Concussions associated with cognitive, behavioral, and emotional consequences for students
July 22, 2020
Science Daily/University of Texas Health Science Center at Houston
Concussions can have a compounding effect on children, leading to long-term cognitive, behavioral, and emotional health consequences, according to researchers at The University of Texas Health Science Center at Houston (UTHealth), who published their findings in the American Journal of Sports Medicine.
In 2017, approximately 2.5 million high school students in the United States reported suffering at least one concussion related to sports or physical activity in the last 12 months, according to information from the U.S. Centers for Disease Control and Prevention (CDC).
The UTHealth researchers analyzed survey data from more than 13,000 high school students in the United States. According to the authors, it is the first study to report on the association between sports-related concussions and negative health implications based on a representative sample of U.S. high school students.
"We have previously speculated that children who suffer a concussion have more behavioral problems, so this study was able to provide a more comprehensive analysis on the various cognitive and behavioral health issues that this population faces in connection with this type of brain injury," said Gregory Knell, PhD, the study's first and corresponding author. Knell is an assistant professor at UTHealth School of Public Health in Dallas and is research faculty at Children's Health Andrews Institute for Orthopaedics and Sports Medicine.
A concussion is the most common form of traumatic brain injury, caused by a mild blow to the head. Common symptoms include a headache, ringing in the ears, nausea, vomiting, fatigue, drowsiness, and blurry vision.
Participants were asked how many times they had suffered a concussion from playing a sport or during physical activity in the last 12 months. Students were also surveyed on relevant cognitive, emotional, and behavioral factors and related health outcomes, including questions on topics such as academics, suicidal ideation, and substance abuse.
The study revealed that 14.5% of female high school athletes and 18.1% of male high school athletes reported experiencing at least one concussion the previous year. These students also reported at least one factor associated to their behavioral, cognitive, and emotional health. The questions covered topics such as difficulty concentrating, poor grades, drinking and driving, carrying a weapon, getting into a physical altercation, using tobacco or marijuana, binge drinking, feeling depressed, and having suicidal thoughts or actions.
Of the male participants who suffered at least one concussion, 33.8% reported they drank and drove in the last 30 days. For the female athletes who reported suffering more than one concussion, 19% stated they had used marijuana at least once in the last 30 days. Both male and female participants who answered that they had been in at least one physical fight in the last year were significantly more likely to have reported having at least one concussion in that same timeframe.
Other associated factors that were significantly more likely in male students who reported a prior concussion included difficulty concentrating, tobacco/e-cigarette use, and binge drinking. Female students who reported prior concussions were more likely to ride in a car with a driver who had been drinking, and have suicidal thoughts or actions.
"Parents need to understand that a concussion is a very serious brain injury, one which requires treatment every time a concussion is sustained. This study has revealed this type of traumatic brain injury can have a compounding effect on children that could lead to more aggressive behavior, academic problems, and social issues," said study co-author Scott Burkhart, PsyD, a neuropsychologist at Children's Health Andrews Institute for Orthopaedics and Sports Medicine.
The research team encourages future studies to continue the surveillance on the prevalence of concussions among student athletes, as well as the severity of these injuries.
https://www.sciencedaily.com/releases/2020/07/200722163225.htm
How side hit to the head could damage brain, lead to concussion
While probing the origins of concussion, researchers identify which regions of the brain are more vulnerable to damage
August 1, 2019
Science Daily/Stevens Institute of Technology
Play contact sports for any length of time and at one point or another you're probably going to have your 'bell rung' by a powerful blow to the head from a hard hit or fall. Rising awareness of the severe, abiding repercussions of strong impacts to the head -- concussions, mild traumatic brain injury, neurological disorders -- have led scientists to focus on what exactly happens inside a skull during a big hit.
Mehmet Kurt, a mechanical engineer at Stevens Institute of Technology who studies the biomechanics of the brain and the skull at rest and during rapid head movements, has now bioengineered simulations that track how the brain behaves upon impact, reconstructing the inertial stresses and strains that prevail inside a brain that's just been hit hard from the side.
"The brain not only rings, but it has a distinct pattern of ringing when the head is hit from the side and experiences rotational acceleration," said Kurt, whose work may not only have implications for brain injury assessment, but for sports helmet makers in search of measurable parameters that can simply distinguish 'concussion' from 'no concussion' to help the industry set safety standards. The paper appears in the July 30 issue of Physical Review Applied.
By analyzing a combination of simulated and human data of brain movement that have led to concussions, Kurt and his group, including Stevens graduate student Javid Abderezaei, digitally reveal that side impacts to the head lead to rotational accelerations that cause mechanical vibrations to concentrate in two brain regions: the corpus collosum, the bridge that links the hemispheres, and the periventricular region, white matter lobes at the brain's root that help speed muscle activation.
Kurt and Abderezaei, with Kaveh Laksari of University of Arizona and Songbai Ji of Worcester Polytechnic Institute, found that the skull's internal geometry and the gelatinous nature of the brain cause these two regions to resonate at certain frequencies and receive more mechanical energy in the form of shearing forces than the rest of the brain. More shear strain presumably yields more tissue and cell damage, particularly since shear, opposing motions tend to deform brain tissue more readily than other biological tissues.
"A hit to the head creates non-linear movement in the brain," said Abderezaei. "That means that small increases in amplitude can lead to unexpectedly big deformations in certain structures."
