In the structure of wounds on the Russian-Ukrainian war, traumatic brain injury takes 33 percent. And more than 80 percent is a mild TBI. Open clinical trial was provided by a multidisciplinary team in the National Military Medical Center (the Main military clinical hospital), Kyiv,Ukraine, under the leadership of the Military Medical Academy of Ukraine. 286 veterans, male, age 27,38±9,67 y.o with history of mTBI were observed for post-concussion syndrome. Causes of concussion were: isolated blast injury-69,3%, combine blast + shrapnel injury- 18,5% , car accidences - 6,1%, falls-7,1%/ Spectrum of PCS symptoms included all manifestations – as a physical , as mental heals problems, but dynamic in time of manifestations show the decreasing of physical signs and increasing of intensity of mental symptoms. Many patients with post-concussion syndrome also have symptoms of PTSD. In the studied group near the 40% of patients have PCL-m score more than 50.Our study shown that post-concussion syndrome, as a result of traumatic brain morphological and functional changes, powered with combat psycho trauma, lead to functional disorders: physical, emotional and cognitive.
In the structure of wounds on the Russian-Ukrainian war, traumatic brain injury takes 33 percent. And more than 80 percent is a mild TBI. Open clinical trial was provided by a multidisciplinary team in the National Military Medical Center (the Main military clinical hospital), Kyiv,Ukraine, under the leadership of the Military Medical Academy of Ukraine. 286 veterans, male, age 27,38±9,67 y.o with history of mTBI were observed for post-concussion syndrome. Causes of concussion were: isolated blast injury-69,3%, combine blast + shrapnel injury- 18,5% , car accidences - 6,1%, falls-7,1%/ Spectrum of PCS symptoms included all manifestations – as a physical , as mental heals problems, but dynamic in time of manifestations show the decreasing of physical signs and increasing of intensity of mental symptoms. Many patients with post-concussion syndrome also have symptoms of PTSD. In the studied group near the 40% of patients have PCL-m score more than 50.Our study shown that post-concussion syndrome, as a result of traumatic brain morphological and functional changes, powered with combat psycho trauma, lead to functional disorders: physical, emotional and cognitive.
Post-concussion symptoms; SCAT2; Head injury ; Síntomas posteriores a la conmoción cerebral; SCAT2; Lesión craneal ; Símptomes posteriors a la commoció cerebral; SCAT2; Lesió cranial ; Self-report measures, particularly symptom inventories, are critical tools for identifying patients with persistent post-concussion symptoms and their follow-up. Unlike in military or sports-related assessment, in general civilian settings pre-injury levels of concussion-like symptoms are lacking. Normative data are available in adolescent and college populations, but no reference data exist to guide clinical adult explorations. The purpose of this study was to use the second edition of the Sport Concussion Assessment Tool (SCAT2) to profile a cohort of 60 healthy community volunteers who had not sustained a head injury. Participating volunteers underwent MRI scanning and were evaluated with the Hospital Anxiety and Depression Scale (HADS). Participants reported a median of 3 concussion-like symptoms and the 97.5 percentile score was found at 10.5 symptoms, out of a total of 22. The median severity score was 4.9 points, and 28.9 was the upper limit of the reference interval. Only 10 participants (16.7%) did not endorse any symptom. The most frequently endorsed symptom was feeling difficulty in concentrating, with 41.7% of the sample reporting it. Age, sex and general distress, anxiety and depressive symptoms were not associated with concussion-like symptoms. Our data yielded elevated cut-offs scores for both the number of symptoms and the symptom severity. In conclusion, postconcussive-like symptoms are frequent in the general non-concussed adult population and it should be taken into account in any future models developed for screening patients at risk of developing physical, cognitive, and psychological complaints following mild traumatic injury. ; UNINN is supported by a Grant from the Generalitat de Catalunya (SGR 2014-844, http://agaur.gencat.cat). This work has been supported in part by the Fondo de Investigacion Sanitaria (Instituto de Salud Carlos III, https://portalfis.isciii.es) with grants FIS PI11/00700 (J.S.) and grant FIS PI13/02397 (M.A.P.), which were co-financed by the European Regional Development Fund (ERDF). A.R. was a recipient of a pre-doctoral grant from the Fundacio Institut de Recerca VHIR (PRED-VHIR-2012-26, http://en.vhir.org).
