Search Results (103)

Background: Sex-based variations in brain structure, hormonal balance, and neurochemistry may influence symptom presentation and recovery after mild traumatic brain injury (mTBI). This systematic review investigated sex-related differences in mTBI severity, symptoms, and recovery outcomes across different injury mechanisms. Methods: This review followed PRISMA 2020 guidelines and was registered with PROSPERO (CRD420251011379). Searches were conducted in PubMed, SPORTDiscus, Web of Science, and Scopus for articles published between 2000 and 2024. Eligible studies included adults (≥18 years) diagnosed with mTBI or concussion (Glasgow Coma Scale 13–15) with quantifiable outcome data for both sexes. Data extraction and quality assessment followed the JBI critical appraisal tools. Results: Forty-one studies involving 15,656 participants (8671 males; 6985 females) met the inclusion criteria. Female participants reported a greater symptom burden, higher pain intensity, and longer recovery times for gait abnormalities and return to activity compared with males. Neuroimaging studies showed more extensive white matter alterations in females, whereas males displayed greater reductions in cerebral blood flow. Cognitive and neurosensory outcomes revealed poorer cognitive performance, slower reaction times, and higher rates of vestibular–ocular and visual abnormalities in females. A limited number of studies explored electrophysiological measures, indicating sex-based differences in early brain responses to emotional stimuli. Conclusions: Sex plays an important role in symptom presentation and recovery after mTBI. Female patients demonstrate heightened vulnerability across several clinical domains, likely due to biological and neurochemical differences. Recognising these sex-specific patterns can support more targeted diagnostic and rehabilitation strategies. Future research should further explore the structural and biochemical mechanisms underlying these differences to improve precision in mTBI management. Full article

Background: Sports-related concussions are complex, traumatic brain injuries as a result of a sporting accident. Prompt diagnosis and assessment with the use of diagnostic protocols help provide athletes with the appropriate management to minimise acute and chronic implications. Objective: The objective of this systematic review is to review the current sailing concussion assessment and diagnostic guidelines and consequently propose a sailing concussion assessment and diagnostic protocol to use. Methods: Sailing organisations such as “World Sailing” were used to find current guidelines used in the sailing community. Electronic databases such as Google Scholar, Springer Link, and PubMed were used to identify relevant scientific papers. Keywords included “sailing”, “concussion”, “guidelines”, “sailing legislation”, and “sports-related concussion”. This systematic review is not limited to a specific sailing subtype. We included papers discussing concussion guidelines and excluded studies with no relevance to sports related concussions and without relevant guideline use. Findings were summarised in in text and tables. Results: While there is much research discussing head injuries in sailing, there is no literature specifically discussing protocols and guidance for concussion diagnosis and management in sailing-related concussions. Six concussion protocol papers are discussed. The World Sailing website advises individuals to use the CRT5 guidelines to assess a suspected concussion, which have been outdated by CRT6. While there are currently no standardised sailing-specific concussion assessment tools available, this review proposes a possible approach, introducing the concussion protocol used in the professional sailing league, SailGP. A sport-specific protocol is vital in addressing the specific risks associated with a sailing-related concussion. Conclusions: Concussions are a considerable risk in sailing due to the unique nature of the sport. Due to the lack of standardised concussion guidelines within the sailing community, a standardised, sport-specific concussion assessment tool, such as the one described for SailGP, should be developed through collaboration between medical professionals and sailing organisations. Full article

