Investigating the Assessment of Sport-Related Concussion in Youth Using Brain and Behavior

Abstract

Concussions affect between 1.6 and 3.8 million people in sports and recreation annually (Langlois et al., 2006). The impact of sports-related concussion and participation in contact sports on the brain and behavior in pediatric populations is not well established. The purpose of this dissertation is to evaluate the immediate behavioral effects of concussion and establish effects of contact sports participation on behavioral and neurological trajectories in youth athletes. Study 1 investigated the different acute concussion assessments currently employed in research for children and adults. This systematic review included a total of 28 studies that showed six assessments used in at least three studies. These six “common” assessments were evaluated with respect to their use by sex, age, and domain. Only 12% of the study populations evaluated by these assessments were female. The age range of participants evaluated was 9-67 years. Many common domains were evaluated. This first study suggests that that there is a need for a “gold standard” assessment. Study 2 examined the effects of contact sport participation on brain and behavior in children and adolescents via a secondary data analysis longitudinal database acquired from the NIH Study of Normal Brain Development, which collected structural MRI, a parent questionnaire, and behavioral and neurological assessments. 306 participants were included in the analysis. Controls were matched to individuals that participated in three common contact sports associated with sports-related concussion based on previous epidemiological studies based on age, sex, race, and total household income. Age and sex main effects were observed in many areas of interest. An Age x Number of Seasons in Contact Sports interactions were observed for a number of areas and behavioral assessments. These results suggest perhaps that participation in contact sports may lead to divergent developmental trajectories in both brain and behavior in healthy children and adolescents. These studies suggest that behavioral and neurological assessments need to be consistently applied across research and clinical domains, before a concussion. Physical and neurological assessment utilized in Study 2 may be more sensitive to subtle neurological changes. Determining the most appropriate assessments is critical for safe sport participation in youth.