Strahle, J; Geh, N; Selzer, B J; Bower, R; Himedan, M; Strahle, M; Wetjen, N M; Muraszko, K M; Garton, H J; Maher, C O
Sports participation with Chiari I malformation Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 17, no. 4, pp. 403–409, 2016.
Abstract | BibTeX | Tags: *Arnold-Chiari Malformation/ep [Epidemiology], *Athletic Injuries/ep [Epidemiology], *Registries/sn [Statistics & Numerical Data], *Sports/sn [Statistics & Numerical Data], Adolescent, Child, Female, Follow-Up Studies, Humans, Male, Preschool
@article{Strahle2016,
title = {Sports participation with Chiari I malformation},
author = {Strahle, J and Geh, N and Selzer, B J and Bower, R and Himedan, M and Strahle, M and Wetjen, N M and Muraszko, K M and Garton, H J and Maher, C O},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {17},
number = {4},
pages = {403--409},
abstract = {OBJECT There is currently no consensus on the safety of sports participation for patients with Chiari I malformation (CM-I). The authors' goal was to define the risk of sports participation for children with the imaging finding of CM-I. METHODS A prospective survey was administered to 503 CM-I patients at 2 sites over a 46-month period. Data were gathered on imaging characteristics, treatment, sports participation, and any sport-related injuries. Additionally, 81 patients completed at least 1 subsequent survey following their initial entry into the registry and were included in a prospective group, with a mean prospective follow-up period of 11 months. RESULTS Of the 503 CM-I patients, 328 participated in sports for a cumulative duration of 4641 seasons; 205 of these patients participated in contact sports. There were no serious or catastrophic neurological injuries. One patient had temporary extremity paresthesias that resolved within hours, and this was not definitely considered to be related to the CM-I. In the prospective cohort, there were no permanent neurological injuries. CONCLUSIONS No permanent or catastrophic neurological injuries were observed in CM-I patients participating in athletic activities. The authors believe that the risk of such injuries is low and that, in most cases, sports participation by children with CM-I is safe.},
keywords = {*Arnold-Chiari Malformation/ep [Epidemiology], *Athletic Injuries/ep [Epidemiology], *Registries/sn [Statistics \& Numerical Data], *Sports/sn [Statistics \& Numerical Data], Adolescent, Child, Female, Follow-Up Studies, Humans, Male, Preschool},
pubstate = {published},
tppubtype = {article}
}
van der Horn, H J; Liemburg, E J; Scheenen, M E; de Koning, M E; Marsman, J B; Spikman, J M; van der Naalt, J
Brain network dysregulation, emotion, and complaints after mild traumatic brain injury Journal Article
In: Human Brain Mapping, vol. 37, no. 4, pp. 1645–1654, 2016.
Abstract | BibTeX | Tags: *Brain Concussion/pp [Physiopathology], *Brain/pp [Physiopathology], *Emotions, *MAGNETIC resonance imaging, *Nerve Net/pp [Physiopathology], Adolescent, adult, Brain Concussion/px [Psychology], Emotions/ph [Physiology], Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging/mt [Methods], Male, middle aged, Prospective Studies, Young Adult
@article{VanderHorn2016,
title = {Brain network dysregulation, emotion, and complaints after mild traumatic brain injury},
author = {van der Horn, H J and Liemburg, E J and Scheenen, M E and de Koning, M E and Marsman, J B and Spikman, J M and van der Naalt, J},
year = {2016},
date = {2016-01-01},
journal = {Human Brain Mapping},
volume = {37},
number = {4},
pages = {1645--1654},
abstract = {OBJECTIVES: To assess the role of brain networks in emotion regulation and post-traumatic complaints in the sub-acute phase after non-complicated mild traumatic brain injury (mTBI). EXPERIMENTAL DESIGN: Fifty-four patients with mTBI (34 with and 20 without complaints) and 20 healthy controls (group-matched for age, sex, education, and handedness) were included. Resting-state fMRI was performed at four weeks post-injury. Static and dynamic functional connectivity were studied within and between the default mode, executive (frontoparietal and bilateral frontal network), and salience network. The hospital anxiety and depression scale (HADS) was used to measure anxiety (HADS-A) and depression (HADS-D). PRINCIPAL OBSERVATIONS: Regarding within-network functional connectivity, none of the selected brain networks were different between groups. Regarding between-network interactions, patients with complaints exhibited lower functional connectivity between the bilateral frontal and salience network compared to patients without complaints. In the total patient group, higher HADS-D scores were related to lower functional connectivity between the bilateral frontal network and both the right frontoparietal and salience network, and to higher connectivity between the right frontoparietal and salience network. Furthermore, whereas higher HADS-D scores were associated with lower connectivity within the parietal midline areas of the bilateral frontal network, higher HADS-A scores were related to lower connectivity within medial prefrontal areas of the bilateral frontal network. CONCLUSIONS: Functional interactions of the executive and salience networks were related to emotion regulation and complaints after mTBI, with a key role for the bilateral frontal network. These findings may have implications for future studies on the effect of psychological interventions.Copyright © 2016 Wiley Periodicals, Inc.},
keywords = {*Brain Concussion/pp [Physiopathology], *Brain/pp [Physiopathology], *Emotions, *MAGNETIC resonance imaging, *Nerve Net/pp [Physiopathology], Adolescent, adult, Brain Concussion/px [Psychology], Emotions/ph [Physiology], Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging/mt [Methods], Male, middle aged, Prospective Studies, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Subbian, V; Ratcliff, J J; Korfhagen, J J; Hart, K W; Meunier, J M; Shaw, G J; Lindsell, C J; Beyette Jr., F R
A Novel Tool for Evaluation of Mild Traumatic Brain Injury Patients in the Emergency Department: Does Robotic Assessment of Neuromotor Performance Following Injury Predict the Presence of Postconcussion Symptoms at Follow-up? Journal Article
In: Academic Emergency Medicine, vol. 23, no. 4, pp. 382–392, 2016.
Abstract | BibTeX | Tags: *Brain Injuries/co [Complications], *Emergency Service, *Post-Concussion Syndrome/di [Diagnosis], *Post-Concussion Syndrome/et [Etiology], *Robotics/mt [Methods], adult, Closed/co [Complications], Diagnostic Techniques, Female, Follow-Up Studies, Head Injuries, Hospital/og [Organization & Ad, Humans, Male, middle aged, Neurological, Observer Variation, Sensitivity and Specificity, Urban Population, Young Adult
@article{Subbian2016,
title = {A Novel Tool for Evaluation of Mild Traumatic Brain Injury Patients in the Emergency Department: Does Robotic Assessment of Neuromotor Performance Following Injury Predict the Presence of Postconcussion Symptoms at Follow-up?},
author = {Subbian, V and Ratcliff, J J and Korfhagen, J J and Hart, K W and Meunier, J M and Shaw, G J and Lindsell, C J and {Beyette Jr.}, F R},
year = {2016},
date = {2016-01-01},
journal = {Academic Emergency Medicine},
volume = {23},
number = {4},
pages = {382--392},
abstract = {OBJECTIVES: Postconcussion symptoms (PCS) are a common complication of mild traumatic brain injury (TBI). Currently, there is no validated clinically available method to reliably predict at the time of injury who will subsequently develop PCS. The purpose of this study was to determine if PCS following mild TBI can be predicted during the initial presentation to an emergency department (ED) using a novel robotic-assisted assessment of neurologic function. METHODS: All patients presenting to an urban ED with a chief complaint of head injury within the preceding 24 hours were screened for inclusion from March 2013 to April 2014. The enrollment criteria were as follows: 1) age of 18 years or greater, 2) ability and willingness to provide written informed consent, 3) blunt head trauma and clinical diagnosis of isolated mild TBI by the treating physician, and 4) blood alcohol level of \<100 mg/dL. Eligible mild TBI patients were enrolled and their neuromotor function was assessed in the ED using a battery of five tests that cover a range of proprioceptive, visuomotor, visuospatial, and executive function performance metrics. At 3 weeks postinjury, participants were contacted via telephone to complete the Rivermead Post-Concussion Symptoms Questionnaire to assess the presence of significant PCS. RESULTS: A total of 66 mild TBI patients were enrolled in the study with 42 of them completing both the ED assessment and the follow-up; 40 patients were included in the analyses. The area under the receiver operating characteristic curve (AUC) for the entire test battery was 0.72 (95% confidence interval [CI] = 0.54 to 0.90). The AUC for tests that primarily measure visuomotor and proprioceptive performance were 0.80 (95% CI = 0.65 to 0.95) and 0.71 (95% CI = 0.53 to 0.89), respectively. CONCLUSIONS: The robotic-assisted test battery has the ability to discriminate between subjects who developed PCS and those who did not. Additionally, poor visuomotor and proprioceptive performance were most strongly associated with subsequent PCS.Copyright © 2016 by the Society for Academic Emergency Medicine.},
keywords = {*Brain Injuries/co [Complications], *Emergency Service, *Post-Concussion Syndrome/di [Diagnosis], *Post-Concussion Syndrome/et [Etiology], *Robotics/mt [Methods], adult, Closed/co [Complications], Diagnostic Techniques, Female, Follow-Up Studies, Head Injuries, Hospital/og [Organization \& Ad, Humans, Male, middle aged, Neurological, Observer Variation, Sensitivity and Specificity, Urban Population, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Strahle, J; Selzer, B J; Geh, N; Srinivasan, D; Strahle, M; Martinez-Sosa, M; Muraszko, K M; Garton, H J; Maher, C O
Sports participation with arachnoid cysts Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 17, no. 4, pp. 410–417, 2016.
Abstract | BibTeX | Tags: *Arachnoid Cysts/ep [Epidemiology], *Athletic Injuries/ep [Epidemiology], *Registries/sn [Statistics & Numerical Data], *Sports/sn [Statistics & Numerical Data], Adolescent, Child, Female, Follow-Up Studies, Humans, Male
@article{Strahle2016b,
title = {Sports participation with arachnoid cysts},
author = {Strahle, J and Selzer, B J and Geh, N and Srinivasan, D and Strahle, M and Martinez-Sosa, M and Muraszko, K M and Garton, H J and Maher, C O},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {17},
number = {4},
pages = {410--417},
abstract = {OBJECT There is currently no consensus on the safety of sports participation for patients with an intracranial arachnoid cyst (AC). The authors' goal was to define the risk of sports participation for children with this imaging finding. METHODS A survey was prospectively administered to 185 patients with ACs during a 46-month period at a single institution. Cyst size and location, treatment, sports participation, and any injuries were recorded. Eighty patients completed at least 1 subsequent survey following their initial entry into the registry, and these patients were included in a prospective registry with a mean prospective follow-up interval of 15.9 +/- 8.8 months. RESULTS A total 112 patients with ACs participated in 261 sports for a cumulative duration of 4410 months or 1470 seasons. Of these, 94 patients participated in 190 contact sports for a cumulative duration of 2818 months or 939 seasons. There were no serious or catastrophic neurological injuries. Two patients presented with symptomatic subdural hygromas following minor sports injuries. In the prospective cohort, there were no neurological injuries CONCLUSIONS Permanent or catastrophic neurological injuries are very unusual in AC patients who participate in athletic activities. In most cases, sports participation by these patients is safe.},
keywords = {*Arachnoid Cysts/ep [Epidemiology], *Athletic Injuries/ep [Epidemiology], *Registries/sn [Statistics \& Numerical Data], *Sports/sn [Statistics \& Numerical Data], Adolescent, Child, Female, Follow-Up Studies, Humans, Male},
pubstate = {published},
tppubtype = {article}
}
Sung, C W; Chen, K Y; Chiang, Y H; Chiu, W T; Ou, J C; Lee, H C; Tsai, S H; Lin, J W; Yang, C M; Tsai, Y R; Liao, K H; Chen, G S; Li, W J; Wang, J Y
Heart rate variability and serum level of insulin-like growth factor-1 are correlated with symptoms of emotional disorders in patients suffering a mild traumatic brain injury Journal Article
In: Clinical Neurophysiology, vol. 127, no. 2, pp. 1629–1638, 2016.
