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Scott L Zuckerman - One of the best experts on this subject based on the ideXlab platform.

  • the role of family and personal psychiatric history in Postconcussion Syndrome following sport related concussion a story of compounding risk
    Journal of Neurosurgery, 2018
    Co-Authors: Andrew D Legarreta, Benjamin L Brett, Gary S Solomon, Scott L Zuckerman
    Abstract:

    OBJECTIVESport-related concussion (SRC) has become a major public health concern. Prolonged recovery after SRC, named Postconcussion Syndrome (PCS), has been associated with several biopsychosocial factors, yet the role of both family and personal psychiatric histories requires investigation. In a cohort of concussed high school athletes, the authors examined the role(s) of family and personal psychiatric histories in the risk of developing PCS.METHODSA retrospective cohort study of 154 high school athletes with complete documentation of Postconcussion symptom resolution or persistence at 6 weeks was conducted. PCS was defined as 3 or more symptoms present 6 weeks after SRC. Three groups were defined: 1) positive family psychiatric history and personal psychiatric history (FPH/PPH), 2) positive FPH only, and 3) negative family and personal psychiatric histories (controls). Three bivariate regression analyses were conducted: FPH/PPH to controls, FPH only to controls, and FPH/PPH to FPH. Post hoc bivariate ...

  • the role of family and personal psychiatric history in Postconcussion Syndrome following sport related concussion a story of compounding risk
    Journal of Neurosurgery, 2018
    Co-Authors: Andrew D Legarreta, Benjamin L Brett, Gary S Solomon, Scott L Zuckerman
    Abstract:

    OBJECTIVE Sport-related concussion (SRC) has become a major public health concern. Prolonged recovery after SRC, named Postconcussion Syndrome (PCS), has been associated with several biopsychosocial factors, yet the role of both family and personal psychiatric histories requires investigation. In a cohort of concussed high school athletes, the authors examined the role(s) of family and personal psychiatric histories in the risk of developing PCS. METHODS A retrospective cohort study of 154 high school athletes with complete documentation of Postconcussion symptom resolution or persistence at 6 weeks was conducted. PCS was defined as 3 or more symptoms present 6 weeks after SRC. Three groups were defined: 1) positive family psychiatric history and personal psychiatric history (FPH/PPH), 2) positive FPH only, and 3) negative family and personal psychiatric histories (controls). Three bivariate regression analyses were conducted: FPH/PPH to controls, FPH only to controls, and FPH/PPH to FPH. Post hoc bivariate regression analyses examined specific FPH pathologies and PCS. RESULTS Athletes with FPH/PPH compared with controls had an increased risk of PCS (χ2 = 8.90, p = 0.018; OR 5.06, 95% CI 1.71-14.99). Athletes with FPH only compared with controls also had an increased risk of PCS (χ2 = 6.04, p = 0.03; OR 2.52, 95% CI 1.20-5.30). Comparing athletes with FPH/PPH to athletes with FPH only, no added PCS risk was noted (χ2 = 1.64, p = 0.247; OR 2.01, 95% CI 0.68-5.94). Among various FPH diagnoses, anxiety (χ2 = 7.48, p = 0.021; OR 2.99, 95% CI 1.36-6.49) and bipolar disorder (χ2 = 5.13, p = 0.036; OR 2.74, 95% CI 1.14-6.67) were significantly associated with the presence of PCS. CONCLUSIONS Concussed high school athletes with FPH/PPH were greater than 5 times more likely to develop PCS than controls. Athletes with only FPH were over 2.5 times more likely to develop PCS than controls. Those with an FPH of anxiety or bipolar disorder are specifically at increased risk of PCS. These results suggest that not only are athletes with FPH/PPH at risk for slower recovery after SRC, but those with an FPH only-especially anxiety or bipolar disorder-may also be at risk. Overall, this study supports taking a detailed FPH and PPH in the management of SRC.

  • predictors of Postconcussion Syndrome in collegiate student athletes
    Neurosurgical Focus, 2016
    Co-Authors: Scott L Zuckerman, Gary S Solomon, Aaron M Yengokahn, Thomas A Buckley, Allen K Sills, Zachary Y Kerr
    Abstract:

    OBJECTIVE Sport-related concussion (SRC) has emerged as a public health problem, especially among student-athletes. Whereas most concussions resolve by 2 weeks, a minority of patients experience Postconcussion Syndrome (PCS), in which symptoms persist for months. The objective of this study was to elucidate factors predictive of PCS among a sample of National Collegiate Athletic Association (NCAA) student-athletes in the academic years 2009-2010 to 2014-2015. METHODS The SRC data originated from the NCAA Injury Surveillance Program (ISP) in the 2009-2010 to 2014-2015 academic seasons. The NCAA ISP is a prospective database made up of a convenience sample of schools across all divisions. All SRCs are reported by certified athletic trainers. The PCS group consisted of concussed student-athletes with concussion-related symptoms that lasted ≥ 4 weeks. The non-PCS group consisted of concussed student-athletes with symptom resolution in ≤ 2 weeks. Those with symptoms that resolved in the intermediate area of 2-4 weeks were excluded. Odds ratios (ORs) were estimated using logistic regression. RESULTS During the 2009-2010 to 2014-2015 seasons, 1507 NCAA student-athletes sustained an SRC, 112 (7.4%) of whom developed PCS (i.e., concussion-related symptoms that lasted ≥ 4 weeks). Men's ice hockey contributed the largest proportion of concussions to the PCS group (28.6%), whereas men's football contributed the largest proportion of concussions in the non-PCS group (38.6%). In multivariate analysis, recurrent concussion was associated with increased odds of PCS (OR 2.08, 95% CI 1.28-3.36). Concussion symptoms that were also associated with increased odds of PCS included retrograde amnesia (OR 2.75, 95% CI 1.34-5.64), difficulty concentrating (OR 2.35, 95% CI 1.23-4.50), sensitivity to light (OR 1.97, 95% CI 1.09-3.57), and insomnia (OR 2.19, 95% CI 1.30-3.68). Contact level, sex, and loss of consciousness were not associated with PCS. CONCLUSIONS Postconcussion Syndrome represents one of the most impactful sequelae of SRC. In this study of exclusively collegiate student-athletes, the authors found that recurrent concussions and various concussion-related symptoms were associated with PCS. The identification of initial risk factors for the development of PCS may assist sports medicine clinicians in providing timely interventions and treatments to prevent morbidity and shorten recovery time after SRC.

  • predictors of Postconcussion Syndrome after sports related concussion in young athletes a matched case control study
    Journal of Neurosurgery, 2015
    Co-Authors: Clinton D Morgan, Scott L Zuckerman, Allen K Sills, Young M Lee, Lauren King, Susan E Beaird, Gary S Solomon
    Abstract:

    OBJECT Sport-related concussion (SRC) is a major public health problem. Approximately 90% of SRCs in high school athletes are transient; symptoms recover to baseline within 1 week. However, a small percentage of patients remain symptomatic several months after injury, with a condition known as Postconcussion Syndrome (PCS). The authors aimed to identify risk factors for PCS development in a cohort of exclusively young athletes (9-18 years of age) who sustained SRCs while playing a sport. METHODS The authors conducted a retrospective case-control study by using the Vanderbilt Sports Concussion Clinic database. They identified 40 patients with PCS and matched them by age at injury and sex to SRC control patients (1 PCS to 2 control). PCS patients were those experiencing persistent symptoms at 3 months after an SRC. Control patients were those with documented resolution of symptoms within 3 weeks of an SRC. Data were collected in 4 categories: 1) demographic variables; 2) key medical, psychiatric, and family history; 3) acute-phase postinjury symptoms (at 0-24 hours); and 4) subacute-phase postinjury features (at 0-3 weeks). The chi-square Fisher exact test was used to assess categorical variables, and the Mann-Whitney U-test was used to evaluate continuous variables. Forward stepwise regression models (Pin = 0.05, Pout = 0.10) were used to identify variables associated with PCS. RESULTS PCS patients were more likely than control patients to have a concussion history (p = 0.010), premorbid mood disorders (p = 0.002), other psychiatric illness (p = 0.039), or significant life stressors (p = 0.036). Other factors that increased the likelihood of PCS development were a family history of mood disorders, other psychiatric illness, and migraine. Development of PCS was not predicted by race, insurance status, body mass index, sport, helmet use, medication use, and type of symptom endorsement. A final logistic regression analysis of candidate variables showed PCS to be predicted by a history of concussion (OR 1.8, 95% CI 1.1-2.8, p = 0.016), preinjury mood disorders (OR 17.9, 95% CI 2.9-113.0, p = 0.002), family history of mood disorders (OR 3.1, 95% CI 1.1-8.5, p = 0.026), and delayed symptom onset (OR 20.7, 95% CI 3.2-132.0, p < 0.001). CONCLUSIONS In this age- and sex-matched case-control study of risk factors for PCS among youth with SRC, risk for development of PCS was higher in those with a personal and/or family history of mood disorders, other psychiatric illness, and migraine. These findings highlight the unique nature of SRC in youth. For this population, providers must recognize the value of establishing the baseline health and psychiatric status of children and their primary caregivers with regard to symptom reporting and recovery expectations. In addition, delayed symptom onset was an unexpected but strong risk factor for PCS in this cohort. Delayed symptoms could potentially result in late removal from play, rest, and care by qualified health care professionals. Taken together, these results may help practitioners identify young athletes with concussion who are at a greater danger for PCS and inform larger prospective studies for validation of risk factors from this cohort.

Gary S Solomon - One of the best experts on this subject based on the ideXlab platform.