Objectives: Strong cervical musculature is recognized as a protective factor against sports-related concussions. Evidence suggests that jaw clenching may activate cervical muscles, potentially reducing head acceleration during impact. Methods: This observational cohort study examined the immediate effects of a customized interocclusal orthotic (CIO) on cervical muscle performance. Forty-two healthy adults (≥18 years) underwent strength and endurance testing with and without a CIO using a digital pressure gauge and six directional isometric contractions. Descriptive statistics and two-way repeated-measures MANOVA models were applied to evaluate condition effects. Results: CIO use produced significant improvements in cervical muscle strength and endurance across all directions compared to non-use. Forward flexion strength increased by 12.96% (p < 0.001, ηp² = 0.185), backward extension by 10.34% (p = 0.017, ηp² = 0.091), right rotation by 19.03% (p < 0.001, ηp² = 0.333) and left rotation by 19.86% (p < 0.001, ηp² = 0.353). Endurance gains demonstrated large effect sizes, with flexor endurance improving by 44.57% (p < 0.001, ηp² = 0.447). Conclusions: Optimized jaw alignment using a customized orthotic can elicit immediate, clinically meaningful enhancements in cervical strength and endurance, suggesting a promising adjunct for concussion risk mitigation in contact sports. Full article

Long-term effects of concussions, particularly in contact sport athletes, have been linked to changes in neuronal health. Lipid dysregulation has emerged as a potential contributor to neuronal injury and may serve as a measurable biomarker of brain pathology. This study investigated cognitive scores and serum lipid biomarkers in retired rugby players with a history of concussion to assess their association with concussion exposure. Serum levels of 24-hydroxycholesterol (24-HC), 25-HC, 27-HC, total triglycerides, and ceramide were compared between retired rugby players with a history of repeated concussions (n = 26) and non-contact sport controls (n = 19). ELISA-based quantification and statistical analyses identified significant group differences. Concussed athletes exhibited significantly lower serum 24-HC and significantly higher levels of 27-HC, triglycerides, and ceramide compared to controls, while no significant difference was observed for 25-HC. These findings indicate that repeated concussion is associated with reductions in cognitive performance and persistent alterations in serum lipid profiles. The observed lipid changes, particularly in 24-HC, 27-HC, ceramide, and triglycerides, may serve as measurable biomarkers of concussion-related biochemical alterations, providing a foundation for future studies aimed at monitoring neurological health in at-risk populations. Full article

Background: Sport-related concussion (SRC) is a recognised public health concern, with combat sport athletes particularly vulnerable due to frequent head impacts. In Taekwondo, concussion incidence is comparable to other contact sports, yet underreporting and misconceptions may hinder safe management. Understanding knowledge, attitudes, and behaviours in this cohort is critical for athlete safety. Methods: This cross-sectional online survey was distributed to Australian Taekwondo athletes (AKA). Participants completed demographic, concussion history, and the Rosenbaum Concussion Knowledge and Attitudes Survey. Knowledge (CKI) and attitudes (CAI) indices were derived. Group differences were analysed using non-parametric tests, with associations between knowledge, attitudes, and reporting behaviours explored via correlation and logistic regression. Results: Athletes (n = 98) demonstrated good knowledge (mean CKI 19.8/25) and positive attitudes (mean CAI 61.6/75), though misconceptions remained. While 92% indicated they would seek medical attention, 21% reported returning to play the same day as a suspected concussion, and over 20% admitted to concealing symptoms. Higher CAI scores, but not CKI, were associated with safer reporting intentions. Conclusions: AKA showed strong knowledge and attitudes towards concussion; however, risky behaviours persisted. Attitudes, rather than knowledge, were more predictive of reporting behaviours, underscoring the need for interventions that strengthen positive attitudes and cultural support for symptom disclosure. Full article

