Life Sciences Commons^™

Head Impact Exposure In Youth And Collegiate American Football, Grace B. Choi, Eric P. Smith, Stefan M. Duma, Steven Rowson, Eamon Campolettano, Mireille E. Kelley, Derek A. Jones, Joel D. Stitzel, Jillian E. Urban, Amaris Genemaras, Jonathan G. Beckwith, Richard M. Greenwald, Arthur C. Maerlender, Joseph J. Crisco

Center for Brain, Biology, and Behavior: Faculty and Staff Publications

The relationship between head impact and subsequent brain injury for American football players is not well defined, especially for youth. The objective of this study is to quantify and assess Head Impact Exposure (HIE) metrics among youth and collegiate football players. This multiseason study enrolled 639 unique athletes (354 collegiate; 285 youth, ages 9–14), recording 476,209 head impacts (367,337 collegiate; 108,872 youth) over 971 sessions (480 collegiate; 491 youth). Youth players experienced 43 and 65% fewer impacts per competition and practice, respectively, and lower impact magnitudes compared to collegiate players (95th percentile peak linear acceleration (PLA, g) competition: 45.6 vs …

In-Season Concussion Symptom Reporting In Male And Female Collegiate Rugby Athletes, Emily E. Kieffer,, P. Gunnar Brolinson, Arthur C. Maerlender, Eric Smith, Steven Rowson

Center for Brain, Biology, and Behavior: Faculty and Staff Publications

Symptom inventories are generally only collected after a suspected concussion, but regular in-season monitoring may allude to clinical symptoms associated with repetitive subconcussive impacts and potential undiagnosed concussions. Despite sex-specific differences in symptom presentation and outcome of concussion, no return-to-play protocol takes sex into account. The objective of this study was to monitor a cohort of contact-sport athletes and compare the frequency and severity of in-season concussion-like symptom reporting between sexes. Graded symptom checklists from 144 female and 104 male athlete-seasons were administered weekly to quantify the effect of subconcussive impacts on frequency and severity of in-season symptom reporting. In-season, …

Developing Methods To Detect And Diagnose Chronic Traumatic Encephalopathy During Life: Rationale, Design, And Methodology For The Diagnose Cte Research Project, Jeffrey Cummings, Numerous Authors, See Full List Below

School of Medicine Faculty Publications

Background: Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that has been neuropathologically diagnosed in brain donors exposed to repetitive head impacts, including boxers and American football, soccer, ice hockey, and rugby players. CTE cannot yet be diagnosed during life. In December 2015, the National Institute of Neurological Disorders and Stroke awarded a seven-year grant (U01NS093334) to fund the “Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy (DIAGNOSE CTE) Research Project.” The objectives of this multicenter project are to: develop in vivo fluid and neuroimaging biomarkers for CTE; characterize its clinical presentation; refine …

A Kinetic Model For Blood Biomarker Levels After Mild Traumatic Brain Injury, Sima Azizi, Daniel B. Hier, Blaine Allen, Tayo Obafemi-Ajayi, Gayla R. Olbricht, Matthew S. Thimgan, Donald C. Wunsch

Mathematics and Statistics Faculty Research & Creative Works

Traumatic brain injury (TBI) imposes a significant economic and social burden. The diagnosis and prognosis of mild TBI, also called concussion, is challenging. Concussions are common among contact sport athletes. After a blow to the head, it is often difficult to determine who has had a concussion, who should be withheld from play, if a concussed athlete is ready to return to the field, and which concussed athlete will develop a post-concussion syndrome. Biomarkers can be detected in the cerebrospinal fluid and blood after traumatic brain injury and their levels may have prognostic value. Despite significant investigation, questions remain as …

Long-Term Impact Of Mild Traumatic Brain Injuries On Multiple Functional Outcomes And Epigenetics: A Pilot Study With College Students, Hyunhwa Lee, Sungchul Lee, Ipuna Black, Laura Salado, Jonica Estrada, Katrina Isla