  • the role of family and personal psychiatric history in Postconcussion Syndrome following sport related concussion a story of compounding risk
    Journal of Neurosurgery, 2018
    Co-Authors: Andrew D Legarreta, Benjamin L Brett, Gary S Solomon, Scott L Zuckerman
    Abstract:

    OBJECTIVESport-related concussion (SRC) has become a major public health concern. Prolonged recovery after SRC, named Postconcussion Syndrome (PCS), has been associated with several biopsychosocial factors, yet the role of both family and personal psychiatric histories requires investigation. In a cohort of concussed high school athletes, the authors examined the role(s) of family and personal psychiatric histories in the risk of developing PCS.METHODSA retrospective cohort study of 154 high school athletes with complete documentation of Postconcussion symptom resolution or persistence at 6 weeks was conducted. PCS was defined as 3 or more symptoms present 6 weeks after SRC. Three groups were defined: 1) positive family psychiatric history and personal psychiatric history (FPH/PPH), 2) positive FPH only, and 3) negative family and personal psychiatric histories (controls). Three bivariate regression analyses were conducted: FPH/PPH to controls, FPH only to controls, and FPH/PPH to FPH. Post hoc bivariate ...

  • the role of family and personal psychiatric history in Postconcussion Syndrome following sport related concussion a story of compounding risk
    Journal of Neurosurgery, 2018
    Co-Authors: Andrew D Legarreta, Benjamin L Brett, Gary S Solomon, Scott L Zuckerman
    Abstract:

    OBJECTIVE Sport-related concussion (SRC) has become a major public health concern. Prolonged recovery after SRC, named Postconcussion Syndrome (PCS), has been associated with several biopsychosocial factors, yet the role of both family and personal psychiatric histories requires investigation. In a cohort of concussed high school athletes, the authors examined the role(s) of family and personal psychiatric histories in the risk of developing PCS. METHODS A retrospective cohort study of 154 high school athletes with complete documentation of Postconcussion symptom resolution or persistence at 6 weeks was conducted. PCS was defined as 3 or more symptoms present 6 weeks after SRC. Three groups were defined: 1) positive family psychiatric history and personal psychiatric history (FPH/PPH), 2) positive FPH only, and 3) negative family and personal psychiatric histories (controls). Three bivariate regression analyses were conducted: FPH/PPH to controls, FPH only to controls, and FPH/PPH to FPH. Post hoc bivariate regression analyses examined specific FPH pathologies and PCS. RESULTS Athletes with FPH/PPH compared with controls had an increased risk of PCS (χ2 = 8.90, p = 0.018; OR 5.06, 95% CI 1.71-14.99). Athletes with FPH only compared with controls also had an increased risk of PCS (χ2 = 6.04, p = 0.03; OR 2.52, 95% CI 1.20-5.30). Comparing athletes with FPH/PPH to athletes with FPH only, no added PCS risk was noted (χ2 = 1.64, p = 0.247; OR 2.01, 95% CI 0.68-5.94). Among various FPH diagnoses, anxiety (χ2 = 7.48, p = 0.021; OR 2.99, 95% CI 1.36-6.49) and bipolar disorder (χ2 = 5.13, p = 0.036; OR 2.74, 95% CI 1.14-6.67) were significantly associated with the presence of PCS. CONCLUSIONS Concussed high school athletes with FPH/PPH were greater than 5 times more likely to develop PCS than controls. Athletes with only FPH were over 2.5 times more likely to develop PCS than controls. Those with an FPH of anxiety or bipolar disorder are specifically at increased risk of PCS. These results suggest that not only are athletes with FPH/PPH at risk for slower recovery after SRC, but those with an FPH only-especially anxiety or bipolar disorder-may also be at risk. Overall, this study supports taking a detailed FPH and PPH in the management of SRC.

  • predictors of Postconcussion Syndrome in collegiate student athletes
    Neurosurgical Focus, 2016
    Co-Authors: Scott L Zuckerman, Gary S Solomon, Aaron M Yengokahn, Thomas A Buckley, Allen K Sills, Zachary Y Kerr
    Abstract:

    OBJECTIVE Sport-related concussion (SRC) has emerged as a public health problem, especially among student-athletes. Whereas most concussions resolve by 2 weeks, a minority of patients experience Postconcussion Syndrome (PCS), in which symptoms persist for months. The objective of this study was to elucidate factors predictive of PCS among a sample of National Collegiate Athletic Association (NCAA) student-athletes in the academic years 2009-2010 to 2014-2015. METHODS The SRC data originated from the NCAA Injury Surveillance Program (ISP) in the 2009-2010 to 2014-2015 academic seasons. The NCAA ISP is a prospective database made up of a convenience sample of schools across all divisions. All SRCs are reported by certified athletic trainers. The PCS group consisted of concussed student-athletes with concussion-related symptoms that lasted ≥ 4 weeks. The non-PCS group consisted of concussed student-athletes with symptom resolution in ≤ 2 weeks. Those with symptoms that resolved in the intermediate area of 2-4 weeks were excluded. Odds ratios (ORs) were estimated using logistic regression. RESULTS During the 2009-2010 to 2014-2015 seasons, 1507 NCAA student-athletes sustained an SRC, 112 (7.4%) of whom developed PCS (i.e., concussion-related symptoms that lasted ≥ 4 weeks). Men's ice hockey contributed the largest proportion of concussions to the PCS group (28.6%), whereas men's football contributed the largest proportion of concussions in the non-PCS group (38.6%). In multivariate analysis, recurrent concussion was associated with increased odds of PCS (OR 2.08, 95% CI 1.28-3.36). Concussion symptoms that were also associated with increased odds of PCS included retrograde amnesia (OR 2.75, 95% CI 1.34-5.64), difficulty concentrating (OR 2.35, 95% CI 1.23-4.50), sensitivity to light (OR 1.97, 95% CI 1.09-3.57), and insomnia (OR 2.19, 95% CI 1.30-3.68). Contact level, sex, and loss of consciousness were not associated with PCS. CONCLUSIONS Postconcussion Syndrome represents one of the most impactful sequelae of SRC. In this study of exclusively collegiate student-athletes, the authors found that recurrent concussions and various concussion-related symptoms were associated with PCS. The identification of initial risk factors for the development of PCS may assist sports medicine clinicians in providing timely interventions and treatments to prevent morbidity and shorten recovery time after SRC.

  • predictors of Postconcussion Syndrome after sports related concussion in young athletes a matched case control study
    Journal of Neurosurgery, 2015
    Co-Authors: Clinton D Morgan, Scott L Zuckerman, Allen K Sills, Young M Lee, Lauren King, Susan E Beaird, Gary S Solomon
    Abstract:

    OBJECT Sport-related concussion (SRC) is a major public health problem. Approximately 90% of SRCs in high school athletes are transient; symptoms recover to baseline within 1 week. However, a small percentage of patients remain symptomatic several months after injury, with a condition known as Postconcussion Syndrome (PCS). The authors aimed to identify risk factors for PCS development in a cohort of exclusively young athletes (9-18 years of age) who sustained SRCs while playing a sport. METHODS The authors conducted a retrospective case-control study by using the Vanderbilt Sports Concussion Clinic database. They identified 40 patients with PCS and matched them by age at injury and sex to SRC control patients (1 PCS to 2 control). PCS patients were those experiencing persistent symptoms at 3 months after an SRC. Control patients were those with documented resolution of symptoms within 3 weeks of an SRC. Data were collected in 4 categories: 1) demographic variables; 2) key medical, psychiatric, and family history; 3) acute-phase postinjury symptoms (at 0-24 hours); and 4) subacute-phase postinjury features (at 0-3 weeks). The chi-square Fisher exact test was used to assess categorical variables, and the Mann-Whitney U-test was used to evaluate continuous variables. Forward stepwise regression models (Pin = 0.05, Pout = 0.10) were used to identify variables associated with PCS. RESULTS PCS patients were more likely than control patients to have a concussion history (p = 0.010), premorbid mood disorders (p = 0.002), other psychiatric illness (p = 0.039), or significant life stressors (p = 0.036). Other factors that increased the likelihood of PCS development were a family history of mood disorders, other psychiatric illness, and migraine. Development of PCS was not predicted by race, insurance status, body mass index, sport, helmet use, medication use, and type of symptom endorsement. A final logistic regression analysis of candidate variables showed PCS to be predicted by a history of concussion (OR 1.8, 95% CI 1.1-2.8, p = 0.016), preinjury mood disorders (OR 17.9, 95% CI 2.9-113.0, p = 0.002), family history of mood disorders (OR 3.1, 95% CI 1.1-8.5, p = 0.026), and delayed symptom onset (OR 20.7, 95% CI 3.2-132.0, p < 0.001). CONCLUSIONS In this age- and sex-matched case-control study of risk factors for PCS among youth with SRC, risk for development of PCS was higher in those with a personal and/or family history of mood disorders, other psychiatric illness, and migraine. These findings highlight the unique nature of SRC in youth. For this population, providers must recognize the value of establishing the baseline health and psychiatric status of children and their primary caregivers with regard to symptom reporting and recovery expectations. In addition, delayed symptom onset was an unexpected but strong risk factor for PCS in this cohort. Delayed symptoms could potentially result in late removal from play, rest, and care by qualified health care professionals. Taken together, these results may help practitioners identify young athletes with concussion who are at a greater danger for PCS and inform larger prospective studies for validation of risk factors from this cohort.

Barry Willer - One of the best experts on this subject based on the ideXlab platform.

