http://informahealthcare.com/bij ISSN: 0269-9052 (print), 1362-301X (electronic) Brain Inj, 2015; 29(2): 127–128 ! 2015 Informa UK Ltd. DOI: 10.3109/02699052.2014.977350
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Brain Injury special edition on Sports concussion
In 1982, the Wall Street Journal coined the term ‘silent epidemic’ in a front page article based upon research findings on minor head injury or what is now refered to as mild traumatic brain injury (mTBI) or concussion [1]. Seven years later, the first large scale study using a baseline and serial post-concussion neurocognitive assessment model in college football was published [2], opening the floodgates for sports concussion research and marking the genesis of the field of Sports Neuropsychology. Judging from the popular press headlines, media broadcasts, high-profile law suits, investments in research and development efforts and government action, sports concussion has become one of the signature public health issues of the time. Professional sports garner the most attention in the public discourse on concussion, but sports participation is a part of the fabric of child development, education and health and the threat of neurologic injury in youth and the potential long-term sequelae has generated a level of concern that has mobilized the general public to join the debate and seek answers. Identifying ground truth in the evaluation of the consequences of concussion and sub-concussive impacts is very difficult given the individual nature of risk and outcome. This special edition of Brain Injury brings together many of the leading scientists and clinical experts in the field of concussion assessment and management/treatment in an effort to provide the latest understanding of the issues surrounding this complex problem. Setting the stage is the history of the neuropsychological study of sports concussion authored by Webbe and Zimmer, which reviews the early research and begins the discussion of the return-to-play algorithms and controversies. The article by MacFarlane and Glenn documents the great progress that has been made using acceleration–deceleration and fluid percussion injury animal models to study the neurochemical cascade of the spectrum of TBI and concussion. This work has given an appreciation for potential biomarkers as indicators of concussion occurrence and may provide insights into the future of concussion management to speed recovery and reduce the potential for persistent symptoms. Riley et al. report on the important work of the Boston group and their findings of the hallmark tauopathy of Chronic Traumatic Encephalopathy (CTE) on post-mortem examination of retired athletes who have demonstrated dementia and severe emotional deteriorization. The origins of CTE and the controversies surrounding its more recent revival in the professional football arena are presented by Solomon and
Zuckerman, who also offer the reader several caveats and healthy skepticism regarding the still preliminary findings in this headline producing area of study. Identifiable concussion may not be the single cause of CTE or chronic traumatic brain injury (CTBI) and Erlanger’s article addresses the utility of multiple sub-concussive exposure models in sport-specific long-term outcome. Following the early neuropsychological assessment research, vestibular and balance evaluations of sports concussions gained traction with Guskiewicz et al.’s [3,4] postural stability studies. Valovich McLeod and Hale report on this literature and the issues surrounding vestibular assessment and intervention models with concussion. Many concussion severity classification systems, return-to-play guidelines and clinical management systems have been developed over the years and Echemendia et al. report on the findings of the four international consensus conferences on concussion in sports and the two American Academy of Neurology evidence-based practice parameter position papers on sports concussion. Gioia’s research and clinical experience with paediatric sports concussion has been largely responsible for state legislation mandating concussion education and management systems in the public schools from K through 12 years. In his article, Gioia focuses on a description of a multi-modal, developmentally adapted, standardized evaluation and management system for children with sports concussion. Special issue contributions by Zasler and Jaffee present upto-date literature reviews and practical headache and sleep assessment and treatment guidelines for concussion, while Broshek et al. provide insights on the need for understanding, assessing and treating psychological factors, such as premorbid and current anxiety disorders, associated with concussion outcome in order to prevent or shorten postconcussion syndrome. Leddy et al. approach post-concussion disorder assessment and management from a pathophysiological perspective involving brain metabolism and vestibular-ocular and cervicogenic dysfunction, with the purpose of identifying and initiating evidence-based, targeted, multidisciplinary therapeutic intervention with these neurological sub-systems. In the absence of evidence-based guidelines, Condor and Condor review the available literature and draw on their clinical experience to posit a conservative approach to treatment of neuropsychological, physical, vestibular and oculomotor symptoms in refractory sports-related concussion.
