Medicine › Epidemiology

Traumatic Brain Injury Research

Works Count: 65021

Wikipedia

Description

This cluster of papers focuses on the epidemiology, impact, and long-term consequences of traumatic brain injury (TBI), particularly concussion and mild TBI. It covers a wide range of topics including neurological outcomes, cognitive rehabilitation, sports-related injuries, neuropathological changes, and consciousness assessment in TBI patients.

Keywords

Concussion; Encephalopathy; Neurological; Recovery; Cognitive; Sports-related; Neuropathology; Consciousness; Mild TBI; Epidemiology

Clinical neuropsychology: Current status and applications

1975-01-01

Ralph M. Reitan , Leslie A. Davison

Disability rating scale for severe head trauma: coma to community.

1982-03-01

M. Rappaport , Kelly Hall , Katherine L. Hopkins +2 more

ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE A Practical Scale

1975-03-01

B. Jennett

Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage

2008-01-29

Jeffrey A. Kleim , Theresa A. Jones

This paper reviews 10 principles of experience-dependent neural plasticity and considerations in applying them to the damaged brain.Neuroscience research using a variety of models of learning, neurological disease, and trauma … This paper reviews 10 principles of experience-dependent neural plasticity and considerations in applying them to the damaged brain.Neuroscience research using a variety of models of learning, neurological disease, and trauma are reviewed from the perspective of basic neuroscientists but in a manner intended to be useful for the development of more effective clinical rehabilitation interventions.Neural plasticity is believed to be the basis for both learning in the intact brain and relearning in the damaged brain that occurs through physical rehabilitation. Neuroscience research has made significant advances in understanding experience-dependent neural plasticity, and these findings are beginning to be integrated with research on the degenerative and regenerative effects of brain damage. The qualities and constraints of experience-dependent neural plasticity are likely to be of major relevance to rehabilitation efforts in humans with brain damage. However, some research topics need much more attention in order to enhance the translation of this area of neuroscience to clinical research and practice.The growing understanding of the nature of brain plasticity raises optimism that this knowledge can be capitalized upon to improve rehabilitation efforts and to optimize functional outcome.

The Ecological Validity of Neuropsychological Tests: A Review of the Literature on Everyday Cognitive Skills

2003-12-01

Naomi Chaytor , Maureen Schmitter‐Edgecombe

Classification for Effective Rehabilitation

1990-03-01

D. A. Andrews , James Bonta , Robert D. Hoge

Four principles of classification for effective rehabilitation are reviewed: risk, need, responsivity, and professional override. Many examples of Case x Treatment interactions are presented to illustrate the principles. Four principles of classification for effective rehabilitation are reviewed: risk, need, responsivity, and professional override. Many examples of Case x Treatment interactions are presented to illustrate the principles.

Paced Auditory Serial-Addition Task: A Measure of Recovery from Concussion

1977-04-01

Dorothy Gronwall

The need for a measure of severity of concussion apart from duration of post-traumatic amnesia is examined. The paced auditory serial-addition test, a measure of rate of information processing, is … The need for a measure of severity of concussion apart from duration of post-traumatic amnesia is examined. The paced auditory serial-addition test, a measure of rate of information processing, is presented as a convenient test for estimating individual performance during recovery. Procedures for administration and control data are given, and the programme used for managing the rehabilitation of concussion patients described.

The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability

1995-01-01

Nigel S. King , Sue E. Crawford , F J Wenden +2 more

Consensus statement on Concussion in Sport – The 4th International Conference on Concussion in Sport held in Zurich, November 2012

2013-05-01

Paul McCrory , Willem Meeuwisse , Mark Aubry +7 more

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The JFK Coma Recovery Scale-Revised: Measurement characteristics and diagnostic utility11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

2004-12-01

Joseph T. Giacino , Kathleen Kalmar , John Whyte

Unreported Concussion in High School Football Players

2004-01-01

Michael McCrea , Thomas A. Hammeke , Gary Olsen +2 more

Objective To investigate the frequency of unreported concussion and estimate more accurately the overall rate of concussion in high school football players. Design Retrospective, confidential survey completed by all subjects … Objective To investigate the frequency of unreported concussion and estimate more accurately the overall rate of concussion in high school football players. Design Retrospective, confidential survey completed by all subjects at the end of the football season. Setting and Participants A total of 1,532 varsity football players from 20 high schools in the Milwaukee, Wisconsin, area were surveyed. Main Outcome Measurements The structured survey assessed (1) number of concussions before the current season, (2) number of concussions sustained during the current season, (3) whether concussion during the current season was reported, (4) to whom concussion was reported, and (5) reasons for not reporting concussion. Results Of respondents, 29.9% reported a previous history of concussion, and 15.3% reported sustaining a concussion during the current football season; of those, 47.3% reported their injury. Concussions were reported most frequently to a certified athletic trainer (76.7% of reported injuries). The most common reasons for concussion not being reported included a player not thinking the injury was serious enough to warrant medical attention (66.4% of unreported injuries), motivation not to be withheld from competition (41.0%), and lack of awareness of probable concussion (36.1%). Conclusions These findings reflect a higher prevalence of concussion in high school football players than previously reported in the literature. The ultimate concern associated with unreported concussion is an athlete’s increased risk of cumulative or catastrophic effects from recurrent injury. Future prevention initiatives should focus on education to improve athlete awareness of the signs of concussion and potential risks of unreported injury.

Traumatic brain injury in the rat: Characterization of a lateral fluid-percussion model

1989-01-01

Tracy K. McIntosh , Robert Vink , Linda J. Noble‐Haeusslein +4 more

Evidence-based cognitive rehabilitation: Recommendations for clinical practice

2000-12-01

Keith D. Cicerone , Cynthia Dahlberg , Kathleen Kalmar +7 more

A systematic review of brain injury epidemiology in Europe

2005-11-26

Fernanda Tagliaferri , Christian Compagnone , Marjan Koršič +2 more

Position Statement: Definition of Traumatic Brain Injury

2010-11-01

David Menon , Karen Schwab , David W. Wright +1 more

Trail making test: normative values from 287 normal adult controls

1996-08-01

Anna Rıta Gıovagnolı , M. Del Pesce , S. Mascheroni +3 more

Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy After Repetitive Head Injury

2009-06-25

Ann C. McKee , Robert C. Cantu , Christopher J. Nowinski +7 more

Since the 1920s, it has been known that the repetitive brain trauma associated with boxing may produce a progressive neurological deterioration, originally termed dementia pugilistica, and more recently, chronic traumatic … Since the 1920s, it has been known that the repetitive brain trauma associated with boxing may produce a progressive neurological deterioration, originally termed dementia pugilistica, and more recently, chronic traumatic encephalopathy (CTE). We review 48 cases of neuropathologically verified CTE recorded in the literature and document the detailed findings of CTE in 3 profession althletes, 1 football player and 2 boxers. Clinically, CTE is associated with memory disturbances, behavioral and personality changes, parkinsonism, and speech and gait abnormalities. Neuropathologically, CTE is characterized by atrophy of the cerebral hemispheres, medial temporal lobe, thalamus, mammillary bodies, and brainstem, with ventricular dilatation and a fenestrated cavum septum pellucidum. Microscopically, there are extensive tau-immunoreactive neurofibrillary tangles, astrocytic tangles, and spindle-shaped and threadlike neurites throughout the brain. The neurofibrillary degeneration of CTE is distinguished from other tauopathies by preferential involvement of the superficial cortical layers, irregular patchy distribution in the frontal and temporal cortices, propensity for sulcal depths, prominent perivascular, periventricular, and subpial distribution, and marked accumulation of tau-immunoreactive astrocytes. Deposition of beta-amyloid, most commonly as diffuse plaques, occurs in fewer than half the cases. Chronic traumatic encephalopathy is a neuropathologically distinct slowly progressive tauopathy with a clear environmental etiology.

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PERSISTENT VEGETATIVE STATE AFTER BRAIN DAMAGE

1972-04-01

Bryan Jennett , Fred Plum

The New Neurometabolic Cascade of Concussion

2014-09-19

Christopher C. Giza , David A. Hovda

Since the original descriptions of postconcussive pathophysiology, there has been a significant increase in interest and ongoing research to study the biological underpinnings of concussion. The initial ionic flux and … Since the original descriptions of postconcussive pathophysiology, there has been a significant increase in interest and ongoing research to study the biological underpinnings of concussion. The initial ionic flux and glutamate release result in significant energy demands and a period of metabolic crisis for the injured brain. These physiological perturbations can now be linked to clinical characteristics of concussion, including migrainous symptoms, vulnerability to repeat injury, and cognitive impairment. Furthermore, advanced neuroimaging now allows a research window to monitor postconcussion pathophysiology in humans noninvasively. There is also increasing concern about the risk for chronic or even progressive neurobehavioral impairment after concussion/mild traumatic brain injury. Critical studies are underway to better link the acute pathobiology of concussion with potential mechanisms of chronic cell death, dysfunction, and neurodegeneration. This "new and improved" article summarizes in a translational fashion and updates what is known about the acute neurometabolic changes after concussive brain injury. Furthermore, new connections are proposed between this neurobiology and early clinical symptoms as well as to cellular processes that may underlie long-term impairment.

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Cumulative Effects Associated With Recurrent Concussion in Collegiate Football Players

2003-11-18

Kevin M. Guskiewicz , Michael McCrea , Stephen W. Marshall +5 more

Approximately 300 000 sport-related concussions occur annually in the United States, and the likelihood of serious sequelae may increase with repeated head injury.To estimate the incidence of concussion and time … Approximately 300 000 sport-related concussions occur annually in the United States, and the likelihood of serious sequelae may increase with repeated head injury.To estimate the incidence of concussion and time to recovery after concussion in collegiate football players.Prospective cohort study of 2905 football players from 25 US colleges were tested at preseason baseline in 1999, 2000, and 2001 on a variety of measures and followed up prospectively to ascertain concussion occurrence. Players injured with a concussion were monitored until their concussion symptoms resolved and were followed up for repeat concussions until completion of their collegiate football career or until the end of the 2001 football season.Incidence of concussion and repeat concussion; type and duration of symptoms and course of recovery among players who were injured with a concussion during the seasons.During follow-up of 4251 player-seasons, 184 players (6.3%) had a concussion, and 12 (6.5%) of these players had a repeat concussion within the same season. There was an association between reported number of previous concussions and likelihood of incident concussion. Players reporting a history of 3 or more previous concussions were 3.0 (95% confidence interval, 1.6-5.6) times more likely to have an incident concussion than players with no concussion history. Headache was the most commonly reported symptom at the time of injury (85.2%), and mean overall symptom duration was 82 hours. Slowed recovery was associated with a history of multiple previous concussions (30.0% of those with > or =3 previous concussions had symptoms lasting >1 week compared with 14.6% of those with 1 previous concussion). Of the 12 incident within-season repeat concussions, 11 (91.7%) occurred within 10 days of the first injury, and 9 (75.0%) occurred within 7 days of the first injury.Our study suggests that players with a history of previous concussions are more likely to have future concussive injuries than those with no history; 1 in 15 players with a concussion may have additional concussions in the same playing season; and previous concussions may be associated with slower recovery of neurological function.

Association between Recurrent Concussion and Late-Life Cognitive Impairment in Retired Professional Football Players

2005-10-01

Kevin M. Guskiewicz , Stephen W. Marshall , Julian E. Bailes +4 more

Cerebral concussion is common in collision sports such as football, yet the chronic neurological effects of recurrent concussion are not well understood. The purpose of our study was to investigate … Cerebral concussion is common in collision sports such as football, yet the chronic neurological effects of recurrent concussion are not well understood. The purpose of our study was to investigate the association between previous head injury and the likelihood of developing mild cognitive impairment (MCI) and Alzheimer's disease in a unique group of retired professional football players with previous head injury exposure.A general health questionnaire was completed by 2552 retired professional football players with an average age of 53.8 (+/-13.4) years and an average professional football playing career of 6.6 (+/- 3.6) years. A second questionnaire focusing on memory and issues related to MCI was then completed by a subset of 758 retired professional football players (> or = 50 yr of age). Results on MCI were then cross-tabulated with results from the original health questionnaire for this subset of older retirees.Of the former players, 61% sustained at least one concussion during their professional football career, and 24% sustained three or more concussions. Statistical analysis of the data identified an association between recurrent concussion and clinically diagnosed MCI (chi = 7.82, df = 2, P = 0.02) and self-reported significant memory impairments (chi = 19.75, df = 2, P = 0.001). Retired players with three or more reported concussions had a fivefold prevalence of MCI diagnosis and a threefold prevalence of reported significant memory problems compared with retirees without a history of concussion. Although there was not an association between recurrent concussion and Alzheimer's disease, we observed an earlier onset of Alzheimer's disease in the retirees than in the general American male population.Our findings suggest that the onset of dementia-related syndromes may be initiated by repetitive cerebral concussions in professional football players.

Methodological issues and research recommendations for mild traumatic brain injury: the who collaborating centre task force on mild traumatic brain injury

2004-02-01

Linda Carroll , J. David Cassidy , Lena W. Holm +2 more

The WHO Collaborating Centre for Neurotrauma Task Force on Mild Traumatic Brain Injury performed a comprehensive search and critical review of the literature published between 1980 and 2002 to assemble … The WHO Collaborating Centre for Neurotrauma Task Force on Mild Traumatic Brain Injury performed a comprehensive search and critical review of the literature published between 1980 and 2002 to assemble the best evidence on the epidemiology, diagnosis, prognosis and treatment of mild traumatic brain injury. Of 743 relevant studies, 313 were accepted on scientific merit and comprise our best-evidence synthesis. The current literature on mild traumatic brain injury is of variable quality and we report the most common methodological flaws. We make recommendations for avoiding the shortcomings evident in much of the current literature and identify topic areas in urgent need of further research. This includes the need for large, well-designed studies to support evidence-based guidelines for emergency room triage of children with mild traumatic brain injury and to explore more fully the issue of prognosis after mild traumatic brain injury in the elderly population. We also advocate use of standard criteria for defining mild traumatic brain injury and propose a definition.

Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome

2010-11-01

Steven Laureys , Gastone G. Celesia , F Cohadon +7 more

Some patients awaken from coma (that is, open the eyes) but remain unresponsive (that is, only showing reflex movements without response to command). This syndrome has been coined vegetative state. … Some patients awaken from coma (that is, open the eyes) but remain unresponsive (that is, only showing reflex movements without response to command). This syndrome has been coined vegetative state. We here present a new name for this challenging neurological condition: unresponsive wakefulness syndrome (abbreviated UWS).Many clinicians feel uncomfortable when referring to patients as vegetative. Indeed, to most of the lay public and media vegetative state has a pejorative connotation and seems inappropriately to refer to these patients as being vegetable-like. Some political and religious groups have hence felt the need to emphasize these vulnerable patients' rights as human beings. Moreover, since its first description over 35 years ago, an increasing number of functional neuroimaging and cognitive evoked potential studies have shown that physicians should be cautious to make strong claims about awareness in some patients without behavioral responses to command. Given these concerns regarding the negative associations intrinsic to the term vegetative state as well as the diagnostic errors and their potential effect on the treatment and care for these patients (who sometimes never recover behavioral signs of consciousness but often recover to what was recently coined a minimally conscious state) we here propose to replace the name.Since after 35 years the medical community has been unsuccessful in changing the pejorative image associated with the words vegetative state, we think it would be better to change the term itself. We here offer physicians the possibility to refer to this condition as unresponsive wakefulness syndrome or UWS. As this neutral descriptive term indicates, it refers to patients showing a number of clinical signs (hence syndrome) of unresponsiveness (that is, without response to commands) in the presence of wakefulness (that is, eye opening).

