Tannerhildebrandt2620
ession and concussion clearance should include a dynamic HITT-MD protocol to ascertain no late phase dynamic EI. Dysautonomia and/or vestibulocular aggravation may be contributors to late phase EI. If EI exists, identifying and targeting underlying causes can aid optimal recovery.
We describe a non-surgical approach to refractory digital neuralgia using cryoneurolysis in a series of 3 professional baseball players.
Thumb injuries are common in baseball players and can sometimes be challenging to effectively manage. Depending on the injury, current treatments include anti-inflammatories, immobilization, physical therapy, corticosteroid injections, and/or surgery. A subset of patients, however, fail nonoperative management yet do not have a clear indication for surgery. Cryoneurolysis or cyroanalgesia is an FDA-approved form of neuromodulation, which has been used safely and effectively on a variety of peripheral nerves. The mechanism of action involves percutaneous introduction of a small probe under local anesthetic to nerve tissue using ultrasound guidance. The probe is then cooled to -88°C using nitrous oxide, which results in secondary Wallerian degeneration. Axonal and myelin regeneration occurs completely in 3-6 months.
Visualization of the superficial radial sensory and ulnhe limitations of a case series, and larger rigorous studies are needed to illuminate causal inferences. Novel, complex technologies may also be more susceptible to placebo effect. Nonetheless, we are able to report marked efficacy and safety from cryoneurolysis of the ulnar digital nerve and the superficial radial sensory nerve in a small group of elite baseball players with refractory digital neuralgia.
To determine the incentivization strategy that maximizes patient adherence to report symptoms and activity via ecological momentary assessment (EMA) following pediatric concussion.
Concussion is a common pediatric injury. Traditionally, outcome assessment has occurred at discrete points-in-time, days or weeks apart, relying on patient's subjective recall of symptoms and activity. EMA is a behavioral measurement approach that allows for reporting of real-time symptoms and behaviors in real-life settings. DFMO While feasible in adolescents, the ideal strategy to maximize responsiveness from the emergency department (ED) setting is unknown.
This was a randomized controlled trial of patients age 13-18 with concussion presenting to an urban, academic pediatric ED within 5 days of injury. Patients were randomized to one of 4 incentive-based arms 2 dynamic (loss-based and streak) and 2 flat-rate (monetary and electronic device). Through the ReCoUPS app, patients reported symptoms 3 times per day and cognitive activsing a dynamic incentivization strategy.
Dynamic incentivization showed higher rates of response to tri-daily symptom prompts compared with flat-fee incentivization. This data shows tracking concussed youth using EMA from ED is feasible using a dynamic incentivization strategy.
We aim to identify the potential risk factors associated with increased susceptibility for persistent post-concussive headaches.
Concussions are common, but complex, traumatic brain injuries seen in pediatric athletes of all ages & skill levels & occur in a wide variety of athletic settings. These mild traumatic brain injuries often have neurologic sequelae, including headaches. Although athletes are advised to rest, duration of post-concussive symptoms is often unpredictable.
We conducted a cross sectional study on patients with head injury aged 5-18 years presented to pediatric concussion clinic (N = 603) from September 2013 to Dec 2018. We excluded patients with skull fractures and intracranial hemorrhage. The data was compiled & analyzed using frequency, Pearson correlation test, chi square & ANOVA test using IBM SPSS- 26.
Patient cohort consisted of 364 males & 239 females. The age range for males was 5-18 years (Mean age ± SD 13.45 ± 2.86) & for females was 6-18 years (Meall.
There was a statistically higher risk of developing persistent headaches for females and those with a history of prior headache, prior concussion, younger age, and those playing football, soccer or basketball.
To explore the utility of an eye-tracking assessment in distinguishing binocular alignment, saccadic movement, and pupillary dynamics among uninjured adolescents, acute cases (= 28 days since concussion), and persistent cases (>28 days since concussion).
Visual and autonomic system disturbances are common sequelae of concussion. Quantification of visual and autonomic dysfunction via an eye tracking device could provide an objective method of acute diagnosis and subacute identification of ongoing injury.
We compared 347 eye tracking metrics, derived from a 220 seconds eye-tracking assessment, among 132 uninjured adolescents (mean age 15.3, 56.2% female), 110 acute cases (mean days since injury 12.5, mean age 15.4, 46.4% female), and 95 persistent cases (mean days since injury 53.6, mean age 15.4, 70.2% female) using Kruskal-Wallis tests with Bonferroni corrections to account for multiple comparisons.
Nine eye-tracking metrics were significantly associated with injury status. One measure of binocularus adolescent concussion population and may identify sex-specific differences in autonomic dysfunction.
Objective eye tracking technology can identify vision and pupillary disturbances after concussion. These metrics could be integrated into clinical practice to monitor recovery in a heterogeneous adolescent concussion population and may identify sex-specific differences in autonomic dysfunction.
To determine the relationship between prolonged exposure to repetitive head impacts (RHI) through contact sports, as assessed by cumulative years contact sport participation, and quality of life outcomes in current/former contact sport athletes.
Cumulative lifetime RHI exposure may be a more meaningful measure than age of first exposure to contact sports to assess effects of RHI on neurologic function, however effects on young adults remain mixed.