Abstract | BibTeX | Tags: *Anxiety/bl [Blood], *Brain Injuries/bl [Blood], *Depression/bl [Blood], *Heart Rate/ph [Physiology], *Insulin-Like Growth Factor I/me [Metabolism], 0 (Biomarkers), 67763-96-6 (Insulin-Like Growth Factor I), adult, Affective Symptoms/bl [Blood], Affective Symptoms/di [Diagnosis], Affective Symptoms/px [Psychology], Anxiety/di [Diagnosis], Anxiety/px [Psychology], Biomarkers/bl [Blood], Brain Injuries/di [Diagnosis], Brain Injuries/px [Psychology], Cohort Studies, Depression/di [Diagnosis], Depression/px [Psychology], Female, Follow-Up Studies, Humans, Male, middle aged, Mood Disorders/bl [Blood], Mood Disorders/di [Diagnosis], Mood Disorders/px [Psychology], Young Adult
@article{Sung2016,
title = {Heart rate variability and serum level of insulin-like growth factor-1 are correlated with symptoms of emotional disorders in patients suffering a mild traumatic brain injury},
author = {Sung, C W and Chen, K Y and Chiang, Y H and Chiu, W T and Ou, J C and Lee, H C and Tsai, S H and Lin, J W and Yang, C M and Tsai, Y R and Liao, K H and Chen, G S and Li, W J and Wang, J Y},
year = {2016},
date = {2016-01-01},
journal = {Clinical Neurophysiology},
volume = {127},
number = {2},
pages = {1629--1638},
abstract = {OBJECTIVE: Patients who have experienced a mild traumatic brain injury (mTBI) are susceptible to symptoms of anxiety or depression. To explore the potential biomarkers for emotional disorders in mTBI patients, we analyzed the frequency domain of heart rate variability (HRV) and serum concentrations of four neurohormones. METHODS: We assessed mTBI patients on their first visit and follow-up. Symptoms were evaluated by the Beck Anxiety Inventory and the Beck Depression Inventory, respectively. Serum levels of adrenocorticotropic hormone (ACTH), melatonin, cortisol, and insulin-like growth factor (IGF)-1 and HRV follow-ups were measured and compared. RESULTS: mTBI patients were more vulnerable to symptoms of anxiety or depression than healthy controls. Reduced HRV was noted in mTBI patients compared to healthy controls. The mTBI patients demonstrated higher serum levels of ACTH, lower IGF-1 compared to healthy controls. In correlation analysis, only IGF-1 was positively correlated with HRV in mTBI patients. Both HRV and IGF-1 were correlated with symptom of depression while only HRV was correlated with symptom of anxiety in mTBI patients. CONCLUSIONS: We infer that HRV may be more significantly correlated with emotional disorders than is IGF-1 in mTBI patients. SIGNIFICANCE: The study is relevant for specific diagnostic markers in mTBI patients.Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.},
keywords = {*Anxiety/bl [Blood], *Brain Injuries/bl [Blood], *Depression/bl [Blood], *Heart Rate/ph [Physiology], *Insulin-Like Growth Factor I/me [Metabolism], 0 (Biomarkers), 67763-96-6 (Insulin-Like Growth Factor I), adult, Affective Symptoms/bl [Blood], Affective Symptoms/di [Diagnosis], Affective Symptoms/px [Psychology], Anxiety/di [Diagnosis], Anxiety/px [Psychology], Biomarkers/bl [Blood], Brain Injuries/di [Diagnosis], Brain Injuries/px [Psychology], Cohort Studies, Depression/di [Diagnosis], Depression/px [Psychology], Female, Follow-Up Studies, Humans, Male, middle aged, Mood Disorders/bl [Blood], Mood Disorders/di [Diagnosis], Mood Disorders/px [Psychology], Young Adult},
pubstate = {published},
tppubtype = {article}
}
Zemek, R; Barrowman, N; Freedman, S B; Gravel, J; Gagnon, I; McGahern, C; Aglipay, M; Sangha, G; Boutis, K; Beer, D; Craig, W; Burns, E; Farion, K J; Mikrogianakis, A; Barlow, K; Dubrovsky, A S; Meeuwisse, W; Gioia, G; Meehan 3rd, W P; Beauchamp, M H; Kamil, Y; Grool, A M; Hoshizaki, B; Anderson, P; Brooks, B L; Yeates, K O; Vassilyadi, M; Klassen, T; Keightley, M; Richer, L; DeMatteo, C; Osmond, M H; Pediatric Emergency Research Canada Concussion, Team
Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED Journal Article
In: JAMA, vol. 315, no. 10, pp. 1014–1025, 2016.
Abstract | BibTeX | Tags: *Post-Concussion Syndrome/di [Diagnosis], Accidents, Adolescent, Age Factors, Area Under Curve, Athletic Injuries/co [Complications], Brain Concussion/di [Diagnosis], Brain Concussion/et [Etiology], Child, Emergency Service, Female, Follow-Up Studies, Hospital, Humans, Male, MEDICAL history taking, MULTIVARIATE analysis, Observer Variation, Outcome Assessment (Health Care), Post-Concussion Syndrome/et [Etiology], Preschool, Prospective Studies, RISK assessment, Sensitivity and Specificity, Sex Factors, Time Factors, Traffic/sn [Statistics & Numerical Data
@article{Zemek2016,
title = {Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED},
author = {Zemek, R and Barrowman, N and Freedman, S B and Gravel, J and Gagnon, I and McGahern, C and Aglipay, M and Sangha, G and Boutis, K and Beer, D and Craig, W and Burns, E and Farion, K J and Mikrogianakis, A and Barlow, K and Dubrovsky, A S and Meeuwisse, W and Gioia, G and {Meehan 3rd}, W P and Beauchamp, M H and Kamil, Y and Grool, A M and Hoshizaki, B and Anderson, P and Brooks, B L and Yeates, K O and Vassilyadi, M and Klassen, T and Keightley, M and Richer, L and DeMatteo, C and Osmond, M H and {Pediatric Emergency Research Canada Concussion}, Team},
year = {2016},
date = {2016-01-01},
journal = {JAMA},
volume = {315},
number = {10},
pages = {1014--1025},
abstract = {IMPORTANCE: Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent postconcussion symptoms (PPCS). However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist. OBJECTIVE: To derive and validate a clinical risk score for PPCS among children presenting to the emergency department. DESIGN, SETTING, AND PARTICIPANTS: Prospective, multicenter cohort study (Predicting and Preventing Postconcussive Problems in Pediatrics [5P]) enrolled young patients (aged 5-\<18 years) who presented within 48 hours of an acute head injury at 1 of 9 pediatric emergency departments within the Pediatric Emergency Research Canada (PERC) network from August 2013 through September 2014 (derivation cohort) and from October 2014 through June 2015 (validation cohort). Participants completed follow-up 28 days after the injury. EXPOSURES: All eligible patients had concussions consistent with the Zurich consensus diagnostic criteria. MAIN OUTCOMES AND MEASURES: The primary outcome was PPCS risk score at 28 days, which was defined as 3 or more new or worsening symptoms using the patient-reported Postconcussion Symptom Inventory compared with recalled state of being prior to the injury. RESULTS: In total, 3063 patients (median age, 12.0 years [interquartile range, 9.2-14.6 years]; 1205 [39.3%] girls) were enrolled (n=2006 in the derivation cohort; n=1057 in the validation cohort) and 2584 of whom (n=1701 [85%] in the derivation cohort; n=883 [84%] in the validation cohort) completed follow-up at 28 days after the injury. Persistent postconcussion symptoms were present in 801 patients (31.0%) (n=510 [30.0%] in the derivation cohort and n=291 [33.0%] in the validation cohort). The 12-point PPCS risk score model for the derivation cohort included the variables of female sex, age of 13 years or older, physician-diagnosed migraine history, prior concussion with symptoms lasting longer than 1 week, headache, sensitivity to noise, fatigue, answering questions slowly, and 4 or more errors on the Balance Error Scoring System tandem stance. The area under the curve was 0.71 (95% CI, 0.69-0.74) for the derivation cohort and 0.68 (95% CI, 0.65-0.72) for the validation cohort. CONCLUSIONS AND RELEVANCE: A clinical risk score developed among children presenting to the emergency department with concussion and head injury within the previous 48 hours had modest discrimination to stratify PPCS risk at 28 days. Before this score is adopted in clinical practice, further research is needed for external validation, assessment of accuracy in an office setting, and determination of clinical utility.},
keywords = {*Post-Concussion Syndrome/di [Diagnosis], Accidents, Adolescent, Age Factors, Area Under Curve, Athletic Injuries/co [Complications], Brain Concussion/di [Diagnosis], Brain Concussion/et [Etiology], Child, Emergency Service, Female, Follow-Up Studies, Hospital, Humans, Male, MEDICAL history taking, MULTIVARIATE analysis, Observer Variation, Outcome Assessment (Health Care), Post-Concussion Syndrome/et [Etiology], Preschool, Prospective Studies, RISK assessment, Sensitivity and Specificity, Sex Factors, Time Factors, Traffic/sn [Statistics \& Numerical Data},
pubstate = {published},
tppubtype = {article}
}
Baker, J G; Leddy, J J; Darling, S R; Rieger, B P; Mashtare, T L; Sharma, T; Willer, B S
Factors Associated with Problems for Adolescents Returning to the Classroom after Sport-Related Concussion Journal Article
In: Clinical Pediatrics, vol. 54, no. 10, pp. 961–968, 2015.
