Chronic Traumatic Encephalopathy (CTE) has been linked to contact sports, most notably boxing and American football, due to their propensity for repetitive head impacts. Concerns in the community for the safety of athletes in all contact sports has driven a significant amount of research into concussions, their long term effects, and strategies for treatment and prevention. Knowledge of long term brain health in response to neurotrauma is limited, a gap especially noticeable in the literature on non-catastrophic brain injuries sustained as a child. Concussion is a common injury that is often self-resolving with no lasting neurologic or cognitive deficits. Although repetitive brain trauma is hypothesized to be necessary and sufficient to lead to CTE, no human or animal models have definitively demonstrated the pathophysiologic connection or confirmed the mechanism of symptoms. The research to date has been case based, lacking prospective cohorts, with data complicated by convenience sampling. These factors limit the generalizability of conclusions. CTE is neuropathologically defined with variable symptoms; however, it is only diagnosable at postmortem autopsy making the etiology and prevalence difficult to understand. As more research is published to understand if there is an association between a neurocognitive degenerative disease and contact sports, the concentration is on professional athletes. Yet professional athletes do not represent the overwhelming majority of all contact sport participants. The proposed study will compare adults who participated in youth football, but not beyond the high school level, to a control group of adults who did not play contact sports. Evaluating their cognitive function with an online assessment, the Behavior Rating Inventory of Executive Function – Adult Version (BRIEF-A), data will be analyzed for signs of clinical cognitive impairment. The objective is to measure adults who represent the high percentage of youth football players who do not continue to the advanced levels. Data obtained from this study will help communities make informed decisions, and create the foundation for future studies on long term benefits and risks of contact sports for children.

sustained multiple concussions may be at risk of cumulative impairment. The role of neuropsychological testing in the management of sports-related concussion is a contentious and challenging issue which has gained credibility given the lack of clear and well-established guidelines pertaining to the diagnosis, assessment and return-to-play decisions following concussion. Despite various traditional paper and pencil tests being shown to be effective indicators of postconcussive neuropsychological dysfunction, testing has not been widely implemented, due to time- and labour-demands. ImPACT, a computer-based neuropsychological assessment instrument, has been recognised as a valid and reliable tool in the monitoring of athletes' symptoms and neurocognitive functioning preseason and postconcussion. As a part of larger-scale concussion research conducted on top-team university rugby players, this is an in-depth case study conducted on a 20-year old participant with a history of multiple concussions, who was referred following a concussion sustained during the season. The objectives of the study were: (i) to determine the sensitivity of ImPACT versus WAIS-III Digit Span and Trail Making Test during the acute postconcussive phase; and (ii) to examine the sensitivity of ImPACT versus a comprehensive battery of neuropsychological tests to possible residual deficits as a result of the multiple concussions. ImPACT was determined to be more sensitive to acute postconcussive impairment following concussion than Digit Span and Trail Making Test. Furthermore, the ImPACT preseason baseline scores appear to be sensitive to neurocognitive dysfunction, possibly due to cumulative concussive injuries.

abstract: Traumatic brain injury (TBI) most frequently occurs in pediatric patients and remains a leading cause of childhood death and disability. Mild TBI (mTBI) accounts for 70-90% of all TBI cases, yet its neuropathophysiology is still poorly understood. While a single mTBI injury can lead to persistent deficits, repeat injuries increase the severity and duration of both acute symptoms and long term deficits. In this study, to model pediatric repetitive mTBI (rmTBI) we subjected unrestrained juvenile animals (post-natal day 20) to repeat weight drop impact. Animals were anesthetized and subjected to sham or rmTBI once per day for 5 days. At 14 days post injury (PID), magnetic resonance imaging (MRI) revealed that rmTBI animals displayed marked cortical atrophy and ventriculomegaly. Specifically, the thickness of the cortex was reduced up to 46% beneath and the ventricles increased up to 970% beneath the impact zone. Immunostaining with the neuron specific marker NeuN revealed an overall loss of neurons within the motor cortex but no change in neuronal density. Examination of intrinsic and synaptic properties of layer II/III pyramidal neurons revealed no significant difference between sham and rmTBI animals at rest or under convulsant challenge with the potassium channel blocker, 4-Aminophyridine. Overall, our findings indicate that the neuropathological changes reported after pediatric rmTBI can be effectively modeled by repeat weight drop in juvenile animals. Developing a better understanding of how rmTBI alters the pediatric brain may help improve patient care and direct "return to game" decision making in adolescents. / Dissertation/Thesis / Masters Thesis Biology 2014