Twenty-one physically active current/former contact sport athletes (35.0 ± 12.2 years, 66.7% male) completed an online questionnaire. To assess quality of life and psychological status, participants completed the Apathy Evaluation Scale-Self Rated (AES-S), Short Form 12 (SF-12), Satisfaction with Life Survey (SWLS), and Sport Concussion Assessment Tool 5 (SCAT5) Symptoms. Participants self-reported years of organized contact sport history (16.9 ± 10.5 years, range 1-45) along with covariates (sex, LD/ADHD, age, concussion history). Generalized linear models wet sport history was associated with better patient reported outcomes in current/former contact/collision sport athletes. This provides insight into later life effects of prolonged RHI exposure on neuropsychological outcomes in a more diverse subject pool outside of retired football players. Long-term neurologic effects remain to be elucidated, however, in early adulthood collision sports have positive mental health outcomes.
The objective was to develop classification models differentiating persistent PTH (PPTH) and migraine using clinical data and MRI-based measures of brain structure and functional connectivity.
PTH and migraine commonly have similar phenotypes. Furthermore, migraine is a risk factor for developing PTH, sometimes making it difficult to differentiate PTH from exacerbation of migraine symptoms.
Thirty-four individuals with migraine without history of TBI and 48 individuals with mild TBI attributed to PPTH but without history of migraine or prior frequent tension type headache were included. Subjects completed questionnaires assessing headache characteristics, mood, sensory hypersensitivities and cognitive function and underwent MRI imaging during the same day. Clinical features and structural brain measures from T1-weighted imaging, diffusion tensor imaging and functional resting-state measures were included as potential variables. A classifier using ridge logistic regression of principal components (PC) waches with mental activity.
Multivariate models including clinical characteristics, functional connectivity, and brain structural data accurately classify and differentiate PPTH vs migraine.
Multivariate models including clinical characteristics, functional connectivity, and brain structural data accurately classify and differentiate PPTH vs migraine.
To identify whether concussion causes abnormalities in fixational eye movements, specifically the generation of microsaccades.
Microsaccades are microscopic rapid eye movements that occur normally with attempted fixation. However, changes in microsaccade rate, magnitude, etc have been linked with neurologic and ophthalmic pathologies.
We collected baseline data for college athletes (n = 116) at Sterling College (Sterling, KS) as they reported for the physical examination before the beginning of the athletic season. None of the athletes had a prior history of concussion. Concussion patients (n = 86) were selected from patients who had an initial visit for concussion at a private concussion clinic. Patients were included if they presented within 50 days of injury. All participants were between 18 and 23 years of age. For each participant we measured the number of saccades generated, the size and speed of the micro saccades, the area covered and the ratio of vertical-to-horizontal direction component of thussion. Concussion patients present larger and more vertical eye movements during fixation.
Determine the utility of P300 Evoked Response Potentials (ERP) voltage patterns in predicting phenotypical sequelae of patients with complex concussions or Persistent Post Concussive Symptoms (PPCS).
ERPs have been used to aid in the diagnosis of multiple neurologic disorders. They have also been recently used in the evaluation of concussions.
A retrospective study of 54 patients, 10-71 year (mean age 29.6 yrs), with PPCS were tested between 6 and 12 weeks post-injury using the standard oddball audio P300 ERP protocol with measures extracted including best central parietal P300 ERP. PPCS Phenotyping was completed in each patient using a standardized post-concussive questionnaire and Rivermead method for 5 primary phenotypes and mixed type.
P300 average Voltage for the entire group was 11.6 mV. Overall, these were significantly lower than age-matched non concussed controls whose average voltage was 16.3 mV (
< 0.0001). Average P300 voltages for each phenotype Cognition- 14.1 mV, Vestibular- 8.6 mVad in the aid in diagnosis, prognosis, subtyping, and targeted phenotype management.
P300 ERPs may help identify persistent abnormal complex concussion neurophysiology. ERPs can also potentially exhibit phenotype specific patterns and be a useful tool in helping differentiate more somatic/physiologic vs mood-based phenotypes. This can ultimately lead in the aid in diagnosis, prognosis, subtyping, and targeted phenotype management.
Investigate the changes in sway velocity vestibular markers in mTBI patients with exercise intolerance (EI) during exertional testing as part of a 5-Step Exertional Rehab Protocol (ERP).
Exertional testing can be used to determine one's therapeutic exercise threshold. A number of systems have been shown to be related to Exercise Intolerance (EI) including autonomic, cervical, and vestibular, and visual. Vestibular function can be measured before and after exercise and may shed light into its impact on EI.
Retrospective review of 342 trials of exertional testing in mTBI patients, ages 10-60, in 2020. Exertional testing was completed with pre/post force plate sway velocity calculated. Protocol A involved single leg stances, while protocol B involved 2 feet stances. A concussion specialist determined exercise tolerance (ET) by evaluating for the onset of signs/symptoms or cardiovagal dysautonomia.
Of 342 exertional test trials, 34.8% exhibited EI due to symptom exacerbation and/or signs of autonomic dysfunction.
