Are There Sex-specific Changes Post Concussion? – Exploring Alterations in Neural Organization and Impact on Time Away From Work

Interest in concussion has prompted an explosion of scientific literature, yet prominent gaps persist in research. This doctoral work has utilized an integrative sciences approach to investigate sex- and assault-specific differences post concussion across neural organization and functional outcomes respectively. Our scoping review confirms that the exploration of ‘sex’ as a biological variable and its influence on outcomes post concussion remains under-investigated. To date, only 0.7% of the adult concussion-related neuroimaging literature (n=669) has completed sex stratified analyses. Given the dearth of sex-stratified evidence and the lack of consideration for contextual factors, sound interpretations of subgroup vulnerability estimates are challenging. Next, through an original study, we provide evidence using a large sample (n=111) of post concussive individuals that sex-specific alteration in large-scale neural networks exist across both sexes; but that these alterations occur in distinct networks. Finally, a macro-scale population-based approach was employed to understand the sex-specific ‘functional’ impact of concussion within the context of days off work using an administrative claims database (n=3,129). Given the paucity of research regarding assault, as a mechanism of injury, after characterizing the sample by sex based on demographic and workplace variables and then explored whether workers who sustained work-related-mTBI-assault were more likely to take days off work, compared to those injured from other mechanisms; and if there was a sex-specific effect. We found that assault independently predicted time away from work but there were no statistical differences between sexes. We discuss the need to re-examine the complexities of the person-work-environment within the context of assault-related concussions and issue a call for practitioners to consider mechanism of injury as a possible influencer of outcome. This doctoral work has extensive applications for rehabilitation sciences, including consideration of sex-tailored remediation interventions and consideration of sex and mechanism of injury in clinical guidelines for concussion.Ph.D.2020-03-28 00:00:0