Concussion Research and Approach
Mild traumatic brain injury care must be a conglomeration of research and symptomatic treatment practices as there is no easy solution, and for many the symptoms seem endless.
Rest is not the only option and medications, although sometimes necessary, are not slowing down the brain degeneration or cumulative effects of concussions.
Dr. St. Laurent utilizes all aspects of research to address the root causes of concussions beginning with the brain prior to a concussion or the immediate neurometabolic cascade.
If you or someone you love sustains a concussion come in IMMEDIATELY!
Recovery of cognitive and dynamic motor function following concussion
Dynamic motor tasks, such as walking under varying conditions of attention, are complex, demanding undertakings, which require a longer recovery time following a concussion than cognitive measures. Little statistical relationship was found between the neuropsychological and gait variables, and the recovery curves of neuropsychological and gait domains were observed to be independent.
In order to fully examine the effects of concussion and determine the optimal time for a safe return to activity, a multi-factorial approach, including both cognitive and motor tasks, should be employed.
Cerebral Concussion in Athletes: Evaluation and Neuropsychological Testing
Neuropsychological testing seems to be an effective way to obtain useful data on the short-term and long-term effects of mild traumatic brain injury. Moreover, knowledge of the various definitions and management strategies, as well as the utility of neuropsychological testing, is essential for those involved in decision-making with athletes with mild traumatic brain injuries.
Update on pharmaceutical intervention for disorders of consciousness and agitation after traumatic brain injury in children.
Suskauer SJ, Trovato MK.
Responsiveness and agitation are common targets for pharmaceutical intervention after traumatic brain injury (TBI) in children. This focused review presents a critical discussion of the limited literature available on the use of medications for disorders of consciousness and agitation in children with TBI. For disorders of consciousness, evidence from several small studies supports a potential benefit of dopaminergic agents for improving responsiveness in some children with lower levels of function after TBI. Larger studies, likely requiring multicenter collaborations, are needed to more definitively address questions regarding the use of medications for responsiveness in children with TBI. The literature regarding use of pharmaceutical agents for agitation in children with TBI is even more limited. The dearth of literature regarding the effects of medications used for agitation in children with TBI highlights the need for additional basic and clinical science contributions in this area.
Head Injury in Athletes
Recent research has better defined the epidemiological issues related to sports injuries involving the central nervous system and has also led to classification and management paradigms that help guide decisions regarding athletes' return to play. We currently have methods at our disposal that greatly assist us in managing this group of patients, including improved recognition of the clinical syndromes of MTBI, new testing such as neuropsychological assessment, radiographic evaluations, and a greater appreciation of the pathophysiology of concussive brain injury. The potential for long-term consequences of repetitive MTBI has been recognized, and we no longer consider the dinged states of athletic concussions to have the benign connotations they had in the past. We review the historical developments in the recognition and care of athletes with head injuries, the current theory of the pathophysiology and biomechanics of these insults, and the recommended management strategy, including return-to-play criteria.
Postural Stability and Neuropsychological Deficits After Concussion in Collegiate Athletes
Athletes with cerebral concussion demonstrated acute balance deficits, which are likely the result of not using information from the vestibular and visual systems effectively. Neurocognitive deficits are more difficult to identify in the acute stages of concussion, although concentration, working memory, immediate memory recall, and rapid visual processing appear to be mildly affected. More research is necessary to determine the best neuropsychological test battery for assessing sport-related concussion.
Cognitive behavioural therapy and persistent post-concussional symptoms: Integrating conceptual issues and practical aspects in treatment.
This paper seeks to integrate research findings in mild traumatic brain injury (MTBI) around three central themes relevant to psychological therapies for persistent post-concussional symptoms (PCS). These are (1) the relative lack of symptom specificity, (2) the extent to which subjective (but not necessarily objective) cognitive difficulties predominate, and (3) the role of psychological (especially cognitive-behavioural) processes in the evolution and maintenance of symptoms. Evidence-based models guiding cognitive-behavioural therapy (CBT) for similar symptoms in other clinical groups are considered in relation to persistent PCS, as well as some of the practical considerations in applying CBT with this client group. Outstanding research issues are identified and discussed, including the opportunities and risks of combining CBT and cognitive rehabilitation approaches.
Cumulative effects of concussion in amateur athletes.
There were differences between groups in symptom reporting and memory performance. At baseline (i.e. preseason), athletes with multiple concussions reported more symptoms than athletes with no history of concussion. At approximately 2 days post-injury, athletes with multiple concussions scored significantly lower on memory testing than athletes with a single concussion. Athletes with multiple concussions were 7.7 times more likely to demonstrate a major drop in memory perfomance than athletes with no previous concussions. This study provides preliminary evidence to suggest that athletes with multiple concussions might have cumulative effects.