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Prognosis for mild traumatic brain injury: results of the who collaborating centre task force on mild traumatic brain injury

2004-02-01

Linda Carroll , J. David Cassidy , Paul M. Peloso +5 more

We searched the literature on the epidemiology, diagnosis, prognosis, treatment and costs of mild traumatic brain injury.Of 428 studies related to prognosis after mild traumatic brain injury, 120 (28%) were … We searched the literature on the epidemiology, diagnosis, prognosis, treatment and costs of mild traumatic brain injury.Of 428 studies related to prognosis after mild traumatic brain injury, 120 (28%) were accepted after critical review.These comprise our best-evidence synthesis on prognosis after mild traumatic brain injury.There was consistent and methodologically sound evidence that children's prognosis after mild traumatic brain injury is good, with quick resolution of symptoms and little evidence of residual cognitive, behavioural or academic deficits.For adults, cognitive deficits and symptoms are common in the acute stage, and the majority of studies report recovery for most within 3-12 months.Where symptoms persist, compensation/litigation is a factor, but there is little consistent evidence for other predictors.The literature on this area is of varying quality and causal inferences are often mistakenly drawn from cross-sectional studies.

Acute Effects and Recovery Time Following Concussion in Collegiate Football Players

2003-11-18

Michael McCrea , Kevin M. Guskiewicz , Stephen W. Marshall +6 more

Lack of empirical data on recovery time following sport-related concussion hampers clinical decision making about return to play after injury.To prospectively measure immediate effects and natural recovery course relating to … Lack of empirical data on recovery time following sport-related concussion hampers clinical decision making about return to play after injury.To prospectively measure immediate effects and natural recovery course relating to symptoms, cognitive functioning, and postural stability following sport-related concussion.Prospective cohort study of 1631 football players from 15 US colleges. All players underwent preseason baseline testing on concussion assessment measures in 1999, 2000, and 2001. Ninety-four players with concussion (based on American Academy of Neurology criteria) and 56 noninjured controls underwent assessment of symptoms, cognitive functioning, and postural stability immediately, 3 hours, and 1, 2, 3, 5, 7, and 90 days after injury.Scores on the Graded Symptom Checklist (GSC), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and a neuropsychological test battery.No player with concussion was excluded from participation; 79 players with concussion (84%) completed the protocol through day 90. Players with concussion exhibited more severe symptoms (mean GSC score 20.93 [95% confidence interval [CI], 15.65-26.21] points higher than that of controls), cognitive impairment (mean SAC score 2.94 [95% CI, 1.50-4.38] points lower than that of controls), and balance problems (mean BESS score 5.81 [95% CI, -0.67 to 12.30] points higher than that of controls) immediately after concussion. On average, symptoms gradually resolved by day 7 (GSC mean difference, 0.33; 95% CI, -1.41 to 2.06), cognitive functioning improved to baseline levels within 5 to 7 days (day 7 SAC mean difference, -0.03; 95% CI, -1.33 to 1.26), and balance deficits dissipated within 3 to 5 days after injury (day 5 BESS mean difference, -0.31; 95% CI, -3.02 to 2.40). Mild impairments in cognitive processing and verbal memory evident on neuropsychological testing 2 days after concussion resolved by day 7. There were no significant differences in symptoms or functional impairments in the concussion and control groups 90 days after concussion.Collegiate football players may require several days for recovery of symptoms, cognitive dysfunction, and postural instability after concussion. Further research is required to determine factors that predict variability in recovery time after concussion. Standardized measurement of postconcussive symptoms, cognitive functioning, and postural stability may enhance clinical management of athletes recovering from concussion.

Willful Modulation of Brain Activity in Disorders of Consciousness

2010-02-03

Martin M. Monti , Audrey Vanhaudenhuyse , Martin R. Coleman +5 more

The differential diagnosis of disorders of consciousness is challenging. The rate of misdiagnosis is approximately 40%, and new methods are required to complement bedside testing, particularly if the patient's capacity … The differential diagnosis of disorders of consciousness is challenging. The rate of misdiagnosis is approximately 40%, and new methods are required to complement bedside testing, particularly if the patient's capacity to show behavioral signs of awareness is diminished.At two major referral centers in Cambridge, United Kingdom, and Liege, Belgium, we performed a study involving 54 patients with disorders of consciousness. We used functional magnetic resonance imaging (MRI) to assess each patient's ability to generate willful, neuroanatomically specific, blood-oxygenation-level-dependent responses during two established mental-imagery tasks. A technique was then developed to determine whether such tasks could be used to communicate yes-or-no answers to simple questions.Of the 54 patients enrolled in the study, 5 were able to willfully modulate their brain activity. In three of these patients, additional bedside testing revealed some sign of awareness, but in the other two patients, no voluntary behavior could be detected by means of clinical assessment. One patient was able to use our technique to answer yes or no to questions during functional MRI; however, it remained impossible to establish any form of communication at the bedside.These results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.

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Changing patterns in the epidemiology of traumatic brain injury

2013-02-26

Bob Roozenbeek , Andrew I.R. Maas , David Menon

Base Rates of Malingering and Symptom Exeggeration

2002-12-01

Wiley Mittenberg , Christine L. Patton , Elizabeth M. Canyock +1 more

Base rates of probable malingering and symptom exaggeration are reported from a survey of the American Board of Clinical Neuropsychology membership. Estimates were based on 33,531 annual cases involved in … Base rates of probable malingering and symptom exaggeration are reported from a survey of the American Board of Clinical Neuropsychology membership. Estimates were based on 33,531 annual cases involved in personal injury, (n = 6,371), disability (n = 3,688), criminal (n = 1,341), or medical (n = 22,131) matters. Base rates did not differ among geographic regions or practice settings, but were related to the proportion of plaintiff versus defense referrals. Reported rates would be 2-4% higher if variance due to referral source was controlled. Twenty-nine percent of personal injury, 30% of disability, 19% of criminal, and 8% of medical cases involved probable malingering and symptom exaggeration. Thirty-nine percent of mild head injury, 35% of fibromyalgia/chronic fatigue, 31% of chronic pain, 27% of neurotoxic, and 22% of electrical injury claims resulted in diagnostic impressions of probable malingering. Diagnosis was supported by multiple sources of evidence, including severity (65% of cases) or pattern (64% of cases) of cognitive impairment that was inconsistent with the condition, scores below empirical cutoffs on forced choice tests (57% of cases), discrepancies among records, self-report, and observed behavior (56%), implausible self-reported symptoms in interview (46%), implausible changes in test scores across repeated examinations (45%), and validity scales on objective personality tests (38% of cases).

American Medical Society for Sports Medicine position statement: concussion in sport

2012-12-13

Kimberly G. Harmon , Jonathan A. Drezner , Matthew Gammons +7 more

PURPOSE OF THE STATEMENT: ▸ To provide an evidence-based, best practises summary to assist physicians with the evaluation and management of sports concussion. ▸ To establish the level of evidence, … PURPOSE OF THE STATEMENT: ▸ To provide an evidence-based, best practises summary to assist physicians with the evaluation and management of sports concussion. ▸ To establish the level of evidence, knowledge gaps and areas requiring additional research.▸ Sports medicine physicians are frequently involved in the care of patients with sports concussion. ▸ Sports medicine physicians are specifically trained to provide care along the continuum of sports concussion from the acute injury to return-to-play (RTP) decisions. ▸ The care of athletes with sports concussion is ideally performed by healthcare professionals with specific training and experience in the assessment and management of concussion. Competence should be determined by training and experience, not dictated by specialty. ▸ While this statement is directed towards sports medicine physicians, it may also assist other physicians and healthcare professionals in the care of patients with sports concussion.▸ Concussion is defined as a traumatically induced transient disturbance of brain function and involves a complex pathophysiological process. Concussion is a subset of mild traumatic brain injury (MTBI) which is generally self-limited and at the less-severe end of the brain injury spectrum.▸ Animal and human studies support the concept of postconcussive vulnerability, showing that a second blow before the brain has recovered results in worsening metabolic changes within the cell. ▸ Experimental evidence suggests the concussed brain is less responsive to usual neural activation and when premature cognitive or physical activity occurs before complete recovery the brain may be vulnerable to prolonged dysfunction.▸ It is estimated that as many as 3.8 million concussions occur in the USA per year during competitive sports and recreational activities; however, as many as 50% of the concussions may go unreported. ▸ Concussions occur in all sports with the highest incidence in football, hockey, rugby, soccer and basketball. RISK FACTORS FOR SPORT-RELATED CONCUSSION: ▸ A history of concussion is associated with a higher risk of sustaining another concussion. ▸ A greater number, severity and duration of symptoms after a concussion are predictors of a prolonged recovery. ▸ In sports with similar playing rules, the reported incidence of concussion is higher in female athletes than in male athletes. ▸ Certain sports, positions and individual playing styles have a greater risk of concussion. ▸ Youth athletes may have a more prolonged recovery and are more susceptible to a concussion accompanied by a catastrophic injury. ▸ Preinjury mood disorders, learning disorders, attention-deficit disorders (ADD/ADHD) and migraine headaches complicate diagnosis and management of a concussion.▸ Concussion remains a clinical diagnosis ideally made by a healthcare provider familiar with the athlete and knowledgeable in the recognition and evaluation of concussion. ▸ Graded symptom checklists provide an objective tool for assessing a variety of symptoms related to concussions, while also tracking the severity of those symptoms over serial evaluations. ▸ Standardised assessment tools provide a helpful structure for the evaluation of concussion, although limited validation of these assessment tools is available.▸ Any athlete suspected of having a concussion should be stopped from playing and assessed by a licenced healthcare provider trained in the evaluation and management of concussions. ▸ Recognition and initial assessment of a concussion should be guided by a symptoms checklist, cognitive evaluation (including orientation, past and immediate memory, new learning and concentration), balance tests and further neurological physical examination. ▸ While standardised sideline tests are a useful framework for examination, the sensitivity, specificity, validity and reliability of these tests among different age groups, cultural groups and settings is largely undefined. Their practical usefulness with or without an individual baseline test is also largely unknown. ▸ Balance disturbance is a specific indicator of a concussion, but not very sensitive. Balance testing on the sideline may be substantially different than baseline tests because of differences in shoe/cleat-type or surface, use of ankle tape or braces, or the presence of other lower extremity injury. ▸ Imaging is reserved for athletes where intracerebral bleeding is suspected. ▸ There is no same day RTP for an athlete diagnosed with a concussion. ▸ Athletes suspected or diagnosed with a concussion should be monitored for deteriorating physical or mental status.▸ Neuropsychological (NP) tests are an objective measure of brain-behaviour relationships and are more sensitive for subtle cognitive impairment than clinical exam. ▸ Most concussions can be managed appropriately without the use of NP testing. ▸ Computerised neuropsychological (CNP) testing should be interpreted by healthcare professionals trained and familiar with the type of test and the individual test limitations, including a knowledgeable assessment of the reliable change index, baseline variability and false-positive and false-negative rates. ▸ Paper and pencil NP tests can be more comprehensive, test different domains and assess for other conditions which may masquerade as or complicate assessment of concussion. ▸ NP testing should be used only as part of a comprehensive concussion management strategy and should not be used in isolation. ▸ The ideal timing, frequency and type of NP testing have not been determined. ▸ In some cases, properly administered and interpreted NP testing provides an added value to assess cognitive function and recovery in the management of sports concussions. ▸ It is unknown if use of NP testing in the management of sports concussion helps prevent recurrent concussion, catastrophic injury or long-term complications. ▸ Comprehensive NP evaluation is helpful in the post-concussion management of athletes with persistent symptoms or complicated courses.▸ Students will require cognitive rest and may require academic accommodations such as reduced workload and extended time for tests while recovering from a concussion.▸ Concussion symptoms should be resolved before returning to exercise. ▸ A RTP progression involves a gradual, step-wise increase in physical demands, sports-specific activities and the risk for contact. ▸ If symptoms occur with activity, the progression should be halted and restarted at the preceding symptom-free step. ▸ RTP after concussion should occur only with medical clearance from a licenced healthcare provider trained in the evaluation and management of concussions. SHORT-TERM RISKS OF PREMATURE RTP: ▸ The primary concern with early RTP is decreased reaction time leading to an increased risk of a repeat concussion or other injury and prolongation of symptoms. LONG-TERM EFFECTS: ▸ There is an increasing concern that head impact exposure and recurrent concussions contribute to long-term neurological sequelae. ▸ Some studies have suggested an association between prior concussions and chronic cognitive dysfunction. Large-scale epidemiological studies are needed to more clearly define risk factors and causation of any long-term neurological impairment.▸ There are no evidence-based guidelines for disqualifying/retiring an athlete from a sport after a concussion. Each case should be carefully deliberated and an individualised approach to determining disqualification taken.▸ Greater efforts are needed to educate involved parties, including athletes, parents, coaches, officials, school administrators and healthcare providers to improve concussion recognition, management and prevention. ▸ Physicians should be prepared to provide counselling regarding potential long-term consequences of a concussion and recurrent concussions.▸ Primary prevention of some injuries may be possible with modification and enforcement of the rules and fair play. ▸ Helmets, both hard (football, lacrosse and hockey) and soft (soccer, rugby) are best suited to prevent impact injuries (fracture, bleeding, laceration, etc.) but have not been shown to reduce the incidence and severity of concussions. ▸ There is no current evidence that mouth guards can reduce the severity of or prevent concussions. ▸ Secondary prevention may be possible by appropriate RTP management.▸ Legislative efforts provide a uniform standard for scholastic and non-scholastic sports organisations regarding concussion safety and management.▸ Additional research is needed to validate current assessment tools, delineate the role of NP testing and improve identification of those at risk of prolonged post-concussive symptoms or other long-term complications. ▸ Evolving technologies for the diagnosis of concussion, such as newer neuroimaging techniques or biological markers, may provide new insights into the evaluation and management of sports concussion.