128
Forward
Iverson and Schatz tackle advanced topics in neuropsychological assessment following sports-related concussion. Although neuropsychological assessment of sports concussion has a strong empirical foundation, questions remain regarding the use of traditional vs computerized tests, the value of baseline testing, effort on baseline testing, when to assess following injury, reliability of tests and reliable change methodology for interpreting test data for return-to-play decisions. Finally, McCrea et al. highlight some of the gaps in the existing sports-related concussion research. They frame the discussion of future research opportunities around two key questions that have major clinical and translational significance with regard to protecting the health and safety of athletes, including: (1) Who is at risk for slow or poor outcome from sports-related concussion? and (2) How does one modify these risks for slow or poor outcome? It can be argued that sports-related concussion is the most media intense and, therefore, most discussed neuroscience issue of this decade, culminating in President Obama’s Healthy Kids and Safe Sports Concussion Summit at the White House in April 2014. Sports concussions are likely to become an even greater part of the public health dialogue as more clinical cases are published in the popular press and
Brain Inj, 2015; 29(2): 127–128
opinions presented on social media. Balancing concussion safety with the importance of encouraging physical activity and participation in sports for overall health will continue to be an important topic of discussion. It is hoped that the 15 articles in this special edition will provide a foundation and reference point for the state of the science and clinical practice in sports-related concussion. Jeffrey T. Barth & Donna K. Broshek University of Virginia School of Medicine
References 1. Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury. Neurosurgery 1981;9:221–228. 2. Barth JT, Alves WM, Ryan T, Macciocchi SN, Rimel RW, Jane JA, Nelson WE. Mild head injury in sports: Neuropsychological sequelae and recovery of function. In: Levin HS, Eisenberg HM, Benton AL, editors. Mild head injury. New York: Oxford University Press; 1989. pp 257–275. 3. Guskiewicz KM, Perrin DH, Gansneder BM. Effect of mild head injury on postural stability in athletes. Journal of Athletic Training 1996;31:300–306. 4. Guskiewicz KM, Ross SE, Marshall SW. Postural stability and neuropsychological deficits after concussion in college athletes. Journal of Athletic Training 2001;36:263–273.
Copyright of Brain Injury is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
FORWARD
Brain Injury special edition on Sports concussion
In 1982, the Wall Street Journal coined the term ‘silent epidemic’ in a front page article based upon research findings on minor head injury or what is now refered to as mild traumatic brain injury (mTBI) or concussion [1]. Seven years later, the first large scale study using a baseline and serial post-concussion neurocognitive assessment model in college football was published [2], opening the floodgates for sports concussion research and marking the genesis of the field of Sports Neuropsychology. Judging from the popular press headlines, media broadcasts, high-profile law suits, investments in research and development efforts and government action, sports concussion has become one of the signature public health issues of the time. Professional sports garner the most attention in the public discourse on concussion, but sports participation is a part of the fabric of child development, education and health and the threat of neurologic injury in youth and the potential long-term sequelae has generated a level of concern that has mobilized the general public to join the debate and seek answers. Identifying ground truth in the evaluation of the consequences of concussion and sub-concussive impacts is very difficult given the individual nature of risk and outcome. This special edition of Brain Injury brings together many of the leading scientists and clinical experts in the field of concussion assessment and management/treatment in an effort to provide the latest understanding of the issues surrounding this complex problem. Setting the stage is the history of the neuropsychological study of sports concussion authored by Webbe and Zimmer, which reviews the early research and begins the discussion of the return-to-play algorithms and controversies. The article by MacFarlane and Glenn documents the great progress that has been made using acceleration–deceleration and fluid percussion injury animal models to study the neurochemical cascade of the spectrum of TBI and concussion. This work has given an appreciation for potential biomarkers as indicators of concussion occurrence and may provide insights into the future of concussion management to speed recovery and reduce the potential for persistent symptoms. Riley et al. report on the important work of the Boston group and their findings of the hallmark tauopathy of Chronic Traumatic Encephalopathy (CTE) on post-mortem examination of retired athletes who have demonstrated dementia and severe emotional deteriorization. The origins of CTE and the controversies surrounding its more recent revival in the professional football arena are presented by Solomon and
