Functional neuroimaging and neurocognitive recovery after sports-related concussion

British Journal of Sports Medicine -


Stump, J., M. R. Lovell, W. Eddy, R. Roush, J. Welling, J. Bakal, J. Becker and M. W. Collins.



Introduction: The Concussion in Sport (CIS) group assembled in Austria in 2001 to formulate recommendations for the managing of athletic concussions as well as to elucidate the current state of concussion research and knowledge. This group suggested that neuropsychological testing become a “cornerstone” for concussion management. The group also encouraged further exploration of the pathophysiology of concussion through use of functional neuroimaging and other techniques, as many aspects of the physiology of the injury are poorly understood. The current poster represents early findings from the NIH funded “fMRI and Sport-Related Concussion” study currently being implemented by the UPMC Sports Medicine Concussion Program. The purpose of the larger study is to understand through both functional neuroimaging and cognitive functioning (measured by the ImPACT computerized test battery) the effects of concussion and the process of concussion recovery in athletes aged 13–25. Method: Most subjects in the project have received baseline neurocognitive evaluations on ImPACT through their school or sport organisation. Once concussed, these athletes are retested on ImPACT weekly until their scores return to baseline and they are symptom free at rest and exertion (as recommended by the CIS group). Within 7 days of concussion, the athletes also complete a functional MRI protocol, whereby they complete several cognitive tasks within an fMRI scanner. Once recovered, they again complete the fMRI protocol. Results: Examination of three case studies provide early evidence of differences in activation in key cortical areas occurring with concussion that is not present in control subjects. The presentation will provide ImPACT scores reflecting changes in cognitive functioning in the concussed subjects from baseline to recovery, as well as several MRI slices for each case with functional overlays to demonstrate activation in a control subject (2 scans) a concussed athlete with no prior concussion history (concussed and recovered scans), and a concussed athlete with a prior history of three concussions (concussed and recovered scans). Discussion: Early results suggest differences in activation seen in concussed subjects with or without prior history of concussion that are not seen in controls. Once recovered, these differences in activation appear to resolve, as demonstrated by MRI with functional overlays. The utilisation of functional or physiological neuroimaging following concussion may provide an objective and physiological means to manage concussion in athletes. Furthermore, such technology may help validate the abnormalities commonly seen with neurocognitive testing.

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