  • cerebral blood flow during treadmill exercise is a marker of physiological Postconcussion Syndrome in female athletes
    Journal of Head Trauma Rehabilitation, 2016
    Co-Authors: Mary Clausen, Barry Willer, David R Pendergast, John J. Leddy
    Abstract:

    OBJECTIVE Some patients with Postconcussion Syndrome (PCS) have reduced exercise capacity that may reflect altered central cardiorespiratory control. The purpose of this study was to evaluate control of cerebral blood flow (CBF) during exercise in females with PCS. SETTING University Concussion Clinic. PARTICIPANTS Nine female Division 1 collegiate team athletes with PCS (23 ± 6 years) and a reference group of 13 healthy female recreational aerobic athletes (21 ± 3 years). DESIGN A prospective experimental study. All PCS athletes were compared with the reference group at the beginning of the study. Six of the PCS athletes were subsequently measured before and after a subsymptom threshold aerobic exercise treatment program. MAIN MEASURES Exercise treadmill test during which blood pressure (BP), minute ventilation ((Equation is included in full-text article.)E), end-tidal CO2 (PETCO2), and CBF velocity (CBFV, by transcranial Doppler) were measured. RESULTS Participants with PCS had significantly lower (Equation is included in full-text article.)E (by 18%) and greater PETCO2 (5%) and CBFV (14%) versus the reference group at similar workloads in association with appearance of symptoms and premature exercise cessation. Subthreshold exercise normalized (Equation is included in full-text article.)E, PETCO2, CBFV and exercise tolerance. Before treatment, PCS had low CO2 sensitivity that blunted their exercise ventilation. CO2 sensitivity and ventilation improved after exercise treatment. CONCLUSION Some PCS patients have exercise intolerance due to abnormal CBF regulation that may be the result of concussion-induced altered sensitivity to CO2. Return of normal CBF control and exercise tolerance may be physiological markers of recovery from concussion.

  • diffusion tensor imaging alterations in patients with Postconcussion Syndrome undergoing exercise treatment a pilot longitudinal study
    Journal of Head Trauma Rehabilitation, 2015
    Co-Authors: Paul Polak, John J. Leddy, Barry Willer, Michael G Dwyer, Robert Zivadinov
    Abstract:

    PURPOSE To investigate diffusion tensor imaging characteristics in patients with Postconcussion Syndrome (PCS) who received exercise (n = 4) and placebo stretching (n = 4) treatments compared with a group of healthy controls (n = 15). METHODS Subjects diagnosed with PCS obtained a diffusion tensor imaging magnetic resonance image at pretreatment (baseline) and approximately 8 weeks later (follow-up). Analyses included a groupwise comparison using tract-based spatial statistics and a z-score map that investigated localized regional anomalies compared with the healthy control group projected onto the tract-based spatial statistics skeleton. RESULTS The tract-based spatial statistics analysis detected groupwise differences in the genu of the corpus callosum at both time points with decreased fractional anisotropy and increased radial diffusivity and mean diffusivity values. In contrast, the z-score analysis was more sensitive to heterogeneous changes in fractional anisotropy, with both low- and high-localized areas across various white matter regions, the most prevalent being the corpus callosum, anterior and superior corona radiata, and internal and external capsules. The mean number of voxels different in patients with PCS versus healthy controls was greater in all cases (baseline lower: P < .03 and higher: P < .0001; follow-up lower: P < .0001 and higher: P < .0001). The volume and location of these abnormal regions changed between the 2 diffusion tensor imaging scans, but these did not correlate with the mitigation of symptoms in the patients with PCS. CONCLUSIONS Diffusion tensor imaging revealed spatially varying and heterogeneous localized irregularities in patients with PCS that persisted even as patient symptoms decreased and prognosis improved.

  • Exercise Intolerance in Individuals With Postconcussion Syndrome
    Journal of athletic training, 2013
    Co-Authors: Karl F. Kozlowski, James E. Graham, John J. Leddy, Lee Devinney-boymel, Barry Willer
    Abstract:

    Context: Little is known about exercise intolerance or the utility of an exercise evaluation in patients with Postconcussion Syndrome (PCS). Objective: To assess exercise intolerance in male and female patients with PCS. Design: Cross-sectional study. Setting: Laboratory setting. Patients or Other Participants: Participants included a convenience sample of 34 patients with PCS (17 males, 17 females; age = 25.9 ± 10.9 years) and 22 uninjured individuals on whom we gathered historical deidentified laboratory data (control group; 11 males, 11 females; age = 23.3 ± 6.2 years). Main Outcome Measure(s): Self-reported symptoms, heart rate, systolic and diastolic blood pressures (BPs), and the Borg rating of perceived exertion were measured before, during each minute of, and immediately after a graded treadmill exercise test (Balke protocol). Exercise was stopped when participants could no longer maintain the effort or reported the onset of or increase in PCS symptoms. Results: Exercise test duration (8.5 ± 4.4 m...