Zuckerman, who also offer the reader several caveats and healthy skepticism regarding the still preliminary findings in this headline producing area of study. Identifiable concussion may not be the single cause of CTE or chronic traumatic brain injury (CTBI) and Erlanger’s article addresses the utility of multiple sub-concussive exposure models in sport-specific long-term outcome. Following the early neuropsychological assessment research, vestibular and balance evaluations of sports concussions gained traction with Guskiewicz et al.’s [3,4] postural stability studies. Valovich McLeod and Hale report on this literature and the issues surrounding vestibular assessment and intervention models with concussion. Many concussion severity classification systems, return-to-play guidelines and clinical management systems have been developed over the years and Echemendia et al. report on the findings of the four international consensus conferences on concussion in sports and the two American Academy of Neurology evidence-based practice parameter position papers on sports concussion. Gioia’s research and clinical experience with paediatric sports concussion has been largely responsible for state legislation mandating concussion education and management systems in the public schools from K through 12 years. In his article, Gioia focuses on a description of a multi-modal, developmentally adapted, standardized evaluation and management system for children with sports concussion. Special issue contributions by Zasler and Jaffee present upto-date literature reviews and practical headache and sleep assessment and treatment guidelines for concussion, while Broshek et al. provide insights on the need for understanding, assessing and treating psychological factors, such as premorbid and current anxiety disorders, associated with concussion outcome in order to prevent or shorten postconcussion syndrome. Leddy et al. approach post-concussion disorder assessment and management from a pathophysiological perspective involving brain metabolism and vestibular-ocular and cervicogenic dysfunction, with the purpose of identifying and initiating evidence-based, targeted, multidisciplinary therapeutic intervention with these neurological sub-systems. In the absence of evidence-based guidelines, Condor and Condor review the available literature and draw on their clinical experience to posit a conservative approach to treatment of neuropsychological, physical, vestibular and oculomotor symptoms in refractory sports-related concussion.
128
Forward
Iverson and Schatz tackle advanced topics in neuropsychological assessment following sports-related concussion. Although neuropsychological assessment of sports concussion has a strong empirical foundation, questions remain regarding the use of traditional vs computerized tests, the value of baseline testing, effort on baseline testing, when to assess following injury, reliability of tests and reliable change methodology for interpreting test data for return-to-play decisions. Finally, McCrea et al. highlight some of the gaps in the existing sports-related concussion research. They frame the discussion of future research opportunities around two key questions that have major clinical and translational significance with regard to protecting the health and safety of athletes, including: (1) Who is at risk for slow or poor outcome from sports-related concussion? and (2) How does one modify these risks for slow or poor outcome? It can be argued that sports-related concussion is the most media intense and, therefore, most discussed neuroscience issue of this decade, culminating in President Obama’s Healthy Kids and Safe Sports Concussion Summit at the White House in April 2014. Sports concussions are likely to become an even greater part of the public health dialogue as more clinical cases are published in the popular press and
Brain Inj, 2015; 29(2): 127–128
opinions presented on social media. Balancing concussion safety with the importance of encouraging physical activity and participation in sports for overall health will continue to be an important topic of discussion. It is hoped that the 15 articles in this special edition will provide a foundation and reference point for the state of the science and clinical practice in sports-related concussion. Jeffrey T. Barth & Donna K. Broshek University of Virginia School of Medicine
References 1. Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury. Neurosurgery 1981;9:221–228. 2. Barth JT, Alves WM, Ryan T, Macciocchi SN, Rimel RW, Jane JA, Nelson WE. Mild head injury in sports: Neuropsychological sequelae and recovery of function. In: Levin HS, Eisenberg HM, Benton AL, editors. Mild head injury. New York: Oxford University Press; 1989. pp 257–275. 3. Guskiewicz KM, Perrin DH, Gansneder BM. Effect of mild head injury on postural stability in athletes. Journal of Athletic Training 1996;31:300–306. 4. Guskiewicz KM, Ross SE, Marshall SW. Postural stability and neuropsychological deficits after concussion in college athletes. Journal of Athletic Training 2001;36:263–273.
Copyright of Brain Injury is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
