The neurocognitive correlates of DTI indicators of white matter disorganization in pediatric moderate-to-severe traumatic brain injury.

Introduction: Neuroimaging has expanded our understanding of pediatric brain disorders in which white matter organization and connectivity are crucial to functioning. Paralleling the known pathobiology of many neurodevelopmental disorders, traumatic brain injury (TBI) in childhood can alter trajectories of brain development. Specifically, diffusion tensor imaging (DTI) studies in TBI have demonstrated white matter (WM) abnormalities that suggest microstructural disruptions that may underlie atypical neurodevelopment.

Psychological Constructs From the Fear Avoidance Model and Beyond as Predictors for Persisting Symptoms After Concussion: An Integrative Review.

Objectives: To identify the range of evidence for relationships between psychological factors using the Fear Avoidance Model (FAM) as a guiding framework and relevant clinical outcomes in adult patients with persisting symptoms after concussion (PSaC), develop a comprehensive understanding of psychological factors that have been identified as predictors of clinical outcomes for PSaC, and contribute to the theoretical framework of the FAM for PSaC.

Data Sources: Six databases (CINAHL, Embase, PsycINFO, PubMed, SportDiscus, and Web of Science) were searched by a librarian for empirical and theoretical publications and experimental and quasi-experimental study designs. The literature search was not limited by publication date restrictions.

CARE4Kids Study: Endophenotypes of Persistent Post-Concussive Symptoms in Adolescents: Study Rationale and Protocol.

Treatment of youth concussion during the acute phase continues to evolve, and this has led to the emergence of guidelines to direct care. While symptoms after concussion typically resolve in 14-28 days, a portion (∼20%) of adolescents endorse persistent post-concussive symptoms (PPCS) beyond normal resolution. This report outlines a study implemented in response to the National Institute of Neurological Diseases and Stroke call for the development and initial clinical validation of objective biological measures to predict risk of PPCS in adolescents.

PROTOCOL: Fear avoidance model psychological factors as predictors for persistent post-concussion clinical outcomes: An integrative review.

Background: Persisting symptoms after concussion (PSaC) include physical, cognitive, and psychological symptoms which contribute to rehabilitation challenges. Previous research has not thoroughly investigated the association between PSaC and pain-related psychological factors. Therefore, there is an opportunity to use current pain models, such as the Fear Avoidance Model (FAM), as a framework to explore these relationships.

Frontoamygdala hyperconnectivity predicts affective dysregulation in adolescent moderate-severe TBI.

In survivors of moderate to severe traumatic brain injury (msTBI), affective disruptions often remain underdetected and undertreated, in part due to poor understanding of the underlying neural mechanisms. We hypothesized that limbic circuits are integral to affective dysregulation in msTBI. To test this, we studied 19 adolescents with msTBI 17 months post-injury (TBI: M age 15.

The Effect of Aerobic Exercise on Concussion Recovery: A Pilot Clinical Trial.

Objective: The purpose of this study was to pilot safety and tolerability of a 1-week aerobic exercise program during the post-acute phase of concussion (14-25 days post-injury) by examining adherence, symptom response, and key functional outcomes (e.g., cognition, mood, sleep, postural stability, and neurocognitive performance) in young adults.

Cardiorespiratory Functioning in Youth with Persistent Post-Concussion Symptoms: A Pilot Study.

Dysregulation of the autonomic nervous system (ANS) may play an important role in the development and maintenance of persistent post-concussive symptoms (PPCS). Post-injury breathing dysfunction, which is influenced by the ANS, has not been well-studied in youth. This study evaluated cardiorespiratory functioning at baseline in youth patients with PPCS and examined the relationship of cardiorespiratory variables with neurobehavioral outcomes.

Addition of Occupational Therapy to an Interdisciplinary Concussion Clinic Improves Identification of Functional Impairments.

Background: Concussions, or mild traumatic brain injuries, are prevalent among youth and young adults. These injuries may disrupt a person's daily activities (occupations) including school, physical activity, work, and socialization. Rehabilitation professionals, such as occupational therapists (OTs), are experts in providing individualized intervention to address these temporary life changes during recovery.

