autonomic-function-following-concussion-youth-athletes-an-exploration

Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology

Participation in organized sports makes a significant contribution to youth development, but places youth at a higher risk for sustaining a concussion. To ...

Mathematical models may provide a method of describing and predicting the effect of training on performance. The current models attempt to describe the effects of single or multiple bouts of exercise on the performance of a specific task on a given day. These models suggest that any training session increases fitness and provokes a fatigue response. Various methods of quantifying the training stimulus (training impulse, absolute work, psychophysiological rating) and physical performance (criterion scale, arbitrary units) are employed in these models. The models are empirical descriptions and do not use current knowledge regarding the specificity of training adaptations. Tests of these models with published data indicate discrepancies between the predicted and measured time course of physiological adaptations, and between the predicted and measured performance responses to training. The relationship between these models and the underlying physiology requires clarification. New functional models that incorporate specificity of training and known physiology are required to enhance our ability to guide athletic training, rehabilitation and research.

Systems modelling of the relationship between training and performance.

Mild traumatic brain injury (mTBI) is a common but relatively understudied childhood injury that can impact cognitive functioning and development. The present report describes a case study of a 14-year-old boy who sustained two consecutive sports-related mTBIs within a 24 h period. Neurocognitive functioning at 2, 6, 8, 55 and 225 days after injury is compared to baseline prior to injury assessment on the same measures. Results from Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Conner Continuous Performance Test 2 (CPT-II) and the Attention Network Test (ANT) revealed decreased performance in attention, visual memory functioning and impulsivity, with some measures still not returning to baseline at 225 days post injury. The results are discussed with respect to return to normal activities at 4 days post injury. This case study highlights the need for increased research regarding the clinical management of mTBI in the paediatric population, particularly the potential deleterious effects of cumulative injuries.

Paediatric sports-related mild traumatic brain injury.

Milden traumatischen Gehirnverletzung (mTBI) ist eine gemeinsame, aber relativ erforschten Kindheit-Verletzung, die kognitiven F&auml;higkeiten und die Entwicklung auswirken kann. Der vorliegende Bericht beschreibt eine Fallstudie eines 14 Jahre alten Jungen, die zwei aufeinander folgende sportbezogene mTBIs binnen 24 h erlitten. Neurokognitive funktionieren auf 2, 6, 8, 55 und 225 Tage nach einer Verletzung ist im Vergleich zum Ausgangswert vor der Schadensanalyse auf die gleichen Ma&szlig;nahmen. Ergebnisse von unmittelbaren Post-Concussion Bewertung und kognitive Tests (ImPACT), Conner Continuous Performance Test 2 (CPT-II) und die Aufmerksamkeit-Netzwerk-Test (ANT) offenbart verringerte Leistung in Aufmerksamkeit, visuelles Ged&auml;chtnis funktioniert und Impulsivit&auml;t, mit einigen Ma&szlig;nahmen noch nicht wieder zum Ausgangswert 225 Tage nach Verletzungen. Die Ergebnisse werden in Bezug auf die R&uuml;ckkehr zu normalen Aktivit&auml;ten auf 4 Tage Post Verletzungen besprochen. Diese Fallstudie unterstreicht die Notwendigkeit der verst&auml;rkten Forschung in Bezug auf die klinische Behandlung von mTBI Bev&ouml;lkerungsgruppe, insbesondere die m&ouml;glichen sch&auml;dlichen Auswirkungen kumulative Verletzungen.

P&auml;diatrische sportbezogenen milde Hirntrauma.

Sports-related concussion or mild-traumatic brain injury (mTBI) is common in children who participate in organised sports. We describe two case studies involving 14-year-old girls who each sustained a mTBI during ice hockey competition. Neurocognitive functioning post-injury is compared to baseline pre-injury assessment on the same measures. Results from Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Conners' Continuous Performance Test II (CPT-II) and the Attention Network Test (ANT) revealed decreased performance in attention, memory functioning and reaction time. Furthermore, some measures had not returned to baseline at midseason testing sessions approximately 30-40 days post-injury. The results are discussed with respect to the difference in recovery profiles and the need for thorough and ongoing evaluation following mTBI in the paediatric population, and for girls in particular.

Sports-related mild traumatic brain injury in female youths.

Concussion is the most common athletic injury in youth who are simultaneously undergoing rapid developmental changes in the brain, specifically the development of executive functions (EF). The developing brain is more vulnerable to concussive injury with a protracted and different trajectory of recovery than that of adults. Thus, there is a critical need to enhance understanding of how concussion affects EF in youth.

Developmental and gender influences on executive function following concussion in youth hockey players.