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Behavioural improvements with thalamic stimulation after severe traumatic brain injury

2007-08-01

Nicholas D. Schiff , Joseph T. Giacino , Kathleen Kalmar +7 more

`Oops!': Performance correlates of everyday attentional failures in traumatic brain injured and normal subjects

1997-05-01

Ian H. Robertson , Tom Manly , Jackie Andrade +2 more

The spectrum of disease in chronic traumatic encephalopathy

2012-12-02

Ann C. McKee , Thor D. Stein , Christopher J. Nowinski +7 more

Chronic traumatic encephalopathy is a progressive tauopathy that occurs as a consequence of repetitive mild traumatic brain injury.We analysed post-mortem brains obtained from a cohort of 85 subjects with histories … Chronic traumatic encephalopathy is a progressive tauopathy that occurs as a consequence of repetitive mild traumatic brain injury.We analysed post-mortem brains obtained from a cohort of 85 subjects with histories of repetitive mild traumatic brain injury and found evidence of chronic traumatic encephalopathy in 68 subjects: all males, ranging in age from 17 to 98 years (mean 59.5 years), including 64 athletes, 21 military veterans (86% of whom were also athletes) and one individual who engaged in self-injurious head banging behaviour.Eighteen age-and gender-matched individuals without a history of repetitive mild traumatic brain injury served as control subjects.In chronic traumatic encephalopathy, the spectrum of hyperphosphorylated tau pathology ranged in severity from focal perivascular epicentres of neurofibrillary tangles in the frontal neocortex to severe tauopathy affecting widespread brain regions, including the medial temporal lobe, thereby allowing a progressive staging of pathology from stages I-IV.Multifocal axonal varicosities and axonal loss were found in deep cortex and subcortical white

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Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment

2009-07-21

Caroline Schnakers , Audrey Vanhaudenhuyse , Joseph T. Giacino +5 more

Abstract Background Previously published studies have reported that up to 43% of patients with disorders of consciousness are erroneously assigned a diagnosis of vegetative state (VS). However, no recent studies … Abstract Background Previously published studies have reported that up to 43% of patients with disorders of consciousness are erroneously assigned a diagnosis of vegetative state (VS). However, no recent studies have investigated the accuracy of this grave clinical diagnosis. In this study, we compared consensus-based diagnoses of VS and MCS to those based on a well-established standardized neurobehavioral rating scale, the JFK Coma Recovery Scale-Revised (CRS-R). Methods We prospectively followed 103 patients (55 ± 19 years) with mixed etiologies and compared the clinical consensus diagnosis provided by the physician on the basis of the medical staff's daily observations to diagnoses derived from CRS-R assessments performed by research staff. All patients were assigned a diagnosis of 'VS', 'MCS' or 'uncertain diagnosis.' Results Of the 44 patients diagnosed with VS based on the clinical consensus of the medical team, 18 (41%) were found to be in MCS following standardized assessment with the CRS-R. In the 41 patients with a consensus diagnosis of MCS, 4 (10%) had emerged from MCS, according to the CRS-R. We also found that the majority of patients assigned an uncertain diagnosis by clinical consensus (89%) were in MCS based on CRS-R findings. Conclusion Despite the importance of diagnostic accuracy, the rate of misdiagnosis of VS has not substantially changed in the past 15 years. Standardized neurobehavioral assessment is a more sensitive means of establishing differential diagnosis in patients with disorders of consciousness when compared to diagnoses determined by clinical consensus.

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National Athletic Trainers' Association Position Statement: Management of Sport Concussion

2014-03-01

Steven P. Broglio , Robert C. Cantu , Gérard A. Gioia +4 more

Objective: To provide athletic trainers, physicians, and other health care professionals with best-practice guidelines for the management of sport-related concussions. Background: An estimated 3.8 million concussions occur each year in … Objective: To provide athletic trainers, physicians, and other health care professionals with best-practice guidelines for the management of sport-related concussions. Background: An estimated 3.8 million concussions occur each year in the United States as a result of sport and physical activity. Athletic trainers are commonly the first medical providers available onsite to identify and evaluate these injuries. Recommendations: The recommendations for concussion management provided here are based on the most current research and divided into sections on education and prevention, documentation and legal aspects, evaluation and return to play, and other considerations.

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Evidence-Based Cognitive Rehabilitation: Updated Review of the Literature From 2003 Through 2008

2011-04-01

Keith D. Cicerone , Donna M. Langenbahn , Cynthia Braden +7 more

The minimally conscious state

2002-02-12

Joseph T. Giacino , Stephen Ashwal , Nancy L. Childs +7 more

<b><i>Objective:</i></b> To establish consensus recommendations among health care specialties for defining and establishing diagnostic criteria for the minimally conscious state (MCS). <b><i>Background:</i></b> There is a subgroup of patients with severe … <b><i>Objective:</i></b> To establish consensus recommendations among health care specialties for defining and establishing diagnostic criteria for the minimally conscious state (MCS). <b><i>Background:</i></b> There is a subgroup of patients with severe alteration in consciousness who do not meet diagnostic criteria for coma or the vegetative state (VS). These patients demonstrate inconsistent but discernible evidence of consciousness. It is important to distinguish patients in MCS from those in coma and VS because preliminary findings suggest that there are meaningful differences in outcome. <b><i>Methods:</i></b> An evidence-based literature review of disorders of consciousness was completed to define MCS, develop diagnostic criteria for entry into MCS, and identify markers for emergence to higher levels of cognitive function. <b><i>Results:</i></b> There were insufficient data to establish evidence-based guidelines for diagnosis, prognosis, and management of MCS. Therefore, a consensus-based case definition with behaviorally referenced diagnostic criteria was formulated to facilitate future empirical investigation. <b><i>Conclusions:</i></b> MCS is characterized by inconsistent but clearly discernible behavioral evidence of consciousness and can be distinguished from coma and VS by documenting the presence of specific behavioral features not found in either of these conditions. Patients may evolve to MCS from coma or VS after acute brain injury. MCS may also result from degenerative or congenital nervous system disorders. This condition is often transient but may also exist as a permanent outcome. Defining MCS should promote further research on its epidemiology, neuropathology, natural history, and management.

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CEREBRAL CONCUSSION AND TRAUMATIC UNCONSCIOUSNESS

1974-01-01

Ayub K. Ommaya , Thomas A. Gennarelli

Journal Article CEREBRAL CONCUSSION AND TRAUMATIC UNCONSCIOUSNESS: CORRELATION OF EXPERIMENTAL AND CLINICAL OBSERVATIONS ON BLUNT HEAD INJURIES Get access AYUB K. OMMAYA, AYUB K. OMMAYA Search for other works by … Journal Article CEREBRAL CONCUSSION AND TRAUMATIC UNCONSCIOUSNESS: CORRELATION OF EXPERIMENTAL AND CLINICAL OBSERVATIONS ON BLUNT HEAD INJURIES Get access AYUB K. OMMAYA, AYUB K. OMMAYA Search for other works by this author on: Oxford Academic PubMed Google Scholar T. A. GENNARELLI T. A. GENNARELLI Search for other works by this author on: Oxford Academic PubMed Google Scholar Brain, Volume 97, Issue 1, 1974, Pages 633–654, https://doi.org/10.1093/brain/97.1.633 Published: 01 January 1974 Article history Published: 01 January 1974 Received: 17 April 1974

Behavioural Assessment of the Dysexecutive Syndrome

2004-08-02

Assessments are carried out in order to answer questions. Consequently, the nature of the question determines the assessment procedure. So we would use different tests and procedures for testing out … Assessments are carried out in order to answer questions. Consequently, the nature of the question determines the assessment procedure. So we would use different tests and procedures for testing out a theoretical model than we would for trying to predict the likelihood of successful return to work for a brain-injured patient. An example of the former is the work of Baddeley, Logie, Bressi, Della Sala, and Spinnler (1986), who were trying to support or refute their hypothesis that patients with Alzheimer’s disease had a deficit in the central executive component of the working memory model (Baddeley & Hitch, 1974). An example of the latter is Shallice and Burgess’s (1991) six elements test which requires participants to plan and organise their activity over a 15-minute period while following certain rules. Mayes (1986) discusses the different concerns of researchers and clinicians with regard to memory assessments but his views are equally relevant to assessments of executive functioning. When thinking about frontal lobe or executive functioning clinicians are likely to be concerned with answering such questions as:1. Does this person have cognitive impairments that are typically associated with the Dysexecutive syndrome (DES)?

Medical Aspects of the Persistent Vegetative State

1994-05-26

This consensus statement of the Multi-Society Task Force summarizes current knowledge of the medical aspects of the persistent vegetative state in adults and children. This consensus statement of the Multi-Society Task Force summarizes current knowledge of the medical aspects of the persistent vegetative state in adults and children.

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Contributions to Neuropsychological Assessment

1996-03-01

F Sarazin

Cochrane Database of Systematic Reviews

2011-07-01

Abstract Here, we bring readers extracts from the latest issues of The Cochrane Database of Systematic Reviews relevant to the fields of psychiatry and neurology. We feature a summary of … Abstract Here, we bring readers extracts from the latest issues of The Cochrane Database of Systematic Reviews relevant to the fields of psychiatry and neurology. We feature a summary of the results, reviewers' conclusions, and implications for clinical practice and research, from selected new reviews featured in issues 6 and 7, 2011. For further information, visit www.thecochranelibrary.com . Copyright © 2011 Wiley Interface Ltd

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Definition of mild traumatic brain injury

1993-09-01

NULL AUTHOR_ID

Log in or Register Subscribe to journalSubscribe Get new issue alertsGet alerts Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed … Log in or Register Subscribe to journalSubscribe Get new issue alertsGet alerts Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. Subscribe to eTOC Secondary Logo Journal Logo All Articles Images Videos Podcasts Blogs Advanced Search Toggle navigation Subscribe Register Login Articles & Issues Current IssuePrevious IssuesPublished Online First CollectionsFor Authors Submit a ManuscriptInformation for AuthorsLanguage Editing ServicesMost Common Problems Promoting Your ResearchPubMed Central RequirementsAuthor Permissions Journal Info About the JournalEditorial BoardAffiliated SocietyAdvertisingOpen AccessSubscription ServicesReprintsRights and PermissionsRSS Feeds All Articles Images Videos Podcasts Blogs Advanced Search

Consensus statement on concussion in sport—the 5<sup>th</sup>international conference on concussion in sport held in Berlin, October 2016

2017-04-26

Paul McCrory , Willem Meeuwisse , Jiří Dvořák +7 more

The 2017 Concussion in Sport Group (CISG) consensus statement is designed to build on the principles outlined in the previous statements1–4 and to develop further conceptual understanding of sport-related concussion … The 2017 Concussion in Sport Group (CISG) consensus statement is designed to build on the principles outlined in the previous statements1–4 and to develop further conceptual understanding of sport-related concussion (SRC) using an expert consensus-based approach. This document is developed for physicians and healthcare providers who are involved in athlete care, whether at a recreational, elite or professional level. While agreement exists on the principal messages conveyed by this document, the authors acknowledge that the science of SRC is evolving and therefore individual management and return-to-play decisions remain in the realm of clinical judgement. This consensus document reflects the current state of knowledge and will need to be modified as new knowledge develops. It provides an overview of issues that may be of importance to healthcare providers involved in the management of SRC. This paper should be read in conjunction with the systematic reviews and methodology paper that accompany it. First and foremost, this document is intended to guide clinical practice; however, the authors feel that it can also help form the agenda for future research relevant to SRC by identifying knowledge gaps. A series of specific clinical questions were developed as part of the consensus process for the Berlin 2016 meeting. Each consensus question was the subject of a specific formal systematic review, which is published concurrently with this summary statement. Readers are directed to these background papers in conjunction with this summary statement as they provide the context for the issues and include the scope of published research, search strategy and citations reviewed for each question. This 2017 consensus statement also summarises each topic and recommendations in the context of all five CISG meetings (that is, 2001, 2004, 2008, 2012 as well as 2016). Approximately 60 000 published articles were screened by the expert panels for the Berlin …

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Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football

2017-07-25

Jesse Mez , Daniel H. Daneshvar , Patrick T. Kiernan +7 more

<h3>Importance</h3> Players of American football may be at increased risk of long-term neurological conditions, particularly chronic traumatic encephalopathy (CTE). <h3>Objective</h3> To determine the neuropathological and clinical features of deceased football … <h3>Importance</h3> Players of American football may be at increased risk of long-term neurological conditions, particularly chronic traumatic encephalopathy (CTE). <h3>Objective</h3> To determine the neuropathological and clinical features of deceased football players with CTE. <h3>Design, Setting, and Participants</h3> Case series of 202 football players whose brains were donated for research. Neuropathological evaluations and retrospective telephone clinical assessments (including head trauma history) with informants were performed blinded. Online questionnaires ascertained athletic and military history. <h3>Exposures</h3> Participation in American football at any level of play. <h3>Main Outcomes and Measures</h3> Neuropathological diagnoses of neurodegenerative diseases, including CTE, based on defined diagnostic criteria; CTE neuropathological severity (stages I to IV or dichotomized into mild [stages I and II] and severe [stages III and IV]); informant-reported athletic history and, for players who died in 2014 or later, clinical presentation, including behavior, mood, and cognitive symptoms and dementia. <h3>Results</h3> Among 202 deceased former football players (median age at death, 66 years [interquartile range, 47-76 years]), CTE was neuropathologically diagnosed in 177 players (87%; median age at death, 67 years [interquartile range, 52-77 years]; mean years of football participation, 15.1 [SD, 5.2]), including 0 of 2 pre–high school, 3 of 14 high school (21%), 48 of 53 college (91%), 9 of 14 semiprofessional (64%), 7 of 8 Canadian Football League (88%), and 110 of 111 National Football League (99%) players. Neuropathological severity of CTE was distributed across the highest level of play, with all 3 former high school players having mild pathology and the majority of former college (27 [56%]), semiprofessional (5 [56%]), and professional (101 [86%]) players having severe pathology. Among 27 participants with mild CTE pathology, 26 (96%) had behavioral or mood symptoms or both, 23 (85%) had cognitive symptoms, and 9 (33%) had signs of dementia. Among 84 participants with severe CTE pathology, 75 (89%) had behavioral or mood symptoms or both, 80 (95%) had cognitive symptoms, and 71 (85%) had signs of dementia. <h3>Conclusions and Relevance</h3> In a convenience sample of deceased football players who donated their brains for research, a high proportion had neuropathological evidence of CTE, suggesting that CTE may be related to prior participation in football.

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Whitepaper: Defining and investigating cognitive reserve, brain reserve, and brain maintenance

2018-09-16

Yaakov Stern , Eider M. Arenaza‐Urquijo , David Bartrés‐Faz +7 more

Abstract Several concepts, which in the aggregate get might be used to account for “resilience” against age‐ and disease‐related changes, have been the subject of much research. These include brain … Abstract Several concepts, which in the aggregate get might be used to account for “resilience” against age‐ and disease‐related changes, have been the subject of much research. These include brain reserve, cognitive reserve, and brain maintenance. However, different investigators have use these terms in different ways, and there has never been an attempt to arrive at consensus on the definition of these concepts. Furthermore, there has been confusion regarding the measurement of these constructs and the appropriate ways to apply them to research. Therefore the reserve, resilience, and protective factors professional interest area, established under the auspices of the Alzheimer's Association, established a whitepaper workgroup to develop consensus definitions for cognitive reserve, brain reserve, and brain maintenance. The workgroup also evaluated measures that have been used to implement these concepts in research settings and developed guidelines for research that explores or utilizes these concepts. The workgroup hopes that this whitepaper will form a reference point for researchers in this area and facilitate research by supplying a common language.

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Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012

2013-03-11

Paul McCrory , Willem Meeuwisse , Mark Aubry +7 more

The new 2012 Zurich Consensus statement is designed to build on the principles outlined in the previous documents and to develop further conceptual understanding of this problem using a formal … The new 2012 Zurich Consensus statement is designed to build on the principles outlined in the previous documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. A detailed description of the consensus process is outlined at the end of this document under the Background section. This document is developed primarily for use by physicians and healthcare professionals who are involved in the care of injured athletes, whether at the recreational, elite or professional level.