Nursing Faculty Publications

People who suffer a mild traumatic brain injury (mTBI) have heterogeneous symptoms and disease trajectories, which make it difficult to precisely assess long-term complications. This pilot study assessed and compared deficits in cognitive, psychosocial, visual functions, and balance performance between college students with and without histories of mTBI. Global DNA methylation ratio (5-mC%) in blood was also compared as a peripheral epigenetic marker. Twenty-five volunteers participated, including 14 healthy controls (64.3% females; mean age of 22.0) and 11 mTBI cases (27.3% females; mean age of 28.7 years) who self-reported mTBI history (63.6% multiple; 2.5 ± 1.29 injuries) with 7.1 years …

Sleep And Stress In The Acute Phase Of Concussion In Youth, Arthur C. Maerlender, Caitlin Masterson, Jessica L. Calvi, Todd Caze, Ross Mathiasen, Dennis Molfese

Center for Brain, Biology, and Behavior: Faculty and Staff Publications

This study sought to address the complex interplay between both biological and psychological perceptions of stress and sleep in the acute stages following a mild traumatic brain injury. A secondary goal was to identify potential targets for intervention. Eleven acutely injured youth (mean age 12 years) were studied at home with overnight actigraphy, salivary cortisol and melatonin assays, and subjective ratings of stress and fatigue (injured group). Nine matched control youth also were assessed (control group). Results suggested longer sleep latencies (time to fall asleep) and higher levels of fatigue in the injured group exist (p ¼ 0.025 and p …

Confirmatory Factor Analysis Of Two Computerized Neuropsychological Test Batteries: Immediate Post-Concussion Assessment And Cognitive Test (Impact) And C3 Logix, Caitlin Masterson, Julie Tuttle, Arthur C. Maerlender

Center for Brain, Biology, and Behavior: Faculty and Staff Publications

Introduction: Tests of memory and speed of cognitive and motor responses have been the primary foci in sports-related concussion assessment. This study sought to assess the construct validity of neuropsychological tests within C3 Logix.

Method: Results of both baseline C3 Logix and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) computerized tests from 86 Division I collegiate athletes were submitted to a two-factor confirmatory analysis using structural equation modeling. The two factors of Speed and Memory have been confirmed in previous studies of ImPACT.

Results: Results confirmed the two-factor model of ImPACT, whereas C3 Logix did not …

Is Concussion-Related Sleep Disturbance Present After Return To Play In College Athletes?, Alexander Gallaer

Honors Scholar Theses

As one of the most commonly experienced symptoms, the ramifications of sleep disruption as a result of concussion are potentially great, yet widely unexplored. Particularly troublesome is murky data regarding the length of sleep disruption following a concussion. By analyzing self-reported sleep data via the Pittsburgh Sleep Quality Index, this study seeks to investigate potential differences in sleep quality between injured college athletes 40 days after they have been cleared to play and matched controls. Data was analyzed using ANOVA analysis as well as Pearson correlation. No significant differences were found in sleep quality between groups, nor was there a …

The Effect Of Tackling Training On Head Accelerations In Youth American Football, Eric Schussler, Richard J. Jagacinski, Susan E. White, Ajit M. Chaudhari, John A. Buford, James A. Onate

Rehabilitation Sciences Faculty Publications

Background: Many organizations have introduced frameworks to reduce the incidence of football related concussions through proper equipment fitting, coach education, and alteration of tackling technique.

Purpose: The purpose of this study was to examine the effects of training in a vertical, head up tackling style on the number of head accelerations experienced while tackling in a controlled laboratory situation. The authors hypothesized that training in a head up tackling technique would reduce the severity of head acceleration experienced by participants.

Design: Controlled Laboratory Study.