The Future of Concussion.

Over the past 2 decades, concussion care is increasingly in demand as research and media attention shed light on the importance of proper diagnosis and medical management to prevent complex, potentially disabling sequelae. The purpose of this review is to discuss the future of clinical concussion care across selected topics under the broad themes of diagnosis/assessment, intervention/treatment, and patient characteristics/presentations with the intent to direct clinicians' attention to important anticipated developments in the field. The current status of biomarkers, clinical settings, models of clinical concussion, return-to-activity, clinical subpopulations, treatment approaches, patient perceptions of injury, and social media are reviewed along with predictions for future developments.

Immediate Removal From Activity After Sport-Related Concussion Is Associated With Shorter Clinical Recovery and Less Severe Symptoms in Collegiate Student-Athletes.

Background: Timely removal from activity after concussion symptoms remains problematic despite heightened awareness. Previous studies indicated potential adverse effects of continuing to participate in physical activity immediately after sustaining a concussion. Hypothesis/Purpose: The purpose was to determine the effect of timing of removal from play after concussion on clinical outcomes.

Concussion-Like Symptom Reporting in Non-Concussed Collegiate Athletes.

Objective: Non-concussed individuals may report a variety of concussion-like symptoms even in the absence of a diagnosed brain injury. Previous studies described concussion-like symptom reporting in adolescent athletes. This study provides complementary data on concussion-like symptoms in collegiate athletes.

Baseline Neurocognitive Performance and Clearance for Athletes to Return to Contact.

Context:  Computerized neurocognitive assessments are commonly used to manage sport-related concussion. Variations in baseline performance may influence neurocognitive performance after injury as well as the amount of time needed for an athlete to be cleared for return to sport participation.

Objective:  To investigate the relationship between mean baseline Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) scores and postconcussion reliable decline as well as the association between postconcussion cognitive decline and days missed after injury.

Concussion-like symptom reporting in non-concussed adolescent athletes.

Objective: The primary goals of this study were (1) to report rates of concussion-like symptoms in healthy adolescent student athletes assessed using the Sport Concussion Assessment Tool, 3rd edition (SCAT3) at baseline, (2) to examine rates of psychiatric diagnoses in this population, and (3) to evaluate effects of baseline symptoms on SCAT3 cognitive and balance performance.

Methods: 349 adolescent student athletes (245 male) were administered the SCAT3 during pre-participation physical examinations. We described the prevalence rate of student athletes meeting criteria for International Classification of Diseases, 10th revision, post-concussional syndrome (ICD-10 PCS) diagnosis at baseline, and evaluated associations between symptom reporting and demographic/medical history factors using chi-square tests.

Factors Influencing Clinical Correlates of Chronic Traumatic Encephalopathy (CTE): a Review.

Chronic traumatic encephalopathy (CTE) is a neuropathologically defined disease reportedly linked to a history of repetitive brain trauma. As such, retired collision sport athletes are likely at heightened risk for developing CTE. Researchers have described distinct pathological features of CTE as well a wide range of clinical symptom presentations, recently termed traumatic encephalopathy syndrome (TES).

"Playing Through It": Delayed Reporting and Removal From Athletic Activity After Concussion Predicts Prolonged Recovery.

Context: Preclinical research has demonstrated a window of vulnerability in the immediate aftermath of concussion wherein continued activity and stimulation can impair or prolong neurobehavioral recovery. However, this concept has not been quantified in a human population.

Objective: To examine the effect of delayed reporting and removal from athletic activity after concussion on recovery time.

A normative study of the sport concussion assessment tool (SCAT2) in children and adolescents.

Recent clinical practice parameters encourage systematic use of concussion surveillance/management tools that evaluate participating athletes at baseline and after concussion. Office-based tools (Sports Concussion Assessment Tool; SCAT2) require accurate baseline assessment to maximize utility but no normative data exist for children on the SCAT2, limiting identification of "normal" or "impaired" score ranges. The purpose of this study was to develop child and adolescent baseline norms for the SCAT2 to provide reference values for different age groups.