Abstract | Links | BibTeX | Tags: Absenteeism, Adolescent, adolescent disease, adult, Article, athlete, Athletic Injuries, brain concussion, computer testing, Concussion, disease association, disease severity, Female, follow up, Follow-Up Studies, health service, human, Humans, interview, Interviews as Topic, Logistic Models, major clinical study, Male, Pathophysiology, receiver operating characteristic, recovery time, Recurrence, recurrent disease, return to learn, ROC Curve, school, school problems, sport injury, Sport-related concussion, statistical model, Symptoms, telephone interview, Young Adult
@article{Baker2015,
title = {Factors Associated with Problems for Adolescents Returning to the Classroom after Sport-Related Concussion},
author = {Baker, J G and Leddy, J J and Darling, S R and Rieger, B P and Mashtare, T L and Sharma, T and Willer, B S},
doi = {10.1177/0009922815588820},
year = {2015},
date = {2015-01-01},
journal = {Clinical Pediatrics},
volume = {54},
number = {10},
pages = {961--968},
abstract = {The primary objective of this study was to determine factors in the clinic setting associated with concussion-related problems in the school setting. A total of 91 student athletes, 13 to 19 years old, completed the SCAT2 and computerized testing during their initial visit to the clinic. During a follow-up telephone interview, one-third reported problems with return to school. The presence of problems reported in school was associated with severity of concussion as represented by recovery time and the overall number of symptoms at the first clinic visit. Gender, age, and previous concussions were not associated with school problems. Athletes with computerized test scores below the ninth percentile were more likely to report school problems. The current study offers some descriptive information for clinicians and ideas for future research related to adolescent athletes with concussion and problems with return to the classroom. © SAGE Publications.},
keywords = {Absenteeism, Adolescent, adolescent disease, adult, Article, athlete, Athletic Injuries, brain concussion, computer testing, Concussion, disease association, disease severity, Female, follow up, Follow-Up Studies, health service, human, Humans, interview, Interviews as Topic, Logistic Models, major clinical study, Male, Pathophysiology, receiver operating characteristic, recovery time, Recurrence, recurrent disease, return to learn, ROC Curve, school, school problems, sport injury, Sport-related concussion, statistical model, Symptoms, telephone interview, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Ellis, M J; Leiter, J; Hall, T; McDonald, P J; Sawyer, S; Silver, N; Bunge, M; Essig, M
Neuroimaging findings in pediatric sports-related concussion Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 16, no. 3, pp. 241–247, 2015.
Abstract | BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Brain Concussion/et [Etiology], *Neuroimaging, Adolescent, Arachnoid Cysts/di [Diagnosis], Athletic Injuries/co [Complications], Athletic Injuries/pa [Pathology], Brain Concussion/pa [Pathology], Brain Injuries/di [Diagnosis], Brain Injuries/et [Etiology], Child, Contusions/di [Diagnosis], Dizziness/et [Etiology], Female, Follow-Up Studies, Headache/et [Etiology], Humans, Intracranial Hemorrhages/di [Diagnosis], Magnetic Resonance Imaging, Male, Neuroimaging/mt [Methods], postural balance, Predictive Value of Tests, Retrospective Studies, Skull Fractures/di [Diagnosis], Tomography, Unconsciousness/et [Etiology], X-Ray Computed
@article{Ellis2015b,
title = {Neuroimaging findings in pediatric sports-related concussion},
author = {Ellis, M J and Leiter, J and Hall, T and McDonald, P J and Sawyer, S and Silver, N and Bunge, M and Essig, M},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {16},
number = {3},
pages = {241--247},
abstract = {OBJECT: The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program. METHODS: The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age \< 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board. RESULTS: A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient). CONCLUSIONS: Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.},
keywords = {*Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Brain Concussion/et [Etiology], *Neuroimaging, Adolescent, Arachnoid Cysts/di [Diagnosis], Athletic Injuries/co [Complications], Athletic Injuries/pa [Pathology], Brain Concussion/pa [Pathology], Brain Injuries/di [Diagnosis], Brain Injuries/et [Etiology], Child, Contusions/di [Diagnosis], Dizziness/et [Etiology], Female, Follow-Up Studies, Headache/et [Etiology], Humans, Intracranial Hemorrhages/di [Diagnosis], Magnetic Resonance Imaging, Male, Neuroimaging/mt [Methods], postural balance, Predictive Value of Tests, Retrospective Studies, Skull Fractures/di [Diagnosis], Tomography, Unconsciousness/et [Etiology], X-Ray Computed},
pubstate = {published},
tppubtype = {article}
}
Mayer, A R; Ling, J M; Dodd, A B; Gasparovic, C; Klimaj, S D; Meier, T B
A Longitudinal Assessment of Structural and Chemical Alterations in Mixed Martial Arts Fighters Journal Article
In: Journal of Neurotrauma, vol. 32, no. 22, pp. 1759–1767, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, adult, Article, biological marker, Biomarkers, BRAIN chemistry, brain concussion, brain cortex, brain size, Cerebral Cortex, CHOLINE, clinical article, cognition, Concussion, controlled study, cortical thickness (brain), creatine, executive function, Female, follow up, Follow-Up Studies, frontal gyrus, glutamic acid, glutamine, human, Humans, Injuries, inositol, Longitudinal, Longitudinal studies, longitudinal study, Magnetic Resonance Imaging, Male, martial art, Martial Arts, Memory, middle aged, mixed martial art, n acetylaspartic acid, neuropsychological test, Neuropsychological Tests, nuclear magnetic resonance imaging, NUCLEAR magnetic resonance spectroscopy, occipital cortex, pathology, posterior cingulate, psychology, repetitive injury, Spectroscopy, volumetrics, white matter, Young Adult
@article{Mayer2015b,
title = {A Longitudinal Assessment of Structural and Chemical Alterations in Mixed Martial Arts Fighters},
author = {Mayer, A R and Ling, J M and Dodd, A B and Gasparovic, C and Klimaj, S D and Meier, T B},
doi = {10.1089/neu.2014.3833},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurotrauma},
volume = {32},
number = {22},
pages = {1759--1767},
abstract = {Growing evidence suggests that temporally proximal acute concussions and repetitive subconcussive head injuries may lead to long-term neurological deficits. However, the underlying mechanisms of injury and their relative time-scales are not well documented in human injury models. The current study therefore investigated whether biomarkers of brain chemistry (magnetic resonance [MR] spectroscopy: N-acetylaspartate [NAA], combined glutamate and glutamine [Glx], total creatine [Cre], choline compounds [Cho], and myo-inositol [mI]) and structure (cortical thickness, white matter [WM]/subcortical volume) differed between mixed martial artists (MMA; n = 13) and matched healthy controls (HC) without a history of contact sport participation (HC; n = 14). A subset of participants (MMA = 9; HC = 10) returned for follow-up visits, with MMA (n = 3) with clinician-documented acute concussions also scanned serially. As expected, MMA self-reported a higher incidence of previous concussions and significantly more cognitive symptoms during prior concussion recovery. Fighters also exhibited reduced memory and processing speed relative to controls on neuropsychological testing coupled with cortical thinning in the left posterior cingulate gyrus and right occipital cortex at baseline assessment. Over a 1-year follow-up period, MMA experienced a significant decrease in both WM volume and NAA concentration, as well as relative thinning in the left middle and superior frontal gyri. These longitudinal changes did not correlate with self-reported metrics of injury (i.e., fight diary). In contrast, HC did not exhibit significant longitudinal changes over a 4-month follow-up period (p \> 0.05). Collectively, current results provide preliminary evidence of progressive changes in brain chemistry and structure over a relatively short time period in individuals with high exposure to repetitive head hits. These findings require replication in independent samples. © Mary Ann Liebert, Inc. 2015.},
keywords = {Adolescent, adult, Article, biological marker, Biomarkers, BRAIN chemistry, brain concussion, brain cortex, brain size, Cerebral Cortex, CHOLINE, clinical article, cognition, Concussion, controlled study, cortical thickness (brain), creatine, executive function, Female, follow up, Follow-Up Studies, frontal gyrus, glutamic acid, glutamine, human, Humans, Injuries, inositol, Longitudinal, Longitudinal studies, longitudinal study, Magnetic Resonance Imaging, Male, martial art, Martial Arts, Memory, middle aged, mixed martial art, n acetylaspartic acid, neuropsychological test, Neuropsychological Tests, nuclear magnetic resonance imaging, NUCLEAR magnetic resonance spectroscopy, occipital cortex, pathology, posterior cingulate, psychology, repetitive injury, Spectroscopy, volumetrics, white matter, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Chetelat, G; Eustache, F; Viader, F; De La Sayette, V; Pelerin, A; Mezenge, F; Hannequin, D; Dupuy, B; Baron, J C; Desgranges, B
FDG-PET measurement is more accurate than neuropsychological assessments to predict global cognitive deterioration in patients with mild cognitive impairment Journal Article
In: Neurocase, vol. 11, no. 1, pp. 14–25, 2005.
Abstract | BibTeX | Tags: *Cognition Disorders/dg [Diagnostic Imaging], *Fluorodeoxyglucose F18, *Neuropsychological Tests, *Positron-Emission Tomography, 0Z5B2CJX4D (Fluorodeoxyglucose F18), 80 and over, aged, ANALYSIS of variance, Brain Concussion/dg [Diagnostic Imaging], Brain Concussion/pa [Pathology], BRAIN mapping, Cognition Disorders/di [Diagnosis], Dementia/dg [Diagnostic Imaging], Dementia/di [Diagnosis], Dementia/pp [Physiopathology], Female, Follow-Up Studies, Humans, Male, Memory/ph [Physiology], Mental Status Schedule, middle aged, Predictive Value of Tests, Regression (Psychology), Reproducibility of Results, Time Factors
@article{Chetelat2005,
title = {FDG-PET measurement is more accurate than neuropsychological assessments to predict global cognitive deterioration in patients with mild cognitive impairment},
author = {Chetelat, G and Eustache, F and Viader, F and {De La Sayette}, V and Pelerin, A and Mezenge, F and Hannequin, D and Dupuy, B and Baron, J C and Desgranges, B},
year = {2005},
date = {2005-01-01},
journal = {Neurocase},
volume = {11},
number = {1},
pages = {14--25},
abstract = {The accurate prediction, at a pre-dementia stage of Alzheimer's disease (AD), of the subsequent clinical evolution of patients would be a major breakthrough from both therapeutic and research standpoints. Amnestic mild cognitive impairment (MCI) is presently the most common reference to address the pre-dementia stage of AD. However, previous longitudinal studies on patients with MCI assessing neuropsychological and PET markers of future conversion to AD are sparse and yield discrepant findings, while a comprehensive comparison of the relative accuracy of these two categories of measure is still lacking. In the present study, we assessed the global cognitive decline as measured by the Mattis scale in 18 patients with amnestic MCI over an 18-month follow-up period, studying which subtest of this scale showed significant deterioration over time. Using baseline measurements from neuropsychological evaluation of memory and PET, we then assessed significant markers of global cognitive change, that is, percent annual change in the Mattis scale total score, and searched for the best predictor of this global cognitive decline. Altogether, our results revealed significant decline over the 18-month follow-up period in the total score and the verbal initiation and memory-recall subscores of the Mattis scale. The percent annual change in the total Mattis score significantly correlated with age and baseline performances in delayed episodic memory recall as well as semantic autobiographical and category word fluencies. Regarding functional imaging, significant correlations were also found with baseline PET values in the right temporo-parietal and medial frontal areas. Age and right temporo-parietal PET values were the most significant predictors of subsequent global cognitive decline, and the only ones to survive stepwise regression analyses. Our findings are consistent with previous works showing predominant delayed recall and semantic memory impairment at a pre-dementia stage of AD, as well as early metabolic defects in the temporo-parietal associative cortex. However, they suggest that only the latter predictor is specifically and accurately associated with subsequent cognitive decline in patients with MCI within 18 months of first assessment.},
keywords = {*Cognition Disorders/dg [Diagnostic Imaging], *Fluorodeoxyglucose F18, *Neuropsychological Tests, *Positron-Emission Tomography, 0Z5B2CJX4D (Fluorodeoxyglucose F18), 80 and over, aged, ANALYSIS of variance, Brain Concussion/dg [Diagnostic Imaging], Brain Concussion/pa [Pathology], BRAIN mapping, Cognition Disorders/di [Diagnosis], Dementia/dg [Diagnostic Imaging], Dementia/di [Diagnosis], Dementia/pp [Physiopathology], Female, Follow-Up Studies, Humans, Male, Memory/ph [Physiology], Mental Status Schedule, middle aged, Predictive Value of Tests, Regression (Psychology), Reproducibility of Results, Time Factors},
pubstate = {published},
tppubtype = {article}
}
Strahle, J; Geh, N; Selzer, B J; Bower, R; Himedan, M; Strahle, M; Wetjen, N M; Muraszko, K M; Garton, H J; Maher, C O
Sports participation with Chiari I malformation Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 17, no. 4, pp. 403–409, 2016.