Methods: Twenty-four participants (11.5 ± 0.6 years old, 60.5 ± 2.2 in, 110 ± 18.4 lbs.) …

Multiparametric Mri Changes Persist Beyond Recovery In Concussed Adolescent Hockey Players, Kathryn Y. Manning Msc, Amy Achranz Bmsc, Robert Bartha Phd, Gregory A. Dekaban Phd, Christy Barreira Bsc, Arthur Brown Phd, Lisa Fischer Md, Kevin Asem Md, Timothy J. Doherty, Douglas D. Fraser Md Phd, Jeff Holmes Phd, Ravi S. Menon

Anatomy and Cell Biology Publications

Objective: To determine whether multiparametric MRI data can provide insight into the acute and long-lasting neuronal sequelae after a concussion in adolescent athletes.

Methods: Players were recruited from Bantam hockey leagues in which body checking is first introduced (male, age 11–14 years). Clinical measures, diffusion metrics, resting-state network and region-to-region functional connectivity patterns, and magnetic resonance spectroscopy absolute metabolite concentrations were analyzed from an independent, age-matched control group of hockey players (n 5 26) and longitudinally in concussed athletes within 24 to 72 hours (n 5 17) and 3 months (n 5 14) after a diagnosed concussion.

Results: …

Chronic Traumatic Encephalopathy-Integration Of Canonical Traumatic Brain Injury Secondary Injury Mechanisms With Tau Pathology, Jacqueline R. Kulbe, Edward D. Hall

Spinal Cord and Brain Injury Research Center Faculty Publications

In recent years, a new neurodegenerative tauopathy labeled Chronic Traumatic Encephalopathy (CTE), has been identified that is believed to be primarily a sequela of repeated mild traumatic brain injury (TBI), often referred to as concussion, that occurs in athletes participating in contact sports (e.g. boxing, football, football, rugby, soccer, ice hockey) or in military combatants, especially after blast-induced injuries. Since the identification of CTE, and its neuropathological finding of deposits of hyperphosphorylated tau protein, mechanistic attention has been on lumping the disorder together with various other non-traumatic neurodegenerative tauopathies. Indeed, brains from suspected CTE cases that have come to autopsy …

Validity And Reliability Of Baseline Testing In A Standardized Environment, Kathryn L. Higgins, Todd Caze, Arthur C. Maerlender

Center for Brain, Biology, and Behavior: Faculty and Staff Publications

Objective — The Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) is a computerized neuropsychological test battery commonly used to determine cognitive recovery from concussion based on comparing post-injury scores to baseline scores. This model is based on the premise that ImPACT baseline test scores are a valid and reliable measure of optimal cognitive function at baseline. Growing evidence suggests that this premise may not be accurate and a large contributor to invalid and unreliable baseline test scores may be the protocol and environment in which baseline tests are administered. This study examined the effects of a standardized environment and administration …

Sandbagging On The Immediate Post-Concussion Assessment And Cognitive Testing (Impact) In A High School Athlete Population, Kathryn L. Higgins, Robert L. Denny, Arthur C. Maerlender

Center for Brain, Biology, and Behavior: Faculty and Staff Publications

The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computerized neuropsychological test battery commonly used to assess cognitive functioning after a concussion. It is recommended that application of ImPACT utilizes a baseline administration so athletes have an individualized baseline with which to compare post-injury results should they sustain a concussion. It has been suggested that athletes may provide suboptimal effort, called “sandbagging,” in order to return to their baseline cognitive scores, and thus to play, more quickly. This research examines ImPACT baseline scores when high school athletes were asked to attempt to “sandbag,” and compares those scores with scores …

Relationship Between The Romberg Test And The Wii Basic Balance Test And Cognition In Athletes With Concussion, Nicholas G. Murray, Anthony P. Salvatore, Arthur Islas, Joseph Tomaka, Rebecca J. Reed-Jones

Department of Health Sciences and Kinesiology Faculty Publications

Background: Approximately 30% of individuals with a sport-related concussion present with postural instability. Multiple clinical balance tests exist to diagnose postural instability; yet little is known about the potential relationship between these type of postural assessments and cognition post-concussion. Aim: The purpose of the current study was to assess the relationship between the Romberg test, the Wii Fit basic balance test (WBBT), and the composite scores on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test in a sample of athletes with concussions.