Neuropsychological testing is recognised as one of the cornerstones of concussion evaluation, contributing significantly to both an understanding of the injury as well as management of the recovery process. Despite the high incidence of concussion at school level, traditional paper-and-pencil neuropsychological testing has generally been absent from school concussion management programmes, largely due to time and cost constraints. Now, the recent development of computerised neuropsychological testing is providing the opportunity for including neurocognitive assessment in this process. The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a valid and reliable instrument of this type and normed on 13 - 18 year old North American high school athletes, as well as adult groups. The current recommendation is that athletes are baselined preseason in order to provide an individualised comparative level against which to monitor recovery and provide return-to-play recommendations. This in itself is quite a cumbersome process, thus the present study set out to ascertain whether baseline testing of all athletes is necessary, or whether the use of US or SA normative data alone would provide an appropriate standard against which to interpret the postinjury scores. From a leading South African rugby playing school, the 1st and 2nd rugby teams, (16 - 18 years) were baselined using ImPACT. Three athletes, who were subsequently referred with concussion during the rugby season, were followed up with serial testing on ImPACT. An analysis of the follow up scores was conducted to chart the athletes' recovery process, in relation to the athletes own baseline scores (using US and SA reliable change indices) and age appropriate US and SA normative ranges. The relative utility of individual baselines scores versus these normative ranges was then critically evaluated. It was concluded that a combination of both baseline and normative data provided optimal management of the athlete, with the methods complementing each other in the interpretation of post-injury results. Overall, the SA normative ranges seemed to provide slightly better management guidelines than the US normative ranges when used with this sample of South African high school athletes.

La probité relative aux devoirs envers autrui et aux devoirs de la vie civile, a pour synonyme le mot «intégrité» auquel s'attache l'idée particulière d'une pureté qui ne se laisse entamer ni corrompre. En ce qui concerne les atteintes à la probité, il convient d’appréhender la probité comme un devoir dont le manquement est pénalement sanctionné. En effet, le droit pénal français punit les manquements au devoir de probité qui sont généralement le fait de personnes exerçant des fonctions publiques. Ces incriminations se distinguent les unes des autres par leurs éléments constitutifs, leurs modalités d’accomplissement ou leurs finalités. Les atteintes à la probité méritent d’être étudiées compte tenu de la qualité singulière de leurs auteurs qui ne sont pas des délinquants ordinaires mais des représentants de la puissance publique.A travers cette étude des atteintes à la probité, nous tenterons de mettre en exergue l’importance considérable de ces infractions qui touchent à la puissance publique et la nécessité d’une répression accentuée destinée à sauvegarder les intérêts fondamentaux de la Nation, à prévenir les conflits d’intérêts, à moraliser la vie publique et à rappeler à l’ordre les personnes exerçant une fonction publique et soumises à l’exigence d’exemplarité. / The righteousness relative to the duties to others and to the duties of the civil life, has for synonym the word "integrity" to which becomes attached the particular idea of a purity which is allowed affect nor corrupt. As regards infringements on the righteousness, it is advisable to arrest the righteousness as a duty the breach of which is penally punished. Indeed, the French criminal law punishes the breaches in the duty of righteousness which are generally the fact of people holding public functions. These incriminations distinguish themselves some of the others by their constituent elements, their modalities of fulfillment or their ends. Infringements on the righteousness deserve to be studied considering the singular quality of their authors who are not ordinary delinquents but representatives of the public authorities. Through this study of infringements on the righteousness, we shall try to highlight the considerable importance of these breaches which affect the public authorities and the necessity of a stressed repression intended to protect the fundamental interests of the Nation, to prevent conflicts of interests, to moralize the public life and to call in to order the holding people a public function and subjected to the requirement of exemplary nature.