Background: Sport-related concussion is common in rugby union, yet female players remain underrepresented in research. This study examined seasonal changes in cerebral oxygenation, cardiac function, and concussion symptomology in adult female rugby players, and explored acute physiological responses following a single documented concussion. Methods: A total of 29 adult females (19 amateur rugby, 10 control) completed pre-, mid-, and end-season assessments. Measures included functional near-infrared spectroscopy (fNIRS) of the pre-frontal cortex, seismocardiography (SCG)-derived cardiac timing indices, and Sport Concussion Assessment Tool 6 (SCAT6). Group and time effects were analysed using general linear models and statistical parametric mapping. Typical error (TE) and its 90% confidence intervals (90% CI) were used to determine meaningful changes post-concussion. Results: Rugby players reported more SCAT6 symptoms (number: p = 0.006, η²_p = 0.23; severity: p = 0.020, η²_p = 0.17). They also had shorter systolic time (p = 0.002, η²_p = 0.19) and higher twist force values (p = 0.014, η²_p= 0.21) than controls. fNIRS revealed higher right-hemisphere oxyhaemoglobin (ΔO₂Hb) responses for both tasks (ps < 0.001, η²_p = 0.77 and η²_p = 0.80) and lower activation in specific prefrontal channels. No seasonal changes occurred in global oxygenation or frequency band activity. In the exploratory single-concussion case, symptomology, SCG twist force, ΔO₂Hb, and cardiac band power exceeded TE and its 90% CI at 5 days post-injury. Conclusions: The multimodal approach detected stable group-level physiology alongside localised cortical and cardiac differences, and acute changes following concussion. While these results highlight the potential of combined fNIRS and SCG measures to capture physiological disturbances, the small sample size and single-concussion case necessitate cautious interpretation. Further validation in larger, longitudinal cohorts is required before any biomarker utility can be inferred. Full article

Due to the highly individualised presentation of sport-related concussion (SRC), multi-domain assessments examining cognitive, migraine, vestibular, ocular, mood, sleep, and neck-related function have been suggested to assist clinicians with diagnosis, management, and rehabilitation. Normative data on such assessments for female, community players from countries outside the U.S. are needed. This study aimed to (i) describe normative data from community-level Ladies Gaelic Football players using a multi-domain assessment, and (ii) compare findings between adolescent and adult players. A total of 138 LGF players without SRC (101 adults, 37 adolescents) completed a multi-domain SRC assessment including Sport Concussion Assessment Tool 5th Edition, Concussion Clinical Profiles Screening, Vestibular/Ocular Motor Screening (VOMS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT^®), Patient Health Questionnaire-9, Generalised Anxiety Disorder-7, Pittsburgh Sleep Quality Index, Migraine Disability Assessment, and Neck Bournemouth Questionnaire, and neck dynamometry. Normative data were summarised using descriptive statistics, while differences in test scores between adolescents and adults were examined using parametric or non-parametric tests. While adolescents and adults scored similarly on most measures, adolescents scored worse on ImPACT^® visual–motor speed (d = 0.09) and reaction time (r = 0.52), SCAT5 concentration (V = 0.38), total modified Balance Error Scoring System (r = 0.42), and CP Screen vestibular profile (r = 0.38) (p < 0.05). This is the first study to describe and compare normative data for multidomain SRC assessments in adolescent and adult female, community athletes. Differences in some tests between adolescents and adults highlight the need for demographic-specific normative data when interpreting post-SRC assessment results. Full article

Sports-associated traumatic brain injury is emerging as an under-recognized driver of acute and chronic cardiovascular diseases. Larger population-based studies show that individuals with moderate-to-severe traumatic brain injury experience up to a two-fold excess risk of incident hypertension, coronary artery disease, myocardial infarction, and stroke that persists for at least a decade. Among former professional American-style football players, a higher lifetime concussion burden is uniquely related to a more atherogenic cardiometabolic profile and greater long-term stroke risk. Mechanistically, an acute “sympathetic storm” triggered by cerebral injury provokes catecholamine surges, endothelial dysfunction, and myocardial stunning, manifesting as neurogenic stunned myocardium or Takotsubo-like cardiomyopathy and malignant arrhythmias. Sub-acute to chronic phases are characterized by persistent autonomic imbalance, reflected by reduced heart-rate variability and impaired baroreflex sensitivity weeks to months after concussion, coupled with neuroinflammation, hypothalamic–pituitary–adrenal axis dysregulation, and lifestyle changes that accelerate atherosclerosis. The interplay of these pathways accounts for the elevated burden of cardiovascular disease observed long after neurological function has been restored. Despite robust evidence linking TBI to adverse cardiac outcomes, contemporary sports–cardiology risk stratification prioritizes hemodynamic load, genetics, and performance-enhancing substances, largely overlooking brain injury history. This review integrates epidemiological, clinical, and mechanistic data to (i) delineate acute neurocardiac complications secondary of sports-related traumatic brain injury, (ii) synthesize evidence for chronic cardiovascular risk, (iii) highlight emerging autonomic and inflammatory biomarkers, and (iv) propose surveillance and therapeutic strategies, ranging from heart-rate-variability-guided return-to-play decisions to aggressive cardiometabolic risk modification aiming to mitigate long-term morbidity in this athletic population. By framing sports-related traumatic brain injury as a modifiable cardiovascular risk factor, we aim to foster interdisciplinary collaboration among neurologists, cardiologists, and sports medicine practitioners, ultimately improving both neurological and cardiovascular outcomes across the athlete’s lifespan. Full article