  • exercise treatment for Postconcussion Syndrome a pilot study of changes in functional magnetic resonance imaging activation physiology and symptoms
    Journal of Head Trauma Rehabilitation, 2013
    Co-Authors: John J. Leddy, John G Baker, David R Pendergast, Robert Zivadinov, Jennifer L Cox, David S Wack, Barry Willer
    Abstract:

    PURPOSE To compare functional magnetic resonance imaging (fMRI) activation patterns during a cognitive task, exercise capacity, and symptoms in Postconcussion Syndrome (PCS) patients who received exercise treatment (n = 4) with a PCS placebo stretching group (n = 4) and a healthy control group (n = 4). METHODS Subjects completed a math processing task during fMRI and an exercise treadmill test before (time 1) and after approximately 12 weeks (time 2). Exercise subjects performed aerobic exercise at 80% of the heart rate (HR) attained on the treadmill test, 20 minutes per day with an HR monitor at home, 6 days per week. The program was modified as the HR for symptom exacerbation increased. RESULTS At time 1, there was no difference in fMRI activation between the 2 PCS groups but healthy controls had significantly greater activation in the posterior cingulate gyrus, lingual gyrus, and cerebellum versus all PCS subjects (P < .05, corrected for multiple comparisons). At time 2, exercise PCS did not differ from healthy controls whereas placebo stretching PCS had significantly less activity in the cerebellum (P < .05 corrected) and in the anterior cingulate gyrus and thalamus (P < .001, uncorrected) versus healthy controls. At time 2, exercise PCS achieved a significantly greater exercise HR (P < .001) and had fewer symptoms (P < .0004) than placebo stretching PCS. Cognitive performance did not differ by group or time. CONCLUSIONS Controlled aerobic exercise rehabilitation may help restore normal cerebral blood flow regulation, as indicated by fMRI activation, in PCS patients. The PCS symptoms may be related to abnormal cerebral blood flow regulation.

  • return to full functioning after graded exercise assessment and progressive exercise treatment of Postconcussion Syndrome
    Rehabilitation Research and Practice, 2012
    Co-Authors: John G Baker, Karl F. Kozlowski, John J. Leddy, Michael S Freitas, Barry Willer
    Abstract:

    Exercise assessment and aerobic exercise training for Postconcussion Syndrome (PCS) may reduce concussion-related physiological dysfunction and symptoms by restoring autonomic balance and improving cerebral blood flow autoregulation. In a descriptive pilot study of 91 patients referred to a university clinic for treatment of PCS, a subset of 63 patients were contacted by telephone for assessment of symptoms and return to full daily functioning. Those who experienced symptoms during a graded exercise treadmill test (physiologic PCS, n = 40) were compared to those who could exercise to capacity (PCS, n = 23). Both groups had been offered progressive exercise rehabilitation. Overall 41 of 57 (72%) who participated in the exercise rehabilitation program returned to full daily functioning. This included 27 of 35 (77%) from the physiologic PCS group, and 14 of 22 (64%) from the PCS group. Only 1 of the 6 patients who declined exercise rehabilitation returned to full functioning. Interpretation of these results is limited by the descriptive nature of the study, the small sample size, and the relatively few patients who declined exercise treatment. Nonetheless, exercise assessment indicates that approximately one third of those examined did not have physiologic PCS.

John J. Leddy - One of the best experts on this subject based on the ideXlab platform.

  • cerebral blood flow during treadmill exercise is a marker of physiological Postconcussion Syndrome in female athletes
    Journal of Head Trauma Rehabilitation, 2016
    Co-Authors: Mary Clausen, Barry Willer, David R Pendergast, John J. Leddy
    Abstract:

    OBJECTIVE Some patients with Postconcussion Syndrome (PCS) have reduced exercise capacity that may reflect altered central cardiorespiratory control. The purpose of this study was to evaluate control of cerebral blood flow (CBF) during exercise in females with PCS. SETTING University Concussion Clinic. PARTICIPANTS Nine female Division 1 collegiate team athletes with PCS (23 ± 6 years) and a reference group of 13 healthy female recreational aerobic athletes (21 ± 3 years). DESIGN A prospective experimental study. All PCS athletes were compared with the reference group at the beginning of the study. Six of the PCS athletes were subsequently measured before and after a subsymptom threshold aerobic exercise treatment program. MAIN MEASURES Exercise treadmill test during which blood pressure (BP), minute ventilation ((Equation is included in full-text article.)E), end-tidal CO2 (PETCO2), and CBF velocity (CBFV, by transcranial Doppler) were measured. RESULTS Participants with PCS had significantly lower (Equation is included in full-text article.)E (by 18%) and greater PETCO2 (5%) and CBFV (14%) versus the reference group at similar workloads in association with appearance of symptoms and premature exercise cessation. Subthreshold exercise normalized (Equation is included in full-text article.)E, PETCO2, CBFV and exercise tolerance. Before treatment, PCS had low CO2 sensitivity that blunted their exercise ventilation. CO2 sensitivity and ventilation improved after exercise treatment. CONCLUSION Some PCS patients have exercise intolerance due to abnormal CBF regulation that may be the result of concussion-induced altered sensitivity to CO2. Return of normal CBF control and exercise tolerance may be physiological markers of recovery from concussion.