The purpose of this Master’s research was to explore factors involved in youth athletes’ sport commitment decision following multiple concussions and persistent symptoms. Individual semi-structured interviews were conducted with 11 pre-adolescent and adolescent athletes (three males, eight females) between 12 and 18 years of age (M = 15.25). Participants were involved in a variety of sports including soccer (n = 3), hockey (n = 3), basketball (n = 1), cheerleading (n = 1), gymnastics (n = 1), jiu-jitsu (n = 1), and rugby (n = 1). Based on the data emanating from the interviews, two articles were written. In article one, the sport commitment model (SCM) (Scanlan, Chow, Sousa, Scanlan, & Knifsend, 2016) facilitated the exploration of the determinants of youth athletes’ sport commitment following multiple concussions and persistent (i.e., lasting beyond 28 days) symptoms. A further objective was to expand upon the current SCM by exploring other potential determinants specifically related to return to play after multiple concussions. Findings indicated that sport enjoyment, valuable opportunities, and the desire to excel were the most salient sources of sport commitment. Constructs pertaining to social influences were the least influential in athletes’ sport commitment. Findings also supported the addition of athletic identity as a new construct in the SCM. Article two uncovered the psychosocial challenges faced by youth athletes during recovery and return to play following multiple concussions and protracted symptoms. The findings revealed that athletes with concussions experience concerns about persistent symptoms, re-injury anxiety, a diminished perceived ability, lack of social support, and emotional turmoil and mental health problems. Finally, findings provided insight into the potential role concussions and ensuing psychosocial challenges may play in mental health and wellbeing. Collectively, this research improves the understanding of difficulties experienced by youth athletes following multiple concussions and supports the need to improve concussion education and foster a more supportive environment.

Concussion is an injury that disproportionately affects children and adolescents and has the potential to negatively impact school performance. Currently, a significant proportion of youth with concussion go unreported due to a lack of effective concussion surveillance procedures. Additionally, many individuals who have daily contact with youth (e.g., parents, teachers) lack training in how to assess or manage a concussion. Schools may be the ideal setting to address both of these problems as they have a high level of access to students and employ personnel (e.g., school psychologists, nurses, social workers, counselors) with experience in assessment and intervention. What is not known is how to best design a school-based concussion management (SBCM) procedure in order to facilitate concussion surveillance and management. Accordingly, the overall purpose of this study was to identify and describe factors (i.e., provider implementation characteristics, concussion referral communication) which may inform the design and implementation of SBCM programming. Examining the relationship between relevant SBCM outcomes and factors associated with strong school programming may help build the foundation for future SBCM procedures. Factors that influence program fidelity and outcomes are called school programming implementation characteristics and they reside at multiple levels (i.e., community, school, climate, program, provider) and are positively related to successful outcomes across varied programming. This exploratory study which utilized secondary analysis of existing data focused on the provider level with the primary aim of identifying and describing student services personnel (SSP; n = 144) implementation characteristics. Indicators of provider implementation characteristics consisted of their beliefs, training, and experiences in order to quantify how these characteristics predict perceptions of the impact of concussion on academics, perception of current informal procedures, and the number of students with concussions served. The independent variables primarily under investigation in this study (role, career experience, recent concussion experience, and training subscale) align with empirically supported personnel implementation characteristics. The second aim of this study was to explore pre-existing communication patterns between SSP utilizing the independent variable referral source. It is of note that the school district from which the data were collected had no formal SBCM programming; therefore, all SSP implementation characteristics examined were viewed as baseline characteristics. Results indicated that as all SSP groups (i.e., school psychologists, nurses, counselors, social workers) perceive a need for SBCM as indicated by dissatisfaction with current procedures and agreement that concussion can negatively impact student performance. Although all groups indicated that they did not believe current concussion procedures to be effective, school psychologists and nurses reported the highest levels of dissatisfaction Additionally, nurses were found to have the highest levels of training in concussion assessment and management, and received significantly more concussion referrals per year when compare to the other SSP. These findings suggest that nurses may be effective in delivering concussion related service and establishing effective concussion surveillance procedures. Although more research is needed, this study represents the first step in bridging the gap between experimental concussion research and the successful delivery of these innovations through SBCM programming in order to help students recover from a concussion.