@article{Strahle2016,
title = {Sports participation with Chiari I malformation},
author = {Strahle, J and Geh, N and Selzer, B J and Bower, R and Himedan, M and Strahle, M and Wetjen, N M and Muraszko, K M and Garton, H J and Maher, C O},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {17},
number = {4},
pages = {403--409},
abstract = {OBJECT There is currently no consensus on the safety of sports participation for patients with Chiari I malformation (CM-I). The authors' goal was to define the risk of sports participation for children with the imaging finding of CM-I. METHODS A prospective survey was administered to 503 CM-I patients at 2 sites over a 46-month period. Data were gathered on imaging characteristics, treatment, sports participation, and any sport-related injuries. Additionally, 81 patients completed at least 1 subsequent survey following their initial entry into the registry and were included in a prospective group, with a mean prospective follow-up period of 11 months. RESULTS Of the 503 CM-I patients, 328 participated in sports for a cumulative duration of 4641 seasons; 205 of these patients participated in contact sports. There were no serious or catastrophic neurological injuries. One patient had temporary extremity paresthesias that resolved within hours, and this was not definitely considered to be related to the CM-I. In the prospective cohort, there were no permanent neurological injuries. CONCLUSIONS No permanent or catastrophic neurological injuries were observed in CM-I patients participating in athletic activities. The authors believe that the risk of such injuries is low and that, in most cases, sports participation by children with CM-I is safe.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
van der Horn, H J; Liemburg, E J; Scheenen, M E; de Koning, M E; Marsman, J B; Spikman, J M; van der Naalt, J
Brain network dysregulation, emotion, and complaints after mild traumatic brain injury Journal Article
In: Human Brain Mapping, vol. 37, no. 4, pp. 1645–1654, 2016.
@article{VanderHorn2016,
title = {Brain network dysregulation, emotion, and complaints after mild traumatic brain injury},
author = {van der Horn, H J and Liemburg, E J and Scheenen, M E and de Koning, M E and Marsman, J B and Spikman, J M and van der Naalt, J},
year = {2016},
date = {2016-01-01},
journal = {Human Brain Mapping},
volume = {37},
number = {4},
pages = {1645--1654},
abstract = {OBJECTIVES: To assess the role of brain networks in emotion regulation and post-traumatic complaints in the sub-acute phase after non-complicated mild traumatic brain injury (mTBI). EXPERIMENTAL DESIGN: Fifty-four patients with mTBI (34 with and 20 without complaints) and 20 healthy controls (group-matched for age, sex, education, and handedness) were included. Resting-state fMRI was performed at four weeks post-injury. Static and dynamic functional connectivity were studied within and between the default mode, executive (frontoparietal and bilateral frontal network), and salience network. The hospital anxiety and depression scale (HADS) was used to measure anxiety (HADS-A) and depression (HADS-D). PRINCIPAL OBSERVATIONS: Regarding within-network functional connectivity, none of the selected brain networks were different between groups. Regarding between-network interactions, patients with complaints exhibited lower functional connectivity between the bilateral frontal and salience network compared to patients without complaints. In the total patient group, higher HADS-D scores were related to lower functional connectivity between the bilateral frontal network and both the right frontoparietal and salience network, and to higher connectivity between the right frontoparietal and salience network. Furthermore, whereas higher HADS-D scores were associated with lower connectivity within the parietal midline areas of the bilateral frontal network, higher HADS-A scores were related to lower connectivity within medial prefrontal areas of the bilateral frontal network. CONCLUSIONS: Functional interactions of the executive and salience networks were related to emotion regulation and complaints after mTBI, with a key role for the bilateral frontal network. These findings may have implications for future studies on the effect of psychological interventions.Copyright © 2016 Wiley Periodicals, Inc.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Subbian, V; Ratcliff, J J; Korfhagen, J J; Hart, K W; Meunier, J M; Shaw, G J; Lindsell, C J; Beyette Jr., F R
A Novel Tool for Evaluation of Mild Traumatic Brain Injury Patients in the Emergency Department: Does Robotic Assessment of Neuromotor Performance Following Injury Predict the Presence of Postconcussion Symptoms at Follow-up? Journal Article
In: Academic Emergency Medicine, vol. 23, no. 4, pp. 382–392, 2016.
@article{Subbian2016,
title = {A Novel Tool for Evaluation of Mild Traumatic Brain Injury Patients in the Emergency Department: Does Robotic Assessment of Neuromotor Performance Following Injury Predict the Presence of Postconcussion Symptoms at Follow-up?},
author = {Subbian, V and Ratcliff, J J and Korfhagen, J J and Hart, K W and Meunier, J M and Shaw, G J and Lindsell, C J and {Beyette Jr.}, F R},
year = {2016},
date = {2016-01-01},
journal = {Academic Emergency Medicine},
volume = {23},
number = {4},
pages = {382--392},
abstract = {OBJECTIVES: Postconcussion symptoms (PCS) are a common complication of mild traumatic brain injury (TBI). Currently, there is no validated clinically available method to reliably predict at the time of injury who will subsequently develop PCS. The purpose of this study was to determine if PCS following mild TBI can be predicted during the initial presentation to an emergency department (ED) using a novel robotic-assisted assessment of neurologic function. METHODS: All patients presenting to an urban ED with a chief complaint of head injury within the preceding 24 hours were screened for inclusion from March 2013 to April 2014. The enrollment criteria were as follows: 1) age of 18 years or greater, 2) ability and willingness to provide written informed consent, 3) blunt head trauma and clinical diagnosis of isolated mild TBI by the treating physician, and 4) blood alcohol level of \<100 mg/dL. Eligible mild TBI patients were enrolled and their neuromotor function was assessed in the ED using a battery of five tests that cover a range of proprioceptive, visuomotor, visuospatial, and executive function performance metrics. At 3 weeks postinjury, participants were contacted via telephone to complete the Rivermead Post-Concussion Symptoms Questionnaire to assess the presence of significant PCS. RESULTS: A total of 66 mild TBI patients were enrolled in the study with 42 of them completing both the ED assessment and the follow-up; 40 patients were included in the analyses. The area under the receiver operating characteristic curve (AUC) for the entire test battery was 0.72 (95% confidence interval [CI] = 0.54 to 0.90). The AUC for tests that primarily measure visuomotor and proprioceptive performance were 0.80 (95% CI = 0.65 to 0.95) and 0.71 (95% CI = 0.53 to 0.89), respectively. CONCLUSIONS: The robotic-assisted test battery has the ability to discriminate between subjects who developed PCS and those who did not. Additionally, poor visuomotor and proprioceptive performance were most strongly associated with subsequent PCS.Copyright © 2016 by the Society for Academic Emergency Medicine.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Strahle, J; Selzer, B J; Geh, N; Srinivasan, D; Strahle, M; Martinez-Sosa, M; Muraszko, K M; Garton, H J; Maher, C O
Sports participation with arachnoid cysts Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 17, no. 4, pp. 410–417, 2016.
@article{Strahle2016b,
title = {Sports participation with arachnoid cysts},
author = {Strahle, J and Selzer, B J and Geh, N and Srinivasan, D and Strahle, M and Martinez-Sosa, M and Muraszko, K M and Garton, H J and Maher, C O},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {17},
number = {4},
pages = {410--417},
abstract = {OBJECT There is currently no consensus on the safety of sports participation for patients with an intracranial arachnoid cyst (AC). The authors' goal was to define the risk of sports participation for children with this imaging finding. METHODS A survey was prospectively administered to 185 patients with ACs during a 46-month period at a single institution. Cyst size and location, treatment, sports participation, and any injuries were recorded. Eighty patients completed at least 1 subsequent survey following their initial entry into the registry, and these patients were included in a prospective registry with a mean prospective follow-up interval of 15.9 +/- 8.8 months. RESULTS A total 112 patients with ACs participated in 261 sports for a cumulative duration of 4410 months or 1470 seasons. Of these, 94 patients participated in 190 contact sports for a cumulative duration of 2818 months or 939 seasons. There were no serious or catastrophic neurological injuries. Two patients presented with symptomatic subdural hygromas following minor sports injuries. In the prospective cohort, there were no neurological injuries CONCLUSIONS Permanent or catastrophic neurological injuries are very unusual in AC patients who participate in athletic activities. In most cases, sports participation by these patients is safe.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Sung, C W; Chen, K Y; Chiang, Y H; Chiu, W T; Ou, J C; Lee, H C; Tsai, S H; Lin, J W; Yang, C M; Tsai, Y R; Liao, K H; Chen, G S; Li, W J; Wang, J Y
Heart rate variability and serum level of insulin-like growth factor-1 are correlated with symptoms of emotional disorders in patients suffering a mild traumatic brain injury Journal Article
In: Clinical Neurophysiology, vol. 127, no. 2, pp. 1629–1638, 2016.
@article{Sung2016,
title = {Heart rate variability and serum level of insulin-like growth factor-1 are correlated with symptoms of emotional disorders in patients suffering a mild traumatic brain injury},
author = {Sung, C W and Chen, K Y and Chiang, Y H and Chiu, W T and Ou, J C and Lee, H C and Tsai, S H and Lin, J W and Yang, C M and Tsai, Y R and Liao, K H and Chen, G S and Li, W J and Wang, J Y},
year = {2016},
date = {2016-01-01},
journal = {Clinical Neurophysiology},
volume = {127},
number = {2},
pages = {1629--1638},
abstract = {OBJECTIVE: Patients who have experienced a mild traumatic brain injury (mTBI) are susceptible to symptoms of anxiety or depression. To explore the potential biomarkers for emotional disorders in mTBI patients, we analyzed the frequency domain of heart rate variability (HRV) and serum concentrations of four neurohormones. METHODS: We assessed mTBI patients on their first visit and follow-up. Symptoms were evaluated by the Beck Anxiety Inventory and the Beck Depression Inventory, respectively. Serum levels of adrenocorticotropic hormone (ACTH), melatonin, cortisol, and insulin-like growth factor (IGF)-1 and HRV follow-ups were measured and compared. RESULTS: mTBI patients were more vulnerable to symptoms of anxiety or depression than healthy controls. Reduced HRV was noted in mTBI patients compared to healthy controls. The mTBI patients demonstrated higher serum levels of ACTH, lower IGF-1 compared to healthy controls. In correlation analysis, only IGF-1 was positively correlated with HRV in mTBI patients. Both HRV and IGF-1 were correlated with symptom of depression while only HRV was correlated with symptom of anxiety in mTBI patients. CONCLUSIONS: We infer that HRV may be more significantly correlated with emotional disorders than is IGF-1 in mTBI patients. SIGNIFICANCE: The study is relevant for specific diagnostic markers in mTBI patients.Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Zemek, R; Barrowman, N; Freedman, S B; Gravel, J; Gagnon, I; McGahern, C; Aglipay, M; Sangha, G; Boutis, K; Beer, D; Craig, W; Burns, E; Farion, K J; Mikrogianakis, A; Barlow, K; Dubrovsky, A S; Meeuwisse, W; Gioia, G; Meehan 3rd, W P; Beauchamp, M H; Kamil, Y; Grool, A M; Hoshizaki, B; Anderson, P; Brooks, B L; Yeates, K O; Vassilyadi, M; Klassen, T; Keightley, M; Richer, L; DeMatteo, C; Osmond, M H; Pediatric Emergency Research Canada Concussion, Team
Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED Journal Article
In: JAMA, vol. 315, no. 10, pp. 1014–1025, 2016.
