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Handbook of Clinical Neurology

Daniel B Charek, Michael Collins, Anthony Kontos
Concussion is a major public health concern, with an estimated 1.6-3.8 million sport-related concussions occurring annually in the United States. Although the majority of injured athletes recover within 7-21 days, 20-30% of athletes experience protracted recovery spanning more than a month, suggesting as many as 320,000-760,000 athletes may experience prolonged symptoms. This highlights the need for efficacious clinical interventions to facilitate recovery. While concussion was historically conceptualized as a homogeneous injury, a more nuanced understanding has recently emerged and led to a refined approach of categorizing concussions into clinical trajectories or symptom profiles...
2018: Handbook of Clinical Neurology
David W Wright, Jeffrey J Bazarian
The concussion evaluation commonly takes place in the emergency department (ED), but most clinicians have not received formal training in concussion diagnosis and management. Proper diagnosis and management of concussion in the ED diminish postconcussion complications and improve the likelihood of successful concussion recovery. The ED assessment begins with early recognition of the signs and symptoms of concussion, a directed history, appropriate documentation, and identification of conditions ("red flags") that need immediate intervention such as traumatic intracranial hemorrhage, followed by a systematic assessment for risk factors that can predict prolonged recovery, and a concussion-focused physical exam...
2018: Handbook of Clinical Neurology
Margot Putukian, Zachary Schepart
The recognition and sideline evaluation of possible sport-related concussion are difficult tasks for a physician and other clinicians. Sideline assessment tools have continued to evolve over the years, but objective biomarkers of concussion do not currently exist. Sideline video review programs may aid in the recognition of possible concussion as additional information for the sideline athletic medicine staff. Additional investigational assessments include visual oculomotor processing, reaction time, and rapid eye movements and attention...
2018: Handbook of Clinical Neurology
Grant T Baldwin, Matthew J Breiding, R Dawn Comstock
Sports and recreation-related (SRR) activities are common in the United States. Beyond the benefits to health, SRR activities can create new friendships, give people a sense of belonging, foster teamwork and other leadership skills, and develop sportsmanship and a respect for rules that govern play. Public awareness about the risk of concussion has grown as the long-term consequences of traumatic brain injury (TBI) have become better known, and likely explains the increasing concussion incidence rates. Currently, surveillance systems capture SRR concussions among high school and college athletes participating in sanctioned sports...
2018: Handbook of Clinical Neurology
Christopher Giza, Tiffany Greco, Mayumi Lynn Prins
The majority of the 3.8 million estimated annual traumatic brain injuries (TBI) in the United States are mild TBIs, or concussions, and they occur primarily in adolescents and young adults. A concussion is a brain injury associated with rapid brain movement and characteristic clinical symptoms, with no associated objective biomarkers or overt pathologic brain changes, thereby making it difficult to diagnose by neuroimaging or other objective diagnostic tests. Most concussion symptoms are transient and resolve within 1-2 weeks...
2018: Handbook of Clinical Neurology
Brian Hainline, Robert A Stern
No abstract text is available yet for this article.
2018: Handbook of Clinical Neurology
Ross D Zafonte, Shirley L Shih, Mary Alexis Iaccarino, Can Ozan Tan
Traumatic brain injury (TBI) is associated with several pathophysiologic changes, including: neurostructural alterations; molecular changes with shifts in circulating neurotrophins; impaired neural metabolism; changes in cerebrovascular autoregulation, vasoreactivity, and neurovascular coupling; and alterations in functional brain connectivity. In animal models of TBI, aerobic exercise reduces neuronal injury, promotes neuronal survival, and enhances the production of neuroprotective trophic factors. However, the timing of exercise initiation is an important consideration as early exercise in the acute postinjury period may impede recovery mechanisms, although evidence for this in humans is lacking...
2018: Handbook of Clinical Neurology
Andrew Guidry, Kevin Crutchfield
Neurologic disease does not discriminate, even among athletes. Common neurologic diseases among athletes include multiple sclerosis, seizures, headaches, and sleep disorders. Although concrete guidelines for sport participation among athletes with neurologic diseases do not exist, evidence-based and consensus statements can aid healthcare providers in determining whether and to what extent such athletes should participate in sports. Moreover, sport participation is important, since multiple studies indicate that exercise improves disease-specific symptoms, manifestations, and overall quality of life...
2018: Handbook of Clinical Neurology
Nathan P Olafsen, Stanley A Herring
Corticosteroid, hyaluronic acid, and platelet-rich plasma injections are commonly utilized when managing pain and injury in the athlete. Although there is ample scientific literature on these injection types, there is a paucity of evidence guiding the use of any of these modalities in a younger, athletic population. Injection strategies should be used as just one aspect of a detailed and athlete-specific return to sport and rehabilitation plan. More high-quality research is needed to determine the most appropriate and optimum injection use in the management of painful musculoskeletal conditions, including patient factors and injection formulations...
2018: Handbook of Clinical Neurology
Ilya Igolnikov, Rollin M Gallagher, Brian Hainline
Pain is common in athletes, and pain management in sport has traditionally been equated with injury management. Although both pain and injury interfere with sport performance, they are not synonymous. Acute musculoskeletal injury commonly manifests as nociceptive pain, inflammatory pain, or both. Pain that persists beyond expected injury recovery must account for all potential contributors to pain, including ongoing biomechanical abnormalities, underlying pathophysiology, and psychosocial issues. Pain chronification involves multiple pathophysiologic and neurobehavioral processes that lead from acute injury-related pain to subacute and chronic pain, and must be distinguished from an ongoing biomechanical overuse pattern...