  • diffusion tensor imaging alterations in patients with Postconcussion Syndrome undergoing exercise treatment a pilot longitudinal study
    Journal of Head Trauma Rehabilitation, 2015
    Co-Authors: Paul Polak, John J. Leddy, Barry Willer, Michael G Dwyer, Robert Zivadinov
    Abstract:

    PURPOSE To investigate diffusion tensor imaging characteristics in patients with Postconcussion Syndrome (PCS) who received exercise (n = 4) and placebo stretching (n = 4) treatments compared with a group of healthy controls (n = 15). METHODS Subjects diagnosed with PCS obtained a diffusion tensor imaging magnetic resonance image at pretreatment (baseline) and approximately 8 weeks later (follow-up). Analyses included a groupwise comparison using tract-based spatial statistics and a z-score map that investigated localized regional anomalies compared with the healthy control group projected onto the tract-based spatial statistics skeleton. RESULTS The tract-based spatial statistics analysis detected groupwise differences in the genu of the corpus callosum at both time points with decreased fractional anisotropy and increased radial diffusivity and mean diffusivity values. In contrast, the z-score analysis was more sensitive to heterogeneous changes in fractional anisotropy, with both low- and high-localized areas across various white matter regions, the most prevalent being the corpus callosum, anterior and superior corona radiata, and internal and external capsules. The mean number of voxels different in patients with PCS versus healthy controls was greater in all cases (baseline lower: P < .03 and higher: P < .0001; follow-up lower: P < .0001 and higher: P < .0001). The volume and location of these abnormal regions changed between the 2 diffusion tensor imaging scans, but these did not correlate with the mitigation of symptoms in the patients with PCS. CONCLUSIONS Diffusion tensor imaging revealed spatially varying and heterogeneous localized irregularities in patients with PCS that persisted even as patient symptoms decreased and prognosis improved.

  • Exercise Intolerance in Individuals With Postconcussion Syndrome
    Journal of athletic training, 2013
    Co-Authors: Karl F. Kozlowski, James E. Graham, John J. Leddy, Lee Devinney-boymel, Barry Willer
    Abstract:

    Context: Little is known about exercise intolerance or the utility of an exercise evaluation in patients with Postconcussion Syndrome (PCS). Objective: To assess exercise intolerance in male and female patients with PCS. Design: Cross-sectional study. Setting: Laboratory setting. Patients or Other Participants: Participants included a convenience sample of 34 patients with PCS (17 males, 17 females; age = 25.9 ± 10.9 years) and 22 uninjured individuals on whom we gathered historical deidentified laboratory data (control group; 11 males, 11 females; age = 23.3 ± 6.2 years). Main Outcome Measure(s): Self-reported symptoms, heart rate, systolic and diastolic blood pressures (BPs), and the Borg rating of perceived exertion were measured before, during each minute of, and immediately after a graded treadmill exercise test (Balke protocol). Exercise was stopped when participants could no longer maintain the effort or reported the onset of or increase in PCS symptoms. Results: Exercise test duration (8.5 ± 4.4 m...

  • exercise treatment for Postconcussion Syndrome a pilot study of changes in functional magnetic resonance imaging activation physiology and symptoms
    Journal of Head Trauma Rehabilitation, 2013
    Co-Authors: John J. Leddy, John G Baker, David R Pendergast, Robert Zivadinov, Jennifer L Cox, David S Wack, Barry Willer
    Abstract:

    PURPOSE To compare functional magnetic resonance imaging (fMRI) activation patterns during a cognitive task, exercise capacity, and symptoms in Postconcussion Syndrome (PCS) patients who received exercise treatment (n = 4) with a PCS placebo stretching group (n = 4) and a healthy control group (n = 4). METHODS Subjects completed a math processing task during fMRI and an exercise treadmill test before (time 1) and after approximately 12 weeks (time 2). Exercise subjects performed aerobic exercise at 80% of the heart rate (HR) attained on the treadmill test, 20 minutes per day with an HR monitor at home, 6 days per week. The program was modified as the HR for symptom exacerbation increased. RESULTS At time 1, there was no difference in fMRI activation between the 2 PCS groups but healthy controls had significantly greater activation in the posterior cingulate gyrus, lingual gyrus, and cerebellum versus all PCS subjects (P < .05, corrected for multiple comparisons). At time 2, exercise PCS did not differ from healthy controls whereas placebo stretching PCS had significantly less activity in the cerebellum (P < .05 corrected) and in the anterior cingulate gyrus and thalamus (P < .001, uncorrected) versus healthy controls. At time 2, exercise PCS achieved a significantly greater exercise HR (P < .001) and had fewer symptoms (P < .0004) than placebo stretching PCS. Cognitive performance did not differ by group or time. CONCLUSIONS Controlled aerobic exercise rehabilitation may help restore normal cerebral blood flow regulation, as indicated by fMRI activation, in PCS patients. The PCS symptoms may be related to abnormal cerebral blood flow regulation.

