Thesis (M.A.)--Boston University / Sports-related concussions are a very large public health concern and have only recently been brought into the national spotlight, thanks largely to the increased media coverage following the deaths of several current and former players of the National Football League (NFL). This problem extends not only to professional athletes, but reaches down through college, high school and to our youth athletes as well. The symptoms resulting from concussion are diverse and include both acute and long-term effects, and could have particularly debilitating effects on the developing brains of young athletes. Various neurocognitive deficits, as well as neurodegenerative diseases such as chronic traumatic encephalopathy (CTE) have been associated with concussions. Research about both the short and long-term effects of concussions has been growing in recent years, and will continue to grow as advanced neuroimaging tools and biomarkers become better developed. This will improve diagnostic capabilities, result in better prognoses, as well as treatments and prevention. This review analyzes current literature in order to evaluate the lasting impacts of sports-related concussions. By showing the effects of sports-related concussions, especially on the developing brain, policy changes aimed at the prevention of concussion in sports will be suggested, specifically in terms of mitigating the adverse effects of concussions on brain development.

Background: According to the Center for Disease Control and Prevention, approximately 1.6 to 3.8 million Americans suffer a sports related concussion each year. Concussion is defined as a transient alteration of the brain structure caused by a direct or indirect force. During the last decade, a vast amount of clinical research on the long term effects of repetitive head trauma has occurred, especially on the subject of chronic traumatic encephalopathy (CTE), depression and dementia. Objective: The purpose of this literature review is to examine the literature pertaining to multiple concussion and the long-term effects of multiple concussion such as neurodegenerative diseases and psychological. Methods: A literature review was conducted using an electronic search of the following databases: MEDLINE, Cochrane Database of Systematic Reviews, and SportDiscus. The key search terms included were concussion, "sport concussion" and "sports concussion". One of the above three terms needed to be in conjunction with one of the following key search terms: depression, dementia, "mild cognitive impairment", "chronic traumatic encephalopathy" (CTE), or "psychological disorder". Additional inclusion criteria also included studies that targeted the adult athlete population who had sustained more than one concussion. Studies only were included if they were peer-reviewed, in the English language, and were published after 1990. To be included in the review, the study must have examined the long term effects of repetitive concussion. Results: The research completed to date suggests there is a strong correlation between the number of concussions an athlete suffers and the long-term ramifications of neurodegenerative and psychological disorders. However, more research is needed.

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Adult hippocampal neurogenesis, or the process of creating new neurons in the dentate gyrus (DG) of the hippocampus, underlies learning and memory capacity. This cognitive ability is essential for humans to operate in their everyday lives, but cognitive disruption can occur in response to traumatic insult such as brain injury. Previous findings in rodent models have characterized the effect of moderate traumatic brain injury (TBI) on neurogenesis and found learning and memory shortfalls correlated with limited neurogenic capacity. While there are no substantial changes after one mild TBI, research has yet to determine if neurogenesis contributes to the worsened cognitive outcomes of repetitive mild TBI. Here, we examined the effect of neurogenesis on cognitive decline following repetitive mild TBI by utilizing AraC to limit the neurogenic capacity of the DG. Utilizing a BrdU fate-labeling strategy, we found a significant increase in the number of immature neurons that correlate learning and memory impairment. These changes were attenuated in AraC-treated animals. We further identified endothelial cell (EC)-specific EphA4 receptor as a key mediator of aberrant neurogenesis. Taken together, we conclude that increased aberrant neurogenesis contributes to learning and memory deficits after repetitive mild TBI. / Doctor of Philosophy / In the United States, millions of people experience mild traumatic brain injuries, or concussions, every year. Patients often have a lower ability to learn and recall new information, and those who go on to receive more concussions are at an increased risk of developing long-term memory-associated disorders such as dementia and chronic traumatic encephalopathy. Despite the high number of athletes and military personnel at risk for these disorders, the underlying cause of long-term learning and memory shortfalls associated with multiple concussions remains ill defined. In the brain, the hippocampus play an important role in learning and memory and is one of only two regions in the brain where new neurons are created from neural stem cells through the process of neurogenesis. Our study seeks to address the role of neurogenesis in learning and memory deficits in mice. These findings provide the foundation for future, long-term mechanistic experiments that uncover the aberrant or uncontrolled processes that derail neurogenesis after multiple concussions. In short, we found an increase in the number of newborn immature neurons that we classify as aberrant neurogenesis. Suppressing this process rescued the learning and memory problems in a rodent model of repeated concussion. These findings improve our understanding of the processes that contribute to the pathophysiology of TBI.

The following is a study on the effects of framing the topic of concussions in the sports media. The study examined the differences between “perceptions of seriousness” of concussions based on two article conditions and how men and women, athletes and non-athletes, sports fans and non-sports fans all viewed the seriousness of concussions. Other variables of analysis included testing participants for their emotional empathy and aggressiveness in relation to their views on concussions. The findings of the study did not confirm most of the hypotheses, but the major hypothesis was supported. For participants who read the “serious” article condition, they reported taking concussions more seriously. Those that were exposed to the “less serious” article condition reported taking concussions less seriously. Therefore, the study shows that the framing of concussions in the sports media could have real consequences for both how the issue is discussed and perceived on the national landscape.

acase@tulane.edu

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.

Background/Purpose: Reducing the incidence and negative consequences of concussion among youth athletes is a public health priority. Fifty states have adopted legislation addressing the problem of sports-related concussions among youth-athletes. In 2010, Massachusetts adopted legislation based on Washington State’s Lystedt Law, enacting state-wide requirements for high school athletic programs. This study explored how the legislation has been implemented within Massachusetts schools and school-districts and identified factors influential to local implementation. Methods: A qualitative multiple-case study approach was utilized. US Census data concerning the household median income and population size of the school-district’s representative town(s) were used to purposively recruit cases. Semi-structured interviews with a breadth of school-district actors in the Commonwealth of Massachusetts and archival records associated with participating schools were used for analysis. Interview data were analyzed using a conventional content analysis approach. Written documents were subjected to an archival analysis. Results: 19 participants from 5 schools were interviewed. Interviewed school personnel included 5 athletic directors, 5 coaches, 4 athletic trainers, 4 school nurses, and 1 health and wellness coordinator. Eight case-level themes related to how the regulation was implemented were identified, and 6 influential factors related to the regulation’s implementation emerged. All participating cases decided to utilize neurocognitive baseline testing programs to assist in diagnosing concussions. Cases also decided to place the decision making authority of removal-from-play and return-to-play situations in the hands of athletic trainers. Primary care physicians were expected to provide medical clearance for concussed student athletes. Funding and man-power emerged as a threat to schools’ ability to implement the regulation with high fidelity. Conclusions: At the local level, provisions of the Massachusetts regulation were implemented with high fidelity. However, differences and similarities regarding local-level implementation decisions existed across cases. Conducting the study qualitatively allowed the study to obtain rich detail and identify implementation decisions made within cases. However, the knowledge generated may not be generalizable to other school districts or other states. The study’s findings speak to the variability often found when implementation is relegated to the local-level.

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