Methods: 55 post-concussed athletes (40 male) completed the Romberg Test (RT) (−/+), the WBBT, and ImPACT test. …

Concussion Awareness And Educational Outreach Through A Website And Mobile Application, Daniel J. Brogan

Neuroscience Summer Fellows

In recent years concussions have become a more apparent problem in youth and adolescent sports. 1 in 5 high school students will sustain a concussion during the season. Due to medical and scientific advances, the diagnosis of concussions is becoming much simpler with key markers that are signs for an injury. Returning to play too soon before an athlete is fully recovered increases the likelihood that serious and irreversible neurological deficits can occur. Symptoms for concussions are necessary to track in order for an athlete to properly report their recovery to a physician. Doctors primarily rely on a patient’s report …

Impaired Executive Function In Concussed Athletes, Marisa Gretz

Neuroscience Summer Fellows

Concussions are classified as mild traumatic brain injuries (mTBI). An individual that has sustained a concussion will experience symptoms such as nausea, possible memory loss, blurry vision, or loss of balance. Most symptoms subside within a few days, but a large pool of research raises concern for the recovery of executive function, specifically impulse control. Executive function relates to all tasks that require deliberate attention. Past research has shown adolescents record the highest number of sports concussions when compared to collegiate and professional athletes. The frontal lobe, which controls executive function, is not fully developed during the time of adolescence. …

Pathological Effects Of Repeated Concussive Tbi In Mouse Models: Periventricular Damage And Ventriculomegaly, Richard H. Wolferz Jr.

Honors Scholar Theses

Repeated concussive traumatic brain injury (rcTBI) is the most prominent form of head injury affecting the brain, with an estimated 1.7 million Americans affected each year (Kuhn 2012). Neurologists have been concerned about the danger of repeated head impacts since the 1920’s, but researchers have only begun to understand the long-term effects of rcTBI (McKee 2009). Although symptoms can be as mild as dizziness, current research suggests that multiple concussions can lead to a progressive degenerative brain disease known as chronic traumatic encephalopathy (CTE) (Luo 2008, McKee 2009, Kane 2013). Research on the brain is just beginning to scratch the …

Concussion Management, Education, And Return-To-Play Policies In High Schools: A Survey Of Athletic Directors, Athletic Trainers, And Coaches, Amanda Esquivel, Sadiq Haque, Patrick Keating, Stephanie Marsh, Stephen Lemos

Kinesiology, Health and Sport Studies

Background: Concussions represent 8.9% to 13.2% of all high school athletic injuries. How these injuries are managed is currently unknown.

Hypothesis: There are differences in concussion management and awareness between boys football, boys ice hockey, and boys and girls soccer.

Study Design: Descriptive epidemiologic study.

Methods: High school athletic directors were contacted via email and asked to complete an online survey with four separate sections for athletic directors, head coaches, team physicians, or certified athletic trainers.

Results: According to coaches, concussion awareness education was provided for football (97%), hockey (65%), and boys and girls soccer …

Spectrum Of Acute Clinical Characteristics Of Diagnosed Concussions In College Athletes Wearing Instrumented Helmets, Ann-Christine Duhaime,, Jonathan G. Beckwith, Arthur C. Maerlender, Thomas W. Mcallister, Joseph J. Crisco, Stefan M. Duma, P. Gunnar Brolinson, Steven Rowson, Laura A. Flashman, Jeffrey J. Chu, Richard M. Greenwald

Department of Psychology: Faculty Publications

Object. Concussive head injuries have received much attention in the medical and public arenas, as concerns have been raised about the potential shortand long-term consequences of injuries sustained in sports and other activities. While many student athletes have required evaluation after concussion, the exact definition of concussion has varied among disciplines and over time. The authors used data gathered as part of a multiinstitutional longitudinal study of the biomechanics of head impacts in helmeted collegiate athletes to characterize what signs, symptoms, and clinical histories were used to designate players as having sustained concussions.

Methods. Players on 3 college …