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Psychological Testing

1982-01-01

Frederick Sierles

Development of Psychiatric Disorders after Mild Head Trauma according to Birth History

2025-06-25

Kyounghee Oh , Byung Ho | Annals of Child Neurology

Prognostic Utility of Immediate Memory and Delayed Recall Assessments for Adolescent Concussion

2025-06-25

Mani Singh , Katherine L. Smulligan , Mathew J. Wingerson +3 more | Clinical Journal of Sport Medicine

Objective: To evaluate the prognostic utility of 10-word immediate memory and delayed recall assessments at an initial post-concussion evaluation for predicting persisting post-concussion symptom (PPCS) development. Design: Retrospective cohort study. … Objective: To evaluate the prognostic utility of 10-word immediate memory and delayed recall assessments at an initial post-concussion evaluation for predicting persisting post-concussion symptom (PPCS) development. Design: Retrospective cohort study. Participants: Adolescents (N = 160) seen for concussion at a sports medicine center between June 2018 and November 2019. Independent Variables: We categorized participants based on their symptom recovery time, as PPCS (symptoms >28 days) and no PPCS (symptoms ≤28 days). Main Outcomes: Patients completed 10-word immediate memory and delayed recall assessments at the time of their initial evaluation. We grouped patients based on timing of their initial visit: 1 to 7 days post-concussion versus 8 to 21 days post-concussion and calculated their symptom duration (time from injury until symptom resolution). Results: For patients seen 1 to 7 days post-concussion (N = 69; 14.4 ± 2.4 years; 41% female), those who developed PPCS (N = 19, 28%) had significantly worse immediate memory (6.2 ± 1.8 vs 7.2 ± 1.7 words correct; P = 0.04; Cohen d = 0.55) and delayed recall (3.6 ± 1.8 vs 5.5 ± 2.2 words correct; P = 0.002; Cohen d = 0.87) performance compared with those who did not develop PPCS. For patients seen 8 to 21 days post-concussion (N = 91; 14.1 ± 2.6 years; 53% female), there were no significant differences between those who developed PPCS (N = 45, 49%) and did not on immediate memory (7.2 ± 1.7 vs 6.7 ± 2.1 words correct; P = 0.21; Cohen d = 0.26) or delayed recall (5.2 ± 2.3 vs 5.4 ± 2.1 words correct; P = 0.61; Cohen d = 0.11) performance. Conclusions: The 10-word immediate memory and delayed recall assessments have prognostic utility for PPCS when administered within the first week post-concussion and may help clinicians identify those at greatest risk of developing PPCS.

Editorial: Rehabilitation interventions for mild traumatic brain injury

2025-06-24

Fahim Anwar | Frontiers in Neurology

Tools for Diagnosing and Managing Sport-Related Concussion in UK Primary Care: A Scoping Review

2025-06-23

Sachin Bhandari , Susanna Mak , Neil Heron +1 more | Sports

Background: The UK Department for Digital, Culture, Media, and Sport (DCMS) grassroots concussion guidance, May 2023, advised that all community-based sport-related concussions (SRCs) be diagnosed by a healthcare practitioner. This … Background: The UK Department for Digital, Culture, Media, and Sport (DCMS) grassroots concussion guidance, May 2023, advised that all community-based sport-related concussions (SRCs) be diagnosed by a healthcare practitioner. This may require that general practitioners (GPs) diagnose and manage SRCs. Diagnosing SRCs in primary care settings in the United Kingdom (UK) presents significant challenges, primarily due to the lack of validated tools specifically designed for general practitioners (GPs). This scoping review aims to identify diagnostic and management tools for SRCs in grassroots sports and primary care settings. Aims: To identify tools that can be used by GPs to diagnose and manage concussions in primary care, both adult and paediatric populations. Design and Methods: A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScRs). Five databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, Google Scholar) were searched from 1946 to April 2025. Search terms included “concussion”, “primary care”, and “diagnosis”. Studies that discussed SRCs in community or primary care settings were included. Those that exclusively discussed secondary care and elite sports were excluded, as well as non-English studies. Two reviewers independently screened titles, abstracts, and full texts, with a third resolving any disagreements. Data were extracted into Microsoft Excel. Studies were assessed for quality using the Joanna Briggs critical appraisal tools and AGREE II checklist. Results: Of 727 studies, 12 met the inclusion criteria. Identified tools included Sport Concussion Assessment Tool 6 (SCAT6, 10–15 min, adolescent/adults), Sport Concussion Office Assessment Tool 6 (SCOAT6, 45–60 min, multidisciplinary), the Buffalo Concussion Physical Examination (BCPE, 5–6 min, adolescent-focused), and the Brain Injury Screening Tool (BIST, 6 min, ages 8+). As part of BCPE, a separate Telehealth version was developed for remote consultations. SCAT6 and SCOAT6 are designed for healthcare professionals, including GPs, but require additional training and time beyond typical UK consultation lengths (9.2 min). BIST and BCPE show promise but require UK validation. Conclusions: SCAT6, SCOAT6, BIST, and BCPE could enhance SRC care, but their feasibility in UK primary care requires adaptation (e.g., integration with GP IT systems and alignment with NICE guidelines). Further research is required to validate these tools and assess additional training needs.

Correction: A rapid review of periviable (22 + 0 to 23 + 6 weeks) counselling practices and the need for a trauma-informed care approach

2025-06-23

| Frontiers in Pediatrics

Exploring challenges and opportunities related to the identification of mild traumatic brain injury and concussion in rehabilitation trauma inpatients: a qualitative study

2025-06-23

Zoe Li , Y Ahmed , Lesley Gotlib Conn +7 more | Disability and Rehabilitation

To examine the perspectives of healthcare providers regarding missed mild traumatic brain injury and concussion (mTBI/C) diagnosis in trauma populations in rehabilitative and other post-acute settings. An inductive qualitative study … To examine the perspectives of healthcare providers regarding missed mild traumatic brain injury and concussion (mTBI/C) diagnosis in trauma populations in rehabilitative and other post-acute settings. An inductive qualitative study design was undertaken to obtain insights from healthcare providers across care settings (e.g. acute care, rehabilitation) about mTBI/C. A total of 20 healthcare providers took part in semi-structured interviews. Data were analyzed using codebook thematic analysis. Four main themes were identified from the data: (1) the prevalence of missed mTBI/C; (2) the challenges of identifying and managing mTBI/C; (3) current approaches to identifying and managing mTBI/C, and; (4) recommendations for improving mTBI/C identification and management. Our qualitative research sheds light on the complexities encountered by healthcare providers with regard to identifying and managing mTBI/C at a patient, practice and system-level. The findings from this work highlighted the variability in diagnostic methods and approaches across care settings and disciplines, emphasizing the need for standardized approaches and enhanced interdisciplinary communication to optimize mTBI/C care.

Interprofessional Approaches to the Treatment of Mild Traumatic Brain Injury: A Literature Review and Conceptual Framework Informed by 94 Professional Interviews

2025-06-23

John Shelley-Tremblay , Teri B. Lawton | Medical Sciences

Background/Objectives: Mild traumatic brain injury (mTBI) presents with persistent, heterogeneous symptoms requiring multifaceted care. Although interdisciplinary rehabilitation is increasingly recommended, implementation remains inconsistent. This study aimed to synthesize existing literature … Background/Objectives: Mild traumatic brain injury (mTBI) presents with persistent, heterogeneous symptoms requiring multifaceted care. Although interdisciplinary rehabilitation is increasingly recommended, implementation remains inconsistent. This study aimed to synthesize existing literature and clinician perspectives to construct a practice-informed conceptual framework for interprofessional mTBI rehabilitation. Methods: Structured interviews were conducted with 94 clinicians—including neurologists, neuropsychologists, optometrists, occupational and physical therapists, speech-language pathologists, neurosurgeons, and case managers—across academic, private, and community settings in the United States. Interviews followed a semi-structured format adapted for the NIH I-Corps program and were analyzed thematically alongside existing rehabilitation literature. Results: Clinicians expressed strong consensus on the value of function-oriented, patient-centered care. Key themes included the prevalence of persistent cognitive and visual symptoms, emphasis on real-world goal setting, and barriers such as fragmented communication, reimbursement restrictions, and referral delays. Disciplinary differences were noted in perceptions of symptom persistence and professional roles. Rehabilitation technologies were inconsistently adopted due to financial, training, and interoperability barriers. Equity issues included geographic and insurance-based disparities. A four-domain conceptual framework emerged: discipline-specific expertise, coordinated training, technological integration, and care infrastructure, all shaped by systemic limitations. Conclusions: Despite widespread clinician endorsement of interprofessional mTBI care, structural barriers hinder consistent implementation. Targeted reforms—such as embedding interdisciplinary models in clinical education, expanding access to integrated technology, and improving reimbursement mechanisms—may enhance care delivery. The resulting framework provides a foundation for scalable, patient-centered rehabilitation models in diverse settings.

Uncovering injury-specific proteomic signatures and neurodegenerative risks in single and repetitive traumatic brain injury

2025-06-22

Sarah Mantash , Soulaimane Aboulouard , Hassan Dakik +7 more | Signal Transduction and Targeted Therapy

Traumatic brain injury (TBI) is a major public health concern associated with an increased risk of neurodegenerative diseases including Alzheimer's disease (AD), Parkinson's disease (PD), and chronic traumatic encephalopathy, yet … Traumatic brain injury (TBI) is a major public health concern associated with an increased risk of neurodegenerative diseases including Alzheimer's disease (AD), Parkinson's disease (PD), and chronic traumatic encephalopathy, yet the underlying molecular mechanisms in repetitive TBI remain poorly defined. This study investigates proteomic and behavioral changes following single and repetitive mild TBI in a mouse model, focusing on molecular alterations in the cortex and hippocampus across acute (48 h) and subacute (1 week) stages. Using shotgun proteomics and bioinformatics approaches, including weighted gene co-expression network analysis (WGCNA) and machine learning, we analyzed the proteomic landscapes of TBI-affected brain regions including the hippocampus and the cortex. We assessed motor and cognitive outcomes at 2-, 7-, and 30-days post-injury to explore functional impairments associated with observed molecular changes. Our findings reveal spatio-temporal injury- and time-specific proteomic changes, with a single TBI promoting neuroprotective and repair mechanisms, while repetitive TBI exacerbating neuronal damage and synaptic deficits in the hippocampus. Key deregulated proteins, including Apoa1, ApoE, Cox6a1, and Snca, were linked to neurodegenerative pathways, suggesting molecular connections between TBI and diseases like AD and PD. Behavioral assessments indicated that repetitive TBI significantly impaired motor and cognitive functions, with recovery in motor function by day 30, whereas cognitive deficits persisted. This study provides a detailed analysis of the proteomic and behavioral consequences of TBI, identifying molecular networks as potential biomarkers or therapeutic targets for mitigating long-term cognitive decline associated with repetitive head trauma. These findings underscore the importance of mitochondrial and synaptic integrity in TBI response and suggest that targeting these pathways could reduce neurodegenerative risk following repetitive TBI.

Misconceptions About Traumatic Brain Injury: A Survey of Endorsements by North Carolina School Psychologists and Impact of a State‐Wide Training Program

2025-06-21

Phyllis Landau , Stephen R. Hooper , Peter J. Duquette | Psychology in the Schools

ABSTRACT This study surveyed school psychologists' misconceptions about traumatic brain injury (TBI) and their perceived competency working with students affected by TBI. A state‐wide curriculum devoted to TBI also was … ABSTRACT This study surveyed school psychologists' misconceptions about traumatic brain injury (TBI) and their perceived competency working with students affected by TBI. A state‐wide curriculum devoted to TBI also was examined with respect to its impact on the rates of myths and misconceptions. A sample of 145 school psychologists in North Carolina (NC) participated in the survey which assessed 27 common misconceptions about TBI. Compared to a similar survey in 2006, the current sample showed improvement on four items. However, high rates of endorsement of misconceptions (over 30%) were still identified on ten items related to recovery, amnesia, and the complex consequences of pediatric TBI. School psychologists who completed the state's TBI‐specific professional development program and those with more years of work experience endorsed fewer misconceptions. Education level, personal exposure to TBI, and number of TBI cases handled had little effect on rates of endorsement of misconceptions. Perceived adequacy of training to serve students with TBI increased significantly as well (57% compared to 16% in 2006). School psychologists who completed TBI‐specific professional development or had greater exposure to TBI cases rated their TBI training as sufficient. This study supports the effectiveness of the NC TBI training program and emphasizes the ongoing need for graduate and postgraduate training on TBI for practicing school psychologists in an effort to improve school psychologists' knowledge of pediatric TBI.

The Welfare Prison Experiment: Philosophical Treatrise on Mental Health as Undocumented Pediatric TBI Patient in Norway

2025-06-21

Olav Smorholm

Brain injury — the younger the patient — the more plagued and troubled from neglectand difficulties with logical separation of physical and psychological trauma. The moreproblematic cognitive dissonance become around … Brain injury — the younger the patient — the more plagued and troubled from neglectand difficulties with logical separation of physical and psychological trauma. The moreproblematic cognitive dissonance become around general services in welfare states withwestern mental health politics.**Methods:** Analysis of CT and MRI using FreeSurfer to work out how and why it’s possibleto write reports that fail to identify old cranial fractures and compression damage to thebrain with life-long consequences in referrals that request a report on the topic with relevantmedical complications decades after the fact with patient journal that document reducedfunction and capacity.**Result:** Traumatic Brain Injury must always be documented with the burden to respect,follow up, and suspect it — to counteract hopes, dreams and wishes on behalf of personalnurturing motivations and experiences of those supposed to help and document fact. For apatient group especially vulnerable to maltreatment and malpractice, good intentions rarelylead to an awakening of unhealthy patient relations with the risk of creating them

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The value of multimodal neuroimaging in the diagnosis and treatment of post-traumatic stress disorder: a narrative review

2025-06-20

Hanyi Zhang , Yining Hu , Yi‐Tao Yu +7 more | Translational Psychiatry

Post-traumatic stress disorder (PTSD) is a delayed-onset or prolonged persistent psychiatric disorder caused by individuals experiencing an unusually threatening or catastrophic stressful event or situation. Due to its long duration … Post-traumatic stress disorder (PTSD) is a delayed-onset or prolonged persistent psychiatric disorder caused by individuals experiencing an unusually threatening or catastrophic stressful event or situation. Due to its long duration and recurrent nature, unimodal neuroimaging tools such as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and electroencephalography (EEG) have been widely used in the diagnosis and treatment of PTSD for early intervention. However, as compared with an unimodal approach, a multimodal imaging approach can better capture integrated neural mechanisms underlying the occurrence and development of PTSD, including predisposing factors, changes in neural activity, and physiological mechanisms of symptoms. Moreover, a multimodal neuroimaging approach can aid the diagnosis and treatment of PTSD, facilitate searching for biomarkers at different stages of PTSD, and explore biomarkers for symptomatic improvement. However, at present, the majority of PTSD studies remain unimodal, while the combination of multimodal brain imaging data with machine learning will become an important direction for future research.

Sex Differences in Head Acceleration Events in Law Enforcement Corrections Cadets

2025-06-20

Carly R. Smith , Enora Le Flao , Samantha N DeAngleo +7 more | Annals of Biomedical Engineering

Abstract Purpose Law enforcement cadets (LECs) undergo subject control technique training that may expose them to repetitive head impacts recorded as head acceleration events (HAEs) using instrumented mouthguards. Prior research … Abstract Purpose Law enforcement cadets (LECs) undergo subject control technique training that may expose them to repetitive head impacts recorded as head acceleration events (HAEs) using instrumented mouthguards. Prior research suggests that sex and/or gender differences in HAE frequency and magnitude vary by sport. This study aimed to examine sex differences in HAE exposure among LECs during training. Methods We collected HAEs from 82 civilian LECs (16 females, mean age = 30 ± 9 years) using instrumented mouthguards. We compared peak linear acceleration (PLA) and peak rotational velocity (PRV) of HAEs > 5 g between sexes using a mixed-effects linear model, with sex and cohort as fixed-effect predictors and a random intercept for subject to account for repeated HAEs within individuals. Additionally, we assessed sex differences in the number of HAEs per athlete exposure using a negative binomial regression controlling for cohort. Results PLA was lower in female than male cadets (e.g., median PLA: females = 10.9 g, males = 12.3 g, p < 0.001). However, there were no statistically significant sex differences in the number of HAEs per athlete exposure (e.g., median: females = 10, males = 14, p = 0.169) or PRV (e.g., median PRV: females = 7.4 rad/s, males = 7.9 rad/s, p = 0.110). Conclusions Overall, sex differences in HAE frequency and magnitude during subject control technique trainings were minimal. When differences were observed, female cadets exhibited less frequent and less severe HAEs than male cadets. This finding suggests that current training practices, including sex- and/or skill-matched pairing, may effectively reduce HAE exposure risk to females.