In: International review for the sociology of sport: irss ; a quarterly edited on behalf of the International Sociology of Sport Association (ISSA), Band 54, Heft 8, S. 1020-1024
Abstract A 25-year-old male military veteran presented with diagnoses of post concussion syndrome and post traumatic stress disorder three years after loss of consciousness from an explosion in combat. The patient underwent single photon emission computed tomography brain blood flow imaging before and after a block of thirty-nine 1.5 atmospheres absolute hyperbaric oxygen treatments. The patient experienced a permanent marked improvement in his post-concussive symptoms, physical exam findings, and brain blood flow. In addition, he experienced a complete resolution of post-traumatic stress disorder symptoms. After treatment he became and has remained employed for eight consecutive months. This case suggests a novel treatment for the combined diagnoses of blast-induced post-concussion syndrome and post-traumatic stress disorder.
Traumatic brain injury is a significant public health issue and represents the main contributor to death and disability globally among all trauma-related injuries. Martial arts practitioners, military veterans, athletes, victims of physical abuse, and epileptic patients could be affected by the consequences of repetitive mild head injuries (RMHI) that do not resume only to short-termed traumatic brain injuries (TBI) effects but also to more complex and time-extended outcomes, such as post-concussive syndrome (PCS) and chronic traumatic encephalopathy (CTE). These effects in later life are not yet well understood; however, recent studies suggested that even mild head injuries can lead to an elevated risk of later-life cognitive impairment and neurodegenerative disease. While most of the PCS hallmarks consist in immediate consequences and only in some conditions in long-termed processes undergoing neurodegeneration and impaired brain functions, the neuropathological hallmark of CTE is the deposition of p-tau immunoreactive pre-tangles and thread-like neurites at the depths of cerebral sulci and neurofibrillary tangles in the superficial layers I and II which are also one of the main hallmarks of neurodegeneration. Despite different CTE diagnostic criteria in clinical and research approaches, their specificity and sensitivity remain unclear and CTE could only be diagnosed post-mortem. In CTE, case risk factors include RMHI exposure due to profession (athletes, military personnel), history of trauma (abuse), or pathologies (epilepsy). Numerous studies aimed to identify imaging and fluid biomarkers that could assist diagnosis and probably lead to early intervention, despite their heterogeneous outcomes. Still, the true challenge remains the prediction of neurodegeneration risk following TBI, thus in PCS and CTE. Further studies in high-risk populations are required to establish specific, preferably non-invasive diagnostic biomarkers for CTE, considering the aim of preventive medicine.
Context: Concussions are a serious injury that could result in both short and long-term consequences, particularly if not recognized and managed appropriately. Concussion education has been implemented, mostly as a result of Concussion legislation. Coach and athlete concussion education has been evaluated in the literature, however the literature is scarce on parental concussion education. Purpose: To assess concussion knowledge and understanding in guardians of Georgia High School Association (GHSA) student-athletes that completed the GHSA concussion awareness form, in comparison to those that received additional concussion education. Methods: This study utilized a prospective cross-sectional descriptive research design. Participants were GHSA guardians (n=102) that were recruited during athletic events throughout the Fall 2016 athletic season. Participants completed a 34 item paper-based survey. The survey included demographic questions, concussion knowledge questions, and scenario questions to assess concussion understanding. Participants were divided into groups based upon level of concussion education they had received. Independent-t tests were calculated to evaluate differences in concussion knowledge, understanding, and overall score. A Pearson correlation examined the correlation between knowledge and understanding score. All statistical analyses were conducted using SPSS 23.0. Significance levels were set a priori at p < 0.05. Results: There was a response rate of 82%, with a sampling rate of 35%. Overall, the group that only completed the form had a mean knowledge score of 75% and mean understanding score of 82%, while the group that completed additional concussion education had a mean score of 79% for knowledge, and 84% for understanding. No statistically significant differences were found between groups on knowledge (t(100) =1.742, p=.085), understanding (t(100)=.833, p=.407), and total scores (t(100)=1.878, p=.063).The Pearson correlation revealed a non-significant weak correlation between concussion knowledge and understanding (r = .03; p = 0.76). Conclusions: Guardians of high school student-athletes displayed a moderate knowledge and understanding of concussion. Knowledge transfer techniques, such as the Knowledge to Action framework, as well as learning strategies that are geared towards adult learners may benefit this population. A multifaceted approach to concussion education should be utilized in order to most effectively reach every guardian in order to meet their educational needs. INDEX WORDS: Concussion, Education, Knowledge, Understanding, Guardians
Recent legislation in the state of Ohio now allows chiropractic physicians who possess certain credentials to both diagnose and clear young patients who have sustained concussions. Unfortunately, little if any existing research examines the knowledge and abilities of chiropractic physicians regarding the management of this condition. Therefore, the purpose of this study was to provide a general overview of chiropractic physicians' knowledge regarding the diagnosis and management of pediatric concussions. A survey was emailed to 1,344 chiropractors in the state of Ohio. Of those who were contacted, 71 completed the survey. The survey included questions regarding demographics, patient scenarios, and concussion management. Although 66.7% of chiropractors qualified to care for concussions reported the utilization of guidelines, the rate dropped to 35.2% when all respondents were included. There were statistically significant differences concerning familiarity with the Graded Symptom Checklist (p=0.001) and the Post-Concussion Symptom Scale (p=0.007). In addition, the results of a question regarding the implementation of graduated return-to-play protocols were found to be borderline significant (p=0.06).The results of the study indicated that chiropractors who possess the credentials required by law are more knowledgeable regarding concussion diagnosis and management than those who do not.