Oculomotor dysfunction identified within the first 10 days of sport-related concussion (SRC) is a risk factor for Persisting Post-Concussion Symptoms (PPCS). Oculomotor rehabilitation is the recommended treatment for oculomotor dysfunction from the subacute period onwards. However, there are delays in initiating rehabilitation due to a limited number of specialized providers and associated healthcare costs. Delays in initiating treatment are associated with worse outcomes. We performed a retrospective, quasi-experimental trial to evaluate whether providing instructions for self-guided oculomotor rehabilitation in adolescents with 3 or more abnormal oculomotor findings after SRC (Experimental Arm, n = 27, mean age = 15.50 ± 1.53 years, 63.0% male, 5.74 ± 2.43 days since injury) reduced the number of persisting impairments at 4 weeks compared to a wait-and-see approach (Standard Care Arm, n = 106, mean age = 14.98 ± 1.87 years, 59.4% male, 5.69 ± 2.78 days since injury). A small difference was seen in the incidence of neck tenderness but there were no differences between groups in symptom severity or number of abnormal oculomotor findings at initial presentation. Overall, 50 out of 106 (47.2%) participants in the Standard Care Arm had PPCS compared to 7 out of 27 (25.9%) in the Experimental Arm, which was significantly different (Chi-squared = 3.966, p = 0.046). This corresponds to an absolute risk reduction of 21.3%. Results from our pilot study suggest these treatment guidelines are feasible to incorporate into a busy outpatient practice in a cost-effective manner. Prospectively designed randomized controlled trials are warranted to validate the effectiveness of this treatment. Full article

Objectives: Sports-related concussion (SRC) is mostly associated with contact and combat sports. However, emerging evidence suggest that cyclists are also at risk of repeated concussion injury. Moreover, long-term neurophysiological outcomes in cycling cohorts remain underexplored. This novel study investigated the long-term effect of repetitive concussions in cyclists. Road, mountain biking (MTB), and BMX riders with a history of concussions and self-reported persistent symptoms were assess for neurophysiology and cognitive–motor performance compared to previously concussed cyclists with no ongoing symptoms. Both groups were compared to age-matched with controls. Methods: Using a cross-sectional between-group design, 25 cyclists with a history of concussions (15 symptomatic, 10 asymptomatic) and 20 controls completed symptom reporting, cognitive and balance assessments (SCAT5), sensorimotor testing using vibrotactile stimulation, and neurophysiological assessments via transcranial magnetic stimulation (TMS). Results: Symptomatic cyclists reported a higher number of concussions compared to asymptomatic cyclists (p = 0.041). Cognitive testing revealed large effects (d > 1.0), with impaired concentration in symptomatic cyclists compared to controls (p = 0.005). Motor assessments demonstrated large effects (d > 1.0), with slower tandem gait times (p < 0.001) and greater errors (p = 0.02) in the symptomatic group. Sensorimotor testing indicated slowed simple reaction times (p = 0.001) and poorer temporal order judgement (p = 0.038). TMS showed large effects (d > 1.0) in increased cortical inhibition in the symptomatic group, with prolong cortical silent periods (p < 0.05) and large effects (d > 1.0), and reduced short interval intracortical inhibition (p = 0.001) compared to asymptomatic cyclists and controls. Conclusions: Cyclists reporting persistent symptoms showed greater cortical inhibition and impaired cognitive–motor performance, consistent with findings in contact sport athletes. These results suggest that repeated concussions in cycling carry risk of chronic neurophysiological alterations. Cycling disciplines should consider more rigorous concussion identification protocols and stricter management strategies to mitigate persistent and long-term consequences. Full article