Functional connectome integration observed after antispastic epidural cervical spinal cord stimulation in a patient with TBI-induced disorder of consciousness: a case report

2025-06-20

L. A. Mayorova , Ekaterina Bondar , Margarita Radutnaya +1 more | Frontiers in Human Neuroscience

We report the case of a patient with disease of consciousness who underwent 6 days of antispastic spinal cord stimulation followed by consolidation of a functional connectome as measured by … We report the case of a patient with disease of consciousness who underwent 6 days of antispastic spinal cord stimulation followed by consolidation of a functional connectome as measured by resting state fMRI (rs-fMRI). The test spinal cord stimulation (SCS) system (with electrodes placed epidurally at the C3-C5 level) was used to evaluate its potential to relieve muscle contracture as the primary clinical target. Neurological and rs-fMRI examinations were performed before and after surgical placement of the spinal cord stimulation system. For neurological assessment of spasticity we used the Ashworth scale. To analyze fMRI, we used the extraction of functional connectivity coefficients and the construction of a connectivity matrixes. To construct a normative matrix of functional connectivity, 10 healthy volunteers of appropriate age were recruited as a control group. Analysis of rs-fMRI data showed that after a short course of epidural cervical spinal cord stimulation, the patient’s functional connectivity matrix similarity with the control group increased, which was manifested in the growth of ROI-to-ROI and inter-network functional connectivity coefficients. This finding may indicate the complexity of the neuromodulatory effect of spinal cord stimulation and its consolidating effect on the functional connectome of the brain, including brain regions associated with the function of maintaining arousal and awareness, even when the clinical effect is not perceptibly pronounced. We supposed to conduct the spinal cord therapy for this patient in a permanent way not only to relieve spasticity but also to support consciousness. We assume that functional connectome assessment in such clinical cases may help to give additional arguments in SCS-therapy prescription in patients with disorders of consciousness as well as to understand in the future the pathophysiological mechanism of the effect of this procedure.

Exploring the meaning of life (MoL) after acquired brain injury (ABI) in Costa Rica

2025-06-20

Mónica Salazar Villanea , Javeth Calvo-Molina | Neuropsychological Rehabilitation

This study aimed to explore the process of MoL-Resignification following ABI in a Costa Rican sample. A cross-sectional, exploratory mixed-method approach. Qualitative narratives about the MoL-Resignification were collected and supported … This study aimed to explore the process of MoL-Resignification following ABI in a Costa Rican sample. A cross-sectional, exploratory mixed-method approach. Qualitative narratives about the MoL-Resignification were collected and supported with quantitative data using instruments like the Mental and Physical Health Adapted Scale (MPHAS), Brief Resilient Coping Scale (BRCS), UCLA Loneliness Scale Revised (UCLALS-R), and New Me Scale (NMS). Four dimensions of MoL-Resignification after ABI were identified: Individual, Social, Global, and Spiritual. Narratives regarding the Individual MoL ranged from coping with the limitations imposed by ABI to adopting new values and senses of identity. Social MoL emphasized the importance of family support, while Global MoL centred on adopting a present-focused perspective. The Spiritual MoL highlighted the role of faith and religious beliefs in helping individuals navigate their lives after ABI. Resignification processes were associated with greater life satisfaction post-ABI (NMS), lower psychological and physical burdens (MPHAS), reduced loneliness (UCLALS-R), and more effective coping strategies (BRCS). MoL-Resignification and Identity change after ABI, demonstrates the importance of family and spiritual beliefs in coping within the context of Costa Rican culture. These factors should be addressed in future research and rehabilitation efforts.

The Integrative PTSD Healing Center: A Novel Three-Tier Treatment Model Bridging Neuroscience, Spirituality, and Alternative Medicine

2025-06-19

| Journal of Psychology and Neuroscience

Background: Current PTSD treatments demonstrate significant limitations, with approximately 40% of patients classified as nonresponders to evidence-based interventions. The artificial separation of neurobiological, psychological, and spiritual dimensions in conventional care … Background: Current PTSD treatments demonstrate significant limitations, with approximately 40% of patients classified as nonresponders to evidence-based interventions. The artificial separation of neurobiological, psychological, and spiritual dimensions in conventional care may contribute to suboptimal outcomes, particularly for complex trauma presentations. Objective: To describe an innovative integrative treatment model that systematically combines precision neuroscience, spiritual healing practices, and alternative medicine approaches within a comprehensive clinical framework. Methods: The Integrative PTSD Healing Center implements a three-tier treatment approach: (1) neurobiological assessment using QEEG biomarkers and personalized neurofeedback protocols, (2) sacred therapeutic encounters incorporating hermeneutic medicine and narrative-based interventions, and (3) comprehensive alternative healing modalities including Reiki, acupuncture, and somatic therapies. Expected Outcomes: This model aims to achieve 85% treatment response rates compared to conventional care’s 60% rate, while addressing the complex needs of trauma survivors through holistic healing approaches that honor the intersection of science and spirituality. Conclusions: The integration of cutting-edge neuroscience with time-honored healing traditions represents a paradigmatic shift toward treating trauma’s impact on the complete spectrum of human experience.

Letter: Does Mechanism of Injury Affect Recovery After Sport-Related Concussion in Basketball? A Pilot Study

2025-06-19

Rob D. Dickerman , Matthew T. Bennett , Sterling Ortega | Neurosurgery

Sex-related differences in cognition after severe murine traumatic brain injury: A Morris water maze study evaluating learning and memory

2025-06-19

Patricia Santos Carlin , Michael James Coons , Priyanka Bele +7 more | Journal of Trauma and Acute Care Surgery

BACKGROUND A number of sex-related outcomes following severe traumatic brain injury (TBI) appear to principally favor females. However, sex-related differences in post-TBI learning and memory remain underexplored. We hypothesized that … BACKGROUND A number of sex-related outcomes following severe traumatic brain injury (TBI) appear to principally favor females. However, sex-related differences in post-TBI learning and memory remain underexplored. We hypothesized that females realize greater cognitive recovery than males following severe TBI. METHODS CD1 male (n = 12) and female (n = 12) mice were randomized to controlled cortical impact (severe TBI: impactor tip diameter, 3 mm; impact velocity, 6 m/s; depth, 1 mm; dwell time, 100 milliseconds) or sham craniotomy and followed for 14 days. Body weight loss recovery was measured daily as a surrogate of neuroclinical recovery. Mice underwent Morris water maze testing to evaluate learning (locating submerged escape platform) with cued and spatial trials and to recall (remembering platform location after it was removed) with probe trials. RESULTS Compared with uninjured male mice, male mice with TBI failed to recover lost weight for the first 7 postinjury days (i.e., day 5: MTBI: −3.7% ± 1.5% vs. MSh: +4.1% ± 1.4% body weight; p < 0.01), while female mice with TBI recovered the same lost weight and at the same rate as sham female mice (FTBI: −1.6% ± 1.0% vs. FSh: −1.8% ± 0.9%, −0.02% ± 0.01%; p > 0.9). Learning (cued and spatial) after TBI was significantly worse in males but not in females. In probe trials, impaired memory after injury was only observed in females. CONCLUSION Severe TBI worsens cued and spatial learning and impairs weight loss recovery in male but not female mice. Female, but not male, mice sustain memory impairment after identical severe TBI. While the mechanism(s) that underpin these observations remain unclear, sex-related neurocognitive outcome differences question the universal applicability of trial-based evidence for clinical care.

Neurobiology and Impact of Chronic Traumatic Encephalopathy in Athletes: A Focused Review

2025-06-19

Jennifer Makhoul , Ahmed Nasr , Zemar G Qazi +3 more | Cureus

Concussion Risk and the Need for Prevention: An Exploration into the Complexity of Community Perspectives in Rugby Union

2025-06-19

Marelise Badenhorst , Janelle Romanchuk , Danielle Salmon +3 more | Sports Medicine

Abstract Background Community perceptions of injury risk can impact participation rates and may influence attitudes and behaviours around prevention efforts. Understanding how end-users think about concussion-related risk and the need … Abstract Background Community perceptions of injury risk can impact participation rates and may influence attitudes and behaviours around prevention efforts. Understanding how end-users think about concussion-related risk and the need for prevention is critical for the design and implementation of interventions. This study aimed to explore community rugby union stakeholders’ perceptions of concussion risk and the need for prevention. Methods This pragmatic, qualitative descriptive study utilised semi-structured interviews and focus groups with 62 school- and club-level community rugby stakeholders (provincial union representatives, players, coaches, school/club sport administrators, team leads (managers), physiotherapists, nurses and doctors) from across New Zealand during the 2022 rugby season. Reflexive thematic analysis was used to analyse the data. Results Three themes were developed from the data. The theme ‘concussion risk: a spectrum of concern’ included a spectrum of beliefs ranging from ‘concussions are a problem’ to the belief that concussions are only a problem if not managed well or that it has always been part of the game, and the risks are being exaggerated. A second theme, ‘focus on technique and conditioning, or is injury just the nature of the game?’, described beliefs in the importance of technique and conditioning or contrary beliefs such as ‘as long as there is contact, there will be concussion’. A third theme, ‘conflicting concussion narratives’, described the tendency of some participants to move back and forth across the spectrum of risk and prevention perceptions, depending on the context. Conclusions Findings reveal a diversity of perspectives on how concussions should be managed or prevented. Balancing these perspectives is critical. This involves addressing unfavourable beliefs, prioritizing both prevention and effective management and community-wide education.

Long-term neurodegenerative sequelae of concussion: implications for musculoskeletal injury risk and neuromuscular interventions

2025-06-19

Tyler A. Wood , Mahgolzahra Kamari , Nicholas E. Grahovec +1 more | Frontiers in Musculoskeletal Disorders

Concussions pose significant health risks across the lifespan, with most symptoms typically resolving within four weeks in otherwise healthy adults. However, emerging research suggests that individuals with a history of … Concussions pose significant health risks across the lifespan, with most symptoms typically resolving within four weeks in otherwise healthy adults. However, emerging research suggests that individuals with a history of concussion—even after receiving medical clearance—may face an increased risk of subsequent upper- and lower-extremity musculoskeletal injuries. Additionally, prior concussions have been linked to an elevated risk of osteoarthritis later in life. The 6th Consensus Statement on Concussion in Sport highlights the urgent need for further research into recovery determinants and the long-term neurodegenerative consequences of concussion. This mini-review explores the potential neurodegenerative sequelae following concussion and examines the role of neuromuscular exercise interventions in mitigating these effects. By addressing these concerns, such interventions may help reduce concussion-related injury risks and enhance long-term health outcomes.

A Comparison of Quantitative Pupillometry and VOMS in Division 1 Female Soccer Players

2025-06-19

John D. Heick | Medicina

Background and Objectives: Vision uses about half of the pathways within the brain, and these anatomical structures are susceptible to injury in concussion. Authors have suggested that subconcussive head impacts, … Background and Objectives: Vision uses about half of the pathways within the brain, and these anatomical structures are susceptible to injury in concussion. Authors have suggested that subconcussive head impacts, common in soccer, may disrupt visual function. The following study aimed to explore and compare quantitative pupillometry and Vestibular Ocular Motor Screening (VOMS) in female soccer athletes. Materials and Methods: Twenty-six Division 1 female soccer athletes (20.46 ± 2.36 years) received baseline quantitative pupillometry and VOMS measurements. Results: Of the 26 tested athletes, 3 (11.5%) had clinically significant pupillometry findings at baseline. The mean Neurological Pupil Index or NPi, a composite generated from pupillometry, did not vary: 3.9 ± 0.4 (right eye) and 4.0 ± 0.4 (left eye). No difference in NPi was observed compared to the VOMS score (p > 0.05). Kruskal-Wallis H tests were significant in the right eye for constriction percentage (χ2(2) = 17.843, p < 0.001, E2 = 0.69) and minimum pupil size (χ2(2) = 7.976, p = 0.019, E2 = 0.31). A post hoc Dunn test showed significant differences in constriction percentage and minimum pupil size between low NPi and high NPi groups (p < 0.05). One athlete sustained a concussion. NPi was measured within 24 h and was normal, but VOMS was not (total score = 4). Conclusions: The components of pupillometry need more investigation, and there is a need for agreement on concussion-specific cutoffs for quantitative pupillometry for concussion assessment. The lack of a relationship between quantitative pupillometry and VOMS suggests that these tools evaluate different constructs. Athletes with an NPi < 3.8 had significantly less constriction percentage and larger minimum pupil size than athletes with higher NPi scores. More research should be carried out to determine the usefulness of the NPi score, and perhaps researchers should consider individual pupillometry components.

In Reply: Does Mechanism of Injury Affect Recovery After Sport-Related Concussion in Basketball? A Pilot Study

2025-06-19

Anthony E. Bishay , Avi N. Albert , Grant H. Rigney +5 more | Neurosurgery

Early Amantadine Treatment in Children with Severe Traumatic Brain Injury: A Dual-Center Cohort Study and Brief Review

2025-06-18

Hüseyin Bahadır Şenol , Kaan Furkan Bıyık , Çağatay Günay +7 more | Research Square (Research Square)

<title>Abstract</title> Purpose Traumatic brain injury (TBI) is a major public health concern and a leading cause of disability and mortality worldwide. While the acute phase of TBI is characterized by … <title>Abstract</title> Purpose Traumatic brain injury (TBI) is a major public health concern and a leading cause of disability and mortality worldwide. While the acute phase of TBI is characterized by increased dopamine release, long-term alterations in the dopaminergic system often lead to dopamine deficiency. Amantadine, a dopamine agonist and NMDA antagonist, has been suggested as a potential therapeutic agent for cognitive and behavioral impairments in TBI. In pediatric populations, amantadine has been primarily used in the rehabilitation phase; however, its effects during the acute phase remain unclear. This study aimed to evaluate the neurological and systemic outcomes of early amantadine treatment in children with severe TBI. Methods This retrospective study analyzed data from pediatric patients with severe TBI admitted to two centers between 2020 and 2025. Patients were divided into two groups based on whether they received amantadine treatment. The treatment protocol was initiated during the acute phase. Functional outcomes were assessed at intensive care unit discharge (ICU) and six months post-injury. Results A total of 60 patients were included, with 32 receiving amantadine. The median ICU stay was 11 days, and the hospital stay was 20 days. At the six-month follow-up, there was a significant improvement in functional status scores compared to ICU discharge (p < 0.001*), but no significant difference was observed between the amantadine and non-amantadine groups in functional recovery. A strong positive correlation was observed between functional scores and length of hospitalization. Conclusion Early administration of amantadine in pediatric patients with severe TBI did not provide a significant functional benefit. However, it was well tolerated and demonstrated a favorable safety profile.