@article{Zemek2016,
title = {Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED},
author = {Zemek, R and Barrowman, N and Freedman, S B and Gravel, J and Gagnon, I and McGahern, C and Aglipay, M and Sangha, G and Boutis, K and Beer, D and Craig, W and Burns, E and Farion, K J and Mikrogianakis, A and Barlow, K and Dubrovsky, A S and Meeuwisse, W and Gioia, G and {Meehan 3rd}, W P and Beauchamp, M H and Kamil, Y and Grool, A M and Hoshizaki, B and Anderson, P and Brooks, B L and Yeates, K O and Vassilyadi, M and Klassen, T and Keightley, M and Richer, L and DeMatteo, C and Osmond, M H and {Pediatric Emergency Research Canada Concussion}, Team},
year = {2016},
date = {2016-01-01},
journal = {JAMA},
volume = {315},
number = {10},
pages = {1014--1025},
abstract = {IMPORTANCE: Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent postconcussion symptoms (PPCS). However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist. OBJECTIVE: To derive and validate a clinical risk score for PPCS among children presenting to the emergency department. DESIGN, SETTING, AND PARTICIPANTS: Prospective, multicenter cohort study (Predicting and Preventing Postconcussive Problems in Pediatrics [5P]) enrolled young patients (aged 5-\<18 years) who presented within 48 hours of an acute head injury at 1 of 9 pediatric emergency departments within the Pediatric Emergency Research Canada (PERC) network from August 2013 through September 2014 (derivation cohort) and from October 2014 through June 2015 (validation cohort). Participants completed follow-up 28 days after the injury. EXPOSURES: All eligible patients had concussions consistent with the Zurich consensus diagnostic criteria. MAIN OUTCOMES AND MEASURES: The primary outcome was PPCS risk score at 28 days, which was defined as 3 or more new or worsening symptoms using the patient-reported Postconcussion Symptom Inventory compared with recalled state of being prior to the injury. RESULTS: In total, 3063 patients (median age, 12.0 years [interquartile range, 9.2-14.6 years]; 1205 [39.3%] girls) were enrolled (n=2006 in the derivation cohort; n=1057 in the validation cohort) and 2584 of whom (n=1701 [85%] in the derivation cohort; n=883 [84%] in the validation cohort) completed follow-up at 28 days after the injury. Persistent postconcussion symptoms were present in 801 patients (31.0%) (n=510 [30.0%] in the derivation cohort and n=291 [33.0%] in the validation cohort). The 12-point PPCS risk score model for the derivation cohort included the variables of female sex, age of 13 years or older, physician-diagnosed migraine history, prior concussion with symptoms lasting longer than 1 week, headache, sensitivity to noise, fatigue, answering questions slowly, and 4 or more errors on the Balance Error Scoring System tandem stance. The area under the curve was 0.71 (95% CI, 0.69-0.74) for the derivation cohort and 0.68 (95% CI, 0.65-0.72) for the validation cohort. CONCLUSIONS AND RELEVANCE: A clinical risk score developed among children presenting to the emergency department with concussion and head injury within the previous 48 hours had modest discrimination to stratify PPCS risk at 28 days. Before this score is adopted in clinical practice, further research is needed for external validation, assessment of accuracy in an office setting, and determination of clinical utility.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Baker, J G; Leddy, J J; Darling, S R; Rieger, B P; Mashtare, T L; Sharma, T; Willer, B S
Factors Associated with Problems for Adolescents Returning to the Classroom after Sport-Related Concussion Journal Article
In: Clinical Pediatrics, vol. 54, no. 10, pp. 961–968, 2015.
@article{Baker2015,
title = {Factors Associated with Problems for Adolescents Returning to the Classroom after Sport-Related Concussion},
author = {Baker, J G and Leddy, J J and Darling, S R and Rieger, B P and Mashtare, T L and Sharma, T and Willer, B S},
doi = {10.1177/0009922815588820},
year = {2015},
date = {2015-01-01},
journal = {Clinical Pediatrics},
volume = {54},
number = {10},
pages = {961--968},
abstract = {The primary objective of this study was to determine factors in the clinic setting associated with concussion-related problems in the school setting. A total of 91 student athletes, 13 to 19 years old, completed the SCAT2 and computerized testing during their initial visit to the clinic. During a follow-up telephone interview, one-third reported problems with return to school. The presence of problems reported in school was associated with severity of concussion as represented by recovery time and the overall number of symptoms at the first clinic visit. Gender, age, and previous concussions were not associated with school problems. Athletes with computerized test scores below the ninth percentile were more likely to report school problems. The current study offers some descriptive information for clinicians and ideas for future research related to adolescent athletes with concussion and problems with return to the classroom. © SAGE Publications.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Ellis, M J; Leiter, J; Hall, T; McDonald, P J; Sawyer, S; Silver, N; Bunge, M; Essig, M
Neuroimaging findings in pediatric sports-related concussion Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 16, no. 3, pp. 241–247, 2015.
@article{Ellis2015b,
title = {Neuroimaging findings in pediatric sports-related concussion},
author = {Ellis, M J and Leiter, J and Hall, T and McDonald, P J and Sawyer, S and Silver, N and Bunge, M and Essig, M},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {16},
number = {3},
pages = {241--247},
abstract = {OBJECT: The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program. METHODS: The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age \< 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board. RESULTS: A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient). CONCLUSIONS: Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Mayer, A R; Ling, J M; Dodd, A B; Gasparovic, C; Klimaj, S D; Meier, T B
A Longitudinal Assessment of Structural and Chemical Alterations in Mixed Martial Arts Fighters Journal Article
In: Journal of Neurotrauma, vol. 32, no. 22, pp. 1759–1767, 2015.
@article{Mayer2015b,
title = {A Longitudinal Assessment of Structural and Chemical Alterations in Mixed Martial Arts Fighters},
author = {Mayer, A R and Ling, J M and Dodd, A B and Gasparovic, C and Klimaj, S D and Meier, T B},
doi = {10.1089/neu.2014.3833},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurotrauma},
volume = {32},
number = {22},
pages = {1759--1767},
abstract = {Growing evidence suggests that temporally proximal acute concussions and repetitive subconcussive head injuries may lead to long-term neurological deficits. However, the underlying mechanisms of injury and their relative time-scales are not well documented in human injury models. The current study therefore investigated whether biomarkers of brain chemistry (magnetic resonance [MR] spectroscopy: N-acetylaspartate [NAA], combined glutamate and glutamine [Glx], total creatine [Cre], choline compounds [Cho], and myo-inositol [mI]) and structure (cortical thickness, white matter [WM]/subcortical volume) differed between mixed martial artists (MMA; n = 13) and matched healthy controls (HC) without a history of contact sport participation (HC; n = 14). A subset of participants (MMA = 9; HC = 10) returned for follow-up visits, with MMA (n = 3) with clinician-documented acute concussions also scanned serially. As expected, MMA self-reported a higher incidence of previous concussions and significantly more cognitive symptoms during prior concussion recovery. Fighters also exhibited reduced memory and processing speed relative to controls on neuropsychological testing coupled with cortical thinning in the left posterior cingulate gyrus and right occipital cortex at baseline assessment. Over a 1-year follow-up period, MMA experienced a significant decrease in both WM volume and NAA concentration, as well as relative thinning in the left middle and superior frontal gyri. These longitudinal changes did not correlate with self-reported metrics of injury (i.e., fight diary). In contrast, HC did not exhibit significant longitudinal changes over a 4-month follow-up period (p \> 0.05). Collectively, current results provide preliminary evidence of progressive changes in brain chemistry and structure over a relatively short time period in individuals with high exposure to repetitive head hits. These findings require replication in independent samples. © Mary Ann Liebert, Inc. 2015.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Chetelat, G; Eustache, F; Viader, F; De La Sayette, V; Pelerin, A; Mezenge, F; Hannequin, D; Dupuy, B; Baron, J C; Desgranges, B
FDG-PET measurement is more accurate than neuropsychological assessments to predict global cognitive deterioration in patients with mild cognitive impairment Journal Article
In: Neurocase, vol. 11, no. 1, pp. 14–25, 2005.
@article{Chetelat2005,
title = {FDG-PET measurement is more accurate than neuropsychological assessments to predict global cognitive deterioration in patients with mild cognitive impairment},
author = {Chetelat, G and Eustache, F and Viader, F and {De La Sayette}, V and Pelerin, A and Mezenge, F and Hannequin, D and Dupuy, B and Baron, J C and Desgranges, B},
year = {2005},
date = {2005-01-01},
journal = {Neurocase},
volume = {11},
number = {1},
pages = {14--25},
abstract = {The accurate prediction, at a pre-dementia stage of Alzheimer's disease (AD), of the subsequent clinical evolution of patients would be a major breakthrough from both therapeutic and research standpoints. Amnestic mild cognitive impairment (MCI) is presently the most common reference to address the pre-dementia stage of AD. However, previous longitudinal studies on patients with MCI assessing neuropsychological and PET markers of future conversion to AD are sparse and yield discrepant findings, while a comprehensive comparison of the relative accuracy of these two categories of measure is still lacking. In the present study, we assessed the global cognitive decline as measured by the Mattis scale in 18 patients with amnestic MCI over an 18-month follow-up period, studying which subtest of this scale showed significant deterioration over time. Using baseline measurements from neuropsychological evaluation of memory and PET, we then assessed significant markers of global cognitive change, that is, percent annual change in the Mattis scale total score, and searched for the best predictor of this global cognitive decline. Altogether, our results revealed significant decline over the 18-month follow-up period in the total score and the verbal initiation and memory-recall subscores of the Mattis scale. The percent annual change in the total Mattis score significantly correlated with age and baseline performances in delayed episodic memory recall as well as semantic autobiographical and category word fluencies. Regarding functional imaging, significant correlations were also found with baseline PET values in the right temporo-parietal and medial frontal areas. Age and right temporo-parietal PET values were the most significant predictors of subsequent global cognitive decline, and the only ones to survive stepwise regression analyses. Our findings are consistent with previous works showing predominant delayed recall and semantic memory impairment at a pre-dementia stage of AD, as well as early metabolic defects in the temporo-parietal associative cortex. However, they suggest that only the latter predictor is specifically and accurately associated with subsequent cognitive decline in patients with MCI within 18 months of first assessment.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Strahle, J; Geh, N; Selzer, B J; Bower, R; Himedan, M; Strahle, M; Wetjen, N M; Muraszko, K M; Garton, H J; Maher, C O
Sports participation with Chiari I malformation Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 17, no. 4, pp. 403–409, 2016.