  • return to full functioning after graded exercise assessment and progressive exercise treatment of Postconcussion Syndrome
    Rehabilitation Research and Practice, 2012
    Co-Authors: John G Baker, Karl F. Kozlowski, John J. Leddy, Michael S Freitas, Barry Willer
    Abstract:

    Exercise assessment and aerobic exercise training for Postconcussion Syndrome (PCS) may reduce concussion-related physiological dysfunction and symptoms by restoring autonomic balance and improving cerebral blood flow autoregulation. In a descriptive pilot study of 91 patients referred to a university clinic for treatment of PCS, a subset of 63 patients were contacted by telephone for assessment of symptoms and return to full daily functioning. Those who experienced symptoms during a graded exercise treadmill test (physiologic PCS, n = 40) were compared to those who could exercise to capacity (PCS, n = 23). Both groups had been offered progressive exercise rehabilitation. Overall 41 of 57 (72%) who participated in the exercise rehabilitation program returned to full daily functioning. This included 27 of 35 (77%) from the physiologic PCS group, and 14 of 22 (64%) from the PCS group. Only 1 of the 6 patients who declined exercise rehabilitation returned to full functioning. Interpretation of these results is limited by the descriptive nature of the study, the small sample size, and the relatively few patients who declined exercise treatment. Nonetheless, exercise assessment indicates that approximately one third of those examined did not have physiologic PCS.

Julie A. Suhr - One of the best experts on this subject based on the ideXlab platform.

  • Cognitive factors in Postconcussion Syndrome symptom report
    Archives of Clinical Neuropsychology, 2004
    Co-Authors: John Gunstad, Julie A. Suhr
    Abstract:

    Past studies suggest a variety of factors that influence the report of Postconcussion Syndrome (PCS) symptoms, including head injury, depression, pain, and subjective expectation. Participants included 190 undergraduates across 8 groups chosen to examine the relative contribution of these factors, as well as treatment-seeking behavior, in the report of both current and past PCS symptoms. Depressed persons, depressed persons receiving treatment, and headache sufferers receiving treatment reported elevated rates of PCS symptoms when compared to controls. Five of the eight groups reported experiencing more current than past symptoms. Head-injured persons and headache sufferers underestimated premorbid symptom rates relative to the baseline of controls. These findings are consistent with the growing number of studies that suggest non-neurologic factors may be more closely related to PCS symptom report than head injury status and raise further concern regarding use of self-reported PCS symptoms in the diagnosis of head injury.

  • perception of illness nonspecificity of Postconcussion Syndrome symptom expectation
    Journal of The International Neuropsychological Society, 2002
    Co-Authors: John Gunstad, Julie A. Suhr
    Abstract:

    A growing number of studies show Postconcussion Syndrome (PCS) symptom report is influenced by factors other than head injury, suggesting symptoms typically associated with PCS may not be specific to head injury. Given the role that symptom expectation has been hypothesized to play in PCS symptom etiology, a comparison of symptoms expected for various disorders seems overdue. The present study asked 82 undergraduates to report the symptoms they currently experience, and then to report the symptoms they would expect to experience if they had had suffered either a head injury, an orthopedic injury, posttraumatic stress, or depression. No current differences in overall symptoms or in symptom subscales emerged. Results showed individuals portraying head injury, posttraumatic stress, and depression expected an increase in total symptoms, though individuals portraying an orthopedic injury did not expect such an increase. Results also showed simulators of head injury, posttraumatic stress, and depression expected equivalent rates of overall symptoms, memory/cognitive complaints, somatic concerns, and distracter symptoms, though head-injured individuals reported fewer affective symptoms than those portraying psychological disorders. In all, these findings suggest that individuals have a relative lack of specificity in symptom expectation for various disorders, with the implication that symptom checklists for "PCS" may not be useful for diagnosis.

  • expectation as etiology versus the good old days Postconcussion Syndrome symptom reporting in athletes headache sufferers and depressed individuals
    Journal of The International Neuropsychological Society, 2001
    Co-Authors: John Gunstad, Julie A. Suhr
    Abstract:

    The present study explored the explanatory power of Mittenberg’s “expectation as etiology” theory for the persistence of Postconcussion Syndrome (PCS) complaints. One hundred forty-one participants completed a PCS symptom checklist under 2 conditions. Normal controls, healthy athletes and depressed individuals reported current symptoms and symptoms expected following a hypothetical mild head injury. Head-injured athletes, chronic headache sufferers, and a 2nd sample of normal controls reported current symptoms and retrospective symptoms (prior to their injury0illness or from some point in the past). Depressed individuals reported more current symptoms than normal controls and healthy athletes, demonstrating that “ PCS” symptoms are not specific to PCS. All groups expected more symptoms following mild head injury than currently experienced, supporting the idea that individuals expect negative consequences following head injury. However, healthy athletes expected fewer symptoms than normals or depressed individuals, possibly due to preexisting expectations for speedy recovery. Both head-injured athletes and headache sufferers reported more current symptoms than the past, but not at a rate lower than baseline of normal controls. Results suggest that the “expectation as etiology” hypothesis may be too specific, and that, following any negative event, people may attribute all symptoms to that negative event (the “good old days” hypothesis). ( JINS, 2001, 7, 323‐333.)