2018: Handbook of Clinical Neurology
Athena M Lolis, Susan Falsone, Aleksandar Beric
Peripheral nerve injuries are unusual in sport but impact an athlete's safe return to play. Nerve injuries result from either acute trauma (most commonly in contact/collision sports) or from repetitive microtrauma and overuse. Diagnosis of overuse nerve injuries includes nerve localization and surrounding soft-tissue anatomy, and must account for possible causes of repetitive microtrauma, including biomechanics, equipment, training schedule, and recovery. Prognosis is related to the type of nerve injury. Management should not simply be rest and gradual return to sport but should address biomechanical and training predispositions to injury...
2018: Handbook of Clinical Neurology
Clara Karton, T Blaine Hoshizaki
Head impacts that transfer mechanical energy to the skull and create brain injuries have unique dynamic responses and brain tissue trauma characteristics. The magnitude of the impact energy and how it is transmitted creates three-dimensional linear and rotational accelerations of the head, resulting in unique strains on brain tissue. Biomechanical investigations of head injuries in contact sports have historically focused on attenuating energy transfer to the skull and brain. Typically, severe life-threatening events are caused by high-energy impact events that result in anatomic damage...
2018: Handbook of Clinical Neurology
W Ben Kibler, Todd Ellenbecker, Aaron Sciascia
Neuromuscular activity, organized in coordinated patterns, forms the basis of task-specific function in sports and exercise. The content and extent of these patterns may be variable, but include elements of activation/inhibition, co-activation, concentric/eccentric activation, proximal-to-distal activation, plyometric activation, and preactivation stiffness. They may be based on inherent neuromuscular architecture, but are commonly affected by positive or negative adaptations to imposed functional demands. Positive neuromuscular adaptations improve the efficiency of performing the task, which can result in less energy expenditure, maximum force delivered to the task, and protection of involved joints from excessive loads/motions, and improve the effectiveness of task performance...
2018: Handbook of Clinical Neurology
Brian Hainline
Peripheral nerve injury in sport results from acute trauma or repetitive overuse. Repetitive overuse injuries must be assessed with the broad context of tissue overload, kinetic chain continuum, periodization, recovery, equipment, and sport-specific biomechanics. Simply diagnosing the anatomic location and extent of nerve injury is inadequate. Management must consider all contributors to nerve injury. This chapter provides an overview of emerging information for assessing and managing peripheral nerve injury in sport...
2018: Handbook of Clinical Neurology
Greg Ungerer
Classification of athletes for para sport is a complex process, and provides the necessary structure for competition. Classification systems aim to ensure that para athletes achieve sporting excellence. By minimizing the effect of the impairment on sports performance, classification systems ensure para sport is not dominated by those athletes with the least impairment, but rather athletic excellence is the key determinant of success. For athletes with cervical spinal cord injuries, assessment of manual muscle power is most commonly used as the starting point for athlete evaluation...
2018: Handbook of Clinical Neurology
Erik E Swartz
Participation in any sport activity carries risk of cervical spine trauma, but certain activities have a higher risk than others, and hence, demand concerted efforts in developing prevention strategies. Prevention often includes efforts surrounding education of stakeholders, creating or modifying rules, and specific policies adopted for decreasing such risk. Stakeholders include sport clinicians, participants, coaches, parents, league administrators, officials, and the public. Thus, both athlete-specific and setting-specific factors must be considered and controlled to the extent possible for a multipronged approach for decreasing cervical spine injury risk...
2018: Handbook of Clinical Neurology
Joseph Dadabo, Prakash Jayabalan
Traumatic cervical spine injuries represent a significant cause of morbidity and mortality in sports. Appropriate management of such injuries is critical to minimizing harm and facilitating optimal long-term recovery and outcome. Management strategies begin with emergency preparedness amongst sideline providers and extends to paramedic services and medical teams in the acute care setting. This chapter outlines the principles of treatment across the care continuum, with a primary focus on hospital-based care...
2018: Handbook of Clinical Neurology
Daniel Blatz, Brendon Ross, Joseph Dadabo
Cervical spine trauma is a relatively rare but catastrophic event in sports. These critical situations depend on sports medicine personnel understanding every aspect of sideline care to ensure a safe and successful evaluation. This involves thorough preparation, vigilant observation of the sporting event to detect the possible mechanism of injury, and initiation of the appropriate action plan when a potentially catastrophic injury is suspected. Sideline management of cervical spine trauma requires the appropriate primary survey, with spine stabilization if necessary, secondary survey for concomitant injury, and, potentially, initiation of full spine stabilization with a spine board...
2018: Handbook of Clinical Neurology
James Dowdell, Jun Kim, Samuel Overley, Andrew Hecht
The cervical spine functions to position the head while maintaining stability and protecting the spinal cord. The anatomy of the cervical spine dictates the amount of physiologic motion at each level. Knowledge of the normal biomechanical anatomy of the cervical spine is imperative to the understanding of the biomechanics of injury to the cervical spine. There are a variety of reproducible injury patterns based on the direction and magnitude of force applied to the cervical spine. Knowledge of these forces can allow an understanding of the mechanical and neurologic stability of the cervical spine and can also help guide treatment options...
2018: Handbook of Clinical Neurology
Henrik Zetterberg, Kaj Blennow
Chronic traumatic encephalopathy (CTE) is a neuropathologic condition that has been described in individuals who have been exposed to repetitive head impacts, including concussions and subconcussive trauma. CTE cannot currently be diagnosed during life. Clinical symptoms of CTE (including changes in mood, behavior, and cognition) are nonspecific and may develop after a latency phase following the injuries. Differential diagnosis based solely on clinical features is, therefore, difficult. For example, some younger patients who do not experience the latency phase (i...
2018: Handbook of Clinical Neurology
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