Concussions Among United States High School and Collegiate Athletes
Sport-related injury surveillance systems can provide scientific data to drive targeted injury-prevention projects. Developing effective sport-related concussion preventive measures depends upon increasing our knowledge of concussion rates, patterns, and risk factors.
Neurocognitive Performance of Concussed Athletes When Symptom Free
Neurocognitive decrements may persist when athletes no longer report concussion-related symptoms. The exclusive use of symptom reports in making a return-to-play decision is not advised. A multifaceted approach to concussion assessment that includes evaluation of a myriad of functions is warranted.
Posttraumatic Retrograde and Anterograde Amnesia: Pathophysiology and Implications in Grading and Safe Return to Play
Initial and follow-up assessments of PTA, anterograde and retrograde, are an essential part of the neurologic evaluation of the head-injured athlete. Increasingly, neuropsychological testing, including computer models, is being employed in this assessment. The importance of not just PTA but all postconcussion signs and symptoms being absent at rest and exertion before allowing the athlete to return to play is emphasized.
Considerations for Return-to-Play and Retirement
Decisions After Concussion
Although many return-to-play and retirement decisions are based on a culmination of factors specific to each individual patient (Table 1), some conditions and situations contraindicate returning to play or any type of participation, especially in collision sports (Table 2). These situations include the following: persistent postconcussion symptoms (including chronic headache), symptomatic neurologic or pain-producing abnormalities about the foramen magnum, permanent central neurologic sequelae from a head injury, hydrocephalus, and spontaneous subarachnoid hemorrhage from any cause. Persons experiencing increasingly more prolonged postconcussion symptoms from increasingly minor head impacts are the athletes for whom return to a collision sport is contraindicated. Furthermore, as indicated in this article, a variety of conditions, outcomes, and factors must be considered during each return-to-play or retirement decision.
Relationship Between Concussion and Neuropsychological Performance in College Football Players
Our study suggests that neuropsychological assessment is a useful indicator of cognitive functioning in athletes and that both history of multiple concussions and LD are associated with reduced cognitive performance. These variables may be detrimentally synergistic and should receive further study.
Neuropsychological Test Performance Prior To and Following Sports-Related Mild Traumatic Brain Injury
Neuropsychological tests are useful in the detection of cognitive impairment following mTBI. The test data appear to be more effective than subjective report of symptoms in differentiating between injured and non-injured athletes at 48 hours post-injury. Although significant individual variability existed, most injured athletes recovered within 1 week of injury. A battery of tests, rather than any single test, is necessary to capture the variability that exists among injured athletes.
Differential Rate of Recovery in Athletes After First and Second Concussion Episodes
The findings of this study confirm our previous research indicating the presence of long-term residual visual-motor disintegration in concussed individuals with normal neuropsychological measures. Most importantly, athletes with a history of previous concussion demonstrate significantly slower rates of recovery of neurological functions after the second episode of MTBI.
Posttraumatic migraine characteristics in athletes following sports-related concussion
The differences among these groups can be used as a basis to argue that PTM characteristics triggered by sports-related concussion are related to increased neurocognitive dysfunction following mild traumatic brain injury. Thus, athletes suffering a concussion accompanied by PTM should be examined in a setting that includes symptom status and neurocognitive testing to address their recovery more fully. Given the increased impairments observed in the PTM group, in this population clinicians should exercise increased caution in decisions about treatment and when the athlete should be allowed to return to play.
Post-Traumatic Migraine: Chronic Migraine Precipitated by Minor Head or Neck Trauma
Minor trauma to the head or neck is occasionally followed by severe chronic headaches. We have evaluated 35 adults (27 women, 8 men) with no prior history of headaches, who developed recurrent episodic attacks typical of common or classic migraine following minor head or neck injuries (“posttraumatic migraine” - PTM). The median age of these patients was 38 years (range 17 to 63 years), which is older than the usual age at onset of idiopathic migraine. The trauma was relatively minor: 14 patients experienced head trauma with brief loss of consciousness, 14 patients sustained head trauma without loss of consciousness, and 7 patients had a “whiplash” neck injury with no documented head trauma. Headaches began immediately or within the first few days after the injury. PTM typically recurred several times per week and was often incapacitating. The patients had been unsuccessfully treated by other physicians, and there was a median delay of 4 months (range I to 30 months) before the diagnosis of PTM was suspected. The response to prophylactic anti-migraine medication (propranolol or amitriptyline used alone or in combination) was gratifying, with 21 of 30 adequately treated patients (70%) reporting dramatic reduction in the frequency and severity of their headaches. Improvement was noted in 18 of the 23 patients (78%) who were still involved in litigation at the time of treatment. The neurologic literature has placed excessive emphasis on compensation neurosis and psychological factors in the etiology of chronic headaches after minor trauma. Physicians must be aware of PTM, as it is both common and treatable.