Paediatric traumatic brain injury: bridging evidence and care

2025-06-18

Rebekah Mannix , Shruti Agrawal , Vicki Anderson +7 more | The Lancet Neurology

Is cognitive motor dissociation just a minimally conscious state 'plus' by another name?

2025-06-18

Martin M. Monti | medRxiv (Cold Spring Harbor Laboratory)

Abstract Cognitive Motor Dissociation (CMD) describes a condition whereby brain injury patients can demonstrate response to command through advanced electrophysiology and imaging assessments but are unable to do so through … Abstract Cognitive Motor Dissociation (CMD) describes a condition whereby brain injury patients can demonstrate response to command through advanced electrophysiology and imaging assessments but are unable to do so through in standard, behavior-based, clinical assessments. Rightfully, significant emphasis has been placed on the fact that despite a similar behavioral phenotype, patients with CMD show better outcomes than patients without CMD. Yet, this finding is not overly surprising when considering that patients with CMD might just be minimally conscious state “plus” patients (MCS+; i.e., patients capable of response to command) who were misdiagnoses due to the known limitations of behavioral assessments in the presence of sensory, cognitive, or motor comorbidities. The present work brings together 131 DOC patients, from two separate longitudinal studies, to assess whether patients able demonstrate response to command via brain responses but not behavioral responses (i.e., CMD patients) are “just” misdiagnosed MCS+ patients, in terms of short-term outcomes, or whether they represent a separate diagnostic entity. Robust general linear modelling reveals that, while CMD patients show greater short-term gains than patients with no evidence of CMD, consistent with prior work, these gains are not different from those seen in patients who can demonstrate response to command behaviorally (i.e., MCS+ patients). This pattern of results remains unchanged when separately analyzing Vegetative State (VS; i.e., entirely unresponsive) and Minimally Conscious State “minus” patients (MCS-; i.e., patients only able to show non-language-mediated response) with and without CMD, and when restricting analyses to traumatic brain injury patients only. These findings suggest that, at least in terms of short-term outcomes, patients with CMD are not meaningfully different from MCS+ patients. Rather, CMD patients are best understood as MCS+ patients who were misdiagnosed likely due to the well-known limitations of behavioral assessments in the presence of comorbidities affecting sensory input, cognitive processing, and/or motor output. These results thus support the suggestion by the European Union practice guidelines to assign diagnoses based on the highest level of response obtained in a patient across behavioral and non-behavioral assessments, as well as the use of advanced assessments not only in behaviorally VS patients, consistent with the US guidelines, but also in MCS- patients. Finally, from a nosological perspective, these findings suggest that patients with CMD might best be described as “MCS+ patients with CMD,” to convey at once their true level of consciousness (i.e., MCS+) and the presence of motor output limitations (i.e., CMD).

Advancing next-generation brain organoid platforms for investigating traumatic brain injury from repeated blast exposures

2025-06-18

Eyal Bar-Kochba , Catherine M. Carneal , Vanessa D. Alphonse +7 more | Frontiers in Bioengineering and Biotechnology

Service members and law enforcement personnel are frequently exposed to blast overpressure during training and combat due to the use of heavy weaponry such as large-caliber rifles, explosives, and ordnance. … Service members and law enforcement personnel are frequently exposed to blast overpressure during training and combat due to the use of heavy weaponry such as large-caliber rifles, explosives, and ordnance. The cumulative effects of these repeated low-level (&lt;4 psi) blast exposures can lead to physical and cognitive deficits that are poorly understood. Brain organoids—human stem cell-derived three-dimensional in vitro culture systems that self-organize to recapitulate the in vivo environment of the human brain—are a promising alternative biological model to traditional cellular cultures and animal models, offering a unique opportunity for studying the mechanisms of mild blast-induced traumatic brain injury (mbTBI) resulting from repeated exposure. In this article, we review the current state of brain organoid models and discuss future directions for advancing their physiological relevance for studying mbTBI. These will be presented within a framework for developing next-generation platforms that integrate relevant loading devices, as well as non-invasive technologies for assessing the brain organoid’s response while increasing throughput. These next-generation platforms aim to accelerate the development of new interventions for mbTBI.

The Acute Effects of Non-concussive Head Impacts on Brain Microstructure, Chemistry and Function in Male Soccer Players: A Pilot Randomised Controlled Trial

2025-06-18

Nathan Delang , Rebecca V Robertson , Fernando A Tinoco Mendoza +7 more | Sports Medicine - Open

Abstract Background Head impacts, particularly, non-concussive impacts, are common in sport. Yet, their effects on the brain remain poorly understood. Here, we investigated the acute effects of non-concussive impacts on … Abstract Background Head impacts, particularly, non-concussive impacts, are common in sport. Yet, their effects on the brain remain poorly understood. Here, we investigated the acute effects of non-concussive impacts on brain microstructure, chemistry, and function using magnetic resonance imaging (MRI) and other techniques. Results Fifteen healthy male soccer players participated in a randomised, controlled, crossover pilot trial. The intervention was a non-concussive soccer heading task (‘Heading’) and the control was an equivalent ‘Kicking’ task. Participants underwent MRI scans ~ 45 min post-task which took ~60 min to complete. Blood was also sampled, and cognitive function assessed, pre-, post-, 2.5 h post-, and 24 h post-task. Brain chemistry: Heading increased total N -acetylaspartate ( p = 0.012; g = 0.66) and total creatine ( p = 0.010; g = 0.77) levels in the primary motor cortex (but not the dorsolateral prefrontal cortex) as assessed via proton magnetic resonance spectroscopy. Glutamate-glutamine, myoinositol, and total choline levels were not significantly altered in either region. Brain structure: Heading had no significant effects on diffusion weighted imaging metrics. However, two blood biomarkers expressed in brain microstructures, glial fibrillary acidic protein and neurofilament light, were elevated 24 h ( p = 0.014; g = 0.64) and ~ 7-days ( p = 0.046; g = 1.19) post-Heading ( vs . Kicking), respectively. Brain Function: Heading decreased tissue conductivity in 11 clusters located in the white matter of the frontal, occipital, temporal and parietal lobes, and cerebellum ( p ’s < 0.001) as assessed via electrical properties tomography. However, no significant differences were identified in: (1) connectivity within major brain networks as assessed via resting-state functional MRI; (2) cerebral blood flow as assessed via pseudo continuous arterial spin labelling; (3) activity within electroencephalography frequencies (infra-slow [0.03–0.06 Hz], theta [4–8 Hz], alpha [9–12 Hz], or beta [13–25 Hz]); or (4) cognitive (memory) function. Conclusions This study identified chemical, microstructural and functional brain alterations in response to an acute non-concussive soccer heading task. These alterations appear to be subtle, with some only detected in specific regions, and no corresponding cognitive deficits observed. Nevertheless, our findings suggest that individuals should exercise caution when performing repeated non-concussive head impacts in sport. Trial registration ACTRN12621001355864. Date of registration: 7/10/2021. URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382590&isReview=true .

Factors Associated With Persisting Symptoms After Concussion in Adults With Mild TBI

2025-06-18

Samantha McIntosh , Melanie H. Vergeer , Jean‐Michel Galarneau +2 more | JAMA Network Open

Importance Up to 30% of individuals who sustain a mild traumatic brain injury (mTBI) develop persisting symptoms after concussion (PSAC). Identifying acute risk factors for PSAC can enhance clinical care … Importance Up to 30% of individuals who sustain a mild traumatic brain injury (mTBI) develop persisting symptoms after concussion (PSAC). Identifying acute risk factors for PSAC can enhance clinical care in adults with concussion. Objective To evaluate summary odds ratio (OR) estimates for acute factors associated with PSAC in adults with mTBI. Data Sources For this systematic review and meta-analysis, a systematic search of Ovid MEDLINE, Embase, PsycINFO, CINAHL, SPORTDiscus, and the Cochrane Central Register of Clinical Trials (studies published from 1970 to February 15, 2024) and backward reference searching was performed on February 15, 2024. Search terms were mTBI , concussion , prognostic variables , predictors , and PSAC. Study Selection Peer-reviewed studies in English that reported clinical factors collected within 1 month (≤28 days) of injury and associated with poor outcome, specifically PSAC, more than 1 month after concussion were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. Data Extraction and Synthesis Independent extraction and quality assessment were performed by 2 author reviewers. Study characteristics and ORs were extracted using the Modified Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prognostic Factor Studies. Risk of bias was assessed using the Quality in Prognostic Studies tool. Three-level meta-analytic models examined factors associated with PSAC 1, 3, and 6 months after mTBI. Main Outcomes and Measures Adjusted OR (AOR) estimates for the association of acute clinical measures with PSAC. Results Thirty-four studies were reviewed; data were extracted from 15 studies (44.1%) included in the meta-analysis (592 406 adults with concussion; mean age, 29.3 years [range, 16-89 years]; 57.8% male). Acute concentration difficulty was associated with greatest odds of PSAC across all time points (AOR, 3.43 [95% CI, 1.85-6.36]). Medical history of anxiety and/or depression or of sleep disorders (AOR, 2.47 [95% CI, 1.62-3.78]) and clinical signs (loss of consciousness and amnesia; AOR, 1.90 [95% CI, 1.28-2.84]) were associated with increased odds of PSAC across all time points. At 1 month (AOR, 3.12 [95% CI, 1.43-6.82]) and 6 months (AOR, 26.81 [95% CI, 3.42-210.06]), difficulty concentrating was associated with greatest odds of PSAC, while medical history of anxiety and/or depression or of sleep disorders was associated with greatest odds of PSAC at 3 months (AOR, 2.92 [95% CI, 1.39-6.14]). Conclusions and Relevance In this systematic review and meta-analysis, acute cognitive symptoms, medical history of anxiety and/or depression or of sleep disorders, and the presence of clinical signs (loss of consciousness and amnesia) were the factors associated with greatest odds of PSAC in adults across all time points. The findings suggest that evaluating specific acute symptoms and signs may contribute to the prognosis of PSAC in adults.

Nightly Sleep Duration and Symptom Burden Over 1 Month Following Pediatric Concussion

2025-06-18

Lauren Butterfield , Roger Zemek , Michael M. Borghese +7 more | JAMA Network Open

Importance Approximately half of all youths with concussions report sleep disturbance, including short and long sleep durations, in the first week of recovery. Limited longitudinal research exists regarding the association … Importance Approximately half of all youths with concussions report sleep disturbance, including short and long sleep durations, in the first week of recovery. Limited longitudinal research exists regarding the association between sleep duration and symptom burden during acute pediatric concussion recovery. Objective To investigate the association between mean nightly sleep duration over 1 week (days 1 to 7) and 2 weeks (days 1 to 14) postinjury and subsequent symptom burden at 1, 2, and 4 weeks following pediatric concussion. Design, Setting, and Participants This cohort study used data from a randomized clinical trial conducted in 3 emergency pediatric departments in Ontario, Canada, from March 2017 to December 2019 (with secondary analysis conducted between September 2022 and September 2024). Eligible participants were between ages 10 years and 18 years who received treatment for a concussion within 48 hours. Exposure Sleep postinjury was measured with waist-worn accelerometers 24 hours per day for 2 weeks and daily sleep logs. Main Outcomes and Measures Symptom burden was measured with the Health and Behavior Inventory at 1 week, 2 weeks, and 4 weeks postconcussion. A nonlinear mixed-effects model was applied that estimated symptom burden at 1, 2, and 4 weeks from mean sleep duration over days 1 to 7 and days 1 to 14. Logistic regressions were performed to assess the odds of being reliably symptomatic at 2 and 4 weeks by mean sleep duration. Conservative ( z ≥ 1.65) and liberal ( z ≥ 1.28) definitions of reliable change in symptoms were evaluated. All models compared 10th vs 50th, 25th vs 75th, and 50th vs 90th percentile contrasts, and were adjusted for prognostic pre-injury demographic and baseline injury variables. Results A total of 291 participants (median [IQR] age, 13.2 [11.6-14.9] years; 128 female [44.0%]) were included in the main analysis. Mean nightly sleep duration beyond 9.5 hours in the first week postconcussion was associated with higher symptom burden at 1 week (75th percentile [10.5 h] vs 25th percentile [9.5 h]: estimate, 1.3 [95% CI, 0.25-2.28]; 90th percentile [11.3 h] vs 50th percentile [10.0 h]: estimate, 2.9 [95% CI, 1.22-4.69]). Mean sleep duration beyond 9.9 hours in the first 2 weeks postconcussion was associated with higher symptom burden at 2 weeks (90th percentile [10.9 h] vs 50th percentile [9.9 h]: estimate, 2.2 [95% CI, 0.85-3.47]) and 4 weeks (estimate, 2.2 [95% CI, 0.85-3.47]), and increased odds of persisting symptoms at 4 weeks (conservative: odds ratio [OR], 1.73 [95% CI, 0.91-3.26]; liberal: OR, 1.93 [95% CI, 1.07-3.47]). Conclusions and Relevance In this observational study of adolescents, average nightly sleep durations beyond 9.9 hours over the first 2 weeks of concussion recovery were associated with high symptom burden and persistent symptoms. Clinicians should monitor youths’ sleep after concussions.

EEG brain states for real-time detection of covert cognition in disorders of consciousness

2025-06-18

Gabriel Della Bella , Di Zang , Peng Gui +7 more

One of the biggest challenges in cognitive neuroscience is developing diagnostic tools for Disorders of Consciousness (DoC). Detecting dynamical connectivity brain states seems promising, specifically those linked to transient moments … One of the biggest challenges in cognitive neuroscience is developing diagnostic tools for Disorders of Consciousness (DoC). Detecting dynamical connectivity brain states seems promising, specifically those linked to transient moments of enhanced cognitive states in patients. A growing body of evidence indicates that fMRI brain states properties are strongly modulated by the level of consciousness , as theoretically predicted by whole brain modeling. fMRI-based brain states, however, have very limited practical application due to methodological constraints. In this work we defined EEG-based brain states and explored their potential as a bedside, real-time tool to detect transient windows of enhanced brain states. We analysed data from 237 individual patients with chronic and acute DoCs -100 Unresponsive Wakefulness Syndrome (UWS), 96 Minimally Conscious State (MCS) and 41 acute- and 101 healthy controls obtained in three independent research centers (Fudan hospital in Shanghai, Pitié Salpêtrière in Paris and Purpan hospital in Toulouse). We determined five EEG functional connectivity brain states, and show that their probability of occurrence is strongly related to the level of consciousness. Distinctively, high entropy brain states are exclusively found in healthy subjects, while low-entropy brain states increase their probability with DoC’s severity, spanning from acute unarousable comatose state, to more chronic DoC’s patients, who are awake but show fluctuating (MCS) or absent awareness (VS). Furthermore, the brain state probability distribution of each individual subject —and even the presence of certain key brain states— significantly vary with the patients’ outcome. We also tested whether our procedure has an actual potential for real-time, bedside brain state detection, and proved that we can reliably estimate the concurrent brain state of a patient in real time, paving the way for a broad application of this tool for DoC patients’ diagnosis, follow-up, and neuroprognostication.

