This video demonstrates a procedure to refine pediatric concussion diagnosis based on research evidence from children and youth using new multimodal and integrative approaches. First, a pre-injury neuropsychological baseline profile is obtained structural and functional MRI. Baseline images are also obtained to quantify the subject's brain function during a cognitive task prior to experiencing a traumatic brain injury following hockey, playing an injury.
Post-concussion neuropsychological testing and neuroimaging are obtained to examine neuros sequelae associated with mild traumatic brain injury. Results show changes in brain structure and activity accompanying recovery from concussion. This method can help answer key questions in the brain injury field, such as what are the neural implications and recovery profile of concussion in children and youth.
Demonstrating the procedure will be Nick Reed and Stephanie Green. Graduate students from my laboratory Before hits to the head are recorded during hockey playing. The subject first comes into the lab for pre-injury neuropsychological baseline testing.
Begin by administering a balanced assessment test while the subject is standing on a force play in the following order of conditions. First, have the subject stand on the force plate with their eyes open. Then have the subject stand on the force plate with their eyes closed.
Lastly, have the subject stand on the force plate while wearing the visual conflict dome, which consists of a spherical dome constructed from a paper lantern that is worn over the subject's head, preventing visual perception of the environment. Next place the blue foam AirX balance pad on top of the force plate and repeat the balance assessment conditions, having the subject stand on top of the AirX balance pad and force plate combined. Now measure and record hand grip strength and administer the grooved peg board test for both the left and right hands.
Administer the jump test on the jump mat first from a squat position, and then in the counter movement position completing three trials for each position. Next, conduct leg maximal voluntary contraction testing using the force plate and strength bar. Finally, administer the neuropsychological test battery.
Now let's see how to acquire the functional MRI baseline images on the subject when the subject arrives for the MRI baseline testing. Review their consent and screening forms and provide an age appropriate orientation to the MRI machine. Once the subject has removed all metal objects from their body, have them insert ear plugs before moving the subject into the scanner.
Explain how to respond to stimuli presented during the working memory task through the use of the LU touch paddles. These provide an MRA safe mouse with left and right buttons only, and then ask them to lie down on the scanner bed. Stabilize the head using foam inserts and place a reminder strap across the forehead.
Now, position the subject's head in the head coil and move the scanner bed into the scanner. Place the video screen outside the bore of the scanner and orient the subject to the mirror on the head coil where the working memory task will be projected. Obtain a T one weighted structural image using a 3D spoiled gradient with inversion preparation and obtain DTI data as well.
After the structural image is acquired, administer the working memory task and collect functional MRI images using a single shot T two star weighted sequence with spiral in and spiral out readout. Once the functional images are acquired, remove the subject from the scanner. Now let's see how to record the force and direction of hits to the head during hockey playing.
To allow recording of the force and direction of hits to the head during hockey playing. First, obtain a proper fit for the hockey helmet on the subject's head. Once the fit has been adjusted, remove the batteries from the helmet, charge them fully and return them to the helmet.
Prior to collecting game data, ensure that the helmets and hit system are transmitting and receiving data respectively. Each hockey helmet contains six single axis accelerometers designed to continuously measure all accelerations of the head, as well as the magnitude and location of sustained head impacts. Real-time acceleration data are timestamped and wirelessly transmitted through a radio frequency telemetry.
Link to a sideline laptop computer. When the helmet system is working properly, collect data during gameplay manually recording each hockey period. Stop and start time.Now.
Let's see how to perform post MTB. I follow-up testing on the same day that an injury report is received. Complete the hit injury report form with the parent to obtain clinical and functional details regarding the injury.
Administer the post-concussion symptom scale revised to the subject, and determine the current severity of the symptoms approximately one day post-injury. Administer the PCSR again. Do not administer the full neuropsychological test battery until symptoms have returned to baseline levels.
Schedule the subject for a follow-up scanning session within 70 hours post-injury. The follow-up scanning session is identical to the baseline scanning session. If the subjects symptoms are unresolved at the time of the first follow-up scanning session, schedule a second follow-up scanning session.
Once symptoms are resolved, the hits data interface is depicted showing the locations of the six head impacts depicted. Here are serial FMRI results from concussed athletes with symptom resolution compared to those with no symptom resolution. Task related brain activity in the frontal region is clearly observed only in athletes with symptom resolution.
After watching this video, you should have a good idea of how to examine recovery from concussion using multimodal and integrative techniques.