Background/Objectives: Sports-related concussions can result in prolonged symptoms and deficiencies in stability and balance. Effective and standardized rehabilitation protocols remain limited. This case report introduces a novel balance training program using virtual reality and force plate technology to address persistent post-concussion symptoms. Methods: A 20-year-old National Collegiate Athletic Association (NCAA) Division I football player with a history of multiple concussions and balance-related symptoms completed a 10-week intervention. The program utilized a multi-axis force platform and immersive visual tasks to train vestibular, oculomotor, and proprioceptive systems. Each weekly session consisted of seven tasks progressing in difficulty, which were completed three times per session. Performance was measured by the percentage of time a digital cursor remained within task boundaries using the distribution of their center of mass. Symptom self-reports were also recorded. Results: Cumulative mean performance improved from 75.87% in the first session to 91.67% in the final session. All individual template scores increased, including those on the most complex template, which rose from 55.76% to 80.20%. The patient also reported reduced dizziness, disorientation, and improved functional balance across the 10-week period. Conclusions: This virtual-reality-based balance training program shows promise in resolving persistent post-concussion symptoms. Its objective measurement, engaging format, and ease of use suggest potential for broader application in concussion rehabilitation. Full article

Concussion, or mild traumatic brain injury, is a significant public health challenge, with females experiencing high rates and prolonged symptoms. Reliable and objective tools for early diagnosis are critically needed, particularly in pediatric populations, where subjective symptom reporting can be inconsistent and neurodevelopmental factors may influence presentation. Five minutes of resting-state (RS) EEG data were collected from non-concussed and concussed females between 15 and 24 years of age. We first applied a deep learning approach to classify concussion directly from raw, RS electroencephalography (EEG) data. A long short-term memory (LSTM) recurrent neural network trained on the raw data achieved 84.2% accuracy and an ensemble median area under the receiver operating characteristic curve (AUC) of 0.904. To complement these results, we examined causal connectivity at the source level using information flow rate to explore potential network-level changes associated with concussion. Effective connectivity in the non-concussed cohort was characterized by a symmetric pattern along the central–parietal midline; in contrast, the concussed group showed a more posterior and left-lateralized pattern. These spatial distribution changes were accompanied by significantly higher connection magnitudes in the concussed group (p < 0.001). While these connectivity changes may not directly drive classification, they provide evidence of large-scale brain reorganization following concussion. Together, our results suggest that deep learning models can detect concussion with high accuracy, while connectivity analyses may offer complementary mechanistic insights. Future work with larger datasets is necessary to refine the model specificity, explore subgroup differences related to hormone cycle changes and symptoms, and incorporate data across different sports. Full article

Background: Downhill mountain biking (MTB) is a high-velocity sport where riders are potentially exposed to impacts and concussion. Rapidly obtained Event-Related Potentials (ERPs) are a promising use of portable electroencephalography for clinical assessment of concussion-related neurological impairment at the point of care. However, the baseline neuroelectric profile of this specific sporting population is not fully understood. This study investigated the amplitude and latency of the N100, P300 and N400 ERPs at baseline among MTB athletes by age, sex and caffeine consumption. Methods: MTB athletes, aged 13–45, competing in the 2024 Whistler Crankworx MTB competition were recruited for this cross-sectional analysis. Self-reported sex, age and caffeine consumption were captured and pre-event baseline neurological evaluations of the N100, P300 and N400 ERPs (n = 92) were completed using a portable electroencephalograph (NeuroCatch). Results: Females had a 1.12 µV higher N100 amplitude (95%CI; 0.15, 2.08, p = 0.024) and 2.11 µV higher P300 amplitude (95%CI; 0.69, 3.52, p = 0.004) than males. Further, the N400 amplitude was 0.05 µV lower per year that age increases (95%CI; −0.08, −0.01, p = 0.011). Greater than normal caffeine consumption was associated with a 1.39 µV lower (95%CI; −2.68, −0.09, p = 0.036) and 18.96 ms (−28.29, −9.64, p < 0.001) faster N100 response. Conclusions: Age, sex and caffeine consumption must be considered to inform the clinical implement of ERPs for monitoring concussion in extreme sport athletes. Full article

