Concussions are common in young athletes but the underlying changes in brain function that occur have been poorly understood.
Now, a University of Pittsburgh School of Medicine study is the first to link changes in brain function directly to the recovery of the athlete. Results of the five-year study, funded by the National Institutes of Health, are published in the August issue of the scientific peer-reviewed journal, Neurosurgery, the official journal of the Congress of Neurological Surgeons.
We found that abnormal brain activity in children and adolescents on functional MRI (fMRI) was clearly related to their performance on neuropsychological tests of attention and memory and to their report of symptoms such as headaches, said principal investigator Mark Lovell, Ph.D., asssociate professor in the departments of orthopaedic surgery and neurological surgery at the University of Pittsburgh School of Medicine.
These results confirm crucial objective information that is commonly obtained by neuropsychological testing to help team doctors and athletic trainers make critical decisions about concussion management and safe return to play, added Dr. Lovell, who is founding director of the University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, a clinical service and research program focused on the management of sports-related concussions.
Our findings have several implications for understanding the recovery process after sports-related concussions, said study co-author Michael (Micky) Collins, Ph.D., assistant professor in the departments of orthopaedic surgery and neurological surgery at Pitts School of Medicine, and assistant director of the UPMC program.Although the results of this study must be considered preliminary, fMRI represents an important evolving technology that is providing further insight now for safe return-to-play decisions in young athletes and may help shape guidelines in the future.
According to the Centers for Disease Control and Prevention, between 1.4 and 3.6 million sports and recreation-related concussions occur each year, with the majority happening at the high school level.An explosion of scientific research over the past decade has taught us more about mild traumatic brain injury or concussion than we have ever known, noted Dr. Lovell,including the knowledge that mismanagement of even seemingly mild concussions can lead to serious consequences in young athletes.
A concussion can occur when an athlete receives a traumatic force to the head or upper body that causes the brain to shake inside of the skull. Injury is defined as a concussion when it causes a change in mental status such as loss of consciousness, amnesia, disorientation, confusion or mental fogginess. The severity, effects and recovery of concussion are difficult to determine because no two concussions are alike, and symptoms are not always straightforward. In recent years, research has shown that until a concussed brain is completely healed, the brain may be vulnerable to further injury, which has led to published studies that have raised public awareness and significantly changed the way sports concussions are managed. Importantly, much of this research has included data that proves the usefulness of objective neuropsychological test data as part of the comprehensive clinical evaluation to determine clinical recovery following concussion. In fact, recent international concussion management guidelines have emphasized player symptoms and neuropsychological test results as cornerstones of the injury evaluation and management process.
While neuropsychological testing has become an increasingly useful tool, no published studies have examined the relationship between changes in computerized neuropsychological testing completed in a medical clinic and brain function as measured by fMRI. The lack of studies using fMRI may be due to the fact that studies of this nature are very expensive and equipment necessary to undertake this research is not readily available outside of a handful of academic medical centers. UPMC is one of few such centers with the capability of collecting both neurophysiological (fMRI) and neuropsychological data from injured and clinically managed athletes.
fMRI is one of the few brain scanning tools that can show brain activity, not just the anatomy. Traditional brain scanning techniques such as MRI and CT are helpful in viewing changes to the brain anatomy in more severe cases, but cannot identify subtle brain-related changes that are believed to occur on a metabolic rather than an anatomic level. fMRI can determine, through measurement of cerebral blood flow and metabolic changes, which parts of the brain are activated in response to different cognitive activities.