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Post-Coma Neurorehabilitation: Neurophysiological Assessment as an Additional Strategic and Essential Competence for the Physiatrist

2025-06-18

Luigi Di Lorenzo , Carmine D’Avanzo | Journal of Personalized Medicine

Neurophysiological techniques, particularly somatosensory evoked potentials (SEPs) and electroencephalography (EEG), are essential tools for the functional and prognostic evaluation of patients with prolonged disorders of consciousness (DoC) in intensive neurorehabilitation … Neurophysiological techniques, particularly somatosensory evoked potentials (SEPs) and electroencephalography (EEG), are essential tools for the functional and prognostic evaluation of patients with prolonged disorders of consciousness (DoC) in intensive neurorehabilitation settings. This narrative review critically analyzes the most relevant evidence regarding the use of SEPs and EEG in the management of post-comatose patients, highlighting the strategic role of physiatrists in integrating these assessments into individualized rehabilitation plans. A systematic search was conducted across major international databases (PubMed, Embase, Scopus, Cinahl, and DiTA) until December 2024, selecting consensus documents, official guidelines (including the 2021 ERC/ESICM guidelines), systematic reviews, observational studies, and significant Italian neurophysiological contributions. The literature supports the strong prognostic value of the bilateral presence of the N20 component in SEPs, while its early bilateral absence, particularly in post-anoxic cases, is a robust predictor of poor neurological outcomes. EEG provides complementary information, with continuous, reactive, and symmetrical patterns associated with favorable outcomes, while pathological patterns, such as burst suppression or isoelectric activity, predict a worse prognosis. Combining SEP and EEG assessments significantly improves prognostic sensitivity and specificity, especially in sedated or metabolically compromised patients. Additionally, the use of direct muscle stimulation (DMS) and nerve conduction studies enables accurate differentiation between central and peripheral impairments, which is crucial for effective rehabilitation planning. Overall, SEPs and EEG should be systematically incorporated into the evaluation and follow-up of DoC patients, and the acquisition of neurophysiological competencies by physiatrists represents a strategic priority for modern, effective, and personalized neurorehabilitation.

Role of video review for sport-related concussion identification: a systematic review

2025-06-18

Dominic Townsend , A. Saker , Katie Scandrett +5 more | British Journal of Sports Medicine

Objective To determine the frequency and diagnostic utility of visible signs identified through video review for sport-related concussion detection and to evaluate the role of injury mechanism in predicting concussions. … Objective To determine the frequency and diagnostic utility of visible signs identified through video review for sport-related concussion detection and to evaluate the role of injury mechanism in predicting concussions. Design Systematic review. Data sources MEDLINE, SPORTDiscus, Web of Science and Cochrane Library from 2001 to June 2024. Eligibility criteria Original, peer-reviewed studies focusing on sport-related concussion, where video review identified visible signs or the mechanism of injury relevant to clinical decision-making. Studies were included irrespective of study design but had to be published in English and use a clinical diagnosis or consensus definition of sport-related concussion as a reference standard. Results Out of 1001 records screened, 29 studies involving 3281 sport-related concussions were included for quantitative synthesis. Only eight studies had a low risk of bias. All studies used clinical diagnosis as a reference standard; 26 were conducted in professional competitions, with two studies including female athletes. The most frequently observed visible sign was ‘slow to get up’ (37.6%), followed by ‘motor incoordination’ (26.7%). Sensitivity of visible signs was generally low (<50%), while specificity was high (>90%) across most studies. Four studies across three sports examined mechanism of injury characteristics, identifying common themes, such as high speed of impact, potentially associated with sport-related concussion occurrence. Inter-rater and intrarater reliability varied, with indications of higher reliability among expert raters. Conclusions Expert video review can reliably identify visible signs of sport-related concussion. However, due to their low frequency and limited diagnostic sensitivity, the diagnosis of sport-related concussion should be supported by a multimodal assessment.

Street Shadows and Neural Scars for Brain Plasticity: Neurological and Behavioral Consequences of Trauma and Drug Abuse in Street-Connected Children Wired for Survival

2025-06-18

Priyaranjan Maral , Namita Pande | International Journal of Health Sciences and Research

Background: Street-connected children in India face chronic adversity, often compounded by trauma and substance abuse. These factors are known to affect cognitive development and emotional regulation, yet there is limited … Background: Street-connected children in India face chronic adversity, often compounded by trauma and substance abuse. These factors are known to affect cognitive development and emotional regulation, yet there is limited empirical research examining their combined impact on brain-related functioning in this high-risk population. This study aimed to explore how trauma and drug use influence neurocognitive and behavioral outcomes among on- and off-street children in urban India. Materials and Method: The sample consisted of 106 street-connected children (64 males, 42 females), aged 8 to 16 years (M = 12.4, SD = 2.3), drawn from urban cities: Allahabad, Kanpur, and Banaras. Standardized instruments were used to assess trauma exposure (CTQ), substance use severity (DUSI-R), cognitive functioning (Trail Making Test A & B, Digit Span), behavioral problems (CBCL), and neurological soft signs. Group comparisons and multiple regression analyses were conducted. Results: On-street children reported significantly higher trauma (M = 68.9) and substance use severity (M = 11.2) than off-street peers (M = 55.4 and M = 7.4, respectively). Cognitive assessments revealed lower working memory scores (Digit Span M = 7.2, SD = 2.1) and slower executive functioning (TMT-B M = 93.6 seconds). Behavioral problems were elevated, with mean CBCL externalizing scores reaching M = 66.7 (SD = 14.3. Although the regression model did not yield statistically significant predictors (R² = 0.011, p = .771), descriptive trends suggested a link between trauma, drug use, and neurobehavioral impairments. Conclusion: Findings highlight the neurodevelopmental impact of trauma and drug abuse among street-connected youth, particularly those with greater exposure to environmental instability. Interventions must extend beyond basic services to include trauma-informed, brain-based rehabilitation approaches. Policy reform is needed to recognize these children as neurologically at-risk and deserving of specialized, long-term support. Key words: Brain Plasticity, Street-Connected Children, Trauma, Drug Use, Cognitive Development, Behavioral Problems, Neurodevelopment

Online concussion resources for young children and caregivers: a systematic search

2025-06-17

Nikoleta Odorico , Mackenzie Kauth , Shane Butt +3 more | Brain Injury

In Canada, concussions are common among children aged 3-12 years. Caregivers play a vital role in their child's post-concussion care, highlighting the need for resources tailored to children and caregivers. … In Canada, concussions are common among children aged 3-12 years. Caregivers play a vital role in their child's post-concussion care, highlighting the need for resources tailored to children and caregivers. Although many online pediatric concussion resources exist, their suitability for younger children and caregivers remains unclear. To identify and assess the quality, readability, usability, and suitability of online concussion resources for children aged 3-12 years and their caregivers. A four-phased systematic search strategy was used and involved: 1) searching Canadian children's hospital websites, 2) applying pre-established inclusion/exclusion criteria, 3) evaluating content quality, and 4) evaluating resources for suitability, readability, and usability. The search yielded 738 resources.17 met the final criteria. Among these, 82.4% (n = 14) required the ability to read text, 11.8% (n = 2) specified the age of the resource targeted, and 5.9% (n = 1) focused on return to play beyond organized sport. The identified resources offer accurate concussion information for children and caregivers, but lack specificity for their intended audience and accessibility for nonreaders. Future resources should consider specifying the intended age group, improving accessibility for nonreaders, and including information about important activities for this age group such as returning to active play.

Driving After Concussion: Clinical Measures Associated with Post-concussion

2025-06-17

Kumiko Hashida , Julia Drattell , Kim Love +4 more | Journal of Athletic Training

ABSTRACT Context: Post-concussion driving assessment has been limited to driving simulators, which are not clinically feasible. There is a need to equip clinicians with tools that can assist in making … ABSTRACT Context: Post-concussion driving assessment has been limited to driving simulators, which are not clinically feasible. There is a need to equip clinicians with tools that can assist in making recommendations on return to driving. Objective: To determine the association between clinical measures and driving simulator performance in college students within a week of a concussion. Design: Cross-sectional. Setting: Laboratory. Patients or Other Participants: Forty-three college students with concussion and 46 controls. Main Outcome Measures: Clinical outcomes include: total symptom score, dual-task tandem gait completion time and dual-task cost (the percentage increase in completion under dual-task and single-task), Complex Figure performance, Useful Field of View performance, and Vestibular Ocular Motor Screening (VOMS) symptom provocation score. Driving simulator outcomes include: the number of collisions, speed exceedances, stop signs missed, centerline crossings, and road edge excursions. Within each of the drive segments, we collected standard deviation of speed (SDS) and lane position (SDLP). Separate models for each clinical assessment and driving outcome with negative binomial and linear regression models were used. Results: Greater dual-task cost was associated with increased road edge excursions ( p =.018) and SDS ( p =.009). Higher VOMS symptom provocation was associated with less SDS (all p <.050). A higher Complex Figure copy score was associated with decreased centerline crossings (p=.001), road edge excursions (p<.001), SDS (p<.001), and SDLP (all p<.050). A slower Complex Figure copy completion time was associated with lower SDS (p=.010). A higher Complex Figure delayed score was associated with fewer road edge excursions and lower SDLP (all p<.050). Longer Complex Figure delayed completion time was associated with greater SDS (p=.03). Conclusions: Dual-task and Complex Figure might be useful when assessing post-concussion driving ability. Higher VOMS symptom provocation was associated with better driving performance, possibly indicating individuals experiencing vestibular-oculomotor symptoms may adopt more cautious strategies.

Reliability and Validity of the Functional Assessment of Neurocognition in Sport (FANS): A Paradigm Shift in Post-Concussion Return-to-Sport Decision-Making

2025-06-17

Landon B. Lempke , Benjamin L. Brett , Douglas P. Terry | Journal of Athletic Training

ABSTRACT Context: Assessments used after concussion provide strong diagnostic accuracy and aid in initial healthcare planning, but can have limited utility after the acute timeframe. Current concussion assessments have low … ABSTRACT Context: Assessments used after concussion provide strong diagnostic accuracy and aid in initial healthcare planning, but can have limited utility after the acute timeframe. Current concussion assessments have low ecological validity in assessing return-to-sport readiness. We developed a functional assessment protocol, the Functional Assessment of Neurocognition in Sport (FANS) to address these limitations. Objective: To evaluate the psychometric properties of FANS, including test-retest reliability, minimal detectable change, and divergent validity. Design: Repeated measure design at two-timepoints, 14-days apart. Setting: Clinical laboratory. Patients or Other Participants: Seventeen healthy, physically active individuals (age:21.9±3.2years, 58.8% female; 76.5% no lifetime concussion history). Main Outcome Measures: Participants completed FANS at two timepoints, and conventional clinical assessments (symptom checklist, balance, computerized neurocognitive testing) at the first timepoint. FANS examined 7-cognitive domains (verbal memory, visual memory, reaction time, processing speed, cognitive-motor flexibility, delayed verbal memory, delayed visual memory) through incorporating neuropsychological test paradigms with whole-body cognitive-movement tasks. We used intraclass correlation coefficients (ICC 3,k ) with 95% confidence intervals (95% CI) and Pearson r correlations to evaluate test-retest reliability and divergent validity. Results: All FANS outcomes displayed acceptable test-retest reliability (ICCs ≥ 0.63), with the lowest being verbal memory’s interference subtest. Standard errors of measurement and minimal detectable changes overall displayed small values relative to score ranges. Correlations between FANS and conventional clinical assessments demonstrated select FANS reaction time and processing speed outcomes exceeding the divergent validity threshold with computerized neurocognitive testing reaction time ( r range: -0.79-0.77). Conclusions: FANS overall displayed acceptable test-retest reliability comparable to more traditional neurocognitive test platforms, and acceptable divergent validity. FANS reaction time and processing speed may partially overlap with computerized neurocognitive testing reaction time, and warrants further examination in a clinical population. Though FANS is reliable and valid for use, future research is needed to establish FANS utility for return-to-sport readiness.

Consensus on covert awareness: A Delphi study

2025-06-17

Caroline Schnakers , Berno U. H. Overbeek , Niko Fullmer +6 more | medRxiv (Cold Spring Harbor Laboratory)

Abstract Background: Identifying willful brain activity in patients with Disorders of Consciousness (DoC) is critical, as some patients fail to exhibit behavioral signs of consciousness at the bedside but respond … Abstract Background: Identifying willful brain activity in patients with Disorders of Consciousness (DoC) is critical, as some patients fail to exhibit behavioral signs of consciousness at the bedside but respond to active tasks via neuroimaging or electrophysiological measures. Standardized terminology for this subgroup is absent while it is essential for advancing research and clinical care. To determine the level of consensus among a large group of international experts on terminology and definitions for this clinical entity, as described by terms such as covert awareness (CA), cognitive motor dissociation (CMD), functional locked-in syndrome (fLIS), and non- behavioral minimally conscious state (MCS*). Methods: A Delphi study was conducted using REDCap to evaluate expert agreement on terminology and definitions. The study was conducted among international experts in DoC, primarily from Europe/UK, the USA, and other regions. Findings : Ninety-six experts participated. Among these, 75 (78%) completed both rounds. Participants were predominantly clinical scientists (71%) working in rehabilitation settings (63%). A Delphi method was followed. Consensus on terminology and related definitions was defined as a median score of 5, an interquartile range (IQR) ≤ 1, and ≥ 75% agreement (scores of 4 or 5). Within two rounds, consensus was achieved for over two-thirds of the statements. The term "Covert Awareness" (CA) and its associated definition were identified as the preferred terminology by an international expert panel. Interpretation : We recommend the use of "Covert Awareness" (CA) since our large group of international experts consistently agreed on such preferred term for this subgroup of patients with DoC. This consensus (>75% agreement) establishes a foundation both for future research and clinical standardization. The findings have implications for improving diagnostic accuracy and advancing understanding of covert awareness in DoC, although further study is needed to refine and apply the agreed-upon definition in clinical practice. Funding : Nihil. Research in context Evidence before this study Since the initial description of a patient with covert awareness in 2006 using mental imagery tasks during fMRI, a substantial number of publications has reported similar findings. Two meta-analyses have shown that 14–17% of patients diagnosed behaviorally as being in a vegetative state (VS) actually exhibit willful brain activity detectable through neuroimaging or electrophysiological paradigms. Recent multicenter studies reported that up to 25% of such patients may demonstrate covert command-following. Despite this growing body of evidence, the field has lacked a standardized nomenclature to describe this subgroup of patients. A 2022 systematic review identified 25 different terms in use—such as covert awareness (CA), cognitive motor dissociation (CMD), functional locked-in syndrome (fLIS), and non-behavioral minimally conscious state (MCS*)—underscoring the inconsistency in terminology. No prior study has evaluated expert consensus on preferred terminology and its definition. Added value of this study This study is the first international Delphi consensus effort specifically aimed at determining the most appropriate term and corresponding definition for patients with disorders of consciousness who exhibit willful brain activity detectable only through neuroimaging or electrophysiology. Thanks to a large group of international experts across diverse clinical and research backgrounds, consensus was reached on “Covert Awareness” (CA) as the preferred term, along with a precise definition. This consensus was robust across disciplines and geographic regions. Implications of all the available evidence Establishing consensus on the term “Covert Awareness” (CA) provides a critical foundation for future research, clinical practice, and guideline development. Standardized nomenclature can improve diagnostic consistency, enhance communication across care teams, and promote better public and caregiver understanding. It also enables more rigorous comparative research by providing clear inclusion criteria for future studies. While additional refinement of the definition may be required, this consensus marks a key step in formalizing the recognition of CA as a distinct clinical entity. Future efforts should also consider the development of specialized diagnostic centers and the integration of CA detection into clinical pathways and treatment trials.

