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Objective: To determine the extent to which aspects of the Sport Concussion Assessment Tool 3 (SCAT3) or Child SCAT3 (C-SCAT3), and the King-Devick Test (KDT) predict Three-Dimensional Multiple Object Tracking (3D-MOT) speed. Participants: A sample of 304 healthy, non-concussed participants with a sporting history (101 females, 203 males) ranging in age from 7-29 years (mean age = 16.05 +/- 4.36) were included in the analysis. Methods: Participants completed the SCAT3, KDT and 3D-MOT in a single visit. Data Analysis: A regression analysis was performed to determine the extent to which aspects of the SCAT3 (immediate memory (IM), coordination (COOR), delayed recall (DR)), and the KDT predicted 3D-MOT speed. Results: Using the stepwise method, it was found that KDT, DR and COOR explain a significant amount of the variance in the speed of the 3D-MOT (F(3, 256)) = 11.82, p < .000 with an R2 = .12. The analysis shows that KDT (Beta = -0.01, p < .000), DR (Beta = 0.07, p < .02), and COOR (Beta = .23, p < .03), were significant predictors of 3D-MOT speed. Conclusions: This study suggests that the KDT, DR, and COOR significantly account for 12% of the 3D-MOT scores, however, there is a large portion of variability unaccounted for by the SCAT3 or C-SCAT3 and KDT. This shows that 3D-MOT likely accounts for central cognitive functions above and beyond the SCAT3 or C-SCAT3 and KDT. Future studies should examine this relationship at baseline, post-injury, and through concussion recovery. This could provide valuable information to better inform clinicians responsible for making return to play determinations. Keywords: Concussion, Mild Traumatic Brain Injury, 3D-MOT, King-Devick Test, Sport Concussion Assessment Tool 3, Child Sport Concussion Assessment Tool 3. / Graduate / 0769 / 0633 / 0566 / oslundk@uvic.ca

Le syndrome post-commotionnel (SPC) a été proposé comme un ensemble de symptômes qui peuvent apparaître après un traumatisme crânien léger (TCL) et perdurer des semaines, des mois, parfois jusqu’à un an, engendrant des conséquences importantes sur la vie quotidienne. Des débats entourent la définition et même l’existence du SPC. Ils portent notamment sur la spécificité des symptômes (qui peuvent apparaître dans d’autres conditions, ou chez des personnes non traumatisées), et sur la validité des outils diagnostiques qui restent très hétérogènes. La relation entre le SPC et le stress post-traumatique (SSPT) est également au cœur de ces questionnements. La cohorte PERICLES permet d’apporter un éclairage sur ces questions. Elle porte sur un groupe de patients TCL ainsi qu’un groupe de patients avec un traumatisme léger dont le siège n’est pas la tête. Dans un premier temps, nous avons étudié la spécificité des symptômes en comparant leur prévalence et évolution entre ces deux groupes de patients. Nous avons ensuite tenté de définir un critère diagnostique à partir des symptômes spécifiques à l’aide de tests de corrélations et analyse factorielle. Les facteurs prédictifs du SPC ont été évalués à partir de ce critère, à l’aide d’une régression logistique. Dans un deuxième temps, les facteurs prédictifs des SPC et SSPT ont été évalués et comparés, tout comme la proximité des symptômes des deux syndromes, à l’aide d’une analyse des correspondances multiples. Huit symptômes ont été sélectionnés comme spécifiques au TCL. Un critère diagnostique a pu être défini à partir de ces huit symptômes. Le TCL a été observé facteur prédictif du SSPT (OR = 4,47 [2,38 - 8,40]) mais pas du SPC. Enfin, les symptômes du SPC présentaient une forte proximité avec les variables de la dimension « hypervigilance » du SSPT. Ainsi, le SSPT apparaît être plus spécifique du TCL que le SPC. Les variables du SPC semblent être proches de celles du SSPT. Il semblerait que le stress lié au traumatisme joue un rôle plus important dans la persistance de symptômes à long terme que le mécanisme subi par le cerveau. / Postconcussion syndrome (PCS) has been proposed as a set of symptoms that may occur after mild traumatic brain injury (MTBI) and continue for weeks, months, sometimes up to a year, causing a significant impact on daily life. Debates surround the definition and even the existence of the PCS. They relate in particular to the specific symptoms (which may occur in other conditions or in people not traumatized), and the validity of diagnostical tools that are very heterogeneous. The relationship between the SPCS and post-traumatic stress disorder (PTSD) is also at the heart of these questions. The Pericles cohort can shed light on these issues. It focuses on a group of MTBI patients and a group of patients with mild trauma not related to the head (controls). At first we studied the specificity of symptoms by comparing their prevalence and evolution between these two groups of patients. We then attempted to define a diagnostical test based on specific symptoms using test correlations and factor analysis. Predictors of PCS were evaluated from this test, using logistic regression. In a second step, predictors of PCS and PTSD were assessed and compared, as well as the proximity between symptoms of both syndromes using a multiple correspondence analysis.Eight symptoms were selected as specific to MTBI. A diagnostic criterion has been defined from the eight symptoms. TCL was observed as a predictor of PTSD (OR = 4.47 [2.38 to 8.40]) but not of PCS. Finally PCS symptoms showed strong proximity with variables from "hypervigilance" PTSD dimension. Thus, PTSD appears to be more specific to MTBI than PCS. PCS variables appear to be similar to those of PTSD. It seems that the stress linked to the trauma plays a more important role in the persistence of long-term symptoms than the mechanism of the brain.