Traumatic brain injury (TBI) remains a significant public health concern, particularly among military personnel and contact sport athletes who are frequently exposed to repeated blast overpressure waves and mild concussive impacts, respectively. While moderate and severe TBIs have been extensively studied, the long-term neuroendocrine consequences of mild, repetitive brain trauma are poorly understood. In this study, we investigated the temporal dynamics of hypothalamic–pituitary–adrenal (HPA) axis dysregulation following repeated mild concussive head impacts and blast exposures using two clinically relevant rodent models. Male Sprague-Dawley rats were subjected to repeated mild concussive impacts using a modified weight drop model or repeated blast exposures using an advanced blast simulator. Plasma levels of adrenocorticotropic hormone (ACTH) and corticosterone were measured on days 1 and 30 post-injuries. Our findings revealed that repeated blast exposures induced elevation of plasma ACTH and corticosterone on days 1 and 30 post-blasts. After the repeated mild concussive impacts, increased plasma levels of corticosterone were observed on days 1 and 30, but ACTH levels were increased only on day 30. This study is among the first to directly compare neuroendocrine outcomes of repeated mild concussive impacts and blast exposures within a unified experimental framework. Our findings demonstrate distinct temporal trajectories of HPA axis dysregulation depending on injury type and highlight plasma levels of ACTH and corticosterone as potential biomarkers of subclinical brain trauma. These insights may inform early diagnostic approaches and therapeutic strategies aimed at mitigating long-term stress-related complications following mild traumatic brain injuries. Full article

Background: The UK Department for Digital, Culture, Media, and Sport (DCMS) grassroots concussion guidance, May 2023, advised that all community-based sport-related concussions (SRCs) be diagnosed by a healthcare practitioner. This may require that general practitioners (GPs) diagnose and manage SRCs. Diagnosing SRCs in primary care settings in the United Kingdom (UK) presents significant challenges, primarily due to the lack of validated tools specifically designed for general practitioners (GPs). This scoping review aims to identify diagnostic and management tools for SRCs in grassroots sports and primary care settings. Aims: To identify tools that can be used by GPs to diagnose and manage concussions in primary care, both adult and paediatric populations. Design and Methods: A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScRs). Five databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, Google Scholar) were searched from 1946 to April 2025. Search terms included “concussion”, “primary care”, and “diagnosis”. Studies that discussed SRCs in community or primary care settings were included. Those that exclusively discussed secondary care and elite sports were excluded, as well as non-English studies. Two reviewers independently screened titles, abstracts, and full texts, with a third resolving any disagreements. Data were extracted into Microsoft Excel. Studies were assessed for quality using the Joanna Briggs critical appraisal tools and AGREE II checklist. Results: Of 727 studies, 12 met the inclusion criteria. Identified tools included Sport Concussion Assessment Tool 6 (SCAT6, 10–15 min, adolescent/adults), Sport Concussion Office Assessment Tool 6 (SCOAT6, 45–60 min, multidisciplinary), the Buffalo Concussion Physical Examination (BCPE, 5–6 min, adolescent-focused), and the Brain Injury Screening Tool (BIST, 6 min, ages 8+). As part of BCPE, a separate Telehealth version was developed for remote consultations. SCAT6 and SCOAT6 are designed for healthcare professionals, including GPs, but require additional training and time beyond typical UK consultation lengths (9.2 min). BIST and BCPE show promise but require UK validation. Conclusions: SCAT6, SCOAT6, BIST, and BCPE could enhance SRC care, but their feasibility in UK primary care requires adaptation (e.g., integration with GP IT systems and alignment with NICE guidelines). Further research is required to validate these tools and assess additional training needs. Full article