A multi-dimensional approach to identify individuals with post-concussion syndrome

Purpose: Every year, at least 1.7 million TBIs occur in the United States alone across all age groups. Over 75% of the 1.7 million TBIs that occur yearly in the US are considered “mild” TBIs, more commonly known as a concussion. Most of the post-concussion symptoms (PCS) usually get better by 3 months. The World Health Organization classifies PCS as having 3 or more persistent symptoms of the following: headache, dizziness, fatigue, irritability, insomnia, difficulty concentrating, or memory difficulty. Patients with PCS are typically prescribed rest, which has been shown to delay recovery. On the contrary, exercise has shown to improve symptoms. Prescribing exercise necessitates identification of truly symptomatic individuals. Our study is going to utilize a specific stationary biking exercise (i.e. Buffalo Concussion Bike Test) in addition to the Post Concussion Symptom Scale to identify the true symptomatic individuals with concussion 3 months after their last injury. Additionally, we will compare baseline standing balance and cognitive function in both symptomatic as well as asymptomatic individuals with concussion. Methods: We will recruit 20 individuals with mTBI for one visit that will last 1.5 hours. Standing balance and cognition will be assessed before a stationary biking exercise. A standardized force platform will be utilized for quantifying various parameters of postural sway during four conditions: eyes open-bipedal stance, eyes closed-bipedal stance, eyes open-unipedal stance & eyes closed-unipedal stance. Cognition will be assessed using NIH Toolbox- Cognitive battery. We will primarily measure processing speed, attention, memory and executive function domains of cognitive function. A stationary bike exercise will be used evaluate exercise tolerance and symptom monitoring, where participants will be asked to exercise on a bicycle ergometer to the point of symptom exacerbation, or until 20 minutes has passed. Results: Data collection is pending IRB approval References 1. Daneshvar, D. H., Riley, D. O., Nowinski, C. J., McKee, A. C., Stern, R. A., & Cantu, R. C. (2011, November). Long-Term Consequences: Effects on Normal Development Profile After Concussion. Physical Medicine and Rehabilitation Clinics of North America. https://doi.org/10.1016/j.pmr.2011.08.009 2. Leddy, J. J., Kozlowski, K., Donnelly, J. P., Pendergast, D. R., Epstein, L. H., & Willer, B. (2010). A Preliminary Study of Subsymptom Threshold Exercise Training for Refractory Post-Concussion Syndrome. Clinical Journal of Sport Medicine, 20(1), 21–27. https://doi.org/10.1097/JSM.0b013e3181c6c22c 3. Leddy, J. J., Haider, M. N., Ellis, M. J., Mannix, R., Darling, S. R., Freitas, M. S., et al. (2019). Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatrics, 173(4), 319–325. https://doi.org/10.1001/jamapediatrics.2018.4397 4. Leddy, J. J., & Willer, B. (2013). Use of Graded Exercise Testing in Concussion and Return-to-Activity Management. Current Sports Medicine Reports, 12(6), 370–376. https://doi.org/10.1249/JSR.0000000000000008 5. Silverberg, N. D., & Iverson, G. L. (2013). Is Rest After Concussion “The Best Medicine?” Journal of Head Trauma Rehabilitation, 28(4), 250–259. https://doi.org/10.1097/HTR.0b013e31825ad65