The primary aim of the present study was to evaluate the effectiveness of the intervention provided by Massey University Concussion Clinic for individuals following Mild Traumatic Brain Injury (MTBI). Concussion Clinics were set up across New Zealand to provide early intervention and assessment for individuals with MTBI to prevent long term complaints. Treatment outcomes at these clinics have not been empirically examined before. The current study compared the levels of post concussion symptoms, anxiety, depression, and psychosocial functioning between an intervention and a control group using a quasi-experimental design. In addition, reasons for nonattendance to the clinic, and participants’ perceptions of their recovery were also explored. The main outcome measures used were the Rivermead Postconcussion Symptoms Questionnaire, the Hospital Anxiety and Depression Scale, and the Sydney Psychosocial Reintegration Scale-2. Outcomes were initially assessed soon after injury or referral to the clinic and then three months later. Participants were recruited from the Palmerston North Hospital Emergency Department and the Massey University Concussion Clinic. With 20 participants in the intervention group and 15 in the control group, the main results showed that the Concussion Clinic intervention significantly decreased the level of anxiety and depression reported by participants in the intervention group over the control group. Greater improvements in post concussion symptoms and psychosocial functioning were also indicated in the intervention group. Additional findings suggest difficulty with transportation as a reason for nonattendance, which could be a potential barrier to recovery. Furthermore, participants highlighted the benefits of attending the service and its role in their recovery. Important issues relating to the referral processes were also identified. Findings of the current study suggest that the Concussion Clinic intervention is effective in improving recovery for those accessing the service. Nevertheless, these results must be interpreted with caution due to the small sample size. Further research is warranted to examine the effectiveness of the Concussion Clinics with larger samples, and the current study may serve as a valuable pilot for these future investigations.