These non-linear vibrations are not surprising in a complex organ featuring a range of tissue densities. Add in the restraining effects of the tough protective membranes, particularly the falx and the tentorium, that hold the brain in place from both above and below, and certain regions are bound to come off worse in side hits.
Identifying the parts of the brain that are most at hazard in side impacts makes them prime targets for further investigation in quest of insights into concussions and detailed brain behavior in collisions. Such knowledge can't come soon enough more than 300,000 American children and teenagers suffer sports-related concussions every year.
https://www.sciencedaily.com/releases/2019/08/190801093312.htm
Impact of concussions reduced in children with more years of sport experience
April 4, 2019
Science Daily/York University
More years in sports -- not less -- may help protect the brains of children who have had a concussion, against future concussions, a new study says.
Research from York University's Faculty of Health found that children who have played in a performance sport for at least seven years, and have a history of concussion, recover better from concussions than children who have fewer years in the sport. Their years in the sport may give them more skill-related motor "reserve" that helps them to get back to the level they were playing at previously.
"Our results suggest there's an advantage to staying with skilled activity to the point where your brain can maintain performance even when it's still being affected in subtle ways by a past injury," says senior author, Lauren Sergio, professor in the School of Kinesiology and Health Science and Centre for Vision Research at York University. "This performance may be protective and would reduce vulnerability to another concussion when playing with non-concussed peers."
Sergio and her former postdoctoral student and lead author, Marc Dalecki, now an assistant professor in the School of Kinesiology at Louisiana State University, along with co-author Alison Macpherson, professor in York's School of Kinesiology & Health Science, examined factors that may influence performance recovery after a concussion.
"The findings of this study are important because it demonstrates that athletes with more years of experience return to pre-concussion levels more quickly than inexperienced athletes," says Macpherson. "This can be one factor to help guide decisions about returning athletes to play."
Their study looked at 126 youth, aged eight to 17 years old, 64 with a history of concussion and 62 without, over a two-year period from 2013 to 2015. Participants, parents, team managers, and coaches were interviewed in order to obtain detailed information about the concussion history. All concussion history participants were defined as "asymptomatic" in accordance with current return-to-play protocol guidelines at the time of testing. Participants were asked to perform two visuomotor tasks over 20 trials that required sliding the index finger of the dominant hand along a dual-touch screen laptop, with touch screens in the vertical and horizontal planes.
In the first condition, they moved their hand on the vertical screen in the same direction as the target on the screen. In the second condition, participants had to slide their finger along the horizontal touch screen in the opposite direction of a presented target on the screen. In other words, in order to move the cursor to the left, they had to slide their finger to the right. This type of condition is similar to passing a hockey puck to a teammate on the left while skating to the right.
Researchers found youth with a concussion history with seven or more years of sport experience and higher levels of eye-limb coordination-related sport experience had quicker motor skill recovery times (around 12 months) compared to their peers with less than six years of sport experience (around 30 months or two seasons later). They found no differences in these results when factoring sex or age.
https://www.sciencedaily.com/releases/2019/04/190404104401.htm
Sports-related concussion symptoms linger twice as long for adolescent girls
Recovery may be complicated by pre-existing conditions more prevalent in females
October 2, 2017
Science Daily/American Osteopathic Association
Adolescent female athletes suffer concussion symptoms twice as long as their male counterparts, according to a new study. Researchers found the extended recovery period may be due to underlying conditions including migraines, depression, anxiety and stress.
The research analyzed the medical records of 110 male and 102 female athletes, ages 11 to 18, with first-time concussion diagnoses. The median duration of symptoms was 11 days for boys and 28 days for girls. The data also showed that symptoms resolved within three weeks for 75 percent of boys, compared to 42 percent of girls.
"These findings confirm what many in sports medicine have believed for some time," said lead researcher John Neidecker, DO, a sports concussion specialist in Raleigh, North Carolina. "It highlights the need to take a whole person approach to managing concussions, looking beyond the injury to understand the mental and emotional impacts on recovery when symptoms persist."
Prior research has shown that concussions exacerbate some pre-existing conditions, including headaches, depression, anxiety and stress, all of which are more prevalent in girls and mirror hallmark concussion symptoms, according to a consensus statement from the 5th International Conference on Concussion.
Treating the right condition
Understanding the overlap of symptoms means physicians must be skilled at eliciting patient history to get a full understanding of factors that might complicate recovery.
"Often in this age range, issues like migraines, depression and anxiety have not yet been diagnosed," said Dr. Neidecker. "So, if I ask a patient whether they have one of these conditions, they're likely to say 'No'. But when I ask about their experiences, I get a much clearer picture."
Dr. Neidecker gives an example of a patient with no history of migraines who admitted experiencing weekly headaches prior to the head injury. She thought the headaches were normal, but in fact the patient was suffering from migraines.
He uses a similar approach to uncovering anxiety, mental stress and depression, and says diagnosis is tricky because adolescence is inherently emotional and stressful. To better understand the patient, he recommends asking young athletes whether they are hard on themselves or feel bad about not performing their best.
Patients with Type A personality traits typically have a baseline level of stress about the need to perform and become more stressed when they cannot, Dr. Neidecker explained. Losing the physical outlet of sport for managing their stress compounds the issue during the recovery period.
"It can really become a vicious cycle for some of these kids," said Dr. Neidecker. "Uncovering and addressing any underlying conditions gets them back on the field faster and ultimately helps them be healthier and happier in the future."
https://www.sciencedaily.com/releases/2017/10/171002090506.htm