Head injuries are a major health concern for sport participants as 90% of emergency department visits for sport-related brain injuries are concussion related (Canadian Institute for Health Information, 2016). Recently, reports have shown a higher incidence of sport-related concussion in female athletes compared to males (Agel et al., 2007). Few studies have described the events by which concussions occur in women’s hockey (Delaney et al., 2014, Brainard et al., 2012; Wilcox et al., 2014), however a biomechanical analysis of the risk of concussion has not yet been conducted. Therefore, the purpose of this study was to identify the riskiest concussive events in elite women’s hockey and characterize these events through reconstructions to identify the associated levels of peak linear and angular acceleration and strain from finite element analysis. 44 head impact events were gathered from elite women’s hockey game video and analyzed for impact event, location and velocity. In total, 27 distinct events based on impact event, location and velocity were reconstructed using a hybrid III headform and various testing setups to obtain dynamic response and brain tissue response. A three-way Multivariate Analysis of Variance (MANOVA) was conducted to determine the influence of event, location and velocity. The results of this study show that head-to-ice impacts resulted in significantly higher responses compared to shoulder-to-head collisions and head-to boards impacts however, shoulder and boards impacts were more frequent. All events produced responses comparable to proposed concussion threshold values (Zhang et al., 2004). This research demonstrates the importance of considering the event, the impact characteristics, the magnitude of response, and the frequency of these impacts when attempting to capture the short and long term risks of brain trauma in women’s hockey.

Abstract Head injury is the leading cause of death and disability in trauma patients, and alcohol misuse is often associated with such injuries. Despite modern diagnostic facilities, the extent of traumatic brain injury (TBI) is difficult to assess and supplementary diagnostic tools are warranted. The contribution of alcohol misuse to traumas also needs to be elucidated, as the role of different patterns of alcohol drinking in particular has received less attention. We investigated the clinical utility of a novel serum marker of brain damage, protein S100B, as a tool for assessing TBI in patients with trauma. We also investigated the patterns of alcohol drinking among trauma patients and the trauma mechanisms in relation to blood alcohol concentration (BAC), with special emphasis on head traumas. Finally, we studied the early identification of hazardous drinkers among trauma patients. Serum protein S100B was found to be a feasible supplementary method for assessing TBI, as the latter was shown to elevate its levels significantly, the highest values being found in patients with severe injuries. S100B was also found to be elevated in patients with mild head injury, where it was associated with an increased risk of developing post-concussion symptoms (PCSs). Extracranial injuries also increased S100B values in patients with multitrauma. Accordingly, S100B was not specific to TBI. The more severe the extracranial injury, the higher the S100B value that was found. Binge drinking was found to be the predominant pattern in trauma patients. Alcohol intoxication on admission and hazardous drinking patterns were more often present in patients with head injury than in those with other types of trauma. The risk of sustaining a head trauma significantly increased with increasing BAC. The results also demonstrated that BAC on admission is the best marker of alcohol misuse in trauma patients. The BAC test depicts hazardous alcohol drinking better than conventional biochemical markers of alcohol misuse such as gamma-glutamyl transpeptidase (GGT), aspartate aminotransferase (AST), carbohydrate-deficient transferrin (CDT), or mean corpuscular volume (MCV) of erythrocytes. The findings support the use of S100B as a supplementary method for assessing TBI and the use of BAC as a marker of alcohol misuse in trauma patients.

A number of computerised tests have been especially developed to facilitate the medical management of the sports-related concussion. Probably the most widely used of these programmes is the ImPACT test that was developed in the USA and that is registered with the HPCSA for use in the South African context. A recent Afrikaans version of the test served as the basis of the present study with the following objectives: (i) to collect Afrikaans ImPACT normative data on a cohort of Afrikaans first language adolescent rugby players with Model C education for comparison with existing South African English first language adolescent rugby players with Private/Model C schooling, and (ii) to investigate the pre-versus postseason ImPACT neurocognitive test profiles of this cohort of Afrikaans first language adolescent rugby players versus equivalent noncontact sports controls. The results for Part 1 of the study generally demonstrate poorer performance in respect of the Afrikaans cohort, which is understood to be the result of poorer quality of education. The results for Part 2 demonstrated failure of the rugby group to benefit from practice on the ImPACT Visual Motor Speed composite score to the same extent as the control group. It is argued that this apparent cognitive vulnerability in the rugby group is due to lowered cognitive reserve capacity in association with long term exposure to concussive and sub-concussive injury.