Abstract | BibTeX | Tags: *Arnold-Chiari Malformation/ep [Epidemiology], *Athletic Injuries/ep [Epidemiology], *Registries/sn [Statistics & Numerical Data], *Sports/sn [Statistics & Numerical Data], Adolescent, Child, Female, Follow-Up Studies, Humans, Male, Preschool
@article{Strahle2016,
title = {Sports participation with Chiari I malformation},
author = {Strahle, J and Geh, N and Selzer, B J and Bower, R and Himedan, M and Strahle, M and Wetjen, N M and Muraszko, K M and Garton, H J and Maher, C O},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {17},
number = {4},
pages = {403--409},
abstract = {OBJECT There is currently no consensus on the safety of sports participation for patients with Chiari I malformation (CM-I). The authors' goal was to define the risk of sports participation for children with the imaging finding of CM-I. METHODS A prospective survey was administered to 503 CM-I patients at 2 sites over a 46-month period. Data were gathered on imaging characteristics, treatment, sports participation, and any sport-related injuries. Additionally, 81 patients completed at least 1 subsequent survey following their initial entry into the registry and were included in a prospective group, with a mean prospective follow-up period of 11 months. RESULTS Of the 503 CM-I patients, 328 participated in sports for a cumulative duration of 4641 seasons; 205 of these patients participated in contact sports. There were no serious or catastrophic neurological injuries. One patient had temporary extremity paresthesias that resolved within hours, and this was not definitely considered to be related to the CM-I. In the prospective cohort, there were no permanent neurological injuries. CONCLUSIONS No permanent or catastrophic neurological injuries were observed in CM-I patients participating in athletic activities. The authors believe that the risk of such injuries is low and that, in most cases, sports participation by children with CM-I is safe.},
keywords = {*Arnold-Chiari Malformation/ep [Epidemiology], *Athletic Injuries/ep [Epidemiology], *Registries/sn [Statistics \& Numerical Data], *Sports/sn [Statistics \& Numerical Data], Adolescent, Child, Female, Follow-Up Studies, Humans, Male, Preschool},
pubstate = {published},
tppubtype = {article}
}
van der Horn, H J; Liemburg, E J; Scheenen, M E; de Koning, M E; Marsman, J B; Spikman, J M; van der Naalt, J
Brain network dysregulation, emotion, and complaints after mild traumatic brain injury Journal Article
In: Human Brain Mapping, vol. 37, no. 4, pp. 1645–1654, 2016.
Abstract | BibTeX | Tags: *Brain Concussion/pp [Physiopathology], *Brain/pp [Physiopathology], *Emotions, *MAGNETIC resonance imaging, *Nerve Net/pp [Physiopathology], Adolescent, adult, Brain Concussion/px [Psychology], Emotions/ph [Physiology], Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging/mt [Methods], Male, middle aged, Prospective Studies, Young Adult
@article{VanderHorn2016,
title = {Brain network dysregulation, emotion, and complaints after mild traumatic brain injury},
author = {van der Horn, H J and Liemburg, E J and Scheenen, M E and de Koning, M E and Marsman, J B and Spikman, J M and van der Naalt, J},
year = {2016},
date = {2016-01-01},
journal = {Human Brain Mapping},
volume = {37},
number = {4},
pages = {1645--1654},
abstract = {OBJECTIVES: To assess the role of brain networks in emotion regulation and post-traumatic complaints in the sub-acute phase after non-complicated mild traumatic brain injury (mTBI). EXPERIMENTAL DESIGN: Fifty-four patients with mTBI (34 with and 20 without complaints) and 20 healthy controls (group-matched for age, sex, education, and handedness) were included. Resting-state fMRI was performed at four weeks post-injury. Static and dynamic functional connectivity were studied within and between the default mode, executive (frontoparietal and bilateral frontal network), and salience network. The hospital anxiety and depression scale (HADS) was used to measure anxiety (HADS-A) and depression (HADS-D). PRINCIPAL OBSERVATIONS: Regarding within-network functional connectivity, none of the selected brain networks were different between groups. Regarding between-network interactions, patients with complaints exhibited lower functional connectivity between the bilateral frontal and salience network compared to patients without complaints. In the total patient group, higher HADS-D scores were related to lower functional connectivity between the bilateral frontal network and both the right frontoparietal and salience network, and to higher connectivity between the right frontoparietal and salience network. Furthermore, whereas higher HADS-D scores were associated with lower connectivity within the parietal midline areas of the bilateral frontal network, higher HADS-A scores were related to lower connectivity within medial prefrontal areas of the bilateral frontal network. CONCLUSIONS: Functional interactions of the executive and salience networks were related to emotion regulation and complaints after mTBI, with a key role for the bilateral frontal network. These findings may have implications for future studies on the effect of psychological interventions.Copyright © 2016 Wiley Periodicals, Inc.},
keywords = {*Brain Concussion/pp [Physiopathology], *Brain/pp [Physiopathology], *Emotions, *MAGNETIC resonance imaging, *Nerve Net/pp [Physiopathology], Adolescent, adult, Brain Concussion/px [Psychology], Emotions/ph [Physiology], Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging/mt [Methods], Male, middle aged, Prospective Studies, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Subbian, V; Ratcliff, J J; Korfhagen, J J; Hart, K W; Meunier, J M; Shaw, G J; Lindsell, C J; Beyette Jr., F R
A Novel Tool for Evaluation of Mild Traumatic Brain Injury Patients in the Emergency Department: Does Robotic Assessment of Neuromotor Performance Following Injury Predict the Presence of Postconcussion Symptoms at Follow-up? Journal Article
In: Academic Emergency Medicine, vol. 23, no. 4, pp. 382–392, 2016.
Abstract | BibTeX | Tags: *Brain Injuries/co [Complications], *Emergency Service, *Post-Concussion Syndrome/di [Diagnosis], *Post-Concussion Syndrome/et [Etiology], *Robotics/mt [Methods], adult, Closed/co [Complications], Diagnostic Techniques, Female, Follow-Up Studies, Head Injuries, Hospital/og [Organization & Ad, Humans, Male, middle aged, Neurological, Observer Variation, Sensitivity and Specificity, Urban Population, Young Adult
@article{Subbian2016,
title = {A Novel Tool for Evaluation of Mild Traumatic Brain Injury Patients in the Emergency Department: Does Robotic Assessment of Neuromotor Performance Following Injury Predict the Presence of Postconcussion Symptoms at Follow-up?},
author = {Subbian, V and Ratcliff, J J and Korfhagen, J J and Hart, K W and Meunier, J M and Shaw, G J and Lindsell, C J and {Beyette Jr.}, F R},
year = {2016},
date = {2016-01-01},
journal = {Academic Emergency Medicine},
volume = {23},
number = {4},
pages = {382--392},
abstract = {OBJECTIVES: Postconcussion symptoms (PCS) are a common complication of mild traumatic brain injury (TBI). Currently, there is no validated clinically available method to reliably predict at the time of injury who will subsequently develop PCS. The purpose of this study was to determine if PCS following mild TBI can be predicted during the initial presentation to an emergency department (ED) using a novel robotic-assisted assessment of neurologic function. METHODS: All patients presenting to an urban ED with a chief complaint of head injury within the preceding 24 hours were screened for inclusion from March 2013 to April 2014. The enrollment criteria were as follows: 1) age of 18 years or greater, 2) ability and willingness to provide written informed consent, 3) blunt head trauma and clinical diagnosis of isolated mild TBI by the treating physician, and 4) blood alcohol level of \<100 mg/dL. Eligible mild TBI patients were enrolled and their neuromotor function was assessed in the ED using a battery of five tests that cover a range of proprioceptive, visuomotor, visuospatial, and executive function performance metrics. At 3 weeks postinjury, participants were contacted via telephone to complete the Rivermead Post-Concussion Symptoms Questionnaire to assess the presence of significant PCS. RESULTS: A total of 66 mild TBI patients were enrolled in the study with 42 of them completing both the ED assessment and the follow-up; 40 patients were included in the analyses. The area under the receiver operating characteristic curve (AUC) for the entire test battery was 0.72 (95% confidence interval [CI] = 0.54 to 0.90). The AUC for tests that primarily measure visuomotor and proprioceptive performance were 0.80 (95% CI = 0.65 to 0.95) and 0.71 (95% CI = 0.53 to 0.89), respectively. CONCLUSIONS: The robotic-assisted test battery has the ability to discriminate between subjects who developed PCS and those who did not. Additionally, poor visuomotor and proprioceptive performance were most strongly associated with subsequent PCS.Copyright © 2016 by the Society for Academic Emergency Medicine.},
keywords = {*Brain Injuries/co [Complications], *Emergency Service, *Post-Concussion Syndrome/di [Diagnosis], *Post-Concussion Syndrome/et [Etiology], *Robotics/mt [Methods], adult, Closed/co [Complications], Diagnostic Techniques, Female, Follow-Up Studies, Head Injuries, Hospital/og [Organization \& Ad, Humans, Male, middle aged, Neurological, Observer Variation, Sensitivity and Specificity, Urban Population, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Strahle, J; Selzer, B J; Geh, N; Srinivasan, D; Strahle, M; Martinez-Sosa, M; Muraszko, K M; Garton, H J; Maher, C O
Sports participation with arachnoid cysts Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 17, no. 4, pp. 410–417, 2016.
Abstract | BibTeX | Tags: *Arachnoid Cysts/ep [Epidemiology], *Athletic Injuries/ep [Epidemiology], *Registries/sn [Statistics & Numerical Data], *Sports/sn [Statistics & Numerical Data], Adolescent, Child, Female, Follow-Up Studies, Humans, Male
@article{Strahle2016b,
title = {Sports participation with arachnoid cysts},
author = {Strahle, J and Selzer, B J and Geh, N and Srinivasan, D and Strahle, M and Martinez-Sosa, M and Muraszko, K M and Garton, H J and Maher, C O},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {17},
number = {4},
pages = {410--417},
abstract = {OBJECT There is currently no consensus on the safety of sports participation for patients with an intracranial arachnoid cyst (AC). The authors' goal was to define the risk of sports participation for children with this imaging finding. METHODS A survey was prospectively administered to 185 patients with ACs during a 46-month period at a single institution. Cyst size and location, treatment, sports participation, and any injuries were recorded. Eighty patients completed at least 1 subsequent survey following their initial entry into the registry, and these patients were included in a prospective registry with a mean prospective follow-up interval of 15.9 +/- 8.8 months. RESULTS A total 112 patients with ACs participated in 261 sports for a cumulative duration of 4410 months or 1470 seasons. Of these, 94 patients participated in 190 contact sports for a cumulative duration of 2818 months or 939 seasons. There were no serious or catastrophic neurological injuries. Two patients presented with symptomatic subdural hygromas following minor sports injuries. In the prospective cohort, there were no neurological injuries CONCLUSIONS Permanent or catastrophic neurological injuries are very unusual in AC patients who participate in athletic activities. In most cases, sports participation by these patients is safe.},
keywords = {*Arachnoid Cysts/ep [Epidemiology], *Athletic Injuries/ep [Epidemiology], *Registries/sn [Statistics \& Numerical Data], *Sports/sn [Statistics \& Numerical Data], Adolescent, Child, Female, Follow-Up Studies, Humans, Male},
pubstate = {published},
tppubtype = {article}
}
Sung, C W; Chen, K Y; Chiang, Y H; Chiu, W T; Ou, J C; Lee, H C; Tsai, S H; Lin, J W; Yang, C M; Tsai, Y R; Liao, K H; Chen, G S; Li, W J; Wang, J Y
Heart rate variability and serum level of insulin-like growth factor-1 are correlated with symptoms of emotional disorders in patients suffering a mild traumatic brain injury Journal Article
In: Clinical Neurophysiology, vol. 127, no. 2, pp. 1629–1638, 2016.