The relationship between cognitive reserve, cognitive performance, and outcomes of return to work and life satisfaction after brain injury: a retrospective cohort study

2025-06-16

Natascha Ekdahl , Marianne Lannsjö , Britt‐Marie Stålnacke +1 more | Disability and Rehabilitation

Cognitive reserve and neuropsychological test results are linked to outcomes after acquired brain injury (ABI), but their interaction and their impact on different types of outcomes remains to be explored. … Cognitive reserve and neuropsychological test results are linked to outcomes after acquired brain injury (ABI), but their interaction and their impact on different types of outcomes remains to be explored. This study aimed to explore how cognitive reserve, measured by education, is related to neuropsychological outcomes, return-to-work and life satisfaction after ABI. Long term follow-up of 83 patients with ABI, 5-15 years after specialized brain injury rehabilitation. Logistic regression was used to analyze the relationship between independent variables and outcomes (return-to-work and life satisfaction). Return-to-work was associated with cognitive reserve (OR = 1.31, p = 0.024), age (OR = 0.95, p = 0.042), general fatigue (OR = 0.77, p = 0.034), and Cognitive Profiency Index (measures of working memory and processing speed, OR = 1.06, p = 0.037). Verbal and spatial abilities were related to education, but not to return-to-work. General fatigue was related to satisfaction with mental health in both univariate (OR = 0.78, p = 0.008) and multivariate analyses (OR = 0.8, p = 0.037), but no other variables were significantly associated with life satisfaction in multivariate analyses. Patients with lower cognitive reserve paired with slower processing speed and poor working memory may need additional support for successful return-to-work, while life satisfaction appears to depend more on other factors.

Psychological outcomes following moderate-to-severe acquired brain injury: A longitudinal study

2025-06-16

Anna Igoe , Deirdre M. Twomey , Niamh Allen +7 more | Applied Neuropsychology Adult

Emotional distress is highly prevalent in the years following an acquired brain injury (ABI). Yet, there is a lack of research examining the long-term psychological outcomes and potential influencing factors, … Emotional distress is highly prevalent in the years following an acquired brain injury (ABI). Yet, there is a lack of research examining the long-term psychological outcomes and potential influencing factors, among individuals with ABIs. In this study, we trace longitudinal changes in neuropsychological outcomes in 32 individuals with moderate-to-severe ABI who engaged in neurorehabilitation in a post-acute hospital. Outcomes assessed at one- and eight-years post-ABI include emotional distress, coping, subjective experience of injury-related difficulties, and quality of life (QOL). Almost half of all participants reported clinically elevated symptoms of anxiety and depression at eight-years post-ABI (t2). There was minimal variation in neuropsychological outcomes between one- and eight-years post-ABI. Greater use of maladaptive coping responses was associated with greater symptoms of anxiety and depression at t1. As the subjective experiences of injury-related difficulties increased, so too did the symptoms of anxiety and depression at both timepoints. Higher levels of depression were associated with lower psychological and social QOL at t1 and lower levels of psychological, physical, social, and environmental QOL at t2. This study offers a unique insight into the intricate links that exist longitudinally between coping responses, subjective experiences of injury-related difficulties, QOL, and emotional distress following an ABI. It also highlights the need to conceptualize ABI as a chronic health condition that requires long term psychological support.

Distinct Symptom Recoveries Based Upon Highest Level of Care in Patients with Sport-related Concussion or Traumatic Brain Injury and Glasgow Coma Scale 13-15

2025-06-16

Shawn R. Eagle , Bryan Lamb , Daniel L. Huber +5 more | Clinical Neurology and Neurosurgery

Multiparty Communication: A New Direction in Characterizing the Impact of Traumatic Brain Injury on Social Communication

2025-06-16

Sophia Kekes-Szabo , Sharice Clough , Sarah Brown‐Schmidt +1 more | American Journal of Speech-Language Pathology

Purpose: The purpose of this viewpoint is to advocate for increased study of common ground and audience design processes in multiparty communication in traumatic brain injury (TBI). Method: Building on … Purpose: The purpose of this viewpoint is to advocate for increased study of common ground and audience design processes in multiparty communication in traumatic brain injury (TBI). Method: Building on discussions at the 2024 International Cognitive-Communication Disorders Conference, we review common ground and audience design processes in dyadic and multiparty communication. We discuss how the diffuse profiles of neural and cognitive deficits place individuals with TBI at increased risk for keeping track of who knows what in group settings and using that knowledge to flexibly adapt their communication behaviors. Results: We routinely engage in social communication in groups of three or more people at work, school, and social functions. While academic, vocational, and interpersonal domains are all areas where individuals with TBI are at risk for negative outcomes, we know very little about the impact of TBI on group, or multiparty, communication. Conclusions: The empirical study of common ground and audience design in multiparty communication in TBI presents a promising new direction in characterizing the impact of TBI on social communication, uncovering the underlying mechanisms of cognitive-communication disorders, and may lead to new interventions aimed at improving success in navigating group communication at work and school, and in interpersonal relationships.

Wearing a Guardian Cap Does Not Mitigate On-field Head Impact Severity

2025-06-16

Robert C. Lynall , Aaron M. Sinnott , Charles Van Dyke +3 more | Medicine & Science in Sports & Exercise

ABSTRACT Purpose Guardian Cap usage is growing amongst youth, college, and professional football players. Little on-field data exist describing Guardian Cap effectiveness, with combined published evidence based on less than … ABSTRACT Purpose Guardian Cap usage is growing amongst youth, college, and professional football players. Little on-field data exist describing Guardian Cap effectiveness, with combined published evidence based on less than 1,000 Guardian Cap impacts. Our objective was to compare on-field head impact biomechanics (magnitude, location, frequency) between college football athletes wearing a Guardian Cap and teammates not wearing a Guardian Cap during practices and games throughout a season. Methods Fifty-four participants from two institutions were enrolled. Eleven (20.4%) wore a Guardian Cap for all contact practices, 43 (79.6%) did not wear a Guardian Cap for one season. Instrumented mouthguards recorded on-field head impact kinematics. Impact magnitude (linear mixed effects models), frequency, and location (generalized linear mixed models) were analyzed. Results A total of 7,509 impacts were recorded, including 1,379 (18.4%) impacts when the Guardian Cap was worn. There were no significant effects of Guardian Cap use for any impact magnitude outcome (p ≥ 0.127) or impact frequency (p = 0.508). The odds of a facemask impact relative to other locations were 36.2% lower among those wearing the Guardian Cap relative to non-wearers (p = 0.014). The odds of a rear impact relative to other locations were 151.6% greater among those wearing the Guardian Cap relative to non-wearers (p = 0.001). Conclusions The Guardian Cap had no on-field effect on head impact magnitude or frequency, but impact location patterns presented between wearers and non-wearers, suggesting Guardian Cap usage could influence how players use their head during collisions. Our findings partially align with other published data. The effect of Guardian Cap use on other factors we did not explore (e.g., injury epidemiology, clinical injury management) warrants consideration in the context of the data we present.

Purpose Renewal in Adults With Persisting Symptoms After Concussion: Results of a Non-Randomized Feasibility Trial

2025-06-16

Natalie V. Covington , Mary Vining Radomski , Alisa Kocian +7 more | Journal of Head Trauma Rehabilitation

Background: Living with a sense of purpose in life is associated with numerous health benefits; however, some individuals with persisting symptoms after concussion are at risk for purpose disruption. The … Background: Living with a sense of purpose in life is associated with numerous health benefits; however, some individuals with persisting symptoms after concussion are at risk for purpose disruption. The Compass Course is a group-based tele-practice intervention that supports purpose renewal after major health transitions. Objectives: To assess the feasibility, acceptability, and implementability of the Compass Course for adults with persisting symptoms after concussion, in preparation for a future randomized controlled trial. Setting: Large healthcare system in the Midwestern United States. Participants: Convenience sample of 37 adults with persisting symptoms after concussion. Design: Non-randomized pilot prospective cohort design. Intervention: Compass Course purpose renewal intervention delivered in a group setting via Zoom by an interdisciplinary team of allied health clinician-researchers (occupational therapy, speech-language pathology, psychology). Main Outcome Measures: Participants completed Likert scales to rate acceptability of the Compass Course intervention. Treatment fidelity was assessed by tracking the number of key intervention elements presented in each treatment session. Potential benefits of the intervention were assessed using validated measures of purpose and meaning in life. Results: Acceptability ratings were strong across the vast majority of participants. Treatment fidelity was strong with nearly perfect adherence to prespecified intervention elements. Participants who completed the intervention had gains across all purpose in life outcomes, with improvements maintained at 2-month follow-up. Conclusions: The Compass Course was highly acceptable to participants who completed the intervention; however, there was significant attrition suggesting a need for adaptations to the intervention and to trial procedures. Future work includes further intervention development, and a controlled feasibility trial to estimate treatment effects for a future well-powered clinical trial.

The Scale of Neurodegeneration in Moderate‐to‐Severe Traumatic Brain Injury: A Systematic Review of Longitudinal Studies

2025-06-16

Bhanu Sharma , Leanne Monteiro , Alana Changoor +2 more | Annals of Neurology

Objective Although moderate‐to‐severe traumatic brain injury (msTBI) was once considered a static neural event following resolution of acute injuries, numerous studies now demonstrate progressive losses to volume and white matter … Objective Although moderate‐to‐severe traumatic brain injury (msTBI) was once considered a static neural event following resolution of acute injuries, numerous studies now demonstrate progressive losses to volume and white matter integrity in the months and years postinjury, leading to a paradigm shift in our understanding. These findings have yet to be synthesized. Therefore, our objective was to assimilate longitudinal studies of chronic msTBI to better elucidate the scale and timelines of neurodegeneration, regions of vulnerability, and ongoing gaps in the literature. Methods As per our published systematic review protocol (see PROSPERO CRD42019117548), 6 electronic databases were searched from inception to June 2024. Included studies examined adults (> 17) with msTBI, were longitudinal with first acquisition at least 2 months postinjury, and reported whole brain and/or regional volumetrics or fractional anisotropy (FA). Results We identified 21 studies, with and without controls, and computed annualized percent change for the limited studies with overlapping regions and timelines with sufficient data. Overall, widespread progressive volumetric and FA losses were observed, with no evidence of accelerated progression across time. No volumetric but some FA increases (predominantly nonsignificant) were observed. Annualized percent changes in ascending order were: total grey matter volume (−0.28%), total white matter volume (−0.65%), hippocampal volume (−1.98%, bilaterally), and corpus callosum FA (−3.15%). Interpretation Gaps in our understanding include mechanisms of degeneration, whether progressive losses remain constant or attenuate with time, and how patterns vary by region. Longitudinal research with 3 timepoints, standardized reporting, and additional outcome modalities (eg, functional magnetic resonance imaging [fMRI], and blood biomarkers) would refine our understanding and inform treatment research. ANN NEUROL 2025

The Lived Experiences of NCAA Athletes with One or Multiple Concussions

2025-06-16

J. Schwegler , Kristin N. Mauldin , Kerri Racin-Anderson +5 more | Trauma Care

Background/Objectives: Concussions, their physical presentation, and patients’ recovery have been researched and documented numerous times, but the experiences of surviving and recovering from a concussion need to be explored further. … Background/Objectives: Concussions, their physical presentation, and patients’ recovery have been researched and documented numerous times, but the experiences of surviving and recovering from a concussion need to be explored further. The purpose of this study was to examine the lived experiences of NCAA Division I, II, and III student athletes who had suffered from one or more concussions. Methods: The consensual qualitative research (CQR) methodology was employed, guiding the formation of the interview questions and the analysis of the responses. The participants completed a free-response questionnaire as well as a semi-structured virtual interview that utilized a blend of idiographic, inductive, hermeneutic, and interpretive phenomenological approaches. Through their questionnaire and interview responses, they discussed their experience being concussed at a collegiate level. Results: Ten NCAA student athletes described their various physical, cognitive, emotional, and sleep-related symptoms due to receiving their concussion(s). Many of these student athletes reported feelings of loneliness, being misunderstood, or even not feeling “normal or at baseline” during and after their concussion recovery. One primary finding was the key role the athletic trainers played in the student athletes’ recovery process from initially receiving the concussion to their return to play. Conclusions: These findings will help contribute to the knowledge of what it is like to experience one or multiple concussions, the recovery process, and how that process can be improved.

The Level and Nature of Impairment on the Iowa Gambling Task Following Acquired Brain Injury: A Meta-analysis

2025-06-14

Sammy Moore , Kristin Naragon‐Gainey , Carmela Pestell +4 more | Neuropsychology Review

Abstract The Iowa Gambling Task (IGT) is a popular measure of risky decision-making, but to date, no formal quantitative reviews have been conducted, focused exclusively on IGT performance amongst individuals … Abstract The Iowa Gambling Task (IGT) is a popular measure of risky decision-making, but to date, no formal quantitative reviews have been conducted, focused exclusively on IGT performance amongst individuals with acquired brain injury (ABI). Therefore, this meta-analytic study firstly explored performance differences between individuals with ABI vs controls. Second, we extended this comparison by investigating differences in IGT scoring and interpretive approaches (e.g., total score vs later block analysis). Finally, we explored potential IGT performance moderators (e.g., average age). A total of 25 studies, containing 39 samples (total n = 2188), were included. Overall findings suggested that the IGT is sensitive to the presence of ABI, particularly non-TBI and medically confirmed TBI, which becomes evident by block 2 of 5. Medium effect sizes were obtained for IGT total score, as well as indicators using later blocks only. Performance moderators such as population type and region influenced IGT performance, whilst average age, average education, and proportion of males did not. These results indicate that the IGT is sensitive to decision-making impairment following ABI, although we conclude that further research is needed to confirm the IGT’s ability to detect impairment relative to specific brain regions.

Blink Reflex Parameters are Affected Acutely After Sport-related Concussion in Military Cadets

2025-06-13

Dena P. Garner , Andrew S. Davis , Michelle Lomonoco +3 more | Military Medicine

ABSTRACT Objective A pilot study reported sport-related concussion (SRC) affects the stimulated blink reflex response in collegiate male cadets, demonstrating hyper-reflexive blinks, increased time between closure of the ipsilateral and … ABSTRACT Objective A pilot study reported sport-related concussion (SRC) affects the stimulated blink reflex response in collegiate male cadets, demonstrating hyper-reflexive blinks, increased time between closure of the ipsilateral and contralateral eyelid, and increased number of eyelid oscillations post-blink. The purpose of this study was to validate our earlier findings in a larger and diverse sample. Materials and Methods Prospective cohort study at a military cadet college enrolled participants between 2018 and 2022. Participants’ blink reflex was assessed at preseason physicals and then again within 48 hours of concussive head injury using the EyeStat. Thirty-two cadets with SRC (mean age 20.1 years, 78% male) and 6 cadets with a repeat SRC during the enrollment period (mean age 21.7 years, 83% male) were assessed, a mean of 1 day post injury, and included in the analysis. Blink reflex parameters included latency, differential latency, eyelid velocity, excursion, oscillations, and delta 30. Results In the primary concussion group, SRC significantly reduced ipsilateral latency (2.93 [0.44, 5.42] ms, P = .022) and increased differential latency (1.46 [0.24, 2.69] ms, P = .020). No significant difference was observed for oscillations (P = .167). Although underpowered, our exploratory analysis suggests that this finding was not affected by participant age or sex. In repeat concussions, ipsilateral latency had a similar trend, but differential latency did not. Conclusions The blink reflex is affected after SRC, and its assessment may provide objective data to aid diagnosis. However, additional research is warranted to assess how blink reflex parameters change after subsequent concussions.