Mild traumatic brain injury (mTBI) is common in youth, especially in those who participate in sport. Recent investigations from our group have shown that asymptomatic children and adolescents with mTBI continue to exhibit alterations in neural activity and cognitive performance compared with those without a history of mTBI. This is an intriguing finding, given that current return-to-learn and return-to-play protocols rely predominately on subjective symptom reports, which may not be sensitive enough to detect subtle injury-related changes. As a result, youth may be at greater risk for re-injury and long-term consequences if they are cleared for activity while their brains continue to be compromised. It is currently unknown whether mTBI also affects brain microstructure in the developing brain, particularly cortical thickness, and whether such changes are also related to cognitive performance. The present study examined cortical thickness in 13 asymptomatic youth (10-14 years old) who had sustained an mTBI 3-8 months prior to testing compared with 14 age-matched typically developing controls. Cortical thickness was also examined in relation to working memory performance during single and dual task paradigms. The results show that youth who had sustained an mTBI had thinner cortices in the left dorsolateral prefrontal region and right anterior and posterior inferior parietal lobes. Additionally, cortical thinning was associated with slower reaction time during the dual-task condition in the injured youth only. The results also point to a possible relationship between functional and structural alterations as a result of mTBI in youth, and lend evidence for neural changes beyond symptom resolution.

Cortical Thickness Changes and Their Relationship to Dual-Task Performance following Mild Traumatic Brain Injury in Youth.

  Despite the growing popularity of ice hockey among female youth and interest in the biomechanics of head impacts in sport, the head impacts sustained by this population have yet to be characterized.

Player and Game Characteristics and Head Impacts in Female Youth Ice Hockey Players.

Heart rate variability (HRV), a measure of cardiac autonomic nervous system functioning, has emerged as a physiological indicator for emotional regulation and psychological well-being. HRV is understudied in the context of depression and anxiety in young people (10-24years old). Main objectives: (1) describe the nature and breadth of reviewed studies; and (2) synthesize main findings in the context of clinical and non-clinical populations of young people with depression and/or anxiety.

Clinical and non-clinical depression and anxiety in young people: A scoping review on heart rate variability.

Postural stability plays a key role in sport performance, especially after concussion. Specific to healthy child and youth athletes, little is known about the influence development and sex may have on postural stability while considering other subjective clinical measures used in baseline/preinjury concussion assessment. This study aims to describe age- and sex-based trends in postural stability in uninjured child and youth athletes at baseline while accounting for concussion-related factors.

Postural Stability in Healthy Child and Youth Athletes: The Effect of Age, Sex, and Concussion-Related Factors on Performance.

Heart rate variability (HRV) is a non-invasive neurophysiological measure of autonomic nervous system regulation emerging in concussion research. To date, most concussion studies have focused on the university-aged athlete with no research examining healthy active youths. Corroborating changes in HRV alongside traditional subjective self-report measures (concussion symptoms) in the non-concussed state provides a foundation for interpreting change following concussion. The objectives were to (1) explore the influence of age and sex on HRV and (2) examine the relationship between HRV and baseline/pre-injury concussion symptom domains (physical, cognitive, emotional, and fatigue) in healthy youth athletes.

Article	Year
Systems modelling of the relationship between training and performance. Sports medicine (Auckland, N.Z.)\| PubMed ID: 14599233	2003
Paediatric sports-related mild traumatic brain injury. BMJ case reports\| PubMed ID: 21686913	2009
Sports-related mild traumatic brain injury in female youths. BMJ case reports\| PubMed ID: 22791784	2010
Developmental and gender influences on executive function following concussion in youth hockey players. Brain injury\| PubMed ID: 26362811	2015
Cortical Thickness Changes and Their Relationship to Dual-Task Performance following Mild Traumatic Brain Injury in Youth. Journal of neurotrauma\| PubMed ID: 27629883	2017
Player and Game Characteristics and Head Impacts in Female Youth Ice Hockey Players. Journal of athletic training\| PubMed ID: 28715282	2017
Clinical and non-clinical depression and anxiety in young people: A scoping review on heart rate variability. Autonomic neuroscience : basic & clinical\| PubMed ID: 28870754	2017
Postural Stability in Healthy Child and Youth Athletes: The Effect of Age, Sex, and Concussion-Related Factors on Performance. Sports health\| PubMed ID: 29131721	2018
Heart Rate Variability in Healthy Non-Concussed Youth Athletes: Exploring the Effect of Age, Sex, and Concussion-Like Symptoms. Frontiers in neurology\| PubMed ID: 29403426	2017

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