Review articleSport related concussion – Potential for biomarkers to improve acute management
Introduction
Our understanding of sport-related concussion and its adverse health consequences is increasing. Historically, concussion describes an alteration in mental state caused by biomechanical forces to the head that usually spontaneously resolves over a short period of time [1], [2], [3]. Some recent evidence suggests concussion may have longer-term consequences. Press coverage of high-profile athletes retiring due to the effects of concussions has intensified debate about safe management of head trauma in sport [4], [5]. With an estimated 1.6–3.8 million sport-related concussions in the USA each year the health care community and policy makers are under increased pressure for consensus on how to protect athletes from the serious consequences of concussion [6], [7]. Disagreement and uncertainty exists amongst medical practitioners and sports administrators about how to manage sport-related concussion [2]. Clear guidelines and translatable methods of concussion management are needed to protect and care for athletes who are at risk of head knocks at all competition levels. This paper will provide an overview of sports-related concussion, including common signs and symptoms, incidence rates, and important modifiable factors (e.g. sex, age, and genetics). After reviewing existing concussion diagnosis and management tools we present promising new methods of concussion management.
Section snippets
Definition, signs, symptoms
Concussion is described as a type of mild traumatic brain injury (TBI), on the less-severe end of the brain injury spectrum [1], [2], [3]. Concussion is caused by a direct blow to the head or from impact elsewhere on the body that causes biomechanical force, acceleration and/or deceleration to be transmitted to the brain [8]. This triggers complex pathophysiological processes that cause rapid alteration in conscious state [2], [3]. Loss of consciousness often occurs in more severe cases.
Current concussion management
Current sport-related concussion management is centered on a symptom free waiting period (of variable length) of cognitive and physical rest before allowing the athlete to begin graduated activity before gaining medical clearance to return to play [1], [2]. A variety of concussion tools are available to guide clinical diagnosis and management of concussion, the most common of which are outlined below.
Emerging concussion management tools
Considering the potential long-term effects of concussions, and the concerns and limitations with current management methods, recent research efforts have attempted to identify more sensitive and/or objective indicators of concussion and recovery that may one day supplement or replace symptom-based concussion management.
Conclusion
Concussion remains a difficult injury to define, diagnose and monitor. We currently rely on symptom based assessment tools that may not capture the full spectrum of concussion injuries and time to recovery. Research into genetics, age and gender differences in concussed athletes is expanding our understanding of the complexity of concussive injuries and individual differences in susceptibility to injury. Objective concussion biomarkers may reduce the uncertainty surrounding diagnosis,
Sources of support
SRS is funded by a fellowship from the Australian NHMRC.
References (91)
- et al.
The neuropathology and neurobiology of traumatic brain injury
Neuron
(2012) - et al.
Epidemiology of concussion in sport: a literature review
J Chiropractic Med
(2013) A critical review of chronic traumatic encephalopathy
Neurosci Biobehav Rev
(2015)The King-Devick test and sports-related concussion: study of a rapid visual screening tool in a collegiate cohort
J Neurol Sci
(2011)Evaluation of the King-Devick test as a concussion screening tool in high school football players
J Neurol Sci
(2015)Ocular motor assessment in concussion: current status and future directions
J Neurol Sci
(2016)Plasma micro-RNA biomarkers for diagnosis and prognosis after traumatic brain injury: A pilot study
J Clin Neurosci
(2017)Multimodal assessment of primary motor cortex integrity following sport concussion in asymptomatic athletes
Clin Neurophysiol
(2014)Neuroinflammation and brain atrophy in former NFL players: an in vivo multimodal imaging pilot study
Neurobiol Dis
(2015)- McCrory P, et al. Consensus statement on concussion in sport: the 4th international conference on concussion in Sport,...
American Medical Society for Sports Medicine position statement: concussion in sport
Br J Sports Med
Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016
Br J Sports Med
The clinical spectrum of sport-related traumatic brain injury
Nat Rev Neurol
The epidemiology and impact of traumatic brain injury: a brief overview
J Head Trauma Rehabil
Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets: clinical article
J Neurosurg
Differential diagnosis of dizziness after a sports-related concussion based on descriptors and triggers: an observational study
Inj Epidemiol
Concussion recovery time among high school and collegiate athletes: a systematic review and meta-analysis
Sports Med
The difficult concussion patient: what is the best approach to investigation and management of persistent (>10 days) postconcussive symptoms?
Br J Sports Med
Neuropsychology and clinical neuroscience of persistent post-concussive syndrome
J Int Neuropsychol Soc
The incidence of concussion in youth sports: a systematic review and meta-analysis
Br J Sports Med
Concussion incidence in professional football: position-specific analysis with use of a novel metric
Orthop J Sports Med
A systematic review of concussion in rugby league
Br J Sports Med
Epidemiology of sports-related concussion in seven US high school and collegiate sports
Inj Epidemiol
Concussion in youth rugby union and rugby league: a systematic review
Br J Sports Med
Concussion in chronic traumatic encephalopathy
Curr Pain Headache Rep
Punch drunk
J Am Med Assoc
Postconcussion neurosis-traumatic encephalitis: a conception of postconcussion phenomena
Arch Neurol Psychiatr
Chronic traumatic encephalopathy: historical origins and current perspective
Annu Rev Clin Psychol
Chronic traumatic encephalopathy in athletes: progressive tauopathy following repetitive head injury
J Neuropathol Exp Neurol
TDP-43 proteinopathy and motor neuron disease in chronic traumatic encephalopathy
J Neuropathol Exp Neurol
The spectrum of disease in chronic traumatic encephalopathy
Brain
Chronic traumatic encephalopathy in a National Football League player
Neurosurgery
Chronic traumatic encephalopathy: where are we and where are we going?
Curr Neurol Neurosci Rep
Chronic traumatic encephalopathy and athletes
Neurology
Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA concussion study
Jama
Association between recurrent concussion and late-life cognitive impairment in retired professional football players
Neurosurgery
Recurrent concussion and risk of depression in retired professional football players
Med Sci Sports Exerc
Neurodegenerative causes of death among retired National Football League players
Neurology
Oculomotor cognitive control abnormalities in Australian rules football players with a history of concussion
J Neurotrauma
Is there a gender difference in concussion incidence and outcomes?
Br J Sports Med
Sex differences in reported concussion injury rates and time loss from participation: an update of the national collegiate athletic association injury surveillance program from 2004–2005 through 2008–2009
J Athl Train
Differences in symptom reporting between males and females at baseline and after a sports-related concussion: a systematic review and meta-analysis
Sports Med
The utility of the King-Devick test as a sideline assessment tool for sport-related concussions: a narrative review
J Can Chiropr Assoc
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