Abstract | BibTeX | Tags: *Anxiety/bl [Blood], *Brain Injuries/bl [Blood], *Depression/bl [Blood], *Heart Rate/ph [Physiology], *Insulin-Like Growth Factor I/me [Metabolism], 0 (Biomarkers), 67763-96-6 (Insulin-Like Growth Factor I), adult, Affective Symptoms/bl [Blood], Affective Symptoms/di [Diagnosis], Affective Symptoms/px [Psychology], Anxiety/di [Diagnosis], Anxiety/px [Psychology], Biomarkers/bl [Blood], Brain Injuries/di [Diagnosis], Brain Injuries/px [Psychology], Cohort Studies, Depression/di [Diagnosis], Depression/px [Psychology], Female, Follow-Up Studies, Humans, Male, middle aged, Mood Disorders/bl [Blood], Mood Disorders/di [Diagnosis], Mood Disorders/px [Psychology], Young Adult
@article{Sung2016,
title = {Heart rate variability and serum level of insulin-like growth factor-1 are correlated with symptoms of emotional disorders in patients suffering a mild traumatic brain injury},
author = {Sung, C W and Chen, K Y and Chiang, Y H and Chiu, W T and Ou, J C and Lee, H C and Tsai, S H and Lin, J W and Yang, C M and Tsai, Y R and Liao, K H and Chen, G S and Li, W J and Wang, J Y},
year = {2016},
date = {2016-01-01},
journal = {Clinical Neurophysiology},
volume = {127},
number = {2},
pages = {1629--1638},
abstract = {OBJECTIVE: Patients who have experienced a mild traumatic brain injury (mTBI) are susceptible to symptoms of anxiety or depression. To explore the potential biomarkers for emotional disorders in mTBI patients, we analyzed the frequency domain of heart rate variability (HRV) and serum concentrations of four neurohormones. METHODS: We assessed mTBI patients on their first visit and follow-up. Symptoms were evaluated by the Beck Anxiety Inventory and the Beck Depression Inventory, respectively. Serum levels of adrenocorticotropic hormone (ACTH), melatonin, cortisol, and insulin-like growth factor (IGF)-1 and HRV follow-ups were measured and compared. RESULTS: mTBI patients were more vulnerable to symptoms of anxiety or depression than healthy controls. Reduced HRV was noted in mTBI patients compared to healthy controls. The mTBI patients demonstrated higher serum levels of ACTH, lower IGF-1 compared to healthy controls. In correlation analysis, only IGF-1 was positively correlated with HRV in mTBI patients. Both HRV and IGF-1 were correlated with symptom of depression while only HRV was correlated with symptom of anxiety in mTBI patients. CONCLUSIONS: We infer that HRV may be more significantly correlated with emotional disorders than is IGF-1 in mTBI patients. SIGNIFICANCE: The study is relevant for specific diagnostic markers in mTBI patients.Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.},
keywords = {*Anxiety/bl [Blood], *Brain Injuries/bl [Blood], *Depression/bl [Blood], *Heart Rate/ph [Physiology], *Insulin-Like Growth Factor I/me [Metabolism], 0 (Biomarkers), 67763-96-6 (Insulin-Like Growth Factor I), adult, Affective Symptoms/bl [Blood], Affective Symptoms/di [Diagnosis], Affective Symptoms/px [Psychology], Anxiety/di [Diagnosis], Anxiety/px [Psychology], Biomarkers/bl [Blood], Brain Injuries/di [Diagnosis], Brain Injuries/px [Psychology], Cohort Studies, Depression/di [Diagnosis], Depression/px [Psychology], Female, Follow-Up Studies, Humans, Male, middle aged, Mood Disorders/bl [Blood], Mood Disorders/di [Diagnosis], Mood Disorders/px [Psychology], Young Adult},
pubstate = {published},
tppubtype = {article}
}
Zemek, R; Barrowman, N; Freedman, S B; Gravel, J; Gagnon, I; McGahern, C; Aglipay, M; Sangha, G; Boutis, K; Beer, D; Craig, W; Burns, E; Farion, K J; Mikrogianakis, A; Barlow, K; Dubrovsky, A S; Meeuwisse, W; Gioia, G; Meehan 3rd, W P; Beauchamp, M H; Kamil, Y; Grool, A M; Hoshizaki, B; Anderson, P; Brooks, B L; Yeates, K O; Vassilyadi, M; Klassen, T; Keightley, M; Richer, L; DeMatteo, C; Osmond, M H; Pediatric Emergency Research Canada Concussion, Team
Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED Journal Article
In: JAMA, vol. 315, no. 10, pp. 1014–1025, 2016.
Abstract | BibTeX | Tags: *Post-Concussion Syndrome/di [Diagnosis], Accidents, Adolescent, Age Factors, Area Under Curve, Athletic Injuries/co [Complications], Brain Concussion/di [Diagnosis], Brain Concussion/et [Etiology], Child, Emergency Service, Female, Follow-Up Studies, Hospital, Humans, Male, MEDICAL history taking, MULTIVARIATE analysis, Observer Variation, Outcome Assessment (Health Care), Post-Concussion Syndrome/et [Etiology], Preschool, Prospective Studies, RISK assessment, Sensitivity and Specificity, Sex Factors, Time Factors, Traffic/sn [Statistics & Numerical Data
@article{Zemek2016,
title = {Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED},
author = {Zemek, R and Barrowman, N and Freedman, S B and Gravel, J and Gagnon, I and McGahern, C and Aglipay, M and Sangha, G and Boutis, K and Beer, D and Craig, W and Burns, E and Farion, K J and Mikrogianakis, A and Barlow, K and Dubrovsky, A S and Meeuwisse, W and Gioia, G and {Meehan 3rd}, W P and Beauchamp, M H and Kamil, Y and Grool, A M and Hoshizaki, B and Anderson, P and Brooks, B L and Yeates, K O and Vassilyadi, M and Klassen, T and Keightley, M and Richer, L and DeMatteo, C and Osmond, M H and {Pediatric Emergency Research Canada Concussion}, Team},
year = {2016},
date = {2016-01-01},
journal = {JAMA},
volume = {315},
number = {10},
pages = {1014--1025},
abstract = {IMPORTANCE: Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent postconcussion symptoms (PPCS). However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist. OBJECTIVE: To derive and validate a clinical risk score for PPCS among children presenting to the emergency department. DESIGN, SETTING, AND PARTICIPANTS: Prospective, multicenter cohort study (Predicting and Preventing Postconcussive Problems in Pediatrics [5P]) enrolled young patients (aged 5-\<18 years) who presented within 48 hours of an acute head injury at 1 of 9 pediatric emergency departments within the Pediatric Emergency Research Canada (PERC) network from August 2013 through September 2014 (derivation cohort) and from October 2014 through June 2015 (validation cohort). Participants completed follow-up 28 days after the injury. EXPOSURES: All eligible patients had concussions consistent with the Zurich consensus diagnostic criteria. MAIN OUTCOMES AND MEASURES: The primary outcome was PPCS risk score at 28 days, which was defined as 3 or more new or worsening symptoms using the patient-reported Postconcussion Symptom Inventory compared with recalled state of being prior to the injury. RESULTS: In total, 3063 patients (median age, 12.0 years [interquartile range, 9.2-14.6 years]; 1205 [39.3%] girls) were enrolled (n=2006 in the derivation cohort; n=1057 in the validation cohort) and 2584 of whom (n=1701 [85%] in the derivation cohort; n=883 [84%] in the validation cohort) completed follow-up at 28 days after the injury. Persistent postconcussion symptoms were present in 801 patients (31.0%) (n=510 [30.0%] in the derivation cohort and n=291 [33.0%] in the validation cohort). The 12-point PPCS risk score model for the derivation cohort included the variables of female sex, age of 13 years or older, physician-diagnosed migraine history, prior concussion with symptoms lasting longer than 1 week, headache, sensitivity to noise, fatigue, answering questions slowly, and 4 or more errors on the Balance Error Scoring System tandem stance. The area under the curve was 0.71 (95% CI, 0.69-0.74) for the derivation cohort and 0.68 (95% CI, 0.65-0.72) for the validation cohort. CONCLUSIONS AND RELEVANCE: A clinical risk score developed among children presenting to the emergency department with concussion and head injury within the previous 48 hours had modest discrimination to stratify PPCS risk at 28 days. Before this score is adopted in clinical practice, further research is needed for external validation, assessment of accuracy in an office setting, and determination of clinical utility.},
keywords = {*Post-Concussion Syndrome/di [Diagnosis], Accidents, Adolescent, Age Factors, Area Under Curve, Athletic Injuries/co [Complications], Brain Concussion/di [Diagnosis], Brain Concussion/et [Etiology], Child, Emergency Service, Female, Follow-Up Studies, Hospital, Humans, Male, MEDICAL history taking, MULTIVARIATE analysis, Observer Variation, Outcome Assessment (Health Care), Post-Concussion Syndrome/et [Etiology], Preschool, Prospective Studies, RISK assessment, Sensitivity and Specificity, Sex Factors, Time Factors, Traffic/sn [Statistics \& Numerical Data},
pubstate = {published},
tppubtype = {article}
}
Baker, J G; Leddy, J J; Darling, S R; Rieger, B P; Mashtare, T L; Sharma, T; Willer, B S
Factors Associated with Problems for Adolescents Returning to the Classroom after Sport-Related Concussion Journal Article
In: Clinical Pediatrics, vol. 54, no. 10, pp. 961–968, 2015.
Abstract | Links | BibTeX | Tags: Absenteeism, Adolescent, adolescent disease, adult, Article, athlete, Athletic Injuries, brain concussion, computer testing, Concussion, disease association, disease severity, Female, follow up, Follow-Up Studies, health service, human, Humans, interview, Interviews as Topic, Logistic Models, major clinical study, Male, Pathophysiology, receiver operating characteristic, recovery time, Recurrence, recurrent disease, return to learn, ROC Curve, school, school problems, sport injury, Sport-related concussion, statistical model, Symptoms, telephone interview, Young Adult
@article{Baker2015,
title = {Factors Associated with Problems for Adolescents Returning to the Classroom after Sport-Related Concussion},
author = {Baker, J G and Leddy, J J and Darling, S R and Rieger, B P and Mashtare, T L and Sharma, T and Willer, B S},
doi = {10.1177/0009922815588820},
year = {2015},
date = {2015-01-01},
journal = {Clinical Pediatrics},
volume = {54},
number = {10},
pages = {961--968},
abstract = {The primary objective of this study was to determine factors in the clinic setting associated with concussion-related problems in the school setting. A total of 91 student athletes, 13 to 19 years old, completed the SCAT2 and computerized testing during their initial visit to the clinic. During a follow-up telephone interview, one-third reported problems with return to school. The presence of problems reported in school was associated with severity of concussion as represented by recovery time and the overall number of symptoms at the first clinic visit. Gender, age, and previous concussions were not associated with school problems. Athletes with computerized test scores below the ninth percentile were more likely to report school problems. The current study offers some descriptive information for clinicians and ideas for future research related to adolescent athletes with concussion and problems with return to the classroom. © SAGE Publications.},
keywords = {Absenteeism, Adolescent, adolescent disease, adult, Article, athlete, Athletic Injuries, brain concussion, computer testing, Concussion, disease association, disease severity, Female, follow up, Follow-Up Studies, health service, human, Humans, interview, Interviews as Topic, Logistic Models, major clinical study, Male, Pathophysiology, receiver operating characteristic, recovery time, Recurrence, recurrent disease, return to learn, ROC Curve, school, school problems, sport injury, Sport-related concussion, statistical model, Symptoms, telephone interview, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Ellis, M J; Leiter, J; Hall, T; McDonald, P J; Sawyer, S; Silver, N; Bunge, M; Essig, M
Neuroimaging findings in pediatric sports-related concussion Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 16, no. 3, pp. 241–247, 2015.