Includes bibliographical references. ; Spring ; Importance: Comprehensive nationwide evaluation of state traumatic brain injury (TBI) laws is vital given growing populations of high school athletes. Objective: To evaluate the effectiveness of state level TBI legislation by examining longitudinal trends in incident and recurrent concussion rates and to determine if variations in language used in TBI laws affected the observed trends. Design: A retrospective longitudinal ecological study of sports-related concussion data collected from 2005/06 through 2017/18. Setting: A large national sample of US high schools participating in the High School RIOTM Surveillance Study. Participants: High school athletes that sustained a sports-related concussion. Exposures: State-specific TBI law passage and specific language used in the laws. Main Outcomes and Measures: Incident and recurrent concussion rates. Results: Overall 16,670 concussions were studied (15,153 (90.9%) incident; 1,517 (9.1%) recurrent). Overall incident concussion rates increased by 1.85% per standardized month (STDM) (95%CI: 1.14%, 2.56%) prior to law passage and decreased by 1.08% per STDM (95%CI: -1.43%, -0.72%) after law passage. Overall recurrent concussion rates increased by 1.12% per STDM (95%CI: 0.00%, 2.26%) prior to law passage and decreased by 0.62% per STDM (95%CI: -1.40%, 0.16%) after law passage. Among states specifying the category of healthcare provider for return to play clearance, post-law recurrent concussion rates decreased by 2.01% per STDM (95%CI: -3.72%, -0.28%). Among states not specifying the category of healthcare provider, post-law recurrent concussion rates decreased by 0.46% per STDM (95%CI: -0.86%, -0.06%). Conclusions and Relevance: The passage of state-specific TBI laws was associated with an increase in overall incident and recurrent concussion rates prior to law passage and a decrease in rates after law passage. Compared to states with TBI laws not specifying the category of healthcare provider, states specifying the category of healthcare provider for return to play clearance had a greater rate of decline in post-law recurrent concussions rates. Results of this study indicate that states should specify the category of healthcare provider for return to play clearance in their respective TBI laws, if they haven't done so already.
Mounting research in the field of sports concussion biomarkers has led to a greater understanding of the effects of brain injury from sports. A recent systematic review of clinical studies examining biomarkers of brain injury following sports-related concussion established that almost all studies have been published either in or after the year 2000. In an effort to prevent CTE and long-term consequences of concussion, early diagnostic and prognostic tools are becoming increasingly important; particularly in sports and in military personnel, where concussions are common occurrences. Early and tailored management of athletes following a concussion with biomarkers could provide them with the best opportunity to avoid further injury. Should blood-based biomarkers for concussion be validated and become widely available, they could have many roles. For instance, a point-of-care test could be used on the field by trained sport medicine professionals to help detect a concussion. In the clinic or hospital setting, it could be used by clinicians to determine the severity of concussion and be used to screen players for neuroimaging (CT and/or MRI) and further neuropsychological testing. Furthermore, biomarkers could have a role in monitoring progression of injury and recovery and in managing patients at high risk of repeated injury by being incorporated into guidelines for return to duty, work or sports activities. There may even be a role for biomarkers as surrogate measures of efficacy in the assessment of new treatments and therapies for concussion.