Objective: The long-term cognitive effects of mild traumatic brain injury (MTBI) and sport-related concussion (SRC) are not always clear. Higher-level longer-term cognitive difficulties can indicate enduring neurological damage, as part of a post-concussion syndrome (PCS). This study aimed to investigate whether cognitive performance and self-reported PCS symptoms of athletes (rugby players) relate to SRC and whether gender moderates these effects. Method: Eighty-six participants completed a questionnaire detailing SRC history (frequency and severity) and rated long-term symptoms using the Sport Concussion Assessment Tool 3 (SCAT3) symptom evaluation scales, before completing the CogState Brief Battery and STOP-IT (stop-signal response inhibition task). Results: No significant relationships between SRC dosage (frequency/severity), self-reported PCS symptoms, and cognitive test performance were identified. A greater proportion of males reported SRC compared to females, but no effect of gender was found on any of the cognitive outcome measures or self-reports of PCS symptoms. Conclusions: The results show that SRC has no observable long-term effects on cognitive test performance or PCS symptom self-reports. The analysis may have lacked power to detect effects. Analysis of individual performance over time against baseline scores may be more relevant for accurate diagnosis than relying on normative test scores. Recommendations for future research were made.

Mild traumatic brain injury (MTBI) has gained increasing attention over recent years with much research directed at the nature of persisting symptoms experienced by individuals with MTBI. Owing to the subtle nature of cognitive-communicative difficulties after MTBI, as well as the lack of sensitivity of traditional assessment tools in identifying these difficulties, individuals with MTBI are seldom referred for speech-language therapy services. The need has therefore arisen for the communicative abilities of individuals with MTBI to be assessed in ways other than through the implementation of traditional assessment tools. This preliminary study, for which a qualitative approach with a multiple case study design was adopted, aimed to investigate communication following MTBI from the perspective of a spouse. The spouses of three individuals with MTBI were selected to participate in this study. Semi-structured interviews consisting of two open-ended questions were held with each spouse. The content obtained from the interviews was subjected to a discourse analysis (DA) and the themes that were identified were interpreted within the Model of Social Communication (Hartley, 1995). The results of this study revealed that each of the participants perceived changes in the communication of their spouses since the MTBI. When interpreted within the Model of Social Communication (Hartley, 1995), these communication difficulties were considered to be either the result of impaired internal processes (including impairments in executive control, stored knowledge, subcortical and limbic input or cognition) or the interaction between these impaired internal processes and the environment. The implications of these results regarding the role of the speech-language therapist in MTBI are highlighted. The potential value of the spouse, and the use of DA as both a methodological and clinical tool in the field of speech-language therapy are discussed. Recommendations for future research are made. / Dissertation (M (Communication Pathology))--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / M (Communication Pathology) / unrestricted

The process of controlling executive and motor behaviours is central to one’s ability to self-regulate and accomplish day-to-day goals across the lifespan. Executive and motor control share a set of underlying neural substrates that support a common set of processes, including planning, sequencing and monitoring of behaviour. They share a bidirectional relationship, such that gains or deficits in one area can have profound effects on the other. This doctoral dissertation examines the interplay between executive and motor control at three distinct stages of life and in the context of neurological conditions whose clinical manifestations shed additional light on the nature of the constructs. Central to each investigation is the methodological theme of intraindividual variability, as a means of leveraging valuable data within-persons. Chapter 2 examines executive and motor control in typically developing children and children with attention-deficit/hyperactivity disorder (ADHD). Findings suggest that dysregulation of motor processes accounts for hyperactive symptoms in ADHD and detracts from higher-order executive control. Chapter 3 examines the impact of mild traumatic brain injury (mTBI) in young adult varsity athletes, who routinely practice executive motor control by virtue of their level of play. Findings suggest that the impacts of mTBI are discernible through a dampened electrophysiological response during computerized tests of higher order executive functioning, and may not outweigh the otherwise myriad health benefits of athletic engagement. Chapter 4 examines the impact of dementia on executive motor control during gait dual-tasking in older adults. Findings suggest that the consistency of performance across multiple indicators of gait is sensitive to dementia, and that engagement in cognitive and social lifestyle behaviours is protective against likelihood of both dementia and mild cognitive impairment (MCI) classification. On mass, these findings highlight the importance of assessing executive motor control to understand the pathophysiology of neurological conditions. The potential benefits that may generalize from one area to the other offer unique opportunities for preventative and rehabilitative efforts. / Graduate