Abstract | BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Brain Concussion/et [Etiology], *Neuroimaging, Adolescent, Arachnoid Cysts/di [Diagnosis], Athletic Injuries/co [Complications], Athletic Injuries/pa [Pathology], Brain Concussion/pa [Pathology], Brain Injuries/di [Diagnosis], Brain Injuries/et [Etiology], Child, Contusions/di [Diagnosis], Dizziness/et [Etiology], Female, Follow-Up Studies, Headache/et [Etiology], Humans, Intracranial Hemorrhages/di [Diagnosis], Magnetic Resonance Imaging, Male, Neuroimaging/mt [Methods], postural balance, Predictive Value of Tests, Retrospective Studies, Skull Fractures/di [Diagnosis], Tomography, Unconsciousness/et [Etiology], X-Ray Computed
@article{Ellis2015b,
title = {Neuroimaging findings in pediatric sports-related concussion},
author = {Ellis, M J and Leiter, J and Hall, T and McDonald, P J and Sawyer, S and Silver, N and Bunge, M and Essig, M},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {16},
number = {3},
pages = {241--247},
abstract = {OBJECT: The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program. METHODS: The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age \< 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board. RESULTS: A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient). CONCLUSIONS: Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.},
keywords = {*Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Brain Concussion/et [Etiology], *Neuroimaging, Adolescent, Arachnoid Cysts/di [Diagnosis], Athletic Injuries/co [Complications], Athletic Injuries/pa [Pathology], Brain Concussion/pa [Pathology], Brain Injuries/di [Diagnosis], Brain Injuries/et [Etiology], Child, Contusions/di [Diagnosis], Dizziness/et [Etiology], Female, Follow-Up Studies, Headache/et [Etiology], Humans, Intracranial Hemorrhages/di [Diagnosis], Magnetic Resonance Imaging, Male, Neuroimaging/mt [Methods], postural balance, Predictive Value of Tests, Retrospective Studies, Skull Fractures/di [Diagnosis], Tomography, Unconsciousness/et [Etiology], X-Ray Computed},
pubstate = {published},
tppubtype = {article}
}
Mayer, A R; Ling, J M; Dodd, A B; Gasparovic, C; Klimaj, S D; Meier, T B
A Longitudinal Assessment of Structural and Chemical Alterations in Mixed Martial Arts Fighters Journal Article
In: Journal of Neurotrauma, vol. 32, no. 22, pp. 1759–1767, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, adult, Article, biological marker, Biomarkers, BRAIN chemistry, brain concussion, brain cortex, brain size, Cerebral Cortex, CHOLINE, clinical article, cognition, Concussion, controlled study, cortical thickness (brain), creatine, executive function, Female, follow up, Follow-Up Studies, frontal gyrus, glutamic acid, glutamine, human, Humans, Injuries, inositol, Longitudinal, Longitudinal studies, longitudinal study, Magnetic Resonance Imaging, Male, martial art, Martial Arts, Memory, middle aged, mixed martial art, n acetylaspartic acid, neuropsychological test, Neuropsychological Tests, nuclear magnetic resonance imaging, NUCLEAR magnetic resonance spectroscopy, occipital cortex, pathology, posterior cingulate, psychology, repetitive injury, Spectroscopy, volumetrics, white matter, Young Adult
@article{Mayer2015b,
title = {A Longitudinal Assessment of Structural and Chemical Alterations in Mixed Martial Arts Fighters},
author = {Mayer, A R and Ling, J M and Dodd, A B and Gasparovic, C and Klimaj, S D and Meier, T B},
doi = {10.1089/neu.2014.3833},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurotrauma},
volume = {32},
number = {22},
pages = {1759--1767},
abstract = {Growing evidence suggests that temporally proximal acute concussions and repetitive subconcussive head injuries may lead to long-term neurological deficits. However, the underlying mechanisms of injury and their relative time-scales are not well documented in human injury models. The current study therefore investigated whether biomarkers of brain chemistry (magnetic resonance [MR] spectroscopy: N-acetylaspartate [NAA], combined glutamate and glutamine [Glx], total creatine [Cre], choline compounds [Cho], and myo-inositol [mI]) and structure (cortical thickness, white matter [WM]/subcortical volume) differed between mixed martial artists (MMA; n = 13) and matched healthy controls (HC) without a history of contact sport participation (HC; n = 14). A subset of participants (MMA = 9; HC = 10) returned for follow-up visits, with MMA (n = 3) with clinician-documented acute concussions also scanned serially. As expected, MMA self-reported a higher incidence of previous concussions and significantly more cognitive symptoms during prior concussion recovery. Fighters also exhibited reduced memory and processing speed relative to controls on neuropsychological testing coupled with cortical thinning in the left posterior cingulate gyrus and right occipital cortex at baseline assessment. Over a 1-year follow-up period, MMA experienced a significant decrease in both WM volume and NAA concentration, as well as relative thinning in the left middle and superior frontal gyri. These longitudinal changes did not correlate with self-reported metrics of injury (i.e., fight diary). In contrast, HC did not exhibit significant longitudinal changes over a 4-month follow-up period (p \> 0.05). Collectively, current results provide preliminary evidence of progressive changes in brain chemistry and structure over a relatively short time period in individuals with high exposure to repetitive head hits. These findings require replication in independent samples. © Mary Ann Liebert, Inc. 2015.},
keywords = {Adolescent, adult, Article, biological marker, Biomarkers, BRAIN chemistry, brain concussion, brain cortex, brain size, Cerebral Cortex, CHOLINE, clinical article, cognition, Concussion, controlled study, cortical thickness (brain), creatine, executive function, Female, follow up, Follow-Up Studies, frontal gyrus, glutamic acid, glutamine, human, Humans, Injuries, inositol, Longitudinal, Longitudinal studies, longitudinal study, Magnetic Resonance Imaging, Male, martial art, Martial Arts, Memory, middle aged, mixed martial art, n acetylaspartic acid, neuropsychological test, Neuropsychological Tests, nuclear magnetic resonance imaging, NUCLEAR magnetic resonance spectroscopy, occipital cortex, pathology, posterior cingulate, psychology, repetitive injury, Spectroscopy, volumetrics, white matter, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Chetelat, G; Eustache, F; Viader, F; De La Sayette, V; Pelerin, A; Mezenge, F; Hannequin, D; Dupuy, B; Baron, J C; Desgranges, B
FDG-PET measurement is more accurate than neuropsychological assessments to predict global cognitive deterioration in patients with mild cognitive impairment Journal Article
In: Neurocase, vol. 11, no. 1, pp. 14–25, 2005.
Abstract | BibTeX | Tags: *Cognition Disorders/dg [Diagnostic Imaging], *Fluorodeoxyglucose F18, *Neuropsychological Tests, *Positron-Emission Tomography, 0Z5B2CJX4D (Fluorodeoxyglucose F18), 80 and over, aged, ANALYSIS of variance, Brain Concussion/dg [Diagnostic Imaging], Brain Concussion/pa [Pathology], BRAIN mapping, Cognition Disorders/di [Diagnosis], Dementia/dg [Diagnostic Imaging], Dementia/di [Diagnosis], Dementia/pp [Physiopathology], Female, Follow-Up Studies, Humans, Male, Memory/ph [Physiology], Mental Status Schedule, middle aged, Predictive Value of Tests, Regression (Psychology), Reproducibility of Results, Time Factors
@article{Chetelat2005,
title = {FDG-PET measurement is more accurate than neuropsychological assessments to predict global cognitive deterioration in patients with mild cognitive impairment},
author = {Chetelat, G and Eustache, F and Viader, F and {De La Sayette}, V and Pelerin, A and Mezenge, F and Hannequin, D and Dupuy, B and Baron, J C and Desgranges, B},
year = {2005},
date = {2005-01-01},
journal = {Neurocase},
volume = {11},
number = {1},
pages = {14--25},
abstract = {The accurate prediction, at a pre-dementia stage of Alzheimer's disease (AD), of the subsequent clinical evolution of patients would be a major breakthrough from both therapeutic and research standpoints. Amnestic mild cognitive impairment (MCI) is presently the most common reference to address the pre-dementia stage of AD. However, previous longitudinal studies on patients with MCI assessing neuropsychological and PET markers of future conversion to AD are sparse and yield discrepant findings, while a comprehensive comparison of the relative accuracy of these two categories of measure is still lacking. In the present study, we assessed the global cognitive decline as measured by the Mattis scale in 18 patients with amnestic MCI over an 18-month follow-up period, studying which subtest of this scale showed significant deterioration over time. Using baseline measurements from neuropsychological evaluation of memory and PET, we then assessed significant markers of global cognitive change, that is, percent annual change in the Mattis scale total score, and searched for the best predictor of this global cognitive decline. Altogether, our results revealed significant decline over the 18-month follow-up period in the total score and the verbal initiation and memory-recall subscores of the Mattis scale. The percent annual change in the total Mattis score significantly correlated with age and baseline performances in delayed episodic memory recall as well as semantic autobiographical and category word fluencies. Regarding functional imaging, significant correlations were also found with baseline PET values in the right temporo-parietal and medial frontal areas. Age and right temporo-parietal PET values were the most significant predictors of subsequent global cognitive decline, and the only ones to survive stepwise regression analyses. Our findings are consistent with previous works showing predominant delayed recall and semantic memory impairment at a pre-dementia stage of AD, as well as early metabolic defects in the temporo-parietal associative cortex. However, they suggest that only the latter predictor is specifically and accurately associated with subsequent cognitive decline in patients with MCI within 18 months of first assessment.},
keywords = {*Cognition Disorders/dg [Diagnostic Imaging], *Fluorodeoxyglucose F18, *Neuropsychological Tests, *Positron-Emission Tomography, 0Z5B2CJX4D (Fluorodeoxyglucose F18), 80 and over, aged, ANALYSIS of variance, Brain Concussion/dg [Diagnostic Imaging], Brain Concussion/pa [Pathology], BRAIN mapping, Cognition Disorders/di [Diagnosis], Dementia/dg [Diagnostic Imaging], Dementia/di [Diagnosis], Dementia/pp [Physiopathology], Female, Follow-Up Studies, Humans, Male, Memory/ph [Physiology], Mental Status Schedule, middle aged, Predictive Value of Tests, Regression (Psychology), Reproducibility of Results, Time Factors},
pubstate = {published},
tppubtype = {article}
}