre-injury and injury predictors was significantly associated with self-reported Negative Affect and Fatigue symptoms (F (8,93) =6.09, p<.001) and Executive and Social Function symptoms (F (8,93) = 2.18, p=.036). Due to limitations within the Risk Behaviors subscale, binary (Yes/No) outcomes were used. A combination of pre-injury and injury factors was also significantly associated with self-reported Risk Behaviors [χ2(8) = 18.84, p=.016]. Across subscales, total number of recent life stressors remained a significant predictor of persistent symptoms. The results from this study indicated that a combination of injury-related and personal factors is predictive of persistent symptoms and that recent life stressors contribute to the experience of these symptoms.