Subconcussive (SC) impacts have become a growing concern within the neuroscience community regarding the immediate and long-lasting effects of sports-related injuries. While a single low-level impact, i.e., a subconcussion, may not cause cerebral perturbations, it has been increasingly recognized that repeated SC exposure can induce deleterious effects. Therefore, determining the lower limits of systematic perturbation resulting from multiple SC impacts is of critical importance in expanding our understanding of cerebral vulnerability and recovery. Currently, there is a lack of correlation between a mild traumatic brain injury (mTBI) and repeated SC impacts with respect to injury biomechanics. Moreover, the cumulative threshold for repetitive low-level impacts is currently undefined. Thus, this research was designed to determine the pathophysiological differences between a single impact of an mTBI and repeated SC impacts with a subdivided cumulative kinetic energy of the single mTBI impact. In order to address this gap in knowledge, the present investigation employed a surgery-free, closed-head, weight drop injury device capable of producing repeatable, head impacts within a rat model. General locomotion and anxiety-like behavior were assessed using an Open Field Test and motor coordination dysfunction was measured using the rotarod assay. Neuroinflammation was measured using immunohistochemical assessment of astrogliosis (GFAP) and microgliosis (Iba-1) within the hippocampus. Additionally, immunohistochemical assessment of neuronal loss (NeuN) was measured within the hippocampus. To investigate the tolerance and the persistence of cerebral vulnerability following a single mTBI and repeated subconcussive impacts, measurement outcomes were assessed over two-time points (3- and 7-days) post final impact. Although injury groups were not statistically different from their associated sham groups with respect to behavioral outcomes; on average, RSC injury rats displayed a significant increase in anxious-like behavior after 7-days of recovery compared to the single mTBI group. From an inflammatory perspective, both mTBI and RSC injury groups led to extensive microgliosis in the gray matter following 3-days post-impact. Overall, this work’s findings do not provide evidence in support of the notion that repeated subconcussive impacts do result in behavioral disturbances and neuroinflammation, that do not manifest following a single mTBI of the same energy input.

Indiana University-Purdue University Indianapolis (IUPUI) / Traumatic brain injury (TBI) has emerged as a major cause of morbidity among U.S. soldiers who have served in Iraq and Afghanistan. Even mild TBI (mTBI) can result in cognitive impairments that can impact how veterans experience such things as physical symptoms, emotions and behaviors, instrumental activities of daily living, interpersonal interactions, and community reintegration. The purpose of this study was to develop a comprehensive self-management intervention for veterans with mTBI to facilitate their community reintegration upon returning from deployment to combat zones. This study was conducted in two Phases. Phase I entailed collecting qualitative data regarding needs, concerns, strategies used, and advice given by eight veterans with mTBI, guided by a conceptual model derived from Ferrans’ and colleagues’ health-related quality of life model and the TBI literature. Six key categories and predominant themes emerged providing further support for the model (cognitive impairments, physical symptoms, emotions and behaviors, instrumental activities of daily living, interpersonal interactions, and community reintegration). Guided by the conceptual model, a mTBI Veteran Needs and Concerns Checklist and 14 algorithms making up the VETeranS Compensate, Adapt, REintegrate (VETSCARE) intervention were developed. Phase II entailed obtaining review of the mTBI Veteran Needs and Concerns Checklist and the 14 VETSCARE algorithms from six TBI experts. On a scale of 1 to 5, with 5 being strongly agree, expert ratings provided moderate evidence of content validity for the checklist (3.33), and for the 14 algorithms (problem relevance 3.92, accuracy 3.73, feasibility 3.80, acceptability 3.84). The average overall expert rating for the VETSCARE intervention was 3.82. The checklist and the 14 algorithms are being revised based on specific comments provided by the experts. Once revised, the mTBI Veteran Needs and Concerns Checklist and the VETSCARE intervention will be tested for feasibility in a future pilot study with veterans with mTBI who have recently returned from combat zones in Iraq and Afghanistan.